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A Survey of Edentulous Patient Preference among Different Denture Esthetic Concepts
Abstract
Despite the fact that solutions to functional problems are available, successfully restoring the appearance of an edentulous patient remains a challenge.
The aim of this survey was to determine if edentulous respondents could differentiate among three denture esthetic concepts and if there was an overall preference among the three.
Six edentulous test subjects were selected based on age and smile criteria. One wax tooth arrangement was completed according to each of the three esthetic concepts for a total of three wax tooth arrangements per test subject. The three esthetic concepts followed were natural, supernormal, and denture look. Standardized full-face digital photographs were made of each arrangement (three) during maximum smile for each subject (six). These 18 photographs were included in a questionnaire. Respondents were asked questions about their preference among the three randomly ordered concept photographs for each of the six subjects. A total of 147 completed questionnaires were analyzed.
Ninety-six percent of respondents were able to differentiate among the three esthetic denture concepts. Natural tooth arrangements were preferred by 55% of the respondents, supernormal tooth arrangements were preferred by 19%, and the denture look arrangements were preferred by 26%.
Within the limitations of this survey, the questionnaire respondents differentiated between the three esthetic denture concepts. The tooth arrangement most closely resembling the anatomical average was selected by 55% of the respondents. Preference for a particular concept changed when responses to each test subject set were considered individually. Demographic factors do not significantly affect patient preference.
Three esthetic concepts for complete denture construction have been differentiated. Questionnaire respondents preferred appearances that are far from the anatomical average 45% of the time.
... Recently patients are becoming more esthetically demanding, seeking near ideal teeth arrangements that are much better than any available pre-extraction record, and denture teeth with bleached shades. [38][39][40][41] The currently available Digital Smile Design (DSD) computer software create a virtual wax-up, and provides insights into the perfect smile that most of the patients seek whether dentulous or edentulous. 42,43 This study aimed to use one of these software packages to evaluate the already made complete dentures smile, and extract the criteria of a beautiful denture smile. ...
... However, there was a significant relationship (p =.035) between gender and teeth shade, where the female patients needed a whiter shade more than the female patients as presented in Table 5. Brewer 20 emphasized the impossibility of standard esthetic arrangement or composition of teeth that would be acceptable for all. Waliszewski 40 has also referred to the same problem, and claimed that intraoral and extra oral landmarks of the completely edentulous patients have presented a low reliability for tooth selection or arrangement, and cannot be used to provide those patients with the same smile of dentate patients. However, several other studies [15][16][17][18][19][20][21][22] have suggested that these biometric guides can be used to produce properly functioning dentures with a pleasant smile due to the restoration ...
... Recently patients are becoming more esthetically demanding, seeking near ideal teeth arrangements that are much better than any available pre-extraction record, and denture teeth with bleached shades. [38][39][40][41] The currently available Digital Smile Design (DSD) computer software create a virtual wax-up, and provides insights into the perfect smile that most of the patients seek whether dentulous or edentulous. 42,43 This study aimed to use one of these software packages to evaluate the already made complete dentures smile, and extract the criteria of a beautiful denture smile. ...
... However, there was a significant relationship (p =.035) between gender and teeth shade, where the female patients needed a whiter shade more than the female patients as presented in Table 5. Brewer 20 emphasized the impossibility of standard esthetic arrangement or composition of teeth that would be acceptable for all. Waliszewski 40 has also referred to the same problem, and claimed that intraoral and extra oral landmarks of the completely edentulous patients have presented a low reliability for tooth selection or arrangement, and cannot be used to provide those patients with the same smile of dentate patients. However, several other studies [15][16][17][18][19][20][21][22] have suggested that these biometric guides can be used to produce properly functioning dentures with a pleasant smile due to the restoration ...
Introduction: Esthetics is becoming more important to completely edentulous patients than ever before, and more of them are asking for the smile of movie stars. The purpose of this study was to adopt the Digital Smile Design (DSD) software as a new method for complete dentures smile evaluation, that is more reliable than the subjective judgement of the dentist, the patient, or the patients' relatives.
... In 2006, Waliszewski and colleagues performed an investigation of edentulous esthetic preferences. 48 Three denture trial arrangements, each representing one of the esthetic concepts, were made for each of six patients of varying age and gender demographics. Frontal smile photographs of the test subjects were combined into a booklet for evaluation by respondents. ...
... The process of their creation has been described previously. 48 In summary, six edentulous test subjects underwent conventional complete denture therapy. One male and one female of three differing age categories were selected. ...
Most esthetic preference research and anatomical average analysis come from dentulous populations. If edentulous patients have a different preference, application of this data during denture construction is problematic.
The aim of this survey was to compare dentulous and edentulous respondent preference among three different denture esthetic concepts.
A questionnaire and test booklet of standardized full-face digital photographs were used. It included three arrangements during maximum smile for six subjects. Dentulous and edentulous respondents were asked questions about their preference among the three randomly ordered concept photographs for each of the six subjects. A total of 167 dentulous and 269 edentulous questionnaires were analyzed descriptively and with Chi-squared tests to compare the esthetic preference of the respondents.
There was no statistically significant difference overall between dentulous and edentulous preference. Respondent preference varied significantly depending upon subject set and gender. Preference data compared closely to previous research.
