Natural Looking Dentures

[CShof]

Anyone willing to share pointers on gingival toning? Any tips or tricks learned over the years in the setup/finish to make a more natural looking denture? Such as tooth placement, stippling techniques, etc.

 

[Clear Precision Dental]

I've been thinking a lot about this topic so I am glad you started this thread. I need to round up some photos, but I will be participating...

 

[CloudPeakDL]

- I made a denture a few weeks ago I tried to photograph but I couldn't get the lighting right and you couldn't see the texture.
I try to set the teeth in a more natural way- everyone wants straight teeth but you can subltly twist, maybe round corners or tweak the set up so they don't look like "perfect".
- Custom staining is a little harder to describe; light pink and red are the most common adds I do now but when I was in the military I did a lot of custom staining for ethnic dentures. I had a shade guide that was three shades of brownish pink. Rarely did we use the "purple" that was standard.
The best way to start custom staining is to play with shade tabs and keep accurate records of how much you mixed with what. Silicone dappen dishes work well to make shade tabs or you can do a suck down over a square piece of stone and use it.
- contouring the denture base; look at casts of people with teeth and try to reproduce the contours you see, I have three instraments I use to contour, a cleoid dicoid the pointed end, a woodson, and a PKT. I don't use a brush or bur to stipple because I can't stand the yuck that builds up on the denture, but the marks I make with the woodson give it detail. Moldent works great to repolish teeth after changing contours.
I try to study cast and look at peoples smiles and tissue colors. My friends are use to me by now but it can freak people out when you start staring at thier teeth. :+)
Will try again to take some pictures.

 

[yooper886]

There is a book called Analysis by Gerald Ubassy and is sold through Ivoclar. All it has is pictures in it and it is made mainly for fixed but there is a section in the book that shows lots of gingival contours, textures and shading of patients tissue. I would recommend this as one to study. As well as discussing it here on the forum there are a couple of technicians I would recommend that you attend one of the courses when you can. Tom Zaleske and Rob Kreyer, they both offer excellant tips and tricks in making your dentures more life like and stand out from the rest of the crowd.

 

[TheLabGuy]

There is a book called Analysis by Gerald Ubassy and is sold through Ivoclar. All it has is pictures in it and it is made mainly for fixed but there is a section in the book that shows lots of gingival contours, textures and shading of patients tissue. I would recommend this as one to study. As well as discussing it here on the forum there are a couple of technicians I would recommend that you attend one of the courses when you can. Tom Zaleske and Rob Kreyer, they both offer excellant tips and tricks in making your dentures more life like and stand out from the rest of the crowd.

It's an awesome book for fixed......love it.

 

[Brian]

Bill,

You beat me to it! Ubassy is the ticket!!!! You can literally spend hours looking at the book.. Got mine through Dental Dialog..

The biggest advice that I could give is to look at natural contours. I also took an impression of my wife and studied her tissue and emergence profile and mine as well.

The very next thing I will offer is, take a look at an existing denture orally and then ask yourself does this look fake? Does it fit the patient? If you answer yes and no then ask the question why? Analyzing is really the only way to change what you or I are delivering. I don't claim to be a Tom Z or a Dennis Purinton, Kreyer or god forbid a Jurg Stuk, But if you study what these guys produce, you will start to gradually change your approach.

I for one am glad someone has finally started a thread about this subject. You know whats funny? Ceramist and C&B guys try there hardest to make a tooth look like a tooth and the majority in removables don't strive for the same. About time we change that perception and move forward.

As for colorization, I use the wet technique. Colorizing acrylic in a dish and layering the negative of the flask with a brush. I feel this provides more depth.

BTW: I'm also a BIG fan of Ruth Burke and Annette Hajmasy.

 

[Al.]

Bill,

You beat me to it! Ubassy is the ticket!!!! You can literally spend hours looking at the book.. Got mine through Dental Dialog..

The biggest advice that I could give is to look at natural contours. I also took an impression of my wife and studied her tissue and emergence profile and mine as well.

The very next thing I will offer is, take a look at an existing denture orally and then ask yourself does this look fake? Does it fit the patient? If you answer yes and no then ask the question why? Analyzing is really the only way to change what you or I are delivering. I don't claim to be a Tom Z or a Dennis Purinton or god forbid a Jurg Stuk, But if you study what these guys produce, you will start to gradually change your approach.

I for one am glad someone has finally started a thread about this subject. You know whats funny? Ceramist and C&B guys try there hardest to make a tooth look like a tooth and the majority in removables don't strive for the same. About time we change that perception and move forward.

As for colorization, I use the wet technique. Colorizing acrylic in a dish and layering the negative of the flask with a brush. I feel this provides more depth.

BTW: I'm also a BIG fan of Ruth Burke and Annette Hajmasy.

Brian I saw some pics of your work on another forum where you put the whiter acrylic on the roots etc. Why dont you post some pics with how to tips like Ive done with c&b in the case presentation section. It was some really beautiful finished stuff you showed. Show how you do it.
Al

 

[Brian]

Al,

Thanks for the vote of confidence! More than willing to share any of my techniques; few that there is, I'm willing.
Keep in mind I too am still evolving as a technician..

The first step is to create contours and not a festoon. (BTW: festooning is the art of adding garnishments to wreaths and what not..) Interdental spaces should be blunt not pointy and taking up the inter proximal aspects as seen in this photo

 

[Brian]

More along the lines of this..

Well hell that didn't work...

 

[Brian]

Again, more on the lines of this...

