Complete denture esthetics/ cosmetic dentistry training

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.co
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CONTENTSCONTENTS
• Introduction
• Review of literature
• Esthetics
fundamentals of esthetics
psychology of esthetics
diagnostic interview
• Anterior tooth selection
dentogenic concept
spa factor
color
size, shape and form.www.indiandentalacademy.co
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• Esthetics and occlusion
• The esthetics of anatomy
• Artificial teeth
• Characterization of denture
• contouring and positioning
• personalizing the teeth
• Troubleshooting esthetic problems
• Summary
• My views
• References
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In our modern competitive society, a pleasingIn our modern competitive society, a pleasing
appearance often means the difference betweenappearance often means the difference between
success and failure in both our personal andsuccess and failure in both our personal and
professional lives. Scottish physiologist Charles bellprofessional lives. Scottish physiologist Charles bell
(1774-1842) was quoted as remarking that the thought(1774-1842) was quoted as remarking that the thought
is to the word that the feeling is to the facialis to the word that the feeling is to the facial
expression. He pointed out in 1806 that a smile couldexpression. He pointed out in 1806 that a smile could
convey a thousand different meanings, yet it is theconvey a thousand different meanings, yet it is the
most easily recognized expression.most easily recognized expression.
IntroductionIntroduction
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And because the mouth is one of the focalAnd because the mouth is one of the focal
points of the face , it should come as nopoints of the face , it should come as no
surprise that the smile plays a major rolesurprise that the smile plays a major role
in how we perceive ourselves, as well asin how we perceive ourselves, as well as
in the impressions we make on thein the impressions we make on the
people around us.people around us.
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“Empty page, empty brain, and emptyEmpty page, empty brain, and empty
mouth, have got no expression of Beauty”mouth, have got no expression of Beauty”
• Tooth
• Smile
• Happiness
• Beauty
• Health.
These 5 entities of life even though means different, they are
highly related and inter-dependent. As tooth plays important
role in all these entities our selection and arrangement of tooth
in complete denture prosthesis should be scientifically and
psychologically based and esthetically pleased.
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REVIEW OF LITERATUREREVIEW OF LITERATURE
1.Felix A French in 1951
Studied different theories of selection of teeth and
arrangement of the teeth.
They are
In 1901, introduced Temperamental theory of tooth selection.
Here each patient is classified as either nervous, sanguine,
bilious, or lymphatic, and teeth were chosen which the
manufacturer had designed for that class.
In 1914, Geometric theory of tooth selection was presented by
Dr. J. Leon Williams. He showed definite relationship
between the outline form of the face and the outline form of
the upper central incisors. He classified face as square,
ovoid, and tapering. It was widely accepted by the
profession
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• In 1920, Nelson studied relation between arch form and
alignment form and showed definite relation between
the form of the maxillary arch and outline form of the
upper anterior teeth.
• Nelson classified arch forms and alignment forms into
square, tapering, and ovoid and gave characteristics of
each.
• Arch forms
• Square arch- palatal vault is broad and shallow
• Tapering arch-vault is high and inverted V shaped
• Ovoid arch- vault is medium high and rounded
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• Alignment of teeth.
• Square arch-teeth are set straight up and
down, incisal edges are even.
• Tapering arch-slant out, incisal edges are
forward from the cervical part, central incisors
tend to overlap and set to a V-shaped
alignment.
• Ovoid- central incisors are set slanting
inward.
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• In 1936, Stein had challenged the Williams
Geometric theory of tooth selection.
• He opposed concept of harmony between the
face form and tooth form. He did extensive study
and showed wide teeth in narrow skulls, short
teeth in narrow skulls, similar teeth in dissimilar
skulls.
• He concluded that upper anterior teeth are like
fingerprints, they vary from one individual to
another- yet they have basic patterns.
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• Basic patterns are
• Anatomical constants
• Anatomic variants.
• The ways in which tooth resemble each other, is
anatomical constants.
• It gives the tooth its general form.
• The ways in which teeth differ from one another,
is anatomical variants.
• It gives the tooth its personality.
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Anatomical constantsAnatomical constants
Throughout the races of mankind, incisor are
different-yet they all have basic patterns
such as size, contour, color, and out line
form (square, tapered and ovoid).
These basic patterns will undergo changes
throughout the life
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Anatomical variantsAnatomical variants
• Anatomical variability
manifests itself in size,
color, form, contours and
surface markings.
• The outline form of a
natural anterior teeth is
subjected to change
throughout life.
• The surface contours and
markings of the incisors
show marked variations.
• The mesiodistal contour is
the most influential, this
gives the tooth its
personality.
Variations in labial surface
of central incisor.
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2. Earl pound in 1954,
He emphasized that development of a pleasing
oral and facial expression for the patient
depends upon the dentist’s ability to replace 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.
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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
This mechanical concepts can be resolved by;
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3. John P Frush And Roland D Fisher in3. John P Frush And Roland D Fisher in
19551955
• In 1952 they started Swissdent Foundation to improve
the esthetics in prosthetic dentistry.
• They introduced the word “dentogenic” in prosthetic
dentistry to ease the selection of anterior teeth in
complete denture prosthodontics.
• They concluded that factors of Dentogenic restorations,
 sex,
 age, and
 Personality has improved appearance of the denture
wearer.
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4. Donald F K in 19564. Donald F K in 1956
• Studied relation between the denture esthetics and denture
base. The factors relating to the denture base are the
reproduction of the contours of the tissue covered by the
base, and its staining to reproduce the natural tissue hues.
• Study showed indications for esthetic denture bases in
patients with active upper lip
patient with prominent premaxillary area
theatrical performers and singers
psychologic effect on the patient.
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5. Frush and fisher in 19585. Frush and fisher in 1958
• They studied the qualities of femininity, masculinity,
personality and the various physiologic ages in smile.
• They showed that by application of Dynesthetic techniques
to the Dentogenic concept have accomplished the pleasing
personality, masculinity, and femininity, effectively.
• To apply the Dynesthetic techniques we should require a
knowledge of the Dentogenic concept. 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.
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7. Richard E. lombardi in 19737. Richard E. lombardi in 1973
• He studied the science and principles of visual
perception and their influence in creating intense
vitality, beauty,and realism on denture prosthesis.
• They discussed principles of esthetics such as unity,
composition, dominance, proportion, illusion in
denture esthetics.
• segregating forces must be introduced into the
dental composition to produce dynamic unity.
• Dominance was improved by selecting larger central
incisor compared to lateral incisors.
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• The dominance of the dental composition may be
increased by making it more visible. Increasing
mold size, using lighter teeth, placing the teeth
farther anteriorly, and increasing the exposed
gingivoincisal length.
• They stressed importance of gradation, negative
space, balance of pairs in achieving dental
esthetics.
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6.T Curtis and L Shaw in 19876.T Curtis and L Shaw in 1987
• They have studied the various clinical and
laboratory prosthodontic procedures and concepts
and its effect on esthetics, of resulting complete
denture prosthesis.
• They have 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.
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1. The science of beauty in nature and arts.
2. Concerns with beauty or the appreciation of
beauty. (Oxford Dictionary)
3. Beauty as the substance of the imagination and
feeling, that cannot be an exact science.
4. In Plato’s words “Beauty is measure and
symmetry and virtue the world over”
Definition
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Esthetic principlesEsthetic principles
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• Essential beauty may be the invisible
background of the physically perceptive,
concrete beauty that presents constant
equilibrium of shapes and colors observed in
any geographic location.
• Human beings represent the sensitive vector
that gives life to virtual or essential beauty.
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Composition:Composition:
The increase of visibility is
proportional to the increase in
contrast.
The relationship between objects
made visible by contrasts is
called composition.
In dentistry we use this
terminology in
dental composition,
dentofacialcomposition
facial composition
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Contrast:Contrast:
It is that factor which makes the various
elements of a composition visible.
The eye can differentiate the parts of an object
due to contrast of colors, lines, patterns,
textures, etc.
The selection of correct lightness or darkness
results in successful shade selection.
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Unity or Oneness:Unity or Oneness:
Unity between different
parts of the face, and
teeth is essential to give
the effect of oneness or
wholeness to the dento-
facial composition
Bound together as a ‘whole’ a static unity
is inert based on geometric and repetitive
patterns.
static
dynamic
“It gives different parts of
the composition the effect
of a whole”.
Bound together as a ‘whole’ a dynamic unity is a
living, growing entity, based on dynamic units.
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cohesive forces:
Any element which tends to unify a composition is
a cohesive force. A border is a cohesive force, as well
arrangements of elements in a definite form or according
