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DR. SAJID SHAIKHDept. of Prosthodontics

JR-1

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The dentist who is treating a patient

esp. with complete dentures has more

to do with the beauty of the face then

any other person. The appearance of

the entire lower half of the face depends

on the denture.

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External Anatomy of Eyes

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- Imaginary line

running between the

two pupils of the eye

when the patient is

looking straight

forward.

- Establishing the

anterior Occlusal

plane of the artificial

teeth of the denture.

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- Imaginary line running

from the Inferior border

of the ala of the nose to

the superior border of the

tragus of the ear.

- Establishing the

posterior Occlusal plane

of the artificial teeth of

the denture.

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- Imaginary line

running from the outer

canthus of the eye to

the superior border of

the tragus of the ear.

- Locating the position

of the condyles

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The actions of the zygomatic

muscle in elevating the corner

of the mouth in smiling or

laughing produce the

nasolabial sulcus.

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- Nasolabial fold

become more

prominence with aging

& is restored by:

1- vertical dimension

2- anterior teeth

positioning

3- labial flange

- After extraction of

teeth it becomes

accentuated and

should be restored by

complete denture.

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Marionette lines are the lines which runs from the

angle of mouth towards the chin. Important

landmarks for the general expressions of the face.

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NASOLABIAL

ANGLE It is the angle formed between

lower border of the nose and a

line connecting the intersection

of nose and the upper lip with

the tip of the lip.

This angle is normally 110

degree

It reduces in patients with

proclaimed upper incisors

prognathic maxilla.

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Mentolabial Sulcus

Horizontal groove

midway between

the vermillion

border & the

inferior border of

the chin in the

lower is called

Mentolabial sulcus

or groove.

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- It determines the Angle of

Classification:

1- Angle class [I]: Normal ridge

relationship.

2- Angle class [II[: Retruded mandibular

position.

3- Angle class [III]: Protruded maxillo-

mandibular relation ship.

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Incorrect positioning of the anterior

teeth or supporting base material

complete dentures will alter the normal

appearance of the mentolabial sulcus,

vermillion border, and the philtrum in

edentulous patients.

Extra fullness of the lower lip may be the result of too broad mandibular arch or the the elimination or reduction of the mentolabial sulcus.

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- Diamond-shaped

area between the

centre of the upper

lip and the base of

the nose.

- After extraction of

teeth it becomes

flattened and should

be restored by a

complete denture.

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The drooping corners of the mouth tell the

story of the mishappens and misplaced dental

arch form of the anterior teeth.

- (Angular Chilitis): Inflammation and

ulceration as a result of:

1- Prolonged edentulism.

2- ↓ vertical dimension of complete denture.

3- Vitamin B deficiency.

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Ear lobe

The ear lobes can be used during maxillo-

mandibular relationship registration. This is

commenced by comparing the Fox plane guide

should be equal on both the sides and this is

estimated with the practitioners eyes. Any

discrepancies can be adjusted by adding or

removing from the oclusal rim.

As the ear lobes are important stable landmarks

unlike the moving pupils of the patients.

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• Orbitale (B) - Located by Hanau

facebow with help of orbital pointer.

• Orbitale minus 7 mm (C) - This

plane represents Frankfort plane.

• Nasion (A) - Used with quick mount

facebow (Whip mix)

• Ala of nose (D) - This plane

represents campers plane

• 43 mm superior from lower border

of upper lip (Denar reference plane

locator – Denar facebow uses this

reference point)

Various Anterior Reference Points

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Advantages of anterior reference point

1. Can visualize anterior teeth & occlusion

in the articulator in the same frame of

reference.

2. Determines which plane in the head will

become the plane of reference.

3. Determines the level at which the casts

are mounted to establish a baseline for

comparative studies between patient.

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Posterior reference points

A---Beyron point – 13 mm ant to

post margin of tragus of outer

canthus of eye

B---Gysi – 13mm ant to ant margin

of EAM

C---Snow – 11 -13 mm ant to

tragus

D---Denar’s – 12 mm ant to post

border of tragus and 5 mm inferior

to line from EAM and outer

canthus

Posterior Reference PointsIt helps in determining the position of true hinge axis on either side of the face.

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Facial Profiles

Aesthetics and appearance are very crucially

related to the facial profile of the person

concerned.

Faces come in different forms and are often

classified according to their shape and profile

which represent the front and side views

respectively.

These profiles are used to judge aesthetics

of appearance and analysis of characteristic traits

of a subject by face reading professionals

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The facial profile is examined by viewing the

patient from the side. the facial profile helps in

diagnosing the gross deviation of maxillo-

mandibular relationship. the profile is assessed

by joining the following two reference lines.

