September-October 2004 453

Esthetic dentistry is associated most often

with anterior restorative dental care. Es-
thetic dentistry describes the efforts
made to restore teeth or prostheses with-
out drawing attention to those changes.
Esthetic dentistry also may enhance ones
appearance by improving contours of
teeth and gingival architecture or by pro-
viding a brighter and more noticeable
look. Removable partial dentures
(RPDs) are one aspect of esthetic restora-
tive dental care that often is neglected.
Due to the emphasis placed on esthetic
dentistry in the media and the advances
made in this area during the past 15
years, patients have come to demand
prostheses that not only are comfortable
but also are less noticeable or more natu-
ral in appearance. Many of the materials,
techniques, and designs that may en-
hance esthetics often are not taught to un-
dergraduate dental students.
1,2
Most den-
tal schools are reducing the curriculum
hours devoted to the clinical teaching of
removable prosthodontics at a time when
the need for RPDs is increasing.
3
Implant dentistry may be used to re-
place RPDs for some patients; however,
financial, anatomic, psychological, or
medical considerations still require den-
tists to understand how to create a treat-
ment plan, design, and treat patients for
removable prostheses. Fabricating in-
conspicuous implant restorations in the
esthetic zone is challenging and often can
be performed more satisfactorily by uti-
lizing RPDs. RPDs also offer a less com-
plicated, less expensive, and time-saving
alternative to implant treatment.
This article describes the esthetic
zone, how it should be evaluated, and
how it relates to the six partially edentu-
lous dental categories that determine
RPD treatment options.
The esthetic zone
The term esthetic zone is used here to de-
scribe the teeth and gingiva as they are
observed when a patient emits a hearty
laugh; this laugh should be described,
drawn in the treatment plan, or displayed
in a photograph. This practice will allow
dentists to avoid including unwarranted
displays of clasps and other metal com-
ponents in the treatment plan (Fig. 1).
According to Preston, the esthetic zone is
wherever the patient thinks it is.
4
Even
though the patient may not display metal
while laughing, he or she still may believe
that it can be observed. Dentists should
always communicate to patients when
metal is to be used on the facial surfaces
of teeth, even when the metal will not be
visible in the esthetic zone. Patients
should have the opportunity to select al-
ternative designs.
In 1984, Tjan et al demonstrated that
87% of all patients had what was referred
to as the average smile, in which the cervi-
cal to incisal length of all maxillary ante-
rior teeth was displayed to either the first
or second premolar.
5
In light of this find-
ing, dentists must be vigilant to eliminate
clasps, metal proximal plates, spaces, or
any obstruction in the esthetic zone for
the majority of individuals in their prac-
tice. In that same study, 4.0% of the pa-
tients displayed all of their maxillary an-
terior and posterior teeth and their
attached gingiva. These patients are the
most difficult to satisfy since all frame-
work components and acrylic resin
flanges will be visible (Fig. 2). Dentists
must pay attention to flange design (that
is, contours) in such cases; custom color
characterization also may be necessary
for optimal esthetics. Finally, the study
noted that 6.0% of all patients displayed
only the maxillary anterior teeth from ca-
nine to canine when smiling and may dis-
play only part of those teeth and no at-
tached gingiva (Fig. 3). Dentists can offer
these patients a wide array of RPD design
concepts that do not compromise the es-
thetic zone.
Mandibular anterior teeth must be ob-
served and described in the treatment
plan.
6
Most patients display only 50% of
the mandibular anterior teeth and 50% or
less of the buccal surfaces of the premo-
lars in the esthetic zone, while all occlusal
surfaces of the premolars usually are visu-
alized. Dentists can conceal distracting
RPD components in these patients but
planning is more complicated for the
Esthetic removable partial dentures
Stephen Ancowitz, DDS, FACP
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This article provides information regarding the many ways that removable partial den-
tures (RPDs) may be used to solve restorative problems in the esthetic zone without
displaying metal components or conspicuous acrylic resin flanges. The esthetic zone is
defined and described, as are methods for recording it. Six dental categories are
presented that assist the dentist in choosing a variety of RPD design concepts that may
be used to avoid metal display while still satisfying basic principles of RPDs. New
materials that may be utilized for optimal esthetics are presented and techniques for
contouring acrylic resin bases and tinting denture bases are described.
