Complete Denture Dent 482.01 and

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Setting Maxillary Anterior Teeth
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When viewed facially, all maxillary anterior
teeth are tilted mesially, with the lateral
incisor inclined the most and raised about 1-2 mm
above the plane. When viewed laterally, the
incisors are depressed at the cervical, with the
lateral incisor being the most depressed, and the
canine being straight with the long axis
perpendicular to the occlusal plane.
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The anterior teeth should not be positioned any
further forward than the depth of the labial
vestibule, determined by a line drawn from the
depth of the vestibule and perpendicular to a
line drawn parallel to the occlusal plane. The
depth of the vestibule is the fulcrum point and
the further forward a tooth extends beyond this
point, the greater are the forces that tend to
dislodge the denture in the posterior.
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The middle of the depth of the vestibule should
be marked on the land areas of the maxillary
mandibular casts. Next, mark the midline of the
patients face by placing a dot on the incisive
papilla and marking this midline on the maxillary
anterior land area, extending down the front of
the cast.
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Mark the midline of the palate on the anterior
wax rim using the middle of the incisive papilla
as a guideline.
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Make a cut with a heated, sharp knife, at the
midline in the anterior wax rim. Cut all the way
to the baseplate. Make a similar cut just distal
to the canine point. Remove this section of wax
completely, then reduce the anterior ridge of the
maxillary baseplate to provide a little extra
space for the tooth, and reduce the tooth on the
root end if necessary to make it fit properly.
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Add melted wax with a hot instrument to the
area where the section was removed. Set the
maxillary central incisor, being careful to not
disturb the midline as recorded by the remaining
section of wax rim. Check its relationship to the
occlusal plane by placing a flat plate on the
occlusal surface of the wax rim.
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The central incisor must contact the flat plate
resting on the occlusal plane.
The rest of the
anterior teeth are set on the left side according
to the curve defined by the plastic ruler. The
only part of the tooth that should contact the
ruler is the facial surface at the labioincisal
line angle of the incisors, as well as the
midbuccal surface of the canine.
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Note that the lateral incisor is set about 1mm
above the occlusal plane.
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The alignment of the teeth is checked with a
flexible ruler to make sure it is correct with
the contour of the wax rim. A section of wax is
removed from the right side of the anterior rim.
The teeth on the right side of the baseplate are
set following the same procedures and guidelines
used for the left side.
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The teeth are checked to make sure they are
still set on the occlusal plane. The alignment of
the teeth is again checked with a flexible ruler
to make sure it is correct with the contour of
the wax rim and the rest of the teeth.
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An anterior view of the maxillary anterior
teeth shows that only the lateral incisors do not
touch the occlusal plane as recorded by
mandibular wax rim. An occlusal view shows that
the proper surfaces of all teeth are in contact
the flexible ruler. With the maxillary anterior
teeth set, the patients midline is recorded and
proper labial support is established. A lateral
view shows the proper angulation and the
horizontal overlap of the teeth in relation to
the mandibular wax rim.
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Note If the patient has an Angles Class II
musculoskeletal relationship (Overjet), they may
want you to set their teeth further back on the
ridge. If you do this, they will ask you to
remove the denture flange, because they feel this
is too thick and pushes the lip out. You cannot
do this because you would decrease the denture
bearing area and lose the vacuum seal you have
under the maxillary denture. If you make the
flange too thin, it will break and the patient
will not want it thickened in the repair. Avoid
this situation by properly educating the patient
on their Class II relationship and its
consequences prior to making the denture.
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The maxillary cast is placed back on the
articulator. A quick look will show that the
maxillary teeth are set on the same plane as the
mandibular occlusion rim. If the maxillary teeth
are not on this same plane, they must be reset.
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Review of steps

1. Mark midline on max. rim.
2. Cut this midline through to the baseplate.
3. Cut a line distal to the canine on one side.
4. Remove this entire section.
5. Set the central incisor, then the lateral, then
   the canine.
6. Check the height with a flat plate.
7. Check the labial position with a flexible ruler.
8. Cut out a section of the wax rim from the midline
   to the distal of the other canine.
9. Repeat steps 4-7 with these teeth.
10. Mark the midline on the mandibular rim using the
    maxillary midline as a reference.

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The End