Complete Denture Esthetics

Scribd Upload a Document Search Documents

Explore
DocumentsBooks - FictionBooks - Non-fictionHealth &
MedicineBrochures/CatalogsGovernment DocsHow-To
Guides/ManualsMagazines/NewspapersRecipes/MenusSchool Work+ all
categoriesFeaturedRecentPeopleAuthorsStudentsResearchersPublishersGovernment &
NonprofitsBusinessesMusiciansArtists & DesignersTeachers+ all categoriesMost
FollowedPopularSign Up|Log In
1First Page
Previous Page
Next Page
/ 14Sections not available
Zoom Out
Zoom In
Fullscreen
Exit FullscreenSelect View Mode
View ModeSlideshowScroll Readcast
Add a Comment
Embed & Share
Reading should be social! Post a message on your social networks to let others
know what you're reading. Select the sites below and start sharing.Readcast this
Document
Login to Add a Comment
Share & EmbedAdd to Collections
Download this Document for FreeAuto-hide: on
COMPLETE DENTURE ESTHETICS Introduction Denture esthetics is defined as the
cosmetic effect produced by a dental prosthesis which affects the desirable
beauty, attractiveness, character and dignity of the individual. The subject of
esthetics is not a totally scientific and objective discipline nor is it 100% an
art form . Esthetics is a combination of the art and the science of
prosthodontics. Hardy said it best when he wrote "make the teeth look like
natural teeth. If a dentist is to make a denture, where in the teeth look they
grew there, teeth must be set in an esthetic and convincing arrangement that
also meets the patients functional needs. It appears that beauty really does lie
in the eye of the beholder and more often is a matter of genetic programming of
course, there are individual as well as cultural variation. A denture is usually
perceived as esthetic when the teeth and bases are in harmony with the facial
musculature as well as size and shape of the head. Pre extraction records, old
casts, photographs or Immediate dentures can be extremely helpful both for tooth
selection and arrangement. The subject of esthetics should be examined from 3
points of view - biological - physiological, biomechanical and psychological.
Biological - physiological It is necessary to have an understanding of facial
musculature, normal facial appearance, and the physiological limits within which
esthetic compromises are to be made. A proper impression procedure is necessary
to provide the dentist with a final maxillary cast that has an accurate
representation of the labial vestibule and all of the other remaining
structures. 1)The dentist should also have a visual concept of the cause and
effect relationship. eg: - If an edentulous patient has a tight, drawn & thin
lips, proper support with a fully formed occlusion rim and lip support by the
labial 2/3 of the artificial maxillary anterior teeth, should evert the
vermillion border of the lip. This would -afford a much more natural appearance.
2)As patients become older the natural lines of farce tend to deepen and to
appear accentuated and the elasticity of the facial musculature is lost. There
is a tendency to want to plump out the face with additional thickness of the
denture base material and the musculature tends to loosen the denture or the
facial appearance, becomes strained. 3)Another approach to removing facial
wrinkles is to Increase the VD. This approach is fraught with the greatest of
dangers and must be used with caution. The actual process of trial placement of
the maxillary anterior teeth and the function of the maxillary and mandibular
anterior during the production of speech give one of the best guidelines for
creating and maintaining an adequate inter occlusal distance. The following
principles should be followed in the placement of anterior teeth. 1) The lower
anteriors should be placed lower in order to maintain an adequate interarch
space. This will necessitate lowering of the occlusal plane posteriorly. This
will have the effect of placing the teeth closer to the mandibular ridge giving
stability to the lower denture. 2)The maxillary teeth should be moved slightly
more anteriorly at the incisal edges. Tilting the incisal edges of the
mandibular incisors; lingually should be avoided. According to Muysigmes for
every lmm the incisal edges of the mandibular anterior teeth are posterior to
their normal arrangement, the tongue is deprived of approximately 100cub mm of
space in which to function. Biomechanical There are certain mechanical
limitations in the placement of anterior teeth that must be taken into account.
The anterior teeth should be placed closely in relation to the residual ridge as
were the original natural teeth. Fish says the proper position for the teeth is
not necessarily on the ridge, inside the ridge, or outside the ridge, but at a
point where the tongue and cheek pressures balance. Psychological Patient's self
image is an important factor in esthetics. -:A patients perception of his or her
appearance may result in a broad simle (if it is a positive self evaluation.) or
a tight - lipped, small, controlled smile, A patient with a poor self image may
appear done, unsure, questioning and introverted,. A patient with a more
positive feeling tends to smile more broadly. Camperâ s line may be thought of as
a psychological plane of orientation. In a person who appears happy this line
tends to rise and in a person who to depressed it may slant downward. The
occlusal plane established by the dentist has an effect in determining the
appearance of a patients psychological state. eg: - by effecting a downward
slant to the plane posteriorly an observer may gain a negative impression of
the patients emotional or phychological state. ANTERIOR TOOTH SELECTION There
are many methods of choosing anterior teeth for the edentulous patients.
