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A R T IC L E S

The geometric theory of selection of artificial


teeth: is it valid?
Ryle A. Bell, DDS, MS, Washington, DC

T h e validity o f W illiam ss g e o m etric theory o f selectio n o f artificial


teeth was tested. Data fro m 31 su b jects w hose m a x illa ry incisors
w e re co n s id e re d esthetically a c c e p ta b le w e re ru n through
a co m p u ter to d eterm in e co rrela tio n s b e tw een f a c e a n d tooth fo rm .
No correlation was fo u n d .

A he selection of artificial teeth for


dentures is to a large degree based on
the su bjective judgm ent of the den
tist. As a result, selectio n of artificial
teeth is one of the m ost u n scien tific
processes in dentistry. S e le ctio n of
m axillary incisors is a particular
problem becau se their size, shape,
and arrangem ent are esthetically
cru cial. A ttem pts have been m ade to
find an orderly basis for selectio n of
anterior teeth, but so far none has
been satisfactory.
T h e tem peram ental theory was one
of the earliest theories prop osed .1
P eople w ere classified as nervous,
lym phatic, biliou s, or sanguine
ou s,2,3 qualities believed to describe
certain types of p ersonalities and
physical characteristics. Apart from
the problem s involved in deciding
w hether a persons behavior was typ
ical or atypical on a given day, the
artificial teeth m anufactured by dif
ferent com panies varied so w idely
w ithin the same category that this
m ethod was not dependable. In 1914,
W illiam s4 proposed what has com e

to be know n as th e geom etric theory.


T h is theory related the form of the
face to the form of the teeth. W illiam s
believed that the contour lin es of
your upper in cisors m ust be, in a
general way, the reverse of what they
are in the face. O bservance of this
rule w ill alw ays give you perfect
harm ony the harm ony of opposi
tion of lin e . 5 T h is was the accepted
theory for about 50 years. T h en Frush
and F ish er6 introduced the SPA
theory, in w hich selectio n of teeth
was determ ined on the b asis of sex,
personality, and age of th e in d i
vidual. In spite of the SPA basis of
theory, the geom etric theory is prob
ably still the way in w hich m ost den
tists select anterior artificial teeth.
For this reason, it was d ecided to try
to assess its validity. In 1936, W right7
studied the geom etric theory and
found that 60.7% of h is subjects had
natural m axillary in cisors that were
not sim ilar in form to the facial form;
30% were generally like the facial
form , but only 13% w ere identical.
W illiam ss data were sim ilar to

W rights, but in spite of his find ings,


he based his theory on these data.

M a te ria ls an d m e th o d s
T hirty-one subjects w hose m axillary
incisors were considered esth etically
acceptable by both dentist and su b
ject, were chosen. Casts were m ade of
the m axillary arch, intraoral p hoto
graphs were taken, and periapical
radiographs w ere m ade w ith the par
allellin g techniqu e. T h is tech n iqu e
was chosen becau se in conversation
w ith G. Pappas, DDS (January 1975) I
was inform ed that w ith th is m ethod
there is no distortion of the shape of
the teeth.
From the study of the casts, the in
traoral photographs, and the rad io
graphs, three dentists classified the
form s of the faces and of the m ax il
lary central incisors. E ach dentist
was instructed in the W illiam s
m ethod of classifying tooth and face
form : a square in ciso r w as one that
was parallel m esially and d istally for
at least h a lf of the ce rv ico in cisal
length; a tapered tooth converged
from th e in cisa l edge to the cervix;
and an ovoid tooth was bicon vex (Fig

1).
T h e facial ou tline w as determ ined
by the ou tline of the tem poral bone at
the h eight of the h airlin e, tem poral
process of the zygom atic arch, and
gonion. T he square face was one in
w h ich th e ou tline of the face betw een
JADA, Vol. 97, October 1978 637

A R T IC L E S

Fig 2 Left, square face; middle, tapered face; right, ovoid face.

the reference points show ed no de


v iation from the vertical. The tapered
face converged from tem poral bone
to gonion, and the ovoid face d i
verged from tem poral bone to gonion
(Fig 2 ).5
T h e classificatio n of the form s of
the teeth was done at w eekly in ter
vals to m inim ize attem pts at recall by
the exam iners. They were all in
structed as to the criteria to be used.
First, the form s of all the casts were
classified , then the forms seen in the
radiographs were classified the next
w eek, and so on. A fter the forms of
the teeth derived from the different
sou rces w ere classified , the forms of
the faces w ere categorized.

