DENTOGENIC CONCEPT Part -I

Omkar Shetty1 Sabita Ram2

Abstract
Dentogenics is the art, practice and technique of creating the illusion of natural teeth in artificial dentures and is based on the elementary factor influenced by sex, personality and age of the patient Dentogenic concept is an adventure in the realm of cosmetic art. It was once written that we greet the world with our faces.The following article is a review of the dentogenic concept and the method of teeth arrangement in complete dentures.

Introduction
There are two worlds: the world we can measure with line and rule, and the world that we feel with our hearts and imagination. The dynesthetic and dentogenic concept, when applied, provides a more natural, harmonious prosthesis, which not only is desired by patients, but also is a quality of care they deserve. Outstanding esthetics can be achieved by simple guidelines; using tooth molds specifically sculpted for males and females, arranging prosthetic teeth to correspond the sex, personality and age and sculpting the matrix (visible denture base) with more natural contours.

for m of the teeth for dentur es. A square face deser ved square teeth, an ovoid face deserved ovoid teeth and tapered face, the tapered teeth. Dentogenic concept of dental estheticSPA factor

Dentogenic Interpretation
There are only two sexes immediately identifiable upon sight, but they can be identified in dress, hair style, and all other visible features. Age can be easily separated into young, middle or elderly and no patient in any group deserves the tooth form or tooth color of either of the other classifications. Personality is a bit more complex, but, again it can be of three types i.e.,vigorous, medium and delicate.

History Of Dentogenics
In 1915 Willia ms introduced the square, ovoid and tapering concept of choosing the
Professor1 , HOD & Pr ofessor2 , Deparment of Prosthodontics Dr. D Y patil D ental College a nd hospital N erul, Na vi Mu mbai.

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Dentogenic Interpretation Of The Sex Factor

A women is a woman from her finger tips to her smile and a man from his fists to his smiles. Keeping a woman a woman and man a man, after each looses the natural teeth has become so important a problem that modern day thinking emphasizes that a dentist must be an artist and a sculptor with highly developed perceptive qualities. The expression of Feminine characteristics Femininity is expressed by roundness, smoothness and softness that is typical of women. Therefore the selection of basic shape which has the soft lines expression of the feminine form, together with effective personality characteristics is particularly helpful. The expression of Masculine characteristic A typical masculine form is described as (cuboidal) hard muscular, vigorous appearance beyond the evaluation of physical appearance. A basic tooth form, which expresses masculine characteristic show big or, boldness and hardness. Thus sex identity becomes an automatic part of our esthetic procedures .

Sex Interpretation Of Tooth Positioning

Positioning of the teeth is necessary in further conveying sex characteristics to a denture. However, definite positions cannot be assigned to one sex or the other, as other factors other than sex must be taken into consideration. The anterior teeth should be arranged in a lively position. Central incisor can be arranged in four different harmonious lively positions. The incisal edge of one upper central incisor can be brought anteriorly to create on effect of hardness. If one of the central incisor is moved out at the base but leaving the incisal edge together softness is important to the anterior teeth. A more vigorous look can be given by one of the central incisor bodily anterior to the other, yet another position for incisors is a combined rotation of the two central incisor with their distal surface forward having one incisor depressed at the cervical and the other depressed incisally. These 4 positions can be treated either softly or more vigorously as it is for men or women Their placement controls i) midline ii) speaking line iii) smile line iv) lip support v) labioversion

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Lateral Incisors: (Right/left lateral incisor should have asymmetric long axis) This tooth is referred to as the sex tooth or it imparts effect of hardness or softness to anterior tooth by its position. If lateral incisor is rotated mesially. The effect of the smile is hardened which is best for vigorous man. The soft position (S) of the lateral incisor is produced by rotating its mesial surface outward and inward rotation produces hard position (H) Lateral incisor rotated to shape its mesial surface, slightly over lapping the central incisor imparts softness and youth fullness to smile

the widest, almost always the longest, and therefore, the most noticeable of the six anterior teeth. It is necessary to develop the desired effect in the depth grinding by consideration of these main factors a flat thin narrow tooth is delicate looking and fits delicate women ( little depth grinding) a thick bony big sized tooth heavily carved on its labial surface is vigorous and to be used exclusively for men (severe depth grinding) For the average patient the depth grinding will be an average between delicate and vigorous Depth grinding reduces the width of the central incisor according to the severity of grinding to be accomplished.

