Teeth selection

Dr.Suresh V

contents

Introduction Evolution in anterior teeth selection Methods of teeth selection Dentogenics Golden proportion Evolution in posterior teeth selection Factors in selecting a posterior tooth Review of literature Conclusion References

Introduction
An acceptable cosmetic effect in any dental restoration has always been regarded as a important to good dentistry. A well made prosthesis will fail if it is deficient in this respect. Teeth selection in complete denture process plays a huge role in great prosthetic success and a great patient operator relationship. Since ages various methods and guidelines are put forth to achieve the best prosthetic out come.

The evolution

During the ivory age and early porcelain period ,teeth were selected or created mostly by dimensional measurements of the denture space and arch size with little regard to esthetics. J W White in 1872 projected correspondence and harmony theory, temperamental theory was fading out of medicine but white reached over and suggested that temperaments called for similarity of form in faces and teeth. The temperamental theory is a theory of fluids of the body, especially the blood ,the phlegm and the bile. It was conceived by the Hippocrates in 5th century BC and was used by the medical profession in diagnosis and treatment planning.

Tempermental theory

W.R. Hall in 1887 projected Typal form concept , this was the initiation of geometric theory later. The basis of this classification Major basis - a) labial surface curvature b) outline form and neck width Minor basis labiolingual inclination of the upper incisors in relation to the profile types.

Berrys biometric ratio method (1906); projected the outline form of the inverted central incisor tooth closely approximated the outline form of face . Hence the outline form of face indicated the outline form of the anterior teeth to be chosen . Berrys further investigation led to the finding of Maxillary central incisor was 1/16th width of the face and 1/20th its length.

Since 1985 J. Leon Williams wanted revolution in teeth selection process , later in 1909 he proposed the technique to build wax occlusal rims of proper height and form, with patients lips at rest, marked the location of corner of mouth ,high lip line, lower lip line ,and after removing the occlusal rim the distal end of second molar is marked. Using a fleximeter the distance between the markings were read.

Although Hall had proposed earlier about Typal theory it was neglected for twenty five years , williams did a extensive study in 1914 to give three basic typal forms ovoid ,tapering, square. He studied in extracted human teeth and skulls .

According to him it was combination forms tapering or ovoid or both inblended into square square or ovoid or both inblended into tapering square or tapering or both inbleded into ovoid

The photograph were distributed among dentist and face form were used as guide.

Young emphasized on teeth selection based on emotion, mental imagery and stored knowledge. Nelson in 1920 projected palatal vault form ,in this technique the mid palatal shape was determined to select a tooth shape . In 1936 photometric method was proposed by wright, in this using a photograph of the patient with natural teeth and establishing a ratio by comparative computation of measurements of like areas of the face and photograph is done and using a simple mathematical formulas the teeth is selected.

Anthropometric cephalic index method projected by sears in 1941, was based on the fact that the width of the upper central incisor could be determined by dividing either the transverse circumference of the head by 13 or by bizygomatic width by 3.3. Bioform technique proposed by the dentist s supply company in 1950, was based on the geometric outline forms of face and teeth the house classification for 4 basic , 3 combination typal forms and 3 dimensional harmony of tooth form and face form were considered.

The Trybyte mould selector method was advocated by the dentists supply company. On the edentulous cast measurement in millimeters was made using the incisive papilla as a focal point of triangle and the distance measured from the papilla to the hamular notches and inter distance between hamular notches were found . The total length in millimeters is input into

Methods of teeth selection

Pre extraction records

Diagnostic casts Recent photographs Radiographs of teeth

Post-extraction examination
Size and form of edentulous foundation. Matching teeth to faceforms and arch forms. If patient is already a denture wearer, mouth should be examined with the dentures in the mouth giving importance to physiological and esthetic aspects.

Form of anterior teeth

Based on face form:

Based on arch form

 Based on profile of the face

The labial surface of the tooth viewed from the mesial aspects should show a contour similar to that when viewed in profile.

The labial surface of the tooth viewed from the incisal aspect should show a convexity or flatness similar to that seen when the face is viewed from under the chin or from the top of the head.

