Reconstruction of coronal anatomy in ceramic

restorations of the anterior teeth

Yoshimi Nishimura*

Very tooth in a natural dentition has its own

natomy, which, at first glance, seems to have
lO connection with that of the other teeth,
"he reality is that although every tooth is speifically designed for a certain job at a certain
tte in the mouth, it also fits in harmoniously
/ith the dentition as a whole. This is because
iie design of each row of teeth follows a speific set of norms and rules that takes into acuunt each tooth's individual anatomy. Prosleses can likewise be fabricated to blend in
armoniously with existing dentition by foliwing these same guidelines.
Key elements when fabricating the restoraon of an anterior crown are design and tooth
antour. It is critical to take note of the relaonship between the expanse and direction of
le ridges and grooves and to consider the antomic variations of the teeth that will be adicent to the restoration.
In this article, the anatomic variations of the
iterior teeth (central incisor, lateral incisor,
mine), which are vital for esthetic considera3ns, are examined from the point of view of
le dental technician.

11-607, M2JD, Ibargi-stii, Osaka 567, apar.

Anterior Teeth Viewed From the

Labial Aspect
When examining the individual teeth in the
anterior region, the external anatomy of the
teeth can be divided roughly into five areas
(Figs 1 and 2):
The
The
The
The
The

incisai edge
mesioincisal and distoincisal angles
contact areas
contour line
cervical line

The Incisai Edge

The incisai edge is the straightcst in the central incisor, because its mesial, central, and distal ridges all lie on almost the same level.
Pronounced tapering begins and progresses in
the lateral incisors and the canines as the distal and mesial ridges of the incisai edge appear
in increasingly lower positions in these teeth,
and a clearly distinguishable arrow-head
shape results (Figs 2 and 3).
Compared to the central incisor, the position
of the highest incisai elevation moves increasingly toward the mesial part of the tooth in
the lateral incisor and canine. The horizontal
distance between the transition from the mesQDT 1994 67

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Fig 1 Anterior teeth: {a) labial view, {b) incisai view, (L) palatal view, (li) cervical view.

contact surface
incisai edge
angular region
proximal
contour line
cuniatute of

the cervical line

Fig 2 Variations in anatomy of central incisor, lateral incisor, and canine. Note differences in incisai
edge, angular region, contact surface, cervical tapering, and cervical line.
Fig 3 Tapering of indsal shape
and enlargement of angular region.

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Fig 4 Contact surfaces; note shift in position

from incisai area to middle of crown. Surfaces
decrease in size so that a > b > c .

iolabial ridge to the incisai edge and between

the transition from the distolabial ridge to the
incisai edge is longest in the central incisor
and becomes progressively shorter in the lateral incisor and the canine. This is because the
ratio of the mesial and distal thicknesses to
the palatal and vestibular thicknesses grows,
leading to an increasingly tapered and
rounded shape.
Mesioincisal and Distoincisal

Angles

The angular region grows progressively larger

from the central incisor to the canine, assumes
an increasingly rounder form proximally, and
increasingly tapers incisally (Figs 2 and 3). The
mesial angle in all teeth is smaller and sharper
than the distal angle, while the distal angle is
characteristically rounder and larger, in addition, the angles become absolutely rounder
and larger as one moves from the mesial angle
jf the anterior incisor to distal angle of the caline. The mesial angle of the central incisor is
sharpest and smallest, the distal angle of the
rentrai incisor is slightly rounder and larger,
md the mesial angle of the lateral incisor is
?ven rounder and larger; this pattern continles to the canines.
"Contact Areas
^he contact areas in the central incisor lie
nesially near the incisai edge and shift inreasingly to the middle of the crown in the

lateral incisor and canine. The shape of these

areas, which is initially elongated, gradually
shortens, following the same progression (Figs
2 and 4).
Contour Lines
The labial silhouettes of the teeth show an increasing cervical taper in the same pattern, becoming sharper from the central incisor to the
lateral incisor and then to the canine. In addition, the mesial and distal sides of the teeth
become increasingly asymmetric; specifically,
the labial concave contour becomes lower and
deeper distally. The resultant shape is doubly
curved (Fig 2).
Curvature of the Cervical Line
The cervical line is almost horizontal in the
central incisor and gradually arches downward
in the lateral incisor and canine.
The incisai embrasure exhibits a very sharp
angle in the center of the row of anterior teeth
and is smallest there. The angle becomes
larger distally, both incisovertically and mesiodistally. The incisai embrasure between the canine and first premolar is the largest and
roundest. This is caused by the tapering of the
teeth, by the difference in angle characteristics, and by the transposition of the contact
surface cervically. The cervical embrasure between these teeth is large incisocervically and
narrow mesiodistally. Laterally, the embrasure
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Nishlmura Reconstruction of coronal anatomy in ceramic restorations of the anterior teeth

labial surface
transition surface
prxima i surface

Fig 5 Tootb outhne viewed from the incisai aspect. Compare labial, labioproximal transition, proximal,
palatoproximal transition, and palatal surfaces.

Fig 6 Progression of width:

strength ratio (ratio between the
mesiodistal and labiopalatai extensions of tooth); compared ivith
the central incisor, the labiopalatai
extension (thickness) increases
and the mesiodistal extension
(width) decreases in the lateral incisor and canine.

becomes smaller incisovertically and widens

mesiodistally. This is caused by the displacement of the contact zone to the middle of the
crown and by the increasing cervical tapering.