Within the limitations of this survey, dentulous and edentulous respondent preference among the three esthetic concepts was not significantly different. Questionnaire respondents continued to frequently prefer appearances that are far from the anatomical average.
... The three smile esthetic concepts used in this investigation were previously explained by 22 . The preferences of dentist's regarding an exclusively edentulous population were investigated in this study. ...
Introduction:Complete dentures have been a commonly used treatment modality for the management of completely edentulous patients. Patients have expressed a high level of satisfaction with complete denture construction techniques. Aim: The aim of the study was to evaluate the dentist's perception on the esthetic choice of completely edentulous patients of three different age groups young, middle and old respectively. Material and Methods: Dentures were fabricated for 6 patients-young female, young male, middle age female, middle age male, old female , old male respectively with 3 denture concepts in mind-natural, supernormal and denture look respectively. A questionnaire with the patient photographs were circulated amongst dentists and their perception of esthetic look was analysed and Chi-square test and frequency analysis was used to explore the relationship between the variables. Results: In the present study it was observed that in the group of young females the most preferred smile type was natural smile(72.6%) while the least was the denture look(6.16%).In the group of young males most dentists advised the supernormal look(50.0%) followed by the natural look. Amongst the middle aged females the denture look(48.6%) was most popularly voted while the natural look and the supernormal look(24%) were similarly preferred.The middle aged men looked best in supernormal look (44%) according to most doctors while the look that least suited them was the denture look. The old aged women and men both looked best in the natural look (41% and 50% respectively). Conclusion:The authors observed that the esthetic perception of dentists vary for each group depending on the age or gender of the patient. Although no particular smile type can be assigned to each gender or age group, it should be noted that with the advent of fixed prosthodontics all patients shouldnt be blindly given the denture look, but the teeth arrangement can be done to suit the patient's esthetic profile satisfying function at the same time.
... This result is partly supported by a previous study by Langer et al. 2 who found that more women complained about the appearance of their dentures, while more men had objections regarding mastication. Waliszewski et al. 23 evaluated preference of tooth arrangement (aesthetics) among edentulous patients using three types of set-ups, i.e. natural, supernormal and denture look. The natural look was a standard tooth arrangement, while the supernormal and denture look were with larger and smaller moulds of teeth, respectively. ...
This article focuses on understanding our older patients who require complete prosthodontic care. By breaking down the patient psychology to its component parts, it is easier to obtain a clear picture of this special cohort of patients. Considering the increase in number of geriatric edentulous patients, this knowledge will help the dentist serve the geriatric population better.
The role of psychology and personality in complete denture treatment is well documented. The geriatric patient who needs complete dentures has a psychological aspect that needs consideration. Although significant, these aspects may sometimes be ignored or considered irrelevant.
A review of relevant literature was carried out to obtain data on the psychology and personality of geriatric, complete denture patients and their behavioural changes. The obtained data was filtered and condensed to provide a short but comprehensive look at the geriatric edentulous patient's psychology.
When handling geriatric edentulous patients, the dentist must be confident of addressing and managing the psychology of these patients. A thorough understanding of the geriatric mental state thus becomes important and significant for the clinician.
... When considering aesthetics in complete denture construction the characterisation of the denture base, the use of appropriate root contouring and stippling have been identified as features in the production of a natural looking complete denture (Fig. 21). 33 Where patients wish to have a prosthesis that is similar to their pontic proportions (Figs. 10, 16-18). Indeed patients who have undergone surgical procedures to improve soft tissue topography may still require the use of gingivally coloured porcelain to optimise aesthetics of the final restoration. ...
Periodontal disease, trauma, and congenital defects can result in both soft tissue and hard tissue defects that can present with aesthetic problems. The management of these problems may be limited to prevention or surgical management which can result in significant morbidity especially if a second surgical site for grafting is utilised. This article describes the various prosthodontic techniques to improve gingival aesthetics using contemporary materials such as gingivally coloured composite and gingivally coloured porcelain in addition to more traditional materials such as standard prosthetic acrylic.
This paper presents an overview of dental disciplines involved in the treatment of orofacial pain, temporomandibular disorders (TMD), and occlusion and provides an evidence-based contemporary update of their interrelationships. English language peer-reviewed articles were identified using PubMed. Key words bruxism, implants, occlusion, orofacial pain, orthodontics, prosthodontics, restorative dentistry, and TMD were used.
Dentogenic concept is an esthetic philosophy.Its purpose is to present knowledge whereby the prosthodontist may replace the lost dentition in such a manner as to effect an appearance which is complimentary to the sex, personality and age of the patient.Both physical aids and knowledge has been placed in the hands of the dentist so that he may be able to guide the patient to look with the eye and see with the mind.
Dental occlusal concepts have developed over time, essentially by trial and error. Most have stood the test of observation, and more recently science has verified some of the viewed occlusal successes. The purpose of this article is to examine and distill, in an evidence-based manner, the commonalities that allow practitioners of one occlusal philosophy or another to achieve consistent success. Medline and the Cochrane Collaboration were used to procure relevant articles.
