1. Definitive Obturators: Partially
Edentulous Patients
John Beumer III DDS
Division of Advanced Prosthodontics
UCLA School of Dentistry
Mark T. Marunick
Director, Maxillofacial Prosthetics
Wayne State University School of Medicine
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2. Definitive Obturators: Partially
Edentulous Patients
v Treatment concepts
v RPD design concepts
v RPD design exercise
v Clinical procedures
v Impressions
v Physiologic adjustment of RPD castings
v Altered cast impressions of the defect
v Maxillo-mandibular relations
v Processing
v Delivery and Followup
v Esthetics

3. Maxillary Defects
Challenges
l Multiple axis of rotation
l Compromised support, stability and retention
on the defect side
l Lack of cross arch stabilization because of the
loss of palatal structures on one side
l Long lever arms with the resultant load
magnification
l Forces of gravity become more significant

4. Principles of RPD design
v Major connectors must be rigid.
v Occlusal rest must direct occlusal forces along the
long axis of the teeth.
v Guide planes are employed to enhance stability and
bracing.
v Retention must be within the limits of physiologic
tolerance of the periodontal ligament.
v Maximum support is gained from the adjacent soft
tissue denture bearing surfaces.
v Designs must consider the needs of cleansibility.

5. Maxillary Defects – Objectives
Partially edentulous patients
l Restore the partition between the oral and nasal cavities
(necessary for velopharyngeal closure and speech
and swallowing)
l Restore palatal contours and replace missing dentition
(necessary for speech articulation)
l Provide retention, stability, support for the partial
denture-obturator prosthesis
l Create partial denture designs that do not stress
abutment teeth beyond their physiologic tolerance

6. Treatment Concepts Partially
Edentulous Patients
Location of the defect
Movement of the prosthesis
Length of the lever arm
Arch form
Teeth
Forces of occlusion vs the
forces of gravity
Partial denture design

7. Location of the defect
Invariably the surgical resection includes the
distal portion of the maxilla and rarely does a
distal abutment remain. Therefore a
Kennedy Class II partial denture with an
extensive lever arm is required for most
patients.

8. Movement of the prosthesis
l Potential exists for substantial movement as
compared to the normal unresected patient
l The defect must be employed as effectively as
possible to minimize this movement.
Clinical significance: There is greater risk of overloading
abutment teeth with inappropriate partial denture designs.

9. Length of the lever arm
Length of lever arms are much greater
than seen in conventional prosthodontics
Clinical significance: There is greater risk of overloading
abutment teeth with inappropriate partial denture designs.

10. Arch form
v Square and ovoid arch forms possess more palatal
bearing surface perpendicular to the occlusal loads
v Tapering arch forms provide less palatal shelf area
following radical maxillectomy
v Indirect retention more effective with ovoid or square
arch forms
Clinical significance: In tapering arches or in defects with little
palatal shelf remaining, support is compromised, leading to greater
movement of the prosthesis into the defect during function, and
potentially overloading abutment teeth if the partial designs are
inappropriate.

11. Preservation of teeth
RPD designs must anticipate and
accommodate the movements of the
prosthesis during application of occlusal
forces, without exerting pathologic
stresses on the abutment teeth.
Clinical significance: If the RPD designs do not conform
to this idea there is risk that abutment teeth may be
overloaded leading to their premature loss.

12. Forces of occlusion vs the forces of gravity
Although the forces of gravity and other
forces are more substantial than normal
the forces of occlusion are still the most
important forces to be taken into account
when designing RPD frameworks for
patients with maxillary defects.

13. Partial denture design concepts for
radical maxillectomy defects
v Abutments adjacent to the defect are
subjected to the most stress
v Arch form effects designs
v Fulcrum lines are multiple
v Nature of the defect affects designs
v Degree of movement affects designs

14. Partial denture design concepts for
radical maxillectomy defects
l Trismus can affect designs
l Bolus manipulation affects designs
l Buccal vs lingual retention
l Swing lock designs are not
recommended

15. Retention
v “I”
bars adjacent to the defect
v Take advantage of the defect
Stability
v When doubt provide additional bracing
v Linear configurations
v Tapering arches
v Unfavorable defects
Support

16. Abutments adjacent to the defect
l These teeth are subject to more vertical and lateral
forces and are more frequently lost than abutments in
other positions. Why?
l The extension areas immediately adjacent to the defect offer little
support.
l The long lever arms magnify the loads delivered
Clinical significance: Design and position of rests on these teeth
must direct occlusal forces along the long axis of the teeth. In some
patients splinting these teeth to adjacent teeth may be useful, in
others it is best to use these teeth as overdenture abutments.

