COMPLETE DENTURES 0011-8532/96 $0.00 + .

20

COMPLETE-DENTURE ESTHETICS
Robert L. Engelmeier, BS, DMD, MS

Over the past century, dentists have written about and debated the various
elements of complete-denture esthetics. During the past 50 years, however,
significant improvements have been made in the quality of denture teeth and
materials, which allow for dentures to be far more esthetic than ever before.
Concurrently, a number of significant articles were added to the classic prostho-
dontic literature. These articles instruct contemporary dentists on how to pro-
duce very esthetic, natural looking, complete dentures.
Hardy" said it best when he wrote, "Make the teeth look like natural
teeth." Modern materials and the tremendous variety of esthetic, artificial teeth
currently available are not all that is necessary to achieve optimum esthetics in
complete-denture fabrication. If a dentist is to make a denture wherein "the
teeth look like they grew there," he or she must set the teeth in an esthetic and
convincing arrangement that also meets the patient's functional needs. Therein
lies the art and science of complete-denture prosthodontics.
In general, humans are programmed similarly as to what is esthetic and
what is not. It appears that beauty really does lie in the eye of the beholder and,
more often than not, is a matter of genetic programming. Of course, there are
individual as well as cultural variations. A good example is the Golden Propor-
tion, which was one of Euclid's elements and which was used extensively in
ancient Greek architecture. It is a proportion that exists throughout nature and
one that humans are programmed genetically to recognize as esthetic. Lom-
bardi" and later Levin" related the Golden Proportion to complete denture
esthetics. A denture usually is perceived as esthetic when the teeth and bases
are in harmony with the facial musculature as well as the size and shape of the
head. A denture usually is noted to be unesthetic when a disharmony exists.
The lack of harmony could be anything from incorrect size and shape of the
teeth to an improper orientation of the occlusal plane. A denture with such
disharmonies generally appears unesthetic to everyone. Conversely, a denture
with all of the teeth properly oriented and arranged generally appears esthetic
to everyone.

From the University of Texas Dental Branch, Houston, Texas

DENTAL CLINICS OF NORTH AMERICA

VOLUME 40· NUMBER 1· JANUARY 1996 71

72 ENGELMEIER

Thorough patient evaluation is essential if good denture esthetics are to be

achieved. The patient's personality, cosmetic index, and various physical factors
all impact on esthetics. All pre-extraction records are invaluable. Old casts,
photographs, or immediate dentures can be extremely helpful both for tooth
selection and arrangement. Particular attention should be directed to tooth
angulations and special characteristics, such as rotations, crowding, or dia-
stemata.
This article illustrates methods for achieving good complete denture esthet-
ics by reviewing both anatomic and functional guidelines for setting artificial
teeth from the classic prosthodontic literature. The discussion is divided into the
selection of the anterior teeth, the arrangement of the teeth, and the characteriza-
tion of the denture bases.

TOOTH SELE:CTION

Tooth selection involves choices of shade, size, and shape of the artificial
teeth.

Tooth Shade

Historically, shade selection was based on the patient's hair and eye color,
complexion, and age. Boucher' made the point, however, that hair color changes
throughout life and actually can be changed abruptly by artificial coloring. He
further pointed out that the color of the iris of the eye involves such a small
area that its influence on tooth shade is negligible. He recommended that teeth
be harmonious with skin color and, in short, be inconspicuous. Several authors':
8.9.11.16.24 have noted that teeth darken naturally with age and, therefore, recom-

