|Year : 2015 | Volume
| Issue : 1 | Page : 60-64
Characterization of complete denture - 11 Case reports
Suja Joseph1, Sebastion Thomas2, Suja Mathew3, George Jose Cherackal4, Alex K George5
1 Department of Prosthodontics, Pushpagiri College of Dental Science, Medicity, Perumthuruthy, Thiruvalla, India
2 Department of Prosthodontics, Sri Sankara Dental College, Kollam, India
3 Department of Prosthodontics, Pushpagiri College of Dental Science, Medicity, Perumthuruthy,Thiruvalla, India
4 Department of Orthodontics, Anoor Dental College, Ernakulam, India
5 Department of Oral Pathology, Pushpagiri College of Dental Science, Medicity, Perumthuruthy, Thiruvalla, Kerala, India
|Date of Web Publication||19-Jan-2015|
Department of Prosthodontcs, Pushpagiri College of Dental Science, Medicity, Perumthuruthy, Thiruvalla, Kerala
Arranging the teeth for complete denture involves specific laid out principles, which are instructed in dental schools. A dentist who graduates from a dental school is expected to be sufficiently trained in the theory and the practice of teeth setting. Whether it is a conventional removable or implant retained complete denture, the principles of teeth setting remain the same. The possible effect is that all dentists may give almost identical complete dentures to their patients. The complete denture patients may be satisfied with what the dentists provides. It is the duty of the dentist to inform the patient that his or her complete dentures can be characterized to suit his/her wish and appearance better. Incorporation of correct tooth size, shade and position has a visual impact on patient's appearance. This will bring out proper harmony and balance between a persons smile and facial design. Meeting patients' expectations by giving importance to their demands is the most important criteria for success. Even though the importance should be given to the patient's choice an operator can take the liberty to arrange the teeth in an esthetic and acceptable form. This will have a positive effect on patient's self-esteem. Each complete denture patient should be evaluated individually, and the dentist should strive to make the complete denture unique to that person. The authors present 11 case reports of complete denture characterizations. Denture characterization provides infinite possibilities for the dentist.
Keywords: Complete denture, denture aesthetics, teeth arrangement, teeth setting
|How to cite this article:|
Joseph S, Thomas S, Mathew S, Cherackal GJ, George AK. Characterization of complete denture - 11 Case reports. SRM J Res Dent Sci 2015;6:60-4
|How to cite this URL:|
Joseph S, Thomas S, Mathew S, Cherackal GJ, George AK. Characterization of complete denture - 11 Case reports. SRM J Res Dent Sci [serial online] 2015 [cited 2019 Jul 18];6:60-4. Available from: http://www.srmjrds.in/text.asp?2015/6/1/60/149597
| Introduction|| |
Complete edentulousness is a physical disability as specified by WHO.  A total of 12 million persons in the United States has edentulousness in one arch, representing 7% of the adult population.  Up to 46% of the 65 + age group population in Saudi Arabia is edentulous.  Prevalence of tooth loss in India population is 91.2% in above 65 years age group. Total edentulous patients suffer from compromised function, appearance, and they have a decreased quality of life.  A denture can be functional and comfortable, however, it can be repulsive in the eyes of the wearer. 
To alter by application of unique markings, indentations, coloration and similar custom means of delineation on a tooth or dental prosthesis thus enhancing the natural appearance (GPT 8).
Esthetic perception of the clinician and approval of the patient is the most important step in the arrangement of teeth. Teeth were set on wax occlusion rims, tried in the patient's mouth, occlusion and appearance were verified by the clinician as well as the patient. The finalized wax denture was acrylized and inserted in the next appointment. Teeth setting or arranging the teeth for complete denture involves specific laid out principles that are taught in dental schools.  Professionals who passes out of graduate from dental schools are expected to be trained in the theory and the practice of teeth setting. Whether it is a conventional removable or implant retained complete denture, the principles of teeth setting remain the same.