Received: March 4, 2004 Accepted: April 19, 2004
Fig. 1. A patients esthetic zone. Note the
visible clasps.
Fig. 2. A patient whose maxillary teeth and
attached gingiva are visible upon smiling.
Fig. 3. A patient showing 50% of the anteri-
or teeth from canine to canine.
DART
Two hours of CDE credit
454 General Dentistry www.agd.org
many patients who dont fall into this cat-
egory. Patients display more mandibular
teeth and gingiva as they age.
7
Categories of partial
edentulism
This article is divided into six categories
of partial edentulism that are used to de-
termine RPD treatment options.
Esthetic zone is not a concern
and no need exists for abutment
retainers
Most prosthodontists agree that a less-
complicated approach to RPD treatment
is best.
8
Any conventional clasping
arrangement can be used, provided abut-
ment teeth are not restored and the es-
thetic zone does not display an RPDs
components. The patient must be in-
formed that clasps will be placed on the
facial surfaces of teeth. These clasps will
not be visible when the patient smiles or
emits a hearty laugh; however, they may
be visible if the lips are displaced forcibly.
The patient should consent to this prior
to treatment rather than after a frame-
work has been constructed.
Infrabulge clasps are the most esthetic
of the conventional retentive clasps, of-
fering dentists the best opportunity for
placing metal in less-conspicuous loca-
tions.
9
The foot of the infrabulge clasp
often can be reduced for optimal place-
ment. Ideally, these clasps should be
placed in the gingival third of a tooth and
the approach arm should not traverse
soft tissue undercuts.
Wrought wire and cast circumferen-
tial clasps are alternative designs for sur-
veyed casts and appropriately recon-
toured abutment teeth. The approach
arm of these clasps should emanate from
the middle third of an abutment tooth
and the retentive tip of the clasp should
be in the gingival third of the abutment
tooth. The proximal section of circum-
ferential clasps should not emanate from
the occlusal third of the tooth.
10
When tooth-supported RPDs are pos-
sible, a posterior anterior rotational path
RPD also should be considered. This
RPD will allow conservation of tooth
structure on posterior abutments while
avoiding facial and lingual clasps that can
irritate the tongue and facial attached
gingival tissues (Fig. 4). The rotational
path RPD design will be described in de-
tail later in this article.
Esthetic zone is a concern and no
need exists for abutment retainers
When the facial surfaces of abutment
teeth are visible in the esthetic zone, den-
tists should consider other locations for
retentive and/or bracing clasps. It is im-
portant to distinguish between bracing
and reciprocating clasps as part of a
clasping assembly.
11
Reciprocating a
force from a retentive clasp cannot be at-
tained practically without milling a cast
restoration. Bracing is a term used to de-
scribe what has been known convention-
ally as a reciprocating clasp. The bracing
clasp is used to prevent horizontal move-
ment after the clasping assembly is seated
completely. Together with the retentive
clasp and rest of a clasping assembly, the
bracing clasp satisfies a basic principle of
clasp design by encircling the abutment
tooth by more than 180 degrees.
12
Using lingual retention to hide a re-
tentive clasp often is an excellent option.
If the abutment tooth has the appropriate
contour, a lingual undercut can be uti-
lized for the retentive clasp that is not vis-
ible. To satisfy the basic principle of en-
circlement, bracing can be utilized on the
distofacial aspect of the abutment
teethtogether with rests, minor con-
nectors, and tooth contacts (Fig. 5 and
6)without the unsightly display of a
buccal clasp arm.