Based on anthropometric system

Bizygomatic width = estimated width of maxillary central incisors. 16 Bizygomatic width = approximate width of six anterior teeth 3.3

Based on marking on the corners of mouth

Dentogenic concept
A woman is a woman from her finger tips to her smile , and a man is a man from his fists to smile . The purely mechanical and mathematical approach to tooth selection is largely responsible for the neuter gender denture look

Dentogenic and sex factor

Frush and Fisher in 1955 were the first to introduce dentogenic restoration to dental community. Dentogenics described a denture that is eminently suitable to the wearer in that it adds to the persons charm, character, dignity or beauty in a fully expressive smile. According to the authors sex identity in dentures carried a greater significance in achieving better esthetics. Feminine form is characteristically spherical with a roundness, smoothness and softness, whereas the masculine form is cuboidal , with hard, muscular, vigorous. The procedure therefore is to select a basically feminine or masculine mould and then harmonize it to the individual patient depending upon the personality and age factors by modifying individual teeth.

When the dentogenic concept evolved , the full meaning of esthetics was carried into the 3rd dimension :

The wearer of a dentogenic restoration must have inner sensibility of well being. The viewer of the dentogenic restoration must perceive beauty or a fulfillment of the wearers personality in his smile . Then the dentists who created the dentogenic restoration would feel deeply rewarded.

When the laterals are nearly as broad as the other front teeth the denture is said to have strong or masculine appearance , when the laterals are narrower then it depicts feminine or delicate. Lateral incisor if rotated to show its mesial surface gives softness and youthful appearance to the smile. If rotated mesially the effect of smile is hardened.

The authors described a procedure called depth girding, which involves the accentuation of the third dimensional depth to eliminate the flat appearance of the artificial upper anterior teeth. The depth grinding is done on the mesial surface of the central incisors only .They are the widest , longest and most noticeable in the six anterior teeth.

With a soft stone , the mesiolabial line angle of the central incisor is ground in a definite and flat cut , following the same curve as mesial contour of the tooth in order to move the deepest visible point of the tooth further lingually .after this cut has been made careful rounding and smoothing of the sharp line angle is made. It is necessary to develop the desired effect in depth grinding by a consideration of these main factors a flat thin narrow tooth is delicate looking and fits delicate woman and involves little depth grinding , wheras a thick , bony , big sized tooth, heavily carved on its labial face is vigorous and is to be used exclusively for men. this involves rather severe depth grinding. Depth grinding reduces the width of the central incisors according to the severity of grinding accomplished . Therefore to maintain, the normal harmony of contrast in size between the six anterior teeth, a larger central incisor of the same mold should be selected.

Dentogenics and personality factor

1. 2. 3.

In 1956 , Frush and Fisher discussed another aspect of dentogenic the personality of the patient . They stated that foundation for the dentogenic restoration is the personality of the patient simply because the male and female tooth form is a refinement of that tooth form which has its inception in the personality factor. They devised the personality spectrum and explained the precise prosthodontic application of the otherwise abstract word personality by 3 divisionsof the personality spectrum. Delicate fragile, frail , opposite of robust Medium pleasing normal, moderately robust, healthy and intelligent appearing. Vigorous- the opposite of delicate, hard , aggressive, muscular type.

The personality spectrum can be used in our artistic endeavor to inject a variety of tooth form and tooth position, at the comprehensive level of individual patient personality analysis.

A small percentage of patients are delicate , slightly larger percentage are vigorous, the remaining majority of the patients fall into the medium section of the personality spectrum. The use of dentogenic concept has made easier, by considering the smile as the primary objective . The smile, personality trait and the personality spectrum is used in selection of the mould category.

Dentogenic age factor

It was considered in 1957 by the same authors. The dignity of the advancing age must be appropriately portrayed in the denture by careful tooth color selection and mould refinement Lighter shades are considered appropriate for young people and darker shades are considered for older people. Also bluish incisal tinges are preferred for the young people and greyish shades for the older. Mould refinement is done by producing worn incisal edges and cuspid tips, attritional and abrasional facets, development of diastemas to indicate tooth loss and subsequent drifting.

The environment of the tooth were arranged is also important, the matrix of the artificial tooth should be meaningful and not repetitive and inartistic. With very life like material available ,we can even feature the interdental papillae in a realistic manner. In youth interdental papillae are finely stippled and pointed and tight against the tooth, as age increases the attached gingiva looses stippled appearance and appear edematous and smooth, even shortening of the papillae can be depicted by raising the gingival line.

1.