17. Abutments adjacent to the defect
l Rest position and contour

18. Rest position and contours
Both incisors were periodontally
compromised and were transformed into
overdenture abutments.
To minimize the risk of caries
the RPD casting covers the
two overdenture abutments
(oval).

19. Rest position and contours
l Incisal rests are contraindicated on teeth adjacent to
the defect. In this patient the incisal rest on the cuspid
will disengage when an occlusal force is applied
posteriorly.

20. Anterior teeth
adjacent to the
defect must have
positive cingulum
rests.

21. Anterior teeth adjacent to the defect must
have positive cingulum rests.

22. Rest position and contours
l Incisors – Splinting and cingulum rests. We recommend
that incisors adjacent to the defect be splinted together
with full veneer crowns and cingulum rests be developed

23. Rest position and contours
l Cuspids
In most patients a full veneer crown will need to be fabricated in
order to design a cingulum rest with proper contours.

24. Rest position and contours
l Cuspids
In this patient a positive cingulum rest was created without
perforation of the enamel. This is a 21 year followup photo and
this is the original RPD casting.

25. Rest position and contours
l Premolars – If a premolar is adjacent to the defect,
the rest should be placed on the mesial and a guide
The rest should be formed in the shape of a half circle, so that the RPD
framework will freely rotate when posterior occlusal loads are applied.

26. Rest position and contours
l Bonded cingulum rests - Long term results have
been very disappointing.
l However, in view of new and improved bonding
this issue is worth revisiting

27. Arch form and palatal shelf
l Tapering arches have less
palatal shelf for support, and the
remaining dentition is more
likely to exhibit a linear
configuration. Such
configurations are likely to lead
to more movement in and out of
the defect and indirect retention
is less effective.
l In such patients more
retention and bracing on the
lingual side are required.

28. Arch form
l Ovoid or square arch forms
have more palatal shelf area
and indirect retention is more
effective, resulting in less
movement of the prosthesis in
and out of the defect
l In such patients less
retention and bracing is
required

29. Fulcrum line
l Fulcrum lines are dynamic and once the sites of
occlusal rests are selected, the axis of rotation is
dependent upon the site of load application
Load #1 – Fulcrum
line A - B
Load #2 – Fulcrum
line C - D
Load #3 – Fulcrum
line E - F

30. Importance of the defect
l If
the support, stability and retention
of the prosthesis can be enhanced by
engaging selected areas in the
defect, fewer retainers will be
necessary and less bracing required.

31. Note the increased use of lingual plating, and
the greater number of retainers used in the
Favorable Unfavorable
Defect Defect

32. Note the increased number of retainers
used in the unfavorable defect
Favorable Unfavorable
Defect Defect

33. Degree of movement of the prosthesis
l Larger the defect the greater the movement
l Remaining teeth on the resected side – More teeth,
indirect retention becomes more effective, and less
movement in and out of the defect
l Arch form – Ovoid and square arch forms provide more
palatal shelf area than tapering arch forms, more
effective indirect retention and therefore, less
movement in and out of the defect
l Palatal shelf area
l How much remains – The more available for support the less
movement into the defect
l Is the residual palatal shelf parallel to the occlusal plane – The
more parallel it is the less movement into the defect

34. Stability and Bracing
l Lingualplate
l Suprabulge retainers
More bracing is required in maxillary resection defects
and so supra-bulge retainers are use on posterior teeth
and lingual plating is frequently employed.

35. l Linear configuration of the residual dentition require aggressive lingual
plating for bracing particularly if the defect is of poor quality.
Retainers are positioned on the teeth with the most root surface area,
in this case the cuspid and the molars.
x The primary axis of rotation, which
occurs when the patient incises the
bolus (arrow), is represented by the
dotted line.
The retainer on the cuspid will tend
to rotate into an undercut when an
incisal load is applied.
The retainers on the molars, will deliver an extraction force, when
incisal loads are delivered. However, because of their large root surface
area, the molars are not affected clinically.

36. Movement of the prosthesis
Linear configuration and no palatal shelf
l A prosthesis fabricated for this defect will be subject to
significant movement potentially delivering significant
stresses to the abutment teeth.
Such patients require more bracing to enhance
stability and distribute lateral and gravity forces
more widely. Suggested design shown.

