1

Esthetics in Complete Dentures

Introduction
Nature has endowed everyone with dignity and satisfaction of
being an indi...
2

Methods for Achieving Complete Denture Esthetics

0*

Accurate impressions

1*

Jaw relations

2*

Selection of anterio...
3

Vertical Jaw Relations
Correct vertical dimension is essential for proper positioning
of Orbicularis oris and associate...
4

6*

Tempramental Theory Of Tooth Selection - Hippocrates 2400

years ago felt man was composed of 4 body - blood, phleg...
5



Typal Form Theory

It was introduced by Leon Williams in 1917. According to this,
the shape of the teeth is governed...
6



Dentogenic Concept

In 1956-57 Frush And Fisher proposed the Dentogenic Concept
of Teeth Selection . This concept ex...
7

Tooth Position

11*

Move one central incisor out at the cervical end, leaving incisal

edges together for a lively and...
8

Depth Grinding
It is done on the mesial surface of central incisor. Mesio-labial
line angle is ground in order to move ...
9

Erosion in gingival thirds and drifting of teeth (e.g.
diestema) due to premature loss of teeth may be reproduced in de...
10

17*

Shade

18*

Size

19*

Shape

SHADE
Natural teeth vary as much in colour as they do in size and
shape. Selection ...
11

Natural Teeth
Natural teeth are not monochromatic but consist of three shades.

o Cervical
o Incisal

- more chroma

-...
12

But hair colour changes through out life or by artificial
colouring. Secondly iris seems to be too small to influence ...
13

Age and Tooth Colour
Colour of natural teeth progressively darkens with age. Pulp
chambers become smaller because of d...
14

Dentogenic Concept
According to dentogenic concept darker shade in suitable for
men or vigorous personalities. Lighter...
15

SIZE
Pre Extraction Records

37*

Diagnostic casts prior to extraction

38*

Recent photos before loss of teeth

39*

...
16

Post Extraction Examination
For a denture wearer examine the following-

40*

Do the teeth appear lost in face (too sm...
17

49*

As a rule <48 mm upper anteriors are small, > 52 large

Available Space

50*

Length of maxillary wax rim first e...
18

Red Proportion
According to Daniel H Ward when golden proportion is
used, lateral incisors seem to be too narrow and c...
19

55*

70% seems to be more pleasing but should be modified to fit face

skeletal structure and general body type.

56*
...
20

SHAPE (Form)
Around the turn of century dental investigators searched for
a direct relationship between tooth form and...
21

64*

Labial surface of teeth viewed from the incisal should show a

convexity or flatness similar to that seen when fa...
22

Requirements
Orientation of occlusal plane
In sagittal view the occlusal plane is determined by the incisal
edges and ...
23

1. Horizontal orientation of anterior teeth
2. Vertical orientation
3. Inclination
4. Harmony in composition
5. Refine...
24

Aids
25

o Photographs
69*
70*

can be very helpful

Pre extraction diagnostic casts

Ridge relation must be taken into account...
26

Amount of upper anterior teeth seen during speech and facial
expression depend upon length of upper lip. Long upper li...
27

Harmony in General Composition of Anterior Teeth
It can be divided into

74*

Harmony in dental arch form and form of ...
28

Harmony of Dental Arch Form and Form of Residual Ridge

80*

The form of residual ridge may be generally classified as...
29

Ovoid arch form

87*

Distance between canines is narrower.

88*

Curvature of anterior ridge is more severe than squa...
30

Tapering arch form

92*

Distance of canines is narrower.

93*

Curvature of anterior arch is more severe than any oth...
31

When a person smiles, the lower lip forms a pleasant
curvature known as smile line. This can be used as a guide line f...
32

Harmony of Opposing Lines of Labial and Buccal Surfaces
Setting teeth with the long axis parallel to each other, resul...
33

The incisal edges and proximal surfaces of anterior teeth wear
with age. The incisal edges of denture teeth should alw...
34

Maxillary Anteriors

97*

Central Incisor- long axis slightly towards the midline when

viewed from front, labial incl...
35

Individual tooth positions and forms can be varied to depict the
age, sex and personality of the individual such as

1...
36

Absolutely white, regular flawless teeth contained in smooth
highly polished, uniform pink colour denture base appear ...
37

Contour of Denture Base

109* Anatomical

contours of marginal and free gingiva, labial and

buccal mucosa, root emine...
38

Carving and contouring
FACIAL SURFACE

112* Gingival

margin and free gingiva are formed by removing wax

with wax car...
39

121* In

general labial and buccal flanges are shaped concave.