Anterior tooth selection is a tentative step, which can be verified only by the
dentist utilizing the trial base and confirmed by the patient and family or
friends. The best time to gain insight into the esthetic problems of a patient
is the first time we meet the patient. The decision should be made at the first
visit about the shape, shade, position and mold of the teeth to be used. If the
patient had a previous set of dentures, changes to be made can be discussed with
the patient. A smile is the most visible record of a dentists care of an
edentulous patient. interior tooth selection is the area of prosthodontic care
in which the patient should be given a primary responsibility to determine the
esthetic outcomes. A.T.S. has been based on theories that, tooth shape relates
to head shape and tooth appearance, is influenced by patient aye, sex and
personality. Our aims is to achieve a harmonious blending of shade, shape,
arrangement and position so that the final result is a removable restoration
that creates an illusion of being what it is not shade Krajicek states, is not
so important what shade is selected, but a variety of shades of teeth be used in
a single 6 tooth composition . A study by Hallarman showed that there is
apparently little correlation between either natural hair or eye colour and
tooth colour. There is also little correlation between skin colour of the
forehead or cheek and patients own anterior teeth. His study also confirmed that
canines are darker than the central incisors and colour darkens with aye.
Females tends to have lighter natural teeth than to males. Colour has basically
3 qualities hue saturation and brilliance.
Hue is the dimension of colour by which the eye distinguishes different wave
length of the visible spectrum. It is specific colour produced by a specific
wave length of light acting on the retina of the visible spectrum. It is
possible to recognize 2 different hues in artificial teeth one yellow and one
red. The individual teeth of each set, although of the same hue, should vary in
their purity the central incisors being more pure than the lateral incisors and
canines. If artificial teeth are to resemble pleasing natural teeth they, too
under all conditions of lighting should appear to be warm and living. Saturation
(Chroma) It is the amount of colour/unit area of an object eg: some teeth appear
more yellow than others. When more of the hue or less of white is present, there
is said to be greater saturation. A tooth is said to be darker because of an
increase in saturation or a decrease in brilliance. Both brilliance and
saturation must be held within limits and must be related to each other in
correct proportions for each hue natural tooth colours are to be imitated.
Brilliance (Value) Refers to the lightness or darkness of an object. It is the
quantity of light reflected from the surface. The inclination of surfaces,
position of surfaces, character of surfaces and the intensity of the projected
light all affect the lightness of an object. Curved surfaces appear more darker
than the surfaces at right angles to light. Surfaces closer to the observer will
be lighter than similar surfaces further away. Polished surface will reflect
more of than light received and will be lighter than roughened surfaces. Surface
appear lighter when it is illuminated by Intense light. People with fair
complexions generally have teeth with less colour and are lighter. People with
dark complexions usually have darker teeth. However a light teeth in the mouth
of a patient with very light complexion may appear dark. Likewise dark teeth in
dark complexion appear to be lighter than they are.
Translucency It is the property of an object that permits passage of light
through it. Translucency of artificial teeth has the effect of mixing the
various colours of teeth. This results in teeth that look alive. A natural tooth
is composed of a slightly translucent ivory colored body covered with a jacket
of almost colourless material of greater translucency. Because the enamel jacket

varies a great deal in thickness in different parts of the mouth, many

characteristic visual effects are produced. Shade Selection Colour of the teeth
should be in harmony with that of the face. Women usually tend to have lighter
teeth. Other factors are 1) Hair colour 2) Colour of the eyes 3) Age Hair Colour
according to Bcucher is not a constant factor and can be unreliable & inaccurate
Colour of the eyes; Ace to Heart well it is an excellent guide but is not quite
so according to Boucher as he says that - The iris of the eyes is so small
compared to the area of the total face & the eyes are not close to the teeth.
Age & Tooth colour Natural tooth colour changes with age. In youth the pulp
chamber are large and the red colour of the pulp affects the tooth colour. later
the pulp chamber becomes smaller due to deposition of secondary dentin. This
makes the tooth more opayue. The general rule is that darker teeth are more
appropriate in older patients and lighter teeth in younger patients. Shade
guides are useful in the shade selection observation of the shade guide should
be made in 3 positions. 1.) Outside the mouth along the side of the nose 2.)