1. A line joining the forehead and the soft

tissue point A(deepest point in curvature of

upper lip)

2. A line joining point A and the soft tissue

pogonion(most anterior part of the chin)

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The types of face profiles

are as follows:•

Planar or straight :

In this profile, the person

will have neither the

intentional character of the

concave type or the

demanding nature of the

convex type. Their face is

a moderation between the

two profiles.

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Convex:

Convex profile includes

sloping forehead, slightly

prominent brows and

large slightly curved nose.

Further, people of convex

type have a receding chin

shape.•

This kind of profile occurs

as a result of prognathic

maxilla retrognathic

mandible as seen in class

II div 1

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Concave:

Concave profile comes with a

prominent forehead and

almost flat eyebrows. The

nose is bent or smaller and

straight or slightly curved

inward. There is usually flat

and chin is well formed with

an outward curve.

• This type of profile is

associated with a prognathic

mandible or retrognathic

maxilla as in CLASS III

MALOCCLUSION

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Scientists have found eleven

points to map and analyse fac

ial profiles called “fiducials”.

They are:

1.Forehead,

2.Glabella,

3.Nasion (bridge of nose),

4.Pronasale (tip of nose),

5.Subnasale (base of nose),

6.Labiale superius (top lip),

7.Stomion (middle of lips),

8.Labiale

inferius (bottom lip),

9.Supramenton,

10.Menton (chin) and

11.Throat

It is basically the outline form of face esp., anterior view sometimes described geometrically are as1. Square2. Square tapering3. Tapering4. Ovoid

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Smile line

Smile line refers to an imaginary line along the incisal

edges of the maxillary anterior teeth which should

mimic the curvature of the superior border of the lower

lip while smiling. Another frame of reference for the

smile line suggests that the centrals should appear

slightly longer or, at least, not any shorter than the

canines along the incisal plane.

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This approach is particularly useful in

cases of lip symmetry or extreme lip

curvature during smile formation. Reverse

smile line or inverse smile line occurs

when the centrals appear shorter than the

canines along the incisal plane

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Lip line

Lip line should not be confused with the smile

line. It refers to the position of the inferior border

of the upper lip & the gingival edge of the

maxillary central incisors and thereby

determines the display of tooth or gingiva at this

hard and soft tissue interface

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However a 2mm limit should be

established above and below

the gingival edge, thus

instituting 3 classes

1. High lip line – A 2mm or

above display of gingival

tissues.

2. Medium lip line – Gingival

margin & the lip line is

congruent.

3. Low lip line – A 2mm or

more below the cervical line

of upper central incisors.

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Although Maxillary lip line is evaluated

during smiling

Mandibular low lip line is evaluated

during speech

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Extra oral midline references

Determination of the midline reference line

The best way to assess the symmetry of a face is

through the creation of a reference line in the

center of the face. This reference line is usually

obtained by joining two points of the face:

Glabella and Subnasale . The Glabella (Gl) is the

midpoint between the eyebrows and the

Subnasale (Sn) is the base of the nose.

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The line going through Glabella and Subnasale becomes the reference

line . In a clinical setting, a piece of dental floss may be used to

determine the reference midline. This line will be used to determine the

alignment and symmetry of the facial structures in the transverse

dimension. From this line, the general symmetry of the face will be

assessed. Any noticeable variations should be noted.

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Determination of the upper dental midline

A point is placed between the two central

incisors. If the point is on the reference line, the

upper dental midline is centered. If the point is

located to the left or right of the reference line

then the upper midline is deviated and the

direction and the amount of deviation should be

noted. It is important to differentiate between the

facial (Gl-Subnasale) and the upper dental

midline.

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Evaluation of the mandibular midline

A point is placed on the centre of the chin.

This point is called the soft tissue

Pogonion The Pogonion (Pg) is the most

anterior part of the chin. If the soft tissue

pogonion is aligned with the reference

line, the mandible is centered. If this point

is not on the reference line, the mandible

is deviated in the direction of the point.

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Conclusion

It is vivid from the above discussion that the

prosthesis or smile we create should be

aesthetically appealing and functionally

sound too in respect to normal harmony of

the facial landmarks. It is our duty to

carefully diagnose, analyse and deliver the

best to our patients, taking into account all of

the discussed factors.

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References

• Bouchers book of Prosthodontics 9th edition

• Prosthodontic treatment for edentulous patients Zarb 13th

edition

• Essentials of Complete dentures prosthodontics- Winkler

• Journal of Baghdad College of Dentistry vol 22 no 1 2010

pg 11-12

• Current knowledge & perspectives in prosthodontics

kumar p, kumar a

• Esthetic dentistry in clinical dentistry- Marc geissberger

• Internet

• www.dentalpaedia.ca/orthondontic

• www.academia.edu/facialprofiles

• www.toothbody.com/earlobes

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