This document provides an overview of factors affecting esthetics in complete dentures. It discusses key considerations like tooth shape, size, color and arrangement. Additional factors that influence esthetics are outlined, such as lip support, the midline, and smiling line. The document also examines interpreting a patient's sex, personality and age through tooth selection and positioning. Specifically, it describes how tooth shape, rotation and arrangement can be modified to appear more feminine, masculine, youthful or mature. Interpretation of these esthetic factors is an important aspect of creating natural-looking complete dentures.

1. Esthetics in
Complete Denture
Presented by DR Sara Bahaa Mohamed

2. 1. Introduction
2. Definition
3. Review of literature
4. Fundamentals of esthetics
5. Impression making
6. Jaw relation
7. Anterior tooth selection
8. Anterior and posterior teeth arrangement
9. Characterization of denture
10. Errors in esthetics
11. References
Contact

3. Introduction:-
• Esthetics is a crucial aspect of complete dentures.
• The appearance of a patient's dentures can have a
significant impact on their self-esteem and confidence.
Patients who are unhappy with the esthetics of their
dentures may avoid social situations or feel embarrassed
about their smile.

4. Definition:-
•Esthetics can be defined as the branch of philosophy
dealing with beauty. Descriptive of a specific
creation that results from such a study: objectifies
beauty and attractiveness and elicits pleasure.
•Denture esthetics : the effect produced by a dental
prosthesis that affects the beauty and attractiveness
of the person.

5. Factors affecting the
esthetics in complete denture

6. •The esthetics of complete dentures can be affected by
various factors, including tooth shape, size, color, and
arrangement. The shape and size of the teeth can affect the
overall appearance of the dentures, as well as the patient's
facial structure and profile. The color of the teeth is also
important, as it can affect the natural look of the dentures
and how they blend in with the patient's remaining teeth.
Factors affecting the esthetics in
complete denture

7. Factors affecting the esthetics
in complete denture
• The arrangement of the teeth is another important factor to
consider when it comes to esthetics in complete dentures.
The dentist must ensure that the teeth are arranged in a way
that looks natural and balanced, while also taking into
account the patient's bite and chewing function. Using
visuals can help illustrate these points and make them easier
for the audience to understand.

8. History
• G.Fonzi an Italian dentist in
Paris invented the Porcelain
teeth that revolutionized the
construction Of dentures
• In 1937 Dr. Walter Wright
introduced resin.
6

9. • John P Frush And Roland D Fisher in 1955
• They introduced
dentistry to ease the selection of anterior
the word “dentogenic” in prosthetic
Teeth in complete denture prosthodontics.
Factors of Dentogenic restorations, sex, age, and
personality has improved appearance of the
denture wearer.

10. • Donald F K in 1956 studied relation between the
denture esthetics and denture base.
• The factors relating to the denture base are the
reproduction of the contours of the tissue covered by the
base, and its staining to reproduce the natural tissue
hues.
Indications for esthetic denture bases in patients
with active upper lip, patient with prominent
premaxillary area, theatrical performers and
singers, produces psychologic effect on the patient

11. • Frush and fisher in 1958, they studied the qualities of
femininity, masculinity, personality and the various
physiologic ages in smile.
• Richard E. lombardi in 1973 ,he studied the science
and principles of visual perception and their influence in
creating intense vitality, beauty, and realism on denture
prosthesis.
By application of Dynesthetic techniques to the
Dentogenic concept have accomplished the pleasing
personality, masculinity, and femininity, effectively.
Principles of esthetics such as unity
, composition,
dominance, proportion, illusion in denture esthetics.

12. Fundamental
of esthetics
Composition
Denture
Esthetics
Proportion
Denture
Esthetics
Balance
Denture
Esthetics
Lines in
Denture
Esthetics
Color in
denture
Esthetics

13. Symmetry:-
It is the regularity of arrangement of forms either from left to
right as in horizontal symmetry, or from a central point to either
side like a mirror image as in radiating symmetry.
The horizontal symmetry looks repetitive and uninteresting while
the radiating symmetry looks dynamic and interesting.
In a dento-facial composition radiating symmetry of the teeth is
more esthetically appealing and is associated with youthfulness
while horizontal symmetry is less appealing and is associated
with aging.

14. Proportion:-
• The relationship of the various units which are
different from each other in a composition but
are associated with each other through a certain
repetitive mathematical factor called as
Repeated ratio.
• The proportion between the various elements of
a harmonious composition, in which the
cohesive and segregate forces are equally
balanced and its various units in an esthetically
appealing, respective proportion to each other
is the Golden proportion.

