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1. 1
Esthetics in Complete Dentures
Introduction
Nature has endowed everyone with dignity and satisfaction of
being an individual personality. Face has been defined as a chart of
destiny, an impression of fullness of life, and mirror of soul.
Variety of facial expressions or lack of it is a perspective of
individual’s thoughts, emotions and attitude. Vital area of expression is
located in region of mouth and it’s the teeth which impart character to
impression. In general humans are programmed similarly as to what is
esthetic and what is not. It appears that beauty does really lie in the
eye of the beholder and more often than not it is a matter of genetic
programming. A denture usually is perceived as esthetic when teeth and
bases are in harmony and unesthetic when disharmony exists

2. 2
Methods for Achieving Complete Denture Esthetics
0*
Accurate impressions
1*
Jaw relations
2*
Selection of anterior teeth
3*
Arrangement of teeth
4*
Characterization of denture
Accurate Impressions
Muscles of facial expression have bony origin and insert in the
soft tissue of the lips or corner of mouth. As teeth are lost functions of
facial muscles are impaired. Resultant edentulous appearance has a
profound effect on personality of the patient. Supporting the facial
muscles with properly formed borders is essential. Generally labial
vestibules have little true space. Over extension of borders gives the
patient having cotton roll beneath the lip.
On the other hand, long
standing edentulous patient with significant resorption requires thicker
borders.

3. 3
Vertical Jaw Relations
Correct vertical dimension is essential for proper positioning
of Orbicularis oris and associated muscles. Insufficient vertical
dimension of occlusion leads to muscles sagging because origins
become too close to insertion. Excessive vertical dimension of
occlusion causes stretched appearance and the patient is unable to
approximate his/her lips resulting in speech problems.
SELECTION OF TEETH
The selection of teeth and their arrangement to meet esthetic
requirements demands artistic skill in addition to scientific knowledge.
There are no rules of thumb but there are anatomic landmarks and
manufactured aids that can be used as guides. Best method to develop
the skill is to observe natural teeth.
Flashback
5*
J.W. White (1872) -Proposed concept of Correspondence and
Harmony.
Factors
considered
were
complexion, colour of hair and eyes.
size
of
body
and
face,

4. 4
6*
Tempramental Theory Of Tooth Selection - Hippocrates 2400
years ago felt man was composed of 4 body - blood, phlegm, yellow
and black bile. Various ailments and differences in man were
explained on the basis of imbalances of these fluids. Dr. Spurzheim
contended that the Hippocrate’s theory should apply to teeth as well.
He classified man according to dominance of humour.
7*
Sanguineous (bold) type for blood dominance.
8*
Phlegmatic (calm) type for phlegm dominance.
9*
Choleric (angry) type for yellow bile dominance.
10*
Melancholic (sad) type for black bile dominance.
Further, in each human body there is a governing
principle (dominant fluid) which ensures harmony of size and form
among several parts, and each group has characteristic teeth.

5. 5

Typal Form Theory
It was introduced by Leon Williams in 1917. According to this,
the shape of the teeth is governed to considerable extent by face
forms. He classified face into three forms- square, tapering and
ovoid.
In 1936, Mr. Stein, from Dept of Anthropology of Colombia
University challenged typal form theory. He contended that upper
anterior teeth are like fingerprints and no two are alike. Outline form
of teeth is relatively unimportant in denture construction for it changes
with the age of person.

6. 6

Dentogenic Concept
In 1956-57 Frush And Fisher proposed the Dentogenic Concept
of Teeth Selection . This concept explains the interpretation of three
vital factors which every individual possesses viz. sex, personality
and age. Construction of dentures is a matter of interpreting these
factors properly in dentures. These are accomplished by altering the
tooth, its position & the matrix. When these three are properly treated,
a
pleasant
personality
is
revealed,
masculinity
and
femininity
effectively created and age of patient is dignified in smile.
Interpretation of Sex Factor
Feminine form is expressed by roundness, smoothness and
softness. Grinding of incisal edges must follow a curve rather than a
straight line. Masculinity is expressed by angularity, aggressiveness
and hardness. By sufficient depth grinding and squaring the incisal
edges of central and lateral incisor masculinity is emphasized.

