SELECTION OF POSTERIOR TEETH IN COMPLETE

DENTURE TREATMENT
INTRODUCTION
Selection and placement of posterior teeth is based on knowledge of
anatomy, histology physiology, pathology and biomechanics. The nature of the
mucosa and submucosa, the form and relationship of the residual ridges, the
general systemic condidtion of the patient, the tone of mandibular musculature,
esthetic factors and post patient experiences can all relate to the size, form and
number of artificial posterior teeth that may be used on the denture bases. The
dentist is solely responsible for the selection of the posterior teeth as he alone
possesses the necessary information required in this regard.
An analysis of dentulous and edentuolous conditions
1. Indiidual tooth moement is possible in natural dentition, but not in the
artificial denture. Thus ertical ! horizontal pressure on a natural tooth
would affect only the indiidual tooth and the local surrounding tissue,
while same type of pressure on an artificial tooth in a denture would affect
the entire denture, probably causing displacement.
". #remature contact of a few natural teeth rarely has an immediate effect on
the whole dentition, but premature contact of artificial teeth could dislodge
denture.
$. %ore pressure can be deeloped between natural teeth than between
artificial teeth, and thus the efficiency of dentures is less. This may be due
to sensory nere endings, working in con&unction with proprioceptor and
exteroceptic nere mechanisms which are located in the soft tissue under
1
the denture base protecting the patient from painful pressure. This is
achieed either by lessening the pressure or moing the mandible to a new
position of comfort if it is found possible.
'. (etention and stability are different for both natural and artificial dentitions.
The natural is able to withstand tolerable force in all directions whereas the
only force which will not tend to dislodge a denture base is one where the
direction is arranged in such a manner that tilting and gliding of the denture
base on the mucosa is aoided.
). Tooth wear in natural dentitions occurs where it is permitted by retention of
abrasie elements in the food. *o changes occur in the denture unless teeth
are made from materials which are too soft to be of serice for long periods
of time, but changes do occur in the underlying tissues.
These differences between the edentulous and dentulous mouth indicates
that a new condition has arisen in which the edentulous condition requires a
new approach.
There are four ma&or patient factors to be considered, along with their
influence on the selection for anatomic, semianatomic, nonanatomic and mold
combinations of teeth.
4 factors *euromuscular control
+nteroposterior &aw relationship
%ediolateral &aw relationship
,sthetics
"
Neurouscular control
-uring the registering and transferring of entire &aw relation position
from the patient to the articulator, the dentist has the opportunity to assess the
muscle control capabilities of the patient. If little difficulty is encountered
during these procedures, use of the anatomic or semianatomic molds are
acceptable. If howeer the muscle control of the patient is questioned and the
dentist experience great difficulty in registering transferring and erifying the
seeral &aw registration records, then molds with precise interdigitation would
not be indicated.
Antero!osterior "a# relations$i!s
+natomic and semianatomic teeth are designed to interdigitate in the
normal class I skeletal and molar relationship. +s long as the patient presents
clinically with an anteroposterior &aw relation position that is a skeletal class I,
the cusp teeth may be arranged and ad&usted to proide the balanced occlusal
concept. Skeletal class II patients may position the mandible in seeral
anteroposterior &aw positions for such actiities as rest, chewing and
swallowing and the range of this forward moement has been obsered to be as
great as the full width of a bicuspid. ,en though the recording and transfer of
the retruded centric &aw relation position may be reproducible, these patients
bring their mandible forward to some anterior position that usually is not
repeatable. The patient will experience multiple deflectie occlusal contacts as
he or she moes to one of the anterior position.
Midiolateral "a# relations$i!s
The patient with a skeletal class III &aw relations will present similar
problems in tooth selection and arrangement as those obsered with class II
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skeletal relationship. +ny attempt to arrange +natomic and Semianatomic teeth
with a different mediolateral contacts other than class I relation will usually
cause multiple deflectie occlusal contacts.
Est$etics% The cusp is an item that contributes to naturalness, especially the
buccal cusp. The .buccal corridor/, the region from the maxillary premolars
posteriorly enhances a patients smile. + tooth mold with a buccal cusp form
most assuredly offers the greatest potential for a pleasing natural appearance.