Again in 1958 Frush and Fisher propounded the Dynesthetic interpretation of the dentogenic concept. Dynesthetics is a compound word, dyn is from the greek word dynamis meaning power. It implies movement ,action ,change ,and progression in the esthetic phase of prosthodontics. The application of dynesthetics allows a denture to be a work of art rather than an artifact. Rules that govern dynesthetics are: The tooth Its position Its matrix (visible denture base)

2.
3.

Dynesthetics outline:
Physiologic shade selection Lip support Midline Labioversion Speaking line Smiling line Position of incisors and cuspids spaces between teeth Buccal corridor


1.

Dynesthtics outline : Physiologic shade selection-

As age advances there is accumulation of tobacco tar, food pigments, and bacterial discoloration. as this occurs ,various degree of color texture changes occur in the incisal edges, therefore in creating the illusion of natural dentition for a older patient ,a darker shade is preferred but this does not imply in all cases, since few people might not smoke , take light pigmented foods, in such case shade should be selected lighter.

Midline : face usually slant one way or another and it is difficult to see a true midline in a dentition. Therefore an eccentric midline is acceptable in denture if it not to exaggerated.

Labio version : most pleasing effect is obtained when the long axis of the central incisors are either vertical or with slight labial inclination, this determination is made when the patient is standing in normal posture. Speaking line: it is the vertical composition of the anterior teeth, it should be noticed when the patient is speaking . A guide to vertical composition using the incisal edges in relation to lip line is : a) young woman 3 mm below lip line at rest b) young man 2 mm below lip line at rest c) middle age 1.5mm below the lip line at rest d)old age ,senility o mmbelow lip line to 2 mm above lip line at rest

Smiling line : the smiling line is the curve whose path follows the incisal edges of the central incisors up and back to the incisal edges of the lateral incisors to tips of the cuspids.its arc is determined by the age of the patient and decreases as patient gets older.

Central incisors position : these are the corner stones of the tooth position, if this tooth position is right all the other teeth position will be right. Their shape is controlled by the physical personality of the patient , and their position determines the strength and action of the dentogenic composition. One central incisor is always placed bodily ahead or behind the other, from this point a various degree of rotation ,labial inclination and axial divergence will produce effects of additional strength, activity, and vigor to entire dental composition.

Lateral incisors : the position of this tooth is subordinated in importance that of the central incisors. its rotation will either harden or soften the dental composition. The right and left lateral incisors should have asymmetric long axes and when positioned least portion of the tooth is seen while speaking. In dentogenics , this is considered as the personality tooth, as sex determination comes from either rounding incisal edge for feminine and squaring incisal edge for masculine effect.

The cuspid position : this tooth controls the size of the buccal coridor, it should be carefully positioned so as to dominate the lateral incisor and to complete the desired upward curve of the smiling line. Basic requirements while placing the tooth are : a) tooth should be rotated to show its mesial surface b) the cervical end should be out c) when observed from side , the long axis of the cuspids should be vertical.

Spaces : between the anterior and posterior teeth is extremely effective , but their size must be artistically and hygenically formed or they will become unsightly repositories for food , plaque and calculus. Rules to be observed while giving spaces are : a) all spaces must be V shaped to shed food b) a diastema between central incisors is unsightly and should be avoided in aged patients. c) diastemas should be asymmetrically placed on either side of the dental arch. d) the width of the diastema should be controlled , so as not to appear unsightly at any instance.

Buccal corridor : it is the space created between the buccal surface of the posterior teeth and the corner of the lips when the patient smiles. It begins at the cuspid , and its size and the shape are controlled by the position and slant of the cuspid even though the actual corridor exist posterior to the cuspid tooth.

Buccal corridor present in the natural dentition, its inclusion in dentogenics accomplishes an added illusion of reality.

Richard E. Lombardi (1973) stated about composition, unity,unity with variety, dominance,mold requirements,colour in denture esthetics and shade selection. As the amount of contrast increases , visibility increases and when contrast decreases the visibility decreases, the study of relationship existing between the objects made visible by the contrast is called composition. The prime requisite of composition is unity means one-ness Two types of unity are static and dynamic If a denture is of static type placed on a dynamic living human makes it unnatural and unpleasing esthetics. Segregating forces must be introduced into the dental composition to produce dynamic unity.

Hogarths line of beauty has been cosidered as outstanding example of the unity with variety.

