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Simulation of natural appearance
COMPLETE
DENTURES
SIMULATION
OF NATURAL
DAYTON
DUNBAR KRAJICEK,
Mission,
Kan.
I
APPEARANCE
D.D.S.
dentistry has made within the past few years, there are still many perplexing clinical problems which are a source of concern in every prosthetic practice. When we consider that the edentulous patient is also a complicated human being, we recognize that some problems are inevitable. The majority of our unsolved questions, however, pertain to the physiologic and mechanical aspects of prosthodontics, while esthetic appearance is more easily attainable than ever before. Some dentists take full advantage of all available opportunities for improving the appearance of dentures. When dentists shirk this responsibility in this phase of prosthetic service, it shows. No laboratory technician, despite his talents and experience, can anticipate and fulfill the individual patient’s requirements of appearance with the samedegree of fidelity which the dentist is able to exercise.l N SPITE
OF THE
PROGRESS
Complete dependence upon auxiliary personnel in this regard merely perpetuates the standard tooth arrangements which follow mechanical rules established by convention rather than those which imitate Nature. This article suggests practical ways and means of incorporating naturalness in complete dentures. TREATMENT
PLANNING
AND
DIAGNOSTIC
PROCEDURES
The measure of a satisfactory appearance of dentures is in proportion to the extent that it is appreciated by the patient, his relatives, and a close circle of friends, One of the most common fears of potential complete denture patients is that of a sudden and drastic change in facial appearance. The learning period with new dentures is difficult in itself, without the further complication of presenting a new face to relatives and friends. For most patients, then, it is far more important that complete dentures possessnaturalness instead of an artificial beauty created by the mind of man. If realism is to be achieved in providing a naturally appearing substitute for Presented
before
the
American
Dental
Association 28
in Los
Angeles,
Calif.
Volume Number
12 1
SIMULATION
OF NATURAL
APPEARANCE
29
the lost dentition, it must be done intentionally and with a definite plan in mind. Conditions which are normal for each individual must be recognized, respected, and maintained. Therefore, considerations of appearance play a part in every dental appointment. Human beings are a complicated, unpredictable mixture of motivations. They are vastly different in their ability to appreciate and to accept appropriate complete dentures constructed for their needs. Because unesthetic dentures are more numerous and more apparent than those which copy Nature, it is not difficult to see how some are unwisely influenced to accept them as a standard. It is also disheartening for the dentist when a patient overwhelmingly approves of a denture and then lacks the confidence to defend his acceptance when confronted by a critical relative or friend. A careful determination of the wants and needs of every patient is mandatory before starting treatment. Thus, simulation of natural appearance becomes an integral part of diagnosis. IMPRESSIONS
Excessive length or thickness of the labial borders of a denture gives the illusion of tenseness and extreme fullness to the lips. This appearance is especially detrimental to normal facial expression, for it produces an unnatural nose to lip contour. Any abnormal fullness of the upper lip from the profile view is unmistakably the “denture look.” Denture borders, as they concern facial appearance, are determined best by recording the functional position of the labial and buccal vestibular sulcus when the final impressions are made. JAW
RELATIONS
A vertical dimension of occlusion that is too great is often established in an effort to gain maximally pleasing facial proportions. This error inevitably results in continuing discomfort for the patient. However, an insufficient vertical dimension of occlusion creates unattractive changes in appearance which are characteristic of the aging process and a source of needless embarrassment. An intelligent compromise is indicated. An error in recording centric relation results in an occlusion which is another constant source of annoyance to patients. If the dentures can be tolerated for even short periods, there is an uncertain, anxious appearance of the face as the mandible constantly searches for some position to avoid stress. CONTOURING
THE
DENTURE
BASE
Natural contouring of the denture base is most important. The technique advocated by Pound2 is invaluable. Not only does this procedure contribute to the appearance of the dentures, but it also provides an adequate supporting wall that allows the muscles of expression and soft tissues of the face to function normally. It is helpful to copy a cast of natural teeth having appropriate investing gingival tissues.