13
The lingual retention
option can be utilized for tooth-support-
ed and tooth-and-tissue-supported res-
torations.
When abutment tooth contours are
favorable, the posterior anterior rotation-
al path RPD can be designed for lingual
retention of the conventional clasping as-
sembly (Fig. 7).
A Saddle-Lock RPD (Boos Dental
Laboratories, Minneapolis, MN; 800.
333.2667) avoids visible clasps by utilizing
a distal facial undercut and a mesial rest.
Fig. 4. A PA rotational path of insertion RPD. Fig. 5. Framework with bracing component
on disto-facial of abutment teeth.
Fig. 6. A patient with lingual retention.
Fig. 7. A PA rotational path RPD with
lingual retention.
Fig. 8. Saddle-Lock RPD with retainer arm
beneath the proximal plate.
Fig. 9. Saddle-Lock RPD retainer beneath
the proximal plate in disto-facial undercut.
September-October 2004 455
This design is particularly suited for
tooth-supported situations. One should
be cautious when using it for tooth-and-
tissue-supported partial dentures, as this
design makes it difficult to establish guid-
ing planes on abutment teeth and it may
compromise retention and stability of the
prosthesis (Fig. 8 and 9).
The Rotational Path of Insertion con-
cept is one of the most appropriate de-
signs for this category.
14,15
By rotating an
RPD into position, dentists can avoid us-
ing the standard number of clasps that
normally are required. It must be re-
membered that this design concept is
used primarily for tooth-supported
RPDs, although there are a variety of ways
to utilize this concept: posterior anterior
(PA), anterior posterior (AP), and lateral
paths of placement. The first letter indi-
cates the initial path of placement (utiliz-
ing a rigid proximal component); the sec-
ond letter indicates the segment of the
prosthesis after rotation has occurred.
This segment has a conventional clasping
system.
The AP design used in Kennedy Class
IV situations (that is, partially edentulous
spaces that cross the midline) is the most
popular rotational path design. This de-
sign eliminates clasps on the facial sur-
faces of anterior teeth. Conventional
clasping can be utilized on both maxil-
lary and mandibular posterior teeth that
are out of the esthetic zone (Fig. 10 and
11). The author has used this concept to
replace first premolars and all maxillary
anterior teeth successfully.
When a limited space (for example,
two central incisors) must be replaced,
dentists should use a dental surveyor to
ensure that rests and rigid proximal
plates are not prevented from seating on
natural teeth during the initial path of
placement. Additional modification
spaces also may be replaced using this
concept but the design is more complex
and proper blockout procedures must be
performed to avoid interferences when
rotation occurs around abutment teeth
(Fig. 12).
Although it is not always considered, a
Kennedy Class III with a modification
space on the other side of the arch (bilat-
eral tooth-supported partially edentulous
spaces) is another method for utilizing
the AP rotational path RPD, precluding
the need for a visible clasp on a first or
second premolar. A distal undercut on
premolars is used for the initial path of
placement and the RPD is rotated with a
conventional clasping system on the mo-
lars (Fig. 13 and 14).
Conceptually, the lateral path of RPD
insertion is not different from the AP, ex-
cept that a Kennedy Class III partially
edentulous space (that is, one that does
not cross the midline) is replaced with a
rotational path RPD that is rotated in a
more diagonal direction. When conven-
tional clasping is utilized, the initial path
is located more anteriorly and the con-
tralateral side is rotated and positioned
more posteriorly (Fig. 15 and 16).
Flexite (Dentsply International, York,
PA, 800.877.0020) is a translucent mate-
rial that can be used to avoid metal dis-
play; it also can be attached to metal
frameworks, resulting in cross-arch stabi-
lization and clasp encirclement. In recent
years, the author has experienced excel-
lent clinical success using this material
with cast frameworks (Fig. 1719). Due
to Flexites lack of tensile strength, it must
be designed with greater vertical height
and thickness than metal, which results
in broader coverage of the abutment
tooth. The author designs Flexite clasps
from the height of contour of the abut-
ment tooth to the tooth gingival junction;
most are 3.04.0 mm high and 1.5 mm
Fig. 10. An AP rotational path RPD designed
to replace teeth No. 710.