The aesthetic denture covers various factors that provide the harmony of mouth and face. The size, shape, and color of the real teeth are important factors that should be considered for a correct selection of the artificial teeth. Moreover, their arrangement in the arches is an essential factor in the development of an aesthetic prosthesis, making it more natural. The purpose of this article was to review the literature regarding dental arrangements used in complete dentures. For this purpose, we searched Bireme, Medline, and SciELO databases for articles published between 1955 and 2013. Teeth arrangement and assembly in complete dentures is a subject that raises much controversy in literature due to the existence of different theories for its making. In order to make a true assessment of the patient's preference, studies that assess tooth arrangement in complete dentures should consider that teeth must be designed having the whole face in mind, since face and teeth are closely connected with facial harmony. In complete denture, aesthetics has been an extremely important factor for success and for the patient's satisfaction, and there are several techniques as to how the design must be made. This choice will depend on the professional's good sense, contributing to the patient's needs and wishes.
Microstomia may result from surgical treatment of orofacial neoplasm, cleft lip, maxillofacial trauma, burns, Plummer-Vinson syndrome, radiotherapy or certain systemic and developmental diseases, scleroderma. Impression making represents the initial difficulty in prosthetic rehabilitation of such patients because of abnormally small oral orifice. Sectional impression trays for both the primary and final impression of maxillary edentulous arches have been introduced. This article presents an impression procedure for obtaining an accurate impression by modification of sectional plastic stock trays to obtain a single full arch impression.
Key words – Microstomia, Sectional impression trays, Restricted mouth opening.
Esthetic considerations have become increasingly important in dental therapy. Evaluation of the soft tissue display during enjoyment smiling can provide useful information for esthetic oral rehabilitation. To date, no study has quantified the amount and frequency of soft tissue display in the area of the papilla. Photographic examination of 66 fully dentate patients with a mean age of 28.5 years was performed during enjoyment smiling. Digital processing and measurement of the tooth, gingival, and papillary display revealed that over 90% of subjects displayed papillae in the anterior teeth and first premolars during enjoyment smiling regardless of sex. The frequency of display in descending order consisted of maxillary lateral incisors (96%), central incisors (94%), canines (94%), first premolars (91%), second premolars (85%), and first molars (39%). The mean papillary display was 3.4 mm (range, 0.0 to 10.0 mm). There was no significant difference in the amount of papillary display between the sexes for anterior teeth, premolars, or first molars (P = .97, P = .79, and P = .48, respectively).
The aim of this study was to evaluate the attitudes of various groups of patients towards the appearance of their teeth.
A questionnaire was used which consisted of six background variables and 13 attitudinal statements concerning the appearance of the teeth. The number of responses obtained was 254. Multiple regression analysis was undertaken to reveal any statistical associations between the answers to the statements and the background variables.
According to the results, the appearance of the teeth was found to be more important to women than to men. For older patients, the appearance of teeth was not as important as for younger patients (r = -0.144, P = 0.012). Patients with limited education had a greater preference for white teeth than patients with a high level of education (r = 0.115, P = 0.037). The perception that very white teeth are beautiful decreased with increasing age (r = 0.112, P = 0.049), and younger patients expressed a greater preference for white teeth than older patients (r = 0.11, P = 0.50).
This study suggests that various groups of patients have different attitudes towards the appearance of their teeth.
The dentogenic concept is an esthetic philosophy. Its purpose is to present knowledge whereby the prosthodontist may replace the lost dentition in such a manner as to effect an appearance which is complimentary to the sex, personality, and age of the patient.Other interests have seemingly occupied the attention of the profession, to the unfortunate exclusion of the esthetic or cosmetic phase. The result of this disinterest has been an impersonal, characterless, or mechanical arrangement of teeth.The dentogenic concept has been explained and demonstrated for the benefit of the dentist and the dental laboratory technician. The technician has been enlightened so that he can lend a helping hand to the dentist when needed.Both physical aids and knowledge have been placed in the hands of the dentist so that he may be able to guide the patient to “look with the eye, and see with the mind,” and thus believe in his dentist's ability and understand his reasoning. Only in this manner can there be a welcome acceptance of the inspired efforts of the dentist, and the entire profession can be led to nobler heights in its service to mankind.
Consideration of the age factor in dentogenics provides a means for intelligent, as well as artistic, correlation of the physiologic and chronologic life lines in the edentulous patient. No longer can it be acceptable to place dentures in patients' mouths which have no identity with the patients' general age structure.The dignity of advancing age must be appropriately portrayed in the denture by careful tooth color selection and by mold refinement; also by the intervention of such characterization as would be fitting for the personality and sex of the patient.Very often, we have observed people in advanced years with dentures displaying a complement of teeth which would seldom be found in the natural dentition of a teenager. This is thoughtlessness, and it is not only embarrassing to the patient but reflects very unfavorably upon the dental profession.The positioning of the teeth in the denture base is the beginning in age interpretation, and it will be found that the subtle nuances ofearly age significance is usually more difficult to achieve than the imperfections associated with increasing age. The diastema so appropriate in the older interpretation must be used very judiciously in the more youthful interpretation.It should be kept in mind that the qualities of age are present in the natural teeth as well as in other tissues of the body, and we must create the illusion of age to a satisfactorily artistic sense in our artificial substances.The matrix in which the teeth are invested is a very important means of expressing the quality of age. Not only is this possible by the use of color in the matrix, but, even more important, by particular attention to the interdental papillae as to shape, length, and breadth. These are the subtle but powerful nuances at the command of the observing dentist.