15. Dental esthetics and golden proportion (Edwin I. Lewin JPD
40;3, 1978)
• Golden proportion has been used since time immemorial
• It was extensively used in greek architecture eg the
Parthenon on the Acropolis of athens.

16. Proportion between teeth
• In its simplest form it is the proportion between the larger
part and smaller part.
0.618 1
A B
• When ratio between B and A is in the golden proportion,
then B is 1.618 times larger than A.
• The width of central incisor is in golden proportion to the
width of the lateral incisor.
• Width of the lateral incisor to width of canine is also in
golden proportion, as is the width of canine to first
premolar.

17. Proportion between teeth and smile
• In the esthetically pleasing smile, the space between the
corner of the mouth and the dental arch form a
“backdrop” in which the anterior esthetic segment is
featured.
• This segment is in the golden proportion to the width of
the smile.

18. Form of the corner of the anterior esthetic
segment
• In any smile the central incisor dominate.
• The next dominant harmony should be in the
region of canine or premolar.
• One of these teeth should be dominant to mark
the corner of the mouth, and to stress the visual
strength contained in the arch.
• The most difficult aspect of the prosthodontics is
to establish the exact shape of the corner of the
arch so as to be in complete harmony with the
visual personality projected by the patient.

20. Illusion
• The front to back progression is a critical factor because
illusion of arch shape and depth must be provided in the
composition.
• If two like structure are placed at different distance on a
line, the closest one to the viewer will appear larger.
• If other structure are placed in between the size
reduction will appear to be gradual .

21. • Buccal corridor helps achieve this gradation by altering
the light.
• If two objects are the same size the lighter one appears
larger, this is principle of illumination.
• As the teeth pass posteriorly, the light is reduced and
this gives a gradually darkershade and therefore a
smaller appearance.
Principle of illumination,
lighter one appear larger
Teeth of equal width but different
length appear to have different
widths

22. Line in denture esthetics:-
- shape of the tooth
- relationship between the adjacent teeth
- between the teeth and the matrix
- between the teeth and the background
-between the teeth and the dark space area between upper
and the lower teeth when the mouth is open
• Line is also involved in line formed by the incisal edges
and buccal cusp tips of the teeth, in the occlusal plane,
and the perspective illusion created by the total
composition.

23. Line in dental composition
• The strongest relationship that can exist between two lines is a
perpendicular relationship because it exhibits greatest possible
contrast.
• Most harmonious is parallel relationship, because it exhibits least
possible contrast.
• The line relationship between adjacent teeth should be
Towards parallelism and
harmonious, that is striving
therefore harmony.
• The chief offender is usually the
line formed by the distal outline
of lateral incisor.
• The buccal surface of first
bicuspid is a very close.

24. • It is often necessary to reduce the distolabioincisal
contour and the incisal third of the distal outline of the
lateral incisor to eliminate the conflicting line.
• The neck of the lateral incisor may be kept out labially to
minimize the line conflict.
• The line formed by the labial outline of the cuspid is
especially important because it is close to the line formed
by the lower lip as it curves upward towards the
commisure, it completes the smile line.
• If the incisal edge is tipped lingually, the line formed by the
labial surface of the cuspid is more nearly parallel to the
line of the lower lip and exhibits a soft relationship.

25. • If the incisal edges of the anterior teeth parallel the line of
the lower lip as in the smiling line, a harmonious
relationship exists.
• As the cuspid is tipped more labially at the incisal edge it
becomes more perpendicular to lip line and exhibits a
strong relationship.

26. • The occlusal plane is another critical line and must be
located in proper position. The plane must not be allowed
to drop as it progress posteriorly to prevent sin against
reality and beauty.

27. Color in denture esthetics
• Hue - characteristic of a color, eg Red, Yellow, Blue
• Intensity - amount of pigment in the color being described
• Value - lightness or darkness of a color
• Value in denture esthetics –
The problem of matching is one of selecting proper value,
not the proper color (hue). The selection of correct lightness
or darkness results in successful shade selection.

28. • Factors affecting color
- amount of light striking the tooth
- texture of the tooth, glaze (without glaze or convoluted
surface, less reflection)
- inciso-gingival angulation
-background against which a color is seen (dark
background makes color seem lighter)
- lighter tooth appears closer and vive-versa.(principle of
illumination)
• Shade selection
Personality-1) strong, outgoing, vivacious, dynamic, zippy,
indicator for a lighter shade
2) Weak, opposite of strong, darker shade
3) Average, between strong and weak

29. • Skin color
-Dark skinned, shades adjusted downwards because
background will make shade appear lighter
- Light skinned- lighter
- Average- intermediate
• with age skin wrinkles and appear darker
• strong features require lighter teeth
• Heavy lipped individual with a low lip line require a lighter
shade
• The mouth with the reduced amount of illumination on the
teeth makes the strongest demand for lightness of shade.