to a principle.
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Segregate forces
Those elements which break the monotony of the
composition. Naturalness has combination of cohesive
and segregate forces. A proper mix of segregate and
cohesive forces adds variety to the composition making
it more dynamic and interesting.
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Symmetry
It is the regularity of arrangement of forms
either from left to right as in horizontal symmetry,
or from a central point to either side like a mirror
image as in radiating symmetry.
The horizontal symmetry looks repetitive
and uninteresting while the radiating symmetry
looks dynamic and interesting.
In a dento-facial composition radiating
symmetry of the teeth is more esthetically
appealing and is associated with youthfulness
while horizontal symmetry is less appealing and is
associated with aging.www.indiandentalacademy.co
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Proportion
To be able to give a certain mathematical
representation of beauty for numerically expressing
the relationship of the various units that combine to
make a composition, the term proportion is used.
The relationship of the various units which are
different from each other in a composition but are
associated with each other through a certain
repetitive mathematical factor is the Repeated ratio.
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The proportion between the various elements of a
harmonious composition, in which the cohesive and
segregate forces are equally balanced and its
various units in an esthetically appealing,
respective proportion to each other is the
Golden proportion.
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Golden proportion (Pythagoras) the
proportion of ancient origin. A
rectangular frame, with sides of the
ratio of this golden proportion, shown
to have particular beauty.
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Apollo Belvedere
the body is
proportionate to 8
times the height of
the head
The
Doryphorus
showing
symmetry
on all parts
of the body
The realism of Greek art
dissimulates mathematical
formulas that are used as a
basis for artistic creation
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Dental,
Dentofacial,
and Facial
compositions,
contain a
variety of
relationships.
Proportionate
relationships
provide
qualitative value
of esthetic
appraisal.
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Lombardi and Levin related the golden proportion to
complete denture esthetics as denture perceived as
esthetic when the teeth and bases are in harmony
with the facial musculature as well as the size and
shape of the head.
Golden proportion is a proportion that exists
throughout nature and one that humans are
programmed genetically to recognize as
esthetic.
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Balance:
It is achieved when there is an exact equilibrium between the
forces present on either side of the fulcrum in a composition.
In dentistry this implies the balance of the elements in
relation to the midline. Most important factor to be seen
in try-in of denture.
Visual Tension is the tension brought about by the presence
of certain elements that cause an imbalance in the given
composition.
Placement of a round form
in its background
produces visual tension
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In moving this form toward the
center, visual tension is
relieved
The same phenomenon
occurs in placing another
form in a position of
equilibrium
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DOMINANCE:
It exists when a strong centralized structure is
surrounded by well-demarcated, characterized
structures. In a dento-facial composition it creates
immaculate unity leading to a harmonious
composition. The absence of dominance makes the
composition weak. Color, shape and size are the
factors which can control dominance.
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• Esthetics is an art form, where dentist and
patient will develop a personal interaction
and arrive at a judgment as to what is
esthetically appealing.
• Esthetics is also a science, where dentist
must assess morphology and physiology
of tissue of oral cavity to place a
prosthesis.
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• If a patient already has personality problems and
distortion of self image like Anxiety, dependency
and aggression, he’s likely to have serious
difficulty accepting something that affects his
appearance.
• Patients with following traits will respond
differently to dentist’s simple question. For e.g.
• Dentist: what can i do for u?
• Patient (anxiety): I have such terrible problems-
health , family, job, rather than, my teeth are
bothering me.
• Such patients use the dental symptoms and
services to express anxiety about many things
and focus on the appearance of their teeth to
mask out this underlying anxiety.
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• Patient (dependency): Doctor, you decide, you
know the best. But then express displeasure at
the outcome.
• These patients don’t know their own minds. They
usually accompany someone else for the
treatment.
• Patient (hostile or aggressive): how long will this
take? My friend had her teeth done in a week, or
for the money I'm paying you could use better
materials.
• They are easily frustrated and have a low
threshold of irritability. They get aggressive when
decisions are not made immediately.
• All these patients wants the dentist or relatives to
make the decisions about color, shape or size of
teeth of artificial denture.
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• How do we handle these patients?
• First, it’s a function of time. In those people who
find it difficult to accept changes, treatment might
have to be extended over a year, rather than a
few months. We might need the help of a
psychiatrist or a family counselor. Patients must
be given support all along the treatment course as
we don’t really change or resolve character
disorder.
• Second, it is a function of an incremental
conditioning or learning procedure. For e.g., we
slightly alter the patient’s old prosthesis, if
available, from visit to visit.
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• The personal relationship between dentist and
patient is hallowed by tradition and borne out
by common sense.
• Establishing a personal relationship and
maintaining it are the Sine qua non of esthetic
practice- we must foster it from the beginning.
• Listen to what your patients say…. Then find
out what they really mean.www.indiandentalacademy.co
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Following factors can helpFollowing factors can help
• First visit
• Patient attitudes
• Limitations
• Patient vs. dentist ideas
• Presentation aids
• Cost
• communication
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• First visit- gross clinical examination oral hygiene
habits and radiographs are done, more specific
comments should be reserved for second visit.
• Patient attitudes- pay full attention to patient
attitudes towards the treatment. Sometimes
patient wants may be impossible or more of
profound desire.
• Limitations- take particular care to warn patients of
the practical, mechanical limitations of esthetics
both in terms of accomplishment and of durability.
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• Patient vs. dentist ideas- avoid imposing your own
ideas of esthetics on your patients. It is
inappropriate for the dentist to feel that his
knowledge and training makes him superior to the
patient that the patient’s achievable desires do not
count.
• Presentation aids- a case presentation book,
featuring before and after pictures of previous
treatments, models of prosthesis give the patient
tangible evidence of esthetic treatment and help to
determine patient desires.www.indiandentalacademy.co
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• Cost-the expense involved in esthetic treatments
must be discussed candidly. Patient must recognize
that a dentist’s time is valuable and proper esthetic
treatment may require a extensive personalized
attention.
• Communication- you must be dentist, psychologist
and counselor. You should regard every patient as a
unique individual and gauge your own advice and
service accordingly.
Esthetic failures are a leading cause of patient
disenchantment and personalized attention can help
to prevent this. www.indiandentalacademy.co
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STRUCTURAL ESTHETIC COMPONENTS
1.Facial components
2. Components of smile
3. Dental components
4. Gingival components
Facial features
Tooth visibility
Lip line
Smile line
Upper lip curvature
Negative space
Smile symmetry
Dental midline
Golden rule
Axial alignment
Dental morphology
Contact points
Gingival morphology
Gingival contour
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FACIAL COMPONENTS
A) FACIAL FEATURES
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B) TOOTH VISIBILITY:
It is more important for females than males as the average
exposure of teeth is twice in females as that of males.
AGE
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SMILE COMPONENTS
A) LIP LINE - refers to height of the upper lip relative to the maxillary central incisors.
High lip line Medium lip line
Low lip line Anterior low lip linewww.indiandentalacademy.co
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B) SMILE LINE
A hypothetical curved line drawn along the edges of the
four anterior maxillary teeth that has to coincide or run parallel
with the curvature of the inner border of the lower lip
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Feminine type of smile line
Masculine type of smile line
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C) UPPER LIP CURVATURE : In smile, upper lip height is
located at the gingival margin of maxillary central incisors.
Directed upwards Straight
Slightly downwards Pronounced downwards
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D) NEGATIVE SPACE (buccal corridors)
Gradation effect
Is the dark space that
appears b/w jaws during
laughter and mouth opening.
Adequate restoration of the
lateral negative spaces will
permit the characterization
of the smile and enhances
personality.
The diminution of size and
detail must occur gradually
to increase buccal corridor
space.
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E) SMILE SYMMETRY
Evaluation of the symmetric placement
of the corners of the mouth in the
vertical plane with reference to
commissural and occlusal lines
Coincidence of
commissural and pupillary
line requisite for appraisal
of the smile.
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DENTAL COMPONENTS
A) DENTAL MIDLINE
It is an imaginary vertical line that separates the two central
incisors.
Recommended protocol
a) Placing this midline precisely in accordance with facial midline
or in the middle of the mouth using the incisive papilla or labial
frenum as landmarks.
b) Never establish it in a precise midline because it may
contribute to an artificial appearance.
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B) GOLDEN RULES
Golden proportion
between central and
lateral incisor. Type of
proportion between lateral
incisor and canine disturbs
