Denture esthetics

DENTURE ESTHETICS
DR.SRISHTI RELAN
I MDS
PRESENTED BY:

ESTHETICS
It is derived from the Greek word “Aesthesis”
It is a branch of philosophy that deals with the nature
of beauty and taste, as well as the philosophy of art.
 Denture Esthetics:
the effect produced by a dental prosthesis that affects
the beauty and attractiveness of the person;
GPT-9

“It is difficult to overcome the natural antipathy of the
patient to a truthful reproduction of his own teeth, where
fillings and decay are present, when it is his desire to
improve his appearance with newer, cleaner and a better
looking arrangement”
-Milton Cohen
“The dental profession is going to be forced to produce
more esthetic dentures as the public is becoming more
educated to appreciate good looking, well cared for natural
teeth-which makes them more observant of artificial teeth.”
-Hopper
Young HA. Denture esthetics. The Journal of Prosthetic Dentistry. 1956 Nov
1;6(6):748-55.

 With respect to dentistry, it is observed as art with rules
and principles pertaining to the arrangement of teeth,
gingival tissue contours, and restoring the normal
dimensions of the face for a particular individual.

A PLEASANT SMILE IS AN EXPRESSION OF
JOY…!!!!!!!!!!!!
 The dentition and how it influences the formation of a
pleasing smile is extremely important in the emotional
development of the individual.
 plays a vital role in improving one’s confidence and there
by allowing them to smile freely.
 It is the dentist’s responsibility to preserve, enhance or
create a pleasing smile through dental treatment without
impairing function
“Review: Characterization of Denture Bases -Redefining Complete Denture Esthetics”
Dr.Sanjay Lagdive 1,Dr.Abhishek Darekar2, Dr.Sushma Lagdive3

HISTORY
 MEXICAN DENTURES (2500 BC): animal teeth
 ECTRUSAN DENTURES (700BC pre roman
civilisation):human and animal teeth bound by gold
wire
 MAYAN DENTURES(600BC): stones and seashells
carve
 EGYPTIAN DENTURES (300 BC): gold and silver
wires
 JAPANESE DETNURES (15th century):wooden
 17th century: IVORY DENTURES
 18th century: PORCELAIN TEETH
 Late 18th century: VULCANITE DENTURES
th

 Esthetics in complete dentures is more challenging
to achieve, as there are no remaining teeth for
reference.
 Dentures can enhance the patient’s personal image,
if they appear natural and attractive
 Allows the patient to return to normalcy and social
well-being.

CONSTRUCTION OF AN ESTHETIC DENTURE
Esthetics
PINK WHITE

Pink esthetics
 Polymethyl methacrylate revolutionized the field of
denture base materials in 1937.
 Pink esthetics in complete denture deals with the
replication of these gingival contours and the various
aspects of gingiva such as stippling, staining, and
pigmentation
Roumanas ED. The social solution—denture esthetics, phonetics, and function. Journal of
Prosthodontics: Implant, Esthetic and Reconstructive Dentistry. 2009 Feb;18(2):112-5.

Festooning
 Festooning is carving the denture base to create
natural tissues contours in the denture
Common Errors during Wax-up
Over contouring of gingiva
Interdental papilla when attempted to replicate must be
done with care
Palatal wax-up must be done uniformly

Stippling
 Lynn C. Dirksen introduced stippling in dentures.
1. Toothbrush technique
2. Offset bur technique
3. Blow wax technique

Custom 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 by the dentist or technician after the denture
has been processed.
International J. of Healthcare & Biomedical Research, Volume: 1, Issue: 1, October 2012

Requires the following armamentarium:
 Denture tinting chart.
 Soft tissue shade guide.
 #6 camel hair brush.
 Acrylic resin stains or shade modifiers in a variety of
colors including red, brown and black.
 Dappen dishes
 Pressure pot or a light curing unit for curing the stains.

Soft tissue shade guide
 The soft tissue shade guide is used to select a denture
base material which is most representative of each
patient's tissues.
 This is done at the appointment when the artificial teeth
are selected.

