Esthetics In Complete Denture

Dr. Abdul Razak

Prof And Head

Dept. Of Prosthodontics and Crown & Bridge

MES Dental College And Hospital, Perinthalmanna

first dental prosthesis - believed to have been constructed in Egypt about 2500 BC

Introduction

• Humanity has always been preoccupied with facial beauty
• Esthetic norms have changed with time and success can be obtained only if we know the definitions of modern ideals which have socal acceptance
• Lower third of face provides significant beauty mainly due to presence of mouth
• Smile is affected when teeth are lost
• Importance of smile has made esthetics of denture a significant factor

DEFINITIONS

• Esthetics 1. The branch of philosophy dealing with beauty

2. In dentistry , the theory and philosophy that deal with beauty and the beautiful , especially with respect to the appearance of a dental restoration , as achieved through its form or color. Those subjective and objective elements and principles underlying the beauty and attractiveness of an object , design and principle.

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Glossary of Prosthodontic Terms, Edition 9, J Prosthet Dent 2017;1-105

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1.Felix A French in 1951

1901 Temperamental theory of tooth selection

• Nervous
• Sanguine
• bilious
• lymphatic

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1914 Geometric theory of tooth selection - Dr. J. Leon Williams.

• definite relationship between outline form of face and outline form of upper central incisors.
• square, ovoid, and tapering

F A French. The selection and arrangement of the anterior teeth in prosthetic dentures. J.Prosthet Dent 1951;1:587-593

• 1920- Nelson- arch form and alignment form
• showed definite relation between form of maxillary arch and outline form of upper anterior teeth.

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Alignment of teeth.

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Square arch-teeth are set straight up and down, incisal edges are even.

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Tapering arch-slant out, incisal edges are forward from the cervical part, central incisors tend to overlap and set to a V-shaped alignment.

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Ovoid- central incisors are set slanting inward.

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Nelson, A. A.: The Esthetic Triangle in the Arrangement of Teeth, Nat. D. Assn. 9:392-401, 1922.

• 1936 Stein challenged Williams Geometric theory
• opposed concept of harmony between face form and tooth form.
• showed wide teeth in narrow skulls, short teeth in narrow skulls, similar teeth in dissimilar skulls.
• upper anterior teeth are like fingerprints, vary from one individual to another- yet they have basic patterns.

Stein, M. R. : Williams’ Classification of Anterior Tooth Forms, J. Am. Dent. A. 23:1512-1518, 1936.

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2. Earl pound in 1954,

emphasized in replacing in the denture, both in contour and color, all of the structures that have wasted away.

He stressed that the first principle of esthetics is replacing the teeth in the natural position from which they came.

He concluded the review with the fine arts of denture prosthesis have lost in the fallacies of mechanical concepts.

E Pound. lost-fine arts in the fallacy of the ridges. J.Prosthet Dent 1954;4:06-16

1. Evaluating residual ridges as a changeable denture foundation rather than as a guide for tooth positioning.

2. Devoting more study to improve the health of our patients by the preservation of the alveolar residual ridges.

3. Studying and applying principles of esthetics in placing teeth and the supporting structures of their normal anatomy

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This mechanical concepts can be resolved by;

3. John P Frush And Roland D Fisher in 1955

• 1952 started Swissdent Foundation - improve esthetics in prosthetic dentistry.

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• introduced “dentogenic” to ease selection of anterior teeth
• They concluded that factors of Dentogenic restorations,
• sex,
• age, and
• Personality has improved appearance of the denture wearer.