Fig. 11. A patient wearing the AP rotational
path RPD seen in Figure 10.
Fig. 12. An AP rotational RPD path with
modification spaces.
Fig. 13. Initial path of insertion on distal of
first premolar, left side.
Fig. 14. Initial path of insertion on distal of
first premolar, right side.
Fig. 15. Lateral path of insertion framework
with diagonal rotation.
Fig. 16. Lateral path of insertion RPD re-
placing teeth No. 6 and 7.
456 General Dentistry www.agd.org
thick. Flexite is a relatively new material
and there is concern regarding its clasp
strength and stability in the mouth over
time; as a result, this design would be the
last choice for achieving an optimal es-
thetic result in this category.
Esthetic zone is a concern and the
need exists for abutment retainers
All of the above concepts can be utilized
when metal ceramic crowns are needed
to restore abutment teeth in tooth-sup-
ported situations. This section focuses
on tooth-and-tissue-supported RPDs.
Precision attachments are needed for this
situation to avoid clasps in the esthetic
zone. While there are numerous preci-
sion attachments on the market, it would
be desirable for a dental practice to limit
the available attachments to two or three.
Limiting the available choices will reduce
the number of necessary components
and result in greater efficiency and re-
duced cost.
As stated previously, most prostho-
dontists agree that a less-complicated ap-
proach to RPD treatment is best. Howev-
er, dentists must be prepared to place
precision attachments on unrestored
abutment teeth when the esthetic de-
mand is high. In these situations, the au-
thor prefers to use extracoronal attach-
ments, which are easier to fabricate and
more amenable to repair than intracoro-
nal attachments. Extracoronal attach-
ments also minimize tooth reduction and
satisfy stress-releasing or stress-direction
principles that are required for tooth-
and-tissue-supported RPDs (Fig. 20).
16
Based on experience, the author prefers
the ASC-52 anterior protect system
(Medesco Attachment/Implant Company,
Laguna Hills, CA; 800.633.3726) and the
ERA-RV attachment (Sterngold Attach-
ments, Attleboro, MA; 800.243.8942).
17
The ASC-52 attachment is a universal
joint resilient extracoronal attachment,
containing an iridium platinum receptacle
that is cast with the abutment crown (Fig.
21). The receptacle is resistant to wear and
avoids food retention due to its open de-
sign. The ASC-52 is a spring-loaded dow-
el that can be replaced easily. As a univer-
sal joint, this attachment is unique because
it does not require parallelism to function,
it does not torque the abutment teeth, and
it can be used with a single abutment sup-
port when good cross-arch stability is
achieved.
18
One major advantage the ASC-52 sys-
tem offers is the accuracy between the at-
tachment and the metal ceramic crown
that is maintained during the processing
of the acrylic resin. A brass processing
dowel is used during the investing process
(in place of the attachment ferrule) to se-
cure the relationship between the attach-
ment and the crown. This brass dowel
prevents damage during divesting by al-
lowing the laboratory technician to re-
move the metal ceramic crowns from the
master cast prior to investing; it also main-
tains the exact relationship of the RPD
framework and the crown (Fig. 22). De-
livery of the RPD is accomplished without
difficulty and the need to correct an ill-fit-
ting attachment with an auto-cured resin
pick-up at delivery is reduced.
The ERA attachment has a plastic re-
ceptacle that is connected to the wax-up
for the metal ceramic crown. For the ERA
attachment to fit accurately into the recep-
tacle, an excellent casting process is re-
quired. Because the receptacle is made
from the same metal as the crown, a met-
al of sufficient hardness must be used to
limit wear. The manufacturer recom-
mends a Vickers hardness of 200 and a
minimum of 85,000 psi ultimate tensile
strength. Dentists must be aware of this
metal requirement and communicate this
to the technician, although metal recepta-
cles will wear as a result of the plastic at-
tachment regardless of the metal that is
used.