7. 7
Tooth Position
11*
Move one central incisor out at the cervical end, leaving incisal
edges together for a lively and harmonious position.
12*
Move one central incisor bodily anterior to other for a more
vigourous position.
13*
Rotate both the central incisors with distal surface forward with
one depressed cervically and other incisally.
14*
The lateral incisor is rotated to show its mesial surface (may
slightly overlap the central incisor) to give soft and youthful
appearance.
15*
By rotating the lateral incisors mesially effect is hardened.
16*
A more prominent cuspid eminence gives a more vigourous or
masculine look.

8. 8
Depth Grinding
It is done on the mesial surface of central incisor. Mesio-labial
line angle is ground in order to move the deepest visible point further
lingually. A flat, thin, narrow looking tooth is delicate looking suitable
for delicate women. A thick, bony, big sized tooth is vigourous and
suitable for men.
Personality
A person can be delicate, medium or vigourous when placed on
personality spectrum. Only small proportion of patients would be on
extreme ends. The mold selected for the patient should be in
accordance with the personality.
Management of Age Factor
Early youth is apparent by mamelon and bluish incisal
edge. As age progresses the mamelons disappear and bluish incisal
edge may be abraded. The pointed tip of the canine wears down to a
mature form. The tip of the canine should be artistically ground so as
to imply abrasion against the opposing tooth.

9. 9
Erosion in gingival thirds and drifting of teeth (e.g.
diestema) due to premature loss of teeth may be reproduced in denture.
Advancing age can be indicated by shortening the papilla and raising
the gum line. Attached gingiva looses its stippled appearance and
appears smooth and edematous with age.
Guidelines for Selection of Teeth
Teeth are selected for

10. 10
17*
Shade
18*
Size
19*
Shape
SHADE
Natural teeth vary as much in colour as they do in size and
shape. Selection of a suitable shade for an edentulous patient is a
matter
of
individual
judgment.
There
are
however
a
few
generalizations. Shade itself possesses three dimensions
20*
Hue- specific colour produced by a specific wave length
21*
Chroma- amount of colour per unit area of an object. Fair
complexion people have less chroma
22*
Value- the relative lightness or darkness of an object.

11. 11
Natural Teeth
Natural teeth are not monochromatic but consist of three shades.
o Cervical
o Incisal
- more chroma
- more translucency
o Transitional
Maxillary central incisors are the lightest teeth, maxillary
lateral & mandibular Incisors - slightly darker, Canines are darker still.
Posterior teeth are uniform in colour & slightly lighter than canine.
Teeth darken slightly with age. Mixing artificial anterior teeth from
different sets produces better esthetic results.
Aids for selection of shade
23*
Hair colour
24*
Eye colour
25*
Complexion
26*
Age

12. 12
But hair colour changes through out life or by artificial
colouring. Secondly iris seems to be too small to influence tooth shade.
So a more logical approach to select teeth is based on
27*
Skin colour
28*
Age
29*
Patient’s desire
Skin Colour
Yellow is suitable for fresh complexion. Grey tinged with blue is used
dark complexion. Opal suits to a clear pale complexion. Small pearly
white teeth are so rare that they always look false.

13. 13
Age and Tooth Colour
Colour of natural teeth progressively darkens with age. Pulp
chambers become smaller because of deposition of secondary dentin.
As a result the tooth becomes opaque. Also there is increased wear of
incisal edges and the enamel is lost. Translucency also disappears and
dentin picks up various stains.

14. 14
Dentogenic Concept
According to dentogenic concept darker shade in suitable for
men or vigorous personalities. Lighter shade is used for women and
delicate personalities. Also teeth darken with advancing age.
Requirements for Shade Selection
30*
Patient -upright position.
31*
Dentist’s plane of vision - perpendicular to plane of teeth.
32*
Teeth viewed from diff. angles to make sure shadows don't
influence colour.
33*
Patient’s mouth - not be opened too wide
34*
White light with filters or natural light (preferably 10am to 2pm)
35*
Eyes fatigue easily- should not be focussed on a tooth for more
than a few seconds.
36*
For proper value, shade guide should be viewed from a distance
of 6-8 feet.

