Complete denture esthetics/ cosmetic dentistry training


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Complete denture esthetics/ cosmetic dentistry training

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education m
  2. 2. 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 m
  3. 3. • 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 m
  4. 4. 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 m
  5. 5. 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. m
  6. 6. “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. m
  7. 7. 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 m
  8. 8. • 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 m
  9. 9. • 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. m
  10. 10. • 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. m
  11. 11. • 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. m
  12. 12. 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 m
  13. 13. 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. m
  14. 14. 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. m
  15. 15. 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; m
  16. 16. 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. m
  17. 17. 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. m
  18. 18. 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. m
  19. 19. 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. m
  20. 20. • 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. m
  21. 21. 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. m
  22. 22. m
  23. 23. 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 m
  24. 24. Esthetic principlesEsthetic principles m
  25. 25. • 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. m
  26. 26. 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 m
  27. 27. 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. m
  28. 28. 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. m
  29. 29. 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. m
  30. 30. 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. m
  31. 31. 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 m
  32. 32. 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. m
  33. 33. 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. m
  34. 34. 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. m
  35. 35. 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 m
  36. 36. Dental, Dentofacial, and Facial compositions, contain a variety of relationships. Proportionate relationships provide qualitative value of esthetic appraisal. m
  37. 37. 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. m
  38. 38. 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 m
  39. 39. In moving this form toward the center, visual tension is relieved The same phenomenon occurs in placing another form in a position of equilibrium m
  40. 40. 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. m
  41. 41. m
  42. 42. • 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. m
  43. 43. • 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. m
  44. 44. • 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. m
  45. 45. • 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. m
  46. 46. m
  47. 47. • 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 m
  48. 48. Following factors can helpFollowing factors can help • First visit • Patient attitudes • Limitations • Patient vs. dentist ideas • Presentation aids • Cost • communication m
  49. 49. • 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. m
  50. 50. • 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 m
  51. 51. • 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. m
  52. 52. 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 m
  54. 54. 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 m
  55. 55. m
  56. 56. 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 m
  57. 57. 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 m
  58. 58. Feminine type of smile line Masculine type of smile line m
  59. 59. 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 m
  60. 60. 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. m
  61. 61. 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. m
  62. 62. 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. m
  63. 63. 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. m
  64. 64. 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. m
  65. 65. E) CONTACT POINTS m
  66. 66. 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 m
  67. 67. m
  68. 68. 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 m
  69. 69. 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 m
  70. 70. 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. m
  71. 71. 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. . m
  72. 72. 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 m
  73. 73. “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 m
  74. 74. m
  75. 75. • 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. m
  76. 76. • 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. m
  77. 77. • 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 m
  78. 78. m
  79. 79. 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. m
  80. 80. 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? m
  81. 81. • 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. m
  82. 82. m
  83. 83. • 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. m
  84. 84. 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 m
  85. 85. 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. m
  86. 86. Esthetic principlesEsthetic principles m
  87. 87. • 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. m
  88. 88. 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.. m
  89. 89. m
  90. 90. Sex, Age and PersonalitySex, Age and Personality m
  91. 91. 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 m
  92. 92. • 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 m
  93. 93. • 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 m
  94. 94. 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. m
  95. 95. 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. m
  96. 96. 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. m
  97. 97. • 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 m
  98. 98. The soft position (S) of the lateral incisor is produced by rotating it’s mesial surface outward and inward rotation produces hard position (H) m
  99. 99. 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
  100. 100. 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
  101. 101. 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
  102. 102. 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
  103. 103. • 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
  104. 104. Characterization of anterior segment Frush and Fisher Sex, Age and Personality (SAP) Rufenacht Sexual type, Aggressivity and Personality (SAP) m
  105. 105. • 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
  106. 106. 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
  107. 107. 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
  108. 108. • 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
  109. 109. • 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
  110. 110. • 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
  111. 111. 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
  112. 112. 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
  113. 113. • 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
  114. 114. 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
  115. 115. • 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
  116. 116. 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
  117. 117. 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
  118. 118. • 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
  119. 119. 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
  120. 120. 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