30 TOOTH
KRA
JICEK
J. Pros. Jan.-Feb.,
Den. 1962
FACTORS
Teeth must be selected and arranged according to a plan of Nature with naturalness as the goal. Five factors contrast the artificial with the natural dentition as we copy Nature and observe the appearance of natural teeth. Listed in order of their importance in the composition, they are position, dimension, shade, alignment, and form. POSITION
The dentist must know Nature’s scheme for upper anterior teeth even though tooth orientation is tentatively determined when the upper occlusion rim is contoured. The erroneous placement of the maxillary anterior teeth on the residual ridge has contributed more to the artificially senile appearance of the face than any other single factor. Not only does this position encourage an abnormal inward sagging of the upper lip, but it also contributes to a loss of facial function because of the incorrect anatomic relationship of the orbicularis oris and its related muscles. The resorption pattern of the anterior residual ridge is constant and in an upward and backward direction. Therefore, the anterior edentulous ridge crest is constantly moving more and more posteriorly. Surely, this ridge is an unreliable guide for tooth orientation. We simply imitate Nature to make complete dentures look like natural teeth. Only from Nature can we deduce the normal relationship between tooth and alveolar ridge. The anteroposterior position of ‘the upper anterior teeth is governed by a consideration of the lips and the muscles around the mouth which insert into the orbicularis oris muscle. The maxillary anterior teeth are positioned to support the lip adequately for both function and appearance since the muscles control the expression and mirror the personality of every individual wearing complete dentures. This position places the teeth in front of the incisive papilla. Fortunately following Nature’s plan of positioning teeth does not lead to instability of the denture bases by disregarding the laws of ‘leverage as some might suppose. Unfavorable, leverage is avoided since some space between the mandibular and maxillary anterior teeth is not only permissible but recommended. The incisors are placed in their natural positions to prevent the upper lip from thinning and losing the vermilion outline. The arrangement is done best by the dentist with the patient present. Instructing the patient to count slowly from 1 to 10 gives further opportunity to analyze the vertical tooth position during conversation. The sounds s, f, V, and th are particularly significant. Frush and Fisher3 have directed attention to the “smiling line.” They point out that natural teeth which are pleasing in appearance do not have the incisal edges on a flat plane. Rather, there is a curve upward from the central incisors to the cuspids, so that the incisal edges of all the upper anterior teeth form a pleasing arch that coincides with the curvature of the upper border of the lower lip during a smile. Reproducing this relationship between upper anterior teeth and the curvature of the lower lip adds a lifelike touch to the composition.
Volume Number
12 1
SIMULATION
OF NATURAL
APPEARANCE
31
The patient’s old dentures provide a clue as to what or what not to do. When no diagnostic casts are available, an appropriate cast of natural teeth from another patient is selected and followed while devising the anterior composition. This cast is used with the full consent of the patient. A photograph of the patient is useful as a supplemental guide. The pictures which the patient can locate may or may not be of value in determining tooth position. However, they do create an awareness on the part of the patient as to the interest of the dentist in his appearance. DIMENSION
The second most important factor governing the anterior composition is tooth size. Patients generally have a mistaken understanding of the prominent role of this factor in appearance. Small teeth are considered by some patients to be the epitome of perfection. The dentist must explain that there is normally a harmonious relationship between the size of anterior teeth and the size of the face. Correct tooth size in relation to the face is as vital as the correct size of clothing is to the person. We may be inclined to ignore the potential possibilities of esthetics when the patient makes the statement, “My natural teeth were small, white, and even.” This is not necessarily the reaction of an opinionated individual. The word small is a relative term and suggests the question, “Small in comparison to what ?” Patients are not familiar with the mold guides and have no knowledge of the vast range of tooth sizes which are available. It is illogical, then, to automatically select t’eeth of tiny mesiodistal dimensions. The size of anterior teeth is related to the dimensions of the face and head and not to the changing size of the residual ridge from one cuspid eminence to the other. Berry’s4 investigation, substantiated by the research of House,5 indicates that the upper central incisor is approximately one-sixteenth of the facial width. With this hypothesis as a guide, first the greatest width of the face is measured from zygomatic arch to zygomatic arch. The distance is expressed in millimeters and divided by 16. The dentist can select central incisor teeth of a pleasing width without restricting his artistic ability since this measurement is not precise, rather a reliable guide. Interproximal wear of teeth is a normal aging change and makes them appear smaller. This narrowing of the mesiodistal width must be considered when selecting central incisor teeth for patients beyond the age of 50 years. Lateral incisors and cuspids are selected individually to complete the dental composition. There should be a minimum of difference in size between the central incisors and the lateral incisor teeth for men, probably an average of 1.5 mm. The broad lateral incisor is characteristic of masculinity. In contrast, smaller lateral incisor teeth impart a distinctive feminine quality to the appearance.617 SHADE
Most complete dentures fail to create the illusion of the natural dentition because the teeth are too perfectly matched in color from the central incisor to the second
32
KRA
J. Pros. Jan.-F&.,
JICEK
molar. This monotonous wall of porcelain the upper lip allows teeth to be seen.
