Introduction. Definitions. Winkler’s concepts of esthetics. Application of esthetic principles in CD construction. Diagnosis and treatment planning. Impressions. Occlusion contour rims & occlusal plane. Jaw relations. Selection of artificial teeth. Arrangement of teeth. Denture characterization. Classification of esthetic errors. Conclusion.

1. ESTHETICS
IN
COMPLETE DENTURE

2. CONTENTS
 Introduction.
 Definitions.
 Winkler’s concepts of esthetics.
 Application of esthetic principles in CD construction.
 Diagnosis and treatment planning.
 Impressions.
 Occlusion contour rims & occlusal plane.

3.  Jaw relations.
 Selection of artificial teeth.
 Arrangement of teeth.
 Denture characterization.
 Classification of esthetic errors.
 Conclusion.
 References.

4. INTRODUCTION
 The subject of esthetics, however, has
always been a grey area in dentistry.
 It is neither a totally scientific and objective
discipline, nor a 100% art form.
 Denture esthetics has been a blending, or
combination of the art and the science of
prosthodontics.

5. DEFINITIONS
Esthetics –
 Pertaining to the study of beauty and the sense of
beautiful. Descriptive of a specific creation that
results from such study; objectifies beauty and
attractiveness, and elicits pleasure.
 Pertaining to sensation.
GPT-8, 2005.

6. Denture Esthetics –
 The effect produced by a dental prosthesis that affects the
beauty and attractiveness of the person.
- GPT-8, 2005.
 The cosmetic effect produced by a dental prosthesis which
affects the desirable beauty, attractiveness, character and
dignity of the individual.
- Sheldon Winkler.

7. WINKLER’S CONCEPT OF ESTHETICS
 Should be examined from 3 points of view as:
1) Biological-physiological.
2) Biomechanical.
3) Psychological/ self-image view.
 Facial musculature and facial appearance.
 Proper impression procedures and accurate denture bases.
Biological-physiological view:

8. Biomechanical view:
 Neutral zone
Psychological/ self-image view:
• Incisal line, occlusal plane and vertical dimension -
dynamics of function and not by static relationship.
• Camper’s plane - psychological plane of orientation.
• Vain person/ happy person - camper’s plane tends to rise.
• Depressed person - plane may slant downwards.

9.  Patient with self evaluation may have a broad smile
/ a tight-lipped small controlled smile.
 Positive feeling - smile broadly.
 Poor self image - hesitant, unsure, questioning and
introverted.

10. APPLICATION OF ESTHETIC PRINCIPLES IN
CD CONSTRUCTION.
 Diagnosis and treatment planning.
 Impressions.
 Occlusion contour rims.
 Jaw relations.
 Selection of artificial teeth.
 Arrangement of teeth.
 Denture characterization.

11. Diagnosis and treatment planning:
 Careful evaluation of mental attitude.
 Preconceived hopes and desires should be determined.
 Emotional response regarding esthetics - attitude of
indifference to demanding.
 This mental harmony between patient and dentist must exist
or failure is inevitable.

12. Impressions
Esthetics is one of the main objectives of impression making.

13. • Natural appearance of the lips in relation to the base
of nose is of prime significance.
• Improperly contoured labial border - tenseness and
extreme fullness of lip.
• Overcontoured border - denture displacement.
• Thus the impression visit is an appearance phase
visit.

14. Occlusion contour rims
 Labial surface of maxillary rim – fullness
required to support the upper lip naturally
in repose and function.

15.  Resorbed maxillary ridge form should not be used to control
the anteroposterior position of the wax. Rather it should be
adjusted with consideration for the orbicularis oris muscle and
the muscles attached to it.
 Correct placement of the occlusal plane is important with
respect to denture stability, function, and esthetics .
 The occlusal plane should be half way between maxillary and
mandibular ridges.

17. Maxillomandibular opening
 The occlusal vertical dimension is responsible for the
harmony between the lower third of the face and the face as
a whole.
 With loss of vertical dimension there is also an acquired
antero-rotation of the mandible.
 Vertical dimension and centric relation are closely
interrelated, and loss of vertical dimension results in a more
exaggerated class III occlusion and facial appearance.