The Sex factor, the first of three important factors in the concept of dentogenics, has been discussed. A feminine tooth in a masculine mouth is just as much out of place as a young tooth in an old mouth. The selection of the mold, the teeth, and the denture base, and, most important, the positioning and the coloring of the artificial teeth and denture base should be influenced by the sex, as well as the personality and age of the patient. The prosthodontist can develop into both an artist and a sculptor, with both the artist's and the sculptor's imagination. The dentist must recognize the sex and then discover the personality of his patient which can then be expressed dentogenically in the restoration made for that patient. The laboratory procedures must carry through the artistic concepts of the dentist. There is a degree of masculinity in many feminine patients. There is a degree of youthfulness in many elderly patients. To determine these factors and to balance them with the artistry of practical denture construction is the problem.The interpretation of the vital sex factor can be of great moral and psychologic help to the patient. The second factor in dentogenics—Personality, will be described and its application demonstrated in a subsequent article.
1.Personality is a practical and inspiring approach to primary mold selection. It paves the path for the further sex and age refinements which are necessary to the dentogenic restoration.2.The consideration of the personality factor allows a realistic approach to the problem posed by the necessity of using artificial substances to create an illusion of reality in the smile.3.The personality factor has been shown to be one that can be employed specifically for the predetermination of esthetic results and can help to eliminate the costly and unsatisfactory “trial and error” procedure for obtaining acceptable esthetic results. The personality factor has been interpreted and suggestions for its practical application have been described.4.The dentist is the artist whose accomplishments in dentogenics are limited only by the degree of skill he has acquired.
Little is known about dental appearance in terms of the elderly population. The purpose of this paper is to compare self‐reported dental appearance with dentist‐rated appearance for individuals over 65. The subjects (N = 550) were participants in the Los Angeles based Medicare Screening and Health Promotion Trial. Most were female (57.3%), white (89.0%), and married (62.0%), with a mean age of 74.5 years. About one‐third had incomes greater than $25,000. Results are based on a 45 minute telephone interview and onsite dental screening.
Findings show that 40% of the self‐ratings on a five point scale were higher than the dentist ratings, and 22% were lower. Bivariate analyses showed that both sets of ratings were related to dental status variables, self‐reported health, and education. High self‐ratings were also associated with being white and having a positive mental health status, white high dentist ratings were associated with patients who were younger, married, and who had higher income and social network scores. Comparison of results from two multiple regressions showed unique predictors for the self‐ratings (marital status and GOHAI scores) and for the dentist ratings (sex and income). These discrepancies can raise barriers to effective treatment planning in the elderly, which could affect utilization and satisfaction.
Purpose: This study was designed to determine the perceptions of lay people and dental professionals with respect to minor variations in anterior tooth size and alignment and their relation to the surrounding soft tissues.
Materials and Methods: Smiling photographs were intentionally altered with one of eight common anterior esthetic discrepancies in varying degrees of deviation, including variations in crown length, crown width, incisor crown angulation, midline, open gingival embrasure, gingival margin, incisal plane, and gingiva-to-lip distance. Forty images were randomized in a questionnaire and rated according to attractiveness by three groups: orthodontists, general dentists, and lay people; 300 questionnaires were distributed.
Results: The response rate was 88.2% for orthodontists, 51.8% for general dentists, and 60.6% for lay people. The results demonstrated threshold levels of noticeable difference between the varying levels of discrepancy. A maxillary midline deviation of 4 mm was necessary before orthodontists rated it significantly less esthetic than the others. However, general dentists and lay people were unable to detect even a 4-mm midline deviation. All three groups were able to distinguish a 2-mm discrepancy in incisor crown angulation. An incisal plane cant of 1 mm as well as a 3-mm narrowing in maxillary lateral incisor crown width were required by orthodontists and general dentists to be rated significantly less esthetic. Lay people were unable to detect an incisal plane asymmetry until it was 3 mm, or a lateral incisor narrowing until it reached 4 mm. Threshold levels for open gingival embrasure and gingiva-to-lip distance were both at 2 mm for the orthodontic group. Open gingival embrasure became detectable by the general dentists and lay people at 3 mm, whereas gingiva-to-lip distance was classified by these groups as noticeably unattractive at 4 mm.