RE&IE' OF LITERATURE
De(elo!ent of t$e artificial !osterior toot$
0ntil 111$ artificial posterior teeth were only approximately anatomic in
form
In 111$, 2ysi carried his .normal3bite/ teeth which originated from
aerages of his &aw recordings. They were carried to harmonize with a condylar
inclinatin of $$ degrees from the horizontal and similar incisal guidance.
The normal bite teeth did not function to his satisfaction in cases where
aleolar resorption had so narrowed the maxilla in relation to the mandible that
a cross bite arrangement was necessary to preent dislodgement of denture
bases.
2ysi then introduced the .4ross3bite teeth/. The mandibular teeth were
$$5 and maxillary teeth '65 smaller than the normal bite teeth.
Anatoic teet$% Teeth that hae prominent cusps on the masticating surfaces
and that are designed to articulate with the teeth of the opposing natural or
prosthetics.
'
In 11"7, Sears presented his .4hannel teeth/, the first truly
nonanatomically designed teeth. The purpose was to proide efficient
mastication and eliminate the shifting of dentures caused by anatomic forms.
The maxillary teeth were shaped anatomically on the buccal aspect, but
occlusally they were nonanatomic. Sears maxillary teeth presented both a
buccal and lingual plane, following away from a central horizontal fossa,
because without such inclination, he said it would be impossible to obtain
balanced occlusion during function. The lower teeth were buccolingually less
then one half as wide as anatomic molds and the working occlusal portion, the
only part making contact with the opposing upper teeth was an unbroken ridge
of porcelain 1mm to 1.) mm in width, running mesiodistally the entire length
of the occlusal surface.
*early 16 years after the introducing of channel teeth Sears presented
the .platform posterior/.
In 11"1 8all presented his non anatomic .inerted cusp/ teeth. Their
design was based on the principle of a cutting machine with two cusped disks
taking in opposite directions. The efficiency of these were generally low. They
tend to along the food.
+ short time later, %yerson marketed his .trucusp teeth/. These teeth
had no cuspal inclinations, but had cutting blades and crushing tables cured in
the occlusal surface, along with Sleice ways for escape of the food.
In 11$), 9rench presented his non anatomic teeth. They consisted of
upper bicuspids and molars haing buccolingual cuspal pitch, the width of the
teeth being about the same as anatomically designed teeth. The lower teeth
were much narrower than the conentional pattern but at the same time much
)
wider than Sears channel teeth. 9rench proided a food table on his mandibular
teeth, but the food table was comparatiely narrow consisting of an area which
on an anatomic tooth would be the lingual cusps. The area normally occupied
by the buccal cusps was entirely eliminated, so the tooth was really about one
half a tooth in width. 9rench reasoned that by eliminating the buccal half of the
occlusal surface, greater stability of the denture bases was assessed.
Swenson presented a tooth to improe upon 8all:s theory. The teeth
were proided with sleice ways for clearing food from the depressions
between the cutting edges and they had buccolingual pitch to proide balance.
It was called the .non3lock/ teeth.
+rury ;rothers <11$6= designed teeth which sucked to sole the problem
of efficiency in artificial teeth by haing the teeth definitely interlock
anteroposteriorly, but free them of any cuspal inclines buccolingually. This was
done to promote the shearing principle.
In 11$>, %c2rane discribed a .cured cusp/ tooth constructed with
cerical grooes and cured cusps forming segments of an arc, concentrically
arranged from a radical center corresponding to the right and left rotation
centers in the heads of the condyles in the grenoid fossae. These teeth lak ery
definitely in anteroposterior relationship.
In 11'> Idardy introduced his .metal insert teeth/. These cure plastic
teeth with ribbons of metal inserted on the occlusal surface. It was suggested
that they might make an efficient food shearing tooth.
>
Radical c$an)es in toot$ for
1. Sears chewing members: Sears was of the openion that deriations from
anatomic forms are &ustifiable if the substitute produces efficient
mastication with a minimum of damage or change in appearance with this
in mind he deried nonanatomic teeth built in blocks rather than single
units. +n upper and lower artificial posterior dentition of this design
contains four blocks, a block being composed of two bicuspids and two
molars Sears claims that these teeth are 1. ,fficient, haing fairly steep
inclined planes, ". ?ess traumatic in nature as the antagenists guide
smoothly oer each other instead of interfering as seen in protrusie and
lateral moements with cuspid teeth. $. ,asier to set up, '. +dequate in
appearance.