15. 15
SIZE
Pre Extraction Records
37*
Diagnostic casts prior to extraction
38*
Recent photos before loss of teeth
39*
Radiographs making allowance for lengthening and shortening

16. 16
Post Extraction Examination
For a denture wearer examine the following-
40*
Do the teeth appear lost in face (too small or set posteriorly)?
41*
Do they appear too regular like picket fence?
42*
Teeth set too high?
43*
Too large?
44*
Do maxillary teeth show during smiling and mandibular during
speech?
Various Formulas
45*
Width of maxillary central incisors= 1/16 bizygomatic width
46*
Max. Six anteriors= 1/3.3 bizygomatic width
47*
Length of max central incisors= 1/16 length of face
48*
Cranial circumference= 10 x width of upper anteriors

17. 17
49*
As a rule <48 mm upper anteriors are small, > 52 large
Available Space
50*
Length of maxillary wax rim first established by phonetics (f & v
sounds) and adequate support for soft tissues of upper lip.
51*
Maxillary central incisor =Incisal edge of rim to high lip line
52*
Vertical lines are scribed on wax rims directly down from right
and left alae of nose. These measurements on curve of wax rim=
width of six anteriors
Golden Proportion
Levin observed that widths of maxillary anterior teeth when viewed
from front lie in golden proportion .i.e.,
53*
Width of central incisor X 0.618= width of lateral incisor
54*
Or
62%
of
central
incisors
width=
62% of width of lateral incisor = canine and so on
lateral
incisor

18. 18
Red Proportion
According to Daniel H Ward when golden proportion is
used, lateral incisors seem to be too narrow and canine is not prevalent
enough.This author has proposed a RED proportion or Reoccurring
Esthetic Dental Proportion . According to this the dentist can establish
his own proportion and remain consistent while moving distally.

19. 19
55*
70% seems to be more pleasing but should be modified to fit face
skeletal structure and general body type.
56*
Endomorph - higher proportion.
57*
Ectomorph - lower proportion.
58*
Secondly width to height ratio for central incisor 66%- 80%
(78% is quite pleasing). For taller persons lower ratios.
Dentogenic Concept
59*
Incisors tend to be longer in younger individuals
60*
Women’s teeth are smaller than men, larger persons -large teeth
usually
61*
Distinct difference between the size of central incisor and lateral
incisor in women
62*
Incisors in men are proportionately shorter.
(Robert G. Vig in 1978 reported that average maxillary central incisor
exposure in men was 1.91mm; in women- 3.40 mm)

20. 20
SHAPE (Form)
Around the turn of century dental investigators searched for
a direct relationship between tooth form and facial form. Berry was
probably the first to demonstrate the outline form of maxillary central
incisor and inverted outline of face. J. Leon Williams applied typal
forms of face art to classification of maxillary anterior teeth. William
classified face as square, tapering and ovoid
Guidelines
Tooth selected should be in harmony with the face of the
individual. Outline form is considered from the front view of the
patient and from labial of maxillary central incisor. The shape of the
labial surface is more important-
63*
The labial surface of the tooth viewed from the mesial should
have a contour similar to patient’s profile. - Convex/ straight/
concave.

21. 21
64*
Labial surface of teeth viewed from the incisal should show a
convexity or flatness similar to that seen when face is viewed from
under the chin or top of head.
65*
Also
there
may
be
reverse
curves
in
the
form
of
mild
irregularities.
66*
Contact areas or surface of anterior teeth should show wear
according to age
67*
Broadened contact areas look more natural
68*
Women tend to have ovoid form of teeth with rounded distal
incisal angles while men tend to have squarish tooth forms
ARRANGEMENT OF TEETH

