Denture Renaissance
Dr Mahmood Suleiman reports on a Seminar for the dental team on the Aesthetics of Removable Dentures.

The Medical Society of London provided the venue for a Seminar aimed at producing full and partial dentures with true to life aesthetics. The first speaker was Dr Charlotte Stillwell who is a general dental practitioner and a specialist in prosthodontics. Charlotte described her philosophy of how modern dentures can restore aesthetics and function through careful treatment planning and design. She placed importance on the need to create unity between the denture and the existing teeth and also on the need for the denture to safeguard the oral environment they inhabit. Having established and recorded the patient’s objectives and special requests Charlotte described how she followed a design sequence aimed at making the denture compatible with those objectives. The preliminary design should highlight the teeth that need to be replaced together with the major connector and potential guide surfaces. Her general rule is to use only two clasps deriving indirect retention by other means. Another concept applied is that of the ‘3mm rule’. Charlotte went on to expand on this by showing cases where the design looks to keep the denture 3mm away from gingival margins and embrasures wherever possible to allow unrestricted salivary flow and consequently gingival health. With complete dentures we were shown how diagnostic but reversible changes were made to patients’ existing dentures with the aim of improving stability and retention. It was enlightening to see how a consultation appointment can be used to alter the morphology of a denture and evaluate the benefit of such a change. This should lead to a prescription for a subsequent denture, which should eliminate the presenting problems. If it does not then new denture construction should not be embarked on.

The second speaker was René la Cour a Danish Clinical Dental Technician. René started his presentation by looking at dentate patients in different decades of their lives. He highlighted the appearance of the soft tissue, clinical crown height and degree of wear and staining throughout the ageing process. He also showed how the dentition changes from being homogenous and symmetrical in a 20 year old to being individual and characterised in a 60 year old. René cleverly managed to switch at some point imperceptibly onto patients with full dentures to highlight his observations. Call me thick but it took me three cases before I realised that we were looking at the sheer excellence of full dentures with gingival imitation, characterised teeth with simulated stains, fillings and individual distinctive marks. René advocated the use of Myerson Special teeth as these certainly make the smile look more natural. He told us that these teeth have stains, fillings and multicoloured layers designed to produce a more natural appearance. Many of these irregularities are individually added by hand and the characterisation varies across the shades. Multicoloured layers and special effects are manufactured within the Myerson Special range rather than on the surface, which means that the teeth can be ground and modified to match the patient’s natural teeth without affecting the shade. When we think logically, homogenous, symmetrical teeth look perfectly natural on a 20-year-old, but on a 50-year-old they can look quite unrealistic.
René then went on to show in exquisite detail how he will mix shades and moulds within a set up and how he places great importance on texture and asymmetry. We were shown techniques to retract papillae, processing techniques for imitating the natural surface of gingivae and how to achieve asymmetry.

A testament to the appeal of this topic was not only mixed nature of the audience consisting of clinicians and technician but also the nature of the discussion that followed the talks.

The evening was sponsored by Myerson and Kemdent.

Dr Mahmood Suleiman
High Wycombe, Bucks.