Hardy*s etal insert teet$
8e deised his teeth basically for obtaining efficiency in mastication.
This tooth form in occlusal outline in similar to the other types except that it is
composed of one block of plastic with embedded underlating strips of metal.
,fficiency is ery high. These teeth are useful with patients who hae heay
bites that fracture porcelain teeth or wear plastic teeth.
Ty!es of !osterior teet$ accordin) to cus! inclines
#osterior artificial teeth are manufactured with cusp inclines that ary
from relatiely steep to flat planes. The commonly used posterior teeth are
those with cuspal inclination of $$@, "6@ and 6@. The cuspal inclination is
measured as the angle formed by the incline of the mesiobuccal cusp of the
lower first molar with the horizontal plane.
A
The $$@ posterior teeth offer the maximum opportunity for a fully
balanced occlusion. 8oweer the final effectie height of the cusp for a gien
patient depends on the way in which the teeth are inclined <tipped= and the
interelation of the other factors of occlusion, that is the incisal guidance, the
height of the occlusal plane and the compensating cure maintaining a shallow
incisal guidance compatible with esthetics allows a balanced occlusion to be
deeloped with as little cusp height on the posterior teeth as possible, thus
reducing lateral forces on the residual ridges.
The "6@ posterior tooth is semianatomic in form and wider
buccolingually than corresponding $$@ tooth. The "6@ tooth proides less cusp
height with which to deelop balancing contacts in eccentric &aw positions that
the $$@ tooth does. *on anatomic teeth are adisable when only a centric
relation record is transferred from the patient to the articulator and no effort is
directed to establish a cross arch balanced occlusion. *on anatomic teeth are
also effectie when it is difficult!impossible to precisely record centric &aw
relation from the patient or there are abnormal &aw relationships.
Factors influencin) function of anatoic and non anatoic teet$
1. Efficiency: ,fficiency has been defined as the ability to produce results.
This is applicable to denture functions the aim of mastication being the
comminution of food.
Factors influencin) efficiency
a. Type of patient
b. 4ondition of the mucosa and bony ridge.
c. Type of denture
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d. The biting force
e. The character of food and size of the bolus
f. The arrangement of the teeth
+, Directional forces
9orces on dentures must be in a direction which will gie the greatest
stability.
This is accomplished by
a. The form of the tooth
b. #lacement of the tooth
c. The arrangement of the teeth.
a- For of t$e toot$% + flat occlusal surface makes it relatiely simple not
only to direct the force of mastification where it is desired, but to eliminate any
resultant horizontal stresses. The proponents of the anatomic teeth, howeer
claim that it is not the presence of the cusp that influences direction of force but
the mismanagement of these cusps.
Bne of the greatest ob&ections to the use of anatomic teeth is the
difficulty to maintain them in occlusal balance after dentures are inserted in the
mouth. This is due to dentures .settling because of alterations of tissues under
the denture base. + new denture position is then produced with a resulting
change in the prearranged directional force. 4usps tend to cause anteroposterior
locking which preents the dentures from moing to their new position of
directional force, thus resulting in a loss of stability. The forces are also
redistributed, sometimes causing excessie pressure in certain areas with a
1
resulting resorption of portions of the ridge. This in turn causes further
malalignment of the dentures.
The nonanatomic tooth is easier to arrange and maintain in proper line
of force under similar conditions.
.- Placeent of t$e toot$% -ue to the greater retention of the upper denture,
any mismanagement of directional forces tends to occur at the expense of the
lower, producing an unstable lower replacement. 9orces directed to fall inside
the mandibular ridge create increased stability. This can be accomplished by
placing the lower tooth lingual to the lower ridge and ! or tilting the tooth so
that force is directed lingually.