or resin advertises
Den. 1962
falseness each time
In contrast, natural teeth are a blend of several shades. Fillings, stains from tobacco, coffee, and tea, and varying degrees of trauma all leave their mark, to give each natural tooth a distinctive color texture. We must train ourselves to see this delicate mingling of shades within t.eeth as well as the harmonious variations of color from tooth to tooth as natural dentitions are studied. This is a continuous learning process and can only be applied to the extent that our artistic ability has been developed. A base shade is selected individually for each anterior tooth in the denture composition. To introduce visible color variation, cuspids must be at least two shades darker than the central incisors to reflect the yellowish color characteristics which are typical of natural cuspid teeth. Lateral incisors are best selected from the yellow-gray part of the shade guide. The dentist should carefully consider the age of the patient, the individual complexion pattern, and the attitude of the patient in choosing the exact shade. Shade selection is not an exacting procedure. It is not so important what shade is selected but that a variety of shades of teeth be selected to duplicate normal, natural conditions. ALIGNMENT
The alignment of natural teeth is influenced by two principal factors. First, the growth and development pattern of the head and face governs how, when, and where each tooth will make its entrance into the dental arch. It is extremely rare to find perfection in tooth alignment, even in young adults, since the controlling agents are too complex and held in too delicate a balance. Second, the normal passing of time leaves its distinguishing mark on natural dentitions and the positional relationship of teeth to one another. For example, at age 30, the average person has lost a total of 8 teeth. Because tooth loss without replacement always allows drifting of the remaining teeth, this oral manifestation will be noted in persons of middle age. The unoriginal, conventional tooth arrangements seen in the mouth of many denture wearers draw attention to their obvious falseness because of glaring contrast. There is utter perfection in the arrangement of teeth set in a background of normal aging changes of the face. Stereotyped tooth arrangements can always be detected as artificial since they are contrary to the laws of Nature. Natural tooth alignments cannot be achieved unless teeth are set with typical inclinations and rotations that the eye has been accustomed to seeing.8 Casts of natural teeth are used as guides. Variations are introduced when irregularities appear to be too harsh in the opinion of the patient. The most typical irregularities involve rotational positions of the lateral incisor teeth. Anterior compositions devised by this plan are pleasing in appearance, defy detection as artificial, and harmonize with individual facial features.