R e su lts
T h e data were electro n ically reduced
by com puter. T h ey were pro
gram m ed into S P S S crosstabs (the
638 JADA, Vol. 97, October 1978

Table 1 Relationship of face form to form of maxillary central incisors as


shown on intraoral photographs.
F a c e form
In all fa ce form s
Tooth form
Ovoid
No. cases
% ovoid tooth form
w ith ovoid, square, or
tapered fa ce form s
% ovoid fa ce form w ith
ovoid, squ are, or tapered
tooth form s
% o f to ta l num ber
Sq u are
No. cases
% sq u are tooth form with
ovoid, square, or
tapered fa ce form s
% sq u are face form with
ovoid, square, or tapered
tooth form s
% o f to ta l n um ber
Tapered
No. cases
% tapered tooth form with
ovoid, square, or tapered
fa ce form s
% tapered fa ce form w ith
ovoid, square, or tapered
tooth form s
% o f to tal
T otal tooth form s

Ovoid

Squ are

T apered

40.0

60.0

0.0

33.3
12.3

42.9
19.4

0.0
0.0

33.3

33.3

33.3

33.3
12.9

28.6
12.9

80.0
12.9

44.4

44.4

11.1

33.3
12.9
12 (38.7% )

28.6
12.9
14 (45.2% )

20.0
3.2
5 (16.1% )

No.

10

32.3

12

38.7

29.0

31

100.0

C hi-square = 4.98624 with 4 degrees of freedom ; sig nifican ce = 0.2887. R esu lt: no co rrelatio n.

ARTICLES

Table 2 Relationship of face form to form of maxillary central incisors as seen


on casts.
Face Form
In all face forms
Tooth form
Ovoid
Square
Tapered
No.
%
Ovoid
No. cases
4
4
1
9
29.0
% ovoid tooth form
with ovoid, square, or
tapered face forms
44.4
44.4
11.1
% ovoid face form with
ovoid, square, or tapered
33.3
28.6
20.0
tooth forms
12.9
% of total number
12.9
3.2
Square
No. cases
8
6
4
18
58.1
% square tooth form with
ovoid, square, or
44.4
tapered face forms
33.3
22.2
% square face form with
ovoid, square, or tapered
tooth forms
66.7
42.9
80.0
% of total number
25.8
19.4
12.9
Tapered
No. cases
0
4
0
4
12.9
% tapered tooth form with
ovoid, square, or tapered
face forms
0.0
100.0
0.0
% tapered face form with
ovoid, square, or tapered
tooth forms
0.0
28.6
0.0
% of total
0.0
12.9
0.0
Total tooth forms
12 (38.7%) 14 (45.2%) 5 (16.1%)
31
100.0
Chi-square = 6.20000 with 4 degrees of freedom; significance = 0.1847. Result: no correlation.

program used by the O hio State U n i


versity for com puting chi-squares)
(Tables 1-3). T h e vertical colum ns
represent the tooth form s w hereas
the horizontal colum ns represent the
face form s. In Table 1, the tooth form
w as determ ined by the intraoral p h o
tographs; in Table 2, by th e casts, and
in Table 3, by the radiographs.

In th e Tables, the first num ber rep


resents the total num ber of cases with
that com bination. For exam ple, in
T ab le 1, there are four instances of
ovoid faces appearing w ith ovoid
teeth, w hen the teeth were classified
w ith u se of the intraoral photograph.
T h e second num ber, the percent row,
is the percentage of ovoid teeth that

T a b le 3 Relationship of face to form of m axillary cen tral incisors as determ ined


by radiographs.
Face form
Tooth form
Ovoid
No. cases
% ovoid tooth form
with ovoid, square, or
tapered face forms
% Ovoid face form with
ovoid, square, or tapered
tooth forms
% of total number
Square
No. cases
% square tooth form with
ovoid, square, or
tapered face forms
% square face form with
ovoid, square or tapered
tooth forms
% of total number
Tapered
No. cases
% tapered tooth form with
ovoid, square, or tapered
face forms
% tapered face form with
ovoid, square, or tapered
tooth forms
% of total
Total tooth forms

Ovoid

Square

Tapered

42.9

35.7

21.4

50.0
19.4

35.7
16.1

60.0
9.7

28.6

71.4

0.0

16.7
6.5

35.7
16.1

0.0
0.0

40.0

40.0

20.0

33.3
12.9
12 (38.7%)

28.6
12.9
14 (45.2%)

40.0
6.5
5 (16.1%)

In all face forms


No.
%
14

45.2

22.6

10

32.3

appear w ith square, tapering, and


ovoid faces as classified according to
the intraoral photographs. T h e third
num ber, the percent colum n, is the
num ber of ovoid faces w ith square,
tapering, and ovoid teeth as seen by
the intraoral photograph. The final
figure in each category is the percent
of cases of th e total num ber. A sig
n ifica n ce level of 0 .0 5 was chosen
becau se it is the level m ost often used
in evaluating b io lo g ical data.