/, Hori0ontal stress% Chen a ertical force is applied to an inclined plane
nonertical forces or horizontal stresses appear. It is essential to minimize
horizontal stress or dentures for the maintenance of oral comfort, health and
denture serice, the proponents of flat teeth claim cusps cause this particular
stress, whereas Schuyler maintains that the inclination of the eminentia
articularis portion of the mandibular fossa along with the incisal guidance, and
not the tooth form goerns horizontal stress. In other words cuspid posterior
tooth, as long as it confirms to these factors will not cause denture moement.
1, Sta.ility% It is the ability of the denture to remain in position during
masticatory and nonmasticatory moements. 9actors
Selection of posterior teeth
The selection includes Shade ;uccolingual width
Size %esiodistal length
*umber Dertical length
9orm
16
S$ade%
It should harmonize with the shade of the anterior teeth
;ulk influences the shade of the teeth and for this reason it is adisable to
select a slightly lighter shade for the bicuspids if they are to be arranged for
esthetics. They may be slightly lighter than the other posterior teeth but not
lighter than anterior teeth.
Si0e and nu.er of !osterior teet$
The size and number of posterior teeth are closely related to usage. These
characteristics are dictated by the anatomy of the surrounding oral
enironment and physiologic acceptance of supporting tissues. The
posterior teeth must support the cheeks and tongue and function in harmony
with the musculature in swallowing and speaking as well as in mastication.
2uccolin)ual #idt$ of !osterior teet$
The buccolingual width of artificial teeth should be greatly reduced from
the width of natural teeth they replace.
+rtificial posterior teeth that are narrow in buccolingual direction enhance
the deelopment of the correct form of the polished surfaces of the denture
by allowing the buccal and lingual denture flanges to slope away from the
occlusal surfaces. This occlusal form permits forces from the cheeks and
tongue to maintain the dentures in position on their residual ridges.
*arrow occlusal surfaces with proper escapeways for food also reduce the
amount of stress applied on food during mastication to the supporting
11
tissues of the basal seat. Bn the other hand, the posterior teeth should hae
sufficient width to act as table upon which to hold food during trituration.
-I+2(+%
Mesiodistal #idt$ of !osterior teet$
The mesiodistal width of the posterior teeth are determined by the
edentulous area between the distal of the mandibular cuspids and the
ascending area of the mandible. +fter the six mandibular anterior teeth hae
been placed in their final position a point is marked on the crest of the
mandibular ridge at the anterior border of the retromolar pad. This is the
maximum extent posteriorly of any artificial teeth on the mandibular ridge.
In well formed ridge the apex of retromolar pad is taken as posterior leel
and in resorbed ridges the point where retromolar pad turns upward.
-I+2(+%
&ertical len)t$ of .uccal surfaces of !osterior teet$
It is best to select posterior teeth corresponding to the interarch space and to
the length of the anterior teeth. The length of the maxillary first premolars
should be comparable to that of the maxillary canines to hae the proper
esthetic effect.
Ty!e of !osterior teet$ accordin) to aterials
%ost artificial teeth are made of air fired or acuum fired porcelain, acrylic
resin or a combination of acrylic resin and metal occlusal surfaces.
1"
Dacuum fired porcelain teeth are more resistant to abrasion and therefore
maintain their luster longer than acrylic resin teeth.
+crylic resin teeth can be altered and will bond with the denture base for
retention in instances of limited inter arch space.
+crylic resin teeth are preferred when the teeth in the opposing arch hae
been restored with gold, as the porcelain has a higher coefficient of wear
than gold.
+crylic posterior teeth should neer be used in combination with porcelain
anterior teeth. The rate of wear of resin teeth in relation to that of porcelain
teeth is such that the excessie forces from opposing tooth contact will
eentually be deeloped in the anterior part of residual aleolar ridges. The
supporting structures for the dentures are unusually least able to withstand
increased stress in this region.
Ad(anta)es of cus! !osterior teet$
1. They are considered more efficient in the cutting of food, thererby reducing
the forces that are directed at the support during masticatory moements.
". They can be arranged in balanced occlusion in the eccentric &aw positions.
$. Chen the cusps are making contact in the fossae at the correct ertical
dimension of occlusion with the &aws in ertical relation, the position is
comfortable. This position is a definite point of return, as through
proprioception the &aws will return to this position.
'. They look more like natural teeth and are therefore acceptable esthetically.
