The kinetics of anterior tooth display
Robert G. Vig, D.D.S.,* and Gerald C. Brundo, D.D.S.**
University of California, School of Dentistry, Los Angeles, Calif.
D entists can usually identify denture wearers at a
glance. An untrained observer can identify most
dentures by their monotonous tooth positions,
contours, and shades. This study deals with one
aspect of the "denture look'"--the amount of maxil-
lary and mandibular tooth exposure with the lips at
rest. A survey was made of people of all ages with
natural dentitions to determine the relationship of
lips and teeth and to note the changes that occur
with aging in anterior tooth exposure.
M a n y prosthodontic techniques require that the
maxillary occlusion rim be contoured and adjusted
to determine the proposed length of the maxillary
incisors. Various textbooks offer guides to estab-
lishing a lip length-incisal edge relationship. T h e y
do not suggest that this relationship is related to the
age of tile patient. T h e other esthetic factor, which
has been largely ignored, is the amount of exposure
of the mandibular anterior teeth.
Boucher and associates ~- suggest modifying the
maxillary rim "so that it is gently caressed by the
lower lip during pronunciation of the l e t t e r f a n d at a
height that allows for the length of the natural tooth
plus the amount of bone reduction that has
occurred." Heartwell and Rahn ~ suggest that the
"maxillary occlusion rim extends approximately 2
millimeters below the relaxed lip." This length is
modified until the inferior border contacts the
vermillion border of the lower lip w h e n f s o u n d s are
made. In some cases a line drawn between the
commissures of the lips is used. Sharry 4 says that "for
a patient with an average length of upper lip, 1 to 2
millimeters of occlusion rim should be seen when the
lip is at rest. For that patient with a short upper lip,
perhaps 5 to 6 millimeters of occlusion rim should be
seen." Ellinger and associates ~ suggest that with a
"Read before the Pacific Coast Society of Prosthodontists, San
Francisco, Calif.
*Clinical Professor of Dentistry.
**Assistant Professor of Dentistry.
502 MAY ]978 VOLUME39 NUMBERS
normal lip the occlusion rim extend just below the
resting lip with variations for short or long lips.
The textbook instructions make no distinction
between the sexes, different ages, or racial types. T h e
phonetic aids o f f and v sounds should automatically
determine the correct placement of maxillary incisal
edges and preclude any other considerations.
However, the phonetic system is often not used or
results are misinterpreted. This survey was made in
an effort to correlate these factors and others with
the amount of tooth display with the lips at rest. It
was hoped that the information developed by an
extensive survey of natural dentitions would furnish
guides to denture tooth placement under various
conditions.
SURVEY T E C H N I Q U E
The subjects were examined by the authors in the
UCLA clinical spaces. No attempt was made to
maintain a racial balance or a fixed male-to-female
ratio. Some age groups were larger than others, but
all were believed to be adequately sized.
No subjects were included with atypical condi-
tions such as traumatized lips, mobile or extruded
anterior teeth, extreme abrasion, or prosthetic ante-
rior tooth replacements. Uncooperative individuals
were also excluded from tile survey.
Data collected included tile subject's sex, race, age,
lip type, upper lip length, and the amount of tooth
display with tile lip gently parted. This data was
analyzed in v~irious ways and charts prepared (Figs.
1 and 2).
RESULTS
Variability of sexes. T h e average amount of
maxillary incisor exposure in men was 1.91 mm. In
women almost twice as much maxillary tooth expo-
sure was noted, 3.40 mm. As could be anticipated,
the men displayed more of the mandibular incisors
than the women, namely 1.23 m m compared to 0.49
m m (Table I).
0022-3913/78/0539-0502500.30/0 9 1978 The C. V. Mosby Co.
ANTERIOR TOO'Ilt DISPLAY

Table I. Tooth exposure by sex

Mean amount of tooth exposed (mml

Maxillary central Mandibular central

Sex incisor incisor
I
Male 1.91 1.23
Female 3.40 0.49

Table II. Tooth exposure by race

r

Mean amount of tooth exposed (mm)

Maxillary cenlral Mandibular central L..