Acrylic Resin Stains
 After the denture is processed with the appropriate shade
denture base material, contouring and smoothening are
done with an acrylic bur but not polished
 Shade modifiers can be used for denture tinting with
colors including red, brown, and black.
Journal of Advanced Clinical & Research Insights ● Vol. 6:3 ● May-Jun 2019

Photocured denture coating
 Previous color characterization techniques rarely
recommended surface staining of finished dentures with
autopolymerizing acrylic resin stains because of the lack
of color stability and the lack of abrasion resistance of
these stains.
 In this technique, surface staining of finished dentures is
possible because of clear, light-cured resin coatings.
 The clear coating provides a hard, high gloss which
makes the polishing of dentures unnecessary

Light cured gum shading
 consist of micro filled composite resin ,
 can be applied in multilayered technique
 delivers unlimited possibilities for gingival
reproduction.

1. Excellent mechanical and physical properties of a
micro-filled composite.
2. Shades based on natural gingival tissue.
3. Lifelike esthetics.
4. Unlimited possibilities for gingival tissue
reproduction.
5. Easy to polish and clean.

1. History of Anterior Teeth Selection
2. Characterization of Complete Denture
3. Mathematical Concepts of Teeth Arrangement

History of Anterior Teeth Selection
 The importance of dental esthetics and anterior
teeth selection was understood from the 19th
century
 Concepts of tooth selection
 Selecting the size of tooth
 Selection of Tooth Shade

Concepts of
tooth selection
Anand V, Manoharan PS. The dynamics of pink and white esthetics in complete denture.
Journal of Advanced Clinical and Research Insights. 2019 May 1;6(3):78-82.

Selecting the
size of tooth
Anand V, Manoharan PS. The dynamics of pink and white esthetics in complete denture.
Journal of Advanced Clinical and Research Insights. 2019 May 1;6(3):78-82.

Selection of Tooth Shade
 Select basic colors appropriate for the individual’s face.
 In determining the shade for an edentulous patient we
strive for color harmony. This is selecting teeth of a hue
which will blend and conform with the general color
pattern of the complexion, eyes, hair, and lips without
being conspicuous.
 As the color of the skin and hair change with advancing
age, so will the color of teeth require change to keep
pace and harmonize with individual characteristics.
Krajicek DD. Achieving realism with complete dentures. Journal of Prosthetic Dentistry.
1963 Mar 1;13(2):229-35

 AGE:
Younger the patient, lighter the shade is preferred
 GENDER:
Females prefer lighter and brighter teeth than the
males
 SKIN COLOUR:
Lighter teeth are suitable for lighter skin shade
Darker teeth shade for darker skin

Characterization of Complete Denture
This can be done using the patient’s pre-exiting records and
by knowing the expectations and perceptions of the patient .
Changing the
long axis of
the teeth
Use an
eccentric
midline
Rotation of
teeth
Long clinical
crowns
Diastema
A hairline
crack can be
given in the
teeth
Silver filling
can be given
on posterior
teeth
Modifying the arrangement of teeth according to the patient.
Martone has stated that, “The key to esthetics lies in
asymmetry”

CONCEPTS IN DENTURE ESTHETICS
1. Early concepts
2. Modern concepts
Golden proportion
Repeated ratio
Recurrent esthetics dental (RED) proportion

Early Concepts— Temperamental And Typal
The earliest dental restorations were created for
appearance alone with no thought to function.
 White introduced what is probably the first esthetic
concept when he described his theory of correspondence
and harmony .
 White described this theory as a correspondence
between tooth form and color in harmony with age and
gender. This was later accepted as the temperamental
theory of denture construction.
 It was based on the idea that a subject’s temperament or
bodily characteristics matched the size, proportion,
arrangement, and color of the teeth.