1$
). The contours are more like natural teethE therfore they will be more
compatible with the surrounding oral enironment.
>. +n attempted occlusion without cusps is disorganized because occlusion
has depthE it is not a sudden closure of flat surfaces.
Ad(anta)es of ono!lane teet$
1. Chen teeth are contacting in non masticatory mandibular moements as in
bruxism, the flat polished surfaces offer less resistance, therefore less force
is directed to the support.
". Chen the monoplane teeth are arranged to proide een contacting
bilaterally with the ertical dimension of &aw separation in harmony with
the &aws in centric relation, this position is comfortable. Through
proprioceptie impulses the patient will return to this position reflexly.
$. In cases of resorbed ridges dislodgement by horizontal or torquing forces
can occur. %onoplane teeth offer less resistance to these forces.
'. These teeth will allow a greater range of moement which is necessary in
patients with malrelated &aws.
). Chere the neuromuscular controls are so uncoordinated that &aw relation
records are not repeatable, the cusp form tooth cannot be balanced.
%onoplane teeth are less damaging than cusp teeth.
>. In case of diabetic patients where the underlying bone is ulnerable to
damage less stress is transmitted by the use of monoplane teeth.
Indications for use of Anatoic and Nonanatoic artificial !osterior teet$
1'
Payne indicates that flat teeth be used
1. Chere ridges are flat, rendering dentures more susceptible to horizontal
stress.
". In old age where the ridges are flat.
$. Chen the ertical dimension is great which would cause tipping forces to
deelop.
'. If a maximum of ertical force and a minimum of horizontal stress is
desired.
4usp teeth are to be used 1) where good ridges exist 2) with younger
people.
Shanahan suggests that the general rule, .8igh cusps for the young and
low or flat cusps for the aging/ be the criteria of tooth selection.
Pro.les #it$ anatoic toot$ fors
1. The use of an ad&ustable articulator is mandatory.
". ,ccentric records must be made for articulator ad&ustments. Setting the
ad&ustments will ary from dentist to dentist with the same records.
$. %esiodistal interlocking will not permit settling the base without horizontal
forces deeloping.
'. 8armonious balanced occlusion is lost when settling occurs.
1)
). The bases need prompt and frequent refitting to keep the occlusion stable
and balanced.
>. The presence of cusps generates more horizontal force during function.
Pro.les #it$ non anatoic teet$
1. *on anatomic teeth occlude in only two dimensions <length and width= but
the mandibular has an arcuate three dimensional moement due to its
condylar behaiour.
". The ertical component present in mastication and non functional
moements is not proided for so that this form loses shearing efficiency.
$. ;ilateral and protrusie balance is not possible with a purely flat occlusion.
*on anatomic teeth set on inclines for balance require as much concern as
anatomic teeth for &aw moements.
'. The flat teeth do not function efficiently unless the occlusion surface
proides cutting ridges and generous spillways <seeral ways=.
). They cannot be corrected by much occlusal grinding without impairing their
efficiency.
>. *on anatomic teeth appear dull and unnatural to some patients which may
create a psychological problem concerning function.
CONCLUSION
There are no definite guidelines for selection of posterior teeth. ;ut it
mainly depends on the type of patient and the condition of the supporting
1>
tissues. +nd hence, the selection of teeth is the responsibility of the dentist
which he acquires through knowledge and experience.
(eferences
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th
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116.
'= 4harles 8. 8eartwel, +rthur B. (ahn F Syllabus for complete dentures.
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Third ,dition.
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1A
1= *asr %.9. et al F The relatie efficiency of different types of posterior
teeth. G. #rosthet. -ent., 17 F $, 11>A.
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""13"$", 11>A.
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$ F A'A, 11)$.
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1$= (obert %. %orrow, Gohn ,. (hoads, Henneth -. (udd F 4omplete
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nd
edition, #g. 17A.
1'=(obert (app F the occlusion and occlusal patterns of artificial posterior
teeth. G. #rosthet. -ent., ' F '>1, 11)'.
1)=Sears D.8. F Selection and management of posterior teeth. G. #rosthet.
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1>= Sheldon Cinkler F ,ssentials of complete denture prosthodontics. "
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