30. INTERPRETATION OF SEX
Expression of feminine characters -
•Roundness, smoothness and softness that is typical of
women. The feeling of softness is typical of feminine form.
•Select a mold which expresses softer anatomic
characteristics or one which is highly adaptable to being
shaped and formed into a delicate type of tooth by certain
recommended grinding procedures.

32. • Expression of masculine characters
• A schema of masculine form illustrates cuboidal, hard,
muscular, vigorous appearance which is typical of men.
•Masculinity expresses aggressiveness boldness,
hardness, strength, action and forcefulness.
•But some men have a qualifying softness which will guide
to compromise the typical hardness of a masculine tooth
interpretation.

33. • The Central Incisor - The two positions of the central
incisors, set in perfect symmetry, are the starting
positions for conventional tooth setups.
• By bringing the incisal edge of one central incisor
anteriorly, we create a position which is evident but
harsh.
• However, if we move one of the central incisors from the
starting position out at the cervical end, leaving the
incisal edges together we have created a harmonious
lively position.
• The more vigorous position is to move one central
incisor bodily anterior to the other.

34. The Lateral Incisors
• The lateral incisors, being generally narrower and
shorter than the central incisors, are less apparent;
however, they can impart a quality of softness or
hardness to the arrangement by their positions.
• The lateral incisor rotated to show its mesial surface
whether slightly overlapping the central incisor or not,
gives softness or youthful ness to the smile.

35. • By doing the reverse, that is, by rotating the lateral
incisors mesial, the effect of the smile is hardened.
We would select the soft positions for the very
feminine smile, and the hard positions for the
vigorous.

36. The Cuspid Teeth
• The cuspids should never be set with the tip of the tooth
out labially further than the cervical end, except in very
rare instances where ,we have to harmonize the
arrangement with a rough or primitive type of patient.
• A prominent cuspid eminence gives to the cuspids
greater importance and therefore gives to the smile a
vigorous appearance more suitable to the masculine
sex.

37. • General, we will adopt for the cuspid conjointly the three
following positions:
(1) out at the cervical end, as seen from the front
(2) rotated to show the mesial face
(3) almost vertical as seen from the side

38. INTERPRETATION OF PERSONALITY FACTOR
• Development of personality spectrum is helped in
classifying different personalities of patient.
• This personality spectrum depends upon the individual
dentist’s ability to visualize the position of his patients
within this framework.
• Most men are found to be toward the vigorous end of the
spectrum and most women are found to be in delicate
end of the spectrum.

40. INTERPRETATION OF AGE
•Symbols of youth in the natural teeth are lightness of
shade, the unblemished form of the newly erupted teeth,
earliest appearance of the mamellon is present at the
incisal edge of the central and lateral incisors.
•The cuspid presents a pointed tip which is very sharp in
appearance.
The mamellon is soon abraded away, and the tooth
assumes the youthful adult form evidenced by the enamel
incisal edge of variable depth and of bluish hue.

41. • Later the sharp tip of the cuspid wears down to a more
mature form.
• As we advance along the chronologic life line of the
individual, normal wear, trauma, and, in some instances,
malocclusion, and disease make inroads upon the
original purity of tooth form.
• The tooth ages with the individual, and, very often, the
mouth condition gets far ahead of the chronologic life
line.

42. • In the artificial tooth, then, we may reflect the
appropriate age effects by such means as grinding the
incisal edges and removing the incisal enamel at such
an inclination and to such depth as to convey reality to
composition.
• The sharp tip of the cuspid suggests youth, and, as age
increases, it should be judiciously shaped, not abruptly
horizontally flattened, but artistically ground so as to
imply abrasion against opposing teeth.

43. Dynesthetic theory
• Patient’s sex, personality, and age are considered
as primary factors. Where as dynesthetic
techniques are considered as secondary factors of
dentogenic restorations.
• For e.g. , artificial teeth are selected according to
the personality of the patient, subsequent
sculpturing is directed toward accentuating
masculinity or femininity, and the denture base
color and contour helps to satisfy the age factor.
• These secondary factors are called dynesthetics.
• Dynesthetics means vital beauty.