the anterior teeth
arrangement.
The golden proportion
existing between the
elements of the
anterior segment
produces a steady
impression of
harmony.
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C) AXIAL ALIGNMENT
Mesial inclination tends to
be more pronounced from
the central incisors to the
canines
Bilateral axial alignment of
the teeth of the posterior
segment responds to the
phenomenon of balance of
lines around central
fulcrum.
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E) CONTACT POINTS
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GINGIVAL COMPONENTS
The location of the
gingival zenith in
relation to tooth axis is
distal in the maxillary
central incisors and
canines and coincides
on lateral incisorswww.indiandentalacademy.co
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Porcelain teethPorcelain teeth
• All porcelain anterior and posterior teeth meet
the highest requirements concerning
Strength,
Grindability,
Anatomical shape,
Natural characterization,
Shades (available in several shade systems), and
Fluorescence.
Porcelain teeth are most resistant to wear
and staining.
Unfortunately, they are more likely to chip
or fracture
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Acrylic teethAcrylic teeth
• All acrylic anterior and posterior teeth meet
the highest requirements concerning
Strength,
Grindability, and
Anatomical shape.
Acrylic resin teeth are the least resistant to
wear, and they tend to collect stain more
rapidly than porcelain; they are the least likely
to chip or fracture
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The new hard acrylic resin teeth are more wear resistant
than regular acrylic resin teeth and they do not have the
major staining problem noted with the composite resin.
Acrylic resin posterior teeth are specifically called for when
they oppose natural teeth or teeth whose occlusal
surfaces have been restored with gold.
They reduce the possibility that the artificial teeth will cause
unnecessary abrasion and destruction of the natural or
metallic occlusal surfaces of the opposing teeth. Gold
occlusal surfaces can be developed for the artificial teeth
and used in a similar manner.
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Acrylic resin is also desirable when the tooth
must be excessively reduced in length
because of a small interarch distance.
The chemical bonding of the resin with, the
denture base prevents these teeth from
breaking away from the denture base. In
addition, it is desirable when a tooth must be
shaped to fit a small space for esthetic
purposes or be placed in contact with the,
retainer for a removable partial denture.
.
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Acrylic resin posterior teeth must not be used with
porcelain anterior teeth on complete dentures.
The resin will wear more rapidly than the anterior
porcelain and eventually create excessive and
destructive occlusal forces in the anterior part of
the mouth.
The anterior basal seat is usually least able to
withstand increased stresses
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“A captivating smile showing an even
row of gleaming white natural teeth is a
major factor in achieving the dominant
characteristic known as personality. This
entails a lack of inferiority complex which
causes a hand to be raised to cover the mouth.
It is this lack of confidence in the dental
equipment, which often spells the difference
between success and failure in the life of
Dr. Charles Pincus the Father of Esthetic Dentistry in the year
1937 quoted
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• Hardy said “Make the teeth look like natural
teeth”.
• To achieve esthetics in complete denture
fabrication a dentist has to make a denture
wherein “the teeth look like they grew there”.
• Prosthodontist must set the teeth in an esthetic
and convincing arrangement that also meets the
patient’s functional needs. Therein lies the art
and science of completedenture Prosthodontics.
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• A knowledge and understanding of a number of
physical and biological factors directly related to the
patient are required to appropriately select and arrange
artificial teeth to rehabilitate the occlusion and
esthetics.
• The anterior teeth are primarily selected to satisfy
esthetic requirements, whereas the posterior teeth are
primarily selected to satisfy masticatory requirements.
• Both the anterior and posterior teeth must function in
harmony with and be anatomically and physiologically
compatible with the surrounding oral environment.
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• The selection of teeth and their arrangement to meet
esthetic requirements demand artistic skill in addition
to scientific knowledge. Teeth meet esthetic
requirements when they look natural, and the best
method of developing the skill required to attain natural
appearances is by observing natural teeth.
• There are no rules of thumb for this procedure;
however, there are anatomic landmarks and
manufactured aids that can be used as guides
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DENTOGENIC( Frush and Fisher,1955)
• Is a coined word meant to convey, in reference to
prosthetic dentistry, exactly the same meaning as the
suffix-genic imports to photograph in the word
“photogenic”. Precisely, according to Webster’s
dictionary that means “eminently suitable for
production or reproduction”.
• In our word “dentogenic” we seek to describe only such
a denture as is “eminently suitable” in that for the
wearer, the denture adds to that person’s charm,
character, dignity or beauty in a fully expressive smile.
• “Dentogenics” then, means the art, practice, and
techniques used to achieve that esthetic goal in
dentistry.
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Factors in Dentogenic restorations.Factors in Dentogenic restorations.
• The factors can be explained by asking following
questions to ourselves seeing two, well made,
symmetrical, uniform, and shiny, with high
translucency complete upper dentures.
• Were the dentures made for a man or a
woman?
• For what age patient either of those was
made?
• To what type of personality either of those
denture was made for?
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• Dentogenics explains esthetics in 3
dimensions:
I. The wearer of a dentogenic
restoration must have an inner sensibility of
well being.
II. The viewer of a dentogenic
restoration must perceive beauty or a
fulfillment of the wearer’s personality in his
smile.
III. The third requisite would then follow
without cavil, in that the dentist who
created the dentogenic restoration would
feel deeply rewarded.
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Anatomical constantsAnatomical constants
Throughout the races of mankind, incisor are
differentyet they all have basic patterns
such as size, contour, color, and out line
form (square, tapered and ovoid).
These basic patterns will undergo changes
throughout the life
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UnityUnity
• Unity means oneness.
• Unity is the ordering of the parts of a composition to give
the individual total effect of the “whole”.
• It exist in two types
• Static and dynamic
• Static unity is exhibited by such structures as regular
geometric shapes.
• It is passive and inert. E.g. snowflakes and crystals.
• Plants and animals are dynamic unities.
• It is active, living and growing.
• Static designs are based on a regular repetitive pattern,
whereas the dynamic are like flowing continuity of the
logarithmic spiral with its generating nucleus..
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Sex, Age and PersonalitySex, Age and Personality
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INTERPRETATION OF SEX
Expression of feminine characters
• Roundness, smoothness and softness that is
typical of women. The feeling of softness is
typical of feminine form
• Select a mold which expresses softer
anatomic characteristics or one which is highly
adaptable to being shaped and formed into a
delicate type of tooth by certain
recommended grinding procedures
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• The selection of a basic shape which has the soft
lines expressive of the feminine form, together
with effective personality characteristics is
particularly helpful. Thus selection of a basic
feminine tooth form is conditioned by the
personality and age factor.
Expression of masculine characters
• A schema of masculine form illustrates cuboidal,
hard, muscular , vigorous appearance which is
typical of men
• Masculinity itself goes beyond the evaluation of
the physical appearancewww.indiandentalacademy.co
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• Masculinity expresses aggressiveness boldness,
hardness, strength, action and forcefulness
• Harshness and angularity.
• But some men have a qualifying softness which will
guide to compromise the typical hardness of a
masculine tooth interpretation
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The Central Incisor
The two positions of the central incisors, set in perfect
symmetry, are the starting positions for conventional
tooth setups.
By bringing the incisal edge of one central incisor
anteriorly, we create a position which is evident but
harsh.
However, if we move one of the central incisors from the
starting position out at the cervical end, leaving the
incisal edges together we have created a harmonious
lively position.
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The more vigorous position is to move one central incisor
bodily anterior to the other.
The third position is a combined rotation of the two
central incisors with the distal surface forward, with one
incisor depressed at the cervical end and the other
depressed incisally.
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The Lateral Incisors
The lateral incisors, being generally narrower and
shorter than the central incisors, are less
apparent; however, they can impart a quality of
softness or hardness to the arrangement by their
positions.
The lateral incisor rotated to show its mesial
surface whether slightly overlapping the
central incisor or not, gives softness or youthful
ness to the smile.
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• By doing the reverse, that is, by rotating the lateral
incisors mesial, the effect of the smile is hardened We
would select the soft positions for the very feminine
smile, and the hard positions for the vigorous.
• It is important to note that Nature never repeats
herself, and in the mouth, we avoid symmetry of tooth
positions on both sides of the mouth
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The soft position (S) of the lateral incisor is
produced by rotating it’s mesial surface outward
and inward rotation produces hard position (H)
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The Cuspid Teeth
The cuspids should never be set with the tip of
the tooth out labially further than the cervical
end, except in very rare instances where ,we
have to harmonize the arrangement with a rough
or primitive type of patient.
A prominent cuspid eminence gives to the cuspids
greater importance and therefore gives to the
smile a vigorous appearance more suitable to the
masculine sex.
m

