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Esthetic and phonetics in complete dentures

Article · December 2011

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Clinical Dentistry

AESTHETICS
AND PHONETICS
IN COMPLETE
DENTURE

Tooth loss and rehabilitation with dentures can a 'e

tremendous patient impact and social implications. In an "rr ~e-
conscious society, dentures restore a sense r a '::: 3~:::;
allow the patient the abili IO imeran :."t rr':"5.~:' ~:::;5:
frequen denture complains· c L1 e cne,',·" s::::;~-::;':3~::;
objectionable aesthetics and pno Etics. )e:en·"'""'·~g ::3: :'~:
expec ations and their i f1uence -ac:' "-,.,
treatment is critical. Currem e idence Of) cunnio a 0 -co .es
patient satisfaction, and cost-effe iveness 0 rea men t,·-n
conventional dentures ersus implants are impor am facors i:O
consider during treatment planning for the edentulous pa ;en .
The purpose of this article isto review some exemplary litera ure
for the successfultreatment of the edentulous patient in ter s
of aesthetics and phonetics.

II KeyWords
Complete denture, Aesthetics, Phonetics.
 Oinicol Dentistry

II Introduction and the surrounding tissue so the prosthesis should

Aesthetics and phonetics start with patient be as close to the natural as possible and for that
evaluation at the time of diagnosis and ends up the accuracy of impression is a must, as this will be
with the acceptance of the patient. Aesthetics and the future base of the final prosthesis (well rounded
phonetics in complete denture run almost parallel to borders with adequate thickness should be recorded.)
each other; only the consideration of post dam area
is in a different line, where aesthetics has nothing to
" Orientation of Occlusal Plane
do muchIlJ Methods of achieving aesthetics as well
In saggital view occlusal plane lies parallel tochamper's
as phonetics can be: Patient evaluation, accurate
line and in frontal plane, parallel to interpupillary line.
impression (for peripheral outline and denture
[7] Fox-plane (designed by Dr. Frank Fox) can be used
thickness), orientation of occlusal plane, occlusal rims
to check these relations. The amount of incisal edge
(with anterior posterior position of incisors), vertical
visible is determined by the length of the lip (short
jaw relation, selection of anterior teeth, arrangement
or long). [8) It is adjusted by the labiodental sounds (F
of individual teeth, characterization of denture and
and V). If the plane is set too high correct positioning
lastly acceptance by the patient.
of the lower lip may be difficult.lfthe plane is too low,
the lip will overlap the labial surface of the maxillary
" Patient Evaluation teeth which will affect the phonation. [9)
To achieve optimal aesthetics in a patient's personality,
his cosmetic index and various other physical factors
play a vital role. All pre-extraction records which " Occlusal RIMS
The rims should be made to fulfil the space once
include old casts, old dentures, immediate denture,
occupied by the natural teeth. They should offer
photographs, radiographs, etc. are very useful.
Characteristics like diastema, rotation or crowding adequate support for soft tissue and also allow
etc. should be noted. [2,3]Other than this the author for aesthetic buccal corridors. In case of extreme
suggests that the patients' chief complaint and his/ resorption it is best to set teeth in cross bite to get
her working place should be noticed carefully as this good aesthetics. If oriented properly, it should follow
gives a brief idea of patient's psychological as well as the smile line of lower lip. [10] According to Heartwell
his primary requirement. [2,3,4) and Rahn, mandibular teeth become more visible
with age[111According to Vig, men display about 1.23
mm mandibular teeth whereas women display 0.49
" Accurate Impression
Once the teeth are lost, functions of the facial mm. (12)For phonetics rims are adjusted by production
muscles are impaired. The support of the facial of labiodental sounds (F and V). [6J If they are placed
muscles is essential with properly formed borders. [5) too far palatally the contact of lower lip with incisal
Over extended borders give the appearance of hairy and labial surface will be difficult.
cotton roll beneath the lip. On the other hand the The author suggests that when the rim is fabricated
patient who has undergone significant resorption its width should be as close as possible to the natural
requires thicker borders. These factors, if overlooked, teeth, i.e., rim should gradually be thicker as it moves
while making the impression, the prosthesis will give
posteriorly. It should also be properly finished and
an unaesthetic appearance.
polished. The author has utilized Vig method for
The depth of the sulci varies with the movement of the the establishment of the maxillary rim and for the
tongue, lips and cheeks during speech. Any interference mandibular prefers Pounds' closest speaking space
in movement will cause alteration of speech. One of method. :9, '2]
the most important factors for phonetics is denture
thickness. With consonant like t and d, tongue makes " Vertical Jaw Relations
a firm contact with the anterior part of the palate. If Correct vertical relation is essential for proper
artificial rugae are too f1ronounced or if denture base in positioning of orbicularis oris and the associated
this region is too thick, it will cause obstruction which, muscles. Excessive vertical dimension of occlusion
in turn, will give noticeable difference of speech. If
causes stretched appearance and the patient is unable
the denture is thick in postdam area it will irritate the
to proximate his lip resulting in poor aesthetics and
dorsum of tongue which, in turn, will affect the speech
phonetics. The author suggests that if vertical is not
and possibly feeling of nausea. [i,6)
accurately established then there can be occlusal as
The author suggests that the dentists should always well as temporomandibular problems which, in turn,
keep in mind that they are replacing the lost tooth definitely affect both aesthetics and phonetics. [13.14)
II Selection of Anterior Teeth