22. 22
Requirements
Orientation of occlusal plane
In sagittal view the occlusal plane is determined by the incisal
edges and the approximate juncture of upper and middle thirds of
retromolar pads. The occlusal plane lies parallel to camper ’s line in
sagittal plane and parallel to interpupillary line in frontal plane. Fox
plane can be used to check these two relations.
Occlusal rims
Wax rims should be developed with great care to fill the space
once occupied by patient’s natural teeth. Rims should offer adequate
support for soft tissues of face. They should allow for esthetic buccal
corridor.
Arrangement of Teeth for Esthetics And Functional Harmony Can Be
Divided into

23. 23
1. Horizontal orientation of anterior teeth
2. Vertical orientation
3. Inclination
4. Harmony in composition
5. Refinement of individual tooth positions
6. Dentogenic concept
Horizontal Orientation
Position and expression of lips and lower part of face are the
best guides. Greatest harm is done by setting the max. Teeth back to or
under the ridge (regardless of actual absorption). This is evident by
dropping of the corner of mouth, reduction in vermilion border,
philtrum prominence deepening of nasolabial grooves. Excessive lip
support - too far anterior placement of teeth gives a stretched, tight
appearance of lips, a tendency for lips to dislodge dentures during
function, elimination of normal contours of lips, distortion of philtrum
and sulci.

24. 24
Aids

25. 25
o Photographs
69*
70*
can be very helpful
Pre extraction diagnostic casts
Ridge relation must be taken into account.if mandibular ridge is
prognathic the anteriors can be set end to end.
71*
Observation of position of anterior teeth when trial denture base
is out of mouth can be helpful.
72*
The labial surface of most natural central incisor is 8-10 mm. in
front of middle of incisive papilla.
73*
An imaginary transverse line between upper canines as viewed
from tissue contacting surface should cross close to middle of
incisive papilla.
Vertical Orientation

26. 26
Amount of upper anterior teeth seen during speech and facial
expression depend upon length of upper lip. Long upper lip- teeth may
not be visible even during speech. Short upper lip- full crown may be
visible along with large amount of mucous membrane/ denture base.
During smile incisal and middle thirds of maxillary teeth are visible in
most people. Incisal 1/3rd of mandibular anteriors is visible in most
people. Mandibular teeth are more visible than maxillary during speech
in half the patients (esp. in above 40 age group). Lower lip is a better
guide, in most people incisal edges of canine and pre molars are even
with corners of mouth when slightly open. Upper and lower trial
dentures should approx. Of equal size in most patients
Inclination of Anterior Teeth
Photographs and diagnostic casts can be very helpful. In many
patients upper anterior teeth are inclined labially relative to frontal
plane. Usually there is an obtuse angle between the bone and labial
surface of teeth. If extractions were done without unnecessary surgery,
the original inclination of labial plate is preserved for quite some time.
The facial profile is indicative of natural anterior tooth inclination.

27. 27
Harmony in General Composition of Anterior Teeth
It can be divided into
74*
Harmony in dental arch form and form of residual ridge
75*
Harmony of the long axis of central incisors and face
76*
Harmony of teeth with smile line of lower lip
77*
Harmony of opposing lines of labial and buccal surfaces
78*
Harmony of teeth and profile line
79*
Harmony of incisal wear and age

28. 28
Harmony of Dental Arch Form and Form of Residual Ridge
80*
The form of residual ridge may be generally classified as
1. Square
2. Ovoid
3. Tapering
Square arch form
81*
The distance between canines is wider.
82*
Posterior ridge are more parallel than other types.
83*
Curvature of anterior ridge is mild.
84*
Distal end of the central incisor is rotated towards the lip.
85*
Edge of lateral incisors is perpendicular to midline.
86*
Distal end of canines is rotated towards the line of posterior arch
form. These provide vigour and individuality to anterior set up.

29. 29
Ovoid arch form
87*
Distance between canines is narrower.
88*
Curvature of anterior ridge is more severe than square arch.
89*
Lateral incisors follow the arch line.
90*
Distal end of canine is towards the line of posterior ridge.
91*
This provides softness in appearance.