General, we will adopt for the cuspid conjointly the three
following positions:
(1) out at the cervical end, as seen from the
front
(2) rotated to show the mesial face
(3) almost vertical as seen from the side
m

INTERPRETATION OF PERSONALITY
FACTOR
.
Development of personality
spectrum is helped in
classifying different
personalities of patient.
This personality spectrum
depends upon the individual
dentist’s ability to visualize the
position of his patients within
this framework.
Most men are found to be
toward the vigorous end of the
spectrum and most women are
found to be in delicate end of
the spectrum.
m

There are three divisions of personality spectrum :
• Delicate- meaning fragile, frail, the opposite of
robust.
• Medium pleasing- meaning normal, moderately
robust, healthy and of intelligent appearance.
• Vigorous- meaning opposite of delicate; hard and
aggressive in appearance, muscular type.
m

• When we incorporate the personality factor in
esthetics we do so keeping in mind the influence of
the sex and age factors as we proceed.
• The introduction of different aspects of the
personality into dental elements to permit a more
precise characterization of the dental composition
gave origin to SAP concept of Frush and Fisher.
m

Characterization of anterior segment
Frush and Fisher
Sex, Age and Personality (SAP)
Rufenacht
Sexual type, Aggressivity and Personality
(SAP)www.indiandentalacademy.co
m

• Both concepts are aimed at characterizing the
dental elememts of the anterior segment.
• The difference between concepts are mainly
evidenced by the significance and evolution of the
central incisor.
• Frush and Fisher sap concepts showed progressive
wear with advancement of age of anterior teeth
with length of the maxillary central incisor
considered constant throughout life.
• According to Rufenacht tooth wear stressed
functional disturbances of an individual.
m

Personality and mold considerationPersonality and mold consideration
• Top row of teeth would be
used for youthful, good
looking “model” type of
patient.
• Mainly indicated for women
• Second row teeth are more
“coarse” and would be
adaptable to amplebodied,
obese woman.
• Third row teeth are typically
robust form hence indicated
for men.
m

INTERPRETATION OF AGE
• Symbols of youth in the natural teeth are
lightness of shade, the unblemished form of the
newly erupted teeth, earliest appearance of the
mamellon is present at the incisal edge of the
central and lateral incisors.
• The cuspid presents a pointed tip which is very
sharp in appearance.
● The mamellon is soon abraded away, and the
tooth assumes the youthful adult form evidenced
by the enamel Incisal edge of variable depth and
of bluish hue.
m

• Later the sharp tip of the cuspid wears down
to a more mature form.
• As we advance along the chronologic life line
of the individual, normal wear, plus trauma,
and, in some instances, malocclusion, and
disease make inroads upon the original purity
of tooth form.
• The tooth ages with the individual, and, very
often, the mouth condition gets far ahead of
the chronologic life line.
m

