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Use of natural upper anterior teeth in complete dentures
Use of natural Donald E. Hayward, T’eterans Administration
upper
anterior
D.D.S.* Center,
Togus,
teeth
in complete
dentures
Maine
1 he use of human teeth in the replacement of missing teeth dates as far back as 1600 to 687 B.C. when the Phoenicians used human and oxen teeth for this purpose. The Etruscans used human and oxen teeth during the period from 753 to 300 B.C. The first extensive production of porcelain teeth for the dental profession was started in 1825 by Samuel Stockton, but human teeth were used in denture construction until the middle of the 19th century.’ Porcelain and plastic teeth arc available to the dental profession in a large variety of molds and shades. With these and available stains and materials, the dentist is able to duplicate or obtain any desired contour, hue, or imperfection in artificial teeth. Therefore, to suggest the use of natural teeth in complete dentures may seem a step backward. However, this procedure provides capabilities in esthetics that, in certain instances, may be appropriate. I have made six complete dentures in which the patients’ natural upper anterior teeth were used. This was done over a period of years. The first patient was treated in this manner out of curiosity as to how long and how well the natural teeth would retain their characteristics. The original dentures and others constructed are still being worn with the natural teeth uncha.nged (Fig. 1) . The patients feel that their dentures are unique. The use of their own upper anterior teeth proved favorable to both their morale and self-esteem. I have not used natural posterior teeth or natural lower anterior teeth in complete dentures. The size of lower anterior teeth through the cervical region would not permit adequate retention or the removal of the pulpal tissue without undue weakening of the teeth. TECHNIQUE A maxillary impression is made in irreversible hydrocolloid. The casts are poured, and a plaster core is made that covers the palatal and lingual surfaces of the anterior teeth on the cast (Fig, 2 ) . The core is necessary during the construction of the dentures for positioning the natural teeth. *Staff
Dentist.
359
360
Haywar-d
Fig. 2. A plaster used
for
positionincr
CON
is made the uppr
prior to the cxtrac-tion antwior teeth durinp
of thr upper thr construction
teeth. ‘I’hc of the dcnturc3s.
;tnterior
core
is
‘I’hc renioval of thcx Ippr anterior twth is usually the last phase of the oral surgical procedures. After extraction, the upper anterior teeth am clcancd, and the roots are removed 1 mm. below the c‘crnc:nto-c~nanlel junction with a separating disc. Cuts approximately I mm. deep arc made OII th nwsial and distal surfaces of each tooth just apical to the ccrllcrlto-erlarllcl junc.tion to aitl in the retention of the teeth in the denture base material. The pulpal tissue of each tooth is removed with a No. -L round bur. If necessary. a ru’o. 6 round bur is used to enlarge the openirr, (r so that a No. 4 bur can be inserted further into the pulp chamber (Fig. S 1. Any necessary changes irr the restorations of the extracteti teeth are completed. Then, the teeth are stored in a covered bottle containing water. After healing of the residual ridges is sufficiently advanced to start denture
Volumr Number
19 4
Use of natural
Fig. 3. The roots have been sectioned, retention grooves distal surfaces, and the pulpal tissue has been removed. face of the right cuspid has been restored with gold foil.
Fig. 4. The anterior part of the occlusion rim has been Tinfoil is placed on the anterior part of the ridge.
teeth
in complete
have been The rarious
removed
for
dentures
made on the lesion on the
the reception
361
mesial and distal
sur-
of the teeth.