Incisai View of the Contour Lines

When the teeth are examined from the incisai
aspect (Fig 5), a change in the ratio between
the mesiodistal width and the labiopalatai
thickness is apparent; from the centra! incisor
to the canine, the labiopalatal thickness increases as the mesiodistal width decreases proportionately (Fig 6),

ally becomes more clearly curved labially than

does that of the central incisor. At the same
time, the curvature becomes less pronounced
(Fig 7) because of the curve characteristic and
the tooth anatomy, which is similar in the adjacent zones surrounding the contact surfaces.
The degree of tapering is slight and the palatal surface broad in the central incisor, so that
the tooth's cross section is asymmetric labiopalatally. This cross section becomes increasingly symmetric in the lateral incisor and
canine (Fig 8a). Conversely, the central incisor
is more symmetric mesially and distally, and
the other anterior teeth become increasingly
asymmetric in this aspect as the twisting of
the teeth becomes visible (Fig 8b).

The Labial External Anatomy

As a result of the changed ratio of width to
thickness and the differing shapes of the mesial, central, and distal labial ridges, the labial
outline of the lateral incisor and canine gradu70

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Lnterdental Embrasures
In addition to the anatomy of the anterior
teeth, the spaces created by this anatomy,
known as interdental embrasures, are also im-

CERAMIC RESTORATIONS

Fig 7 Progression of the curvature characteristic; compared with the central incisor, the curvature increases in the lateral incisor and canine.

Figs 8a and 8b (Left) Incisai view of central incisor, lateral incisor, and canine; labial and palatal surfaces become increasingly symmetric. (Right) Mesiodistal view of central incisor, lateral indsor, and canine; labial and palatal surfaces
become increasingly asymmetric.
Fig 9 Upper and lower interdental embrasures; angles of upper spaces enlarge so that
A<B<C, angles of lower spaces decrease so
that a < b < c . Angles change as a result of cervical tapering and angle characteristics.

Fig 10 Incisai view of embrasures; labial embrasures grow larger so that A<B<C, and the
palatal embrasures grow larger so that c < b < a .

portant (Fig 9). These spaces have clearly definable angle characteristics both incisally
above the contact zones and cervically.
Viewed incisally, the angles of the embrasures formed by the labial proximal and contact surfaces become more and more obtuse

from the central incisor to the canine because

of the curvature of the dental arch, and the
angles of the embrasures formed by the palatal transitional and contact surfaces, on the
other hand, become more acute in the same
progression (Fig 10).
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Fig 11 Proximal view of anatomic variations'

angles formed hy the labial and palatal surfaces
of the incisai region grow larger so that
C < B < A . Location of the maximum curvature
is displaced incisally on both the labial and palatal sides in the lateral incisor and canine when
compared to the central incisor.

Coronal Anatomy Viewed From the

Proximal Aspect
When examined from the proximal aspect, the
crown exhibits a three-part structure consisting of the incisai, middle, and cervical regions
(Figs 11 and 12).

The Survey Line

The boundary between the middle and cervical regions of the teeth is called the survey
line, and its position changes significantly
among the anterior teeth. The survey line
shifts in an incisai direction labially and palatally from the central incisor to the canine, and
the external shape of the tooth, with the survey line as its vertex, expands following the
same progression.
The difference in development of the ridges
mesially and distally increases in the same
way, resulting in a similar increase in the
mesial slope of the survey line in these teeth.
Therefore, the difference in position of the
survey line distally and mesially increases in
the lateral incisor and canine when compared
to that in the central incisor.
Fig 12 Proximal view showing progression
of three-surface form; (D) distal surface, (M)
mesial surface.

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I A /

-,~->H~^^

L\

ig 13 Cervical view of anatomic variations in the

icisal region; the incisai edge is smooth in the central
idsor, the mesial and distal sides slope down, and the
liddle part of the crown becomes increasingly promient in the lateral incisor and canine.

Fig 14 Cervical view of embrasures; their size increases

so that A<B<C.

rhe Angle Formed by the Labial and

Mlatal Surfaces

rounded and without a great deal of slope in

the mesial and distal parts. The angles become
sharper and the slopes greater in the lateral
indsor and canine.

Accompanying the change in the widthhickness ratio and the position of the survey
ine, the incisai angle formed by the labial and
jalatal surfaces becomes more obtuse. The polition of the indsal edge (the tip of the tooth)
gradually shifts in a labial direction palatally
rom the central incisor through the canine.
rhe Outline of the Labial Surface
\s a result of the changes in the incisai angle
md the position of the survey line, the outline
)f the labial surface, which is still relatively
lat in the central incisor, becomes more and
nore convex in the lateral indsor and canine.
Jimultaneously, the cervical region becomes
iroportionately larger and the midpoint moves
ncisally, as a result of which the size of the
tidsal region becomes proportionally smaller.
The angle formed through the middle and
ncisal regions, whose vertex is created by the
urvey line, becomes sharper from the central
ndsor to the canine because the survey line
dens labialiy and palatally, and the vertex
ies deeper in the body of the tooth. In the
entrai incisor, both the angle between the cerical and middle regions and the angle beween the middle and indsal regions are

Coronal Anatomy Viewed From the

Cervical Aspect
The Shape of the Incisal Edges
From the cervical aspect, the incisal edge of
the central incisor approximates a straight line
(Fig 13). In the lateral incisor and canine, the
middle of the labial surface increasingly projects incisally toward the proximal surface (Fig
14). The incisal region of tbe central indsor is
concave because of the grooves in the labial
surface. In the lateral incisor and the canine,
the shape of the incisal region decreases as the
grooves of the labial surface disappear, and a
V-shaped groove can be found near the incisal
edge.
The Embrasures
In the incisal region, the embrasures between
the lateral incisor and the canine are larger
than those between the central and lateral incisors (Fig 14),
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Nishimura Reconstruction of coronal anatomy in ceramic restorations of the anterior teeth

Fig 15 Photomontage of the contour image o!

the labial surfaces.

Fig 16 Cervical and labial surface ridges.

Fig 17 Variations in the proximally directi

progression of the labial surface ridges.