Volume Number
12 1
SIMULATION
OF NATURAL
33
APPEARANCE
FORM
Outline form has been greatly overemphasized by tooth manufacturers. More important than choosing teeth to follow square, ovoid, or tapering face or arch forms is that teeth must always be ground and reshaped before they are positioned in the denture base. This alteration by the dentist characterizes the teeth so they more logically fit the age pattern of the patient. The unblemished tooth outline form of a teen-ager could hardly belong to an individual in the forties. I fulfill the demands of tooth form by curing hand-molded acrylic resin teeth in permanent metal flasks, These teeth are actual reproductions of the natural teeth of middle-aged individuals. They represent not only contour changes which occur in natural teeth with increasing age but the natural color and staining qualities as well. A detailed description of flask construction and individual tooth curing has been described previously.s SUMMARY
Natural appearance is one of the more easily achieved objectives in complete denture construction. The over-all appearance of the denture is important, but only to the extent that it contributes to a natural appearance and function of the face and lips. Unfortunately, many patients are denied the advantages of improved dentofacial appearance by dentists who regard their professional responsibilities with an air of indifference. Their total expenditure of time and interest in esthetics is restricted to instructions for the dental laboratory technician. Practical guiding principles have been suggested which are designed to break the appearance barrier and place this phase of prosthodontics on a sound basis. REFERENCES
1. Boucher, C. 0.: The Current Status of Prosthodontics, J. PROS. DEN. 10:411-425, 1960. 2. Pound, E. : Esthetic Dentures and Their Phonetic Values, J. PROS. DEN. 1:98-111, 1951. 3. Frush, J. P., and Fisher, R. D.: The Dynesthetic Interpretation of the Dentogenic Concept, J. PROS. DEN. 8:558-581, 1958. 4. Berry, F. H.: Is the Theory of Temperaments the Foundations of the Study of Prosthetic Art? D. Mag. 1:405, 1905-1906. 5. House, M. M.: Form and Color Harmony in Denture Art, Whittier, Calif., 1939, House & Loop, p. 17. 6. Frush, J. P., and Fisher, R. D.: How Dentogenic Restorations Interpret the Sex Factor, J. PROS. DEN. 6:160-172, 1956. 7. Sears, V. H.: Principles and Technics for Complete Denture Construction, St. Louis, 1949, The C. V. Mosby Company, p. 206. 8. Swensonp, gi G.: Complete Dentures, ed. 3, St. Louis, 1953, The C. V. Mosby Company, 9. Krajicek;
D. ‘D.: Personalized
SHAWNEE MISSION MEDICAL MARTWAY, SUITE 20 MISSION, KAN.
6100
Acrylic BLDG.
Resin Anterior
Teeth. J.
PROS.
DEN.
6:29-37,
1956.
DENTURES
SIMULATION
OF NATURAL
DAYTON
DUNBAR KRAJICEK,
Mission,
Kan.
I
APPEARANCE
D.D.S.
dentistry has made within the past few years, there are still many perplexing clinical problems which are a source of concern in every prosthetic practice. When we consider that the edentulous patient is also a complicated human being, we recognize that some problems are inevitable. The majority of our unsolved questions, however, pertain to the physiologic and mechanical aspects of prosthodontics, while esthetic appearance is more easily attainable than ever before. Some dentists take full advantage of all available opportunities for improving the appearance of dentures. When dentists shirk this responsibility in this phase of prosthetic service, it shows. No laboratory technician, despite his talents and experience, can anticipate and fulfill the individual patient’s requirements of appearance with the samedegree of fidelity which the dentist is able to exercise.l N SPITE
OF THE
PROGRESS
Complete dependence upon auxiliary personnel in this regard merely perpetuates the standard tooth arrangements which follow mechanical rules established by convention rather than those which imitate Nature. This article suggests practical ways and means of incorporating naturalness in complete dentures. TREATMENT
PLANNING
AND
DIAGNOSTIC
PROCEDURES
The measure of a satisfactory appearance of dentures is in proportion to the extent that it is appreciated by the patient, his relatives, and a close circle of friends, One of the most common fears of potential complete denture patients is that of a sudden and drastic change in facial appearance. The learning period with new dentures is difficult in itself, without the further complication of presenting a new face to relatives and friends. For most patients, then, it is far more important that complete dentures possessnaturalness instead of an artificial beauty created by the mind of man. If realism is to be achieved in providing a naturally appearing substitute for Presented
before
the
American
Dental
Association 28
in Los
Angeles,
Calif.
