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.

Abstract

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.

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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). https://doi.org/10.1038/sj.bdj.2018.76

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