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J P frush, R Fisher. Introduction to dentogenic restorations. J.Prosthet Dent 1955;5:586-595

SPA- FACTOR

• Incisal edges of the max anterior teeth of female follow the curve of the lower lip
• Distal surfaces of the centrals are usually rotated in posterior direction

Curve suggest softness

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• The max centrals and canine are on a plane parallel to the lip while laterals are above the plane

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• Labial surfaces of centrals are usually not rotated

SEX-

Frush, J. P., & Fisher, R. D. (1956). How dentogenic restorations interpret the sex factor. The Journal of Prosthetic Dentistry, 6(2), 160–172

The Personality Factor

• The personality of people expressed in their habitual pattern and behavior

1)Delicate

2)Medium pleasing

3)Vigorous

The comprehensive use of personality depends upon our manipulation of tooth shapes , tooth color, tooth position

Frush, J. P., & Fisher, R. D. (1956). How dentogenics interprets the personality factor. The Journal of Prosthetic Dentistry, 6(4), 441–IN2.

Delicate contours of the sculpted giraffe are the same

Delicate contours of the teeth

Medium character in the personality in the sculpture IIama

Same medium pleasing character of these teeth

Vigorous type of sculpting as represented by the bull and

The teeth of the same vigorous quality

AGE FACTOR

• age changes take place throughout the entire body including teeth

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• Abrasion- central and lateral incisor abrade in a curve

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• Wearing away of the natural teeth at contact points and migration create space between teeth

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• Smile line loses its sharpness in older age

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Frush, J. P., & Fisher, R. D. (1957). The age factor in dentogenics. The Journal of Prosthetic Dentistry, 7(1), 5–13.

• erosion imparted to the artificial tooth by carefully grinding and polishing, very effectively conveys the illusion of vigor and advanced age.

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• Advanced age can be indicated appropriately by shortening of the papillae and by raising the gingival gum line.

4. Donald F K in 1956

Studied relation between denture esthetics and denture base

• reproduction of contours of tissue covered by the base
• its staining to reproduce the natural tissue hues

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• Study showed indications for esthetic denture bases in

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• patients with active upper lip
• patient with prominent premaxillary area
• theatrical performers and singers
• psychologic effect on the patient.

Donald F K. Esthetics and the denture base. J.Prosthet Dent 1956;6:603-615

5. Frush and fisher in 1958

• Studied the qualities of femininity, masculinity, personality and the various physiologic ages in smile.

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• showed that by application of Dynesthetic techniques to the Dentogenic concept accomplished pleasing personality, masculinity and femininity effectively.

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• To apply the Dynesthetic techniques we should require a knowledge of the Dentogenic concept.

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• The selection of teeth and subsequent sculpturing to the individual and color and contours of the denture base are all part of the Dynesthetic techniques.

J P Frush, R Fisher. The dynesthetic interpretation of the dentogenic concept. J.Prosthet Dent 1958;8:558-581

Physiologic Shade Selection

• Artificial tooth shades should be classified according to the physiologic color changes seen in progressively aging, undiseased natural teeth.
• An illusion of natural dentition to be created
• We must have shades available for older people which are lighter than some of those for younger people
• One other necessary quality of shades of artificial teeth is that of the unusual or special shades seen in natural teeth.

Hue

• Variety of color (red, green, yellow, etc.)

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• Determined by wavelength of observed light within the VLS

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• Reflected wavelength determines hue

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Chroma

The intensity or saturation of a hue

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Low Chroma High Chroma

Value

• The relative darkness or lightness of a color, or brightness of an object
• Range = 0-10 (0=black, 10 = white)
• Amount of light energy an object reflects or transmits
• Objects of different hues / chroma can be identical value
• Restorations too high in value are easily detected

Low Value High Value

Shade Selection

• Along side of nose – basic hue, value & chroma.

• Under lips – only incisal edge exposed – effect of colour with mouth relaxed.

• Under lips – only cervical end covered – smile.

• Use of Squint test.

• Light source

-should be discussed in the same light source

-Tryin must be done with lipstick on (plays a role in background, mouth shape outline, unifying border)

-Tooth next to red lipstick may look green, tooth selected must contain enough red (pink) to neutralize greenish tinge

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• Personality-1) strong, outgoing, vivacious, dynamic, zippy, indicator for a lighter shade

2) Weak, opposite of strong, darker shade

3) Average, between strong and weak

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• Skin color (background)

-Dark skinned, shades adjusted downwards because background will make shade appear lighter

-light skinned- lighter

-Average- intermediate

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• with age skin wrinkles and appear darker

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• Facial features, strong features require lighter teeth

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• Total tooth area- If small amount of teeth shown lighter teeth, because impact of the mouth has to be created in smaller area.

