ESTHETICS IN COMPLETE DENTURE

1. Good morning

2. ESTHETICS IN COMPLETE
DENTURE
ANISH AMIN

3. CONTENTS
• INTRODUCTION
• DEFINITION
• HISTORY
• FUNDAMENTALS OF ESTHETICS
• METHODS OF ACHIEVING COMPLETE DENTURE
ESTHETICS
• DENTOGENICS
• DYNESTHETIC INTERPRETATION OF DENTOGENICS
• LABORATORY STEPS
• CONCLUSION
• REFERENCES

4. DENTURE ESTHETICS
• Esthetics as appreciative of ,responsive to or
zealous about the beautiful,having a sense of
beauty and fine culture.
• Dental esthetics:”The effect produced by a
dental prosthesis that affects the beauty of
that person” - GPT 8

5. HISTORY

6. Fundamentals of esthetics
VISUAL PERCEPTION
COMPOSITION
PROPORTION
DOMINANCE
ILLUSION

7. STEPS FOR ACHIEVING COMPLETE
DENTURE ESTHETICS
• Accurate impressions
• Jaw relation
• Selection of anterior teeth
• Arrangement of teeth
• Characterisation of denture

8. ACCURATE IMPRESSIONS
• As teeth are lost functions of facial muscles are
impaired.Resultant edentulous appearance has profound
influence on patient.
• Supporting the facial muscles with properly formed borders is
essential.
• Thickness can cause unnatural plumping of the upper lip at the
base of the nose and give upper lip a convexity.
• A long standing edentulous patient requires thicker borders.

9. JAW RELATION
Correct vertical dimension is essential for proper
positioning of Orbicularis oris and associated muscles.

10. Insufficient vertical dimension at occlusion

11. Excessive vertical dimension of occlusion

12. Selection of teeth
• The selection of teeth and their arrangement to meet esthetic
requirements demands artistic skill in addition to scientific
knowledge.
• But there are anatomic landmarks manufactured aids that can
be used as guides.
• Best method to develop the skill is to observe natural teeth.

13. PHONETICS
• The mandibular anterior teeth are positioned
to exhibit a 1 to1/2 mm clearance with the
maxillary anterior teeth as the patient speaks
“S” sounds.

14. GOLDEN PROPORTION

15. PROPORTION BETWEEN THE TEETH
Golden grid demonstrating that teeth
are in golden relationship.
Golden proportion relationship existing
between the elements of the anterior
segment produce a steady impression
of harmony

16. PROPORTION BETWEEN TEETH AND
SMILE
Golden proportion calipers
They always open to a constant golden
proportion between the larger and smaller part
The number in the solid circle refers to the
width of the central incisor.There are 7
grids to accept all widths of central incisor
from 7 to 10 mms in steps of ½ mm.The
grid also shows a number in a doted
circlewhich refers to the width of the
smile.

17. METHODS OF TEETH SELECTION
• Pre extraction guides:
• Photographs: Information about size of the teeth and their
outline form.
• Diagnostic casts: reliable guide for arranging teeth
• Radiographs: information about the size and form of the
teeth.
• Extracted teeth: information about the size and form of the
teeth.

18. SIZE OF ANTERIOR TEETH
Guide to select anterior tooth size are:-
• Size of face
• Size of maxillary arch
• Incisal papilla and canine eminence or buccal
frenum
• Maxillomandibular relations
• Contour of the residual ridges
• Vertical distance between the ridges
• The lips
• Nasal width

19. 1) Size of the face
• Size of the teeth should be in proportion to
the face and the head.
• Cephalometric measurements
• Truebyte tooth indicator

20. 2)Size of the maxilla
3)Incisal papilla and canine eminence/buccal frenum
Make the measurements from from the crest of incisal
papilla to the hamular notches and from one hmular notch to
the opposite notch
The combined length of the triangle in millimeters is used on
the selector.The circular slide rule indicates the tooth
sizes,anterior and posterior for both arches

21. 4)Maxillomandibular relations
5)Contour of the residual ridge
Any disproportion in the size beween the maxillary and
mandibular arches influences the length,width and
position of the teeth
Teeth should be placed in relation to follow the
contour of the residual ridges that existed when
natural teeth were present.

22. 6)Vertical distance between the ridges
• According to the available inter-arch
space,length of the teeth can be
selected.Minimal of the denture base should
be visible in the final prosthesis.
• When the space is available,it is more
esthetically acceptable to use tooth long
enough to eliminate the display of the denture
base.