122* Gingival

margin is accentuated by a depression o...
40

Colour distribution of gingiva

129* Deep
130* Pale

red tones - muccobuccal fold and interdental papilla

yellow tone...
41

Staining Armamentarium

133* Red

stains

134* Yellow

stains

135* Blue,

brown or its combination, to be used for me...
42

2ND TECHNIQUE

140* Sequential

application of stains on facial surface of plaster mold

prior to packing.

141* Sprin...
43
Ar thu r O Rahn , Ch arl es M. H ea rtw el l : Tex t book of com pl et e Dent ur es, ed 5,
Lo ndon, 1993.

G eorg e A. ...
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Esthetics in complete dentures 1/certified fixed orthodontic courses by Indian dental academy

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Esthetics in complete dentures 1/certified fixed orthodontic courses by Indian dental academy

  1. 1. 1 Esthetics in Complete Dentures Introduction Nature has endowed everyone with dignity and satisfaction of being an individual personality. Face has been defined as a chart of destiny, an impression of fullness of life, and mirror of soul. Variety of facial expressions or lack of it is a perspective of individual’s thoughts, emotions and attitude. Vital area of expression is located in region of mouth and it’s the teeth which impart character to impression. In general humans are programmed similarly as to what is esthetic and what is not. It appears that beauty does really lie in the eye of the beholder and more often than not it is a matter of genetic programming. A denture usually is perceived as esthetic when teeth and bases are in harmony and unesthetic when disharmony exists
  2. 2. 2 Methods for Achieving Complete Denture Esthetics 0* Accurate impressions 1* Jaw relations 2* Selection of anterior teeth 3* Arrangement of teeth 4* Characterization of denture Accurate Impressions Muscles of facial expression have bony origin and insert in the soft tissue of the lips or corner of mouth. As teeth are lost functions of facial muscles are impaired. Resultant edentulous appearance has a profound effect on personality of the patient. Supporting the facial muscles with properly formed borders is essential. Generally labial vestibules have little true space. Over extension of borders gives the patient having cotton roll beneath the lip. On the other hand, long standing edentulous patient with significant resorption requires thicker borders.
  3. 3. 3 Vertical Jaw Relations Correct vertical dimension is essential for proper positioning of Orbicularis oris and associated muscles. Insufficient vertical dimension of occlusion leads to muscles sagging because origins become too close to insertion. Excessive vertical dimension of occlusion causes stretched appearance and the patient is unable to approximate his/her lips resulting in speech problems. SELECTION OF TEETH The selection of teeth and their arrangement to meet esthetic requirements demands artistic skill in addition to scientific knowledge. There are no rules of thumb but there are anatomic landmarks and manufactured aids that can be used as guides. Best method to develop the skill is to observe natural teeth. Flashback 5* J.W. White (1872) -Proposed concept of Correspondence and Harmony. Factors considered were complexion, colour of hair and eyes. size of body and face,
  4. 4. 4 6* Tempramental Theory Of Tooth Selection - Hippocrates 2400 years ago felt man was composed of 4 body - blood, phlegm, yellow and black bile. Various ailments and differences in man were explained on the basis of imbalances of these fluids. Dr. Spurzheim contended that the Hippocrate’s theory should apply to teeth as well. He classified man according to dominance of humour. 7* Sanguineous (bold) type for blood dominance. 8* Phlegmatic (calm) type for phlegm dominance. 9* Choleric (angry) type for yellow bile dominance. 10* Melancholic (sad) type for black bile dominance. Further, in each human body there is a governing principle (dominant fluid) which ensures harmony of size and form among several parts, and each group has characteristic teeth.
  5. 5. 5  Typal Form Theory It was introduced by Leon Williams in 1917. According to this, the shape of the teeth is governed to considerable extent by face forms. He classified face into three forms- square, tapering and ovoid. In 1936, Mr. Stein, from Dept of Anthropology of Colombia University challenged typal form theory. He contended that upper anterior teeth are like fingerprints and no two are alike. Outline form of teeth is relatively unimportant in denture construction for it changes with the age of person.
