Ala'a Otaibi

Esthetic In Removable Prosthodontic

Prof. F fahmi

March. 2013

INTRODUCTION:
Esthetic:
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
In dentistry: the theory and philosophy that deal with beauty and the beautiful, especially with respect to the appearance of a dental
restoration, as achieved through its form and/or color. Those subjective and objective elements and principles underlying the beauty
and attractiveness of an object, design or principle.
Esthetic zone:
The visible area seen upon full smile, including the teeth, gingiva, and lips. (white and pink esthetic)
- According to Preston: The esthetic zone is wherever the patient thinks it is
- Patients requiring removable dentures have the same desires regarding esthetics as patients receiving fixed prosthodontic therapy,
so the Esthetic analysis is mandatory for all prosthetic procedure.
----------------------------------------Esthetic In complete Denture:
Denture esthetics: is defined as the cosmetic effect produced by a dental prosthesis which affects the desirable beauty, attractiveness,
character and dignity of the individual.
- Denture esthetics demands:
1- Artistic skill
2- Scientific knowledge
- The subject of esthetics is not a totally scientific and objective discipline nor is it 100% an art form . Esthetics is a combination of
the art and the science of prosthodontics.
The subject of esthetics should be examined from 3 points of view:
1- biological
2- physiological
3- biomechanical

4- psychological

- Biological And Physiology :

It is necessary to have an understanding of facial musculature, normal facial appearance, and the physiological limits within which
esthetic compromises are to be made. A proper impression procedure is necessary to provide the dentist with a final maxillary cast
that has an accurate representation of the labial vestibule and all of the other remaining structures.
1) The dentist should also have a visual concept of the cause and effect relationship. eg: - If an edentulous patient has a tight, drawn
& thin lips, proper support with a fully formed occlusion rim and lip support by the labial 2/3 of the artificial maxillary anterior
teeth, should evert the vermillion border of the lip. This would -afford a much more natural appearance.
2) As patients become older the natural lines of face tend to deepen and to appear accentuated and the elasticity of the facial
musculature is lost. There is a tendency to want to plump out the face with additional thickness of the denture base material and the
musculature tends to loosen the denture or the facial appearance, becomes strained.
3) Another approach to removing facial wrinkles is to Increase the VD. This approach is fraught with the greatest of dangers and
must be used with caution. The actual process of trial placement of the maxillary anterior teeth and the function of the maxillary
Part1 (Esthetic in complete Denture)

Ala'a Otaibi

Esthetic In Removable Prosthodontic

Prof. F fahmi

March. 2013

and mandibular anterior during the production of speech give one of the best guidelines for creating and maintaining an adequate
inter occlusal distance.
- Biomechanical:
There are certain mechanical limitations in the placement of anterior teeth that must be taken into account. The anterior teeth
should be placed closely in relation to the residual ridge as were the original natural teeth. Fish says the proper position for the teeth
is not necessarily on the ridge, inside the ridge, or outside the ridge, but at a point where the tongue and cheek pressures balance.
- Psychological:
1- Patient's self image is an important factor in esthetics. (how?)
- A patients perception of his or her appearance may result in a broad simle (if it is a positive self evaluation.)
- A tight - lipped, small, controlled smile, A patient with a poor self image may appear done, unsure, questioning and introverted.
2- Campers line may be thought of as a psychological plane of orientation (how?)
- In a person who appears happy this line tends to rise
- in a person who to depressed it may slant downward.
3- The occlusal plane established by the dentist has an effect in determining the appearance of a patients psychological state.
eg: - by effecting a downward slant to the plane posteriorly an observer may gain a negative impression of the patients emotional or
phychological state.
DENTURE ESTHETIC CHARACTERIZATION:
1- Denture base characterization.

2- Teeth characterization.

1- Denture Base (Gingival Characterization):

Frush & Fisher:

- proposed convex, rounded and shortened papilla in older patients.

- They also proposed the exposure of more of cervical root portions of denture teeth in order to simulate ginglval
recession in older individuals.
- They recommended finer stippling for females and heavy stippling for males.
-They preferred to the tint the interdental pappila and muscle attachment areas with deep shade of red. They used
light shades to tint areas of hard tissue.

Others

- Rugae can be reproduced in denture for natural feel. A 0.003 guage tin foil is adapted over the rugae area of the
edentulous cast of trimmed. This is adapted to the base plate after wax up so as t reproduced the rugae properly

Colour
Distribution in
Gingiva

- Basic pink used over hard tissue as attached gingiva.

- Light red used for papilla and muscle attachments
- Medium red tones mucobuccal folds, rugae.
- Purple blue in heavily plgmented gingiva mostly attached gingiva papilla & marginal gingiva.
- Brown for heavily pigmented gingiva.

