Restoring Dentate Appearance: A Literature Review For Modern Complete Denture Esthetics

Restoring dentate appearance: A literature review for modern complete
denture esthetics
Michael Waliszewski, DDSa
University of Washington, Seattle, Wash
Despite the fact that solutions to functional and comfort problems are often available, successfully
restoring the appearance of an edentulous patient remains a challenge. This review of the literature
demonstrates the limited amount ofuseful evidence-based information available for restoration of
dentate appearance in edentulous individuals. The English language peer-reviewed literature from 1880
to the present was reviewed. Articles were identified through previous literature reviews, an extensive
hand search, and a search of MEDLINE using the key words esthetics and denture esthetics. Three main
areas of information werefound: published guidelines for achieving natural appearance, patient
preference studies, and studies that have collected and analyzed anatomic norms. (J Prosthet Dent
2005;93:386-94.)

T

he number of edentulous patients in the United
States is expected to remain constant at well over 30 million.1 This implies that the demand for restoration of
edentulous patients will remain high for theforeseeable
future. Treatment challenges for such patients have traditionally been described as a combination of function,
comfort, and esthetics.2-5 Complete denture fabrication
techniques, while not universally standardized,6 have
resulted in a high degree of success.4,5 The long-term
success of dental implants has afforded clinicians the
ability to address many of the functional andcomfortrelated problems that previously resulted in completedenture failures.7,8 Patient satisfaction, function, and
comfort are improved even with limited numbers of
implants.9-12 Comfort and function are, therefore, no
longer beyond the dentist’s ability to predictably
address in an increasing percentage of the edentulous
population.
In contrast to the recent success in addressing comfort andfunction, restoring an edentulous patient’s appearance has received little attention in the modern
prosthodontic literature. A search of MEDLINE, as
well as a comprehensive hand search of English language
dental literature since 1973, revealed 24 articles on
restoring dentate appearance in edentulous patients.
Contemporary esthetic research has focused on the
dentate patient. Dentate patientpreference studies and
evaluation of dentate norms may provide information
for complete denture prosthesis fabrication. However,
application of these findings may be invalid since an
edentulous patient’s perception of how teeth should
look may be different from that of a dentate patient.13,14
This article reviews the English language peer-reviewed
literature from 1880 to the present. Articleswere identified from previous literature reviews, an extensive
hand search, and a search of MEDLINE using the key
words esthetics and denture esthetics.
a

Graduate Prosthodontic Resident.

386 THE JOURNAL OF PROSTHETIC DENTISTRY

Esthetics versus function
Some studies regarding predictors of complete denture success failed to show esthetics as more important
than function orcomfort.2,15,16 These studies often
review patients from Veterans Affairs hospital settings,
where one would expect function and comfort to be preferred to esthetics. In contrast to these studies, Carlsson
et al3 found that esthetics was the factor most responsible for complete denture success. Both the patient and
observer conception of the esthetic result were found
to be highly significant. Severalauthors have found further evidence that esthetics is the predominant factor in
complete denture success.13,17-19 Liefer et al19 had statistically significantly fewer adjustment appointments
and a greater number of pleased patients when all esthetic decisions were made by the patient. This implies
that when the esthetic result was successful, the dentures
were more successful overall. Vig20...