The Progression of the Contour

Image of the Labial Surface
The Ridges of the Labial Surface
The mesial, central, and distal ridges in the labial surface of the central incisor are virtually
the same height. In the lateral incisor and canine, the initial positions of the ridges become
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progressively lower both from tooth to tooth

and from ridge to ridge, in the sequence central, mesial, distal (Fig 15). In the labial surface
of the central incisor, the three ridges are
about equally thick, but the central ridge becomes increasingly thicker than the other two
in the lateral incisor and canine (Fig 16),
The external cervical taper becomes sharper
from the central incisor to the canine, which
causes the grooves in the labial surface to become more slanted in the same way.

CERAMIC RESTORATIONS

Fig 18 Peaks of the survey line; note incisai

shift in the lateral incisor and canine. Sharp tapering changes the U shape of the line to a V
shape, and the slope increases mesially and
distally.

Fig 19 Grooves of the labial surface and

V-shaped groove. Paralleling the relative decrease in the incisai region in the lateral incisor
and canine, the grooves in the labial surface become smaller incisaliy. Also, the V-shaped
groove shifts incisaliy because of the incisai displacement of the survey line and the decrease
in size of the incisai region. Compared to the
central incisor, the cervical end of the mesiodistal V-shaped groove in the lateral incisor
and canine exhibits an increasing slope.

The initial positions of the mesial and distal

ridges on the labial surface of the central incisor illustrate the tendency to originate from a
lower position and run to the contact surface
in comparison with the lateral incisor and canine (Fig 17). These ridges in the teeth of
young people are concentrated toward the
middle tip of the incisai edge, that is, toward
the tapering. In addition, the more asymmetric
the tooth is (progressing from the central incisor to the canine), the more the confluence of
ridges moves mesially.
The Survey Eine, V-Shaped Groove, and
Grooves in the Labial Surface
The survey line runs in the direction of the
cervical ridge (Fig 18). In the central incisor, it
is more or less horizontal and located far to
the cervical portion of the tooth. In the lateral
incisor and canine, the survey line is increasingly sloped from the mesial to the distal portion and shifts incisaliy.
The grooves in the labial surface become less

and less visible as a result of the change in

shape of the incisai edges and the increasing
prominence of the cervical ridge (Fig 19).
In the central incisor, the V-shaped grooves
(Fig 19) have mesially and distally similar
shapes and are greatly extended incisaliy. In
the lateral incisor and canine these grooves
become gradually more different. This is because of the development of the three-part
form that accompanies the change in shape of
the incisai edges, the growing prominence of
the cervical ridge, and the change in the survey line.
The initial position of the V-shaped groove
shifts incisaliy in the lateral incisor and canine
because, as a result of the change in the threesided form, the incisai region becomes narrower in these teeth. The end points of the
V-shaped groove change along with the survey line. These points are located at practically
the same height mesially and distally, while in
the canine a steep slope is apparent between
the position of the mesial and distal V-shaped
grooves. Specifically, the end of the mesial
V-shaped groove shifts cervically.

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Nishimura Reconstruction of coronal anatomy in ceramic restorations of the anterior teeth

Fig 20 Compared to the central incisor, the

concave line in the lateral incisor and canine
becomes more clearly visible.

Fig 21 Labial triangular area formed by a line

connecting the ridge positions dlstally and the
concave lines distally. The labial triangular area
narrows distally around the contact surfaces.
Note that the ridges in the labial surface become constricted proximally.

Fig 22 Contour image of the anterior

teeth.

The Concave Line

The Triangular Area of the Labial

Surface

The concave line is more clearly visible in the

lateral incisor and canine than in the central
incisor. It is high and flat mesially and low
and deep distally, and this difference is increased toward the posterior teeth. The twisting of the teeth gradually becomes more
visible because of this configuration (Fig 20).

From the central incisor, the mesial and distal

ridges shift downward and move increasingly
toward the contact surfaces in the central indsor and canine. The triangular area of the labial surface is described by a line connecting
the place where the ridge in the labial surface

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Fig 23 Mesial view of contour image of anterior teeth.

Fig 24 Proximal view of lines of the contact and cervical areas; note progression of positions at which the
ridges in the labial surface cross. Contact areas shift to
the middle of the crown, and the cervical areas that
stand out maximally on the proximal surface become
lower from A to B to C and produce a flatter line.

bends toward the contact surface and a line

connecting the posterior distal concave line,
with the contact surface as its center. This area
becomes increasingly smaller in the lateral incisor and canine (Fig 21 and 22).

The Grooves in the Proximal Surface

The Contour Image of the Proximal

Surface

The external shape of the proximal surface in

the lateral incisor and canine develops an increasingly rounded shape compared to that in
the central incisor. Also, the width-thickness
ratio changes as mentioned above. For this
reason, the groove in the proximal surface becomes steadily broader and flatter posteriorly,
until it is nearly invisible in the canine.

The Contact Surface

Compared to the central incisor, the extension
of the contact surfaces becomes smaller vertically in the lateral incisor and canine because
the contact area shifts to the center and simultaneously becomes larger labiopalatally as a
result of the change in the width-thickness
ratio described above (Fig 23).
The Cervical Line
From the central incisor, the cervical line runs
progressively more horizontally in the lateral
incisor and canine, because the ratio of the extension labiopalatally to the extension mesiodistally (width-thickness ratio) becomes larger
(Fig 24).

The Ridges in the Labial and Palatal

Surfaces
When examining the slope between the position of the central ridge and the position at
which the ridge of the labial and palatal surfaces meet, it appears that this slope becomes
progressively greater in the lateral incisor and
canine as compared to that in the central incisor (Figs 25a and 25b). This is true mesially as
well as distally, but is especially pronounced
distally.
From the proximal aspect, the ridges in the
labial surface mesially, centrally, and distally
are almost in the same position. From the central incisor to the canine, the central ridge in
the labial surface protrudes more labially, and
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Fig 25a Proximal view of incisal edge, cervical

line, and tubercle; the slope of incisal edge increases in the lateral incisor and canine as the
cervical line and tubercle shift to the middle ol
the tooth.