Discussion and conclusion


N one of the sig n ifica n ce levels are
low enough to establish any correla
tion betw een the form of the face and
the form of th e m axillary central in
cisors. Therefore, the geom etric
theory is invalid.
T h e question that rem ains is why
does the theory w ork? Tooth size and
arrangem ent are apparently far m ore
im portant than tooth form. In testing
the rad iographic techniqu e, central
in cisors that w ere to be extracted for
periodontal ' reasons, were first
radiographed and then extracted.
T h e three dentists used in the study
w ere asked to classify the form of the
tooth on the radiograph by any
m ethod they chose. W ithout know
ing that the extracted teeth w ere the
ones radiographed, the dentists were
asked to classify them as w ell. A l
though the classificatio n differed
among the den tists, they all cla ssi
fied the radiograph and the extrac
ted tooth id en tically according to
th eir classificatio n . F re n ch 8 show ed
that one m old of teeth w hen arranged
according to different arch forms
could be m ade to appear square, tap
ering, or ovoid. Casts and intraoral
photographs are not good guides for
selectio n of anterior teeth as gingival
contour and arrangem ent of teeth can
be m isleading in classifying the form
of the tooth. A sin gle periapical
radiograph m ade by the parallelling
techniqu e is a m ore accu rate guide to
the true form of the p a tien ts tooth.

Summary
31

100.0

Chi-square = 3.12319 with 4 degrees of freedom; significance = 0.5374. Result: no correlation.

T h e study was done to determ ine the


valid ity of W illiam ss geom etric
theory of tooth selection . T h e m axil-

B ell: VALIDITY OF THE GEOMETRIC THEORY OF SELECTION OF ARTIFICIAL TEETH 639

A R T IC L E S

lary central incisors of 31 subjects


w ere radiographed and photo
graphed; casts were m ade of the
m axillas; and the su b jects faces were
photographed. Three dentists clas
sified the form of the m axillary cen
tral incisors as show n by intraoral
photographs, radiographs made by
the parallelling techniqu e, and casts,
and also classified the form of the
face from frontal-view photographs.
T h e data collected were reduced by
an electro n ic com puter to determ ine
if a correlation exists. There was no
correlation betw een the form of the
face and the form of the m axillary
central incisors.

T his paper was read at the Carl O. Boucher


Prosthodontic Conference, Columbus, Ohio,
April 1976.

640 JADA, Vol. 97, October 1978

1. Ivy, R.S. Dental and facial types. In Ameri


can system of dentistry. Litch, W.F. (ed.).
Philadelphia, Lea Brothers, 1887, vol 2.
2. Berry, F.H. Is the theory of temperament
the foundation to the study of prosthetic art?
Dent Mag 1:405 1905-6.
3. Trueman, V.H. In The A m erican system of
dentistry. Litch, W.F. (ed.). Philadelphia, Lea
Brothers, 1887, vol 2, pp 573-580.
4. W illiam s, J.L. The temperamental selec
tion of artificial teeth, a fallacy. Dent Digest
20:63 Feb 1914.
5. Clapp, G.W. T he life and works of James
Leon W illiam s. New York, Dental Digest Pub
lishing Co., 1925.
6. Frush, J.P. and Fisher, R.D., Introduction
to dentogenic restorations. J Prosthet Dent 5:586
Sept 1955.
7. Wright, W.H. Selection and arrangement
of artificial teeth for complete prosthetic den
tures. JADA 23:2291 Dec 1936.
8. French, F.A. Selection and arrangement of
the anterior teeth in prosthetic dentures. J Pros
thet Dent 1:587 Sept 1951.

THE AUTHOR

BE LL

Dr. B e ll w as a g rad u ate stu d en t at T h e


O h io S ta te U n iv ersity , C olum bu s. He is
cu rre n tly an in stru cto r, dep artm en t of
p ro sth o d o n tics, C o lleg e o f D entistry,
H ow ard U n iv ersity , W ash in g to n , DC

20059.