(1) the relationship between age, gender, and appearance,
(2) the proper tooth-to-face-size proportion,
(3) color harmony between face and teeth
 The inability to agree on a specific prosthetic tooth for a
certain temperament or to decide which temperaments
existed limited this system’s practical usefulness

 Williams Hall was the first to describe what he believed
was a correlation between face form and tooth form.
 The argument for what became known as the typal form
concept of esthetics was based largely on Williams’ own
anthropologic research.
 He stated that 3 basic forms of teeth existed:
square, tapering, and ovoid.
 Succeeded due to its practicality and manufacturer
support and not because of any actual relationship

 Nelson was the first to assert that tooth arrangement was
the major determinant of tooth-mold appearance and
more important to the overall esthetics. Sears, Richey,
and French built on this concept.
 Frush and Fischer used these early ideas to help
establish the dentogenic concept of denture construction.
 These authors wrote that gender, personality,and age
could be used as guidelines for tooth selection,
arrangement, and characterization to ‘‘enhance the
natural appearance of the individual.’’

DYNESTHETIC THEORY
 compounded word. prefix dyn -the Greek word dynamics,
meaning power.
 We wish to imply movement, action, change, and
progression in the esthetic phase of prosthodontics.
 requires a knowledge of the dentogenic concept.
 This dynamic value has been described as marking the
difference between an artifact and work of art.
TOOTH POSITION MATIX

 Depth grinding
 Abrasion,
 Identification of masculinity or femininity
 Smiling line
 Specific positioning and rotation of central incisors,
lateral incisors, and cuspids
 Embrasures and diastemas
 Long axes of the teeth
 Papillae ,
 gum line
 Stippling

 Dynesthetics affords a comprehensive method of doing
this by a progressive adaptation of these working
principles to the constantly changing environment of the
original restoration.

PROPORTION IN DENTURE ESTHETICS
 The entire human figure can be described in terms of
proportionate sizes of the various parts.
 In discussing the size of the teeth, it is always
necessary to consider the element of proportion.
 The relationship of width to length of a tooth is
important because,

UNITY
 The prime requisite of composition is unity.

UNITY WITH VARIETY.
 Segregating forces must be introduced to produce
dynamic unity
 Unity with variety is necessary to make a design
effective because, although the elements must be
bound together in an organic whole, they must be
bound together in an interesting manner.

HOGARTH'S LINE OF BEAUTY
 Hogarth's line of beauty has long been considered
an outstanding example of unity with variety.
 It is commonly misunderstood to be an "S" curve.
 The line is never the same at any point along its
course yet it never leaves the surface of the cone.
 Adds greatly to the dynamism of a set-up and is
strongly recommended

 Dominance must be exhibited by using a central
incisor of sufficient size to dominate the composition.
 Teeth must not be set on the static curve of a circle,
but on a dynamic line similar to Hogarth's line, and
teeth must be set with regard to a repeated ratio to
provide unity with variety.

Balance of direction and defining of borders

Illusion/Graduation
 Graduation:The diminution in size and detail must
occur gradually

GOLDEN PROPORTION
 Ancient Geek philosopher PYTHOGORUS :”explains
beauty in nature as it relates to science of numbers”
 Used in the Greek architecture to design Parthenon
 Leonardo da Vinci: classic drawings of human anatomy

 Levin used golden proportion –relate to successive
widths of anterior teeth
width of the central incisor should be in golden proportion
to lateral incisor…..

REPEATED RATIO
 Lombardi “ continuous proportion or repeated
ratio which has been established between the
width of central and lateral incisor and is
continued in the ratio of the placement of the
remaining teeth and spaces."

Recurring Esthetic Dental [RED] proportion
 Levin -constant 62%
 Preston –only 17% of the casts he studied had golden
proportion btw central and lateral incisors
 Lombardi – continuous proportion not necessarily 62%
Successive widths of the teeth as viewed from frontal
should remain constant as one moves distally

 IMPRESSION MAKING:
Supporting the facial musculature with properly formed
denture borders is essential. These border are formed by
the functional position of labial and buccal vestibules as
established with final impressions.
 Overextension of these borders gives the patient the
appearance of having a cotton roll beneath the lip.
 A stretched appearance of the lip may result, with
distortion of the philtrum, nasolabial, and mentolabial
folds.
ESTHETIC CONSIDERATIONS WHILE:

The establishment of the correct vertical dimension of
occlusion is absolutely essential in the proper positioning of
the orbicularis oris and associated muscles.
 If an insufficient vertical dimension of occlusion is
provided, the muscles will sag because their origins will
be too close to their insertions.
 excessive vertical dimension of occlusion, in an effort to
eliminate age lines to improve the patient’s appearance,
is usually disastrous-unable to approximate upper and
lower lips
JAW RELATION:

ANTERIOR TOOTH POSITION
Payne writes that, “Teeth should be placed where they
grew.”
 Dentists request that the dental laboratory technician “set
the teeth on the ridge.”
 Require teeth that are too small for the patient’s face.
there will be a lack of muscle support, leaving a reduction
in the visible vermillion border and resulting in deepening
of the nasolabial folds and a wrinkling of the lips.

POSTERIOR TOOTH POSITIONING:
 Lingual version of the maxillary anterior teeth and labial
inclination of the mandibular incisors in the retrognathic
patient are guides for the initial placement of teeth.
 Prognathic patient, the incisal edges of the maxillary
anterior teeth more prominent than the cervical ends of
the teeth.

DENTURE BASE CONTOUR AND COLOR
 To provide adequate support for the midface
musculature, the denture base should have the same
anatomic form as that of the soft and hard tissues
replaced.
 Regardless of how well the teeth are selected, reshaped
and arranged, the denture may well be an esthetic failure
unless the gingival contours, texture, and color are life-
like.

The length and function of the upper lip is
also very important
 If the upper lip is particularly long, little if any upper teeth
will be visible.
 In patients with short upper lips, a large amount of
denture base as well as the entire facial surface of the
teeth may be exposed.
This will depend on the amount of muscle activity which
exists during the normal functions of speech and smiling.

Article: Restoring the dentate appearance

Applying dentate research to edentulous
patients
 A dental midline coincident with the facial midline was
found in 70% of a 500–dentate-patient sample.
 Use of the retromolar pad for posterior positioning of the
occlusal plane height has proven successful both
clinically and scientifically.

This article concluded that:-
 Fortunately, this review demonstrates several esthetic goals when
considering the 2 major esthetic concepts of natural or supernormal
appearance.
 A 100-degree nasolabial angle
 140-degree mentolabial angle
 The incisal edges of the maxillary teeth should follow the lower lip
line
 The dental midline should be both coincident with the facial midline
and vertically straight.
 A gingival-to-lip distance of 4mm or more may be considered
unesthetic.
These factors should be considered baseline esthetic guidelines in
complete denture construction.
white
population

Materials and method
 Six test subjects were selected: One male and one
female patient were selected for each of the three age
 Groups:= /- 3yrs
Lower age-30y
Middle age-50y
Upper age-70y
 minimum current denture tooth display of 8mm measured
by a ruler at the maxillary central incisor during maximum
smile.

 Prior to initiation of the tooth arrangement appointment,
several universal esthetic goals were agreed upon for all
three concepts.
 The maxillary midline was made coincident with the facial
midline and perpendicular to the interpupillary line.
 All posterior teeth were anatomic and selected to match
the size and proportion of the anterior teeth

 This was done by first indexing the natural maxillary
arrangement with the use of a facebow transfer assembly
mediumbody vinyl polysiloxane
 arbitrarily moved 2mm apically and 2 mm lingually for the
denture look arrangement
 arbitrarily moved 2 mm coronally and 2 mm facially for the
supernormal Arrangement.
 The six “subject sets” were then randomly ordered within the
photograph booklet to avoid any visible pattern in age or
gender.

 A pilot study was conducted to evaluate the
respondent’s ability to visually assess the photos.