Fig 25b Compared to the central incisor, the

distance between the point of taper and the intersection of the grooves in the labial surface o
the lateral incisor and canine progressively
increases.

Fig 26 Palatal view of contour image of anterior teeth.

Fig 27 Palatal view of variations in the mesial and distal ric

of tbe anterior teeth.

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Fig 28 Palatal view of incisal edges; note gradual assumption of a shape approximating outspread wings whose angles become more obtuse
in the sequence A < B < C .

CERAMIC RESTORATIONS

oped central and secondary ridges. The central

and secondary ridges become increasingly better developed and more cleariy visible in the
lateral incisor and canine (Figs 26 and 27). The
origination of the incisai ridge shifts distally
from the center in the central incisor to an increasingly downward position in the lateral incisor and canine. The ridge also takes on the
shape of a pair of wings spreading out distally
from the mesial region. Further, embracing the
secondary ridge of the palatal surface, the
ridge becomes constricted proximally (Fig 28).
Fig 29 Palatal view of incisai region and tuhercle; the
incisai region becomes smaller posteriorly, and the tubercle expands upward.

The Cervical Region

the mesial and distal ridges increasingly become constricted inward as the central ridge
develops better labially in the lateral incisor
and canine. As a result, more and more of the
lahial surface becomes visible when the teeth
are examined from the direction of the mesial
or distal contact surface.
The configuration of the ridges in the palatal
surface appears similar. While in the centia!
incisor the middle of the palatal surface shows
a concave shape and the mesial as well as the
distal incisai ridges protrude palatally, the central ridge steadily protrudes more palatally in
the lateral incisor and canine, and the mesial
and distal incisai ridges retrude in the same
progression. In addition, the tubercle expands
palatally, and the secondary ridge becomes
clearly visible. For this reason, more of the
palatal surface becomes visible in the lateral
incisor and canine.

The cervical region is shaped in such a way

that, with the concave line as a boundary, it
expands upward labially (Fig 29).

The V-Shaped Groove

As is the case with the labial surface, a
V-shaped groove forms between the central
groove of the palatal surface and the incisai
groove. This V-shaped groove shifts incisally
from the centra! incisor to the canine, and, as
a result of the change in the tubercle, the terminal point of the groove also shifts upward.
In addition, the shape and depth of the groove
become increasingly visible because of the development of the central ridge in the palatal
surface and the secondary groove (Figs 26 and
29).

The Incisal Ridge and the Concave Line

The Contour Image of the Palatal

Surface
The Incisai Ridge
An examination of the outline of the palatal
surface shows that the central incisor has a
well-developed indsal ridge and poorly devel-

When the anterior teeth are examined from

the palatal aspect, it appears that the distance
between the line connecting the initial positions of the respective incisal ridges with each
other and the line connecting the respective
concavities with each other decreases in the
same manner as the labial surface (Fig 30).
The area that is created inside this pair of lines
is called the palatal triangular area.
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Fig 30 Palatal triangular area in the anterior

teeth, which is formed by a line connecting the
place where the incisai ridges become constricted proximally and a line connecting the
distal concavities. This area narrows in the lateral incisor and canine.

Fig 31 Incisai view of contour image of anterior teeth.

Fig 32 Incisai view of progressive anatomic variation ol

mesial, central, and distal ridges in the labial and palatal
surfaces.

The Contour Image Viewed From

the Incisai Aspect

lateral incisor and canine than in the central

incisor.
Compared to those in the central incisor, the
mesial and distal ridges in the labial surface
increasingly exhibit a shape that enfolds the
secondary ridge and bends off proximally in
the lateral incisor and canine (Fig 32).

The Ridges of the Labial Palatal Surfaces

When the outlines of the anterior teeth are examined from the incisai aspect, either the
mesial and distal ridges in the labial surface
appear to be protruding outward, or all three
ridges appear to be approximately the same
(Fig 31). This is because the mesial and distal
ridges in the lahial surface of the central incisor are strongly developed and the central
ridge is weakly developed.
The central ridges in both the labial and palatal surfaces are increasingly strongly developed and stand out more distinctively in the
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The Concave Line

The concave line in the cervical area assumes
an increasingly gentle curve toward the center
and becomes narrower and more clearly recognizable as a groove posteriorly in the anterior teeth further from the midline. Also, the
distal concave line is located deeper and farther down than the mesial one in the same
pattern.

CERAMIC RESTORATIONS

Fig 33 Labiocervical view of contour image of

anterior teeth.

Fig 34 Labiocervical view of labial surface

ridges; note area between the cervical and
inrisal regions becomes thicker in the lateral indsor and canine.

Fig 35 Labial view of contours of the incisai

edges cf anterior teeth viewed from the labial
aspect; note external shape of the incisai edges,
V-shaped groove, and groove in the labial
surface.

The Contour Image Viewed From

the Cervical Aspect

the outside, and the mesial and distal ridges

widen incisally (Fig 34).

The Ridges in the Labial Surface

The Cervical Ridge

When examining the central incisor from the

cervical aspect, the cenhral, mesial, and distal
ridges stand out about equally strongly, and
the mesial and distal ridges are parallel (Fig
33). In the lateral incisor and canine, on the
other hand, ihe mesial and distal ridges in the
labial surface bend to the outside and widen
proximally. As a result, the central ridge in the
labial surface exhibits a shape that projects to

Compared to its position in the central incisor,

the cervical ridge develops incisally in the lateral incisor and canine. For this reason, the
incisai region becomes proportionately smaller,
and the grooves in the labial surface and the
V-shaped groove in the central incisor become
less visible in the lateral incisor and canine.
Also, the V-shaped groove shifts incisally, resuiting in an incisai contour (Fig 35).
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The Three-Dimensional Nature of