Race Incisor incisor
Fig. 1. The measurement of the amount of exposure of
Caucasian 2.43 0.98 the maxillary central incisors.
Black 1.57 1.42
Asian 1.86 1.Sb

There was a large variation within the groups. It is

helpful to know that women, on the average, display
twice as much maxillary anterior tooth surface as
men.
Variability of races. The races broadly classified
as Caucasian, black, and Asian. In this category
nothing of particular significance was found. In the
black and Asian individuals the amount of maxillary
and man.dibular incisor exposure was roughly equal.
The Caucasians exhibited an average of tile male/ Fig. 2. The measurement of the amount of exposure of
the mandibular central incisors.
female statistics in both maxillary and mandibular
exposure (Table II).
Vm-iabillty of lip lengths. People with short upper
lips display more maxillary tooth structure than
l:~.ople wlfh long upper lips. This seems axiomatic,
but surprlsingly some dentists still set the anterior
teeth t o display 1 to 2 mm of the maxillary incisors
regardless of lip length, since this is an accepted rule.
The survey findings were explicit and had small
' variations.
Als0 note that the longer the upper lip, the more
the mandibular teeth are exposed (Table III). The
measurement was made from the base of the column
to the tip of the phihrum (Fig. 3). ~,, ---~
Variability of lip types. The lip types were catego-
rized as normal, long, short, heavy, or protrusive.
The long and short lip types were covered by the lip Fig. 3. The measurement of the length of the upper lip.
length data. The heavy lip is in essence a long lip.
The protrusive type has more exposure of both incisor with age. No particular thought had been
maxillary and mandibular teeth, as was expected. given to exposure of the mandibular central incisor.
Variabilit)' of age. Groupings were made as The most noteworthy information gained from this
follows: under age 29, 30 to 39, 40 to 49, 50 to 59, and survey can be seen in Table IV.
6 0 a n d older. The anticipated pattern was that of a While maxillary anterior tooth display showed a
gradual decrease in exposure of the maxillary central steady decrease with aging, the mandibular anterior

THE JOURNAL OF PROSTHETIC DENTISTRY 503

 VIG AND BRUNDO

Table III. Tooth exposure by length of upper lip in prosthodontic literature would therefore be
misleading in making the average Complete denture.
Mean amount of tooth exposed (mm)
In fact, the survey findings demonstrate that the
Upper lip Maxillary Mandibular mandibular incisor display in the patients over 60
length (ram) central incisor central incisor years of age should be approximately equal to the
10-15 3.92 0.69 maxilla O, incisor display in patients under 30 years of
16-20 3.44 0.77 age. Treating a l l p a t i e n t s in the same manner
21-25 2.18 0.98 regardless of age differences contributes greatly to
26-30 0.93 1.95 the "denture look."
31-35 0.25 2.25
SUMMARY A N D C O N C L U S I O N
Table IV. Tooth exposure by age A survey has been presented that correlates
measurements of upper lip type, sex, race, and age of
Mean amount of tooth exposed (mm) dentulous patients with the amount of exposure of
Age group Maxillary Mandibular tile maxillary and mandibular anterior teeth with
(yr) central incisor central Incisor the lips gently parted and in tile resting position.
Perhaps the most interesting finding was the gradual
U p to 29 3.37 0.51
30-39 1.58 0.80 reduction in the amount'0f maxillary central incisor
40-49 0.95 1.96 exposure with an increase in age, accompanied by a
50-59 0.46 2.44 gradual increase in the mandibular tooth exposure.
60+ --0.04 2.95 The importance of the .smount of mandibular teeth
seen in complete dentures has not been sufficiently
teeth showed a corresponding increase. The prin- emphasiied in previous literature.
cipal exceptions to this pattern were patients with REFERENCES
moderate to severe Class II malocclusions. 1. Vig, R. G.: The denture look. j PROSTHVT DE,','r 11:9,
1961.
DISCUSSION 2. Boucher, C. O., Hickey, j . C., and Zarb, G. A.: Prostho-
Regardless of judgment and technical ability dontic Treatment for Edentulous Patients, ed 7. St. Louis,
1975, The C. V. Mosby Company, p 224. -
dentists can place artificial teeth more correctly if
3. Heartwell, C. M., and Rahn, A. O.: Syllabus of Complete
clues are available as to former natural tooth posi- Dentures, ed 3. Philadelphia, 1974, Lea & Febiger Publish-
tions. This survey makes available average measure- ers, p 224.
ments for patients based on sex, race, lip length, and 4. Sharry, J. J.: Complete Denture Prosthodontics, ed 3. New
age. Properly used, it may help furnish a startb2g pohzt York, 1974, McGraw-Hill Book Company, Inc., p 234.
5. Ellinger, C. Vr Rayson, J- H~, Terry, J. M., and Rahn, A.
for positioning anterior teeth.
O.: Synopsis of Complete Dentures. Philadelphia, 1975, Lea
Mandibular incisor teeth have been largely & Febiger Publishers, p 163.
neglected in considering esthetic denture composi-
Reprint requests to:
tions. This survey shows that the average maxillary
DR. ROBERT G. Via
tooth display in the group of patients over 60 years of UNIVERSrrY OF CALIFORNIA
age was --0.04 mm; tooth display was 2.95 mm in the SCHOOL OF DENTISTRY
mandibular central incisors. The accepted guidelines LOS t'kNGELE$,CALIF. 90024

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504 MAY 1978 VOLUME 39 NUMBER s