construction, impressions and jaw relation records are made, and the casts are mounted on an articulator. The anterior part of the upper occlusion rim, including the baseplate, is cut out for the reception of the upper anterior teeth. Tinfoil is placed on the ridge anteriorly and is extended from the reflection to beneath the baseplate so that the anterior teeth can be separated from the cast for the try-in (Fig, 4) . The upper occlusion rim is removed and the plaster core is fitted to the upper cast. The natural teeth arc attached to the core with sticky wax (Fig. 5). The wax is flowed interproximally below the teeth and on the labial surface of the tinfoiled ridge to hold the teeth in their original position. Then, the plaster core is replaced by the upper occlusion rim which is attached to the tinfoil on the ridge with sticky wax. The remaining artificial teeth are positioned in the desired occlusion (Fig. 6) . Acrylic resin lower anterior teeth are used
to oppose the natural tlpppr anterior tct:th. ‘I‘h ~qt~)cr trial dmturc is kept in water \I-hile waiting for the tr.y-in appointment. ‘I’hc try-in. intcrocchrsal wcords. proccssin~z and finishing of the dentures are done in the routine mamler. The denturw rnust he dcffasked carefully, and they nlust bc kept in water prior to their plawrncnt in the patiwt’s nrouth. The patient is instructed in thr: car< of the dcnturc at the time of insertion. It is rmphasized that thr: dentuws rnxrt by, krpt ifz zc~at~~ while not in the mouth (Fig. 7’. DISCUSSION The use of a patient‘s natural upper anterior teeth in complete dentures is well accepted by some patients. The natural teeth retain their shade and vital appearance when kept moist. If allov~ctl to dry, the: natural teeth lose their vital appearance and hue: but these characteristics return \vhcn moisture is restored. No complaints of undrsirablc odors or tastes haw heen rcportcd by patients with natural teeth in their dentures. Also. the orc‘urrrnce of caries, breakage, or the natural teeth will not last loss of teeth has not caused problems. However, indefinitely, and cwntually they must bc replaced.
363
Fig. 7. A, The patient whose upper tures. B, The same patient is wearing
anterior teeth were complete dentures
used in construction of complete using his natural upper anterior
denteeth.
SUMMARY A procedure for using natural upper anterior teeth in the construction of coml)lete dentures has been outlined. Natural teeth will retain their hue and strength for a sufficient period of time to make their use practical in some instances. Some patients arc receptive to use of their own natural teeth in dentures. Their use seems to benefit the patient’s mental attitudr toward wearing complete dentures. Reference 1. Houchrr, Mosby
C. O., Company,
Editor: Swenson’s pp. 669-702.
VI~TKRASS ADF~INISTRATI~S Toots, MAINE 04333
<:E~-TER
Complete
Dentures,
ed. 5, St. Louis:
1964,
The
C. V.
upper
anterior
D.D.S.* Center,
Togus,
teeth
in complete
dentures
Maine
1 he use of human teeth in the replacement of missing teeth dates as far back as 1600 to 687 B.C. when the Phoenicians used human and oxen teeth for this purpose. The Etruscans used human and oxen teeth during the period from 753 to 300 B.C. The first extensive production of porcelain teeth for the dental profession was started in 1825 by Samuel Stockton, but human teeth were used in denture construction until the middle of the 19th century.’ Porcelain and plastic teeth arc available to the dental profession in a large variety of molds and shades. With these and available stains and materials, the dentist is able to duplicate or obtain any desired contour, hue, or imperfection in artificial teeth. Therefore, to suggest the use of natural teeth in complete dentures may seem a step backward. However, this procedure provides capabilities in esthetics that, in certain instances, may be appropriate. I have made six complete dentures in which the patients’ natural upper anterior teeth were used. This was done over a period of years. The first patient was treated in this manner out of curiosity as to how long and how well the natural teeth would retain their characteristics. The original dentures and others constructed are still being worn with the natural teeth uncha.nged (Fig. 1) . The patients feel that their dentures are unique. The use of their own upper anterior teeth proved favorable to both their morale and self-esteem. I have not used natural posterior teeth or natural lower anterior teeth in complete dentures. The size of lower anterior teeth through the cervical region would not permit adequate retention or the removal of the pulpal tissue without undue weakening of the teeth. TECHNIQUE A maxillary impression is made in irreversible hydrocolloid. The casts are poured, and a plaster core is made that covers the palatal and lingual surfaces of the anterior teeth on the cast (Fig, 2 ) . The core is necessary during the construction of the dentures for positioning the natural teeth. *Staff
Dentist.
359
360
Haywar-d
Fig. 2. A plaster used
for
positionincr
CON
is made the uppr
prior to the cxtrac-tion antwior teeth durinp
of thr upper thr construction
teeth. ‘I’hc of the dcnturc3s.