mended that darker shades be selected for older individuals. Besides matching
the shade to the patient's complexion and age, Krajickek" emphasized the
necessary consideration of the patient's desires. No matter how harmoniously
the dentist matches a shade to a patient's age and complexion, the patient will
never accept the result if it does not meet his or her own expectations.
In the mid-1950s, Frush and Fisher" introduced the "dentogenic" concept
for establishing the esthetics of a patient's complete dentures. Their theory was
based on a patient's sex, personality, and age. They held that age and tobacco
smoke tend to darken the teeth. They also tended to use darker shades in men
or patients with bold and vigorous personalities. Conversely, they used lighter
shades in women and patients with delicate personalities.
Clark' established the fact that natural teeth are not monochromatic but
rather consist of three distinct shades: (1) cervical, (2) incisal, and (3) a transi-
tional shade in the middle third of the tooth. Like Troland" before him, Clark
also explained that shade itself possesses three dimensions: (1) hue-the basic
color of the spectrum; (2) brilliance (value)-the brightness or reflectance; and
(3) saturation (chroma)-the intensity of the hue. In order to simulate natural
teeth, denture teeth manufacturers fabricate modern artificial teeth with intrinsic
blends of shades and translucencies. In general, there is more chroma in the
cervical area and more translucency in the incisal area of the anterior teeth. In
addition, there is a transition of the shade from the central incisors to the
canines. The canines are less translucent, more opaque, and have more chroma
than the central incisors. A common practice to achieve more variation in the
anterior shade is simply to exchange some of the teeth on a card for others in a
 COMPLETE-DENTURE ESTHETICS 73

more appropriate shade. There are both porcelain and acrylic resin stain systems
available that can be used to "age" and characterize denture teeth. It must be
remembered, however, that all extrinsic stains, no matter how durable, are
subject to wear.

Tooth Size

Generally, larger people have larger teeth. In addition, men usually have
larger teeth than women, particularly when comparing the maxillary lateral
incisors. As stated by Boucher, I however, the maxillary anterior teeth must be
in proportion with the size of the face and head to achieve good esthetics.
Sharry> emphatically held that tooth size was much more important than tooth
shape. He further believed that the size and shape of the mandibular incisors
did not impact on the patient's esthetics as much as the maxillary incisors,
and that following the manufacturer's recommendation to match the maxillary
anterior tooth selection usually yielded a good esthetic result. Sharry." Boucher,'
and Pound" all condemned the practice of selecting teeth based on measurement
of the master cast. All agreed that size selection should be based on facial
measurements and proportions.
There are two popular methods in the classic literature to select the appro-
priate size of the maxillary anterior teeth. The first is to base the selection on
the space available for placement of the teeth. The length of the maxillary wax
rim first is established by phonetics (i.e., fricative ["F" and "V"] sounds) and
adequate support for the soft tissues of the upper lip. The length of the maxillary
central incisor is measured from the incisal edge of the maxillary wax rim up to
the high lip line (smile line of the upper lip). Vertical lines then are scribed on
the wax rim directly down from the right and left alae of the nose. The distance
between these lines gives a good approximation of the width of the six maxillary
anterior teeth and places the canines near the commissures.
The second preferred method of tooth size selection is based on the facial
and tooth size proportion. Pound" emphasized harmony in the proportion of
the maxillary anterior teeth and the face. In his writing, he advocated the same
1:16 ratio described by House and Loop." In his research, House established a
biometric ratio of 1:16 both for the length of the maxillary central incisor
compared with the length of the face and also for the width of the maxillary
central incisor compared with the bizygomatic width of the face.
Levin" observed that the widths of the maxillary anterior teeth when
viewed in the frontal plane lie within the "Golden Proportion" of 1.681 (i.e., the
central incisor is 1.681 times wider than the lateral incisor, etc., in a frontal
view). He suggested that a grid set up in this proportion be used as an aid in
arranging the anterior teeth to achieve maximum esthetics.
Frush and Fisher" varied incisor length from the ideal according to the
dentogenic guidelines of age, sex, and personality. The incisors tend to be longer
in younger individuals and to get progressively shorter with age. In addition,
the incisors of men are proportionately shorter than those of women. This
variation, of course, is meant to simulate attrition. Frush and Fisher,' I like
Pound," emphasized the importance of the incisal edges of the maxillary ante-
rior teeth following the contour of the smile line of the lower lip.
Whether a dentist establishes the size of the maxillary incisors by esthetics
and phonetics or by anatomic proportions, it is prudent for him or her to query
the patient for pre-extraction records, such as dental casts, radiographs, or
photographs, to help establish the ideal tooth size for an individual patient.
74 ENGELMEIER

