What are the criteria for selection of posterior teeth?

Similar to the arguments of centric relation vs. 'neuromuscular,' amalgam vs. composite, and metal vs. non-metal restorations in dentistry, there is a debate about fully balanced vs. lingualized occlusal set-ups. Personally, I believe that there are cases that call for either of these posterior occlusal schemes preferentially. However, there are some basic principles of setting posterior denture teeth that need to be considered in nearly every denture case regardless of your favored philosophy.

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Denture teeth can be extremely esthetic.

Just as with anterior denture teeth, many manufacturers make posterior denture teeth with varying characteristics and a variety of moulds usually designed with cusp steepness of 0o, 10o, 20o, 22o, 30o, 33o, or even 40o teeth with huge plunging maxillary lingual cusps!  How in the world can any reasonable dentist make the 'right' choice? Each manufacturer will tell you why their moulds and designs are best and even might cite research to support their decision.

In my opinion, a denture tooth should be durable ' with about a seven-year expectancy of wear since the average denture should be replaced approximately every five to seven years due to bone and tissue changes. They should come in a wide variety of sizes and moulds and should have posterior occlusal table dimensions that are similar to natural teeth. Being available in VITA shades is critical in combination removable/fixed cases. Ideally, they would also have matching posterior and anterior shading (problems with nearly every brand with which I have worked). Lastly, the first bicuspid lingual cusp should transition smoothly to the canine lingual anatomy. Unfortunately, I have not found a denture tooth company that makes a decent first maxillary bicuspid that transitions nicely on the palatal side from canine to posterior teeth ' their palatal cusps are always too prominent.   

Here are some guidelines for selecting and positioning posterior denture teeth that I have found to aid in successful denture therapy:

• For skeletal class I patients with severely resorbed ridges, use 10o teeth over 0o teeth with a flat anterior-posterior and right-left plane extrapolated from the mandibular incisal edges to a bilateral point approximately 2/3 up the retromolar pads.
• Where the edentulous ridges are in crossbite, 0o teeth over 0o teeth work well and are reasonably esthetic. 

Wax-up of severe cross-bite case immediately after try-in. Incisors were reset chairside per patient desires.

• Be willing to mix and match posterior tooth moulds to suit the anatomical needs of the patient for function. For example, it is often necessary to order two separate maxillary cards if there is a unilateral crossbite ' one with cusps and one without. 
• Avoid setting teeth posterior to the upturn of the mandible behind the buccal shelf because dislodging forces will be created in function, and tissue entrapment of the buccal mucosa will likely occur.
• Teeth should always be set over the crest of the ridge ' not out in space somewhere for esthetic benefit ' because anatomy dictates function.  In other words, put denture teeth where the bone says the natural ones would be, even if esthetics are compromised.
• View the maxillary first bicuspid as a transitional tooth in the arch, focusing more on developing a group function guidance scenario off the buccal triangular cusp than on making the lingual cusp occlude. In fact, it may be necessary to flatten or round the lingual cusp for patient comfort and/or speech pattern.
• Carefully consider articulation as well as occlusion. Articulation is how the prosthesis functions during chewing; occlusion is how the teeth come together in a static position, such as during swallowing. Appropriate articulation is the key to successful denture therapy.
• Avoid using cusps any steeper than 22o because complete denture wearers chew horizontally, with only a slight vertical component ' in contrast to the 'warped teardrop' chewing pattern in dentate patients. Steep cusps often create destabilizing interferences during denture articulation.

(Click this link for more dentistry articles by Dr. Kevin Huff.)

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Kevin D. Huff, DDS, Spear Moderator and Contributing Author - www.doctorhuff.net

Tom Selleck Health: A Comprehensive Look at the Iconic Actor's Wellness Journey

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Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye. Follow us on:  Pinterest Introduction Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing . Early Life and Career Childhood and Athletic Beginnings Tom Selleck was born on January 29, , in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle. Transition to Acting Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from to . necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness. Fitness Regimen Workout Routine Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show. Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles. Importance of Flexibility and Mobility In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit

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