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

Key Points

  • Perfect imperfection – making dentures look like natural teeth and gums.

  • Being brave with tooth positioning and copying nature - selecting the right size and shape of artificial teeth using photometric calculation and assessment.

  • Patient led decision-making at rehearsal – the complete denture “try- in”.

  • Handling the delivery and review stages of complete denture provision.

Abstract

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.

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Figure 1: Photometric method for calculating the width of the two upper central incisors.
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Figure 3: Tooth mould charts can be used to select the most suitable sizes and shapes of the upper anterior teeth, when used in conjunction with the photometric method of calculation of the upper central incisor width.
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Figure 7: Each tooth is added in turn and sealed down with a heated wax instrument at the neck (ridgelap) only.
Figure 8: A lower silicone putty matrix has been made to record the labial contour of the upper rim sent to the lab.
Figure 9: Classic Class II/div.
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Figure 21: The patient assessing the try-in with the dental nurse, looking at her dentate photograph comparing this with the try in on a video.
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Figure 15: Photograph of a natural dentition of a 30-year-old woman.
Figure 16: The natural dentition of a 30-year-old woman.
Figure 17: The natural dentition of an 81-year-old white man.
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Figure 20: The process of producing natural looking gums starts with waxing up.
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Figure 33: Incisors too long.
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Figure 35: Blackened incisal edges in situ (JB) Note a little soreness at the corners of the mouth.
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Figure 43: Upper complete denture made with almost total disregard to the appearance of the lower natural teeth.
Figure 44: Replacement upper complete denture made to appear compatible with the lower natural teeth.
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Figure 49: Real amalgam fillings in a denture ten years old.
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Figure 42: Finished smile in Fig.41, viewed from a distance.

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Acknowledgements

Special thanks are due to Rowan Garstang and Matt Wilde and John Wibberley for their technical advice with these three articles.

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Correspondence to J. N. Besford.

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Besford, J., Sutton, A. Aesthetic possibilities in removable prosthodontics. Part 3: Photometric tooth selection, tooth setting, try-in, fitting, reviewing and trouble-shooting. Br Dent J 224, 491–506 (2018). https://doi.org/10.1038/sj.bdj.2018.222

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