Tooth Form

Around the turn of the century, dental investigators searched for a direct
relationship between tooth form and facial form. Berry'! probably was the first
to demonstrate the correlation between the outlined form of the maxillary central
incisor and the inverted outline form of the face. J. Leon Williams'? applied the
typal forms of facial art to the classification of the maxillary anterior teeth and
thereby gave the profession a much improved method for tooth shape selection.
Williams classified facial form as square, tapering, square-tapering, and ovoid
(Fig. 1).
Following an 18-year study of extracted teeth, House and Loop" classified
teeth according to form. Their classification was based not only on the facial
outline form of a tooth but also on the mesial-distal and gingivo-incisal contours
as well. They proposed three pure typal forms (i.e., square, tapering, and ovoid)
along with six other combination forms (i.e., square-tapering, reverse-tapering,
ovoid-square, ovoid-tapering, ovoid-reverse-tapering, and square-tapering-
ovoid). House held that good esthetics could be achieved only if the face, arches,
and tooth shapes all were in harmony. In addition, he classified arch forms as
square, tapering, and ovoid.
Pound" also believed that harmony was the key to good esthetics. He not
only evaluated the outline form of the face in the frontal plane but also in the
sagittal plane.. This assessment then was related to the labial surfaces of the
artificial teeth in the frontal and sagittal views. Denture tooth manufacturers

(J U o
Figure 1. A comparison of Williams' classification of facial form with examples from House's
corresponding classification of tooth form.
 COMPLETE-DENTURE ESTHETICS 75

Figure 2. The Trubyte Tooth Indicator.

over the years have developed numerous devices to aid the dentist in his or her
selection of denture teeth (e.g., the Trubyte Tooth Indicator, Dentsply Interna-
tional, York, PA) (Fig. 2).
Frush and Fishe r" 9. 11 considered dentogenic factors when selecting tooth
form , as well as tooth size and shade. In an effort to achieve complete harmony
between the patient's teeth and face, the y advocated selective reshaping of the
artificial teeth to account for the influence of age, sex, and personality. Such
characterization can be very effective in sim ulating the attrition seen in old age;
the soft , delicate look of a feminine dentition; or the bold, vigorous look of a
masculine dentition. By overaccentuation of tooth form , shade, and position
they emphasized various aspects of the patient's personality, age , and sex. Each
denture tooth was treated as an ind ivid ual in terms of both form and position.
Overaccentuated maxillary central incisors produce strength and boldness in the
smile. This can be reinforced or softened by reshaping and thoughtful position-
ing of the maxillary lateral incisors. The position of the maxillary canines is of
paramount importance for achieving good esthetics. The shape of the ma xillary
canines further reinforces the stateme nt made by th e ma xillar y incisors. Frush
and Fisher" also emphasized the importance of the ma xillary bicuspids in
complete denture esthetics because they are so visible during an expressive
smil e.
Feminine tooth form s generally are ovoid or a combination type that in-
cludes the ovoid form . Conversely, masculine tooth form s generally are square
or a combination type that includes the square form. Frush and Pisher'" recom-
mend beg inning the denture set-up w ith the proper bas ic typal tooth form
76 ENGELI\1EIER

