Denture Teeth Sizing

[drm313mac]

What are the criteria by which the sizes of the teeth are determined?

Some advocate measuring distance between cusp tips of the canines. Fine if they have teeth, not so easy in edentulous cases.

Some measure facial width then divide this by some formula I have long since forgotten.

While this may somewhat show my age, there used to be a measuring device, sold by Dentsply, that determines teeth sizes. It was called a Clemmometer, or something like that.

Any ideas?

 

[araucaria]

get an old photo (when dentate) and do ratio conversions.
compare with offspring or siblings.
2c

 

[Flipperlady]

What are the criteria by which the sizes of the teeth are determined?

Some advocate measuring distance between cusp tips of the canines. Fine if they have teeth, not so easy in edentulous cases.

Some measure facial width then divide this by some formula I have long since forgotten.

While this may somewhat show my age, there used to be a measuring device, sold by Dentsply, that determines teeth sizes. It was called a Clemmometer, or something like that.

Any ideas?

Very easy to find on edentulous case. look at model and you can see the eminences (sp?) Once you get this # you have the width on the curve.

 

[drm313mac]

Flipper,

In dental school, we were taught several methods. In reality, I have to be able to teach new trainees, and so I must know the various methods.

And I thank you.

 

[kcdt]

What about an alameter? This still seems to provide a good correlation in the edentulous.
Give me a couple of days to search- something tells me I have a journal article that covered this topic within recent memory.

 

[denturist-student]

We mark the cuspid lines just under a line between the inner canthus of the eye ( alternatively just central to the iris) and the ala of the nose and about where the corners of the mouth are. The ala of the nose seems to be a favorite. We are not really concerned with duplication of the original dentition...Only something that looks good. I have seen the canine eminences used before... however they may not be positioned rightly....Also can measure the face from mentum to cupids brow and from Zygoma to Zygoma and divide both by 16....There is really nothing which is definitive...the alameter is a good starting point too....Trubyte puts out a facial meter called a Tooth Indicator with their sizes on the side of the plastic form which is fit over the face. They also have software available and I think its called TruRx ....But these are only starting points. Swissedent also has a system which measures from hamular notch to hamular notch...and one can download the software from Candulour as well which determines which tooth is best for various sizes...Still further Ivoclar has its Blue Line methods to determine tooth size and it is based upon gender as well as size and background.
While I have only done a few cases in school, we do learn to balance the different methods depending upon how much of a change the patient wants from their existing dentures.
At present we are using the Textbook of Complete Dentures sixth edition by Rhan and of course Bouchers Prosthodontic Treatment for Edentulous patients.
We do learn that Europeans desire larger centrals and more curved teeth such as Ivoclar and Westerners prefer Dentsply teeth.
My thinking is that there is no real quick and easy method of tooth selection.
We are encouraged to keep the tooth selection guides away from the patient and only allow them to view one or two appropriate colors.... Regarding Shape, most men look better with square or square tapering and most ladies look better with a tapering ovoid or square ovoid forms....
I have taken some impressions of the patients current dentures and along with alma guage measurements have come close with improvements.....As long as we can explain the improvements and differences most patients will respond well but there are those who are fussier....

We are also taught not to put too much emotional energy into something the patient may not desire.....They are forking over the 2-3000 so they can have some input and have to be pleased with the looks.....If they are pleased with the looks then they will try harder to endure the sore mouth post insertion while we attempt to definitively fit the denture to them....

Also taught that 80 % of sore spots are related to occlusion rather than fit.....so we don't grind unless we can see something on the final impressions.

Hope this helps some...from a Rookie....Take Care....Dan

 

[denturist-student]

Very easy to find on edentulous case. look at model and you can see the eminences (sp?) Once you get this # you have the width on the curve.

Try this...Men are measured from eminence to eminence but along the inside border of the landing....Women might use the midline of the vestibular sulcus. Not too much difference but subtle....Take Care....Dan

 

[kcdt]

Relationship of denture cast
measurements to width of maxillary
anterior teeth
Philip S. Baker, DDS,a Walter J. Morris, DMD,b Carol A.
Lefebvre, DDS, MS,c George A. Price, MSd and Stephen W.
Looney, MS, PhDe
Medical College of Georgia, Augusta, Ga; Veterans
Administration Dental Service, Birmingham, Ala; Sylvan Learning
Center, Augusta, Ga