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• Heavy lipped individual with a low lip line require a lighter shade

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• The mouth with the reduced amount of illumination on the teeth makes the strongest demand for lightness of shade.

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• investigated the influence of changes in tooth color on judgements of facial attractiveness.
• Standardized photographs were taken and digitally manipulated.
• Results showed that naming of teeth as the second most important factor for evaluating the overall attractiveness of a smiling face implies that aspects of teeth other than color are important.

Höfel, Lea & Lange, Matthias & Jacobsen, Thomas. (2007). Beauty and the teeth: Perception of tooth color and its influence on the overall judgment of facial attractiveness. The International journal of periodontics & restorative dentistry. 27. 349-57.

• The subject of esthetics has always been a gray area in dentistry.
• Unlike the sharply defined fit of castings,or the duplicability of a correct jaw relation record , there is no such achievement as “ideal esthetics”.
• Unplanned esthetics will results in a multitude of sins.
• The best time to gain insight into the esthetic problems of a patient is the first time that you meet that patient.

Dental clinics of north america 1977;21(2):285-297

Dynesthetic theory�

• Dynesthetics means vital beauty.
• dyn taken from greek word dynamis = power
• Means producing effect of movement or progression.
• edentulous mouth is in constant and permanent change, our efforts should be in fabricating prosthesis which follows the physiologic age changes in the tissues
• artificial teeth are selected according to the personality of the patient, subsequent sculpturing is directed toward accentuating masculinity or femininity, and the denture base color and contour helps to satisfy the age factor.
• These secondary factors are called dynesthetics.

Considerations in Dynesthetics

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• MOLD: treatment for abrasion, erosion, depth grinding, masculinity, or feminity, shaping and polishing

Progressive abrasion of artificial tooth as

Age progresses, cut made for normal abrasion

Tooth modified to simulate erosion

Depth perception increased by depth grinding , cut made

On the labial mesial line angle of the artificial teeth

Masculine feminine

• LIP SUPPORT: bodily anteroposterior position of teeth which adequately support the upper lip in a natural and pleasing manner

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• Mid Line:

- The features of a face usually slant one or the other way and it is rather difficult to see a true midline

It is usually more eccentric than is noticed.

-An eccentric midline if not too exaggerated is acceptable and may lend to the illusion of natural dentition

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An acceptable midline

(solid line)

An error in composition

Which results when the

Mid axis of central incisor

Is not vertical

• Speaking line: the speaking line is the incisal length or the vertical composition of the anterior teeth. It is so called because the final evaluation is made when patient is speaking.

a) Young women -3mm below lip at rest

b) Young men -2mm below lip at rest

c) Middle age -11/2 below lip at rest

d) Old age -0mm to 2mm above lip at rest

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• Smiling line:

It is determined by the age of the patient and decreases as patient gets older

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Speaking line is correct because a portion of the

Lateral incisor show when the patient speaks

seriously

• Spaces: 1)All spaces should be v shaped to shed food

2) All diastema between the central incisor should be avoided

3)A diastema should be asymmetrically placed on either side of the dental arch

4) The width of diastemas should be controlled so as not to appear unsightly, wide diastemas appear as black holes.

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V shaped areas are the proper self cleansing

Form of all diastemas

Spaces placed between the posterior teeth

Allows additional spillways, additional cutting

Edges achieved by sharpening the marginal

ridges

• Embrasures : There is no separation of the proximal surface since contact areas are touching.
• An embrasure is employed in the same manner as the diastema or spaces but much more frequently.

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• Buccal corridor: It begins at the cuspid, size and shape controlled by position and slant of cuspid

-Use of buccal corridor prevents “sixty tooth smile” or the molar to molar smile which is often characteristic of a denture.