  121. 121. • 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
  122. 122. 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
  123. 123. 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
  124. 124. 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
  125. 125. 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 m
  126. 126. 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
  127. 127. 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
  128. 128. 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
  129. 129. 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
  130. 130. m
  131. 131. 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
  132. 132. 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
  133. 133. 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
  134. 134. 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
  135. 135. 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
  136. 136. • 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
  137. 137. 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
  138. 138. 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
  139. 139. • 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
  140. 140. • 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
  141. 141. (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
  142. 142. 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
  143. 143. 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
  144. 144. Good MorningGood Morning m
  145. 145. Face form -Tooth formFace form -Tooth form Square Tapered Ovoid William’s m
  146. 146. Square arch Ovoid arch Tapered arch Nelson’s classification Arch form-Tooth form m
  147. 147. Dentoginic concept:Dentoginic concept: Interpretation of sex factorInterpretation of sex factor m
  148. 148. 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
  149. 149. Curved smile presents feminine character Examination of entire physique for tooth mold. m
  150. 150. From Her Finger Tips To Her Smile …..A Woman IsFrom Her Finger Tips To Her Smile …..A Woman Is FeminineFeminine Before After m
  151. 151. 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
  152. 152. • Feminine Molds- they have softer edges and a longer structure to accentuate the softer, rounder curves of women. m
  153. 153. 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
  154. 154. From His Hands To His Mouth….A Man Is MasculineFrom His Hands To His Mouth….A Man Is Masculine Before After m
  155. 155. Interpretation of masculine characteristicsInterpretation of masculine characteristics Masculinity is determined by Tooth form Smiling line in male is not curved and attrition of incisal edge shows the strength and aggressiveness. m
  156. 156. • Masculine Molds- have sharper edges and shorter structure, to accentuate the broader and more angular features of men. Interpretation of masculine characteristicsInterpretation of masculine characteristics m
  157. 157. 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
  158. 158. 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
  159. 159. 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
  160. 160. 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
  161. 161. 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
  162. 162. • 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
  163. 163. Dentogenic concept:Dentogenic concept: Age factorAge factor m
  164. 164. Interpretation of ageInterpretation of age Teeth in the young ageTeeth in the young age Teeth in the old ageTeeth in the old age m
  165. 165. Physiologic shade selection.Physiologic shade selection. • Young – Incisal-blue, body-yellow • Older- Incisal-gray, body-yellow m
  166. 166. Interpretation of ageInterpretation of age 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
  167. 167. Interpretation of ageInterpretation of age 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
  168. 168. 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
  169. 169. 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
  170. 170. 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
  171. 171. Mild vigorous Moderate vigorous Rugged vigorous Interpretation of personalityInterpretation of personality m
  172. 172. Active vivacious Medium vivaciousDelicate Interpretation of personalityInterpretation of personality m
  173. 173. 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
  174. 174. 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
  175. 175. Interpretation of personalityInterpretation of personality 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
  176. 176. 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
  177. 177. m
  178. 178. • 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
  179. 179. • 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
  180. 180. m
  181. 181. 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
  182. 182. • 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
  183. 183. 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 m
  184. 184. 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
  185. 185. 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
  186. 186. • 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
  187. 187. Techniques for Creating NaturalTechniques for Creating Natural Dentures.Dentures. m
  188. 188. 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
  189. 189. 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
  190. 190. 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
  191. 191. • 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
  192. 192. •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
  193. 193. 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
  194. 194. 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
  195. 195. 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
  196. 196. 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
  197. 197. 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
  198. 198. 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. m
  199. 199. m
  200. 200. 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. m
  201. 201. • 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. m
  202. 202. 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. m
  203. 203. 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. m
  204. 204. 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 m
  205. 205. 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 m
  206. 206. 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. m
  207. 207. 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. m
  208. 208. • 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 m
  209. 209. 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 m
  210. 210. 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. m
  211. 211. • 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. m
  212. 212. 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. m
  213. 213. • 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. m
  214. 214. • 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. m
  215. 215. 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 m
  216. 216. • 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
  217. 217. • 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. m
  218. 218. 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 m
  219. 219. 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. J.Prosthet Dent 1956;6:603-615 7. J P Frush, R Fisher. Age factor in dentogenics. J.Prosthet Dent 1957;7:05-13 m
  220. 220. 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. J.Prosthet Dent 1959;9:914-920 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 m
  221. 221. 11. Complete denture Prosthodontics- Sheldon Winkler. 12.Textbook of complete dentures – Heartwell 5th edition. 13. Fundamentals Of Esthetics – Rufenacht 14. Esthetics- Stephen J.M m
  222. 222. Thank you For more details please visit m