  6. 6. 6  Dentogenic Concept In 1956-57 Frush And Fisher proposed the Dentogenic Concept of Teeth Selection . This concept explains the interpretation of three vital factors which every individual possesses viz. sex, personality and age. Construction of dentures is a matter of interpreting these factors properly in dentures. These are accomplished by altering the tooth, its position & the matrix. When these three are properly treated, a pleasant personality is revealed, masculinity and femininity effectively created and age of patient is dignified in smile. Interpretation of Sex Factor Feminine form is expressed by roundness, smoothness and softness. Grinding of incisal edges must follow a curve rather than a straight line. Masculinity is expressed by angularity, aggressiveness and hardness. By sufficient depth grinding and squaring the incisal edges of central and lateral incisor masculinity is emphasized.
  7. 7. 7 Tooth Position 11* Move one central incisor out at the cervical end, leaving incisal edges together for a lively and harmonious position. 12* Move one central incisor bodily anterior to other for a more vigourous position. 13* Rotate both the central incisors with distal surface forward with one depressed cervically and other incisally. 14* The lateral incisor is rotated to show its mesial surface (may slightly overlap the central incisor) to give soft and youthful appearance. 15* By rotating the lateral incisors mesially effect is hardened. 16* A more prominent cuspid eminence gives a more vigourous or masculine look.
  8. 8. 8 Depth Grinding It is done on the mesial surface of central incisor. Mesio-labial line angle is ground in order to move the deepest visible point further lingually. A flat, thin, narrow looking tooth is delicate looking suitable for delicate women. A thick, bony, big sized tooth is vigourous and suitable for men. Personality A person can be delicate, medium or vigourous when placed on personality spectrum. Only small proportion of patients would be on extreme ends. The mold selected for the patient should be in accordance with the personality. Management of Age Factor Early youth is apparent by mamelon and bluish incisal edge. As age progresses the mamelons disappear and bluish incisal edge may be abraded. The pointed tip of the canine wears down to a mature form. The tip of the canine should be artistically ground so as to imply abrasion against the opposing tooth.
  9. 9. 9 Erosion in gingival thirds and drifting of teeth (e.g. diestema) due to premature loss of teeth may be reproduced in denture. Advancing age can be indicated by shortening the papilla and raising the gum line. Attached gingiva looses its stippled appearance and appears smooth and edematous with age. Guidelines for Selection of Teeth Teeth are selected for
  10. 10. 10 17* Shade 18* Size 19* Shape SHADE Natural teeth vary as much in colour as they do in size and shape. Selection of a suitable shade for an edentulous patient is a matter of individual judgment. There are however a few generalizations. Shade itself possesses three dimensions 20* Hue- specific colour produced by a specific wave length 21* Chroma- amount of colour per unit area of an object. Fair complexion people have less chroma 22* Value- the relative lightness or darkness of an object.
  11. 11. 11 Natural Teeth Natural teeth are not monochromatic but consist of three shades. o Cervical o Incisal - more chroma - more translucency o Transitional Maxillary central incisors are the lightest teeth, maxillary lateral & mandibular Incisors - slightly darker, Canines are darker still. Posterior teeth are uniform in colour & slightly lighter than canine. Teeth darken slightly with age. Mixing artificial anterior teeth from different sets produces better esthetic results. Aids for selection of shade 23* Hair colour 24* Eye colour 25* Complexion 26* Age
  12. 12. 12 But hair colour changes through out life or by artificial colouring. Secondly iris seems to be too small to influence tooth shade. So a more logical approach to select teeth is based on 27* Skin colour 28* Age 29* Patient’s desire Skin Colour Yellow is suitable for fresh complexion. Grey tinged with blue is used dark complexion. Opal suits to a clear pale complexion. Small pearly white teeth are so rare that they always look false.