• In the artificial tooth, then, we may reflect the appropriate
age effects by such means as grinding the incisal edges
and removing the incisal enamel at such an inclination and
to such depth as to convey reality to composition.
• The sharp tip of the cuspid suggests youth, and, as age
increases, it should be judiciously shaped, not abruptly
horizontally flattened, but artistically ground so as to
imply abrasion against opposing teeth.
m

• In advanced age; the bicuspids should be
"softened" on the tips of the cusps to avoid the
appearance of recently erupted teeth.
• In the natural teeth, we have seen the effects of
erosion high on the gingival third and the necks of
teeth.
• Sometimes it is very advanced, at other times it is
of a lesser degree. This erosion imparted to the
artificial tooth, by careful grinding and polishing
very effectively, conveys the illusion of vigor and
advanced age
m

Dynesthetic interpretation of the dentogenic conceptDynesthetic interpretation of the dentogenic concept
• To construct to dentogenic restoration effectively is a matter
of learning and of interpreting the sex, personality, and age of
the patient properly in the complete denture.
• There are three important parts of the complete denture
prosthesis.
– The tooth
– Tooth position
– The matrix.
• If we can treat the tooth, its position, and its matrix correctly,
the pleasing personality, masculinity and femininity and the
age of the patient, are effectively created.
• By the application of dynesthetic techniques to the dentogenic
concept has considered ease to accomplish this.
m

Dynesthetic theoryDynesthetic theory
• Patient’s sex, personality, and age are considered as
primary factors. Where as dynesthetic techniques are
considered as secondary factors of dentogenic restorations.
• Foe e.g. , 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.
m

• Dynesthetics means vital beauty.
• Prefix dyn taken from greek word dynamis,
meaning power.
• Means producing effect of movement or
progression. As we know edentulous mouth is in
constant and permanent change, our efforts
should be in fabricating prosthesis which follows
the physiologic age changes in the tissues.
m

Dynesthetic techniques.Dynesthetic techniques.
• It concerns with three important divisions of denture
fabrication. The tooth, its position, ans its matrix.
• Techniques includes
• Shade selection
• Depth grinding
• Abrasion
• Identification of masculinity or femininity
m

• Smiling line
• specific positioning and rotation of anterior teeth
• Embrasures and diastemas
• Buccal corridor
• Long axes of the teeth
• Gum line denture base contouring and tissue stippling
m

Dynesthetic considerations to the productionDynesthetic considerations to the production
of a Dentogenic restoration.of a Dentogenic restoration.
• Progressive abrasion of the artificial tooth is done as the age of
the patient progresses.
• Depth perception is limited in the artificial tooth because the
contact point is too near the labial surface. The perception is
increased by depth grinding. This is a cut made on the labial
mesial line angle of the artificial tooth.
• In personality mold selection, a delicate mold is feminine,
vigorous mold is masculine and medium pleasing personality mold
for both.
m

THE THIRD DIMENSION-DEPTH GRINDING
• The "denture look" is due mostly to the flat
appearance of the artificial upper anterior teeth,
their lack of depth, or of "body." The depth grinding
is done on the mesial surface of the central incisor
only. Central incisors are the widest, almost always
the longest, and therefore, the most noticeable of
the six anterior teeth.
It is necessary to develop the desired effect in the
depth grinding by consideration of these main
factors:
m

• A flat thin narrow tooth is delicate looking and
fits delicate women ( little depth grinding)
• A thick bony big sized tooth heavily carved on it’s
labial surface is vigorous and to be used
exclusively for men ( severe depth grinding)
• For the average patient the depth grinding will
be an average between delicate and vigorous
• Depth grinding reduces the width of the central
incisor according to the severity of grinding to be
accomplished.
m

Lip supportLip support
• If is the bodily anterioposterior position of the
teeth which adequately supports the upper lip in
a natural manner.
• Pleasing lip support is achieved by the anterior
teeth and their matrix.
m

MidlineMidline
• The features of a face usually slant one way or
another.
• It is difficult to see a true midline in dentition.
• Hence eccentric midline in a denture, if not too
exaggerated is acceptable.
m

• Marking the mid & smile line.
Marking are made with the patient standing.
It needs three markings on the bite blocks.
One relaxed lip mark
Reference point for incisal length.
One smile high lip mark
Reference point for denture base gum length
Mid-Line mark
m

Mark the smile line using three reference points.
Mid upper lip, nose & chin.
Mark the smile line using two reference points.
Mid upper lip & nose.
Mark the smile line using mid upper lip only.
use one of the above for marking the mid-line.
m

labioversionlabioversion
• Labioversion is necessary because the
most pleasing effect is obtained when the
long axes of the central incisors are either
vertical or with a slight labial inclination.
m

Speaking lineSpeaking line
• The speaking line is the incisal length for the
vertical composition of the anterior teeth. It is
spoken of as the speaking line because the final
evaluation of the incisal length is made when the
patient is speaking.
m

Smiling lineSmiling line
• The smiling line is a curve
whose path follows the
incisal edges of the central
incisors, lateral incisors
and to the tips of the
cuspids.
• Its arc is determined by
the age of the patient and
decreases as the patient
gets older
• The sharp curve of smiling
line is youthful. The
broader curve of smiling
line indicates an older
dental composition.www.indiandentalacademy.co
m

Interincisal distanceInterincisal distance
• The high level of incisal edge of lateral incisor to
the central incisor is indication of older dental
composition.
• Incisal edge of lateral incisor in level with the
central incisor is indication of youth.
• One central incisor is always placed bodily ahead
or behind the other central incisor to simulate
naturality.
m

SpacesSpaces
Spaces placed between the anterior and posterior teeth gives
more effect if placed artistically and hygienically.
Rules are
It should be V-shaped to shed food.
Diastema between central incisor is unsightly so should be
avoided.
It should be asymmetrically placed on either side of the dental
arch
Width of the diastema should be minimum.
m

Buccal corridorBuccal corridor
• It is a space created betweenIt is a space created between
the buccal surface of thethe buccal surface of the
posterior teeth and the cornerposterior teeth and the corner
of the lips when the patientof the lips when the patient
smiles.smiles.
•
• Buccal corridor begins at theBuccal corridor begins at the
cuspid.cuspid.
• Size and shape of it areSize and shape of it are
controlled by position andcontrolled by position and
slant of the cuspid.slant of the cuspid.
• It masks the “sixty toothIt masks the “sixty tooth
smile” or the “molar to molarsmile” or the “molar to molar
“ smile, which is the“ smile, which is the
characteristic of a denture.characteristic of a denture.
m

Interdental papillaInterdental papilla
• It forms main part of the tooth matrix (visible denture base)
• It occupies one-third of the total importance of the dental
composition.
• It creates self cleaning inter dental area
• Determines the age interpretations.
• Determines outline form of the tooth
• The shortening of the papillae is noticed as age progresses
• Interdental surface of the papillae must be convex in all directions
to self-cleaning
m

