The upper posterior setting Before we start setting the upper posterior teeth we should take a look at the

lower posterior (in the sheet that all of you have). Every time you take your articulator should tighten the screws and after every tooth that you set you should make sure that the incisal pin is touching the incisal table because changing it, will change the vertical dimension of the patient. Be careful when set the teeth not to be confused about the left and the right of the patient , so remove the teeth from the box individually in order not to get confused. As you see in the sheet there is a diagram of upper posterior from the buccal , palatal , facial, distal and occlusal. The artificial teeth are set on curves>> the anterioposterior is called curve of spee. In complete denture we call it compensating curve (CC) because it compensates the space between the tooth when the patient moves his/her mouth(mandible) to the right or to the left so this curve maintain the contact between the upper and the lower teeth so instead of having flat contact , we have this compensating curve. The lateral curve that cross the midline we call it the curve of Wilson and both of them are on spee of monson. as you can see we are going to set all the teeth according to reference plane which is a flat plane (occlusal plane) and the tooth that we have are look like normal. So how could I make a curve on them????I have 2 choices >>>one of them is not to take a flat plane as a reference instead we choose a curved one (it's available in some company). The other choice is to choose a flat plane but make a distance between the occlusal plane and the teeth as we go posteriorly so the front teeth are touching it but the back teeth are not and they become higher. we set the teeth in such a way that the buccal cusps are higher than the palatal cusps .if tooth has 4 cusps we don't make them all touching the occlusal plane, we rise the

buccal and make the palatal touching it. Posterior cusp are made higher according to the anterioposterior relationship in order to get a curve. When we rise the buccal cusps that makes us get a curve which is curve of Wilson. Now, let's look at each individual tooth..first the canine it has a distal angulation..then the 1st premolar it has a dotted line which is the palatal cusp(it's raised about 0.5-1mm like the lateral incisor) and it doesn't touch the occlusal plane, but the buccal cusp does. 2nd premolar both cusps touches the occlusal plane, it's straight forward. 1st molar (in the sheet the second draw mesiobuccal and mesiopalatal are wrong , they should disto for both not mesio so correct it) here in 1st molar the curve of spee will start, we have 4 cusps it's similar to the 2nd molar but the distance between the cusps and the occlusal plane is diffrenet. REMEMBER that anterioposterioly we want curve of spee and mesiodistally I want curve of Wilson. in 1st molar the buccal is higher than the mesial so to get curve of spee the mesial is touches and the distal is raised{mesiobuccal and mesiopalatal is lower than distobuccal and distopalatal}. to get curve of Wilson the lingual will touch and the buccal won't. How do I combine between curve of spee and curve of Wilson????? we know that the mesial is lower..and in the buccal side the lingual is lower.so the cusp that will be closer to the plane is the mesiopalatal cusp(that's mean that it'll touch the plane and it's the most prominent cusp) & the distobuccal cusp will be the highest one(it's above the occlusal plane in about 1 mm), the remaining 2 cusps are in the halfway between those 2 and they 're raised by 0.5 mm from the occlusal plane. 2nd molar is identical to the sixth but the measurements are notthe mesiolingual will be raised by 1mm , the distobuccal 2mm ,the distolingual and mesiobuccal 1.5 mm in order to continue the curve of spee and the curve of Wilson. A quick review >>>>