Under the lips with only the incisal edge exposed.
3.) Under the lips with only the cervical end covered and mouth open. The first
step will establish the basic hue, brilliance & saturation. the 2nd will reveal
the effect of the colour of the teeth when the patients mouth is relaxed. The
third will stimulate exposure of the teeth as in a smile. The colour selected
should be so inconspicuous that it will not attract attention to the teeth. The
colour of the teeth should be observed on a bright day when possible with the
patient located close to natural light. The 'squint test' may be helpful in
evaluating colours of teeth with the complexion of the face with the eyelids
partially closed the dentist compares prospective colours of artificial teeth
held along the face of the patient. The colour that fades from view first is the
one that is least consipicious in comparison with the colour of the face. Size
The size of the teeth should be in proportion to the face and head . Generally
larger persons have larger teeth. Men usually have larger teeth than women. This
is especially true of the CI, which normally should be more delicate in women.
Clinical judgement and experience are the criteria in selection of the proper
width and mold. The widely used methods for anterior tooth selection based on
facial and tooth size proportion are A. Pre extraction records. 1) Diagnostic
casts prior to extraction
2) Most recent photographs of the patient before loss of his teeth.
3) Radiographs of the teeth.
B. Post extraction examination If the patient is edentulous and wearing CD
examine the patient with the dentures and ask the patient what changes to be
done in the new denture.
C. Anthropometric studies indicate Measurement of the bizygomatic width and
dividing it by 16 to arrive at the approximate width of the maxillary central
incisior. Dividing this measurement by 3.3 will give the total width of the 6
anterior teeth. D. Mark the corner of the mouth on the wax occlusion rim and
this will give the width of the maxillary anteriors. E. Pound evaluates tooth
width by measuring the distance from zygoma to zygoma, 1 â 1.5 inches back of
the lateral corner of the eyes. Length is , measure of the distance from the
hairline to the lower edge of the bone of the chin with the face a; rest.
Dividing it by 16 will give the length of the central incisor. frush considers
mold, lip support, midline labial version, (speaking line), smiling line, C
position, LI position, cuspid position, spaces embrasures, buccal corridor, long
axis, gum line, and inter dental papillae. (Among the more significant factors
are the treatment of the incisal edge and prominance an position of the teeth.
Rounded corners & Curve contours give feminine appearance. Prominent wide
central with a great deal of incisal abrasion an worn cuspid tips indicate the
wear of aging combine with the projection of a personality of strength an vigor)
Sharry, Boucher & found all agreed that size selection should be based on facial
measurements proportions. Two popular methods are there for selecting the size
of the tooth. 1. Based on the space available for placement of the teeth. The
length of the- maxillary central Incisor is measured from the Inclsal edge of
the maxillary wax rim upto the high lip line. Then vertical lines are scribed on
the wax rim directly down from the
right & left ala of the nose. The distance between these lines give a good
approximation of the width of the 6 max, anterior teeth and places the canine
near the commissures. 2) Based on the facial & tooth size proporation Pound
advocated the same 1:16 ratio described by House & Loop. Levin observed that the
width of the maxillary anterior teeth when viewed in the frontal plane lie
within the golden proportion of 1.681 ie, the CI is 1.681 times wider than the
LI in a frontal view. Frush & fisher varied incisor length from the ideal
according to the dentogenic guidelines of age, sex & personality. The incisors
tend to be longer in young individuals and is shorter in males than in females .
Frush & fisher emphasized the Importance of the incisal edges of the maxillary
anteriors following the contour of the smile line of the lower lip. Tooth form
(shape) Berry in 1930's was probably the first to demonstrate correlation
between outline form of maxillary central incisor and inverted outline form of
face J. Leon Williams classified facial form as square, tapering, square
tapering and ovoid. Follwing 18 years study on extracted teeth House. & Loop
classified teeth according to form. Their classification was based not only on
the facial outline form of tooth but also on mesio distal and gingivo incisal
contours. They proposed 3 pure typical forms - square, tapering and ovoid along
with 6 other combination forms ie, square - tapering, reverse tapering, ovoid -
square, ovoid tapering and square - tapering - ovoid. House hold that good
esthetics could be achieved only if the facial arches, and tooth shapes all were
in harmony. In addition he classified arch forms as square, tapering and ovoid.