Sterngold provides ERA attachments
in a variety of sizes. The increased cir-
cumference provides more retention in
the receptacle attached to the abutment
Fig. 17. Flexite clasp for tooth No. 6 at-
tached to metal framework.
Fig. 18. Full-face view of Flexite clasp on
tooth No. 6.
Fig. 19. A patient with a Flexite clasp
displaying her esthetic zone.
Fig. 20. Stress release using the ASC-52 at-
tachment is demonstrated.
Fig. 21. A platinum iridium receptacle is
placed into wax-up of abutment crown.
Fig. 22. Waxed-up cast prior to investing,
with abutments and castings removed and
brass dowel replacing ASC-52 attachment.
September-October 2004 457
tooth, which compensates for metal wear.
The increased circumference of these at-
tachments is color-coded for ease of se-
lection. Sterngold also recommends
picking up this attachment in the mouth
with an auto-cured acrylic resin during
the delivery of the RPD by making a win-
dow through the lingual flange of the
acrylic resin base (Fig. 23).
An alternative technique involves
placing an analog in the impression by
using a black processing male (Fig. 24).
This technique makes it possible for the
laboratory to connect the attachment
during the processing of the acrylic resin
base rather than forcing the dentist to do
so at chairside. It is critical that this ana-
log is positioned properly into the im-
pression; positioning the analog inaccu-
rately, coupled with the resiliency of the
impression material, could result in an
unsuccessful seating of the prosthesis at
delivery.
19
If seating is unsuccessful, the
misplaced attachment must be removed
and picked up in the mouth as described
previously. Despite these concerns, this
attachment is relatively easy to fabricate,
repair, and maintain when used properly.
Height concerns and impression pro-
cedures are general considerations com-
mon to both attachments. Accurate diag-
nostic mountings are essential when
precision attachments are used. The
space between the proximal gingiva and
the opposing tooth is critical for the use
of these attachments; this distance can be
measured using diagnostic casts (Fig. 25).
The ASC-52 requires a minimum vertical
height of 5.56.0 mm, while the ERA re-
quires 4.50 mm (slightly more if a 0.3 mm
metal housing is used).
The author has found the Turbyfill
technique to be useful for making im-
pressions utilizing the ASC-52 and the
ERA.
19
This technique involves picking
up the abutment crowns from the mouth
and making them an integral part of the
master cast. The RPD framework is
made from this cast to attain a high de-
gree of accuracy when relating the RPD
framework to these crowns. The author
prefers making a one-piece border mold-
ed impression of the teeth and the eden-
tulous areas, utilizing a custom tray with
a polyvinyl siloxane or polyether impres-
sion material. In the mandible, border
molding the alveololingual sulcus is par-
ticularly important to ensure more accu-
rate placement of the inferior section of a
lingual bar or plate. Border molding is
not necessary for areas where a metal
component or acrylic resin flange will
not be present. To avoid locking the tray
in the mouth, it is important to block out
the gingival embrasures of any natural
teeth prior to making the impression.
Impressions made in this manner pre-
clude the use of an altered cast procedure
and are equally accurate.
20
Esthetic zone is not a concern
and loss of a critical abutment
tooth exists
The upper lip becomes longer with age,
making it possible to use more of the
tooth surface without displaying clasps.
7,21
Another esthetically satisfactory method
can be utilized when one cannot observe
the gingival 20% of the existing teeth and
the patient is missing a canine or another
tooth critical for adequate stability or re-
tention. This method involves the Swing-
Lock RPD (Swing-Lock, Dallas, TX;
214.361.8263), which is not often thought
of as an esthetic RPD design. The Swing-
Lock makes it possible to locate retentive
terminals on abutment teeth that are more
cervical than can be accomplished ordi-
narily using conventional clasping mecha-
nisms.