Webster: "Color is the sensation resulting fromWebster: "Color is the sensation resulting from
stimulation of the retina of the eye by light waves ofstimulation of the retina of the eye by light waves of
certain lengthscertain lengths ((380nm to 760nm)380nm to 760nm) ".".
m

Hue:
• Hue is the name of the color.
• In a younger patient hue tends to be similar throughout
the mouth. With aging, variations in hue often occur
because of intrinsic and extrinsic staining from the
restorative materials, food, beverages, smoking and
other influences
m

Intensity:
Saturation or Chroma which refers to the
quality of light distinguishing a brighter tone
of a color from a duller one of the same hue.
Adding white increases the intensity, adding
black diminishes the intensity, adding grey
varies the intensity. In general chroma of
teeth increases with age.
m

Value or Brilliance:
• The lightness or darkness of the hue in relation to
another through the addition of black or white.
• A light tooth has a high value; a dark tooth has a
low value
• Value is the most important factor in shade
matching. if the value blends, small variations in
hue and chroma will not be noticeable
• In the first step the value or lightness is
determined.
m

Opacity and Translucency:Opacity and Translucency:
• As light strikes a surface, it is either totally
reflected, totally absorbed or a combination of
both.
• Opaque objects reflect all of the light that is
incident on them.
• Transparent objects transmit all of the light
that is incident on them.
m

• When part of the light incident on an object is
transmitted, while the rest is scattered, the
property of the object is known as Translucency.
• Translucency, in effect, is the three dimensional
spatial relationship or representation of value.
Highly translucent teeth tend to be lower in value,
since they allow light to transmit through the
teeth, while opaque teeth have higher value.
m

Gloss:Gloss:
Is an optical property associated with
a smooth surface that produces
lustrous surface appearance and thus
reduces the effect of color
differences. In dentistry, unlike
spectral colors, the restorative
materials have pigment colors
incorporated in them
m

Color Of Teeth
When a tooth is viewed for the purpose of
determining it’s color, two principal colors yellow
and gray are evident. The yellow is more
prominent in the gingival third, and the gray is
more prominent in the incisal third.
In teeth with thin incisal edges the yellow
disappears, and the edge appears blue gray. This
is the only place that blue appears in a tooth.
The position of the patient and the source of light
are very important in color selection. The patient
should be in an upright position. The dentist
should be in a position so that the teeth are
viewed in a plane perpendicular to the dentist's
plane of vision
m

• The teeth should be observed from different
angles and the patient's mouth should not be
opened too wide.
• White light is considered suitable. Eyes fatigue to
color perception very rapidly and for this reason
they should not be focused on a tooth for more
than a few seconds.
• If the proper shade is hard to establish the tooth
and the shade guide should be viewed from a
distance of 6 or 8 feet.
m

• The color of the teeth, like the form, must be in
harmony with the surrounding environment if
they are to appear pleasing. Harmony should
exist between the color of the teeth and the color
of the skin, hair, and eyes. The color of the skin
is a more reliable guide.
• A female patient’s cosmetics must be considered
in harmonizing with the complexion.
m

(1) outside the mouth
along the side of the
nose, will establish
the basic hue,
brilliance, and
saturation
Selecting The Color Of Artificial Teeth
Observations of the shade guide teeth should be
made in three positions:
m

3) Under the lips
with only the
cervical end
covered and the
mouth open, will
simulate exposure
of the teeth as in a
smile.
2) under the lips with only
the incisal edge exposed,
will reveal the effect of
the color of the teeth
when the patient's mouth
is relaxed
m

Basic considerations are the harmony of
tooth color with the color of the patient's
face and the inconspicuousness of the teeth.
The color of the teeth should be observed on
a bright day, with the patient located close
to natural light and also in artificial light.
m

Good MorningGood Morning
m

Face form -Tooth formFace form -Tooth form
Square
Tapered
Ovoid
William’s classification.www.indiandentalacademy.co
m

Square arch
Ovoid arch Tapered arch
Nelson’s classification
Arch form-Tooth form
m

Dentoginic concept:Dentoginic concept:
Interpretation of sex factorInterpretation of sex factor
m

Interpretation of feminine characteristics.Interpretation of feminine characteristics.
The feminine form is spherical
Feminine characteristics:
Roundness
Smoothness
And softness
Delicacy and feeling of
softness is typical
femininity.
m

Curved smile presents
feminine character
Examination of entire
physique for tooth mold.
m

From Her Finger Tips To Her Smile …..A Woman IsFrom Her Finger Tips To Her Smile …..A Woman Is
FeminineFeminine
Before After
m

Interpretation of feminine characteristics.Interpretation of feminine characteristics.
A curve suggests softness.
Femininity in denture is
created by grinding of
incisal line of anterior
teeth.
Softer feminine interpretation
in tooth form
m

• Feminine Molds- they have softer edges
and a longer structure to accentuate the
softer, rounder curves of women.
m

Interpretation of masculine characteristicsInterpretation of masculine characteristics
The masculine form is cuboidal
Masculine
characteristics
Cuboidal,
Hard
Vigorous
Masculinity tooth
form expresses
Aggressiveness
Boldness
Strength and
Harshness
m

From His Hands To His Mouth….A Man Is MasculineFrom His Hands To His Mouth….A Man Is Masculine
Before After
m

Masculinity is determined
by Tooth form
Smiling line in male is not
curved and attrition of
incisal edge shows the
strength and
aggressiveness.
m

• Masculine Molds- have sharper edges
and shorter structure, to accentuate the
broader and more angular features of
men.
m

Sex interpretation by Tooth PositioningSex interpretation by Tooth Positioning
• Various positions of maxillary anterior teeth
will convey sex characteristics of a denture.
1.Sex interpretation by central incisor1.Sex interpretation by central incisor
Vigorous nature of male is created by positioning the incisal edge of
one central incisor anteriorly to the other.
m

1.Sex interpretation by central incisor1.Sex interpretation by central incisor
A. Moving one of the central
incisors from the starting
position out at the cervical
end, Creates milder masculine
character
B. Vigorous position is to move
one central incisor bodily
anterior to the other.
C. Harsheness can be created by
combined rotation of the two
central incisor with distal
surface forward, with one
central incisor depressed at
the cervical end and the other
depressed incisally.
m

2. Sex interpretation by lateral incisor2. Sex interpretation by lateral incisor
The soft position (S) of the lateral incisor is produced by rotating it’s
mesial surface outward and inward rotation produces hard position (H)
Positioning of the lateral incisor imparts a
feminine softness.
The lateral incisor rotated to show its mesial
surface whether slightly overlapping the central
incisor or not, gives softness or youthful ness to
the smile
m

Sex interpretation by lateral incisorSex interpretation by lateral incisor
feminine characterfeminine character masculine character
The effect of smile can be hardened by
rotating lateral incisor mesially
m

Sex interpretation by canineSex interpretation by canine
The cuspids set with the
tip of the tooth out
labially further than the
cervical end, show
rough or primitive type
of patient.
A prominent cuspid
eminence gives to the
cuspids gives smile a
vigorous appearance
suitable to the masculine
sex.
m