Dominance is the prime requisite to provide unity.one shape, colour, or line must dominate. The mouth is the dominant feature of the face, the central incisor selected should be larger than the lateral incisor to dominate the composition. The dominance of the dental composition may be increased by making it more visible. Which may be done by -Increasing the mold size,using lighter shade, placing teeth far anteriorly, and increasing the exposed gingivoincisal length.

The relationship of width to length of a tooth is important , because if two teeth are of same width and different length, the longer the tooth will appear to be narrower. Repeated ratio : The width of the golden mean rectangle is one side of a square ;its length is one half the square plus the diagonal of the half the square. This results in a rectangle in which the length / width ratio is 1.618/1. This ratio has been explored in relation to the mouth and as a repeated ratio for the horizontal division of the area of the mouth, it has proved to be too strong for the dental use. If the same ratio between the width of the central incisor and lateral incisor is repeated between the lateral and the amount of cuspid shown, and between the cuspid and bicuspid, each tooth size will be different (variety) but related (unity) because of the same ratio.

Golden proportion
Dominance must be exhibited by using a central incisor of sufficient size to dominate the composition, teeth must not be set on a static cure of circle but on a dynamic line similar to Hogarths line and teeth must be set with regard to repeated ratio to provide unity with variety .The teeth must be modified to harmonize with the patients age, sex and personality to provide subjective unity.

According to Richard E. Lombardi teeth selected on the premise of face shape are as good as or better than those of any of the other systems, but such selection is definitely not the exact science. The guide for selecting the size of the central incisors is 16:1head:tooth ratio Negative space : they provide the illusion of teeth by portraying the dark space of the mouth behind the teeth. By altering the shape of the incisal edges, the contrast against the black back ground brings the dynamism and realism to the smile.

Color in denture esthetics

Three main components : Hue : characteristics of the color that gives the identity. Intensity : describes how much of the actual pigment is in the color been described. Value : describes the lightness or the darkness of a color. Factors affecting color : Lightness or darkness of the tooth is affected by the amount of light striking the tooth that will be reflected to the eye of beholder. The texture of the tooth (incisogingival angulation or smoothness of surface) The back ground against which the color is seen has a definite effect on the color concerned( a darker background makes a color seems lighter than the same color against a light back ground) Lighter objects appear larger (closer) than the darker objects.

1. 2. 3.

4.

Unlike anterior teeth , posterior teeth are selected from Occlusal schemes selected for each individual patients. Bucco lingual width of tooth Mesio distal length available

Posterior teeth selection

History of development of posterior tooth forms : Alfred Gysi designed the 1st anatomic porcelian tooth.(1914) He studied numerous natural dentition and came to a conclusion that anatomic posterior teeth should have 33.

In 1932 Pilkington and Turner anatomic tooth of 30 angulation. According to them the cusps are of tetrahedral form with transverse grooves between them having the buccal and lingual portions in alignment and the apices of the cusps all lying on the surface of sphere. Gysi recognised that his anatomic tooth will not suite all type of ridges , so he designed cross bite,in which maxillary cusp were almost eliminated .

He described this occlusal scheme as mortar and pestle action.

Victor sears (1927) designed the channel tooth, in this the maxillary occlusal suraces consisted of a deep channel that run mesiodistally the entire length of the four posterior teeth. The lower posterior teeth were half the bucco- lingual width of the standard anatomic teeth and were with single central ridge that ran entire length of the occlusal table, they articulated with the central channels of the maxillary teeth. This permitted unlimited protrusive glide and with limited lateral guide.

Avery brothers (1930) introduced the scissors bite technique. In this anteroposteriorly the occlusal surfaces were locked,the occlusal surface was determined by the inclination of the condylar path. They were free during latreal excursions and meant only for shearing food.

In 1937 Max Pleasures scheme proposed to modify the lower posterior teeth occlusal surfaces to a reverse curve by tilting the tooth buccally .

John Vincent in 1942 introduced a change in materials by using metal inserts in resin posteriors

Sosin in 1961 replaced maxillary second bicuspid and first & second molars with cleat shaped vitallium forms called cross-blades.

Levin modified this scheme by reducing the size of the cross-blade to the maxillary lingual cusp.

Non anatomic or Cuspless teeth In 1929 Hall was the first to design cuspless teeth he called inverted cusp tooth.