From 19th century till date different theories, concept
and studies have been placed forward for the
selection of anterior teeth in order to improve
denture aesthetics. The earliest documentation
the year 1872 when JW White proposed the concept
of correspondence and harmony. Thereafter Hall and
White (1887) placed forward the temperamental
theory. This was a widely accepted theory. Factors
considered were patient class, attitude and physical
appearance. Typal form theory was given by Williams
in 1914. He said, 'face form of the patient is similar to
tooth form'. Many other theories and concepts were
put forward like Berry biometric method (1905), Write
photometric theory (1936), Anthropometric cephalic
index method by Sears (1941) and many other until
Frush and Fisher, (1955-59) proposed the dentogenic
concept. This concept was based on difference in sex,
personality and age.[B.15-19.21J
II Guidelines for Selecting Teeth
They can be selected for shade, size and shape.
Shade
Natural maxillary central incisors are the lightest teeth.
Maxillary lateral and mandibular incisors are slightly
darker. Canines are darker still. Posteriors are slightly
lighter than canine. SO,artificial teeth of different shades
can be mixed for better aesthetics. Selection can be
aided by skin colour, age and patient desire. According
to dentogenic concept, darker shades are for men or
vigorous personalities whereas lighter shades are for
women and delicate personalities. [2,8,15-19J
Size and Shape
It can be gained from pre-extraction records as to
which is the best, else there are other tools to select
the anterior teeth;[22J
Width of maxillary central incisor (C.I) =
bizygomatic width,
Length of maxillary C.I = 1/16 length of face
Dentogenic Concepts
Incisors are longer in younger individuals. Women
have small teeth than men and incisors in men are
shorter than women (According to Vig, the average
display of maxillary central incisor in men= 1.91 and
in women = 3.40) [B. 12.15-19J
Golden Proportion
Levin in 1978 put forward the concept of geometric
progression, which stated that the width of the
maxillary anterior teeth lie in golden proportion. [23.
-". - cording to that the width of the maxillary central
incisor X 0.618 = the width of maxillary lateral incisor
and so on. In other words the width of lateral incisor
is 62% of central incisor, the width of canine is 62% of
the lateral incisor and so on.
was in
Red Proportion
Daniel Ward in 2001 stated that the dentist can
establish his own proportion and remain consistent
while moving distally. 70% seems to move pleasing.
[25JContact area should show wear according to
age. Women tend to have ovoid form of teeth with
rounded incisal angles while man tends to have
square tooth forms. There is no single method of
selection of the teeth yet developed/derived. Rather
it should be clubbed in with one or more methods of
teeth selection. A research work was carried out by
the author on the validity of golden proportion for
selection of teeth and the conclusion was that more
number of females was in geometric progression
when compared to males.
II
Arrangement ofTeeth
While arranging teeth they should be viewed in 3
different planes - frontal, saggital and occlusal planes
and in each plane teeth should be arranged keeping
in mind the guidelines laid down by various authors
such as Boucher, Winkler, Wright, Pound, Hickey,
Wehner, etc. [l.2.10.21]
For Maxillary, the incisal edge of central incisor
and canine rest on occlusal plane. Lateral incisor is
approximately 1mm short of the plane. Some authors
prefer lateral incisor conceding the occlusal plane. In
frontal view, the long axis of central incisor is nearly
perpendicular to the occlusal plane whereas long axis
of lateral incisor is slightly angulated medially and for
canine, it is angulated little more than lateral incisor.
In occlusal view, central incisor face forward whereas
canine is rotated distally. In saggital view, central
1/16 incisor flare slightly in labial direction and lateral
incisor is slightly more in the same direction whereas
long axis of canine is perpendicular to occlusal plane.
For Mandibular, in frontal plane the long axis of central
incisor is perpendicular to occlusal plane, lateral incisors
are tipped more medially and for canine, long axis is
tipped more medially than lateral incisor. In saggital
view the central incisors are tipped in labial direction
slightly, long axis of lateral incisor is perpendicular to
the occlusal plane and canine angles slightly forward.
[2.1O.21JImproper placement of teeth will lead to
compromised aesthetics and phonetics.
II
Characterization of Denture
According to GPT-8 denture characterization is the
modification of the form and colour of denture base II Acceptance ByThe Patient
and teeth to produce a more lifelike appearance. The ultimate test for aesthetics is the patient. At
The best way to get this is pre-extraction records the end of day, it is the patient who has to wear
(photographs, cast, etc.) [4. IOJ
the denture. The patient should be educated and
Teeth - brown stains around the neck simulate stains involved in almost every step in the fabrication of the
due to smoking, tea and coffee. White opaque stains prosthesis that is the reason why Michael suggested
represent hypoplastic area. involvement of the patient and preference as the
Denture base- it can be done by simulating the modern concept. [20]

anatomical characterization of oral mucosa with

various stains in a denture base. II Conclusion
Contour of denture base- contours of marginal and free Keeping in mind all the aspects of aesthetics
gingival, labial and buccal mucosa, root eminencies and phonetics and also incorporating them in
can be reproduced Stippling effect. [8.16,17,18) fabrication of the complete denture prosthesis, one

Author characterization of a denture is an art and shall be can achieve the goal of a good prosthesis which is
performed artistically with the concerns of the patient both functionally and aesthetically acceptable to the
and side by side not overlooking the scientific facts. patient.

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