Statement of problem. When making complete dentures, clinicians may have difficulty with selection of properly sized
denture teeth.
Purpose. The purpose of this study was to determine if there are specific measurements made on an edentulous cast
that could be useful to clinicians for selection of proper maxillary anterior denture tooth width.
Material and methods. Following Institutional Review Board approval, measurements were made on 50 maxillary and
mandibular sets of complete denture casts and their marked and contoured occlusion rims and record bases consecutively
submitted to a dental laboratory. The following 6 measurements were recorded for each set of casts: left midmaxillary
to right mid-maxillary, representing the distance between the respective residual ridge crest points adjacent
to each canine eminence; left retromolar pad to right retromolar pad; incisive papilla to left hamular notch; incisive
papilla to right hamular notch; left hamular notch to right hamular notch; and incisive papilla to vibrating line. These
measurements were statistically compared with the control, the canine-to-canine distance as marked on the contoured
maxillary occlusion rim to indicate the relaxed commissures. The casts were also classified as small, medium or
large based upon the tooth width specified by the commercial mold guide for their respective canine-to-canine control
measurement. The estimation bias was determined for each of the 6 measurements, and for those measurements for
which the bias was significantly different from zero, a bias-correction was applied. St. Laurent’s coefficient was used to
describe the agreement between each (bias-corrected) measurement and the canine-to-canine control. A commercial
guide was used to determine the accuracy of each of the 6 bias-corrected measurements in classifying denture teeth
width as small, medium or large as compared to the same classification using the canine-to-canine control.
Results. The bias-corrected measurement from the left hamular notch mark to the right hamular notch mark, obtained
by adding 10 mm, exhibited the greatest degree of agreement with the control. This measurement was also the
only one of the 6 that correctly classified more than 50% of both the medium and large casts. None of the 6 measurements
classified more than 30% of the small casts correctly.
Conclusions. Of the 6 measurements considered here, the bias-corrected measurement from left hamular notch mark
to right hamular notch mark was preferred for selecting denture teeth width. (J Prosthet Dent 2010;105: 44-50)

 

[kcdt]

Restoring dentate appearance: A literature review for modern complete
denture esthetics
Michael Waliszewski, DDSa
University of Washington, Seattle, Wash
Despite the fact that solutions to functional and comfort problems are often available, successfully
restoring the appearance of an edentulous patient remains a challenge. This review of the literature
demonstrates the limited amount of useful evidence-based information available for restoration of
dentate appearance in edentulous individuals. The English language peer-reviewed literature from 1880
to the present was reviewed. Articles were identified through previous literature reviews, an extensive
hand search, and a search of MEDLINE using the key words esthetics and denture esthetics. Three main
areas of information were found: published guidelines for achieving natural appearance, patient
preference studies, and studies that have collected and analyzed anatomic norms. (J Prosthet Dent
2005;93:386-94.)

This article contained some great computer enhanced photos to illustrate the points being made. Some very good points about the difference between dentate appearance and denture cosmetics were made.
I also seem to remember a study the correlated tooth size in natural dentition with available artificial teeth. The conclusion was that, on average, only the largest molds correspond with what is found naturally, and a fair number of natural sizes are too large to even be represented by what's available....

 

[TomZ]

Bravo Kenneth..

 

[kcdt]

Thanks, Tom.

 

[kcdt]

One more:

Denture Tooth Selection:Size matching of natural anterior tooth width with artificial denture teeth.
JPD1994;72:381-4.

"The results indicated that denture teeth are predominantly smaller and natural teeth are larger."

 

[AJEL]

The papila meter will give U a simple length of the Centrals, the "LVI Golden Shimbashi" can give U the width. or Alameter will give U a direct relationship to Swissedent teeth. the inverted picture of the patients face or the shape of the maxillary palate is useful for the shape of the tooth. As U have the patient there U will select the mid-line.
(Shimbashi rule Height to Width Ratio = 77.5% or Length equals 1.29X the Width.) If U would determine the length of a central is 9mm the width would be 7mm. Now lets try Length 11mm width would be 8.5mm. and in this case when setting the teeth the CEJ 8 to CEJ 25 would be 17.75mm.

 

[drm313mac]

Guys, I thought I knew just about every method there was, and well, you just blew me away.

And I thank you.

 

[Joseph Minuk]

I have been using the alameter for over 20 years, it never fails me. If you have a Candulor Working mould guide (or chart) and a Candulor Alimeter, you can convert the measurements to whatever tooth product you work With.