21
Generally, 6.08.0 mm of at-
tached gingival space is necessary for
placing a labial bar. High labial frenum at-
tachments could interfere with the labial
bar placement and are a concern when us-
ing this design concept; a frenectomy or
free gingival graft sometimes is required to
place the frenum in a more apical posi-
tion.
22,23
Based on the authors experience,
the free gingival graft produces a more
predictable and stable result than the
frenectomy.
The Swing-Lock prosthesis does not
need retention for every existing tooth;
two or three vertical clasp tips or lugs is
sufficient for retention. If one or two teeth
display the entire facial surface from cervi-
cal to incisal, a clasp can be eliminated
here and another tooth that allows for
more inconspicuous placement may be
utilized. It also is possible to place clasp
tips at the line angles of teeth rather than
in the center of a tooth (Fig. 26 and 27). In
Fig. 23. Window made in acrylic resin
flange prior to picking up the attachment.
Fig. 24. ERA analogs placed into abutment
crown impressions prior to pouring stone.
Fig. 25. The available space between oppos-
ing teeth and planned precision attachment
abutment tooth gingiva is measured.
Fig. 26. A Swing-Lock prosthesis demon-
strates retention on selected teeth and at a
line angle of tooth No. 8.
Fig. 27. The patient in Figure 26, demon-
strating clasp tips placed out of the esthetic
zone.
458 General Dentistry www.agd.org
the authors opinion, the Swing-Lock par-
tial denture is one of the most underuti-
lized and beneficial designs for RPDs.
Esthetic zone is a concern and loss
of a critical abutment tooth exists
This category does not allow the use of
conventional RPD designs. Extracoronal
precision attachments can be used on
maxillary Kennedy Class IV situations
using premolars as abutments (Fig. 28
and 29). Caution is necessary when pre-
cision attachments are used on anterior
teeth to avoid overcontouring abutment
crowns and interfering with the opposing
occlusion. In these situations, the author
has had success using Flexite clasps and
Flexite major connectors with full palatal
coverage (Fig. 30 and 31). Making palatal
plate major connectors with Flexite ma-
terial seems to provide adequate stiffness.
Another way to treat patients in this
category involves using implants for se-
lective replacement of these lost, critical-
ly needed abutment teeth. Implants can
be used as abutments to assist in retain-
ing a prosthesis. A variety of stud attach-
ments are available as abutments for im-
plants capable of retaining one or more
sections of the RPD. The author has had
excellent clinical success using the Locator
Implant Attachment System (Zest An-
chors, Inc., Escondido, CA; 800.262.2310).
While conventional clasping would not be
placed in the esthetic zone, it may be uti-
lized in other areas of the arch (Fig. 32
and 33).
Utilizing RPDs for esthetic purposes
becomes very difficult when patients
have four or fewer teeth remaining in an
arch. It is difficult to develop acrylic resin
flanges adjacent to natural teeth without
creating unattractive spaces and shadows.
Metal proximal plates often are visible in
the esthetic zone. The retention and sta-
bility of an RPD prosthesis also may be
compromised. When this situation oc-
curs, overdenture prostheses should be
considered for areas where the dentist has
total control of the placement of teeth
and denture base flanges.
24
For the
mandible, it would be beneficial to con-
sider stud or bar attachments to enhance
retention and stability for the overden-
ture prosthesis.
Esthetic zone is a concern and
flange design is important
When treatment planning for a patient
who falls into the small (4%) category of
patients who display all of their anterior
teeth and attached gingiva, it is necessary
to pay attention to the denture flanges of
RPD prostheses. It must be understood
that acrylic resin flanges of RPDs are used
to replace missing bone. The flanges of
many RPDs are overcontoured in relation
to the adjacent teeth and alveolar sup-
port. In the esthetic zone, natural teeth
often require replacement with tooth-
supported prostheses.