Found also believed that harmony was the key to good esthetics. He not only
evaluated outline form of face in frontal plane but also in the sagittal plane.
Boucher also states that shape of tooth should be in harmony with facial form
. frush & fisher considered dentogenic factors when selecting tooth form, as
well as tooth size & shade. They advocated selective reshaping of artificial
teeth to account for the influence of age, sex and personality. eg: -to simulate
the attrition seen in old age,' soft delicate look of feminine dentition or the
bold vigorous look of a masculine dentition. Each denture tooth was treated as
an individual in terms of both form & position. Over accentuate maxillary
central incisors produce strength an boldness in smile. This can be reinforced o
softened by reshaping & positioning of maxlllary lateral Incisors. Position &
shape of maxillary canine is of paramount importance in achieving good
esthetics. Frush & Fisher recommend ovoid teeth for females and square teeth for
males. Frush also considers lip support, midline, labial version speaking line,
smiling line, spaces, embrasure, buccal corridor,aum line and interdental
papilla in esthetics. Hallarman in the 1970's noted the attempts to correlate
tooth form with facial form, sex and personality do not stand up under
scientific investigation. But these give guidelines t translate esthetic
concepts into technique. Tooth Arrangement Nelson, and later french wrote that
the arrangement of the teeth is a far more importer esthetic factor than mold
selection. French illustrates how the same dentures tooth mold c appear as
either square, tapering or ovoid depending. on how the individual teeth are
arranged and how tt base is fabricated to frame the teeth. There are 4 steps in
arranging denture teeth. 1) Proper Orientation of occlusal plane The oclusal
plane lies parallel -.to the campers line in the sagittal plane &parallel to the
inter pupillary line in the frontal plane, Occlusal plane plate designed by Dr.
Frank. Fox is a most useful tool for determining these
relationships. The amount of incisal edge visible below the related upper lip
may range from 0 - several mm owing to variations in lip length from very short
to very long. The incisal length of the rim is adjusted (by having the patient
enuncial F & V sounds) to where the wet or dry line of the L/lip makes light
contact with the incisal edges of maxillary central incisor. 2) Careful
development of wax rims in the space intended for artificial teeth. Wax rims
should be developed with great care to fill the space once occupied by the
patients natural teeth. The rims should offer adequate support for the soft
tissues. They should allow for esthetic buccal corridors. Orientation lines
should be scribed on the wax rim in the mldline, high lip line and 2 vertical
lines in the canine area directly down from the ala of the nose. Arch form
should be harmonious with facial & tooth forms. â ¢ Heart well & Rahn pointed out
that mandibular teeth become more visible with age. Vig & Brundo showed that the
longer the upper lip, the more visible the mandibular teeth become with age via
& Brundo showed that the upper lip, become of men displayed 1.23cm urban when
the I/lip was at repose, where as women, displayed 0.49mm Cade showed that there
is significant exposure of mandibular beyond age 40. 3. Placement of each tooth;
in its correct anatomic position. Should view the positon of each tooth in the
frontal, sagittal & occlusal planes. The incisal edges of the CI & canines rest
on the occlusal plane. LI 1mm short of the plane. In the frontal view the long
axis of LI perpendicular to the occlusal plane LI angle medially slightly,
canines more medially than LI. The tips of the canine should never be more
labial than their necks. In occlusal view LI face forward, where as the canines
are rotated distally. In sagittal view LI flare slightly in a labial direction.
LI flare slightly more in the same direction. The long axis of canines are
nearly perpendicular to the occlusal plane.
Mandibular Teeth. Frontal View - Long axis of CI perpendicular to the occlusal
plane.
- LI tipped medially slightly
- Canines tipped more medially than LI
Sagittal view LI are tipped in a labial direction slightly, long axis of LI
nearly perpendicular to the occlusal plane canines angle forward slightly. 4.
Characterisation of the set up Lombard! felt that the LI make the best statement
of the patients age, LI cannot the patients sex. Canines reflects the patients
vigor. Frush & Fisher believed that dentogenics influence tooth arrangement as
well as shade of tooth selection. To highlight age they accentuated diastemata
and rotations. Probably the most popular characterisation technique is to crowed
and tilt the mandibular anterior teeth. Denture Base Sir Wilfred Fish in his
extensive writing on the polished surface of dentures elaborated on the direct
influence of denture base contours on facial esthetics. He says optimum
esthetics depend on adequate soft tissue support which in turn is directly
related to proper base contours. Frush & Fisher proposed convex, rounded and
shortened papilla in older patients. They also proposed the exposure of more of
cervical root portions of denture teeth in order to simulate ginglval recession
in older individuals. They recommended finer stippling for females and . heavy
stippling for males. They preferred to the tint the interdental pappila and
muscle attachment areas with deep shade of red. They used light shades to tint
areas of hard tissue. Characterization A life like restoration can be obtained
by simulating the anatomical characteristics of oral mucosa with various stains.