Volume Number
12 1
SIMULATION
OF NATURAL
APPEARANCE
29
the lost dentition, it must be done intentionally and with a definite plan in mind. Conditions which are normal for each individual must be recognized, respected, and maintained. Therefore, considerations of appearance play a part in every dental appointment. Human beings are a complicated, unpredictable mixture of motivations. They are vastly different in their ability to appreciate and to accept appropriate complete dentures constructed for their needs. Because unesthetic dentures are more numerous and more apparent than those which copy Nature, it is not difficult to see how some are unwisely influenced to accept them as a standard. It is also disheartening for the dentist when a patient overwhelmingly approves of a denture and then lacks the confidence to defend his acceptance when confronted by a critical relative or friend. A careful determination of the wants and needs of every patient is mandatory before starting treatment. Thus, simulation of natural appearance becomes an integral part of diagnosis. IMPRESSIONS
Excessive length or thickness of the labial borders of a denture gives the illusion of tenseness and extreme fullness to the lips. This appearance is especially detrimental to normal facial expression, for it produces an unnatural nose to lip contour. Any abnormal fullness of the upper lip from the profile view is unmistakably the “denture look.” Denture borders, as they concern facial appearance, are determined best by recording the functional position of the labial and buccal vestibular sulcus when the final impressions are made. JAW
RELATIONS
A vertical dimension of occlusion that is too great is often established in an effort to gain maximally pleasing facial proportions. This error inevitably results in continuing discomfort for the patient. However, an insufficient vertical dimension of occlusion creates unattractive changes in appearance which are characteristic of the aging process and a source of needless embarrassment. An intelligent compromise is indicated. An error in recording centric relation results in an occlusion which is another constant source of annoyance to patients. If the dentures can be tolerated for even short periods, there is an uncertain, anxious appearance of the face as the mandible constantly searches for some position to avoid stress. CONTOURING
THE
DENTURE
BASE
Natural contouring of the denture base is most important. The technique advocated by Pound2 is invaluable. Not only does this procedure contribute to the appearance of the dentures, but it also provides an adequate supporting wall that allows the muscles of expression and soft tissues of the face to function normally. It is helpful to copy a cast of natural teeth having appropriate investing gingival tissues.
30 TOOTH
KRA
JICEK
J. Pros. Jan.-Feb.,
Den. 1962
FACTORS
Teeth must be selected and arranged according to a plan of Nature with naturalness as the goal. Five factors contrast the artificial with the natural dentition as we copy Nature and observe the appearance of natural teeth. Listed in order of their importance in the composition, they are position, dimension, shade, alignment, and form. POSITION
The dentist must know Nature’s scheme for upper anterior teeth even though tooth orientation is tentatively determined when the upper occlusion rim is contoured. The erroneous placement of the maxillary anterior teeth on the residual ridge has contributed more to the artificially senile appearance of the face than any other single factor. Not only does this position encourage an abnormal inward sagging of the upper lip, but it also contributes to a loss of facial function because of the incorrect anatomic relationship of the orbicularis oris and its related muscles. The resorption pattern of the anterior residual ridge is constant and in an upward and backward direction. Therefore, the anterior edentulous ridge crest is constantly moving more and more posteriorly. Surely, this ridge is an unreliable guide for tooth orientation. We simply imitate Nature to make complete dentures look like natural teeth. Only from Nature can we deduce the normal relationship between tooth and alveolar ridge. The anteroposterior position of ‘the upper anterior teeth is governed by a consideration of the lips and the muscles around the mouth which insert into the orbicularis oris muscle. The maxillary anterior teeth are positioned to support the lip adequately for both function and appearance since the muscles control the expression and mirror the personality of every individual wearing complete dentures. This position places the teeth in front of the incisive papilla. Fortunately following Nature’s plan of positioning teeth does not lead to instability of the denture bases by disregarding the laws of ‘leverage as some might suppose. Unfavorable, leverage is avoided since some space between the mandibular and maxillary anterior teeth is not only permissible but recommended. The incisors are placed in their natural positions to prevent the upper lip from thinning and losing the vermilion outline. The arrangement is done best by the dentist with the patient present. Instructing the patient to count slowly from 1 to 10 gives further opportunity to analyze the vertical tooth position during conversation. The sounds s, f, V, and th are particularly significant. Frush and Fisher3 have directed attention to the “smiling line.” They point out that natural teeth which are pleasing in appearance do not have the incisal edges on a flat plane. Rather, there is a curve upward from the central incisors to the cuspids, so that the incisal edges of all the upper anterior teeth form a pleasing arch that coincides with the curvature of the upper border of the lower lip during a smile. Reproducing this relationship between upper anterior teeth and the curvature of the lower lip adds a lifelike touch to the composition.