23. 7)LIPS
• During relaxed state the labial surface of the
maxillary anterior teeth support the upper lip.
• When the teeth are together the incisal edge
of the maxillary incisors supports the superior
border of the lower lip.
• In speech anterior teeth contact the lower lip
at the junction of the moist and dry surfaces
of the vermiliion border.

24. 8)Nasal width
• Wilson et al referred to nasal index as a
guide,which relates the interalar width to the
space available for setting the anterior teeth.

25. Form of anterior teeth
• Form and contour of face :
• The shape of the face can be classified as:-

26. Facial profile

27. DENTOGENICS
• SEX-PERSONALITY-AGE
• Dentogenics describes such a denture as is
eminently suitable in that for the wearer,the
denture adds to the person’s
charm,charecter,dignity or beauty in full
expressive smile.
• Dentogenic means the art,practice and
technique used to achieve the esthetic goal in
dentistry.

28. Sex factor
• Feminine form:spherical with
roundness,smoothness and softness.
• Masculine form is cuboidal,with
hard,muscular vigorous contours.

29. Personality factor
• In 1956,frush and fischer discussed another
aspect of dentogenics – the personality of the
patient.
• The personality spectrum can be used in our
artistic endeavor to inject a variety of tooth
form and tooth position,at the comprehensive
level of individual patient personality analysis.

30. Age factor
• The dignity of advancing age must be
appropriately potrayed in the denture by
careful tooth colour selection and mould
refinement.
• Lighter shades are considered appropriate for
young people and darker shades are
considered for older people.
• Bluish incisal tinges are considered for young
people and grayish shades for the older.

32. Dynesthetic interpretation of dentogenic concept
• Dynesthetic techniques are rules which
concerns the three important divisions of
denture fabrication.
• 1)Tooth
• 2)its position
• 3)Its matrix

33. Dynesthetics outline
• 1)mold
• 2)physiologic shade selection
• 3)lip support
• 4)midline
• 5)labioversion
• 6)speaking line
• 7)smile line
• 8)position of incisors and cuspids
• 9)spacing between teeth
• 10)buccal corridor

34. MOLD

35. Physiologic shade selection

36. Midline

37. Lip support

38. Labioversion
Speaking line
Most pleasing effect is obtained when the long axis of the central
incisors are either vertical or with slight labial inclination, this
determination is made when the patient is standing in normal
posture.
It is the vertical composition of the anterior teeth, it should be
noticed when the patient is speaking

39. Smile line
Sharp curve denotes youthful
component
Broader curve denotes older dental
component

40. Central incisor position
The placement of central incisor controls:
1)midline
2)Speaking line
3)Lip support
4)Labioversion
5)Smile line

41. Lateral incisor position

42. Cuspid position

43. Buccal corridor
• It is a space created between the buccal
surface of the posterior teeth and the corner
of the lips when the patient smiles

44. Colour of anterior teeth
• Hue
• Croma
• Value
• Translucency

45. Yellow-more prominent in the gingival third
– incisal third
With thin incisal edges the yellow disappears and the edge
appears blue gray
Eyes fatigue to color perception very rapidly and for this
reason they should not be focused on a tooth more than a few
seconds.
Two principal colors are:

46. SQUINT TEST
• Eye lids partially closed to reduce light
• The dentist compares prospective colours of
the artificial teeth held along the face of the
patient
• The colour that fades from the view first is the
one that is least conspicuous in the
comparision with the colour of the face.

47. Arrangement of teeth
A teeth arrangement that is too perfect may not be ideal. In
fact, slight modifications such as overlapping, tilting,
rotation and incisal variations may contribute to a natural
looking denture.
Use an eccentric midline.
Place one maxillary central incisor in an anterior direction
to the other central incisor.
Create asymmetry for the maxillary right and left cuspids.
Rotate one in posterior direction than the other

48. Gingival tissues recedes with age. Selecting a long tooth,
contouring the wax to show gingival recession and then
staining a bit , can give a natural appearance
Grinding the incisal edges. Teeth abrade with age.
Reshaping the incisal edges and mesiodistal diameter
makes it possible to modify any tooth to desired form.
Create asymmetry for the maxillary right and left cuspids
also helps like rotating one in posterior direction as
compared with the other.

49. A hair line crack can be given in the teeth.
Silver filling can be given on the posterior teeth.
Cast crown can be given on posterior teeth.
A discolored teeth (as RCT treated ) can be
shown by selecting one or teeth of darker
shade.
Spacing and diastema should be given whenever
possible between lateral incisor and cuspid

50. Denture base characterisation
The esthetic denture bases are indicated for
– Patients with an active upper lip,
– Patients with a prominent premaxillary process,
– Theatrical performers, singers, and others who
may expose normally unobserved gum tissue
areas during their performances, and
– The psychologic effect on the patient

51. Natural denture bases are obtained by
An esthetic wax-up which reproduces the
contours of oral anatomy lost with extraction of
teeth and alveolar resorption,
Staining these contours to give them a vital
appearance. One is of little value without the
other.