The purpose of this investigation was to analyze the clinical crown of the 3 tooth groups of the maxillary anterior sextant of the permanent dentition of normal subjects with respect to (i) width, length and the width/length ratios and (ii) determine if there is a correlation between tooth dimensions or tooth group ratios and subject height. Subjects (≥20 y.o.) were recruited for this study if (i) the free gingival margin on the facial surface of teeth in the maxillary sextant was positioned apical to the cervical bulge, (ii) there was no evidence of attachment loss; as determined by lack of a detectable CEJ and (iii) the marginal tissue was knife edged in form, firm in consistency and coral pink in color. Teeth were excluded if (i) there was evidence of gingival alteration, i.e., gingival overgrowth/hyperplasia, inflammation, altered passive eruption, attachment loss, gingival recession or history of periodontal surgery, or (ii) there was evidence or history of incisal edge/proximal tooth alteration as in, i.e., restorative intervention, traumatic injury or occlusal wear into dentin. At least 1 suitable tooth from each tooth group of the maxillary anterior dentition had to be present. A maxillary impression was taken and poured in yellow die stone. The widest mesial-distal portion and the longest apical-coronal portion of the test teeth were measured. Gender, ethnicity and subject height (SH) were recorded for each participant. Due to a limited ethnic diversity only data from the Caucasian group were analyzed. The mean coronal tooth width (mm) of males versus females was CI: 8.59 versus 8.06, LI: 6.59 versus 6.13 and CA: 7.64 versus 07.15. The mean coronal tooth length (mm) of males versus females was CI: 10.19 versus 9.39, LI: 8.70 versus 7.79 and CA: 10.06 versus 8.89. All width and length measures were significantly greater for males than for females. The mean coronal tooth width/length ratios for males versus females was CI: 0.85 versus 0.86, LI: 0.76 versus 0.79 and CA: 0.77 versus 0.81. A comparison between genders of the width/length ratios of the CI and LI were found not to differ, however the CA ratio for females was significantly greater than for males. A statistically significant difference was found to exist between the mean (cm) SH for males versus females: 181.2 versus 164.0. A positive correlation (p≤0.0001 to 0.0691) was found to exist between tooth group width/height ratios within genders. No significant correlation was found between any of the tooth dimensions or tooth group ratios and SH. The results of this study indicate that within male and female Caucasians, the mean width/length ratio of the maxillary 3 anterior tooth groups is 0.81. As well, within both genders there is a positive correlation between tooth group width/length ratios. The significance of these findings with respect to periodontal mucogingival plastic surgical procedures is discussed.
The function of the masticatory system was analyzed in 19 patients (13 women and 6 men), aged 39 to 68, randomly selected from a group of 165 patients who had been treated with osseointegrated oral implants within the last 7 years (average 3.5 years). The patients were well satisfied with the functional capacity of their implant reconstructions, especially compared with the poor function before treatment. According to the clinical examination, all but one patient had no or only mild symptoms of dysfunction of the masticatory system. Three bite-force levels were recorded. The mean value for gentle biting was 15.7 N, for biting as when chewing 50.1 N, AND FOR MAXIMAL BITING 144.4 N. The patients could thus well discriminate between the different bite-force levels, and the maximal values are much higher than those in persons with removable dentures.
Line drawings of facial profiles and color photographs of dentitions were evaluated subjectively by 1,150 parents, 72 general practictioners of dentistry, and 54 orthodontists with regard to the normality and abnormality in dentofacial morphology and the need for orthodontic treatment. A significant difference was found between the evaluations of the parents and the professional groups in ten of the 11 facial profiles and in seven of the 11 photographs of dentitions. In general, the parents considered more of the examples acceptable and not requiring orthodontic treatment than did the professional groups. The dentists and orthodontists deviated significantly in their ratings onjy in their judgement of "ugly duckling" example (picture 22, higher abnormal rating by the dentists) and the profile example 10 (higher abnormal rating by orthodontists). number of orthondontists may have associated the conditions in picture 10 with a Class II, Division 2 malocclusion and, as such, scored it abnormal.
Factors mediating against excellence in dental esthetics have been classified and enumerated in this article. A formula for producing unesthetic prostheses can be hypothesized as follows: Educational de-emphasis + Lack of research + Technical orientation + Technical tradition + Delegation (abdication) + Poor economics + Fatique + Poor office design + Convention + Conditioning + Schemata leads to POOR DENTAL ESTHETICS. It is postulated that a formula for excellent dental esthetics can be produced by reversing these factors: Altered schemata + Deconditioning + Altered convention + Adequate office design + Elimination of fatique + Favorable economics + Personal participation + Research + Educational emphasis leads to ESTHETIC EXCELLENCE.
A survey has been presented that correlates measurements of upper lip type, sex, race, and age of dentulous patients with the amount of exposure of the maxillary and mandibular anterior teeth with the lips gently parted and in the resting position. Perhaps the most interesting finding was the gradual reduction in the amount of maxillary central incisor exposure with an increase in age, accompanied by a gradual increase in the mandibular tooth exposure. The importance of the amount of mandibular teeth seen in complete dentures has not been sufficiently emphasized in previous literature.
The selection of the proper mold and shade of denture teeth is but one part of denture esthetics. Compensating for lost alveolar bone, correctly positioning anterior teeth for lip support, and reestablishing the correct vertical dimension of occlusion, in combination with proper tooth selection, creates good denture esthetics. Proper contour and normal physiologic movement of the muscles enhances an esthetic denture, whereas improper support can severely detract from it. Even though denture construction requires a step-by-step progression, these steps cannot be isolated but rather must be integrated to produce an optimal result.
This report presents the results of an original investigation designed to determine (1) the prevalence in the natural dentition of a maxillary midline located in the exact middle of the mouth using the philtrum as the most reliable guide and (2) the percentage of people in whom the maxillary and mandibular midlines precisely coincide with each other. Results indicate that the midline is situated in the exact middle of the mouth in approximately 70% of people and that the maxillary and mandibular midlines fail to coincide in almost three fourths of the population.
