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

Key Points

  • Describes impression making to maximise retention, stability and soft tissue support by managing flange thickness.

  • Describes shaping the wax occlusal record rims to prescribe appropriate lip support and natural tooth positions.

  • Demonstrates the shape and extension of dentures giving optimum aesthetics.


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.

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Figure 1: Greenstick compound applied to the posterior buccal sulcus and the fit surface of the maxillary special tray prior to finalising the impression in a low viscosity impression material.
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Figure 3: Maxillary definitive impression in low viscosity addition-cured silicone rubber.
Figure 4: Resorption pattern in the upper central incisor region following extraction of the teeth after a period of 5 and 21 years.
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Figure 7: The shape of a mandibular denture which maximises retention and support.
Figure 8: An example of a definitive impression completed in zinc oxide and eugenol designed to create mandibular suction.
Figure 9: Finished trayless piezographic impression next to an edentulous stock tray, showing the latter's over-extension.
Figure 10: Completed piezographic primary (French) impression.
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Figure 15: Same lips as Figure 13 French impression).
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Figure 19: With the extra support provided by the added wax on the old denture, the patient's upper lip has developed a normal concave profile.
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Figure 27: The wax rim is shaped with reference to the dentate photographs on a large screen in the surgery.


  1. 1

    Glantz P O . Personal communication to John Besford. 1981.

  2. 2

    Blakely L . Presentation at Spring 2012 meeting of The Besford Study Club. 2012.

  3. 3

    McCord J F, Grant A A . A clinical guide to complete denture prosthodontics. London: BDJ Books, 2000.

    Google Scholar 

  4. 4

    McCord J, Grant A . Prosthetics: Impression making. Br Dent J 2000; 188: 484–492.

    Article  Google Scholar 

  5. 5

    Bergman B, Carlsson G . Clinical long-term study of complete denture wearers. J Pros Dent 1985; 53: 56–61.

    Article  Google Scholar 

  6. 6

    Abe J, Kokubo K, Satõ K . Mandibular suction-effective denture and BPS. Tokyo: Quintessence, 2012.

    Google Scholar 

  7. 7

    Sutton A F . A series of 10 patients with suction on mandibular complete dentures. 2011. Video available at (accessed January 2018).

  8. 8

    Klein P . Piezography: dynamic modelling of prosthetic volume. Actual Odontostomatol (Paris) 1974; 28: 266–276.

    Google Scholar 

  9. 9

    Aïche H . A preliminary functional impression for the mandibular complete denture. Int J Prosthodont 1989; 2: 543–548.

    PubMed  Google Scholar 

  10. 10

    McGee G F . Tooth placement and base contour in denture construction. J Pros Dent 1960; 10: 651.

    Article  Google Scholar 

  11. 11

    Harper R N . The incisive papilla—basis of technique to reproduce the positions of key teeth in prosthodontia. J Dent Res 1948; 27: 661–668.

    Article  Google Scholar 

  12. 12

    McGee G F . Tooth placement and base contour in denture construction. J Pros Dent 1960; 10: 651.

    Article  Google Scholar 

  13. 13

    Hickey J C, Boucher C O, Woelfel J B . Responsibility of the dentist in complete denture construction. J Pros Dent 1962; 12: 637–653.

    Article  Google Scholar 

  14. 14

    Martone L C . Clinical application of concepts of functional anatomy and speech science to complete denture prosthodontics. J Pros Dent 1963; 13: 4–33.

    Article  Google Scholar 

  15. 15

    Watt M D . Designing complete dentures. Philadelpia: W B. Saunders, 1976.

    Google Scholar 

  16. 16

    Ortman H R, Tsao D H . Relationship of the incisive papilla to the maxillary central incisors. J Prosthet Dent 1979; 42: 492–496.

    Article  Google Scholar 

  17. 17

    Marvroskoufis F, Ritchie G M . Nasal width and incisive papilla as guides for selection and arrangement of maxillary anterior teeth. J Pros Dent 1981; 45: 592–597.

    Article  Google Scholar 

  18. 18

    Grave A M, Becker P J . Evaluation of incisive papilla as a guide to anterior tooth position. J Pros Dent 1987; 22: 113–119.

    Google Scholar 

  19. 19

    Lau G. Clark R . The relationship of the incisive papilla to the maxillary central incisors and canine teeth in Southern Chinese. J Pros Dent 1993; 70: 86–93.

    Article  Google Scholar 

  20. 20

    Sawiris M . The role of anthropometric measurements in the design of complete dentures. J Dent 1977; 5: 141–148.

    Article  Google Scholar 

  21. 21

    Ehrlich J, Gazit E . Relationship of the maxillary central incisors and canines to the incisive papilla. J Oral Rehabil 1975; 2: 309–312.

    Article  Google Scholar 

  22. 22

    Solomon E, Arunachalam K . The Incisive Papilla: A Significant Landmark in Prosthodontics. J Ind Pros Soc 2012; 12: 236–247.

    Google Scholar 

  23. 23

    Kong H J, Hansen C A . Customizing palatal contours of a denture to improve speech intelligibility. J Pros Dent 2008; 99: 243–248.

    Article  Google Scholar 

  24. 24

    Fayz F, Eslami A . Determination of occlusal vertical dimension: A literature review. J Pros Dent 1988; 59: 321–323.

    Article  Google Scholar 

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Besford, J., Sutton, A. Aesthetic possibilities in removable prosthodontics. Part 2: start with the face not the teeth when rehearsing lip support and tooth positions. Br Dent J 224, 141–148 (2018).

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