30. 30
Tapering arch form
92*
Distance of canines is narrower.
93*
Curvature of anterior arch is more severe than any other arch
form.
94*
Distal end of central incisor be rotated lingually.
95*
Lateral incisors follow the arch line.
96*
Distal end of canine is set up to posterior ridge.
Harmony of the Long Axis of Central Incisor and Face
If the long axis of central incisor teeth is not in harmony with
long axis of face, the arrangement does not blend with face (incisal
plane of anterior teeth not be parallel to interpupillary line). If central
incisor must be divergent, the midline of dental arch should be at
centre of face. Midline of mandibular dental arch aligned with midline
of maxillary central incisor.
Harmony with Smile Line of Lower Lip

31. 31
When a person smiles, the lower lip forms a pleasant
curvature known as smile line. This can be used as a guide line for
arranging upper anterior teeth when the line formed by incisal edges of
upper anterior teeth follows the curve line of lower lip during smiling
the effect is harmonious.

32. 32
Harmony of Opposing Lines of Labial and Buccal Surfaces
Setting teeth with the long axis parallel to each other, results in
esthetic failure.
The labial and buccal lines must have an opposing
equivalent angle or nearly so for harmonious effect. For e.g. if
maxillary right lateral incisor is set at an angle of 5 Degree to
perpendicular to lateral incisor of the left side be similarly placed.
Deviation in angulations may also be balanced by different teeth on
two sides.
Harmony of Teeth and Profile Line of Face
As a general rule the labial surfaces of maxillary central incisors
are parallel to profile line of face. In prognathism patients the incisal
edges of maxillary teeth are out farther than the cervical ends. In the
opposite conditions (Mandibular protrusion) the incisal edges of Max
teeth are inclined lingually more than the cervical ends. When the
labial of Max CI is parallel to the profile line of face the laterals
should be set at an opposite angle to prevent parallelism
Harmony of Incisal Wear and Age

33. 33
The incisal edges and proximal surfaces of anterior teeth wear
with age. The incisal edges of denture teeth should always be ground to
simulate wear surfaces that would have developed by that time.
Refinment of Individual Teeth Positions
Correct angulations of long axis of teeth are very important for
pleasing esthetics and function. These guidelines are general and may
be varied according to arch form or SPA FACTOR.

34. 34
Maxillary Anteriors
97*
Central Incisor- long axis slightly towards the midline when
viewed from front, labial inclination- 15 degree, contacts occlusal
plane
98*
Lateral
Incisor-long
axis
is
more
towards
midline,
labial
inclination -20 degrees, 1mm above occlusal plane
99*
Canine-long axis parallel to vertical axis both when viewed from
front and side
Mandibular Anteriors
100* Central
Incisors- long axis slightly towards vertical axis from
front, and slopes labially when viewed from side. Incisal edge is
2mm above the occlusal plane
101* Lateral
Incisor-
less
inclinations
than
central.2mm
above
occlusal plane
102* Canine-
long axis leans towards midline from front and slightly
lingually when viewed from side. 2mm above occlusal plane
Dentogenic Concept

35. 35
Individual tooth positions and forms can be varied to depict the
age, sex and personality of the individual such as
103* Rotation
of distal surface anteriorly and placement of one C. I.
ahead of the other give a vigourous look.
104* Small
lateral incisors with rounded incisal edges indicate
femininity
105* Femininity
is
also
characterized
by
curved
surfaces
and
prominent smile line
ACCEPTANCE BY THE PATIENT
106* The
107* It
ultimate test for esthetics is the patient
is the patient who has to wear the denture
108* Involvement
and education of the patient is very important at
each step
CHARACTERIZATION OF DENTURES

36. 36
Absolutely white, regular flawless teeth contained in smooth
highly polished, uniform pink colour denture base appear artificial and
lifeless. To create naturalness stains, disfigurement, and natural
pigmentation pattern of human gingiva can be incorporated.
Teeth
Brown stains around the necks of teeth simulate stains due to
smoking, tea and coffee. White opaque stains represent hypoplastic
areas and synthetic fillings.
Denture Bases
By production of contour and simulating the anatomical
characteristics of oral mucosa with various stains in a denture base a
life like restoration can be obtained.