• Gum line: The gum line at the cervical end should vary in height

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The arrow E point to the embrasures

Which add a sense of freedom to the

Appearance of the dental composition

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• 1)Slightly below the high lip line at the central incisor

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• 2)Lower than the central incisor gum line at the lateral incisor

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• 3)Higher than the central or lateral gum line at the cuspid

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• 4)Slightly lower than the cuspid at the bicuspid, and variable for the bicuspid and molars

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Interdental papillae: forms the main part of the visible denture base

1) Must extend to the point of tooth contact for cleanliness

2) It must be of various length

3) Convex in all directions

4) Must be shaped according to age

5) Must end near the labial face of the tooth and never slope inward to terminate toward the lingual portion of the proximal surface

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7. Richard E. lombardi in 1973

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• studied science and principles of visual perception and their influence in creating intense vitality, beauty, and realism on denture prosthesis.
• discussed principles of esthetics such as unity, composition, dominance, proportion, illusion in denture esthetics.

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Lombardi. The principles of visual perception and their clinical application to denture esthetics. J.Prosthet Dent 1973;29:558-381

Esthetic principles

• The greatest SIN against visual perception – placement of a static, dead denture in the most mobile and active of all the facial features in a living, dynamic, human being.

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Denture look

Natural appearance

• Sin against reality –teeth are set tight against the residual ridge so that when they are in the mouth, they appear to be too high and too far back in a position where they could not possibly be placed by nature.

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A 32-year-old edentulous patient with teeth set over the ridge with a straight line set-up resulting in the

typical denture look.

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The superior esthetic results achieved by

placing the maxillary anterior teeth to anatomic harmony.

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composition

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• We see because eye differentiates

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• It differentiates only if contrast exist

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• As contrast increases visibility increase and vice-versa.

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Unity

means "one-ness."

• It gives different parts of composition the effect of whole

Static unity Dynamic unity

• Structures with regular geometric Plants and animals

shapes. eg snowflakes & crystals

• Passive and inert Active living and growing
• Fixed, without motion

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• Elements which unify a composition - cohesive forces
• Elements which lend disunity - segregative forces
• Cohesive forces

-Repetion of shape, color, line

-Arrangement of the elements of a composition in a definite pattern/principle

-presence of a border

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• Unity with variety (segregating forces) is necessary to make design effective

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• Line is never same at any point (absolute variety) along its course yet it never leaves the surface of cone (absolute unity)

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• Adoption of a segment of this line for tooth placement and base festooning adds greatly to the dynamism of a set up

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A line inscribed around a cone .It is never the same at any two points, yet never

Deviates from the principle of the cone structure. Absolute unity with absolute

Variety is provided.

Hogarth’s Line of beauty

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• Example of unity with variety

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• Line inscribed around a cone

Dominance - provides static unity (monotonous)

dynamic unity (vigorous)

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• Dominance

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• one shape, color or line must dominate all the others

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• One tooth must dominate the anterior tooth arrangement by virtue of its size (central incisor is the logical choice)

Prime requisite

unity

Prime requisite

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composition

The dominance of size of the anterior teeth

A weak dominance takes place when

Subsequent elements do not provide

Sufficient factors of contrast.

A strong dominance requires the

Presence of subsequent elements

Providing strong factors of contrast

Proportion :�

• The concept of beauty has most often corresponded to a harmony in proportion
• The true value of proportion in esthetics, is its usefulness as a key tool in providing the unity-with-variety quotient in dental composition.
• Golden proportion has been used since time immemorial.
• It was extensively used in Greek architecture eg the Parthenon on the Acropolis of Athens.
• Kepler called it the “DIVINE PROPORTION”.

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Parthenon

Square of the ancients

Leonardo da Vinci

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Dental esthetics and golden proportion (Edwin I. Levin JPD 40;3, 1978)�

Proportion between teeth

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• In its simplest form it is the proportion between the larger part and smaller part.