• The "denture look" is due
mostly to the flat appearance
of the artificial upper anterior
teeth, their lack of depth, or
of "body.“
• The depth grinding is done
on the mesia labial line angle
surface of the central incisor
only.
• Moderately for both men and
women of average
proportions and increased as
an individual interpretation of
age, sex, and personality of
the patient.
THE THIRD DIMENSION-DEPTH
GRINDING
m

Dentogenic concept:Dentogenic concept:
Age factorAge factor
m

Interpretation of ageInterpretation of age
Teeth in the young ageTeeth in the young age Teeth in the old ageTeeth in the old age
m

Physiologic shade selection.Physiologic shade selection.
• Young –
Incisal-blue, body-yellow
• Older-
Incisal-gray, body-yellow
m

Progressive abrasion of the tooth –
old age
Cut the incisal edge of the artificial
tooth to show age factor.
White line-old age
Red line-middle age
Yellow line-young age
m

Changing cuspid tip with
age
Variable long axes of the
teeth become accentuated
with age.
Cuspids of artificial
teeth be according
to the age of the
patient.
Abrading of
cuspid should be
made in curve
m

Expression of age by Interdental Papilla.
Youth-papillae are finely
stippled, pointed and
tight against the tooth
Middle age-less stipples
appearance, loss of
contact and rounded.
Advanced age-
shortening of papillae,
recession, odematous
and large spaces
between tooth.
m

Dentogenic concept.Dentogenic concept.
Personality factorPersonality factor
Comprehensive use of personality depends upon
our manipulation of tooth shapes (molds), tooth
colors, tooth position and the visible denture
base.
m

Interpretation of personalityInterpretation of personality
Delicate
(fragile, and frail)
Medium pleasing
(normal, moderately robust
and intelligent appearance)
Vigorous
(aggressive, hard, almost
primitive and ugly)
m

Mild vigorous
Moderate
vigorous
Rugged
vigorous
m

Active vivacious
Medium
vivaciousDelicate
m

Personality and mold considerationPersonality and mold consideration
Shaping and grinding the central incisor to
shorter or narrower will create tooth mold
suitable to the different personalities.
softness Hardness The effect of age to tooth
form by abrasion of incisal
edges, diastemas, gingival
recession and interdental
papillae manipulation.
m

Over characterization and personalityOver characterization and personality
Overcharacterization:
overaccentuation of form, color,
and arrangement of artificial
teeth as compared to the
average concept of an artificial
tooth arrangement.
Overaccentuation of color
texture and surface anatomy in
denture is harmonious with the
vigorous personality.
m

Lack of overaccentuation
lends to monotomy and
denture look.
Ugly overaccentuation of
denture.
Mild overaccentuation for
medium pleasing
personaity
Overaccentuation of color
texture and surface
anatomy for aggressive
personality.
m

Performance of individual teeth in personalityPerformance of individual teeth in personality
interpretationinterpretation
Overaccentuation of
central incisor: strength and action in the smile.
Lateral incisor: convey hardness and softness,
vigorous and delicate tendency.
Cuspids: conveys either strong, pleasant, or ugly
primitive accent to the smile.
m

• The correct central incisal
length is determined by
having the lips at a rest
and the mouth slightly
open.
• Young Woman
3 mm below the lip line at
rest
• Middle aged Woman
1.5 to 2 mm below the lip
line at rest
• Older Woman
1 mm below the lip line at
rest
Incisal length for Female
m

• Young Man
2 mm below the lip line at rest
• Middle aged Man
1 mm below the lip line at rest
• Older Man
0 to 2 mm short of the lip line at rest
Incisal length for Male
m

The esthetics of anatomyThe esthetics of anatomy
• The esthetics of anatomy are properly developed
when the anterior teeth and the denture base
material hold the facial muscles at their proper
physiologic length.
• Facial expression of the patient should simulate
the original identity.
• Thus, the esthetics of anatomy are closely
interrelated with physiology.
m

• Muscles the prosthodontist is particularly concerned with
are
• Orbicularis oris,
• Zygomatic triangularis and
• Buccinator muscle.
• when this whole muscle complex is not held in proper
physiologic position, the face droops and patient assume
“Denture look”
m

Mouth turns down,
nasolabial folds sag,
vermilion border of
the lip is barely
visible and skin is
wrinkled wrinkled in
patient with
“denture look”
Positin of the
labial surface of
natural central
incisor in relation
to the labial
vestibular space.
The artficial teeth
should be
similarly located.
When anterior
teeth are
positioned
properly there is
striking
difference.www.indiandentalacademy.co
m

Guide lines: natural teeth the labial
surface of the natural central incisor
lies approximately 8-10mm anterior
to the center of the incisive papilla.
If the distance is less than the 8mm
we can think that it teeth are placed
lingually. location of the imaginary
line extending between the middle of
the upper cuspids in relation to the
incisive fossa indicates proper
location of the anterior teeth.
m

Space between the anterior teeth and the tongue
blade indicates that the teeth are positioned too far
posteriorly.
Proper location of the labial surfaces of the
anterior teeth in relation to the labial flange of the
trial denture base as indicated by the tongue
blade.
m

• Striking difference in
the smile is seen
when old dentures,
are replaced with
new dentures that
hold muscles of facial
expression so that
they can function
properly
m

Techniques for Creating NaturalTechniques for Creating Natural
Dentures.Dentures.
m

Natural denture bases obtained by
An esthetic wax up which reproduces the
contours of the normal anatomy
Staining these contours to give them a vital
appearance.
m

esthetic wax upesthetic wax up
The structures included in waxing the denture are; the
buccal and labial frenula, the gingival sulcus, the free
gingival margin. the attached gingivae (stippled
surface), the interdental papilla, the root eminences and
mucolabial folds.
The incisive papilla, the rugae, the lingual margin of the
posterior teeth are waxed up in palatal surfaces.
m

Procedure of carvingProcedure of carving
• Extreme accuracy of wax up is
necessary, because excess
grinding and polishing of
processed denture will remove
the anatomic contours and
staining.
• Wax spatula is the key
instrument used for carving of
wax.
In order to reproduce rugae,
double thickness of tin-foil is
placed over the rugae area of
the cast and swaged with a
pencil erase to obtain
adaptation.
Excess wax is build up on all
surfaces by softening small
pieces of wax and adapting it to
the base.
m

• The facial surfaces are shaped first
• The gingival margin are formed by the removal
of wax from the cervical portion of the teeth
until sufficient areas of their labial and buccal
surfaces are exposed.
• More facial tooth structure is exposed in aged
patients to represent the normal physiologic
gingival recession.
• The interdental papillae are left long and
pointed for young patients and short and blunt
for older patients.
m

•Variations in levels of
contact point will guide the
height of the gum line of
each tooth
•It should extend up to the
contact points in order to
provide hygienic area.
•It should be convex in all
directions to be self
cleansing
m

Root carvingRoot carving
• Minor root eminences are
left over the root areas of
the incisor.
• Heavy root eminences are
formed over the cuspid
roots
• In posterior region form
continuous alveolar bulk or
minor root contours.
• The gingival margin is
accentuated by indenting it
along the junction of the
attached gingivae and free
gingival margin, blending
the attached portion into
this groove.
m