Which incisal edges or cusps in the upper teeth touch the occlusal plane???? Centrals, canine, buccal cusp of 1st premolar , both cusps of 2nd premolar ,mesiopalatal cusp of 1st molar touch the occlusal plane. lateral , palatal cusps of 1st premolar , the remaining cusps of 1st molar don't touch. ***then we look mesiodistaly at : 1st premolar and 2nd premolar they should be upright. 1st molar has a distal angulation with a neck mesialy . 2nd molar upright and the neck mesialy. ***buccolinguly: 1st premolar and 2nd premolar is upright . 1st & 2nd molar the neck is depressed and buccally inclined . ***the relationship with occlusal plane : upper 4 the buccal touches ,the palatal doesn't. upper 5 both cusps touch, upper 6 only the mesiolingual cusp touch , upper 7 the same as the 6th but we increase the measurement by 1mm . how the tooth set on the curve of occlusion ??? you can see that we have a gentle curve in the anterior teeth , but the posterior teeth are almost in a straight lineto make it easier to set we have some guidelines..you can see that the curve in the posterior teeth is more easier than in the anterior teeth and the canine is like the corner of the mouth. After the canine the angle suddenly goes almost straight back. now from the canine to the canine we have one curve(curved line) , from the canine to the 1st molar another curve(straight line) and from the 1st molar to the 2nd molar another small curve(a bit curved line). What decide how to set the teeth???? remember when we said that we set everything according to the weakest area>>>the weakest part in the posterior occlusion in terms of support and retention are the lower posterior. upper posterior are set buccal to the residual ridge(in about 1-2

mm)to reproduce the normal position of the teeth "because of the direction of bone resorption from outside to inside >> inward resorption ". So the central fossa of the posterior teeth should outside(buccal) the crest of the residual ridge of the upper jaw. in the lower posterior they are set lingual to the residual ridge. and we said also that the mandible is resorbed faster than the maxilla , unstable( mobile more than the maxilla) , and has lower surface area than the maxilla. So instead of putting the artificial teeth in the position of the original teeth ,we set the teeth directly over the crest of the ridge for functional support >>so the cusps of the lower posterior teeth should be directly over the centre of ridge not buccal and not lingual. Q : How can I make sure that the central fossa of the lower posterior teeth will be on the crest of the ridge???? A: the lingual cusps of the upper must be set on the central fossa of the lower and since we set the upper posterior first , I should mark the position of the fossa on the lower rim. so I draw a line from the canine along to the halfway of retromolarpad area and continue the line to the land area( by using a ruler). and now using this line I can set upper posterior teeth with palatal cusps touching this line{the line we draw in the lower rim} , so when we set the lower posterior teeth they should be opposing the upper palatal. >>>in the diagram "in the sheet" you can see which cusps are functional???upper palatal , lower buccal. The upper palatal cusps are on the central fossa of the lower posterior teeth in order to center the lower denture on its place. We will go back to the relationship according to the curve of occlusion: The central fossa of the 1st and 2nd premolar and the mesial triangular fossa of the 1st molar are on one line. posterioly we have a second line from the distal part of the central fossa of the 1st molar through the central fossa of the 2nd molar. so again we have an anterior curve , another curve from 4 , 5 , mesial 6 , and a third curve distal 6 &7.

to make all these curves at the same level >> we look at the external surface of the teeth. >>if the central fossa are lined > the facial surface of the canine , the facial surface of the 1st premolar , the facial surface of the 2nd premolar , and the mesiobuccal of the 1st molar will be on one line>> we can't do that with the lacron carver or the wax knife , and what I do that I put a straight edge here because I want the buccal cusp tip of 4 &5 and mesiobuccal of 1st molar on the same edge. you will notice that the 2nd molar is more inside or more palatal. Now the distobuccal of 6 , mesiobuccal of 7 and distobuccal of 7. it's necessary to have the 1st premolar doesn't stick out(not protruded) in relation to the canine. as all of us know that we didn't see the posterior teeth when we smile because they are only made the buccal corridor we barely see the 6th tooth. >>>>>so in setting the teeth we have many things that we should connect them together: *mesiodistal angulation *buccolingual angulation *the relationship of the tooth to the occlusal plane. *we have to set the posterior teeth in 2 lines{we talked about them above} . *the palatal cusp of the posterior teeth should be on the central fossa of the lower residual ridge. EACH SETTING AFFECT THE NEXT PART >>> upper anterior affect upper posterior & lower anterior, so if you set the upper anterior correctly the upper posterior and the lower anterior will be correct. So be careful when setting the upper anterior teeth and upper posterior Done by : Raneem Rashdan