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• When ratio between B and A is in the golden proportion, then B is 1.618 times larger than A.

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• The width of central incisor is in golden proportion to the width of the lateral incisor.

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• Width of the lateral incisor to width of canine is also in golden proportion, as is the width of canine to first premolar.

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0.618

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A

B

• The Golden Mean Gauge showing that the width of the central incisor is in the Golden Proportion to the width of the lateral incisor.

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• Similarly, the Gauge shows the lateral incisor is in the same Golden Proportion to the canine.

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• The canine is in Golden Proportion to the first premolar as shown by the Golden gauge.

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• The four anterior teeth are the most significant in a smile and they are in the Golden Proportion to each other.

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• The Golden Proportion Grid can assist us in perfecting the esthetics of the anterior teeth.

Recurring esthetic dental proportion

• Proportion of successive width of teeth as viewed from frontal should remain constant as one moves distally
• Dentist may use a proportion of his choice but it should remain consistent while moving distally
• More flexibility
• RED proportion should be modified to fit face, general body type of the patient

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Daniel H. Ward “Proportional smile design using the recurring esthetic dental (RED) proportion” Dental Clinics of North America, 2002; 143-153.

Illusion

• The front to back progression is a critical factor because illusion of arch shape and depth must be provided in the composition

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• If two like structure are placed at different distance on a line, the closest one to the viewer will appear larger.

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• If other structure are placed in between the size reduction will appear to be gradual .

When similar structures are aligned one after

Another they under go a progressive visual

Reduction of size from the nearest to the farthest

Ideal front to back progression of the

Dental composition

• Buccal corridor helps achieve this gradation by altering the light.

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• If two objects are the same size the lighter one appears larger, this is principle of illumination

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• As the teeth pass posteriorly, the light is reduced and this gives a gradually darker shade and therefore a smaller appearance.

Principle of illumination ,lighter one

Appear larger

Teeth of equal width but different length

Appear to have different widths

Balance in denture esthetics

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• The word denotes the stability resulting from equalization or exact adjustment of opposing forces.

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• Isolation is visually impossible, mind is constantly interpreting the relationship of objects to each other.

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• Induced forces-

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There is a desire on the part of the

Beholder to see disk move towards

A more stable position, it exhibits

Induced force (visual tension)

Disc seems more stable

In this position

When a pair of discs are placed

It is the location of the center of

The pair which lends balance

And stability to their placement

• Structural map- the most stable position of the disc is in the center

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• The proper midline location is a must for stability

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• Because of induced forces unbalanced things look transitory, restless, unfinished, accidental, temporary, aggravating, and tense.
• Balanced things, in contrast, look permanent, stable, completed, planned, peaceful, and in repose, because the visual tensions are eliminated.

Proposed structural map of tooth area the most

Stable position is at the intersection of the axes

And indicates the critical role of the midline

• Balance does not require symmetry

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• Formal balance means that things are same on both the sides

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• Informal balance means weight on either side of fulcrum are equal but not symmetrical

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• Balanced weight and direction must be achieved in a successful composition

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Direction and wt must be balanced

Lack of balance of direction is often

The result of cross bite ridge relationship

Imbalance results from altered direction

Of midline

Line in denture esthetics

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• Line is involved in

-shape of the tooth

-relationship between the adjacent teeth

-between the teeth and the matrix

-between the teeth and the background

-between the teeth and the dark space area between upper and the lower teeth when the mouth is open

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-Line is also involved in line formed by the incisal edges and buccal cusp tips of the teeth, in the occlusal plane, and the perspective illusion created by the total composition

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• Mold –shape of the tooth

shape of individual tooth is unimportant Because of two other perception principle

• The first is primacy of the whole.

The shape of the element becomes

Secondary to the shape of a series of the

Elements. The parts become a new whole.

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• The second factor is the presence of a border which binds the elements within into a separate entity

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• In dentistry, the wall (face) and frame (lips)are provided for us by nature.

