Customizing Esthetic Complete Dentures

Dental News Volume XX, Number III, September, 2013

by Dr. Nazem Assaad, Dr. Najib Abou Hamra, Dr. Maha Ghotmi

Introduction and Background

Esthetic is a predominant factor for complete denture success (Carlsson et al, 1967). It is the most frequent complaints among complete denture patients (Jeganathan, 1993). Comfortable but unaesthetic dentures seem to be unaccepted by patients (Brewer, 1967). Compensating alveolar bone loss, correctly supporting lips and reestablishing the correct vertical dimension of occlusion are basic steps for achieving patient normal appearance. However, this is not sufficient to achieve individual denture esthetics. Denture esthetics has been defined as the cosmetic effect produced by a dental prosthesis that affects the desirable beauty, attractiveness, character and dignity of the individual (Glossary of Prosthodontic terms) which means proper form and shade of denture teeth and also individual set up of the teeth in order to achieve individual esthetic. Classically, three esthetic concepts have been differentiated to achieve denture esthetics (Waliszewski et al 2006)

1- The denture look: an esthetic concept developed mainly as a result of a functionally oriented tooth positioning as well as from common errors in fabrication and appearance for complete denture wearers (Fig. 1-2).

Fig 1: Regular arch form

Fig 2: Regular arch form

2- The supernormal teeth:  Shor and colleagues in 2005 defined the supernormal concept as “attractive, idealized, and above-average dental esthetics. A customed made look to please the body image of the patient (Fig. 3-4).

Fig 3

Fig 4

3- The natural look : described by Frush and Fischer as a natural appearance related to anatomic determinants of gender, age and personality. It seeks to restore the most natural patient smile and its appearance (Fig. 5).

Fig. 5: Male teeth setup based on criteria given by the natural look theory

There is limited evidence-based information available when achieving dentate appearance in edentulous patients. However the natural concept of Frush and Fisher (Frush and Fisher, 1955)  is still useful, and this will ensure a better psychological integration of the artistic prosthesis (Waliszewski M 2005).

The aim of this paper is to develop the natural look theory and give a series of clinical examples.

In order to look natural, denture teeth should be as close as possible and look as close as possible to natural teeth. However there might be some discrepancies between the clinical situation of the edentulous mouth and the look of the natural teeth before extractions occurred. It is therefore very important to find a reasonable compromise between the reality of the edentulous mouth and the position of the natural teeth as they should have been. The natural look theory is the way to achieve this goal. The mixture of personality look, gender and age in combination with the clinical situation will determine the final look and position of teeth. To emphazise the personality, age and gender some specific characterization might be also needed to attain this result. Clinical examples will try to explain how this theory can be used (Fig.6-24).

Fig. 6: Rude and aggressive appearance due to the prominent position of the canine following to the strong retruded Position of the lateral incisors especially right side.

Fig. 7: Aggression is reinforced by the existence of the diastema.

 

Fig. 8: Male teeth setup: Free edges touching the horizontal plane, giving a vigorous male look.

 

Fig. 9: As light rotation of the centrals accentuates the vigor look

Fig. 10: The projection of a prominent canine gives to the smile a more rugged and typically male appearance.

Fig. 11: Female teeth set with a curved smile line.

Fig. 12: Regular arch and teeth with more rounded shape.

Fig 13: Anterior rotation mesial of the central incisor combined with cervical inclination express a female character.

Fig. 14: Lateral incisors overlapping the central incisors, gives softness to smile.

Fig. 15: Feminine teeth setup: strong inclination and rotation of the lateral incisors, absence of canine prominent, a smile curved line, give softness to the over all smile.

Fig. 16: The difference in shape and size between the lateral and central incisor accentuates the feminine character.

Fig. 17: Old photo of the patient

Fig. 18: Teeth setup based on the photograph

Fig. 19: Dark teeth and gingival recession in the elderly patient.

Fig. 20: Crowding at the lower incisors especially in the elderly patients.

Fig. 21: Artificial teeth similar to natural teeth (overcrowding, abrasion).

Fig. 22: A result close to the natural staining teeth to simulate cracks in the enamel and other imperfections especially in case of unimaxillary edentulous patient.

Fig. 23: A result close to the natural staining teeth to simulate cracks in the enamel and other imperfections especially in case of unimaxillary edentulous patient.

Fig. 24: Covering the distal part of a tooth on the mesial side of its neighboring one gives an effect of crowding and smaller sized teeth.

Conclusion

Some patients ask for a perfect denture look or for a supernatural teeth form, shade and arrangement; the majority prefer a natural look and smile. This implies an effort from the dentist and his technician to achieve this goal. The end result being an individualized esthetic denture.

Achieving a natural look in complete dentures needs skills, scientific back up information regarding the set up of teeth but most of all the collaboration between the dentist and his patient to find a reasonable compromise between what is expected and what can be done.

References

1- Carlsson GE, Otterland A, Wennstrom A, Odont D. Patient factors in appreciation of complete dentures. J Prosthet Dent 1967; 17:322-8.170.

2- Jeganathan S, Payne JA. Common faults in complete dentures: a review.Quintessence Int. 1993 Jul;24(7):483-7. Review.

3- Frush JP, Fisher RD.Introduction to dentogenicrestorations.JProsthet Dent 1955; 5: 586-95.

4- Brewer A. Selection of denture teeth for esthetics and function. . J Prosthet Dent 1970; 23: 368-734.

5- Waliszewski M, Shor A, Brudvik J, RaigrodskiAJ. A survey of edentulous patient preference among different denture esthetic concepts. J EsthetRestor Dent. 2006;18(6):352-68; discussion 369.

6- Academy of Denture Prosthetics: Glossary of Prosthodontic terms. J Prosthet Dent 1970; 38:81.

7- Waliszewski M. Restoring dentate appearance: a literature review for modern complete denture esthetics. J Prosthet Dent 2005 oct-94 (4):407

8- Shor A, Shor K, Goto Y. The edentulous patient and body image achieving greater patient satisfaction. Pract Proced

Aesthet Dent 2005;17:289–96.