Aesthetic possibilities in removable prosthodontics. Part 3: Photometric tooth selection, tooth setting, try-in, fitting, reviewing and trouble-shooting.

This final article in a series of three on producing complete dentures which the patient considers attractive, describes selecting the denture teeth, setting the front teeth at the chairside, the try-in visits, processing, fitting and reviewing the dentures. The role of the patient as captain of the ship, the dental nurse as the patient's support and liaison officer, and the clinician as the first technical officer is outlined. The use of immediate replay video technology in allowing a patient to see what the trial denture really looks like is described. It is vital that the patient is completely happy with its appearance in every detail before any denture is finished. Dealing with post-fitting aesthetic problems is considered.

Aesthetic possibilities in removable prosthodontics. Part 2: start with the face not the teeth when rehearsing lip support and tooth positions.

Even dentures exhibiting superb aesthetics are of no use if they visibly move during speech and social intercourse. In this, the second paper of three on removable denture aesthetics, we describe impression making and shaping the wax occlusal record rims. Not only are the impressions important for producing dentures with maximum retention, stability and support, but their extensions and the thickness of their borders have a decisive influence on lip support and profile. This article shows how the contours of the definitive impressions and the wax rims are developed so as to prescribe the overall form of the replacement gums and teeth. Properly trimmed rims are in essence an early three-dimensional rehearsal, an opportunity for developing the patient's preferred lip support and natural positioning of the denture teeth at subsequent stages. They can also give an early indication of what speech will be like with the new dentures. Without this 3D clinical information, laboratory technicians have to guess where to put the teeth and have little option but to fall back on the stereotypes of their textbook training.

Aesthetic possibilities in removable prosthodontics. Part 1: the aesthetic spectrum from perfect to personal.

Patients requiring dentures are getting older and as a result can be difficult to treat owing to various co-morbidities. This series of papers presents an overview of the processes involved in making removable dentures which the patient considers to be functionally and aesthetically successful. We hope not only to provide technical suggestions but also to address the issue of the clinician's, technician's and dental nurse's relationships with the dentally depleted patient. It is increasingly clear from defence organisation reports that this has a decisive effect on the success of this fundamentally difficult enterprise ('The only branch of dentistry in which you are trying to attach something to nothing' [Hubert Aïche]). It seems best to conduct the planning and the treatment itself as a co-production - the patient assuming responsibility for choosing between the treatment options offered and playing the leading role in making aesthetic decisions. Distinctions are drawn between the idealised whiter-than-white, 'nobody-in-particular', attention-seeking denture at one extreme, and the highly personalised, discreet and naturalistic denture at the other. Reproducing nature in this way is time consuming and therefore expensive, but many 'denture sufferers' see it as good value. Methods for creating the latter, which through its very normality switches off the social observer's attention, are explained in detail in papers two and three of this series. These papers are designed to help clinicians and technicians involved in providing removable prosthodontics improve the appearance of their dentures and increase their patients' aesthetic satisfaction. They are not scientific articles in the Popperian sense of advancing theories which are capable of being falsified. Instead, they are an amalgamation of 72 years of combined experience in providing removable dental prostheses. We have found this branch of dentistry immensely interesting and have on many occasions had the satisfaction of seeing our patients' lives changed for the better.

A study of the use of photographs for denture tooth selection.

PURPOSE: The aim was to examine a method described by Wehner et al for calculating the width of a missing central incisor using preextraction photographs. MATERIALS AND METHODS: Three photographic views were obtained for each of 30 dentate subjects: full face, oblique, and reduced-size full face. The width of the maxillary right central incisor (MR1) was calculated using a formula. The difference between the actual width and calculated width of MR1 was determined for each subject. The median difference and interquartile range were determined because the data were skewed. RESULTS: The width of MR1 calculated using the larger full-face view was typically smaller than the actual width, with a median difference of -0.18 mm. The interquartile range of the difference was from -0.42 to 0.05 mm. For both the oblique and reduced-size views, the calculated width was typically larger, with a median difference of 1.19 mm with an interquartile range from 0.82 to 1.76 mm and a median difference of 0.84 mm with an interquartile range from 0.59 to 1.41 mm, respectively. CONCLUSION: The technique described by Wehner et al is of proven value in calculating the width of a central incisor when the only available evidence is a preextraction photograph. However, it is of value only when the photograph is a full-face portrait of sufficient size.