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• Attention of the eye is confined

to the contents within the lips

Dimensions of the new whole created

By the entire series

The border unifies the

Elements within it

Line in dental composition

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• The strongest relationship that can exist between two lines is a perpendicular relationship because it exhibits greatest possible contrast

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• Most harmonious is parallel relationship, because it exhibits least possible contrast.

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• The line relationship between adjacent teeth should be harmonious, that is striving towards parallelism and therefore harmony.

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• The chief offender is usually the line

formed by the distal outline of lateral incisor.

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• The buccal surface of first bicuspid is

a very close second

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Conflict of line

• It is often necessary to reduce the distolabioincisal contour and the incisal third of the distal outline of the lateral incisor to eliminate the conflicting line

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• The neck of the lateral incisor may be kept out labially to minimize the line conflict

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• The line formed by the labial outline of the cuspid is especially important because it is close to the line formed by the lower lip as it curves upward towards the commisure, it completes the smile line

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• If the incisal edge is tipped lingually, the line formed by the labial surface of the cuspid is more nearly Parallel to the line of the lower lip and Exhibits a soft relationship

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• As the cuspid is tipped more labially At the incisal edge it becomes more Perpendicular to lip line and exhibits A strong relationship

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• If the incisal edges of the anterior teeth parallel the line of the lower lip as in the smiling line, a harmonious relationship exists

Cuspid Lip Relation-ship

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• The occlusal plane is another critical line and must be located in proper position. The plane must not be allowed to drop as it progress posteriorly to prevent sin against reality and beauty.

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• The lines of the matrix at the gingival must be curved to prevent a sin against reality.

The maxillary bite rim is built parallel to

Camper’s line.

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Occlusal plane must rise as it progresses posteriorly

Negative space

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• dark space of the mouth behind the teeth which is as important in the composition as is the

Positive space or the object being viewed

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• It is in altering the shape of the incisal edges

Contrasted against this black background that

The dynamism and realism factor can be best analyzed for their effect.

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Negative

space

Vase or two profiles ?

Static negative

space

Dynamic negative space

Dynamic negative

space

• Incisal modification in tooth can

Be redily remembered and

Employed by a simple one, two

And three guide.

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• One –central incisor, express

Age

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• Two-lateral incisor, express

Sex

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• Three-cuspid express vigor

6.T Curtis and L Shaw in 1987

• studied the various clinical and laboratory prosthodontic procedures and concepts and its effect on esthetics, of resulting complete denture prosthesis.
• included factors such as
• Importance of the consultation appointment.
• Contribution of impression procedures
• Influence of centric and eccentric relationships
• Location of the occlusal plane
• Contribution of the polished surfaces
• Influence of proper delivery and maintenance.

T.A curtis, shaw, D A curtis. The influence of removable prosthodontic procedures and concepts on the esthetics of complete dentures. J.Prosthet Dent 1987;57:315-322

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• Impression procedures:Role of esthetics is to develop labial and buccal borders so that they are not only retentive but also support the lips and cheeks properly.
• Care must be taken not to over support these structures with borders that are too thick
• ANTERIOR TOOTH POSITION • “teeth should be placed where they grew.” Vertical tooth placement Horizontal tooth placement
• 8-10mm anterior to the center of the incisive papilla line extending between the middle of the upper cuspids in relation to the incisive fossa indicates proper location of the anterior teeth.

Payne,contouring and positioning , new york 1973, medcom,pp 50- 54

Esthetics and Maxillomandibular Relations

• Reduced VDO
• Lower third of face is changed
• Altered facial expression
• Vermilion border is straightened
• Drooping of corner of mouth
• Loss of muscle tone – flabbiness
• Crease at the corners
• Increased VDO
• Increased lower facial height
• Stretching of facial muscles

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TOOTH VISIBILITY:

It is more important for females than males as the average exposure of teeth is twice in females as that of males.