18.  Establishing an acceptable vertical length of face is
a fundamental esthetic concern.
 An excessive VD – strained and artificial
appearance.
 Insufficient VD – changes characteristic of aging
process as chin comes too close to nose,
compresses upper lip at centre and drooping of
corners of the mouth, producing a thin upper lip and
prominent lower lip.

20.  The final VDO must not be determined by
pleasing facial proportions alone, since this
would lead to excessive VD and subsequent
bone resorption.
 At best, an interocclusal distance must be
provided within physiological limits and
individually determined.

21. Selection of artificial teeth
1. Anterior teeth selection.
2. Posterior teeth selection.
 Esthetics plays a major role in selection of Anterior teeth.
 Posterior teeth are less visible & therefore function would be
the prime concern in selection.
 The selection of teeth and their arrangement to meet esthetic
requirements demands artistic skill in addition to scientific
knowledge.

22. ANTERIOR TEETH SELECTION
Patient pre extraction guides

23. Factors to be considered in selection of anterior teeth:
1. Size
2. Form
3. Color
4. material

24. SIZE OF ANTERIOR TEETH
 Method I: pre extraction guides
 Method II:

25. Method III:
 Vertical line extending through the ala of nose
pass through middle of maxillary canine.
 Interalar width measurement- width of upper
anterior teeth.

26. Method IV: Anthropometric measurements
 Bizygomatic width/16 = width of upper CI.
 Bizygomatic width/3.3 = width of 6 anterior teeth.
 Cranial circumference/ width of upper anterior teeth = 10:1.

27.  H.POUND
Bizygomatic width/16 = Width of CI.
Length of face from hairline to chin/16 =
length of CI.
ANTHROPOMETRIC CEPHALIC INDEX METHOD
 Sears in 1941.
 Width of the upper CI=
circumference of the head/13

28. Method V: Trubyte tooth indicator

29. GOLDEN PROPORTION
 Levin stated that "the width of the central incisor should be
in golden proportion to the width of the lateral incisor and
that the width of the lateral incisor to the width of the canine
should also be in golden proportion as should the width of
the canine to the first premolar".
 The golden proportion value is 0.618.

30. FORM OF ANTERIOR TEETH
 Form refers to primarily outline of anything.
 Shape is quality of anything that depends on
relative position of all points composing its
outline.
3 factors:-
The Form & Contour of Face
Sex
Age

31. The Form & Contour of Face
 The general outline of the tooth should
conform to the general outline of the face
when viewed from the frontal aspect.
 A tooth viewed from mesial or distal should
conform to the contour of the profile.

32.  Berry –first to correlate between outlined form of
maxillary central incisor & inverted outline form of
face.

33. J.Leon Williams-
Classified facial forms as
 Square
 Tapering
 Square tapering
 Ovoid

34. The labio incisal contour of the teeth usually conforms
to the profile of the individual.

35. DENTOGENIC CONCEPT
 Frush and fischer in 1956.
 Selective reshaping of tooth - account for age, sex & personality.
Age
 As the features change with aging processes, so does the form of
teeth.
 The lips lose their curves and cupid’s bow, and teeth wear at the
incisal edges and inter proximal areas. The labial surfaces seem
flatter, and the outline form appears more square.

36. Sex
 Curved facial features are associated with feminity and square
features are associated with masculinity.
 Since there is harmony between tooth form and environment,
it follows that teeth of females are ovoid or tapering than
square.
Personality
 Rounded incisal edges, small teeth- frail,delicate.
 Large teeth, straight incisal edges- vigorous personality.

37. SHADE/COLOR OF TEETH
• 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.

38. Hue:
 Hue is the name of the colour ,specific colour produced by a
specific wave length,
Chroma:
 Amount of colour per unit area of an object.
 Fair complexion people have less chroma .

39. Value:
 Value is the relative lightness or darkness of a colour. 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.
Translucency :
 It is the property of an object which permits the passage
of light through it.

40. Color selection
a) By using shade guide
 3 positions
 Outside the mouth along the side of the nose(basic
shade selection that is in harmony with skin color).
 Beneath the lips with only incisal edge showing.
 Beneath the lips with only cervical edge. covered,most
of the tooth covered ( as in smile).