37. 37
Contour of Denture Base
109* Anatomical
contours of marginal and free gingiva, labial and
buccal mucosa, root eminencies be reproduced in a denture base.
110* Over
exaggeration of contours (such as excessive festooning)
should be avoided - never observed in nature.
111*
High polish is given to those areas which are not readily visible.
Procedure for Characterization
After teeth set up excess wax is built up around necks of teeth,
flange area and vestibular sulcus. It’s better to flow molten wax rather
than adding wax strips.

38. 38
Carving and contouring
FACIAL SURFACE
112* Gingival
margin and free gingiva are formed by removing wax
with wax carver directed at 45 degrees.
113* Wax
is removed from cervical portion until sufficient exposure is
made.
114* Don't
produce sulcus as it as it harbours food.
115* More
labial surface is exposed in elderly patients.
116* Interdental
papilla is left long and pointed in young & short and
blunt in older patients.
117* Gingival
margins of upper central incisor and canine are at
higher level than lateral.
118* Creation
of slight bulge to gingival margin gives natural
appearance.
119* Moderate
eminence formed over root area of incisors, heavy and
bold for canines.
120* Posteriors
should have minor root eminences.

39. 39
121* In
general labial and buccal flanges are shaped concave.
122* Gingival
margin is accentuated by a depression or groove along
the junction of free and attached gingiva.
123* Marginal
gingiva and papilla are made convex.
STIPPLING EFFECT
124* Rough
texture of natural attached gingiva is reproduced in
dentures.
125* Stippling
should be done only after the completion of wax up
procedure.
126* A stiff
tooth brush is trimmed to 1 or 2 shortened row of bristles.
127* The
bristles are pricked on labial and buccal surface of wax up.
128* The
depressions are smoothened by passing over a fine flame.

40. 40
Colour distribution of gingiva
129* Deep
130* Pale
red tones - muccobuccal fold and interdental papilla
yellow tones - root eminences.
131* Neutral
pink
tones
-
fan
shaped
areas
between
the
root
eminences.
132* Melanin
pigment -attached gingiva, marginal gingiva as regular
band or irregular spots.

41. 41
Staining Armamentarium
133* Red
stains
134* Yellow
stains
135* Blue,
brown or its combination, to be used for melanin
pigmentation.
136* 1
bottle containing natural pink polymer and other with nylon
fibre. They are mixed together for vascularity and capillary effect
Staining Procedure
1ST TECHNIQUE
137* Trial
packing the denture with neutral pink acrylic resin with a
cellophane between teeth and resin.
138* After
separation of flask halves, acrylic resin is well adapted to
edentulous cast.
139* Sprinkle
a layer of desired tone of stain and moisten it carefully
with monomer using small glass s yringe with 24 gauge needle.

42. 42
2ND TECHNIQUE
140* Sequential
application of stains on facial surface of plaster mold
prior to packing.
141* Sprinkle
142* Place
red tones for melanin to marginal gingiva and papilla.
yellow and pale pink tones over the root areas and moisten
with monomer.
143* Light
red tones - triangular areas between teeth.
144* Deep
red a& blue tones along periphery of labial flange.
145* Light
pink all over the area to complete the veneer.
146* Allow
147* Wet
this veneer to stand for 10 min.
it with monomer every few minutes and cover it with a sheet
of polythene.
148* Later
pack the mold with denture base resin.
RE FE RE NCE S

43. 43
Ar thu r O Rahn , Ch arl es M. H ea rtw el l : Tex t book of com pl et e Dent ur es, ed 5,
Lo ndon, 1993.
G eorg e A. Za rb , Ch arl es L .B ol en d er, Ju d son C. H i ck ey, Gu nn ar E . Carl sson :
Bou cher ’s prost hodont i c t reat m ent for edent ul ous pati ent s, ed 10, B . I P ubl i cat i ons
P vt Lt d.
John J. S h arry: C om pl et e Dent ure P rost hodonti cs, McG rawhi l l B ook Com pan y,
In c . 1962.
S h eld on Win k l er: Essent i al s of com pl et e Dent ure P rost hodont i cs, ed 2, Ishi yak u
Euro Am eri ca Inc .