required by the patient (i.e., ovoid for females and square for males). Depending
on his or her interpretation of the patient's dentogenic factors, the dentist can
feminize the patient's appearance further by softening the lines and arrangement
of the set-up; or the dentist can masculinize the patient's appearance further by
reshaping the teeth to appear more cuboidal and arranging them in a harder,
more vigorous set-up. Their final recommendation involving tooth form is depth
grinding to prevent the look of flatness. In doing this they sought to enhance
the third dimension of depth (labial-lingual) by selective grinding of key areas,
such as rounding of the mesial edge of the maxillary incisors.
A discussion of tooth selection would be incomplete without mention of
the possibility of characterization of key individual teeth with restorations. Chips
and large facets can be ground into the teeth. Some patients have even requested
that their dentist inlay precious stones into the labial surfaces of the maxillary
anterior teeth. This type of characterization exemplifies the recommendation to
overcharacterize in order to emphasize a patient's personality traits.

TOOTH ARRANGEMENT

Nelson." and later French/ wrote that the arrangement of the teeth is a far
more important esthetic factor than mold selection. In his article on complete
denture esthetics, French illustrates how the same denture tooth mold can
appear as either square, tapering, or ovoid depending on how the individual
teeth are arranged and how the base is fabricated to frame the teeth.
There are four steps in arranging denture teeth: (1) the proper orientation
of the occlusal plane; (2) the careful development of wax rims precisely in the
space intended for the artificial teeth; (3) the placement of each tooth in its
correct anatomic position (care should be taken to create as much symmetry as
possible from one side of the arch to the other); and (4) the characterization of
the set-up. (This is achieved by crowding, rotation of teeth, placement of dia-
stemata, and variations in the angulation of the teeth to personalize the set-up
for an individual patient.) It is beyond the scope of this article to discuss
techniques to establish centric relation and vertical dimension of occlusion.
Suffice it to say, however, that in order to achieve optimum esthetics and
harmonious support for the soft tissues of the face, these two relationships must
be located, recorded, and transferred to an appropriate articulator correctly.

Orientation of the Occlusal Plane

In the sagittal view the occlusal plane is determined by the incisal edges of
the maxillary central incisors and the approximate juncture of the upper and
middle thirds of the retromolar pad." The occlusal plane lies parallel to Camper's
line (Fig. 3) in the sagittal plane and parallel to the interpupillary line in the
frontal plane (Fig. 4).
The occlusal plane plate (Dentsply /York Division, York, PA) designed by
Dr. Frank Fox is a most useful tool for determining these two relationships. The
lengths of the maxillary central incisors are established best by esthetics and
phonetics. The amount of incisal edge visible below the relaxed upper lip may
range from zero to several millimeters owing to variation in lip length from
very short to very long. After achieving good facial soft tissue support with the
wax rim, the dentist should adjust the incisal length of the rim by having the
patient enunciate fricative ("F" and "VU) sounds. The length is adjusted to
 COMPLETE-DENTUREESTHETICS 77

---
.... --,

Figure 3. Orientation of the occlusal plane-sagittal view.

where the wet or dry line of the lower lip makes light contact with the incisal
edges of the maxillary central incisors (Fig. 5).23

Occlusal Rims

The wax rims should be developed with great care to fill the space once
occupied by the patient's natural teeth precisely. The artificial teeth should
occupy this space and not be set on the ridge if good esthetics and soft tissue
support are to be realized. First and foremost, these rims should offer adequate
support for the soft tissues of the face. They should allow for esthetic buccal
corridors (bilaterally). In the case of extreme resorption of the alveolar ridges,
the maxillary ridge resorbs upward, medially, and rearward. At the same time,
the mandibular ridge resorbs downward, laterally, and forward. The resorptive
pattern can place ridges formerly in a normal relationship into a crossbite. In
this case it is best to set the posterior teeth in a crossbite to achieve good
esthetics. To do otherwise places the maxillary teeth too far buccally where they
obliterate the buccal spaces, resulting in a very unesthetic denture. If the occlusal
plane is oriented properly, the maxillary wax rim should follow the smile line
of the lower lip." Orientation lines should be scribed on the maxillary rim in
the midline (facial midline); the high-lip line (smile line-most people show the
entire clinical crowns of the maxillary anterior teeth when smiling); and two
vertical lines in the canine area directly down from the alae of the nose. Arch
form, according to House and Loop," should be harmonious with facial form
and tooth form.
78 ENGELMEIER

Figure 4. Orientation of the occlusal plane-frontal view.