  13. 13. 13 Age and Tooth Colour Colour of natural teeth progressively darkens with age. Pulp chambers become smaller because of deposition of secondary dentin. As a result the tooth becomes opaque. Also there is increased wear of incisal edges and the enamel is lost. Translucency also disappears and dentin picks up various stains.
  14. 14. 14 Dentogenic Concept According to dentogenic concept darker shade in suitable for men or vigorous personalities. Lighter shade is used for women and delicate personalities. Also teeth darken with advancing age. Requirements for Shade Selection 30* Patient -upright position. 31* Dentist’s plane of vision - perpendicular to plane of teeth. 32* Teeth viewed from diff. angles to make sure shadows don't influence colour. 33* Patient’s mouth - not be opened too wide 34* White light with filters or natural light (preferably 10am to 2pm) 35* Eyes fatigue easily- should not be focussed on a tooth for more than a few seconds. 36* For proper value, shade guide should be viewed from a distance of 6-8 feet.
  15. 15. 15 SIZE Pre Extraction Records 37* Diagnostic casts prior to extraction 38* Recent photos before loss of teeth 39* Radiographs making allowance for lengthening and shortening
  16. 16. 16 Post Extraction Examination For a denture wearer examine the following- 40* Do the teeth appear lost in face (too small or set posteriorly)? 41* Do they appear too regular like picket fence? 42* Teeth set too high? 43* Too large? 44* Do maxillary teeth show during smiling and mandibular during speech? Various Formulas 45* Width of maxillary central incisors= 1/16 bizygomatic width 46* Max. Six anteriors= 1/3.3 bizygomatic width 47* Length of max central incisors= 1/16 length of face 48* Cranial circumference= 10 x width of upper anteriors
  17. 17. 17 49* As a rule <48 mm upper anteriors are small, > 52 large Available Space 50* Length of maxillary wax rim first established by phonetics (f & v sounds) and adequate support for soft tissues of upper lip. 51* Maxillary central incisor =Incisal edge of rim to high lip line 52* Vertical lines are scribed on wax rims directly down from right and left alae of nose. These measurements on curve of wax rim= width of six anteriors Golden Proportion Levin observed that widths of maxillary anterior teeth when viewed from front lie in golden proportion .i.e., 53* Width of central incisor X 0.618= width of lateral incisor 54* Or 62% of central incisors width= 62% of width of lateral incisor = canine and so on lateral incisor
  18. 18. 18 Red Proportion According to Daniel H Ward when golden proportion is used, lateral incisors seem to be too narrow and canine is not prevalent enough.This author has proposed a RED proportion or Reoccurring Esthetic Dental Proportion . According to this the dentist can establish his own proportion and remain consistent while moving distally.
  19. 19. 19 55* 70% seems to be more pleasing but should be modified to fit face skeletal structure and general body type. 56* Endomorph - higher proportion. 57* Ectomorph - lower proportion. 58* Secondly width to height ratio for central incisor 66%- 80% (78% is quite pleasing). For taller persons lower ratios. Dentogenic Concept 59* Incisors tend to be longer in younger individuals 60* Women’s teeth are smaller than men, larger persons -large teeth usually 61* Distinct difference between the size of central incisor and lateral incisor in women 62* Incisors in men are proportionately shorter. (Robert G. Vig in 1978 reported that average maxillary central incisor exposure in men was 1.91mm; in women- 3.40 mm)
  20. 20. 20 SHAPE (Form) Around the turn of century dental investigators searched for a direct relationship between tooth form and facial form. Berry was probably the first to demonstrate the outline form of maxillary central incisor and inverted outline of face. J. Leon Williams applied typal forms of face art to classification of maxillary anterior teeth. William classified face as square, tapering and ovoid Guidelines Tooth selected should be in harmony with the face of the individual. Outline form is considered from the front view of the patient and from labial of maxillary central incisor. The shape of the labial surface is more important- 63* The labial surface of the tooth viewed from the mesial should have a contour similar to patient’s profile. - Convex/ straight/ concave.