Myerson also design cuspless posterior teeth called True-cusp. It had a series of transverse buccal lingual ridges with sluice ways between them.

In 1934 Nelson described teeth as chopping blocks, which were flat occlusal surfaces with numerous ridges

In 1939 Swenson designed a posterior tooth called nonlock.These were essentially flat teeth with Sluice ways for shredding and allowing food to clear the occlusal table.

In 1946 Hardy designed a metal insert upper and lower posterior which he called Vitallium occlusal.

Three types of posterior teeth : Anatomic 33 Semianatomic - 20 Non anatomic - 0

Anatomical molds usually are selected for bilateral balanced articulation

Nonanatomical or cusp less teeth are generally the choice in the nuetrocentric occlusion

lingualised concept utilises anatomic teeth for the maxillary and monoplane or semianatomic teeth for the mandible

Anatomic teeth
Advantages Penetrates food more easily Resists the rotation of denture bases through cusp interdigitation Provides better esthetics Acts as a guide for proper jaw closure Disadvantages More occlusal disharmony during settling and difficult to correct by adjustment Precise jaw closure and base stability required for interdigitation Increased horizontal forces Difficult to adapt to abnormal jaw relationships

Non Anatomic teeth

Advantages
Does not lock the mandible in one position Minimizes horizontal stress because of the absence of inclined planes Adapts easily to Classes II and III jaw relations More easily adjusted after changes in vertical and horizontal relations Easier to arrange in cross bite

Disadvantages
Poor esthetics Decreased masticatory efficiency More difficult to obtained balanced occlusion

There are four major patient factors to be considered, along with their influence on the selection for anatomic, semianatomic, nonanatomic and mold combinations of teeth.

4 factors

Neuromuscular control Anteroposterior jaw relationship Mediolateral jaw relationship Esthetics

Neuromuscular control

During the registering and transferring of entire jaw 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 however the muscle control of the patient is questioned and the dentist experience great difficulty in registering transferring and verifying the several jaw registration records, then molds with precise interdigitation would not be indicated.

Anteroposterior jaw relationships

Anatomic and semianatomic teeth are designed to interdigitate in the normal class I skeletal and molar relationship. As long as the patient presents clinically with an anteroposterior jaw relation position that is a skeletal class I, the cusp teeth may be arranged and adjusted to provide the balanced occlusal concept. Skeletal class II patients may position the mandible in several anteroposterior jaw positions . Even though the recording and transfer of the retruded centric jaw 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 deflective occlusal contacts as he or she moves to one of the anterior position.

Midiolateral jaw relationships

The patient with a skeletal class III jaw relations will present similar problems in tooth selection and arrangement as those observed with class II skeletal relationship. Any attempt to arrange Anatomic and Semianatomic teeth with a different mediolateral contacts other than class I relation will usually cause multiple deflective occlusal contacts.

Esthetics: The cusp is a part that contributes to naturalness,

especially the buccal cusp. The buccal corridor, the region from the maxillary premolars posteriorly enhances a patients smile. A tooth mold with a buccal cusp form surely offers the greatest potential for a pleasing natural appearance.

Lingualized occlusion
Lingualized occlusion can be used in most denture combinations. It is particularly helpful when the patient places high priority on esthetics but nonanatomic occlusal scheme is indicated by oral conditions such as severe alveolar resorption, a Class II jaw relationship, or displaceable supporting tissue. If the nonanatomic occlusal scheme is used, esthetics in the premolar region are compromised.

With lingualized occlusion, the esthetic result is greatly improved while still maintaining the advantages of a nonanatomic system

The selection includes

Shade Size Number Form

Buccolingual width Mesiodistal length Vertical length

Shade:

It should harmonize with the shade of the anterior teeth Bulk influences the shade of the teeth and for this reason it is advisable 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.
Size and number of posterior teeth :

The size and number of posterior teeth are closely related to usage. These characteristics are dictated by the anatomy of the surrounding oral environment 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.

Buccolingual width of posterior teeth

The buccolingual width of artificial teeth should be greatly reduced from the width of natural teeth they replace. Artificial posterior teeth that are narrow in buccolingual direction enhance the development 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 the tongue to maintain the dentures in position on their residual ridges. Narrow occlusal surfaces with proper escapeways for food also reduce the amount of stress applied on food during mastication to the supporting tissues of the basal seat. On the other hand, the posterior teeth should have sufficient width to act as table upon which to hold food during trituration.