Heartwell and Rahn' ? pointed out that mandibular teeth become more
visible with age. Vig and Brundo" showed in their research that the longer the
upper lip, the more visible the mandibular teeth become. They also showed that
men, on the average, displayed 1.23 mm of the mandibular incisors when the
lower lip was at repose, whereas women only displayed 0.49 mm . Cade? showed
in his research that there is significant exposure of mandibular teeth beyond age
40 and that in a patient over 40 the mandibular anterior teeth affect esthetics as
much as the maxillary anterior teeth . After the occlusal plane and maxillary rim
have been established, the positions of the incisal edges of the mandibular
central incisors can be established very nicely with Pound's" closest speaking
space technique (Fig. 6). The mandibular anterior teeth are set so that their
incisal edges are slightly lingual to the incisal edges of the maxillary incisors (1
to 1.5 mm) when the patient enunciates sibilant sounds. Generally speaking, the
mandibular incisors protrude 0.5 to 2 mm above the relaxed lower lip and the
labial surfaces of these teeth emerge straight up from the mandibular labial
vestibule. Of course, in the case of a retrognathic patient, the mandibular incisors
are tipped forward as far as possible for better esthetics, whereas in a prognathic
patient they are tipped lingually to prevent or at least to minimize an anterior
crossbite.

Individual Tooth Placement

When setting denture teeth, a dentist or laboratory technician should view
the position of each tooth in the frontal, sagittal, and occlusal planes. The
 COMPLETE-DENTURE ESTHETICS 79

5
Figure 5. Establishing the length of
the maxillary incisors by phonetics.
6
Figure 6. Establishing the position of the
mandibular incisors using the closest
speaking space.

maxillary teeth should be arranged according to Figure 7. The incisal edges of

the central incisors and canines rest on the occlusal plane, whereas the lateral
incisors are about 1 mm short of the plane. In a frontal view, the long axes of
the central incisors nearl y are perpendicular to the occlusal plane. The lateral
incisors angle medially slightly. The canines usually angle more medially than
the lateral incisors. The tips of the canines should nev er be more labial than
their necks. In an occlusal view, the central incisors face forward, whereas the
canines are rotated distally, displ aying more of their mesial surfaces. The incisal
edges of the canines pa rallel the alignment of the posterior rid ges. Finally, in a
sagittal view, the central incisors flare slightly in a labial direction, whereas the
lateral incisors flare slightly more in the same direction. The long axes of the
canines, however, nearly are perpendicular to the occlusal plane in this view.
Ideal placement of the mandibular anterior teeth is illustrated in Figure 8.
In a frontal view the long axes of the central incisors are perpendicular to the
occlusal plane. The lateral incisors are tipped medially slightly. The long axes
of the mandibular canines tip more medially than the lateral incisors. In a
sagittal view the central incisors are tipped in a labial direction slightly. The
long axes of the lateral incisors nearly are perpendicular to the occlusal plane in
this view. The mandibular canines angle forward slightly.

Set-Up Characterization

Lombardi" felt that the central incisors make the best statement of the
patient's age, whereas the lateral incisors connote the patient's sex. He held
80 ENGELMEIER

.
• •,

Figure 7. Ideal placement of the maxillary anterior teeth in the frontal, occlusal, and
sagittal planes.