  21. 21. 21 64* Labial surface of teeth viewed from the incisal should show a convexity or flatness similar to that seen when face is viewed from under the chin or top of head. 65* Also there may be reverse curves in the form of mild irregularities. 66* Contact areas or surface of anterior teeth should show wear according to age 67* Broadened contact areas look more natural 68* Women tend to have ovoid form of teeth with rounded distal incisal angles while men tend to have squarish tooth forms ARRANGEMENT OF TEETH
  22. 22. 22 Requirements Orientation of occlusal plane In sagittal view the occlusal plane is determined by the incisal edges and the approximate juncture of upper and middle thirds of retromolar pads. The occlusal plane lies parallel to camper ’s line in sagittal plane and parallel to interpupillary line in frontal plane. Fox plane can be used to check these two relations. Occlusal rims Wax rims should be developed with great care to fill the space once occupied by patient’s natural teeth. Rims should offer adequate support for soft tissues of face. They should allow for esthetic buccal corridor. Arrangement of Teeth for Esthetics And Functional Harmony Can Be Divided into
  23. 23. 23 1. Horizontal orientation of anterior teeth 2. Vertical orientation 3. Inclination 4. Harmony in composition 5. Refinement of individual tooth positions 6. Dentogenic concept Horizontal Orientation Position and expression of lips and lower part of face are the best guides. Greatest harm is done by setting the max. Teeth back to or under the ridge (regardless of actual absorption). This is evident by dropping of the corner of mouth, reduction in vermilion border, philtrum prominence deepening of nasolabial grooves. Excessive lip support - too far anterior placement of teeth gives a stretched, tight appearance of lips, a tendency for lips to dislodge dentures during function, elimination of normal contours of lips, distortion of philtrum and sulci.
  24. 24. 24 Aids
  25. 25. 25 o Photographs 69* 70* can be very helpful Pre extraction diagnostic casts Ridge relation must be taken into account.if mandibular ridge is prognathic the anteriors can be set end to end. 71* Observation of position of anterior teeth when trial denture base is out of mouth can be helpful. 72* The labial surface of most natural central incisor is 8-10 mm. in front of middle of incisive papilla. 73* An imaginary transverse line between upper canines as viewed from tissue contacting surface should cross close to middle of incisive papilla. Vertical Orientation
  26. 26. 26 Amount of upper anterior teeth seen during speech and facial expression depend upon length of upper lip. Long upper lip- teeth may not be visible even during speech. Short upper lip- full crown may be visible along with large amount of mucous membrane/ denture base. During smile incisal and middle thirds of maxillary teeth are visible in most people. Incisal 1/3rd of mandibular anteriors is visible in most people. Mandibular teeth are more visible than maxillary during speech in half the patients (esp. in above 40 age group). Lower lip is a better guide, in most people incisal edges of canine and pre molars are even with corners of mouth when slightly open. Upper and lower trial dentures should approx. Of equal size in most patients Inclination of Anterior Teeth Photographs and diagnostic casts can be very helpful. In many patients upper anterior teeth are inclined labially relative to frontal plane. Usually there is an obtuse angle between the bone and labial surface of teeth. If extractions were done without unnecessary surgery, the original inclination of labial plate is preserved for quite some time. The facial profile is indicative of natural anterior tooth inclination.
  27. 27. 27 Harmony in General Composition of Anterior Teeth It can be divided into 74* Harmony in dental arch form and form of residual ridge 75* Harmony of the long axis of central incisors and face 76* Harmony of teeth with smile line of lower lip 77* Harmony of opposing lines of labial and buccal surfaces 78* Harmony of teeth and profile line 79* Harmony of incisal wear and age
  28. 28. 28 Harmony of Dental Arch Form and Form of Residual Ridge 80* The form of residual ridge may be generally classified as 1. Square 2. Ovoid 3. Tapering Square arch form 81* The distance between canines is wider. 82* Posterior ridge are more parallel than other types. 83* Curvature of anterior ridge is mild. 84* Distal end of the central incisor is rotated towards the lip. 85* Edge of lateral incisors is perpendicular to midline. 86* Distal end of canines is rotated towards the line of posterior arch form. These provide vigour and individuality to anterior set up.