Crown Anatomy
Relationship of the Developmental
Angles and Cuspation of the Incisai Edge
There is greater variation in the anatomy of
maxillary teeth than in those in the mandible,
as is shown by the larger variations in the
incisai embrasures of the maxillary dentition
(Fig 36). The reasons for these greater variations include the wider differences in the
thickness of the teeth and the developmental
angles formed by the mesial, central, and distal ridges of the labial and lingual surfaces.
The greater the difference in the developmental angle when viewed in cross section

Fig 36 Intraoral view of maxilia and mandible

in a young person. Note iarge variations in the
incisai anatomy and embrasures in o the maxillary dentition as compared with that of the
mandible.

nm

Figs 37a to 37j Labial, linguai, mesial, distal, and incisai views of natural mandibular central incisor {a,b,c,d,e) ar
natural maxillary canine {f,g,h,i,j). Note the small differences in the developmental angles in the mandibular central incisor when the mesial, central, and distal ridges of the labial and lingual surfaces are viewed from the proximal direction. In contrast, there are large differences in the developmental angles of the maxillary canine, These differences
affect the irtercuspation of the teeth.

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Fig 38 Illustration of process by which an increase in developmental angles causes cusp formation to become more pronounced. Note
how, as the angle between the compass legs
grows, the top of the compass is lowered.

mesially, centrally, and distally, the stronger

the cusp formation. This is true in both maxillary and mandibular teeth. The smallest differences in the developmental angles are
found in the mandibular central incisors, so
that the incisal edges of these teeth appear to
be in a straight line. The extent of cusp formation increases in the lateral incisor and canine,
and the teeth gradually take on an arrow-head
shape. The differences in developmental angles are much larger in the maxillary canines,
where cusp formation is stronger (Fig 37).
To illustrate this principle, consider the compass shown in Fig 38. As the angle formed by
opening both compass legs equally increases,
the height of the compass decreases. Likewise,
the cusp formation in the anterior teeth depends on the size of the developmental angle
(Figs 39a to 39c). The developmental angles
are smallest in the central incisor, which also
has the least conspicuous cusp formation. The
lateral incisor and canine, with larger developmental angles, have increasingly noticeable
cusp formation. The outline of the incisal edge
of the teeth also changes with the variation in
the developmental angles.
Differences in the formation of the mesial,
central, and distal surfaces of the tooth become more pronounced in teeth further away
from the midline. As a result, the pattern of
movement for the abrasives used during actual
anatomic modifications is such that it does not
impart much difference in the central incisor.
When working with the lateral incisor and canine, it is therefore better to impart this difference in the preparation of the three surfaces.

Ten Check Points for Integrating the

Anatomic Variations of the Anterior
Teeth
The pattern of anatomic changes in the anterior teeth, gradually changing from the central
incisor to the lateral incisor to the canine,
should be apparent. An understanding of this
pattern allows one to carry out anatomic modifications on particular points on the central
incisor so that it will blend in with the other
anterior teeth. This tooth is the key to a harmonious restoration.
There are, in fact, 10 such check points, six
on the labial surfaces and four on the lingual
surfaces (Figs 40a to 40f). Points 1 through 4
and 7 through 10 in Figs 40a to 40f mark
where carving of the cuspation of the incisal
edge occurs when teeth are viewed labialiy.
Points 1 through 4 show the anatomic variations of the incisal edge outline viewed from
the cervical direction, while points 5 and 6 illustrate the constriction and torsion visible in
the cervical outline when viewed incisally.

Essentials of Carving
Points 1 through 4 mark the positions of the
V-shaped grooves on the labial surface of the
tooth, and points 5 and 6 correspond to the
mesial and distal concave lines (Fig 40a). On
the central incisor, points 1 through 4 should
be carved to follow the prescribed form. For
QDT 1994

83

Nishimura Reconstruction of coronal anatomy in ceramic restorations of the anterior teeth

Figs 39a lo 39c Diagrams of maxillary central incisor (top), lateral incisor (middle), and canine (bottom). Diagrams on left show the locations of the vertical sections through the lahial surface of each tooth: A = mesial
region; B = central region; C = distal region. Also shown are the cross sections of each of these regions
viewed from the proximal direction. Diagrams on right show the relationship of the cusp formation of the
tooth and the developmental angle of the ridge in the labiolingual section. The triangle formed hy the inclined surfaces shows the inclination of the ridges on the labial and lingual suifaces. The horizontal line connects the highest points (central mamelon or cusp) of the incisal edge of each tooth. The greater the space
between this line and the peak of the triangle in the mesial and distal regions, the greater the cusp formation. Note also the distance between the upper line and the triangle (developmental angle) formed by the respective labial and lingual surface ridges of each tooth. For the central incisor there is virtually no difference
between the developmental angles in the central, mesial, and distal regions, and the space between this line
and the peak of the triangle is small. However, in the lateral incisor and canine the difference in the developmental angles becomes larger, and the space between the upper line and the triangle peaks also becomes
greater. As the difference in the developmental angles increases, there is a stronger tendency for cuspation.

the lateral incisor and canine, these points

should be carved so that they fan out mesially
and distally, so that they greatly lower the
incisal edge mesially and lingually while curv84

QDT 1994

ing around in the proximal direction. Points 1

through 4 should be carved deeper in the anterior teeth farther from the midline.
In addition, the terminal position of points 3

CERAMiC RESTORATIONS

igs 40a to 40f The 10 carving points; there are six checkpoints on the labial surface and four on the lingual surface.

-ig 40a Direct view of the labial surface.

Fig 40b Direct view of the lingual surface.

Fig 40c View of the mesial proximal surface.

Fig 40d

le View of the incisai edge.

and 4, and 1 and 2 cervically, should be

carved more sharply. Points 1 and 4 should be
carved to define the line of the labial triangle
area toward the incisai edge. This allows for a
smooth transition, from the mesial to the distal sections, in the lahial surface ridges of the
central incisor, lateral incisor, and canine. Har-

View of the distal proximal surface.