41.  Patient position –upright position.
 Viewed in perpendicular plane, at different
angles.
 Mouth not opened too wide.
 Natural light, white light.
 Distance of 6-8 ft.
 10’ clock to 2 pm.

42. b) Squint test
 The dentist compares prospective shades
along the side of the patient’s face.
 The color that fades first from view would be
least conspicuous for the face color of the
particular individual.

43. MATERIALS FOR ANTERIOR TEETH
A) Acrylic.
B) Porcelain.

44. Porcelain teeth
 Brittle, more resistance to abrasion
 Excellent (does not stain).
 Mechanical bonding by pins or undercuts holes.
 Difficult to grind and polish.
 More forces to the mucosa.
 Clicking on contact.

45. Acrylic teeth
 Not brittle, but poor abrasion resistance.
 Esthetic very good.
 Chemical bonding with denture base.
 Easily ground and polish.
 Transmit fewer forces to the mucosa.
 No clicking on contact.
 Thermal expansion same as acrylic denture base.

46. POSTERIOR TEETH SELECTION
 SHADE
 SIZE
 FORM
 MATERIAL
SHADE
 Should harmonise with anterior teeth.
 Max PM- used for esthetic purpose than functional mainly. So
they should be slightly lighter shade than other posterior teeth.

47. Size and number of posterior teeth

48. Form of posterior teeth
• Anatomic
• Semi-anatomic
• Non anatomic

49. ARRANGEMENT OF TEETH
There are certain guidelines for tooth placement and
arrangement which can be viewed in 3 planes as:
1) Frontal view
2) Saggital view
3) Horizontal view

50. FRONTAL VIEW
Anterior teeth
1. Parallel to the interpupillary line.
2. Incisal edge of the maxillary incisors lie at 1 mm to 2
mm below the maxillary lip at rest.
3. No bulging should be evident under the nostrils.
4. Philtrum should be restored, if possible.
5. Full vermillion border of the lip should be seen.
6. “Smile Line” (maxillary incisal edges) should follow the
line of the lower lip during smiling.

51. Posterior teeth
1. Maxillary posteriors (premolars) should be placed buccally enough to
avoid too large a dark corridor (behind the canines) upon smiling, but not
to eliminate it.
2. The occlusogingival length of the maxillary first premolar tooth should be
long enough so that the denture base material is not obvious on smiling.
3. The occlusal surface of the mandibular first bicuspid should never be
superior to the corner of the mouth when the mouth is open only
sufficiently to receive food.
4. Posterior plane of occlusion should not “drop down” posteriorly, or
maxillary posterior teeth will show too much during smiling.

52. SAGGITAL VIEW
Anterior teeth
1. Upper lip should be everted and not fallen in.
2. Tooth support of the lip is by two thirds of the incisal labial
surface of the maxillary central incisors.
Posterior teeth
1. Posterior plane of occlusion should parallel the ala-tragus
plane (Camper’s line).
2. Posterior plane of occlusion should be at a level between 1/3rd
and 2/3rd the height of the retromolar pad.

53. HORIZONTAL VIEW
Anterior teeth
1. Central incisors should be 8 mm to 10 mm anterior to the
midpoint of the incisive papilla.
2. Canines are on a line drawn perpendicular to the midline of
the palate, through the center of the incisive papilla.
Posterior teeth
1. Mandibular central fossa (or buccal cusps) should be placed
over the crest of the ridge.

54.  Factors affecting the arrangement of teeth:
a) age
b) sex
c) personality

55. AGE
 As tonus decreases ,the positions of teeth for support to
the lips & cheeks are more critical.
 Lips & Cheeks –supported by teeth not by denture borders.
 If cheeks sag, horizontal overlap of posterior teeth is
increased to prevent cheek biting.
 Inter incisal distance increases with age.
 Abrasion of teeth and gingival recession can also be seen.

56. SEX
Female
• Curved features
• Roundness of arch form
• Incisal edges of max ant follow
curve of lower lip.
• Mesial surface of lateral is often
anterior relation to disto labial
surface of central.
• Distal surface of lateral is rotated
in posterior direction.
• Distal surface of canine rotated in
posterior direction
Male
• Square features
• Squareness of arch form.
• Central & canine are in plane ,
laterals above plane.
• Is hidden behind distal surface of
central.
• Rotated very slightly
• Rotated less in posterior direction.