  29. 29. 29 Ovoid arch form 87* Distance between canines is narrower. 88* Curvature of anterior ridge is more severe than square arch. 89* Lateral incisors follow the arch line. 90* Distal end of canine is towards the line of posterior ridge. 91* This provides softness in appearance.
  30. 30. 30 Tapering arch form 92* Distance of canines is narrower. 93* Curvature of anterior arch is more severe than any other arch form. 94* Distal end of central incisor be rotated lingually. 95* Lateral incisors follow the arch line. 96* Distal end of canine is set up to posterior ridge. Harmony of the Long Axis of Central Incisor and Face If the long axis of central incisor teeth is not in harmony with long axis of face, the arrangement does not blend with face (incisal plane of anterior teeth not be parallel to interpupillary line). If central incisor must be divergent, the midline of dental arch should be at centre of face. Midline of mandibular dental arch aligned with midline of maxillary central incisor. Harmony with Smile Line of Lower Lip
  31. 31. 31 When a person smiles, the lower lip forms a pleasant curvature known as smile line. This can be used as a guide line for arranging upper anterior teeth when the line formed by incisal edges of upper anterior teeth follows the curve line of lower lip during smiling the effect is harmonious.
  32. 32. 32 Harmony of Opposing Lines of Labial and Buccal Surfaces Setting teeth with the long axis parallel to each other, results in esthetic failure. The labial and buccal lines must have an opposing equivalent angle or nearly so for harmonious effect. For e.g. if maxillary right lateral incisor is set at an angle of 5 Degree to perpendicular to lateral incisor of the left side be similarly placed. Deviation in angulations may also be balanced by different teeth on two sides. Harmony of Teeth and Profile Line of Face As a general rule the labial surfaces of maxillary central incisors are parallel to profile line of face. In prognathism patients the incisal edges of maxillary teeth are out farther than the cervical ends. In the opposite conditions (Mandibular protrusion) the incisal edges of Max teeth are inclined lingually more than the cervical ends. When the labial of Max CI is parallel to the profile line of face the laterals should be set at an opposite angle to prevent parallelism Harmony of Incisal Wear and Age
  33. 33. 33 The incisal edges and proximal surfaces of anterior teeth wear with age. The incisal edges of denture teeth should always be ground to simulate wear surfaces that would have developed by that time. Refinment of Individual Teeth Positions Correct angulations of long axis of teeth are very important for pleasing esthetics and function. These guidelines are general and may be varied according to arch form or SPA FACTOR.
  34. 34. 34 Maxillary Anteriors 97* Central Incisor- long axis slightly towards the midline when viewed from front, labial inclination- 15 degree, contacts occlusal plane 98* Lateral Incisor-long axis is more towards midline, labial inclination -20 degrees, 1mm above occlusal plane 99* Canine-long axis parallel to vertical axis both when viewed from front and side Mandibular Anteriors 100* Central Incisors- long axis slightly towards vertical axis from front, and slopes labially when viewed from side. Incisal edge is 2mm above the occlusal plane 101* Lateral Incisor- less inclinations than central.2mm above occlusal plane 102* Canine- long axis leans towards midline from front and slightly lingually when viewed from side. 2mm above occlusal plane Dentogenic Concept
  35. 35. 35 Individual tooth positions and forms can be varied to depict the age, sex and personality of the individual such as 103* Rotation of distal surface anteriorly and placement of one C. I. ahead of the other give a vigourous look. 104* Small lateral incisors with rounded incisal edges indicate femininity 105* Femininity is also characterized by curved surfaces and prominent smile line ACCEPTANCE BY THE PATIENT 106* The 107* It ultimate test for esthetics is the patient is the patient who has to wear the denture 108* Involvement and education of the patient is very important at each step CHARACTERIZATION OF DENTURES