Fig 40f View from the cervical direction.

mony is preserved in variations of the labial

outline of each tooth, and a smooth anatomic
transition is created in the associated teeth.
The vertical separation between points 5 and
6 becomes more pronounced and the area
around point 6 becomes more clearly defined
in the teeth further away from the midline.
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Nishimura Reconstruction of coronal anatomy in ceramic restorations of the anterior teeth

The degree of constriction in the cervical region and the torsion on the mesial and distal
regions are expressed by incorporating points
5 and 6. To express asymmetry and torsion in
crown anatomy, more emphasis is placed on
carving points 3 through 5 in teeth further
from the midline.
Points 7 through 10 show the position of the
V-shaped grooves on the lingual surfaces of
the teeth (Fig 40b), They are all about the
same level incisally on the central incisor. In
the teeth further from the midline these points
are carved more strongly and cut to curve
more significantly proximally. This creates a
greater slope cervically in the lateral incisor
and canine. In addition, the difference in the
developmental angles, which are formed by
the mesial, central, and distal labial surface
ridges defined by points 1, 2, 3, 4 and 7, 8, 9,
10, becomes larger in these same teeth. Concurrently, cuspation arises in the incisai anatomy and a slight unevenness appears in the
incisai edge.
In the lateral incisor and canine, points 1, 7,
4, and 10, in this order, are carved deeper in
the labiolingual direction (Figs 40c and 40d).
When this is done, the difference in the developmental angle as defined by the central labial and lingual ridges becomes greater, and
the distance between the intersection of points
1 and 7 and 4 and 10 with the central tubercle
becomes greater. A line separating points 1
and 7, 2 and 8, 3 and 9, and 4 and 10 crosses
the tooth in the incisai region (Fig 40e).
Points 5 and 6 are carved primarily to express the constriction in the cervical region,
the torsion of the tooth, and asymmetry between the mesial and distal halves of the
tooth. The carving of point 5 is carried out primarily on the transitional surfaces, proximally,
so as not to section the labial surface ridges. In
contrast, point 6 is carved bolder in teeth further from the midline. This is done not only
on the transitional surfaces, but also on portions of the labial surface proper. Carving in
these areas naturally constricts the proximal
outline and expresses torsion in the tooth. In
addition, the characteristic double curve is expressed in the distal region. By carving points
3 and 4 in the cervical direction in the lateral
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incisor and canines, these points connect with

point 6, the mesial region appears to bulge
out, and the distal region become constricted.
This expresses the asymmetry of the mesial
and distal halves of these teeth.
Figure 40f shows points 1, 2, 3, and 4 from
the cervical direction. In the teeth further from
the midline, points 1 and 4 should be carved
more boldly to curve in sharply in the proximal direction. After reaching the incisai edge,
points 2 and 3 are carved so that the central
ridge projects outward, and the V-shaped
groove seems to appear on the incisai edge. As
mentioned earlier, the V-shaped grooves can
be made to appear toward the incisai edge by
carving points 1 through 4 deeper in the lateral incisor and canine.

The Actual Carving

As an example of the effect these points have
on teeth, they were carved into three identical
casts which were formed by flowing resin intu
an impression of a central incisor (Figs 41a to
43e).
In Figs 41a to 41c, the widthidepth ratio
of the teeth on the right side changes to produce a good balance in the anatomic variations of the teeth adjacent to the central
incisor; the transitional surfaces have also
been correctly incorporated. Comparing these
teeth with those on the left side, it is apparent
that anatomic variations have been achieved
here by solely carving the 10 points similarly
in each central incisor, without taking into account the anatomic variations in the adjacent
teeth. The teeth have a certain amount of harmony, but they are flat and lacking in fullness.
An impression was taken of a central incisor,
three resin models were made (Fig 42a), and
the 10 points mentioned here were carved
(Figs 42b to 42g). Note that because only one
type of central incisor was used as the basis
for fabricating the examples in Figs 42a to
42g, the width:depth ratio needed to incorporate the anatomic variations of the associated
teeth has not been realized. In particular, the
fullness of the cervical and the central regions

CERAMIC RESTORATIONS

Figs 41a lo 41c Example of how anatomic variations established by incorporating the proper width depth ra-

StioTof'aSerior e t " ' " " ' ^""' ' " ' ^"^"'^ "^"^' checkpoints'comhi^ to ^rea'te harmontos r-

Fig 41a Frontal view of six anterior teeth carved

to compare restorations fabricated using only the
10 carving points {left) with those fabricated while
aiso taking into consideration the anatomic variations and the widthidepth ratio of the associated teeth (right). The six anterior teeth shown all
have the same mesiodistal dimension. Compare
the labial surfaces of the three teeth on the ieft,
which lack fullness because their width;depth ratios are all the same, with those on the right,
which have the proper ratios.

Fig 41b Lateral view of a lateral incisor and

canine (the teeth on the left m Fig 41a} that
were fabricated and arranged from identical
central incisors. Anatomic variations were
made according to the 10 carving points.

uf the crown appears deficient both labially

and lingually in the teeth farther from the
midline. This shows the importance of incorporating such variations during the actual clinical modifications by properly carving the 10
check points after first considering the
widthidepth ratio of the teeth. Furthermore,
depending on the patient, there may well be
restrictions on the width:deptb ratio.
The teeth were arranged in Figs 43a to 43e
so that they can be seen as a set. The figures
and their legends explain the actual carving of
the 10 checkpoints.

Fig 41c Lateral view of crowns (the teeth on

the right in Fig 41a) with porcelain extending
to the root that were fabricated and arranged
based en the left centrai incisor as the key
tooth. Anatomic variations were carried out on
the associated teeth while incorporating the
proper width:depth ratio.