This article concluded that
 Within the limitation of the study:
 Completely edentulous survey respondents were able to
differentiate between three esthetic concepts for
complete denture
• natural was preferred by 55%
• supernormal was preferred
by19%,
• denture look was preferred by
26%

Matsuda K-i, et al. A questionnaire survey on denture esthetics and denture
base characterization. J Prosthodont Res (2016),
http://dx.doi.org/10.1016/j.jpor.2015.12.009
A Questionnaire Survey On Denture
Esthetics And Denture Base
Characterization

 AIM:
The aim of this study was to investigate patient desire for
denture esthetics and denture base characterization.
The inclusion criteria were:
(1) patients without serious chronic conditions or dementia
(2) patients wearing removable dentures with no
complaints, pain or major inconvenience
(3) patients who have been wearing dentures for at least 1
year.

Questionnaire
1. Are you concerned about your denture appearance?
(Options: care very much, care, and do not care.)
2. Are you concerned about your denture ‘‘gum’’
appearance?
(Options: care very much, care, and do not care.)
3. Would you like us to apply denture base
characterization? (Options: necessary or
unnecessary.)

 A total of 157 elderly patients (83 males and 74
females) participated in this survey. Their mean age
was 74.6 years

Article concluded that:-
 Results indicate that the
demand for denture base
characterization is significant,
especially in female patients
and those aged under 75
years.

OPERATIVE PROBLEMS
 Brownl’ states that the denture patient is often
accompanied by relatives and friends who have
divergent views which make the prosthodontist’s
problem more difficult than need be.
 Such divergent views forewarn the dentist of the
problems the patients must face after the dentures
are inserted and exhibited to the home or friendship
circle.

TIPS FOR THE PRACTICING DENTIST
1. The psychological aspects of denture therapy are
as critical as the technical. It is important to
establish appropriate dentist–patient rapport at the
onset of treatment.
2. The dentist must understand patient expectations
prior to initiation of treatment.
Prosthodontics: Implant, Esthetic and Reconstructive Dentistry. 2009 Feb;18(2):112-5

Donovan et al.
Indicated that many dentists pay particular attention to
esthetics when providing fixed prostheses, including
implants, to patients.
However, it is an unfortunate reality that many of
these same dedicated practitioners frequently fail to pay
the same attention to detail when providing removable
prostheses

CONCLUSION
 Dentures can enhance the patient’s
personal image, if they appear natural
and attractive. Physical attractiveness is
an important social issue in our culture
which exerts significant influence not
only in the social interactions but also
self-concept, psychological well-being,
and social behavior of an individual

References
 Roumanas ED. The social solution—denture esthetics,
phonetics, and function. Journal of Prosthodontics: Implant,
Esthetic and Reconstructive Dentistry. 2009 Feb;18(2):112-5.
 Lagdive S, Darekar A, Lagdive S. Characterization of Denture
Bases-Redefining Complete Denture Esthetics. Int J Health
Biomed Res. 2012 Oct;1:16-20.
 Matsuda KI, Enoki K, Kurushima Y, Mihara Y, Hatta K, Ikebe K,
Maeda Y. A questionnaire survey on denture esthetics and
denture base characterization. Journal of prosthodontic
research. 2016 Jul;60(3):224.

 Waliszewski M. Restoring dentate appearance: a
literature review for modern complete denture esthetics.
The Journal of prosthetic dentistry. 2005 Apr 1;93(4):386-
94.
 Waliszewski M, Shor A, Brudvik J, Raigrodski AJ. A
survey of edentulous patient preference among different
denture esthetic concepts. Journal of Esthetic and
Restorative Dentistry. 2006 Nov;18(6):352-68.
 Anand V, Manoharan PS. The dynamics of pink and
white esthetics in complete denture. Journal of Advanced
Clinical and Research Insights. 2019 May 1;6(3):78-82.

 Daniel.H Ward.Proportional smile design using recurring
esthetic dental (RED)proportion.Dental clinics of north
america,2001Jan Volume45 number1
 Young HA. Denture esthetics. The Journal of Prosthetic
Dentistry. 1956 Nov 1;6(6):748-55.
 Frush JP, Fisher RD. The dynesthetic interpretation of the
dentogenic concept. Journal of Prosthetic Dentistry. 1958
Jul 1;8(4):558-81.
 Krajicek DD. Achieving realism with complete dentures.
Journal of Prosthetic Dentistry. 1963 Mar 1;13(2):229-35.

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