44. • Dynesthetic techniques.
of denture
• It concerns with three important divisions
fabrication. The tooth, its position, and its matrix.
• Techniques includes
1. Mold selection
2. Depth grinding
3. Abrasion
4. Identification of masculinity or femininity
5. Smiling line
6. specific positioning and rotation of anterior teeth
7. Embrasures and diastemas
8. Buccal corridor
9. Long axes of the teeth
10. Gum line denture base contouring and tissue stippling

45. LIP SUPPORT
• It is the bodily antero-posterior position of the teeth
which adequately supports the upper lip in a natural
manner.
• Pleasing lip support is achieved by the anterior teeth and
their matrix.

46. MIDLINE
• The features of a face usually slant one way or another.
• It is difficult to see a true midline in dentition.
• Hence eccentric midline in a denture, if not too
exaggerated is acceptable.

47. SMILING LINE
• The smiling line is a curve whose path follows the incisal
edges of the central incisors, lateral incisors and to the
tips of the cuspids.
• Its arc is determined by the age of the patient and
decreases as the patient gets older.
• The sharp curve of smiling line is youthful. The broader
curve of smiling line indicates an older dental
composition.

48. SPECIFIC POSITIONING AND ROTATION OF ANTERIOR
TEETH
• The high level of incisal edge of lateral incisor to the central
incisor is indication of older dental composition.
• Incisal edge of lateral incisor in level with the central incisor is
indication of youth.
•Central incisor position: Their placement control’s
1-midline
2-speaking line
3-lip support
4 labioversion
5 smiling line composition
• Lateral incisor position: Its rotation will either harden or soften
the dental composition.
• Cuspid position: It supports the anterior arch form in its widest
part and controls the size of buccal corridor

49. SPACES
• Spaces placed between the anterior and posterior teeth
gives more effect if placed artistically and hygienically.
Rules are It should be V-shaped to shed food.
• Diastema between central incisor is unsightly so should
be avoided. It should be asymmetrically placed on either
side of the dental arch. Width of the diastema should be
minimum.

50. BUCCAL CORRIDOR
• It is a space created between the buccal surface of the
posterior teeth and the corner of the lips when the
patient smiles.
• Buccal corridor begins at the cuspid.
• Size and shape of it are controlled by position and slant
of the cuspid.
• It masks the “molar to molar smile”, which is the
characteristic of a denture.

51. INTERDENTAL PAPILLA
• It forms main part of the tooth matrix (visible denture
base)
• It occupies one-third of the total importance of the dental
composition.
• It creates self cleaning inter dental area.
• Determines the age interpretations.
• Determines outline form of the tooth.
• The shortening of the papillae is noticed as age
progresses
• Interdental surface of the papillae must be convex in all
directions to self-cleaning

53. Achieving complete denture
esthetics
• Accurate impressions
• Jaw relation
• Selection of anterior teeth
• Arrangement of teeth
• Characterisation of denture base

54. Impression stage
• Role of esthetics is to develop labial and buccal
borders so that they are not only retentive but also
support the lips and cheeks properly.
• Care must be taken not to over support these
structures with borders that are too thick.
• Functions of the denture base
• -Support the artificial teeth & provide retention
• -restore the form and appearance of lost soft
tissues and alveolar bone

56. Registration Stage/ Jaw
relation
• Construction of occlusal rims

58. • During registration stage of complete denture
construction, wax is added to or removed from the labial
surface of the upper block until a satisfactory degree of
lip support is achieved , appropriate to patient’s age.
• Tooth visibility is also adjusted , by adjusting the height of
the wax block.

59. Anterior teeth selection
• There are no thumb rule for this procedure however there
are anatomic landmarks that can be used as guides.
• Shade selection: Its based on patients hair and eye color
skin complexion and age
• It has been recommended to select
men with vigorous and bold
1) Darker shade for older
2)Darker shades for
personality

60. Observation of shade guide:
• Outside the mouth along the side of the nose, helps in
establishing basic hue, brialliance and saturation.
• under the lips with only the incisal edge exposed - this
will reveal the color of teeth when the patient mouth is
relaxed.

61. o v o i d t a p e r i n g r e c t a n g u l a r s q u a r e
Size and mold
• Patient preextraction records
• Square, tapering, rectangular, ovoid- the theory of matching
teeth to face form( J.leon williams)
•Bizygomatic width div by 16 gives estimated width of max
CI

62. • Improper vertical dimension can have a profound effect
on esthetics. The patient looks prognathic and old below
the nose with a vertical dimension that is overclose,
excellent esthetics when the vertical dimension is
properly restored.
Overclosure of the vertical dimension of the
occlusion. Note the prognathic appearance and
decreased lower facial length.
Proper vertical dimension of occlusion. Note
how much younger the patient appears.