Palatal surface carvingPalatal surface carving
The palatal surfaces should be contoured so that the
patient can regain maximum of the sensations of
contour present before loss of the dentition.
Three major parts are
– Gingival margin
– Rugae
– Vault form
m

Lingual surfaces of the anterior teeth should be
given a natural cingulum form
Rugae is formed by the tin-foil rugae pattern
made earlier is placed in position, and its
edges are sealed with a warm spatula
Excess wax is removed to minimize impingement
on the tongue surface by the vault surfaces
m

FrenulaFrenula
• Wax labial frenum (b/w central incisors) and buccal
frenula (b/w I and II premolar) is placed with wax
spatula.
• Labial frenum is usually narrow and thin at the margin
whereas buccal frenum is broad thick or fan shaped.
m

Stippling & scallopingStippling & scalloping
The surface of natural
attached gingiva shows
stippling effect.
This stippled effect is
produced on the denture
by the use of a stiff-
bristled tooth brush.
Scalloping should be over
accentuated according to
the age of the patient.
m

Gingival sulcusGingival sulcus
• The production of a slight
bulk of gingival margin and
minute break between it
and the teeth affords an
natural appearance.
• The gingival sulcus is
formed by inserting the tip
of a No:23 explorer
between the tooth and the
wax, then carrying it
mesio- distally along the
cervical end of the tooth.
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IntroductionIntroduction
• In staining the denture base to simulate natural tissue,
three factors must be considered.
• 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.
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• Colors and hues may vary in one area from another.
• Most of the time it follows this pattern.
• Deep red are found in mucobuucal fold, frenula, soft
palate, incisive papilla, interdental papillae and the larger
rugae.
• Pale yellow- in root eminences and the hard palate
• Neutral Pink which fall between extremes of deep and
pale color tones such as
• lingual side of the lateral alveolar processes,
• facially between root eminences.
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Pound technique:Pound technique:
Here, stains are
applied on the stone
investment surfaces
before any packing is
done.
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.
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 techniqueKemnitzer technique
An important variation from pound procedure
is incorporated in packing the flask.
Here staining is done after packing.
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 techniqueKemnitzer technique
The final trial pack separation finds the
acrylic resin adapted to the cast, with an
anatomic reproduction of the lingual and
facial surfaces.
Upper half of the flask with uncured packed
resin is exposed and staining procedure
is carried out.
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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ProcedureProcedure
• Each stain is applied
wherever it is to be used
before the next stain is
added.
• This consists of moistening
the section to be stained
with monomer, adding the
stained polymer, and
carefully moistening with
monomer.
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Custom Denture TintingCustom Denture Tinting
• Previous color characterization techniques
have generally involved applying gingival
stains to the gingival surfaces in the flask
after boil-out.
• In the present technique, color
characterization may be done after the
denture has been processed.
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• Custom staining can be done quickly and requires
the following armamentarium:
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
Dappen dishes
light curing unit for curing the stains.
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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The denture tinting chart
Denture tissue tinting chart with areas to be
tinted and shades selected.
AG = Attached Gingiva
AM = Alveolar Mucosa
B = Blanched areas over roots
F = Frenum Attachments
P = Papillae
Shade Light reddish pink
Shade Reddish pink
Shade Pale pink
Shade Red stain
Shade Light reddish pinkwww.indiandentalacademy.co
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TechniqueTechnique
• 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.
• Custom tinting is done at this time.
procedure
Place monomer and colored
powders in different dappen dishes.
Brush monomer on surfaces to be
tinted.
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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.
• 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
• Keep stains moist with the monomer during this time
to prevent crystallization.
• Cure the acrylic resin stains in the light-curing unit
according to the manufacturers instructions.
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summarysummary
• Better understanding of principles of perception,
we have been enabled to create scenes of intense
vitality, beauty, depth, and realism, all on a two
dimensional canvas.
• The dentogenic concept is an esthetic philosophy.
• Its purpose is to present knowledge whereby the
Prosthodontist may replace the lost dentition in
such a manner as to effect an appearance which
is complimentary to the sex, age and personality
of the patient.
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• we have understood characteristics of each anterior teeth. It
can be said “one, two, three guide”.
• One is the central incisor that expresses age
• Two is the lateral incisor that expresses sex .
• Three is the cuspid that expresses vigor.
• We can also this apply rule to the posterior teeth. i.e
• One is the first bicuspid whose chief function is esthetics.
• Two is the first molar whose function is mastication.
• Three is the second molar whose function is occlusal
balance.
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• Sex identity in dentures is a symbol of progress
in prosthetic dentistry, which is achieved by the
application of dentogenics.
• The selection of the mold, teeth, and the denture
base and most important positioning and coloring
of the artificial teeth and denture base has
showed influence on sex, age and personality of
the patient.
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There is beauty in age as well as in youth” but, in
fact, age has the edge. Age has something that
youth can never have, and that is Dignity. We try
our best to restore his identity by incorporating
vital factors of Dentogenics in complete denture
prosthesis.
Principles of esthetics
Sex, age, and personality factors.
Dynesthetic techniques
MY VIEWS
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• It is truly rewarding for the Prosthodontist to create a
complete denture prosthesis that restores an edentulous
individual’s dignity and its attendant expression of sex,
personality, and age.
• The development and use of an adequate functional
procedure in prosthetic dentistry is the first step
toward creating psychologic as well as physiologic
comfort for our patients
m

• However, success is reliant on good function,
appearance must not be ignored.
• In fact, function and esthetics are inseparable
and interdependent factors of prosthodontic
procedure and success.
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ReferencesReferences
1. F A French. The selection and arrangement of
the anterior teeth in prosthetic dentures.
J.Prosthet Dent 1951;1:587-593
2. E Pound. lost-fine arts in the fallacy of the
ridges. J.Prosthet Dent 1954;4:06-16
3. J P frush, R Fisher. Introduction to dentogenic
restorations. J.Prosthet Dent 1955;5:586-
595
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4. J P Frush, R Fisher. How dentogenic
restorations interpret the sex factor. J.Prosthet
Dent 1956;6:160-172
5. J P Frush, R Fisher. How dentogenics interprets
the personality factor. J.Prosthet Dent
1956;6:441-449
6. Donald F K. Esthetics and the denture base.
7. J P Frush, R Fisher. Age factor in dentogenics.
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7. J P Frush, R Fisher. The dynesthetic interpretation of the
dentogenic concept. J.Prosthet Dent 1958;8:558-581
8. J P Frush, R Fisher. Dentogenics: its practical application.
9. Lombardi. The principles of visual perception and their
clinical application to denture esthetics. J.Prosthet Dent
1973;29:558-381
10. 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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11. Complete denture Prosthodontics- Sheldon
Winkler.
12.Textbook of complete dentures – Heartwell 5th
edition.
13. Fundamentals Of Esthetics – Rufenacht
14. Esthetics- Stephen J.M Medcom.inc
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Thank you
For more details please visit
www.indiandentalacademy.com
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Complete denture esthetics/ cosmetic dentistry training

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