57. PERSONALITY
 The personality of people is expressed in their
habitual patterns & qualities of behaviour .
 Their personality can be influenced by appearance
of their teeth.
 It is obligation of dentist to arrange artificial teeth in
a manner to encourage the development of an
attractive personality.

58. DENTURE CHARACTERISATION
Definition:
Denture characterization is modification of the form and color
of the denture base and teeth to produce a more life like
appearance.
(GPT-8,2005).
 Denture characterisation can be incorporated in case of:
a) Teeth and its alignment in the arch.
b) Denture base.

59. Teeth and its alignment in the arch
 Varying the direction of the long axis of teeth.
 Asymmetry.
 Rotations.
 Eccentric midline.
 Diastema.
 Overlapping.
 Long clinical crowns with receded gingiva.
 Hair line crack within a tooth.
 Discolored tooth and restorations

60. Natural denture bases are obtained by:
i. Esthetic wax-up.
ii. Staining of contours.

61. Esthetic wax-up include:
 Reproduction of characteristic anatomical
structures as:
a) Rugae
b) Frenula
c) Stippling
d) Festooning
e) Sulcus

62. Staining the denture base
3 factors are to be considered as:
a) Extent of vascularity within tissues.
b) Thickness and density of soft tissues.
c) Cellular components of tissue.

63.  Deep (red) tones are found in the mucobuccal fold, frenula, soft
palate, pharyngeal soft tissue adjacent to the tuberosities, incisive
papilla, interdental papillae, and the larger rugae.
 Pale (yellow) tones are found in root eminences and the hard palate.
 Neutral (pink) tones which fall between the extremes of deep and
pale tones are located on the lingual side of the lateral alveolar
processes, and facially in the fan-shaped areas, between root
eminences, that diverge toward the mucobuccal fold.

64. CLASSIFICATION OF ESTHETIC ERRORS
Esthetic errors may be classified according to the following outline:
I. Inharmonious dentofacial ratio
A. Shade disharmony
B. Compositional incompatibility
1. Static denture in dynamic mouth.
2. Inharmonious strength or weakness of dental composition compared
to background features.
- Weak mouth with strong face.
- Strong mouth with weak face.
Lombardi, R. E.: Classification of errors in dental esthetics,
J. PROSTHET. DENT. 29: 358-382, 1973.

65. Il. Intrinsic dental disharmony
A. Space allocation errors
1. Inadequate vertical space allocation.
2. Excessive vertical space allocation.
3. Excessive horizontal space allocation.
B. Structural line errors
1. Elevated occlusal plane.
2. Occlusal plane drops down posteriorly.
3. Asymmetrical occlusal plane.
C. Unnatural lines
1. Reverse smiling line.
2. Unnatural axial inclination.

66. 3. Cuspless posterior teeth
4. Gradation errors
5. Age-sex-personality disharmony
D. Single-line errors
1. Vertical deviation
2. Horizontal deviation
3. Line conflict
E. Imbalance
1. Midline error
2. Imbalance of directions
3. Artifact error
4. Diastema error

67. REFERENCES
 Sheldon Winkler. Essentials of complete denture prosthodontics.2nd edition.
A.I.B.T.S publishers, India; 2012, pg no 202-217.
 Arthur . O . Rahn , Charles . M. Heartwell . Textbook of complete dentures. 4th
edition. Elsevier; 1993, pg no. 305-321.
 Judson. C. Hickey, George. A. Zarb, Charles L. Bolender; Prosthodontic
treatment for edentulous patients; 9th edition. St. Louis:Mosby;1990, pg no.324-
343.
 Kennitzer D.F: Esthetics and the denture base; J. Prosthet. Dent.6:603-16,1956.
 Lombardi, R. E.: Classification of errors in dental esthetics, J. Prosthet. Dent. 29:
358-382, 1973.
 Krajcek D.D: Natural appearance for the individual denture patient; J. Prosthet.
Dent. 10(2):205-214,1960.