Canines: (Rotated to show mesial surface, controls, the buccal corridor). A prominence in the canine tooth imparts great importance and thereby gives the smile a vigorous look, which is more suitable to the male sex. General, we will adopt for the cuspid conjointly in the three following positions: out at the cervical end, as seen from the front rotated to show the mesial face almost vertical as seen from the side The Third Dimension-Depth Grinding The "denture look" is due mostly to the flat appearance of the artificial upper anterior teeth, their lack of depth, or of "body." The depth grinding is done on the mesial surface of the central incisor only. Central incisors are

Grinding of teeth for age abrasion effect Of early youth: Teeth prominent, bulbous gums, no abrasion short stuffy tooth, spacing between lateral, cuspid developmental groove Early middle age incisal wear, mild staining slight spacing due to drifting, which can be incorporated in the dentures. Middle age More incisal wear on C, L, canine, mild staining recession of gum Old age long axis is not in alignment, gum recession, erosion natural staining, occlusal and incisal wear caused by habit. Interpretation of personality factor in dentogenic restoration For a dentogenic restoration the human personalities can be grouped into three categories. The vigorous- Hard, aggressive, muscular type

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The medium type- Normal, robust, healthy The delicate type fragile, frail appearance. Personality of denture depends on the selection of tooth molds, tooth colors tooth position, and the matrix of the teeth (denture base) When we incorporate the personality factor in esthetics we do so keeping in mind the influence of the sex and age factors as we proceed. Personality Spectrum To provide a working tool for dentists as regards the personality factor in dentogenic restorations, they have conceived the personality spectrum, which has color-band or vertical rainbow hues extending from red to violet. The rugged, male extrovert could only fit into the bold, red end of the spectrum. The shrinking violet type female could only belong at the right end of the scale and the medium, normal type, male or female, would fit somewhere in between. The three divisions of personality spectrum are; Delicate type (green to violet band) - 5% Meaning fragile,fraile, the opposite of robust. Medium type (orange to yellow band) - 80% Meaning normal, moderately robust, healthy and of intelligent appearance. Performance of individual teeth in personality interpretation In dentogenics, the concept of the six anterior teeth as a group is not used. Instead each tooth is treated as an individual in form and position to produce independent personality effects in the patients mouth. Central Incisors: Just as various actors on the stage have their parts to play, being in the center and front of the stage, play the leading role. Thus the over-accentuation of central incisors contributes the deserved strength and action of the smile.

Lateral incisors: They are the supporting actors on the stage and convey the hardness or softness, the aggressiveness or submissiveness, vigorous tendency or the delicate tendency. Cuspid: Must dominate the lateral incisors in color form and position, and their treatment conveys either a strong, pleasant modern accent or an ugly primitive accent to the smile. Bicuspid - since dental arch is visible from molar to molar in an expressive smile, the bicuspids are esthetically important. They must achieve individually through variations of their long axis, and through variations of their color. It is extremely effective to vary the shades of the bicuspid and molar teeth, sometimes rather severely. Age in the artificial tooth In females the teeth lose their curves as age proceeds. The teeth of the male become more square in form to complement added weight and squareness of body. The dignity of advancing age must be appropriately portrayed in the denture by careful tooth color selection and by mold refinement, also by the intervention of such characterization, as would be fitting for the personality and sex of the patient. Color selection: Lighter shades for young people and darker shades for older ones. Mold refinement: The mamelons are present at the incisal edge of the central and lateral incisors. The cuspid presents a pointed tip, which is very sharp in appearance. The mamelon is soon abraded away, and the tooth assumes the youthful adult form evidenced by the enamel incisal edge of visible depth and of bluish hue. Later the sharp tip of the cuspid wears down to a more mature form. Teeth abrade with age. Central and lateral incisors abrade in straight line and cuspids abrade in a curve. This results in flattening of the arch

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Dotted line shows the original appearance of the incisal edges of artificial teeth; solid line shows the incisal wear to be incorporated for a particular patient.

The changing cuspid tip with age. Left youth; Center, middle age; right, advanced age.

Erosion seen on the gingival third and the necks of teeth. This is imparted to the artificial tooth, by careful grinding and polishing effectively, conveys the illusion of vigor and advanced age. Grinding and the repolishing the ground surfaces can accomplish this. Variable shading effects will be produced, as the ground surface will reflect light at a different angle from the ungrounded portion of the tooth. Diastema: It is seen very frequently in youth. It is present even more often in the mouth of adult in advancing years, because of the drifting of teeth resulting from premature loss of permanent teeth. In the past diastema was rarely used in the dentures between maxillary centrals. Placing a diastema whilst making the denture can give it a successful illusion of reality. Age in the Matrix Periodontal changes that may occur with age are Gingival inflammation, edema with loss of stippling, recession due to loss of attachment. These changes can be reproduced in complete dentures and will help to improve the esthetics, especially if the gingival tissues and flanges are visible on speaking or smiling widely. The matrix in the artificial tooth must be meaningful and not repetitive or inartistic. Our attempt in dentogenic restorations is to achieve the appearance of youth, middle age

or old age, in the denture base, according to the age of the patient, and according to the age of the other tissues of the body. Particular attention should be paid not only to colour but also to the shape, length and breadth of the interdental papilla in interpreting the age. Today with very lifelike materials available, we can even feature the interdental papillae, in such a realistic manner, as to greatly aid in the illusion of reality. In youth interdental papillae are freely stippled and pointed tight against the tooth . As age increases, Massler says, "the attached gingiva lose their stippled appearance and appear edematous and smooth, buccal mucosa is dry, inelastic and often wrinkled.