Volume Number
12 1
SIMULATION
OF NATURAL
APPEARANCE
31
The patient’s old dentures provide a clue as to what or what not to do. When no diagnostic casts are available, an appropriate cast of natural teeth from another patient is selected and followed while devising the anterior composition. This cast is used with the full consent of the patient. A photograph of the patient is useful as a supplemental guide. The pictures which the patient can locate may or may not be of value in determining tooth position. However, they do create an awareness on the part of the patient as to the interest of the dentist in his appearance. DIMENSION
The second most important factor governing the anterior composition is tooth size. Patients generally have a mistaken understanding of the prominent role of this factor in appearance. Small teeth are considered by some patients to be the epitome of perfection. The dentist must explain that there is normally a harmonious relationship between the size of anterior teeth and the size of the face. Correct tooth size in relation to the face is as vital as the correct size of clothing is to the person. We may be inclined to ignore the potential possibilities of esthetics when the patient makes the statement, “My natural teeth were small, white, and even.” This is not necessarily the reaction of an opinionated individual. The word small is a relative term and suggests the question, “Small in comparison to what ?” Patients are not familiar with the mold guides and have no knowledge of the vast range of tooth sizes which are available. It is illogical, then, to automatically select t’eeth of tiny mesiodistal dimensions. The size of anterior teeth is related to the dimensions of the face and head and not to the changing size of the residual ridge from one cuspid eminence to the other. Berry’s4 investigation, substantiated by the research of House,5 indicates that the upper central incisor is approximately one-sixteenth of the facial width. With this hypothesis as a guide, first the greatest width of the face is measured from zygomatic arch to zygomatic arch. The distance is expressed in millimeters and divided by 16. The dentist can select central incisor teeth of a pleasing width without restricting his artistic ability since this measurement is not precise, rather a reliable guide. Interproximal wear of teeth is a normal aging change and makes them appear smaller. This narrowing of the mesiodistal width must be considered when selecting central incisor teeth for patients beyond the age of 50 years. Lateral incisors and cuspids are selected individually to complete the dental composition. There should be a minimum of difference in size between the central incisors and the lateral incisor teeth for men, probably an average of 1.5 mm. The broad lateral incisor is characteristic of masculinity. In contrast, smaller lateral incisor teeth impart a distinctive feminine quality to the appearance.617 SHADE
Most complete dentures fail to create the illusion of the natural dentition because the teeth are too perfectly matched in color from the central incisor to the second
32
KRA
J. Pros. Jan.-F&.,
JICEK
molar. This monotonous wall of porcelain the upper lip allows teeth to be seen.