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• Young Woman 3 mm below the lip line
• Middle aged Woman 1.5 to 2 mm below the lipline
• Older Woman 1 mm below the lip line
• Young Man 2 mm below the lip line
• Middle aged Man 1 mm below the lip line
• Older Man 0 to 2 mm short of the lip line

Denture Base and Esthetics

• Waxing – Contouring wax base of a trial denture into the desired form

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• Tinting – Simulating the color and shade of natural oral tissue in the denture base

Waxing of the Trial Denture

• Gingival contour
• Canine eminence
• Depression between canine eminence and central incisors
• Gingival bulge
• Canine fossa
• Depression above the posterior gingival bulge
• Stippling of gingiva

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Staining

• In staining the denture base to simulate natural tissue, three factors must be considered.

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• Thickness and density of the soft tissue

greater soft tissue thickness will produce deeper hues, while greater soft tissue density tends to be found in lighter tissue.

• Extent of vascularity within the tissue
• Cellular components of the tissue.

Pound technique:�

Here, stains are applied on the stone investment surfaces before any packing is done.

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Since one has to work from the denture surface inward, all stains must be applied in reverse order, the one representing the outer surface being applied first.

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Disadvantages.

It is impossible to predict the results of application since the effect of adding the stains cannot be observed.

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The repeated addition of the monomer directly against the separating medium may result in the investment adhering to the base acrylic resin when the denture is deflasked.

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Kemnitzer technique

An important variation from pound procedure is incorporated in packing the flask.

Here staining is done after packing.

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Cellophane trial pack sheets are placed between teeth and the acrylic resin being packed, and not between the cast and the resin.

A neutral shade of pale pink color is used for packing

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Kemnitzer technique

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The final trial pack separation finds the acrylic resin adapted to the cast, with an anatomic reproduction of the lingual and facial surfaces.

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Upper half of the flask with uncured packed resin is exposed and staining procedure is carried out.

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Disadvantage:

• In trial packing large amount of resin is forced around the necks of the teeth. This resin cannot be removed completely, and it obliterates much of the stain application

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• Previous color characterization techniques have generally involved applying gingival stains to the gingival surfaces in the flask after boil-out.

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• In the present technique

• Custom staining can be done quickly and requires the following armamentarium:

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• Denture tinting chart
• Soft tissue shade guide
• No.6 Camel hair brush
• Acrylic resin stains or shade modifiers in a variety of colors including red, brown and black

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• Dappen dishes
• light curing unit for curing the stains.

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Kayon Denture Stains, Kay See Dental Mfg.

Palamed Acrylic Shade Modifiers, Heraeus Kulzer

Dentacolor creative Photo curing Color fluids, Heraeus Kulzer

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Technique

• Auto polymerizing and light-cured shade modifiers are used. When the denture has been processed in the appropriate shade of denture base material, it is contoured and smoothed with an acrylic bur but not polished.

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• Custom tinting is done at this time.

procedure

• Place monomer and colored powders in different dappen dishes.

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• Brush monomer on surfaces to be tinted.

The denture tinting chart

Denture tissue tinting chart with areas to be tinted and shades selected.

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• Wet brush and pick up increments of pale pink powder (or gingival toner) and apply to the blanched areas over root prominences.

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• Clean the brush and place red stain on the alvoelar mucosa and frenum attachments.
• The unattached and attached gingiva and the papillae remain as unstained denture base material

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• Keep stains moist with the monomer during this time to prevent crystallization.

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• Cure the acrylic resin stains in the light-curing unit according to the manufacturers instructions.

Conclusion

• “An esthetic denture is a removable restoration that creates an illusion of being what it is not”
• Esthetic challenges are each individual dentist’s responsibility and cannot be subcontracted.
• It is our responsibility as prosthodontics to consider the opportunity to lift the patient out of the category of a geometric figure and restore to him his true quality of a living and breathing man or women , with an individual personality and either the dignity of his years or the freshness of his youth.