that the canines reflect the patient's vigor. Frush and Fisherv" 11 believed that
dentogenics influence tooth arrangement as well as shade and tooth selection.
To highlight age they accentuated diastemata and rotations. In addition, Frush
and Fisher varied the long axes of the teeth and flattened the smile line. To
feminize the set-up, they rotated the mesial surfaces of the maxillary lateral
incisors outward and blended the cuspids in with the other teeth as they
rounded the arch. When they sought to masculinize a set-up, they rotated the
distal incisal corners of the maxillary lateral incisors outward and gave the
canines a more prominent appearance by setting them forward boldly, They
advised against using a diastema between the maxillary central incisors and
admonished their readers always to respect the buccal corridors. Probably the
most popular characterization technique is to crowd and tilt the mandibular
anterior teeth; however, to be esthetic this must be done in a convincing manner
and not simply by a random scrambling of the set-up. It must be emphasized
that even though techniques to accentuate age, sex, and vigor of the personality
can be borrowed from the classic literature, the best guideline for set-up charac-
terization is an old photograph or cast of the patient's natural teeth.
 COMPLETE-DENTURE ESTHETICS 81

,,
•
•••
l
l
l
l
l •

l
l

Figure 8. Ideal placement of the mandibular anterior teeth in the frontal and sagittal planes.

DENTURE BASE

No discussion of complete-denture esthetics would be complete without

consideration of the esthetics of the denture bases. Sir Wilfred Fish" in his
extensive writing on the polished surface of the denture did not address the
esthetics of the denture base itself specifically but did elaborate on the direct
influence that the denture base contours had on facial esthetics. He held that
optimum esthetics depend on adequate soft tissue support, which in turn is
directly related to proper base contours. He went to great lengths to explain the
relationship between the polished surface of the denture and complete harmony
of the facial musculature and soft tissue.
Where the denture base is visible when most patients speak and smile, a
number of authors have addressed the esthetics of the denture base itself.
Frush and Fisher,B.lo in keeping with their dentogenic theory, proposed convex,
rounded, and shortened papilla in older patients. They also proposed the expo-
sure of more of the cervical root portions of the denture teeth in order to
simulate the gingival recession seen in older individuals. They stippled their
dentures but were careful not to stipple the free gingiva. They recommended
using finer stippling along with a lighter base shade in females and a darker
base shade along with heavy stippling and a rougher base texture in males.
They preferred to tint the interdental papilla and muscle attachment areas with
a deeper shade of red. Conversely, they used light shades to tint areas of
hard tissue.
Shade guides for denture base materials can be made easily (Fig. 9). Acrylic
resin disks the size of a quarter, strung on a small chain, can be used to match
the shade of a patient's gingiva conveniently. The disks should vary in thickness
from 0.25 to 3 mm to give a better idea of shade variation because the base
acrylic varies in thickness. A number of the classic writers of complete-denture
82 ENGELMEIER

Figure 9. Denture base material shade guide.

literature" 6. 15. 21,22 advocated anatomically correct festooning, meticulous stip-

pling, and custom staining of the denture base. They also suggested the use of
preformed anatomic palatal and facial gingival forms. Pound" and Choudhary"
both suggested the use of a diagram that maps out the areas to be stained with
each color. A well-illustrated, step-by-step technique for using denture base
stains can be found in Dental Laboratory Proceduree.r' This technique is based on
the use of five shades of Kayon Denture Base Stains (Kay-Cee, Inc., Kansas
City, MO):
H: Basic pink used over hard tissue as attached gingiva
F: Light red used for papilla and muscle attachments
A: Medium red used sparingly

Figure 10. Denture base stain map.

 COMPLETE-DENTURE ESTHETICS 83

Figure 11. Well-festooned and characterized complete dentures.

E: Purple used sparingly in heavily pigmented gingiva

B: Brown used for heavily pigmented gingiva

The importance of mapping out the areas to be stained before the tinting
process is begun is emphasized (Fig. 10). Experience and practice are necessary
to get a well-blended, lifelike characterization of the denture base (Fig. 11). Most
of the pitfalls, such as too much stain, streaks of color, porosity, or displacement
of the stains can be overcome by using an exacting technique.

