|Year : 2013 | Volume
| Issue : 1 | Page : 8-11
Complete denture esthetics revisited
Roseline Meshramkar, Gouri V Anehosur, Lekha K Pillai, Ramesh K Nadiger
Department of Prosthodontics, Sri Dharmasthala Manjunatheshwara College of Dental Sciences and Hospital, Sattur, Dharwad, Karnataka, India
|Date of Submission||12-Oct-2012|
|Date of Acceptance||14-Feb-2013|
|Date of Web Publication||20-Sep-2013|
Department of Prosthodontics, SDM College of Dental Sciences and Hospital, Sattur, Dharwad - 580 009, Karnataka
Source of Support: None, Conflict of Interest: None
Denture esthetics is the effect produced by a denture that affects beauty and attractiveness of a person. It is blending or combination of art and science of prosthodontics. The loss of oral structures primarily affects the appearance of the lower part of the face. The appearance of the entire lower half of the face depends on dentures in edentulous patients. Denture esthetics does not begin and end with selection of denture teeth, factors such as impression technique, occlusal plane, vertical dimension, and centric relation also significantly affect denture esthetics. The dentist must consider esthetic guidelines to achieve esthetics for complete denture.
Keywords: Complete denture, denture esthetics, oro facial esthetics
|How to cite this article:|
Meshramkar R, Anehosur GV, Pillai LK, Nadiger RK. Complete denture esthetics revisited. Indian J Oral Sci 2013;4:8-11
|How to cite this URL:|
Meshramkar R, Anehosur GV, Pillai LK, Nadiger RK. Complete denture esthetics revisited. Indian J Oral Sci [serial online] 2013 [cited 2017 Apr 27];4:8-11. Available from: http://www.indjos.com/text.asp?2013/4/1/8/118511
| Introduction|| |
Poetry and literature for centuries have indicated that the teeth possess beauty of their own and that they also contribute greatly to facial beauty. The term esthetics was coined in 1970 to designate the science of sensuous knowledge that gave beauty, in contrast to the science of logic that gave truth; the term in later years was related to the fine arts as the theory of beauty. 
Various authors have given various definitions for esthetics. Esthetics is the idealizing or harmonizing of the artificial with the natural. Esthetics is the return of normal vertical dimension.  Esthetics is the natural setting. Esthetics fundamentals are beauty, naturalness, and individuality.  Denture esthetics have been defined as the cosmetic affect produced by a dental prosthesis that affects the desirable beauty, attractiveness, character, and dignity of an individual. Denture esthetics is the effect produced by a dental prosthesis that affects beauty and attractiveness of a person.  The loss of oral structures primarily affects the appearance of the lower part of the face, but the restoration must be in esthetic accord with the upper part of the face if the harmony of the entire face has to be achieved.  The appearance of the entire lower half of the face depend upon the dentures.  Normal facial appearance and skin tone depend on proper position and functional length of the muscles.  The proper repositioning of the orbicularis oris muscle is essential for denture esthetics.  Three important factors have been mentioned in the repositioning of the orbicularis oris with complete dentures:
In establishing denture esthetics, three objectives are important:
- Thickness of labial flange of both dentures - This is accomplished at the impression phase of treatment, so that the esthetics as well as retention and stability are important goals. Border thickness should vary with the needs of the patient, depending on the extent of residual ridge loss. The vestibular fornix should be filled, but not overfilled, to restore facial contour. 
- Anteroposterior position of anterior teeth. This should be accomplished prior to recording jaw relation records, and it is dependent on the proper thickness of the labial flange. The occlusal rim is adjusted to restore proper contour of the lip. When this is precisely carried out, placement of anterior teeth is facilitated.
- Amount of separation between maxilla and mandible - This is establishment of the correct vertical dimension of occlusion; proper vertical dimension of occlusion helps restore normal physiological length to muscles and allows normal facial expression.
- Compensate for alveolar bone loss at the impression phase of treatment. Contour occlusal rims properly for adequate support of the musculature and to facilitate placement of teeth. Establish or reestablish the correct vertical dimension of occlusion to restore physiological muscle length and eliminate a prognathic appearance.
- Denture esthetics depends on facial factors and orodental factors. The facial factors to be considered are all significant in producing a pleasing harmonious facial expression. 
The relative overall size of the face, the proportions of the face and the ratio of the facial dimensions, the profile of the face, the outline form of the face, the mouth size, commissure length and form, the thickness, form, curvature, prominences, and tenseness of the lips, the creases and folds in the facial tissue, the squinting of the eyes, the breadth of the nostrils, the spatial position of component elements of the face, nose, eyes, mouth, and chin, and facial impress.