1. There was a high incidence of the personality traits of hypochondriasis, depression, hysteria, and manifest anxiety in the 70 complete denture patients of this study. 2. Most patients in this study were satisfied with the complete dentures received. 3. There was no significant relationship between the personality traits of hypochondriasis, depression, hysteria, and manifest anxiety and the degree of patient satisfaction with dentures. 4. There was no significant relationship between the personality traits of hypochondriasis, depression, hysteria, and manifest anxiety and the techinical quality of dentures. 5. There was no significant relationship between the technical quality of complete dentures and the degree of patient satisfaction with the same dentures.
A study was initiated to determine whether a relationship exists in geriatric patients between self-image and the extent of their denture acceptance. Three assessing instruments were employed, namely, a "Focused Interview," the embedded-figures test, and projective figure drawings. Scores obtained were compared with scores on the Denture-Acceptance Rating Scale. The research results derived from the data follow: 1. Comparison of the degree of denture acceptance with the scores on all three assessing instruments showed significant relationships. Therefore, the hypothesis under study was accepted. 2. The "Focused Interview" appeared particularly well suited to a geriatric population, because it was nonthreatening, provided a communication outlet, and can be readily employed by a practitioner. 3. The embedded-figures test and the projective figure drawings appeared less appropriate for this population because of factors such as psychomotor retardation, perceptual difficulties, and diminution of ego strength which accompany the aging process. 4. The men in this study appeared to accept dentures more readily than the women, manifested higher morale, and were more field-independent. 5. Employed subjects, as compared to unemployed, showed significantly greater denture acceptance, higher morale and self-image, and a greater degree of field-independence. These factors appeared related to greater flexibility of adaptation. 6. Socioeconomic factors appeared to be significantly and positively related to morale factors. 7. Complaints regarding dentures were largely of a physical nature. They appeared to relate primarily to difficulties with adjustment to the new artifact which represented an alteration of body image for the subjects. 8. The study provided corroborative evidence of the need for the dentist to make an initial assessment of those personality factors in his patients which might limit his ability to provide adequate dental services.
A project was devised by the removable prosthodontic faculty to determine clinically if there is a correlation between the length and width of the maxillary central incisor on a cast and the length and width of the face. A millimeter gauge was used to measure the lengths and widths of the maxillary incisor on a cast. The Trubyte tooth indicator was selected to measure the length and width of the face. This tooth indicator is designed for calibration of the 16 to 1 ratio between facial dimension and maxillary central incisors.
Forty-six patients who had shown chronic maladaptive behavior in using complete dentures were treated with osseointegrated implant-supported prostheses. Forty patients needed mandibular treatment, three patients needed treatment in the maxillae, and three required treatment in both dental arches. At the most recent data collection (4 to 9 years after surgical placement of the implants), the 49 dental arches remained successfully treated with 44 implant-supported fixed partial dentures and five implant-supported overdentures. The efficacy of the osseointegration technique in maladaptive prosthetic patients is demonstrated in this descriptive study.
This study is based on an evaluation of patients' opinions of their dentures by means of a questionnaire. The patients had been provided with complete dentures at a university clinic. Of the original sample (n = 139) a test group of 92 patients remained available for the actual study 5 yr after treatment. The replies in the questionnaire were subjected to statistical processing and interpretation. Six clusters could be defined and these were introduced as "scales" representing the patients' score on a specific type of complaint. Apart from the six scales a score was achieved for each patient's overall satisfaction. The correlations between the various scales were calculated with the aid of a computer program. Finally, cross-tabulation was used to see if any significant (inter)correlations could be proved between complaints, satisfaction, and some of the patients' social data. It could be concluded that a correlation exists between complaints of pain and of functional aspects on the one hand and vague complaints on the other hand. There is also a correlation between complaints of looseness of the maxillary denture and complaints about aesthetic factors. Well-fitting and well-functioning dentures, absence of pain, and a socially acceptable appearance contribute much to the patients' satisfaction with dentures. Social variables such as type of insurance (public or private) and marital status influence denture appreciation to a certain extent.
Electrognathographic measurements on 18 patients with implant-attached mandibular complete dentures showed larger and more stable chewing patterns compared to their former dentures without implants. Strain gauge measurements revealed mechanical stress acting on the implants even during the fixation of the bar. In addition to simulating the periodontal ligament, the intramobile element (IME) of the IMZ system compensated minor, clinically undetectable mismatches inherent with technical procedures (casting, soldering). Although the implants are loaded with tensile and compressive stress, tensile stress dominated during the chewing process. The implants were also loaded during swallowing. This load reached half of the value of the chewing loads.
Structured interviews were administered to 168 male veterans from five locations to examine the relationship between attitudes toward dental esthetics, age, self-concept, and dental status. Results indicate the following.
• 1. Subjects who had a more positive self-concept rated their current dental condition higher.
• 2. Veterans who use dentures do not have a lower self-concept than those who have remaining natural teeth and feel more positively about their dental appearance.
• 3. Among the sample studied, dental appearance was considered less important than function or comfort.
• 4. Diminished self-concept is not associated with greater concern for dental esthetics.
The iatrosedative interview is an effective method of helping patients who are unable to adapt to dentures because of fear, anxiety, and depression. It creates an indispensable trusting relationship in the process of determining the factors responsible for the maladaptiveness and offers a solution to the problem.