Characterizing the dentures without deviating grossly from the principles of teeth setting to suit the individual's appearance, is not emphasized in the dental schools. The possible effect is that all dentists may give almost identical complete dentures to their patients. The individual quotient may not be taken into account. All complete denture wearers were looking similar possessing a monotony of sameness, which can be compared to down syndrome patients exhibiting the same set of physical attributes owing to chromosomal abnormality. The complete denture patients may be satisfied with what the dentists provide. They understandably do not ask for what they don't know. It is the duty of the dentist to inform the patient that his or her complete denture can be characterized to suit his/her wish and appearance. Hardy stated that, "To meet the esthetic needs of the denture patient, we should make the denture teeth look like the patients natural teeth." 
Martone stated "The key to esthetics lies in the asymmetry."  Most of the things in nature are asymmetric. The creator itself has incorporated some asymmetry even in case of human beings which gives it a genuine appearance. Characterization helps the dentist to incorporate his artistic skills along with theoretical knowledge in the fabrication of denture. After the approval of the patient, it is important to have the final approval of the patients close relative or the spouse.  Size and shade of the teeth can be selected to match the patients natural teeth. The aim is that the teeth should harmonize with the facial features, and it should be functionally acceptable. Characterization can be done by the labial inclination of anterior teeth when patients are specific about certain tooth positions and importance can be given for speech also. Even though the importance should be given to the patient's choice the operator can take the liberty to arrange the teeth in an esthetic and acceptable form.  Characterization should have some amount of realistic perception rather than incorporating unrealistic features. It includes the inclusion of dentogenic concept. According to Frush and Fisher dentogenic concept includes effects of three main factors such as age, sex and personality in sequence of esthetic planning. 
Frush and Fisher stated that "The environment of the teeth is as important as the tooth itself." Various means like minor irregularities in tooth arrangement, overlapping, tilting, depth grinding, modification of incisal edges, rotations of teeth, stippling, staining, tinting of the denture base, crowding and fixing dental jewelry etc., can be incorporated depending on patients desire towards achieving natural illusion. ,,, It was Pound in 1951 who introduced the technique of tinting acyrlic denture bases to simulate the normal gingival color depending on the racial and individual color pattern. ,, Kemniter used a combination of blue and brown stains to reproduce melanin pigmentation of gingival. Lynn C. Dirken described a method for obtaining natural appearance by a combination of stippling and tinting. ,,, The goal of characterization is to achieve a natural appearance for the denture by creating an illusion of reality in the smile.
The authors present 11 case reports of complete denture characterizations.
| Case reports|| |
Denture flanges mimicking gingival color
Patient was specific about the color of the denture base because the pink color of the previous denture was giving an artificial appearance. The basic shade of the gingiva and the color of pigmentation should be duplicated indentures to make them look more natural. ,, This can be done either intrinsically by incorporating pigments during packing of acrylic or extrinsically after acrylization. Blackish brown pigments were added to the monomer during packing of the denture [Figure 1].
Tobacco staining on complete denture
Patient had the habit of pan chewing. Hence, the patient insisted on having the stains so that the denture looks natural. Brown pigments were incorporated in monomer and painted on to the acrylic teeth [Figure 2].
Anterior teeth with spacing in maxillary single complete denture
Spacing and malalignment can be incorporated in the maxillary denture to match mandibular natural teeth with gingival recession and pathological migration [Figure 3]a. An 80-year-old patient came for a new denture just because the absence of diastema was giving an artificial appearance. The patient was very specific about the diastema, and it was checked during trial. The final denture was fabricated with spacing between the anteriors [Figure 3]b.
|Figure 3: (a) Malaligned anterior teeth with spacing in maxillary single complete denture. (b) Malaligned anterior teeth with spacing in maxillary single complete denture|
Click here to view
Class 2 division 2 orthodontic malocclusion
Patients' natural teeth were proclined, and she wanted the anterior teeth to be prominent in her denture. Class 2 division 2 orthodontic malocclusion can be incorporated, particularly in those edentulous patients with maxillary excess [Figure 4].