Mesiodistal width of posterior teeth

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. After the six mandibular anterior teeth have 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 level and in resorbed ridges the point where retromolar pad turns upward

Vertical length of buccal surfaces of posterior teeth

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 have the proper esthetic effect.

Type of posterior teeth according to materials Most artificial teeth are made of acrylic, porcelain or a combination of acrylic resin and metal occlusal surfaces. porcelain teeth are more resistant to abrasion and therefore maintain their luster longer than acrylic resin teeth. Acrylic resin teeth can be altered and will bond with the denture base for retention in instances of limited inter arch space. Acrylic resin teeth are preferred when the teeth in the opposing arch have been restored with gold, as the porcelain has a higher coefficient of wear than gold. Acrylic posterior teeth should never 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 excessive forces from opposing tooth contact will eventually be developed in the anterior part of residual alveolar ridges.

Review of literature

ByronE.Kern (1967) Anthropometric parameters of tooth selection He studied over 6000 skulls and documented over 509 of them, of which he selected skulls had full complement of teeth and were ages of 22 to 46 . His analysis were on bizygomatic width,skull length,bigonial width, internasal width, cranium circumference to that to the incisors width. Significant results were found in comparison between nasal width of the skulls and cranium cicumference to that to widths of maxillary central incisors width.

Mavroskoufis (1980)- The face form as a guide for selection of maxillary cetrl incisors. His investigations were on 70 subjects, standardised photography of full face and intra oral view of central incisors are recorded . Then slides created were projected to measure apparent and actual face form to that to incisors. The results showed no relation between the face form and maxillary central incisors form and its selection, instead dissimilarity of face form and tooth form were detected.

Fabiana Mansur Varjao (2005): Intercommissural width as a guide for selection of maxillary anterior teeth. cast were made from 160 subjects from 4 different racial groups , location of intercommisural width land marks were made on the subjects and transffered to the cast .the distance between the corners of the mouth and the distal of the canines were measured on the cast and compared. The result showed a weak correlation between them and the author concluded that the use of corner of mouth for selection of artificial teeth as inaccurate.

Fabiana Mansur Varjao(2006):Nasal width as a guide in selecting maxillary anterior teeth. the author studied in 160 subjects in 4 different races, using a sliding caliper the nasal width and the intercanine distance was measured. A selection error in clinical application due to this method was given as 0-2mm , 2-4mm, greater than 4mm. The author concluded that intercanine distance and nasal width comparison was not accurate.

Conclusion
There are two worlds , the world we can measure with line and rule, and the world that we feel with our heart and imagination. Teeth selection is an important part of denture fabrication, although various techniques is advised ,it is necessary to develop a esthetic sense by the observer so as the artificial teeth will nearly look like a natural dentition (living thing) rather than artifacts that are poor replicas of what has been lost.

References
Frush and Fisher : How Dentogenic restorations interpret the sex
factor, J. Prosthet. Dent. 1956;6 :160-172

Frush and Fisher : How Dentogenic restorations interpret the

Personality factor, J. Prosthet. Dent. 1956;6 :441-449 Frush and Fisher :The Age factor in Dentogenics, J. Prosthet. Dent. 1957;7 :441-449

Frush and Fisher: The Dynesthetic interpretation of dentogenic concept, J Prosthet Dent : 1958;8;558 Richard E. Lombardi : The principles of visual perception and their clinical application to denture esthetics, J Prosthet Dent : 1973;29;324 Byron E.Kern : Anthropometric parameters of tooth selection, J Prosthet dent :1967 : 17 :431

Mavroskoufis F. : The face form as a guide for the selection of maxillary central incisors. J Prosthet Dent ; 1980 ;43;501 Zarb - Bolender : Prosthodontic treatment for edentulous patients. Twelfth edition, 2004 Fabiana Mansur Vajrao : Intercommisural width in 4 racial groups

as a guide for selection of maxillary anterior teeth in complete dentures ; Int J Prosthdon ;2005;18;513

Fabiana Mansur Vajrao: Nasal width as guide in selection of anterior teeth : J Prosthodontics ; 2006 ;15;353
Sheldon Winkler: Essential of complete denture prosthodontics, 2nd Edition