37. Degree of movement of the prosthesis
This maxillectomy defect extended past the midline and there is
little useful palatal shelf remaining. The defect offers little support.
Therefore the appliance will be easily displaced into the defect
when an occlusal load is applied on the defect side. The
undercuts in the defect should be aggressively engaged because
of the lack of effective indirect retention.

38. Movement of the prosthesis
Both of these patients have favorable defects and ample
palatal shelf. Partial denture designs can be conservative.
Little bracing is required and few retainers are necessary.
Indirect retention will be quite effective in aiding retention on
the side of the obturator prosthesis.

39. Occlusal loads to consider when designing
RPD frameworks
l Incisal – Common and the RPD design must
accommodate for the forces delivered in this region.
l Posterior on the defect side – The patient is advised to
masticate on the normal side. Therefore partial denture
.
designs need not accommodate these loads.
l Posterior on the unresected side in an edentulous
distal extension area – Common and the RPD must
accommodate for the forces delivered in this area.

40. Bolus manipulation
Patients are advised, and soon learn, to confine the bolus posteriorly on
the unresected side but they will incise on the defect side. Therefore, in
most radical maxillectomy defects, clinically the most significant axis of
rotation will be similar to the C-D axis seen in this defect. However, in
this patient the A-B axis is the most important because the patient will
apply occlusal forces in the extension area.

41. Effect of trismus – Limiting
factor is the depth of the palatal
shelf vs the amount of space
between the anterior teeth upon
maximum opening.
“A” must be equal or
greater than “B” + “C” if
the prosthesis is to be
inserted, removed and
properly adapted.

42. Buccal vs lingual retention
Lingual retention is not recommended
l Retention often inadequate
l Primary axis of rotation (dotted line) is the result of
incising forces (arrow). Therefore, regardless of whether
the retention is lingual or buccal, the retainers are on the
wrong side of the fulcrum line.
Fortunately the incisal
x forces are one fifth the
magnitude of posterior
forces and in most
situations do not lead
to overloading of the
posterior abutments.

43. Swing lock partial dentures
These designs are not recommended. Retention can be
excellent but these designs subject the abutment teeth to
additional stress, resulting in severe wear of the labial and
buccal surfaces of these teeth (arrows) and possible
premature tooth loss. Note also the fracture of two of the
retaining arms.

44. Partial denture design exercise
v S/P maxillectomy
v Unfavorable defect
v Tapering arch form

45. RPD design exercise –
Sample design
v S/P palatectomy
v Remaining teeth in good condition
v Ample palatal shelf
v Ovoid arch form

46. Partial denture design exercise – Sample design
The RPD design used on a patient with a similar defect and dental configuration. The
defect was lined with skin and had a significant undercut associated with the lateral
posterior wall. All retainers have been positioned in undercuts areas (0.01 inch).

47. Partial denture design exercise
The two central incisors were splinted together and provided with cingulum
rests. A cingulum rest was placed on the cuspid and a mesial rest was
placed on the premolar. The most significant loads will be delivered
posteriorly in the extension area on the side opposite the defect (Load #1).
x x
Load #1 Load #1

48. Partial denture design exercise
The axis of rotation for Load #1 will be A-B. With the rest placed
on the mesial of the premolar the “I” bar retainer associated with
the premolar will disengage during a forceful closure. During this
closure, an extraction force will be delivered via the retainer to the
two central incisors. Splinting them together helps them absorb
this force.
A A
B B
x x
Load #1 Load #1

49. Partial denture design exercise
The patient is instructed to keep the bolus on the unresected side. However,
on occasion, during incision of a bolus, loads will be applied on the defect
side (Load #2). The axis of rotation associated with load #2 is C-D. During
application of this force the “I” bar associated with the central incisor will
disengage.
C C Load #2
x
A D A D
B B
x x
Load #1 Load #1

50. Partial denture design exercise
Fortunately these incisal loads are not as great as those generated in the
posterior region, and the resulting extraction force delivered to the premolar
and the cuspid are not clinically significant. Splinting the two centrals
together helps these teeth better withstand the incisal loads.
C C
Load #2 Load #2
x x
A D A D
B B
x x
Load #1 Load #1

51. Partial denture design exercise
The RPD framework must be physiologically adjusted so the
obturator prosthesis can move around these axes without
stressing the abutment teeth beyond their physiologic
tolerance.
C C
Load #2 Load #2
x x
A D A D
B B
x x
Load #1 Load #1

52. Partial denture design exercise
The forces of gravity, delivered to the dentition from the
obturator prosthesis dropping out of the defect, are
counteracted by the positive rest on the cuspid and by
engaging the undercuts in the defect with the obturator.
Lateral forces are best
counteracted by increasing
bracing and uniting the arch
with guide planes and minor
connectors.