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References

1. Zarb,Bolender, Prosthodontic treatment for edentulous patients .Twelfth edition
2. Sheldon Winkler, Essentials of complete denture prosthodontics,second, edition 2000
3. Claude R. Rufenacht: Fundamentals of esthetics, Quintessence Publishing Co , 1992
4. Edwin I Levin :Dental Esthetics and the golden proportion , Journal of Prosthetic Dentistry . 40: 244-252 , 1978.
5. Richard E. Lambarde : The Principle of visual perception and clinical application to denture esthetics , Journal of Prosthetic Dentistry . 29:359-381 ,1973.
6. John P. Frush, Ronald D Fisher :Introduction to Dentogenic Restorations , Journal of Prosthetic Dentistry ,5:587-595,1955.

7. John P. Frush, Ronald D Fisher :The Dynesthetic interpretation of Dentogenic concept, Journal of Prosthetic Dentistry. 8:559-581, 1958.

8 D J Lamb: Appearance and Aesthetics in denture practice, wright bristel, 1987.

9 Bernard levin; Impression for complete dentures, Quintessence pub. co., 1984.

10 Michael waliszwski ; Restoring Dentate Appearance : A Literature review for modern complete denture esthetics, Journal of Prosthetic Dentistry , 93 ; 386-393, 2005.

11 Ascheim , Dale: Esthetic Dentistry , a clinical approach to techniques and materials.2^nd edition , Mosby 2001

12. Ronald E. Goldstein:Esthetics in Dentistry,second edition, BC Decker 2002

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13 John P. Frush, Ronald D Fisher :How dentogenic restoration interpret sex factor,JPD.6:160-172,1956

14 John P. Frush, Ronald D Fisher: How dentogenic interpret the personality factor,JPD,6:441-449,1956

15 John P. Frush, Ronald D Fisher:the age factor in dentogenics,JPD

16 Donald F K. Esthetics and the denture base. J.Prosthet Dent 1956;6:603-615

17 E Pound. lost-fine arts in the fallacy of the ridges. J.Prosthet Dent 1954;4:06-

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Cross-References

1. Hall WR. Temperament in mechanical dentistry. Dental Practitioner 1886;4:49-54
2. Williams JL. The temperamental selection of artificial teeth, a fallacy. Dent Dig 1914;20:63-75
3. Wright WH. Correlation between face form and tooth form in young adults. J Am Dent Assoc 1942;29:1388-92.
4. Nelson AA. The aesthetic triangle in the arrangement of teeth: face form, tooth form, and alignment form, harmonious or grotesque. J Natl Dent Assoc 1922;9:392-401.

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5 Nelson AA. Selecting mould and hue of teeth for artificial restorations. Dent Items Interest 1925;47:767-77.

6 DeVan MM. The appearance phase of denture construction. Dent Clin North Am 1957;2:255-68.

7 Smith M. Measurement of personality traits and their relation to patient satisfaction with complete dentures. J Prosthet Dent 1976;35: 492-503.

8 Davis LG, Ashworth PD, Spriggs LS. Psychological effects of aesthetic dental treatment. J Dent 1998;26:547-54

9 Hirsch B, Levin B, Tiber N. Effects of patient involvement and esthetic preference on denture acceptance. J Prosthet Dent 1972;28:127-32.

10 Pound E. Esthetic dentures and their phonetic values. J Prosthet Dent 1951;1:98-111.

11. Jahangiri L, Reinhardt SB, Mehra RV, Matheson PB. Relationship between tooth shade value and skin color: an observational study. J Prosthet Dent 2002;87:149-52

12. Young L Jr, Glaros AG, Moore DJ, Collins JF. Assessing shade differences in acrylic resin denture and natural teeth. J Prosthet Dent 1994;71: 575-80
13. Nelson, A. A.: The Esthetic Triangle in the Arrangement of Teeth, Nat. D. Assn. 9:392-401, 1922.

14. Stein, M. R. : Williams’ Classification of Anterior Tooth Forms, J. Am. Dent. A. 23:1512-1518, 1936

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