Advancing age, can be indicated appropriately by shortening the papillae and by raising gingival gum line, selecting long tooth, contouring the wax and positioning the tooth

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properly to suggest recession.

Dentogenics: Its Practical Application

It has three educational phases Education of the dentist: The dentist cannot achieve an accomplishment if he does not understand any more than the student. Artists can be expected to produce a portrait comparable to that executed by a master painter. Education of dental laboratory technician: they form the valuable assistant to many dentist. Education of the patient: Without an understanding of the esthetic asset to himself, the patient cannot be expected to desire or even to be willing to submit to the innovations of dentogenics. Education of the dentist There are number of cameras specially equipped for such work. If possible, the pictures should be in natural color, they should include close-ups of the mouth with the previous dentures in position or with whatever teeth may be present. They are invaluable preextraction records. Making two pictures of the teeth at close range and retaining one for the office records can build a most valuable reference library. Dentist may study freehand drawing with a local artist. The matrix or denture base is an exceedingly important feature of a denture. It is expedient to refer again to the collection of magazine pictures of smiling people in order to meet a possible objection by the patient to the shows of the interdental papillae or gingival matrix. Education of the laboratory technician Accurate communication between the dentist and the laboratory technician is essential in complete denture prosthodontics. Unaided by the dentist, the laboratory technician cannot

produce a dentogenic restoration, because he does not come in direct contact with the patient, nor is he professionally trained to meet the challenge posed by the complexities of patient management. Education of the patient The dentist may employ a loose-leaf notebook with plastic inserts under which may be placed pictures cut from current magazines of the well known people who display excellent natural teeth. The pictures should show natural teeth in the mouth in serious speech, and during expressive smiling. Pictures should be selected to illustrate the dynesthetic phase of the dentogenic concept, such as the variable long axis of the anterior teeth, active or passive positions of central incisors, the soft and hard placement of the lateral incisors, and the canines in the desirable and less pleasing inclinations, ultimately patient education manual becomes an indispensable aid. This book will assist the re-establishment of natures design in the mind of the patient and sharpen his recognition of the artificial.

Conclusion
The dentogenic concept is an esthetic philosophy. It considers gender, age and personality to restore the patients dignity and unique individuality that has been missing in far too many prosthesis. There are two worlds: the world we can measure with line and rule, and the world that we feel with our hearts and imagination. The dynesthetic and dentogenic concept, when applied, provides a more natural, harmonious prosthesis, which not only is desired by patients, but also is a quality of care they deserve. Outstanding esthetics can be achieved

Scientific Journal

Vol . I - 2007

Dentogenic ConceptOmkar Shetty et al

by simple guidelines; using tooth molds specifically sculpted for males and females, arranging prosthetic teeth to correspond the sex, personality and age and sculpting the matrix (visible denture base) with more natural contours. Every patient cannot afford the expense of full mouth or implant reconstruction in an effort to avoid complete dentures. Should they become edentulous? By employing dentogenic principles and concepts, it is possible to restore their dignity and individuality. Dentogenics is the guide and not a compulsion and thus our imaginative perception eventually is given more freedom. However, the rules must be learned first, and only practice, in their application will lead to success. Dentist must take full advantage of all concepts to create dentures that restore the natural appearance of their patients.

References
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. John P. Frush and Roland D. Fisher Dentogenics : Its practical application. J. Prosthet. Dent., 1959; 9 : 914-921. Salvatore J. Esposito Esthetics for denture patients J. Prosthet. Dent., 1980; l 44, 608-615. William S. Jameson Dynesthetic and Dentogenic Concept Revisited. J. Esthet. Restor. Dent., 2002; 14 : 139149. John P. Frush and Roland D. Fisher Introduction to Dentogenic Restorations J. Prosthet. Dent., 1955; 5 : 586-595. John P. Frush and Roland D.Fisher How Dentogenic Restorations Interpret The Sex Factor J. Prosthet. Dent., 1956; 6 : 160-172. John P. Frush and Roland D. Fisher How Dentogenic Interprets the Personality Factor

18. J. Prosthet. Dent., 1956; 6 : 441-449. 19. John P. Frush and Roland D. Fisher 20. The Dynesthetic Interpretation of the Dentogenic Concept 21. J. Prosthet. Dent., 1958; 8 : 558-581. 22. George H. Latta 23. The midline and the relation to anatomic landmark in the edentulous patient 24. J. Prosthet. Dent., 1988; 59, 681-683. 25. Jeff Morley and Jimmy Eubank 26. Macroesthetic elements of smile design 27. JADA, 2001; 132, 39-45. 28. George A Zarb et al. 29. Prosthodontic treatment for edentulous patients 10th Edn, 384-424. 30. Charles M Heartwell. 31. Syllabus for Complete Dentures 32. 4th Edn, 350-352. 33. Edwin I. Levin 34. Dental esthetics and the golden proportion. 35. J. Prosthet. Dent., 1978; 40, 244-252. 36. Jack D. Preston 37. The Golden Proportion Revisited 38. J. Esthetic Dent., 1993; 247-251.

Scientific Journal

Vol . I - 2007