53. Partial denture design exercise
l The major connector should not extend to the margin of the
defect. This design permits making of an altered cast
impression of the residual palatal shelf, resulting in better
tissue adaptation in this vital support area.
This design also permits
reline impression of the
palatal shelf area in the
event of tissue changes.

54. Completed removable partial denture with obturator.

55. RPD design exercise – Sample design
This patient required a
partial palatectomy for
removal of an adenoid
cystic carcinoma at
junction of the hard and
soft palate. The
resection included most
of the soft palate. The
lateral wall of the defect
was lined with skin.

56. RPD design exercise – Sample design
Cingulum rests were placed on both cuspids, and rests
positioned on the premolar and molars as seen. Guide
planes were placed on the cuspid and the molar. All
retainers were placed in undercuts (0.10).

57. RPD design exercise – Sample design
This defect is considered unfavorable since it extends all the way
to posterior pharyngeal wall. Additional bracing is enhanced by
engaging the lingual surfaces of the molars as shown.

58. RPD design exercise – Sample design
The forces of gravity are counteracted by engaging the
undercut up the skin lined lateral wall of the defect and by
the cingulum rest on #6 and the rest on #5.

59. RPD design exercise – Sample design
This defect is considered unfavorable since it
extends all the way to posterior pharyngeal wall.
Additional bracing is enhanced by engaging the
lingual surfaces of the molars as shown.

60. Partial denture design exercise
v S/Pmaxillectomy
v Favorable defect
v Ample palatal shelf

61. Partial denture design exercise
v S/P radical maxillectomy. The
defect is favorable and
extends posteriorly to the
junction of the hard and soft
palate There is some palatal
shelf remaining and it is
parallel to the occlusal plane.
The remaining maxillary teeth
are in excellent condition.
Please outline your partial
denture design.
v If the defect were less
favorable how would this
change your design?
v If there were less palatal shelf,
how would this impact your
design?

62. Partial denture design exercise
v S/P radical maxillectomy
v No palatal shelf
v Dynamic defect

63. Partial denture design exercise
This patient is status post radical maxillectomy. The
defect is lined with skin and is favorable but
dynamic. The remaining teeth are healthy and
periodontally sound. Please outline your partial
denture design.
How would your
design change if the
defect extended to
the posterior
pharyngeal wall and
was unfavorable.

64. Partial denture design exercise
Design sequence
v Rests
v Guide planes
v Minor connectors
v Major connectors
v Retainers

65. Partial denture design exercise
l Patient is status post partial palatectomy for a
benign tumor. Significant amounts of the palatal
shelf, parallel to the plane of occlusion, remain.
The two remaining teeth are in reasonable
condition. Please outline your partial denture
design.

66. Clinical procedures
v Impression for the RPD framework
v Physiologic adjustment of partial
denture framework
v Altered cast impressions of the defect
v Centric relation records
v Trial dentures
v Processing
v Delivery and followup

67. Master Impressions
Impressions for the RPD framework
v Stock tray with reversible hydrocolloid
v Stock tray with polysiloxane
Altered cast impressions of the defect
v Bordermolding with dental compound
v Wash impression materials
v Polysulfide vs thermoplastic wax

68. Impressions
Impressions for RPD framework
l Alginate
l Poly siloxane
l Puddy impression of the defect and wash of the dental
elements

69. ImpressionsImpressions
Master for RPD frameworks
A stock tray is used. Periphery wax is used to extend
the tray into the defect and onto the soft palate.
Undercuts on the medial side of the defect should be
blocked out. Otherwise the residual palatal contours
will be distorted upon removal of the tray.
The completed impression
records the contours of residual
tissues, the dentition, and the
defect

70. Master Impressions
Impressions for RPD frameworks
Polysiloxane
vBeware of boney
undercuts

71. Master cast and RPD framework

72. Verify and physiologically
adjust the RPD framework
Framework try-in appointment:
a) Verify accuracy of fit
b) Physiologically adjust framework
c) Occlusal adjustment of framework

73. Physiologic adjustment
Rouge and chloroform is still the most
effective means. Guide planes and
minor connectors should be carefully
evaluated.
Note where the rouge has been
rubbed away from the distal guide
plane (arrow). This area needs
adjustment.

