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Aesthetic Dentistry

Authors : Dr. Sagar J. Abichandani ,Dr. Neha S. Abichandani .


Abstract :

As ageing is an accepted fact with a high concentration of geriatric patients, awareness about the tremendous need for removable prosthodontic services is also paramount. While the basic process of making dentures has changed little over the past several decades, new materials and techniques can help laboratories and clinicians provide functional, esthetic restorations that offer exceptional value to patients. This case report will show how Digital Smile Designing can help integrate perfect esthetics with the science of function.

Introduction :

Dental esthetics In dentistry ,is the theory and philosophy that deal with beauty and the beautiful , especially with respect to the appearance of a dental restoration , as achieved through its form or color. Those subjective and objective elements and principles underlying the beauty and attractiveness of an object , design and principle1. Even the Dental esthetics has a direct relationship with golden proportion - The width of central incisor is in golden proportion to the width of the lateral incisor. Width of the lateral incisor to width of canine is also in golden proportion, as is the width of canine to first premolar2. Frush & Fischer3 also introduced the SPA factor describing esthetics based on patient’s Sex, Personality & Age. But today we have moved to the concept of Digital Smile Design (DSD) as given by Christian Coachman used for treatment planning and conceptualizing the science of esthetic dentistry.

Case Report:

A 80 year old lady came to our clinic with the chief complaint of missing teeth wanting its replacement for eating food and to look presentable(figure1). Patient was asked about dental history and was known that she was advised extraction of all her teeth due to dental caries following which she had pain for an extended duration of time and was therefore reluctant to get further dental treatment.

She was then advised by her general physician to make dentures and start eating food for nourishment. She had a history of Myocardial Infarction (MI) 3 years ago and was on aspirin (blood thinner). Her general physician refused to give consent for implant surgery, so it wa decided to proceed with conventional removable partial dentures with incorporation of Digital Smile Design (DSD) principles for giving her optimum esthetics with function.

On intra oral examination, it was seen that the upper ridge was shallow and well rounded with the lower ridge being severely resorbed, knife edged( figure 2).

Primary impression was taken with impression compound(Harvard impression compound red) and was poured with type II dental plaster (Neelkanth healthcare pvt. Ltd).

Special tray was fabricated using autopolymerising acrylic resin(Self cure Denture base, PIGEON DENTAL, China) and was kept 2mm short of the sulcular depth. Border molding was carried out with low fusing impression compound(HIFLEX tracing sticks) and a wash impression was made with zinc oxide eugenol impression material(DPI impression paste,india). Master casts were obtained using dental stone(Kalabhai ultra stone) over which record bases and occlusal rims were fabricated and jaw relation was obtained ( vertical dimension was established and centric relation was recorded at an established vertical dimension) (figure 3).

After the jaw relations were recorded, Digital Smile Designing (DSD) software was used for getting the planes and teeth alignment as per the facial architecture (figure 4). Try in was done and was well appreciated by the patient.

Acrylization was carried out using heat polymerized acrylic resin(heat cure denture base, DPI), laboratory remount was carried out and using BULL’s principle, selective grinding was carried out. For centric contacts, only the lower central fossa or marginal ridges should be ground and not the upper lingual ridges. For working and balancing contacts, ideally, five working side contacts, five balancing side contacts and no buccal contacts should be obtained.

The dentures were verified in the patient’s mouth (figure 5)for fit, esthetics, phonetics, balanced occlusion and the patient was satisfied with the final result. ( figure 6)
 


Discussion:

Because implants were ruled out, attaining retention and stability was a challenge. So care was taken to follow the principles of accurate impression procedures, adequate extension of the denture border as limited by the movable tissues to permit its movement without interference by the denture base.4 Hence, for the modiolus to function freely, in the premolar region, dentures were shortened and narrowed flange to permit the action that draws the vestibule superiorly and modiolus medially against the dentures.5,6 Care was taken to avoid violation of the neutral zone which is the most common cause of instability7. Bilateral simultaneous contact of the posterior teeth in centric relation was provided to enhance stability.

Summary and Conclusion:

Digital Smile Design (DSD) software is a treatment planning tool which can best utilize the scientific concepts of dental esthetics and can incorporate an optimum result of esthetics and function. (figure 7).

References:
  1. John P. Frush, Ronald D Fisher :Introduction to Dentogenic Restorations , Journal of Prosthetic Dentistry ,5:587-595,1955.
  2. Edwin I Levin :Dental Esthetics and the golden proportion , Journal of Prosthetic Dentistry . 40: 244-252 , 1978
  3. John P. Frush, Ronald D Fisher :The Dynesthetic interpretation of Dentogenic concept, Journal of Prosthetic Dentistry. 8:559-581, 1958.
  4. Corwin R.Wright, :Evaluation of factors necessary to develop stability in mandibular dentures. J. Prosthet. Dent. 92:509-518,2004
  5. Arthur R.F. : Complete denture stability related to tooth position. J. Prosthet. Dent. 1961; 11: 1031-1037.
  6. Strain C.J. : Establishing stability for mandibular complete denture. J. Prosthet. Dent. 21: 359, 1969.
  7. Victor E. and Frank J. :The neutral zone in complete dentures, J. Prosthet. Dent. 1976;36 :356-365
More references are availabe on request.


Acknowledgements:

The authors would like to acknowledge Dr. Christian Coachman , Founder of Digital Smile Design (DSD) and Dr. Rajiv Verma, Lecturer, Digital Smile Design, India.

The authors would also like to acknowledge Silver Line Dental Lab (Mumbai) and Precision Dental Studio (Mumbai ) .