 

[yooper886]

One thing I would add is when you are waxing your contours do not bulk wax and carve but try to wax the denture the way a tech would wax a crown. Once you get used to it I think you will find that waxing a denture instead of carving it takes about the same amount of time but with less stress on your wrists from going through the motion of all the carving.

 

[Brian]

One thing I would add is when you are waxing your contours do not bulk wax and carve but try to wax the denture the way a tech would wax a crown. Once you get used to it I think you will find that waxing a denture instead of carving it takes about the same amount of time but with less stress on your wrists from going through the motion of all the carving.

Bill, your right on the money! Not only that you will start to lose that trenching thing that so many place between each tooth. Bill you should post some pics as well.

 

[yooper886]

Here is a couple of pictures of what Brian was talking about with the papillia's being blunt and not sharp. These were done with very little carving except around the necks of the teeth. I am by far no expert and still learning but this is what I have been able to acheive so far.

 

[Brian]

Close up..

 

[yooper886]

A couple of other tips is on your denture teeth is to take down the seam in the interproximals of them from when they are made. You can also take a rubber wheel and flatten out the contact area in the interproximals. Also on the anteriors you can take a rubber wheel and from the lingual take down the incisal edge just a little to create a wear mark, just make sure you take it down from the lingual and not directly on top of the incisal edge.

 

[Clear Precision Dental]

Love all these ideas. Most of these I learned from old articles by Frush and Fischer (sp?). Most of these techniques went on to be "lifted" by Suissedent (Geneva 2000 "system"),Joe Massad (actually done by his lab tech, Ed) and others.

The old guys made dentures by the hundreds and learned a lot of things.

 

[CShof]

try to wax the denture the way a tech would wax a crown

Unfortunately during my time at a full service lab I didn't get much time to watch anybody wax crowns, can you elaborate?

The way I learned was to take a sheet of wax, heat it up, fold it to proper thickness and push it into place, unless of course the amount of required wax is small, then I use an eyedropper. Is there a better way?

I heard somewhere that for a masculine setup you can place either 8 or 9 slightly labial of the other for a more natural look. I like the idea of custom contouring teeth. Do you find rounding the laterals helps? Is doing all rounding from the lingual the key?

Brian, I'm impressed with your setup. Its hard to tell that picture is a denture in that guy's mouth. How long have you been at this? I like the angle of the lower cuspids, that looks very natural. My old boss would always yell at me for doing those sorts of things, he'd tell me, "gets those necks tucked in!" I learned almost to a fault how to make an ideal denture to perfection. I like all these ideas on how to get a more natural look. Keep em coming!

Yooper, did you get your texture in your wax up with a toothbrush? I've seen it done before but it was only once and awhile back. Can you refresh my memory?

I love the idea of step by step instructions, maybe there should be a section devoted entirely to that subject.

Do you find yourself sticking with a setup that works or do you vary? Such as, do you find yourself doing the same twists and rotations to the same teeth on every setup because it works or is every case different?

 

[Brian]

CShof,

I have been trying for the last 8 years to create an inconspicuous prosthesis.
All along the way doing it through trial and error. I'm a long, long , long way from where I wish to be and if I'm lucky I will never reach that destination.

I have been very fortunate to meet people like Tom Zaleske who have taken their time to point me in the right direction with a few hints here and there.

This grasshopper is a journey that has to be made alone, with some direction given.

1st. Have the passion to create and allow yourself to fail.
2nd. Play with different materials and tools. Find which one you feel comfortable with and expand. Example: I use a sponge from a crown box to do my texture and stippling and I have switched to an electric waxer.

* Remember* The artist uses what "feels" right to them, be it a piece charcoal, pencil or oil paint.

3rd. Never stop looking at others work and looking at natural tissue and teeth. Mimic what you see! Who does it best? Mother nature or some guy rapping your knuckles about not following the Dentsply / Turbyte method.

4th. Yes always adjust your incisal edge from the linqual. If your familliar with morpholgy, get a cheap card of teeth and a rubber wheel and go to town.

5th. Colorize everything! Practice with transitional partials.. You will screw a few up! I actually collected odd teeth did practice wax up and process after hours... Sat up many night till 1 or 2 in the morn playing...

You will get it, if you have the want! I can tell you that the nay sayer have no clue! Doctors and their patients will notice the difference and so will your lab! I'm still on the journey and have allot to learn myself! I'm just getting started good.

 

[Brian]

I heard somewhere that for a masculine setup you can place either 8 or 9 slightly labial of the other for a more natural look. I like the idea of custom contouring teeth. Do you find rounding the laterals helps? Is doing all rounding from the lingual the key?

This I find to be folklore.. I have seen plenty of men that the set up tended to be on the soft side and vise-a -versa for women. One really needs pictures. Every set up I do I set the 8 & 9 labial.. You can actually do allot with the 2 centrals; just as long as they mirror each other. Rounding? Wrong term.. You need to start with from the line angles to re-contour the teeth.

 

[Al.]

How do you get that lighter color to mimic where tissue is thin and the bone color is coming through?
Is that a pinkish white stain you paint on? Is it absorbed into the acrylic or is it on the surface?

I know I have that on the tissue above my cuspids.

To do what you guys are doing it pays to study the the roots of teeth.

Cshof, he is absoutly correct about reducing upper anteriors from the lingual, for C@B it looks terrible if you just shorten teeth buy grinding straight on them. It makes them look thick and blocky. When the patient grinds they grind the uppers from the lingual then out to the incisal edge.

It is the opposite on the lower anteriors though, they grind from the buccal to the lingual so on C@B I reduce lowers the opposite way from the facial to the lingual, leaving the lingual incisal edge slightly higher and sharper if the patient is a grinder and I match the other worn teeth.