Expression of the Labial Triangular Area

When fabricating anterior restorations, avoiding too strong an appearance in any individual
tooth is important. It is also essential that the
arrangement of the teeth is as near as possible
to normal, so close attention must be paid to
the labial triangular area when fabricating the
crowns. If, for example, only a lateral incisor is
missing and other anterior teeth are in their
normal positions, the form of the restoration
may be harmonized by keeping the labial triangle in mind during fabrication.
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Nishimura Reconstruction of coronal anatomy in ceramic restorations of the anterior teeth

Fig 42a to 42g Central incisor, lateral incisor,

and canine fabricated and arranged from resin
models of the same central indsor as In Fig 41.
Anatomic variations were added using the 10
carving points. Although the width:depth ratio
and mesiodistal dimension were the same for all
three of the teeth, it was possible to incorporate
considerable anatomic variation simply by carving the six labial and the four lingual points.
Fig 42a Resin models of the central incisors
fabricated from impressions of the same tooth.

Fig 42b Direct view of the labial surface.

Cusp formation of the incisal edge is expressed
by carving points 1, 2, 3, 4, 7, 8, 9, 10 in the
incisal region. A constricted, twisted appearance is expressed in the cervical region by carving points 5 and 6.

Fig 42c Direct view of the lingual surface. A

decline in the height where the marginal
ridge begins is achieved by carving points 7
and 10, and the accessory ridges at the incisal
region are brought out by carving points 7, 8,
9, and 10.

rmrm
Fig 42d and 42e Views of the mesial and distal surfaces. The slope where the labial and lingual surface ridges cross the incisal edge on the mesial, central, and distal regions is expressed by the extent
to which points 1 and 7 and 4 and 10 are carved.

Fig 42f Incisal view. The cervical region becomes more constricted in the teeth further
from the midline depending on the extent to
which points 5 and 6 are carved, resulting in a
protruding appearance. Also, the constriction of
the tooth and the asymmetry of the mesial and
distal halves can be expressed by the extent io
which points 1,2,5 and 3,4,6 are carved.

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QDT 1994

Fig 42g Cervical view. Points 1 and 4 affect the

projection of the central region. Also, the
V-shaped grooves are brought out in the vicinity
of the indsal edge by carving points 1,2,3, and 4.
The asymmetry of the mesial and distal Vshaped grooves in tho teeth farther from the midline can be expressed by lengthening the connections between points 3 and 6 and 4 and 6.

CERAMIC RESTORATIONS

mrm
Figs 43a 10 43d The same teeth as in Figs 42a to 42g after modifications

Fig 43a Labial surface view. The smooth transitions in the inclined surfaces of the mesial
and dista) areas near the incisal edges of the
lateral incisor and canine are prepared by carving points 1 and 2 and 3 and 4. The gap in the
mesial line angle region is created by carving
point 7. The labial triangular area is'properly
balanced by establishing points 1, 4, and 6 on
the labial triangle line.

Fig 43c Incisal view. Note that all of the teeth

look the same because the transitional surface
towards the proximal region is not carved. Consequently, there is no difference in the labial
embrasure, which would result from the natural anatomic variation in the original associated
teeth. It is necessary to incorporate the labial
embrasures separately from the 10 carving
points
when
making
the
anatomic
modifications.

The Three Basic Tooth Forms and the

Labial Triangular Area
The labial triangular area is not always the
same shape in each tooth, and also differs according to the specific characteristics such as
tooth alignment, facial features, and sex of the
patient The three basic tooth shapes (square.

Fig 43b Lmgual surface view. The transition

of the marginal ridge for the teelh that are farther from the midhne is expressed by establishing points 7 and 10 on the lingual triangle line.

Fig 43d Cervical view. The incisal embrasures

are expressed by carving points 1, 2, 3, and 4.
The orientation of the prescribed form of the
mesial and distal ridses is also established.

round, and tapered) have different effects on

the labial triangle area.
The upper and lower triangle lines are almost parallel in the square tooth, in which the
area of the triangle region is also the greatest
(Fig 44a). In the round tooth, the upper and
lower lines are essentially parallel, but, compared to the square tooth, they are more cenQDT 1994 89

Nishimura Reconstruction of coronal anatomy in ceramic restorations of the anterior teeth

A, square

B, round

C, tapered

A, young

B, middle-aged

C, elderly

Figs 44a to 44c Drawings of the three basic crown

shapes of the surface of the anterior teeth showing the
labial triangle area (upper line = incisai edge, lower line
= labial triangle area).

Figs 45a to 45c Examples of labial surface and triangle

areas in the young, middle-aged, and elderly.

trally located. The area of the region is also

smalier (Fig 44b). Although the incisai line of
the tapered tooth is nearer the incisai edge
than in the square or round teeth, it has a

strong tendency to rise up in teeth away from

the midline. For this reason the triangular area
of this type has the strongest tendency to constrict in these teeth (Fig 44c). In addition, it is

90

QDT 1994

CERAMIC RESTORATIONS

Fig 46 Illustration of use of disk to create the anatomy of the connecting region. Note that the tooth
contact point become shorter vertically in the associated teeth farther from the midline, and its position
also moves towards the center of the crown.

necessary to keep in mind that the shape of

the labial triangular area also differs in long or
short teeth independently of their shape.

shorter vertically in the lateral incisor and

canine.

Variations in the Triangular Area With

Actual Restoration of Anterior

Crowns

Even in the same dentition, the triangular area

changes with age. Although the anatomic features of a younger person's dentition is not
much changed from that which existed when
their teeth first erupted, attrition of the incisai
edge is pronounced in middle-aged and eldedy persons. Attrition normally starts in the
canine and progresses to the central and lateral incisors. Furthermore, recession of the
periodontal tissues increases with age. For this
reason, the labial triangular area appears to
move incisally with age (Figs 45a to 45c),

Three clinical cases and a model case were

used to illustrate actual restorations of crowns.
In all clinical cases (Figs 47a to 47f), the patients' oral cavities were first observed to suggest an ideal basic anatomy for the restorations based on the condition of adjacent teeth,
and attempts were made to harmonize the
dentition. Prostheses were prepared following
the rules guiding basic tooth anatomy for creating a balanced dentition and for varying the
anatomy of anterior teeth as outlined earlier.