63. • The buccolingual placement of
the posterior teeth can also affect
esthetics.
• If the maxillary teeth are placed
too far to the buccal aspect, then
the buccal corridor between the
maxillary posterior teeth and the
corner of the mouth is lost.
• If the maxillary teeth are placed
too far lingually or palatally, then
they appear not to exist.

65. Denture base
characterisation
The esthetic denture bases are indicated for –
• Patients with an active upper lip,
• Patients with a prominent premaxillary process,
• Theatrical performers, singers, and others who may
expose normally unobserved gum tissue areas during
their performances, and the psychologic effect on the
patient.
88

66. Characterization of denture
base
• In the wax up the following characterizations can be done
- Rugae
- Frenula
- stippling
- Gingival sulcus
- Festooning
- denture base staining
.

67. Anatomic wax-up. Anatomic wax-up.
Anatomic wax-up.
Note that the palate
is lightly stippled so
as not to appear
shiny.

68. Denture base
characterization
• Adapt wax and contour it above the necks of anterior
teeth to give a gingival bulge, simulating attached
gingiva
• Contour the canine eminence
• Slight root prominence of central incisors
• Carve the gingival papillae –convex
• Stippling can be done with modified bristle brush or tooth
brush- in attached gingival area(confine to interproximal
areas)
91

69. Denture base
characterization
• Tinting of denture base is done
•Cases are tinted in four basic shades:
(1)light complexion blue-eyed blonds,
(2) medium complexion brunettes,
(3) dark-complexion brunettes, and
(4) non-Caucasians.
Fibres and pigments are added to the acrylic resins for a
more esthetic appeal
92

70. Tinting and staining of dentures
•Steps in tinting Described by Rudd and Morrow
5 primary tinting resins:
• H- light pink (basic colour) attached gingiva
• F- light red
• A- medium red (use cautiously)
• E- purple (used sparingly in most dentures)
• B- brown (in heavy gingival pigmentation)
93

71. 98

72. Common problems with complete dentures
Poor fit is one of the most common problems with complete
dentures. This can cause discomfort, difficulty eating and speaking,
and even mouth sores. A poorly fitting denture can also lead to bone
loss in the jaw over time. Fortunately, a dentist can adjust the
denture to improve its fit and alleviate these issues. Discomfort is
another common problem with complete dentures. It can be caused
by a variety of factors, including pressure points, irritation from the
denture material, or an improper bite. A dentist can identify the cause
of the discomfort and make the necessary adjustments to the denture
to improve comfort

73. Esthetic issues are also a concern for many patients with
complete dentures. These may include teeth that look
too large or small, a denture that looks unnatural, or
teeth that don't match the patient's natural teeth. A
dentist can work with the patient to choose the right
tooth shape, size, and color to create a natural-looking
and aesthetically pleasing denture.

74. Classification of esthetic
errors
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
a. Weak mouth with strong
face
b. strong mouth with weak
face

75. C
• Intrinsic dental disharmony
A. Space allocation error
1 Inadequate vertical space allocation
2 excessive vertical space allocation
3 excessive horizontal space allocation
B. Structural line errors
1 elevated occlusal plane
2occlusal plane drops down posteriorly
3 asymmetrical occlusal plane
Unnatural lines
1 Reverse smiling line
2unnatural axial inclination
3 cuspless posterior teeth
4 gradation errors
5 Age-Sex-Personality disharmony

76. D Single –line errors
1. Vertical deviation
2. Horizontal deviation
3. Line conflict
E Imbalance
1. Midline errors
2.Imbalance of direction
3. Artifact error
4. Diastema error

77.  Complete Dentures: A Clinical Manual for the
General Dental Practitioner by Hugh Devlin and
Mark Finney
 ProsthodonticTreatment for Edentulous Patients:
Complete Dentures and Implant-Supported
Prostheses by George Zarb, Charles Bolender, and
Steven Eckert
 Esthetics and Prosthetics in Dentistry by George
Freedman
References

78. References:-
• Zarb,Bolender, Prosthodontic treatment for edentulous
patients.Twelfth edition
• Sheldon Winkler, Essentials of complete denture
prosthodontics,second, edition 2000
• Richard E. Lambarde : The Principle of visual perception and
clinical application to denture esthetics , Journal of Prosthetic
Dentistry . 29:359-381 ,1973.
• John P. Frush, Ronald D Fisher :Introduction to Dentogenic
Restorations , Journal of Prosthetic Dentistry ,5:587-
595,1955.
• John P.Frush, Ronald D Fisher :The Dynesthetic
interpretation of Dentogenic concept, Journal of Prosthetic
Dentistry. 8:559-581, 1958.
• D J Lamb: Appearance and Aesthetics in denture practice,
wright bristel, 1987.

79. THANK
YOU!!