It is of particular value in:

1. Subjects with active upper lip
2. Persons with prominent pre maxilla
3. Persons like teachers & singers
4. Who expose more of denture base during talking and smiling.
5. Young edentulous patients

Part1 (Esthetic in complete Denture)

Ala'a Otaibi
2- Teeth characterization
A- tooth size and form B- tooth color

Esthetic In Removable Prosthodontic

Prof. F fahmi

March. 2013

C- tooth position

A- Tooth Selection ( Size and Form):

Tooth size and form are considered simultaneously. The selection of the maxillary incisors is the starting point in creating esthetic
dentures. There are many suggested ways to select teeth, including :
(1) pre-extraction records
(2) patient photographs
(3) patient desires, and
(4) facial measurements.
- In 1887, the temperamental theory was proposed. It was one of the earliest to propose that a person's personality might influence
the morphology of the teeth.
- In 1914, Williams rejected the temperamental theory as a fallacy, proposing what is known as the geometric theory, and concluded
that the shape of the face and the shape of the central incisor are related. This approach is still being used by many dentists.
- In 1939, House and Loop expanded on Williams's works to include not only pure typal forms (square, tapered, and ovoid) but also
combinations of typal forms and the discovery of the relationship of the width of the face and the width of the central incisor.
- In a study of 555 subjects, House and Loop found that the majority of central incisors were not only in harmony with facial
outlines, they were also one-sixteenth of the size of the face.
- A study by LaVere and colleagues has confirmed their findings.The author still uses this method as a basic starting place for tooth
selection when other data are not available.
- In 1955, Frush and Fisher brought forth the sex, personality, and age (SPA) theory of tooth selection.
- By 1959, five additional articles followed describing the methods of applying the SPA factors. They concluded that tooth size is
related to the width of the nose. With the use of the Alameter, it is determined whether the patient needs a small, medium, or large
central incisor.
B- Teeth Shade:
- Colour of the teeth should be in harmony with that of the face.
Factors affect the shade selection:
1- Sex (Women usually tend to have lighter teeth)
2-Age
- Natural tooth colour changes with age. In youth the pulp chamber are large and the red colour of the pulp affects the tooth
colour. later the pulp chamber becomes smaller due to deposition of secondary dentin. This makes the tooth more opaque. The
general rule is that darker teeth are more appropriate in older patients
3-Hair colour
- Hair Colour according to Bcucher is not a constant factor and can be unreliable & inaccurate.
4-Colour of the eyes
- According to Heart well it is an excellent guide but is not quite so according to Boucher as he says that : The iris of the eyes is so
small compared to the area of the total face & the eyes are not close to the teeth.
Shade selection should be made in 3 positions:
1.) Outside the mouth along the side of the nose
2.) Under the lips with only the incisal edge exposed.
3.) Under the lips with only the cervical end covered and mouth open.
- The first step will establish the basic hue, brilliance & saturation.
- The 2nd will reveal the effect of the colour of the teeth when the patients mouth is relaxed.
- The third will stimulate exposure of the teeth as in a smile.

Part1 (Esthetic in complete Denture)

Ala'a Otaibi

Esthetic In Removable Prosthodontic

Prof. F fahmi

March. 2013

C- Teeth position:
1. Varying the direction of the long axis of teeth.
2. Place the teeth so that the tips of the maxillary lateral incisors show when the patient speaks seriously; the amount depends on the
age and sex, less for old than for young people and more for woman than for men.
- Lateral incisors personality tooth:
- females labioversion
- males linguoversion
3. Create asymmetry in the divergences of the proximal surfaces of the teeth from the contact points. Martone stated that, The key
to esthetics lies in asymmetry. Most things in nature are asymmetric, and in the human face many minute and subtle differences
are found from one side to the other.
4. Use an eccentric midline.
5. Place one maxillary central and lateral incisor parallel to the midline and rotate the other central and lateral incisors slightly in a
posterior direction.
6. Place one maxillary central incisor slightly in an anterior direction to the other central incisor.
7. Place the neck of one maxillary central incisor in a posterior direction and the neck of other central incisor in an anterior
direction.
8. Create asymmetry for the maxillary right and left cuspids. Rotate one in a posterior direction than the other.
9. Gingival tissues recede with age. Selecting a long tooth, contouring the wax to show gingival recession and then staining it a bit,
can give natural appearance, can reproduce this recession. Long clinical crowns with receded gingiva after periodontal destruction,
may also play a role in achieving a natural-looking denture for selected patients.
10. Grinding the incisal edges. Teeth abrade with age. Reshaping the incisal edges and mesiodistal diameter makes it possible to
modify any tooth to the desired form.
11. A teeth arrangement that is too perfect may not be ideal. In fact, slight modifications in the position of teeth such as overlapping,
tilting, rotation and incisal variations may contribute to a natural-looking denture.
12. Spacing and diastemas often exist in natural dentition. Thus slight diastema can be created between the lateral incisor and the
cuspid on one side. The wearing away of the natural teeth at the contact points creates spaces between the teeth. The migration of
teeth also creates spaces. To simulate the wear by positioning the artificial teeth to create spaces, can give a natural appearance.
Diastema given should exceed 2-3mm and should be wider at the incisal edge than the base. In diastemas smaller than 2-3 mm,
fibrous food tends to be trapped and can be a source of embarrassment.
13. A hair line crack can be given in the teeth.
14. Often, gold or alloy restorations can be placed in these teeth to create the illusion of naturalness. The use of gold occlusal surfaces
on the teeth of prosthesis can contribute to its clinical success.
15. Silver filling can be given on posterior teeth.
16. Cast crown can be given on posterior teeth. Some patients who seek new dentures ask that a metal crown be placed in the
denture to resemble their natural dentition.
17. A discolored tooth (as R.C.T treated) can be shown by selecting one or two teeth of darker shade compared to the rest of the
teeth set. Older patients tend to have darker teeth as a result of discoloration from fillings and food stains.