52. Gingival sulcus
The gingival sulcus is produced by inserting a No.23
explorer tip or a similar sharp instrument between
the tooth and the wax at the gingival margin and
moving it mesiodistally along this junction.

53. Stippling
• The surface of natural attached gingivae
appears rough when it is wiped dry.
• This stippled effect is produced on the denture
by use of a stiff bristled tooth brush.

54. Stippling complete dentures with a non concentric
bur

55. Gingival stippling in labial flanges for complete dentures
1. Wax the anterior flange and perform gingival
characterization (festooning)
2. Flame the wax and press a synthetic sponge made from
low-density polyurethane foam over the flamed region.
Emboss the roughness of the sponge onto the softened
wax.
3. Gently flame the anterior flange again to reduce the
roughness; note that the gingival stippling becomes self-
evident

56. Labial flange without gingival characterization
Appearance of labial flange after characterization
using sponge.
J Prosthet Dent 2007;97:118

57. Tinting and staining of denture
Steps in tinting
Described by Rudd and Morrow
A denture base tinting acrylic should be used.
5 primary tinting resins:
H- light pink
F- light red
A- medium red
E- purple
B- brown

58. Techniques for tinting denture base
Johnson’s technique
Winkler’s technique
Chaudhary and Craig technique
Plack, Todd, Woody technique

59. Errors in esthetics
Morphological factors:
• Bulging lip
• Falling in of upper lip
Severe overbite
Contracted arch
Crowded teeth
Canine too prominent
Anterior teeth show too much
Posterior teeth show too much
Dark teeth
Too white teeth
Teeth and face mismatch
Denture base material too obvious

60. Physiologic factors :
• Anterior tooth movement
• Clicking sounds
• Pronouncing ‘sh’ instead of ‘s’
• Drooling
• Lisping

61. Conclusion
• For a complete denture prosthesis to be
successful it should be mechanically
sound,physiologically acceptable and
esthetically pleasing.
• By having a knowledge about principles and
fundamentals of esthetics and by following
simple steps to incorporate this knowledge in
complete dentures more life like restorations
can be fabricated.

62. References
o GPT- 8
o Frush J P, Fisher R D. Introduction to dentogenic restorations . J
prosthet Dent 1955 ; 5(5): 586-595
o Frush J P, Fisher R D. How dentogenic restorations interpret the sex
factor. J prosthet dent 1956; 6(2): 160-172
o Frush J P, Fisher R D. How dentogenics interprets the personality factor.
J Prosthet Dent 1956;6:441-9
o Nayar S, Craik N W. Achieving predictable gingival stippling in labial
flanges of gingival veneers and complete dentures. J Prosthet Dent
2007;97:118.
o Morrow R M, Rudd K D, Rhoads J E. Dental laboratory procedures –
complete dentures. Volume 1 2nd edition. C V Mosby Company1985.
page 545-50.

63. o Frush J P, Fisher R D. the age factor in dentogenics. J prosthe dent 1957;7: 5-13
o Frush J P, Fisher R D. Dynesthetic interpretation of the dentogenic concept. J
Prosthet dent 1958;8: 558-581.
o Gitto CA, Esposito SJ, Draper JM. A simple method of adding palatal rugae to a
complete denture. J prosthet dent 1999; 81:237-9
o Gonzalez-CasafontAM, Dumbrigue HB. Stippling complete dentures with a
nonconcentric bur. J Prosthet Dent 2002;88:109-10.
o Edwin I Levin :Dental Esthetics and the golden proportion , Journal of Prosthetic
Dentistry 1978; 40: 244-252
o Sheldon Winkler, Essentials of complete denture prosthodontics,second, edition
2000

64. • Johnson. B. H Technique for packing and staining of complete dentures
Journal of prosthetic dentistry 1956;6(2):154-159
• Plack, Todd,Woody charecterisation of denture bases for people of colour J
Am Dent Assoc 1981;103(1):53-54
• Choudhary SS internal charecterisation of denture bases using tissue
paper and acrylic stains Journal of indian prosthodontic society
2011;11(3):202-204
• Winkler SS , Morris H F custom tinting of denture bases by visible light
cure lamination J Am Dent Assoc 2005; 1349-52.