It is of particular value in
1. Subjects with active upper lip
2. Persons with prominent pre maxllla
3. Persons like teachers & singers
4. Who expose more of denture base during talking < smiling.
5. Young edentulous patients
Many others have advocated festooning o. stippling and staining of the denture
base. They also suggested use of preformed anatomic palatal and facial gingival
forms. Rugae can be reproduced in denture for natural feel. A 0.003 guage tin
foil is adapted over the rugae area of the edentulous cast of trimmed. This is
adapted to the base plate after wax up so as t reproduced the rugae properly.
Colour Distribution in Gingiva Basic pink used over hard tissue as attached
gingiva. Light red used for papilla & muscle attachments Medium red tones in
mucobuccal folds, rugae etc Purple blue in heavily plgmented gingiva mostly
attached gingiva papilla & marginal gingiva. Brown for heavily pigmented
gingiva. CONCLUSION Denture esthetics aim in creating artificial substitutes for
lost natural teeth to maintain harmpny, naturality and individuality. Every
effort should be made by the dentist to maintain true identity between
artificial dentures and the sex, personality and age of the patient. REFERENCE
1. Bouchers prosthodontic treatment for edentulous patients - 9th edition
2. Essentials of complete denture prosthodontics Sheldon tinkler - 2nd edition.
3. Dental esthetics - John H. Lee
4. Complete denture esthetics - DCNA Jan. 1996 Vol. 40 5. Sheldon Winkler et al
Characterization of denture bases for people of colour JADA, Vol 81, 1970. 6.
Characterization of denture bases DCNA April 1975 Vol 19.
Complete Denture Esthetics
Download this Document for FreePrintMobileCollectionsReport DocumentReport this
document?Please tell us reason(s) for reporting this document Spam or junk Porn
adult content Hateful or offensiveIf you are the copyright owner of this
document and want to report it, please follow these directions to submit a
copyright infringement notice.Report Cancel
This is a private document.
Info and Rating
Reads:306Uploaded:09/15/2010Category:Books - Non-fiction>Health &
LifestyleRated:Copyright:Attribution Non-commercialA seminar on complete denture
aesthetics
prosthodonticsgolden proportionocclusiondcnadenture
estheticsprosthodonticsgolden proportionocclusiondcnadenture esthetics(fewer)
FollowdrrebaShare & Embed
Related Documents
PreviousNext
p.
p.
p.
p.
p.
p.
p.
p.
p.
p.
p.
p.
p.
p.
p.
p.
p.
p.More from this user
PreviousNext
6 p.
57 p.
14 p.
23 p.
27 p.
43 p.Add a Comment
SubmitCharacters: 400
Print this documentHigh QualityOpen the downloaded document, and select print
from the file menu (PDF reader required).Download and Print
You Must be Logged in to Download a DocumentUse your Facebook login and see what
your friends are reading and sharing.Other login optionsLogin with
FacebookSignupI don't have a Facebook accountemail address (required) create
username (required) password (required) Send me the Scribd Newsletter,
and occasional account related communications.
Sign Up Privacy policy You will receive email notifications regarding your
account activity. You can manage these notifications in your account settings.
We promise to respect your privacy. Why Sign up?Discover and connect with
people of similar interests.
Publish your documents quickly and easily.
Share your reading interests on Scribd and social sites.
Already have a Scribd account?email address or username password Log In
Trouble logging in?
Login SuccessfulNow bringing you back...
« Back to LoginReset your passwordPlease enter your email address below to reset
your password. We will send you an email with instructions on how to
continue.Email address:
You need to provide a login for this account as well.
Login:
Submit
Upload a Document
Search Documents Follow
Us!scribd.com/scribdtwitter.com/scribdfacebook.com/scribdAboutPressBlogPartner
sScribd
101Web StuffScribd StoreSupportFAQDevelopers /
APIJobsTermsCopyrightPrivacyCopyright © 2011 Scribd Inc.Language:EnglishChoose
the language in which you want to experience Scribd:EnglishEspañolPortuguês
(Brasil)