Physical esthetic tooth values, tooth size, tooth outline form, tooth proportions, tooth profile, tooth surface form, tooth color, the arrangement composition, and denture base characteristics. 
| Method for Collection of Data|| |
A search of original articles, case reports, and reviews about denture esthetics were used from PubMed and Google scholar from 1936 to 2011. The following key words: Esthetics, complete denture, denture esthetics, and orofacialesthetics were used for the search. Publications were limited to those of English language and from the scientific peer reviewed literature. A total of 24 publications were selected for this review from these search.
| Discussion|| |
In our image conscious society, dentures restore a natural appearance leading to increased patient confidence and ease in social interaction. A dentist must attempt to create an appropriate smile and appearance that suits the patient's physical character and esthetics needs. Poor esthetics is one of the primary reasons for nonsuccess of maxillary dentures.  Denture esthetics does not begin and end with the selection of denture teeth factors such as impression techniques, occlusal plane, vertical dimension, and centric relation also significantly affect denture esthetics.  Impression techniques supporting the facial musculature with properly formed denture borders is essential. The proper width of the denture borders restores natural facial contours. These borders are formed by the functional position of labial and buccal vestibules, as established with final Impression.  Long-standing edentulous condition with significant residual alveolar ridge resorption requires thicker borders to restore proper muscle position. In the saggital view, the occlusal plane is determined by the incisal plane, which in turn, is determined by the incisal edges of maxillary central incisors and approximate juncture of the upper and middle thirds of the retromolar pad.  The width of the maxillary central incisors are established best by esthetics and phonetics. The amount of incisor edge visible with relaxed upper lip may range from zero to several millimeters. The length is adjusted to where the wet or dry line of lower lip makes light contact with the incisal edges with central incisors.  The occlusal rim should offer adequate support for soft tissues of the face and should allow esthetic buccal corridor. If the occlusal plane is oriented properly, the maxillary wax rim should follow the smile line of the lowerlip.  The establishment of correct occlusal vertical dimension is absolutely essential in the proper positioning of the orbiculars oris and associated muscle.  The occlusal vertical dimension is responsible for the harmony between the lower third of the face as a whole. Vertical dimension and centric relation are closely interrelated and loss of vertical dimension results in a more exaggerated class III occlusion.  For anterior tooth selection, there are anatomic landmarks and manufacturers aids that can be used as guides in the process. The size, morphology, color, placement, and characterization of teeth are all factors to be considered. If the patients presents with existing dentures, careful evaluation is essential. Frush and fisher developed a concept that integrated the selection of teeth into an esthetic system governed by sex, personality, and age of the patient. , An appropriate tooth size is probably the most critical factor in anterior teeth selection. The teeth must harmonize with the face, physical body, and arch size of the patient. Nelson  in 1922 and, later, French in 1951 suggested that arrangement of the teeth is a far important esthetic factor than mold selection. The profile of the face, the arch form, and smile line of the patient are guides to initial placement of anterior teeth. The inclination of the maxillary and mandibular teeth are generally parallel to the profile of the patient's face.  The arrangement and arch form of the anterior teeth have a definite relationship to the arch form of the residual ridge. , Payne suggested that "teeth should be placed where they grew." Teeth should be arranged in harmony with the smile line of the patient. The incisal edges of the maxillary teeth should follow the lower lip line and reverse curve should be avoided. ,, The teeth should gradually rise along the occlusal plane toward the back to follow a smile line and give an impression of distance.  The dental midline should be coincident with the facial midline and vertically straight. , A gingival to lip distance of 4 mm or more may be considered unesthetic.  Mortone has stated that "the key to esthetics lies in asymmetry, slight modifications in the position of incisors, such as overlapping rotation, and small diastema and incisal variation may change the light reflection just enough to produce artistic distal composition desirable for the patient.  It should be recognized that the denture base represent the gingival and mucosal tissue of the arch. The denture base therefore contributes to the oral and facial esthetics in accordance to its bulk, color, and surface characterization. The shade of the tissue can be easily determined and duplicated by comparison with acrylic shade guide.
We must select the denture base with as much care and caution as in selecting the teeth. Today, with life-like material available, we can give the denture base a life-like appearance. By placing vertical fibers on the labial and buccal surface, we can simulate vascular appearance. Advancing age can be indicated by shortening of the papillae and raising the gumline for recession. 
Additional shades can be mixed from earth color pigments, which enable the dentist to match any color of gingival tissue or mucosa. Three esthetic concepts have been put forth in 2005 by Zewskify, they are, natural, supernormal, and denture look. Normal appearance in accordance is determined by inherent character or basic constitution of a person. Use of artistic determinants of personality and anatomic norms for gender and age achieves harmony with overall appearance. Supernormal appearance that departs from what is usual or normal especially so as to appear to transcend laws of nature. Alterations from anatomically norms to provide subject with what he/she regards as beautiful. Denture look appearance that befits or accords with a set of false teeth.  Appearance with error in tooth display shape, size, and arrangement that are typically seen in complete denture wearers.
In 2005, the following universal esthetics goal was given by Micheal for complete denture: The incisal edges of maxillary teeth should follow the lower lip line and reverse curve should be avoided.
The dental midline should be coincident with the facial midline and vertically straight.  A gingival to lip distance of 4 mm or more may be considered unesthetic. These factors should be considered as base line esthetic guidelines in complete denture construction, specific decision about tooth display proportion, size, shape, arrangement, color, and, to some extent, position are based on which esthetic concepts the patient and dentist have selected.
| Conclusion|| |
The concept of esthetics has fascinated mankind for centuries in treating individual patients, each requiring different esthetic approach. Thorough patient evaluation, various physical factors, along with anatomy and physiology of the face should be employed. Modern materials and tremendous variety of esthetic artificial teeth currently available are not all necessary to achieve esthetics. Esthetics goes much further than the simple placement of teeth in occlusal rims. The teeth should be arranged to meet patients' functional needs and follow esthetic guidelines to achieve denture esthetics. The goal of successful denture today is to attain healthy beauty by harmonizing morphology and function.
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