Part1 (Esthetic in complete Denture)

Alaa Al-Otaibi

Esthetic In Removable Prosthodontics

prof. F Fahmi

March. 2013

- Patients requiring removable dentures have the same desires regarding esthetics as patients receiving fixed prosthodontic therapy and they deserve the best possible treatment
outcome.
Esthetic approaches in RPD:
1. Gingival
Approaching Retainer
1- I bar clasp
2. Palatal I-bar
3. RLS-system
4. Twin-flex clasp or
spring-clasp

Illustration

- Occlusal approaching retainer to undercut area on the mesiobucal surface of canine will very bother
esthetics.
- Esthetics of gingival approaching retainer will be better because the metal is more hided.
- In the other hand it can be enhanced an indirect retainer at incisive.
- The indirect retainer that can be selected in the form of cingulum rest beside mesial occlusal surface of
canine, embrasure hook, terminal rest, incisal rest; secondary lingual bar, and so on.
- This way will be more aesthetic, more stabilize, and the free-end saddle are not easy to lift up by sticky
food.
If canine and incisive has weakened, strengthen this teeth by splinting. Splinting can be conducted with
orthodontic wire, or with composite in inter proximal area.
- Splinting wire should place as low as possible in order to more aesthetic appearance.

2. Wrought Wire
Wrought wire is more flexible compared to casting retainer. Because of this characteristic
the tip of retentive arm can be placed more cervical to be more esthetic.
- In the other hand for free-end RPD with retainer design first class lever, a more flexible retentive arm
will decrease leverage to abutment teeth (act as shock absorber)

A. Combination cast and wrought wire

B. Meacock
C. Rush Angker

Part2, Esthetic in Removable partial denture

Alaa Al-Otaibi

Esthetic In Removable Prosthodontics

prof. F Fahmi

March. 2013

3. Special Design Labial This retainer look like labial bow in orthodontic treatment, but there some differences that is
Bow for Retainer
Loop part is smaller
Wire that patch at anterior teeth should place as low as possible near gingival margin, and for better
esthetic the wire close over by red acrylic base.
- The other advantage of Labial Bow like this will united anterior teeth in mastication when distal
extension base lever up, so it is act as splint for anterior teeth.
- The disadvantage is in the early patient feels bothered its lower lip .

4- Attachment

- Attachments may be classified as precision or semiprecision, intracoronal or extracoronal, and resilient

or non resilient. Precision attachments are machined by the manufacturer, while semiprecision
attachments are custom fabricated by the laboratory technician.
- disadvantage:
- The room must be made for the attachment within the crown. Box forms to accommodate the
attachment must be prepared within the tooth at the time of tooth preparation. This removes a
considerable amount of healthy tooth structure and often exacts a biologic price later.

5- Rotational path
Removable partial
denture

- This concept originated in the 1930s.

- The partial denture requires two paths of insertion, with the framework being placed into the undercut
first and then rotated to seat the posterior clasp assemblies.
- When properly designed and fabricated, the removable partial denture cannot be dislodged by a force
perpendicular to the plane of occlusion. The ultimate result is a retentive removable partial denture with
no anterior clasp assemblies and the posterior assemblies in a position where they are not visible.

6- overdenture / overlay Some remain teeth that still healthy enough but over-eruption, tipping, degree one mobility, and
partial denture:
considered not to extracted and conducted for root canal treatment.
For this remain teeth its clinical crown is lessened, then made a dowel-core or dowel with layers that
a- natural tooth
close over clinical crown remains. Restoration will be functioned to give support, stability, and retention
b- implants
for overdenture that made on it. In the other hand it also give informational proprioceptive, and lessen
resorption alveolar ridge.

Part2, Esthetic in Removable partial denture