;tnterior
core
is
‘I’hc renioval of thcx Ippr anterior twth is usually the last phase of the oral surgical procedures. After extraction, the upper anterior teeth am clcancd, and the roots are removed 1 mm. below the c‘crnc:nto-c~nanlel junction with a separating disc. Cuts approximately I mm. deep arc made OII th nwsial and distal surfaces of each tooth just apical to the ccrllcrlto-erlarllcl junc.tion to aitl in the retention of the teeth in the denture base material. The pulpal tissue of each tooth is removed with a No. -L round bur. If necessary. a ru’o. 6 round bur is used to enlarge the openirr, (r so that a No. 4 bur can be inserted further into the pulp chamber (Fig. S 1. Any necessary changes irr the restorations of the extracteti teeth are completed. Then, the teeth are stored in a covered bottle containing water. After healing of the residual ridges is sufficiently advanced to start denture
Volumr Number
19 4
Use of natural
Fig. 3. The roots have been sectioned, retention grooves distal surfaces, and the pulpal tissue has been removed. face of the right cuspid has been restored with gold foil.
Fig. 4. The anterior part of the occlusion rim has been Tinfoil is placed on the anterior part of the ridge.
teeth
in complete
have been The rarious
removed
for
dentures
made on the lesion on the
the reception
361
mesial and distal
sur-
of the teeth.
construction, impressions and jaw relation records are made, and the casts are mounted on an articulator. The anterior part of the upper occlusion rim, including the baseplate, is cut out for the reception of the upper anterior teeth. Tinfoil is placed on the ridge anteriorly and is extended from the reflection to beneath the baseplate so that the anterior teeth can be separated from the cast for the try-in (Fig, 4) . The upper occlusion rim is removed and the plaster core is fitted to the upper cast. The natural teeth arc attached to the core with sticky wax (Fig. 5). The wax is flowed interproximally below the teeth and on the labial surface of the tinfoiled ridge to hold the teeth in their original position. Then, the plaster core is replaced by the upper occlusion rim which is attached to the tinfoil on the ridge with sticky wax. The remaining artificial teeth are positioned in the desired occlusion (Fig. 6) . Acrylic resin lower anterior teeth are used
to oppose the natural tlpppr anterior tct:th. ‘I‘h ~qt~)cr trial dmturc is kept in water \I-hile waiting for the tr.y-in appointment. ‘I’hc try-in. intcrocchrsal wcords. proccssin~z and finishing of the dentures are done in the routine mamler. The denturw rnust he dcffasked carefully, and they nlust bc kept in water prior to their plawrncnt in the patiwt’s nrouth. The patient is instructed in thr: car< of the dcnturc at the time of insertion. It is rmphasized that thr: dentuws rnxrt by, krpt ifz zc~at~~ while not in the mouth (Fig. 7’. DISCUSSION The use of a patient‘s natural upper anterior teeth in complete dentures is well accepted by some patients. The natural teeth retain their shade and vital appearance when kept moist. If allov~ctl to dry, the: natural teeth lose their vital appearance and hue: but these characteristics return \vhcn moisture is restored. No complaints of undrsirablc odors or tastes haw heen rcportcd by patients with natural teeth in their dentures. Also. the orc‘urrrnce of caries, breakage, or the natural teeth will not last loss of teeth has not caused problems. However, indefinitely, and cwntually they must bc replaced.
363
Fig. 7. A, The patient whose upper tures. B, The same patient is wearing
anterior teeth were complete dentures
used in construction of complete using his natural upper anterior
denteeth.
SUMMARY A procedure for using natural upper anterior teeth in the construction of coml)lete dentures has been outlined. Natural teeth will retain their hue and strength for a sufficient period of time to make their use practical in some instances. Some patients arc receptive to use of their own natural teeth in dentures. Their use seems to benefit the patient’s mental attitudr toward wearing complete dentures. Reference 1. Houchrr, Mosby
C. O., Company,
Editor: Swenson’s pp. 669-702.
VI~TKRASS ADF~INISTRATI~S Toots, MAINE 04333
<:E~-TER
Complete
Dentures,
ed. 5, St. Louis:
1964,
The
C. V.