  36. 36. 36 Absolutely white, regular flawless teeth contained in smooth highly polished, uniform pink colour denture base appear artificial and lifeless. To create naturalness stains, disfigurement, and natural pigmentation pattern of human gingiva can be incorporated. Teeth Brown stains around the necks of teeth simulate stains due to smoking, tea and coffee. White opaque stains represent hypoplastic areas and synthetic fillings. Denture Bases By production of contour and simulating the anatomical characteristics of oral mucosa with various stains in a denture base a life like restoration can be obtained.
  37. 37. 37 Contour of Denture Base 109* Anatomical contours of marginal and free gingiva, labial and buccal mucosa, root eminencies be reproduced in a denture base. 110* Over exaggeration of contours (such as excessive festooning) should be avoided - never observed in nature. 111* High polish is given to those areas which are not readily visible. Procedure for Characterization After teeth set up excess wax is built up around necks of teeth, flange area and vestibular sulcus. It’s better to flow molten wax rather than adding wax strips.
  38. 38. 38 Carving and contouring FACIAL SURFACE 112* Gingival margin and free gingiva are formed by removing wax with wax carver directed at 45 degrees. 113* Wax is removed from cervical portion until sufficient exposure is made. 114* Don't produce sulcus as it as it harbours food. 115* More labial surface is exposed in elderly patients. 116* Interdental papilla is left long and pointed in young & short and blunt in older patients. 117* Gingival margins of upper central incisor and canine are at higher level than lateral. 118* Creation of slight bulge to gingival margin gives natural appearance. 119* Moderate eminence formed over root area of incisors, heavy and bold for canines. 120* Posteriors should have minor root eminences.
  39. 39. 39 121* In general labial and buccal flanges are shaped concave. 122* Gingival margin is accentuated by a depression or groove along the junction of free and attached gingiva. 123* Marginal gingiva and papilla are made convex. STIPPLING EFFECT 124* Rough texture of natural attached gingiva is reproduced in dentures. 125* Stippling should be done only after the completion of wax up procedure. 126* A stiff tooth brush is trimmed to 1 or 2 shortened row of bristles. 127* The bristles are pricked on labial and buccal surface of wax up. 128* The depressions are smoothened by passing over a fine flame.
  40. 40. 40 Colour distribution of gingiva 129* Deep 130* Pale red tones - muccobuccal fold and interdental papilla yellow tones - root eminences. 131* Neutral pink tones - fan shaped areas between the root eminences. 132* Melanin pigment -attached gingiva, marginal gingiva as regular band or irregular spots.
  41. 41. 41 Staining Armamentarium 133* Red stains 134* Yellow stains 135* Blue, brown or its combination, to be used for melanin pigmentation. 136* 1 bottle containing natural pink polymer and other with nylon fibre. They are mixed together for vascularity and capillary effect Staining Procedure 1ST TECHNIQUE 137* Trial packing the denture with neutral pink acrylic resin with a cellophane between teeth and resin. 138* After separation of flask halves, acrylic resin is well adapted to edentulous cast. 139* Sprinkle a layer of desired tone of stain and moisten it carefully with monomer using small glass s yringe with 24 gauge needle.
  42. 42. 42 2ND TECHNIQUE 140* Sequential application of stains on facial surface of plaster mold prior to packing. 141* Sprinkle 142* Place red tones for melanin to marginal gingiva and papilla. yellow and pale pink tones over the root areas and moisten with monomer. 143* Light red tones - triangular areas between teeth. 144* Deep red a& blue tones along periphery of labial flange. 145* Light pink all over the area to complete the veneer. 146* Allow 147* Wet this veneer to stand for 10 min. it with monomer every few minutes and cover it with a sheet of polythene. 148* Later pack the mold with denture base resin. RE FE RE NCE S
  43. 43. 43 Ar thu r O Rahn , Ch arl es M. H ea rtw el l : Tex t book of com pl et e Dent ur es, ed 5, Lo ndon, 1993. G eorg e A. Za rb , Ch arl es L .B ol en d er, Ju d son C. H i ck ey, Gu nn ar E . Carl sson : Bou cher ’s prost hodont i c t reat m ent for edent ul ous pati ent s, ed 10, B . I P ubl i cat i ons P vt Lt d. John J. S h arry: C om pl et e Dent ure P rost hodonti cs, McG rawhi l l B ook Com pan y, In c . 1962. S h eld on Win k l er: Essent i al s of com pl et e Dent ure P rost hodont i cs, ed 2, Ishi yak u Euro Am eri ca Inc .

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