Clinical Case 1
The Importance of the Contact Area of
the Connector
The connecting region, corresponding to the
contact areas of independent teeth, is often
overlooked when doing anatomic modifications on a restoration. It is necessary to
shorten this area vertically in teeth farther
from the midline and manipulate the polishing material of the disc, which determines the
anatomy of the connecting region (Figs 46a
and 46b), so that the contact has a long vertical shape at the central incisors and becomes

Porcelain-fused-to-metal crowns were fabricated for both maxillary central incisors and
the maxillary left lateral incisor of this patient.
Almost no attrition of the incisa! regions or
abrasion of the labial surface were present.
The basic tooth shape was flat and rounded,
with a certain amount of rotation. Inspection
of the oral cavity revealed crowns that had
been fabricated on standard forms, giving the
appearance of teeth that had just erupted.
The left lateral incisor was matched to the
anatomy of the root cross section at its marQDT 1994 91

Nishimura Reconstruction of coronal anatomy in ceramic restorations of the anterior teeth

Figs 47a to 47f Three clinical cases in which all of the patients' oral cavities were observed, images
were established for the basic anatomy of the teeth to be restored based on the condition of tbe adjacent
teeth, and attempts were made to establish harmony in the dentitions. The prostheses were prepared as
per the principles discussed earlier and before treatment photographs (a,c,e) and posttreatment photographs (b,d,fl are shown.

gin, the adjacent canine, and the contralateral

incisor. The central incisors were fabricated by
inferring their anatomy from the lateral incisors and canines.
Clinical Case 2
A prosthesis was fabricated for both maxillary
central incisors and the maxillary left lateral
92

QDT 1994

incisor of this patient, who desired a restoration in harmony with existing teeth.
Special anatomic characteristics included attrition of the incisai edge and a certain amount
of abrasion on the labial and lingual surfaces,
as is typical in a middle-aged person. The restoration was harmonized with the adjacent
teeth and incorporated the anatomic variations
of the adjacent teeth while expressing these
special characteristics.

CERAMIC RESTORATIONS

Figs 48a to 48h Samples of anterior teeth formed by fabricating a central indsor based on the basic anatoniic type and the age of tbe patient. Note changes in crowns representing those for older patients. Labial surface abrasion becomes more pronounced and marked attrition appears in the incisal edge.

Fig 48a Square-shaped tooth of a younger

patient.

Fig 48b Round-shaped tooth of a younger

patient.

Fig 48c Tapered tooth of a younger patient.

Fig 48d Ovoid tooth of a younger patient.

Fig 48e Mixed tooth of a younger patient.

Fig 48f Teeth of middle-aged pahent.

Fig 48g and 48h Teeth of elderly patients.

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Nishimura Reconstruction of coronal anatomy in ceramic restorations of the anterior teeth

Clinical Case 3
A prosthesis was fabricated for the right and
left maxillary canines, right and left maxillary
lateral incisors, and right and left maxillary
central incisors. The patient was a young
woman who expressed a desire for young
looking, bright, feminine teeth.
The teeth were of the round type and had a
youthful appearance. The round shape was
preserved in the maxillary central incisors,
which were used as a basis for establishing the
anatomic variations in the maxillary lateral incisors and canines.
Model Restoration
The central incisor was fabricated based on a
standard anatomic type as described earlier
This tooth was then used as the basis for a
model of the anterior dentition that would
preserve the anatomic variations of the associated teeth.
Figures 48a to 48e show model dentitions
for a young person. Fig 48f shows a model
dentition for a middle-aged person, and Figs
48g and 48h show model dentitions for an
older person.
Note that the anatomy of each tooth
changes with age. Marked attrition appears in
the incisal edges of the teeth, and a strong,
carved-out abrasion appears on the labial surfaces. Attrition in the incisal regions cause the
labial triangle areas and embrasures of the
incisal line angles to appear different in the
teeth of older persons. As abrasion from
toothbrushes and the lips lead to acquired anatomic changes on the labial surfaces, it is
necessary to consider such variation when
fabricating crowns for older patients.

Conclusion
As the statistical and scientific elucidation of
the expression of the shade and anatomic res-

94

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toration of anterior crowns has moved forward

in such aspects as coloration and construction
of natural teeth, the technology of materials
has also progressed. The point has now been
reached where theoretically based technical
expression can be carried out. On the other
hand, even though a person might learn the
fundamentals of dental anatomy, the anatomic
expression of the final product may be wanting if one does not understand how to carry
out the technique. In the past, the technician's
instincts took precedence over theoretic considerations. For this reason, it took beginners a
very long time and considerable experience to
master anatomy.
The development of a basic theory and criteria for the fabrication of a restoration hastens
this process. The ability to fabricate clinically
acceptable restorations of all anatomic types
may then be acquired easily and in a minimum amount of time by anyone who has a
certain degree of practice and has learned
these theoretic foundations.
Fabricating a restoration that is in harmony
with the remaining dentition and that expresses the coronal anatomy of anterior teeth
requires an understanding of both the anatomy of the teeth and the means necessary for
achieving this harmony with the adjacent
teeth. This article was structured to simplify
the guiding principles needed to accomplish
such restorations and set them forth from a
dental technician's viewpoint.
A cknowledgm en Is
The author would like to express gratitude to his employer, Dr Ryuji Fujii, head of the Fujii Dental Clinic, for
contributing his time and assistance in preparation of
this manuscript and his cimical examples; to Drs Shigeo
Kataoka, Mitsuru Morihiro, and Hiroto Yamamoto for
their advice and checking of the manuscript; to Mr Yuji
Okubo, who was in charge of the illustrations for the
manuscript; and to the staff at the Misshin Company
who provided material for the skull photographs.