or resin advertises
Den. 1962
falseness each time
In contrast, natural teeth are a blend of several shades. Fillings, stains from tobacco, coffee, and tea, and varying degrees of trauma all leave their mark, to give each natural tooth a distinctive color texture. We must train ourselves to see this delicate mingling of shades within t.eeth as well as the harmonious variations of color from tooth to tooth as natural dentitions are studied. This is a continuous learning process and can only be applied to the extent that our artistic ability has been developed. A base shade is selected individually for each anterior tooth in the denture composition. To introduce visible color variation, cuspids must be at least two shades darker than the central incisors to reflect the yellowish color characteristics which are typical of natural cuspid teeth. Lateral incisors are best selected from the yellow-gray part of the shade guide. The dentist should carefully consider the age of the patient, the individual complexion pattern, and the attitude of the patient in choosing the exact shade. Shade selection is not an exacting procedure. It is not so important what shade is selected but that a variety of shades of teeth be selected to duplicate normal, natural conditions. ALIGNMENT
The alignment of natural teeth is influenced by two principal factors. First, the growth and development pattern of the head and face governs how, when, and where each tooth will make its entrance into the dental arch. It is extremely rare to find perfection in tooth alignment, even in young adults, since the controlling agents are too complex and held in too delicate a balance. Second, the normal passing of time leaves its distinguishing mark on natural dentitions and the positional relationship of teeth to one another. For example, at age 30, the average person has lost a total of 8 teeth. Because tooth loss without replacement always allows drifting of the remaining teeth, this oral manifestation will be noted in persons of middle age. The unoriginal, conventional tooth arrangements seen in the mouth of many denture wearers draw attention to their obvious falseness because of glaring contrast. There is utter perfection in the arrangement of teeth set in a background of normal aging changes of the face. Stereotyped tooth arrangements can always be detected as artificial since they are contrary to the laws of Nature. Natural tooth alignments cannot be achieved unless teeth are set with typical inclinations and rotations that the eye has been accustomed to seeing.8 Casts of natural teeth are used as guides. Variations are introduced when irregularities appear to be too harsh in the opinion of the patient. The most typical irregularities involve rotational positions of the lateral incisor teeth. Anterior compositions devised by this plan are pleasing in appearance, defy detection as artificial, and harmonize with individual facial features.
Volume Number
12 1
SIMULATION
OF NATURAL
33
APPEARANCE
FORM
Outline form has been greatly overemphasized by tooth manufacturers. More important than choosing teeth to follow square, ovoid, or tapering face or arch forms is that teeth must always be ground and reshaped before they are positioned in the denture base. This alteration by the dentist characterizes the teeth so they more logically fit the age pattern of the patient. The unblemished tooth outline form of a teen-ager could hardly belong to an individual in the forties. I fulfill the demands of tooth form by curing hand-molded acrylic resin teeth in permanent metal flasks, These teeth are actual reproductions of the natural teeth of middle-aged individuals. They represent not only contour changes which occur in natural teeth with increasing age but the natural color and staining qualities as well. A detailed description of flask construction and individual tooth curing has been described previously.s SUMMARY
Natural appearance is one of the more easily achieved objectives in complete denture construction. The over-all appearance of the denture is important, but only to the extent that it contributes to a natural appearance and function of the face and lips. Unfortunately, many patients are denied the advantages of improved dentofacial appearance by dentists who regard their professional responsibilities with an air of indifference. Their total expenditure of time and interest in esthetics is restricted to instructions for the dental laboratory technician. Practical guiding principles have been suggested which are designed to break the appearance barrier and place this phase of prosthodontics on a sound basis. REFERENCES
1. Boucher, C. 0.: The Current Status of Prosthodontics, J. PROS. DEN. 10:411-425, 1960. 2. Pound, E. : Esthetic Dentures and Their Phonetic Values, J. PROS. DEN. 1:98-111, 1951. 3. Frush, J. P., and Fisher, R. D.: The Dynesthetic Interpretation of the Dentogenic Concept, J. PROS. DEN. 8:558-581, 1958. 4. Berry, F. H.: Is the Theory of Temperaments the Foundations of the Study of Prosthetic Art? D. Mag. 1:405, 1905-1906. 5. House, M. M.: Form and Color Harmony in Denture Art, Whittier, Calif., 1939, House & Loop, p. 17. 6. Frush, J. P., and Fisher, R. D.: How Dentogenic Restorations Interpret the Sex Factor, J. PROS. DEN. 6:160-172, 1956. 7. Sears, V. H.: Principles and Technics for Complete Denture Construction, St. Louis, 1949, The C. V. Mosby Company, p. 206. 8. Swensonp, gi G.: Complete Dentures, ed. 3, St. Louis, 1953, The C. V. Mosby Company, 9. Krajicek;
D. ‘D.: Personalized
SHAWNEE MISSION MEDICAL MARTWAY, SUITE 20 MISSION, KAN.
6100
Acrylic BLDG.
Resin Anterior
Teeth. J.
PROS.
DEN.
6:29-37,
1956.