SUMMARY
This review of complete denture esthetics addresses the process of tooth
selection, tooth arrangement, and characterization of the denture bases. The
guidelines discussed in this article are all gleaned from the classic prosthodontic
literature. These principles, which were developed over the past century, cou-
pled with state-of-the-art materials and artificial teeth enable contemporary
dentists to fabricate complete dentures with a level of esthetics never before pos-
sible.

References

1. Boucher CO: Swenson's Complete Dentures, ed 6. St. Louis, C.V. Mosby, 1970, pp 312-
317
2. Cade RE: The role of mandibular anterior teeth in complete denture esthetics. J
Prosthet Dent 42:368-370, 1979
3. Choudhary SC: Characterizing the denture base for non-caucasian patients. J Prosthet
Dent 33:73-79, 1975
4. Clark EB: Tooth color selection. J Am Dent Assoc 20:1065-1073,1933
5. Curtis T, et al: The influence of removable prosthodontic procedures and concepts on
the esthetics of complete dentures. J Prosthet Dent 57:315-323, 1987
84 ENGELMEIER

6. Fish W: Principles of Full Denture Prosthesis, ed 6. London, Staples Press, 1964,

pp 52-67
7. French FA: The selection and arrangement of the anterior teeth in prosthetic dentures.
J Prosthet Dent 1:587-593, 1951
8. Frush JP, Fisher RD: The age factor in dentogenics. J Prosthet Dent 7:5-13, 1957
9. Frush JP, Fisher RD: The dynesthetic interpretation of the dentogenic concept. J
Prosthet Dent 8:558-581, 1958
10. Frush JP, Fisher RD: How dentogenic restorations interpret the sex factor. J Prosthet
Dent 6:160-172, 1956
11. Frush JP, Fisher RD: Introduction to dentogenic restorations. J Prosthet Dent 5:586-
595, 1955
12. Hardy IR: Problem solving in denture esthetics. Dent Clin North Am 4:305-320,1960
13. Heartwell CH, Rahn AO: Syllabus of Complete Dentures, ed 3. Philadelphia, WB
Saunders, 1969, p 279
14. House MM, Loop JL: Form and Color Harmony in the Dental Art. Whittier, CA, M.M.
House, 1937, pp 3-33
15. Kemnitzer OF: Esthetics and the denture base. J Prosthet Dent 6:603-615, 1956
16. Krajickek DO: Natural appearance for the individual denture patient. J Prosthet Dent
10:205-214, 1960
17. Levin EI: Dental esthetics and the golden proportion. J Prosthet Dent 40:244-252, 1978
18. Lombardi RE: The principles of visual perception and their clinical application to
denture esthetics. J Prosthet Dent 29:358-382, 1973
19. Morrow RM, et al: Dental Laboratory Procedures, vol 1. St. Louis, c.Y. Mosby, 1986,
pp 545-550
20. Nelson AA: The esthetic triangle in the arrangement of teeth. Nat! Dent Assn 9:392-
401, 1922
21. Pound E: Applying harmony in selecting and arranging teeth. Dent Clin North Am
6:241-258, 1962
22. Pound E: Lost fine arts in the fallacy of the ridges. J Prosthet Dent 4:6-16, 1954
23. Pound E: Utilizing speech to simplify a personalized denture service. J Prosthet Dent
24:586-600, 1970
24. Sharry JJ: Complete Denture Prosthodontics, ed 3. New York, McGraw-Hill, 1974,
pp 248-265
25. Troland LT: Report of Committee on Colorimetry. J Opt Soc Am 6:534,1922
26. Yig R, Brundo G: The kinetics of anterior tooth display. J Prosthet Dent 39:502,1978

Address reprint requests to

Robert 1. Engelmeier, BS, DMD, MS
Department of Prosthodontics
University of Texas Dental Branch at Houston
6516 John Freeman Avenue
Houston, TX 77225