Oral Health Group
Feature

Cosmetic Dentures to Generate Dental Facial Esthetics


April 19, 2016
by Luc Vanderborght (Belgium)

Cosmetic procedures like bleaching and porcelain veneers result in that today people are more conscious about the appearance of their smile than ever before. Often though, people with dentures are deprived of cosmetic outcomes.

This is strange. Because it’s like saying that people with no teeth are not influenced by the cosmetic revolution of today, and that the only thing they are interested in is to be able to chew with their future dentures. With this perception it should be enough to make implant supported over-dentures, with no thoughts of the cosmetic part of the over-dentures.

Sometimes the explanation is that (social) insurance policies are not covering the augmented price for making cosmetic dentures. This is certainly the case. But on the other end, why should we treat dentures as something that should be covered 100 percent by (social) insurance policies while we all agree that bleaching, veneers and other cosmetic treatments are elective out-of-the-pocket treatments. We have to understand the reality that people with dentures are evenly influenced by the cosmetic revolution of today.

This article is a case report of how cosmetic dentures changed the smile and the life of a patient completely.

The Before

A 51-year-old female consulted me while her husband was in treatment for dental implants. She was very ashamed with the way she looked. She was partially edentulous and with her ill sitting dentures her face appeared to have a Class III relationship (Fig. 1).

Both lateral and frontal views showed fallen cheekbones, a sign of being old (Figs. 1 & 2). Instead of 51-years-old, her face looked 61-years-old or more. On the frontal photo, it was also visible that her eyes too seemed to be falling down. The patient was so aware of her situation that she was totally desperate and she started to cry when I took the photos (notice the frontal photo with the patient’s wet eyes).

FIGURE 1.
FIGURE 1.

FIGURE 2.
FIGURE 2.

When asked to smile, she held her lips together, probably because she had always hidden her teeth with her lips. Though I did get a lucky, unclear photo with the patient showing a bit of her teeth (Fig 3).

FIGURE 3.
FIGURE 3.

Upon intra-oral inspection, mobile keratinized mucosa in the pre-maxilla was found together with two Ceka attachments on the natural canines in the lower jaw (Figs. 4 & 5). A diagnosis was made of a rotating upper denture due to the hard Ceka attachments. On the X-ray, severe bone loss together with two horizontal teeth was found (Fig. 5). Also, notice on the X-ray the MISCH D-type bone in the upper and lower jaw, except for the region between the two natural canine roots (Fig. 6).

FIGURE 4.
FIGURE 4.

FIGURE 5.
FIGURE 5.

FIGURE 6.
FIGURE 6.

The patient was totally informed about the possibilities to have bone grafts, the removal of the two horizontal teeth in her lower jaw, as well as the possibilities with dental implants. The patient declined and asked me to make her beautiful again with cosmetic (over) dentures.

The Making Of
The prosthetic treatment involved standard impressions, followed by definitive VPS impressions that were border moulded with O-bite VPS. For the next step baseplates with wax rims were fabricated for the bite registration. Great attention was made that the wax rims indicated the place where the frontal teeth should be placed. The bite was lifted and the denture teeth were set just like a Smile Design.

For the choice of the teeth VITA PYSIODENS 1M1/1M2 were selected. These teeth have a nice bleached colour and important for this patient, they are not as hard as the newer composite denture teeth like CANDULOR Physiostar NFC+ or porcelain teeth (Fig. 7).

FIGURE 7.
FIGURE 7.

New Ceka attachments were placed on the canine roots, so that the patient could have the maximum comfort of a proper fitting over-denture (Fig. 8).

FIGURE 8.
FIGURE 8.

As expected and due to her position of the eyes relative to each other, the teeth at the first fit-appointment were canted. Therefore an ear-bow registration and stick bite to the horizontal were taken (Figs. 9 & 10). The second fit-appointment confirmed that it was not present anymore.

FIGURE 9.
FIGURE 9.

FIGURE 10.
FIGURE 10.

The After
As the patient was very wowed with the final fit result no extra polychromatic colouration of the prosthetic teeth needed to be done. A week after placement of the cosmetic dentures the very pleased patient returned for a check-up appointment.

Please notice (Figures 1, 11, 12, 13):
• The colour of the teeth that are in harmony with the colour of the eyes.
• The cheekbones were lifted.
• The eyes were lifted.
• The face was triangular instead of before being square.
• The Class III was turned into a Class I relationship.
• The teeth were set to the horizon.
• Last not least: the difference of the face before and after.

FIGURE 11.
FIGURE 11.

FIGURE 12.
FIGURE 12.

FIGURE 13.

FIGURE 13.

Final Thoughts

The patient paid very much more than the price of a ‘social insurance” denture in my country. But for the patient the real value of her cosmetic dentures was way above this price. In the next weeks, she wrote me a Thank You note (free translation of Dutch to English):
“… We wanted to thank you again for the wonderful work and the amazing result that you have realised. Also for me you have proven that you are a real specialist, a make-over without an operation, and this only with good sitting dentures.”

I believe that this is the essence of cosmetic dentistry: to co-operate with the dental patient so that it enhances the life of the dentist and the life of the dental patient.

Acknowledgements:
The author would like to acknowledge dental technician Stefan D’Hondt of Excent-Intradent in Belgium for his co-operation to make this case a beautiful case. The author would also like to acknowledge the patient for her written approval to show full-face photos for the purpose of this article. OH


 

Mr. Luc Vanderborght maintains his private practice in Belgium. He graduated as a dentist at the Free University of Brussels. He has a Fellowship of the IADFE and the ICOI. He is a member of the ASDA and the ESCD. He is a participating member of the AACD.

Oral Health welcomes this original article.