Dental perceptions of the elderly and the relationship between self-esteem and self-perceived oral health were studied in 46 non-institutionalized older adults (X̄ = 86.8 yr) living in St. Paul, Minnesota. The most prevalent dentate dental problems were dry mouth, crooked teeth, and shrinking gums. Edentulous subjects cited shrinking gums, dry mouth and poor chewing. A statistically significant negative correlation was found between self-esteem and the number of dental problems perceived by the dentate participants (r = -0.61, P < 0.001). There was no significant correlation between these variables for the totally edentulous participant.
Thirty-two patients initially treated with a complete denture in the maxilla or mandible were examined after 21 years. The examination included a questionnaire plus clinical and radiographic examinations. Denture function was assessed in general as very good or fairly good by the patients, but about half of the subjects also felt that the dentures needed some attention. The patients generally had a high evaluation of their chewing ability. The functional state of the masticatory system, both according to patients' reports and the clinical signs, was generally good compared with previously published epidemiologic studies. The denture quality and tissue health were far from optimum according to prosthodontic criteria. By overall judgment, 14 patients needed new dentures and six needed relining, occlusal adjustment, or repair. Tracing of cephalometric radiographs showed wide variations in bone resorption among patients.
The results of this investigation indicate that the crucial variable in the patients' acceptance of their dentures was their involvement in the process of denture selection and not the esthetic quality of the dentures they received. Further research using other patient populations and more experienced dentists is necessary to determine the value of these findings.
A survey of 3,569 edentulous patients wearing complete dentures was conducted. The subjects were admitted to the hospital for other than dental reasons. Stability, retention, occlusion, cusp form, palatal relief, and other factors were related to oral lesions and patient satisfaction with their dentures. Findings were presented and discussed in relation to clinical significance.
The perceptual principles can free dentists from the confusion existing in the field of dental esthetics and enable them to confidently approach the task of enhancing their patients' appearance.Principles may be applied to all and they eliminate the personal attributes of talent and the need for learning specific formulas for achieving an esthetic result.“The determination of the form principles in a specific example of design means, in a sense, the elimination of the personal element. With this element removed the residue represents merely the planning knowledge possessed by the artist. ... Invariably the higher or more perfect the art, the richer is the remainder when the personal element is removed.”17The eye is a perfectly competent evaluator and errors will become obvious if a long contemplative look is taken at the tooth arrangement during the try-in appointment.A real need for a very detailed, almost histologic approach to dental esthetics exists. Indeed, the perceptive principles may be regarded as the cellular elements of which the tissue of denture esthetics is composed. As familiarity with the principles increases, so does proficiency in their application. With experience, the basic shape and characteristic of the dental tooth arrangement can be visualized even before a single tooth is placed in wax. All that remains is a detailed examination at try-in to look for minor perceptive conflicts, and this too becomes less of a task with the training of the eye to really see.The field of dental esthetics is of critical importance to the well-being of patients, and one of dentistry's greatest challenges is to completely eliminate the delivery of static, poorly planned, clumsily executed dentures. This challenge is each individual dentist's responsibility and cannot be subcontracted. The laboratory technician is a valuable ally, but he has no decision-making role in the area of denture esthetics.Fisher18 has best stated the objectives that must be achieved in denture esthetics. In his words, “It is the purpose of those who have labored diligently and long in the pursuit of a more workable basic principle in esthetics to encourage all of those whose tasks take them into the field of prosthodontics to consider the opportunity to lift the patient out of the category of a geometric figure and restore to him his true quality of a living and breathing man or woman, with an individual personality and either the dignity of his years or the freshness of his youth.” This is the proper note on which to close, or perhaps to begin.
This classification covers errors in tooth arrangement only. A similar classification for errors in base materials can be constructed. It is hoped that, by establishing a classification system for esthetic errors, more meaningful discussions can occur that will produce increased understanding and mutual benefit to both dentist and patient.
As esthetics is a philosophy and a branch of psychology, a study of these disciplines will help us greatly in selecting from the many teeth that are available. As for efficiency, posterior tooth form, unless it affects appearance, is important not to the patientbut only to the dentist. These conclusions were reached after many years of working for, observation of, and research on a great number of patients.Now I would like to offer a few opinions.1If we are not constantly challenging current concepts, we may well be setting dentistry back many years.2The complexity of a procedure does not necessarily enhance the quality of the result.3The man that is really wrong is the man who says, “Fellows, this is the only way to do it!”
The development of oral components of body image and the problems which beset their development was discussed. Several hypnotic techniques relating directly and indirectly to body image in dentistry were presented so that they might be used particularly with patients whose fears make them extremely difficult to work with. Techniques which assist in problems of denture composition and pernicious gagging were stressed. Results are congruent with the excellence of the basic hypnotic technique.
