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

Key Points

  • The predicament of the denture patient, emotional and practical.

  • The importance of good inter-personal relations between the patient and the dental team, with the patient as team leader.

  • Why should we make dentures look like natural teeth?

Abstract

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.

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Figure 2: The same policewoman, less phobic, after scaling, oral hygiene instruction, closing the gaps between the lower front teeth with composite additions and a new upper complete denture.
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Figure 12: Freddie Mercury.

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Acknowledgements

Thanks to Ian Clark, Rowan Garstang and Andrew Taylor for excellent technical work.

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Correspondence to A. F. Sutton.

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Besford, J., Sutton, A. Aesthetic possibilities in removable prosthodontics. Part 1: the aesthetic spectrum from perfect to personal. Br Dent J 224, 15–19 (2018). https://doi.org/10.1038/sj.bdj.2018.2

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