74. Physiologic adjustment of partial
denture frameworks
Rouge and chloroform is still the most effective means.
Guide planes and minor connectors should be carefully
evaluated. Note where the rouge has been rubbed
away from the distal guide plane (arrow).
This area needs adjustment.
Silicone type indicators
are effective, but much
more expensive.

75. Physiologic adjustment of
partial denture frameworks
Another framework. Note the
areas in need of adjustment
(arrows). Adjustments are
made with a high speed air
rotor.

76. Border molding
Altered cast impression tray
The tray must extend the full height of the lateral wall extension
if possible. Note the handle incorporated within the tray.

77. Border molding
Mold the anterior segment first, followed by the posterior
segment. Low fusing compounds with extended working
time is recommended.*
The patient is directed to make eccentric mandibular
movements to trim the posterior lateral portion of the
impression.
*GC Dental Industrial Corp. Chicago, Ill

78. Border molding
When access to the lateral wall of the defect is impaired,
making it difficult to record the undercut in this area, it is
advantageous to place a hole in the altered cast impression
tray as shown, and manipulate the compound digitally.

79. Border molding
l When making the altered cast impression, it is recommended
that an occlusal index be made as shown. Advantages:
l This index can be used as a tentative centric relation record
l The index will stabilize the border molded impression while making the
corrected impression.
l The full vertical height of the prosthesis on the defect side can be
determined prior to processing. Knowing this dimension prior to
insertion saves time during the delivery appointment.

80. Wash impression materials
Polysulfide
l Used in smaller static defects
l Favored when large undercuts need to
be recorded

81. Polysulfide - Cut back and perforating the finish line
Border molded
impression
Completed cut back. Note the
perforations along the finish line. These
perforations will ensure that the RPD
casting seats properly when making the
wash impression.

82. Making the corrected impression
1. Cut back the compound 1-2 mm
and perforate the finish line. 3. Inject the polysulfide
into the lateral undercut
before inserting the
border molded
impression.
2. Apply a thin
layer of adhesive
to the border
molded impression
up to the finish
line.

83. Polysulfide wash impression
Completed altered cast impressions of radical
maxillectomy defects and adjacent tissues
Note the minimal tissue
displacement of these impressions.

84. Polysulfide-Cut back and perforating the finish line
Completed impression.
Note that there is little
spillage of impression
material onto the major
connector.

85. Thermoplastic wax
l Preferred in large, dynamic
defects
l Recommended when the
obturator extends into mobile
border tissues or into the
velopharyngeal area
Scar band

86. Thermoplastic wax
l In this patient the defect
extends into the
velopharyngeal area.
l In the static areas of the
defect, the obturator is
extended up the skin
grafted lateral wall to
enhance retention and
stability.

87. Thermoplastic wax
The extension into the
velopharyngeal area is
confined to the zone of
contraction of the
residual levator and
the superior constrictor
(ovals).

88. Thermoplastic wax
Note that the compound is extended to engage the
mandibular occlusal surfaces.
The index provides occlusal stops on the defect side
while the impression is refined with thermoplastic wax.

89. Thermoplastic wax
l Before the Iowa wax is
added, about 2mm of
compound is removed from
the border molded surfaces.
The wax is heated slowly
and applied with a brush.

90. Thermoplastic wax
The impression is
placed in the mouth
and border molded.

91. Thermoplastic wax
This defect extended into the velopharyngeal area.
Polysulfide was used to record the static areas of the defect.
The velopharyngeal region was corrected with a
thermoplastic wax.

92. Master impressions
Altered cast impression
l Boxing the impression
and making the master
casts

93. Boxing altered cast impressions
v Remove the extension area past the finish line and onto
the major connector
v Cut multiple retention grooves onto the bottom side of
the cast as shown
v Seat the RPD framework onto the cast. Be sure all
rests are seated
v Lute the RPD framework to the cast with sticky wax

94. v Box the impression as shown with
beading and boxing wax.
v Before pouring the impression
soak the boxed impression in slurry
water for at least 5 minutes.
Do not soak the cast in tap water.
Dental stone is water soluble.