This study was initiated in an attempt to obtain some information about two questions: (1) Are the smiles of orthodontically treated patients as attractive as those of persons with “normal occlusion”? (2) What relationship between the lips and teeth, if any exists, should the orthodontist consider in positioning the anterior teeth during orthodontic treatment?Forty subjects, twenty with orthodontically treated occlusions and twenty with “normal occlusions,” were evaluated. There were ten male and ten female subjects in each group. Standardized black and white photographs of their smiles, with the areas surrounding the smiles masked out, were evaluated by a panel of ten men and ten women. No photographs of the smiles of patients prior to orthodontic therapy were used.Five basic components of each smile were studied: (1) the smile line ratio, that is, the congruency of the arc of curvature of the upper border of the lower lip and the arc of curvature of the incisal edges of the upper anterior teeth; (2) the smile symmetry ratio, whether or not the lips on each side of the smile midline were symmetrical with each other; (3) the buccal corridor ratio, the ratio of the width between the canine teeth to the width of the smile; (4) the height of the upper lip, determined by the relationship of the upper lip to the gingival margin of the upper central incisor; and (5) the curvature of the upper lip, whether or not the corners of the smile were above, even with, or below the midline of the upper lip.The following observations were made: 1.1. As a result of the panel members' evaluations, orthodontically treated subjects had significantly poorer smile scores than the subjects with “normal occlusion.”2.2. The smile line ratio appeared to be of importance to an attractive smile, and the most attractive smile displayed a smile line ratio of 1.00 to 1.25 or near perfect harmony between the arcs of curvature of the incisal edges of the upper incisors and the upper border of the lower lip.3.3. The smile symmetry ratio was revealed in this study to be important to a good smile, since no smiles that were asymmetrical had high smile scores.4.4. The buccal corridor ratio appeared to be of no significance to an attractive smile.5.5. The height of the upper lip to the upper central incisor influenced the rating of the smile, the most attractive smiles having the upper lip at the height of the gingival margin of the upper central incisor.6.6. In the subjects studied, the upper lip curvature was most desirable when the corners of the smile were above the midline of the upper lip. However, those smiles in which the corners of the smile were below the midline of the upper lip were attractive if they possessed the most desirable relationships of each of the other components.Further evaluation of these and other components of the smile should lead to the development of a “smile index,” so that the orthodontist may be better able to give the patient an “ideal smile” which would be an expression of the optimum in facial esthetics for that individual.
The purpose of this study was to evaluate whether the lay public perceives anterior teeth selected by Williams's typal matching method as aesthetically pleasing. The theory was tested by laymen responding to questions about photographs of three edentulous male and three edentulous female patients. These patients were selected as representatives of square, tapering, and ovoid facial forms. The photographs were portrait views of the patients wearing different dentures displaying square, tapering, and ovoid teeth.
Substantiation for typal match was found in the square female, square male, and the ovoid female patients. Responses to the photographs demonstrated a preference for square tooth forms over ovoid, and then tapering. Overall, ovoid teeth were preferred for females and square teeth were preferred for males.
The results suggest that, with the exception of retention, differences between patients' and prosthodontists' perceptions of treatment with complete dentures display greater variability with regard to function than to either esthetics or comfort. Although the literature has suggested that satisfying the esthetic concerns of the patient is likely to be a major hurdle in denture treatment success, this study suggests that occlusion, retention, and vertical dimension may be of more importance to effective communication. Misconceptions and unreal expectations should be dealt with early in the treatment program to avoid patient dissatisfaction. During the 1972 International Prosthodontic Workshop held in Ann Arbor, Michigan, the statement was made that patients were generally an unreliable guide as to the adequacy of their dentures, especially after wearing them for a period of time, and that further research to document the patient's reliability seemed unnecessary. This study has demonstrated that patients are quite reliable judges of many criteria related to dentures, provided channels for two-way communication are opened. With the ever greater economic stresses that force dentists to consider patients' concerns, perhaps it is increasingly the dentist's responsibility to better educate patients to evaluate all aspects of the quality of care they receive and encourage extensive two-way communication early in the treatment process. The adjusted quality assessment criteria used in the present study may be a useful instrument to use with patients prior to the initial interview in an effort to establish a better dentist-patient relationship.
A survey of the characteristics of an open smile was conducted with 454 full-face photographs of randomly selected dental and dental hygiene students. Findings show that an average smile exhibits approximately the full length of the maxillary anterior teeth, has the incisal curve of the teeth parallel to the inner curvature of the lower lip, has the incisal curve of the maxillary anterior teeth touching slightly or missing slightly the lower lip, and displays the six upper anterior teeth and premolars. Consideration of the characteristics may be useful in improving the esthetics of restorations.
Osseointegration implies a firm, direct and lasting connection between vital bone and screw-shaped titanium implants of defined finish and geometry-fixtures. Thus, there is no interposed tissue between fixture and bone. Osseointegration can only be achieved and maintained by a gentle surgical installation technique, a long healing time and a proper stress distribution when in function. During a 15-year period (1965-1980), 2768 fixtures were installed in 410 edentulous jaws of 371 consecutive patients. All patients were provided with facultatively removable bridges and were examined at continuous yearly controls. The surgical and prosthetic technique was developed and evaluated over a pilot period of 5 years. The results of standardized procedures applied on a consecutive clinical material with an observation time of 5-9 years were thought to properly reflect the potential of the method. In this group, 130 jaws were provided with 895 fixtures, and of these 81% of the maxillary and 91% of the mandibular fixtures remained stable, supporting bridges. In 89% of the maxillary and 100% of the mandibular cases, the bridges were continuously stable. During healing and the first year after connection of the bridge, the mean value for marginal bone loss was 1.5 mm. Thereafter only 0.1 mm was lost annually. The clinical results achieved with bridges on osseointegrated fixtures fulfill and exceed the demands set by the 1978 Harvard Conference on successful dental implantation procedures.