Attrited mandibular incisor teeth with incisal edges stained
Patient had attrited lower incisors. It was explained to the patient that as age advances, the teeth get attrited this can be made in the denture to mimic aging, and it will give the illusion of natural teeth [Figure 5].
Dental jewellery on maxillary lateral incisor tooth
Cosmetic dentistry trends like dental jewelry may be used in complete dentures. Incorporating the same in a young denture wearer will possibly boost the charm and confidence of the patient.
Tooth jewelry was given to a young female patient to give a natural appearance. The clinician gave an opinion of placing an artificial stone on upper right lateral incisor to give an esthetic and natural look. The stone was fixed to the acrylic tooth with cyanoacrylate [Figure 6].
Maxillary complete denture with peg lateral incisor
Peg shaped lateral incisors occur in approximately 2-5% of the general population. Peg shaped anomalies are found equally on the right and left, uni-or bilaterally and there are no sex differences.  Patient had peg laterals before extraction that he wanted the clinician to incorporate in the denture. In the trial denture, a peg-shaped lateral incisor was placed and tried in the patient's mouth [Figure 7].
Maxillary complete denture with labial lipping
Long standing edentulous patients can develop class 3 jaw relationship and facial appearance.
To counter this and to provide a natural appearance, maxillary complete denture with labial lipping to provide fullness may be used. Patient was unhappy with the previous denture since the wrinkles on the face were evident, and the fullness of cheek and lips were inadequate. During trial wax thickness of 2 mm was added along the borders of the record base to improve the fullness of lips and it was shown to the patient and her close relative for opinion. As per the patient's suggestion thickness was increased to 3 mm which was duplicated and acrylized [Figure 8].
Gum fit dentures
In cases with severe maxillary proclination, avoiding the labial flange, in order not to accentuate the labial fullness further, using careful techniques not to compromise on retention is an accepted modality. The labial flange of the upper denture was given a labial prominence which was not acceptable to the patient. Hence, the labial flange of the denture base was trimmed to make it gum fit [Figure 9].
Fractured central incisor mimicking Ellis class 1 fracture
Incisor of the patient's previous denture was fractured. The patient insisted that the tip of upper right central incisor should be fractured. Incisal edge was trimmed according to patient's suggestion for a realistic appearance [Figure 10].
Crowding and overlapping of the maxillary anteriors
Since the patient had crowding of maxillary anterior teeth in his natural dentition. He did not want the typical even arrangement of artificial teeth in his denture. So the clinician did crowded anterior teeth arrangement which was well accepted by the patient [Figure 11].
Hypocalcification, dental tattooing, receded gum appearance, composite and amalgam restorations, stippling and festooning may also be incorporated in complete dentures. 
| Conclusion|| |
Each complete denture patient should be evaluated individually, and the dentist should strive to make the complete denture unique to that person. The dentist can utilize the degree of skill he has acquired for the accomplishment of dentogenic concept. The dentist can develop into both an artist and a sculptur, incorporating both the artist's and sculptur's imagination . Dentist should think according to sculptors and artists illusion where a curve suggests softness and thus feminity and the straight line a sense of hardness and angularity which is typical of masculinity. According to Leigh Hunt - "There are two worlds; the world we can measure with line and rule and the world we can feel with our hearts and imagination." Combination of dynesthetics with artistic effort will help in achieving the ultimate esthetic goal. This can be used as a guideline for tooth selection, arrangement and characterization.  It helps to illuminate a new pathway and a new procedure to bring more mental comfort, satisfaction and well-being to denture wearers. Denture characterization provides infinite possibilities for the dentist to add his signature to his work and make complete denture practice interesting, challenging and rewarding.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]