95. Centric relation records
Occlusal indices were developed in
dental compound while making the
altered cast impression of the defect
and used to mount the mandibular cast.

96. Processed record base
a b c
d e f
Heat processed record base. These are quite useful in
patients with large or unfavorable defects. d: Wax rim added.
e: Try in. f: Completed prosthesis

97. Centric relation records
Some articulators,
such as the Stratus
300, will accept large
upper casts associated
with maxillectomy
defects.
To mount the maxillary cast with
a face bow transfer record most
articulators will need alteration.
This articulator has been fitted
with vertical columns to create
sufficient space for the upper
cast and mounting.

98. Occlusion
Purpose of the prosthetic dentition on the defect side:
a) Esthetic display
b) Lip support
c) Prevent opposing dentition from super-erupting
A B
Occlusal scheme
l Centric only contact on the defect side is preferred. In patient “B” the
lateral and cuspid were raised and set to the labial to flatten the
incisal angle so as to avoid premature contact during lateral
excursions. The buccal inclines of the buccal cusps need to be
flattened and the buccal cusp tips shortened.

99. Processing and Finishing
The partial denture with obturator is flasked, and
processed with heat polymerizing methyl
methacrylate
The processed resin is
finished and polished in
the usual fashion

100. Processing and Finishing
If conventional processing is used
oversized denture flasks will need
to be employed.

101. Delivery steps
v Pressure indicating paste
v Disclosing wax
v Clinical remount

102. Completed Prosthesis
v The obturator portion is hollowed to reduce weight
v The lateral wall extension is considered an extension
area and is polished after adjustment
Note the undercut in the
posterior lateral portion of
the obturator (arrows).
Note the imprint of the ramus (oval).

103. Identifying Areas of Tissue Displacement
Pressure indicating paste
l Useful for checking tissue displacement in the
defect when salivary flow is normal
l If patient suffers moderate to severe xerostomia
disclosing wax is recommended

104. Identifying Areas of Tissue Displacement

105. Identifying Areas of Tissue Displacement

106. Delivery steps
Disclosing wax is
preferred when
checking the extension
areas or mobile
portions of the defect
Ramus imprint
Note the overextended area in
the velopharyngeal closure
region. This area required
adjustment.
Velopharyngeal
extension area

107. Completed RPD with Obturator
Check the occlusion.
There is occlusal
contact only during
centric occlusion.

108. Completed RPD with Obturator
Speech and swallowing are restored to normal and mastication
can be accomplished effectively on the unresected side.

109. Esthetics in the anterior region
“I” bars are preferred on anterior abutments.

110. Esthetics in the anterior region
v Lip support
v Midfacial contours
v Positive rests on teeth adjacent to the defect will help
control the position of denture teeth anteriorly
v Matching color, texture and shape of teeth and gingiva
v Resilient attachments when indicated
v Tooth positions and lip line

111. Esthetics in the anterior region
This patient is status post partial palatectomy for a benign tumor of the left
hard palate. The left tuberosity remains and it contains a third molar
Note the bracing arm through the proximal of #5 and #6. It is non- retentive
but keeps the RPD framework from being displaced lingually in this
region and with the cingulum rest on #8, keeps the framework
centered over the ERA attachment.
Bracing
arm
Rest
ERA
attachment
Cingulum
rest

112. Completed RPD with Obturator
Bracing arm
The two central incisors have
been splinted together. A
cingulum rest is positioned on
the mesial side of #8. The High smile
ERA attachment is
incorporated within the crown
of #9. Note the bracing arm.

113. Completed RPD with Obturator
High smile
Note the attachment associated with third molar. This serves as an occlusal
stop and has a retentive attachment incorporated within. The ERA should not
be used unless a positive occlusal stop is present on the defect side, either
from a tooth or an implant.

114. Completed RPD with
Obturator
Esthetics in the anterior region

115. Esthetics in the anterior region
The anterior portion of this defect is retained with an “I “ bar. The
two central incisors have been splinted together and both have
cingulum rests. Note the contours and position of the prosthetic
dentition on the defect side, closely match that of the natural
dentition.

116. Esthetics in the anterior region
The contours of the anterior
extension filling the anterior
vestibule and supporting the upper
lip (arrow) was carefully developed.
During normal speech the “I” bar is not visible. It is
apparent only during a high smile.

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