Alveolar defects vary from person to
person. When adjacent natural teeth are
present, the supporting alveolar structure
should be used as a guide for blending
acrylic resin to develop the edentulous
soft tissue. Inaccurate placement of tooth
gingival junctions of the artificial teeth
relative to the natural teeth leads to thick,
bulky denture flanges that replace hard
and soft tissue apically and proximally, re-
sulting in readily visible esthetic compro-
mises. Occasionally, it is possible to re-
place the artificial tooth with little or no
Fig. 29. A patient wearing the attachment
from Figure 28.
Fig. 30. Flexite prosthesis with full palatal
coverage and Flexite clasp on tooth No. 8.
Fig. 31. A patient wearing the Flexite pros-
thesis from Fig. 30.
Fig. 32. Locator stud attachments placed on
teeth No. 12 and 15 for RPD retention.
Fig. 33. RPD with plastic locator attach-
ments.
Fig. 34. Artificial teeth with minimal inter-
proximal tissue replacement between the
teeth.
Fig. 35. A patient wearing the RPD from
Figure 34.
Fig. 28. An ASC-52 precision attachment uti-
lizing teeth No. 6 and 13 as abutments.
September-October 2004 459
denture flange (Fig. 34 and 35). The
proximal and apical flanges of acrylic
resin on tooth-supported RPDs should be
knife-edged rather than rounded. This
edging will prevent shadows and allow the
color of the soft tissue to blend and even
show through in these critical areas. It
also is important to control the proximal
contours of teeth in these circumstances,
since bell-shaped teeth with proximal gin-
gival undercuts will create a dark space
between the adjacent artificial tooth and
the flange of the prosthesis.
4
Proper use of
a dental surveyor is important for over-
coming these esthetic concerns.
Tinting or characterization tech-
niques are critically important for pa-
tients whose attached gingival tissues
have melanin pigmentation or coloration
that does not match the available colors
of acrylic resin. However meticulous the
design and fabrication, all could be lost if
denture base tinting is disregarded, espe-
cially for the 4% of patients who show all
of their natural teeth and attached tissue.
Characterization of acrylic resins is a
simple technique that involves gently sift-
ing colored powder and liquid into the
denture mold prior to processing the
acrylic resin (Fig. 36 and 37). Acrylic
resin is available in a variety of colors,
which can be used individually or mixed
to arrive at a desired color (Kay-Dental,
Kansas City, MO; 816.842.2817). Photos
of these patients may be given to a dental
technician who is familiar with this tech-
nique; the patient also may go to the den-
tal laboratory during the processing of
the acrylic resin base.
Summary
The esthetic zone should be evaluated as
part of the clinical findings. The dentist
should photograph, diagram, or describe
the esthetic zone in writing for reference.
Thorough esthetic evaluation will serve
the dentist through all fabrication proce-
dures and help to avoid costly mistakes.
RPD designs, new materials, adjunctive
techniques to help characterize denture
bases, and implants that can replace miss-
ing critical abutment teeth mean that den-
tists no longer have to invade the esthetic
zone with unsightly RPD components.
Disclaimer
The opinions expressed in this article rep-
resent the sole views of the author. The
author has no commercial interest in any
of the manufacturers listed in this article.
Author information
Dr. Ancowitz is the program director,
prosthodontic residency program, West
Los Angeles Veterans Administration
Medical Center, and an assistant clinical
professor, Department of Prosthodon-
tics, UCLA School of Dentistry. He also
is a continuing education faculty mem-
ber for postgraduate programs in Esthet-
ic Dentistry at the State University of
New York at Buffalo, the University of
Minnesota in St. Paul, the University of
California at San Francisco, and the Uni-
versity of Florida at Gainesville.
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Fig. 36. An acrylic resin monomer placed
on polymer in lower half of denture flask.
Fig. 37. An example of denture base tinting
apical to teeth No. 8 and 9.