Dynesthetic and Dentogenic Concept Revisited

WILLIAM S. JAMESON, BS, DDS*

ABSTRACT
The dynesthetic and dentogenic concept, when applied, provides a more natural, harmonious
prosthesis, which not only is desired by patients, but also is a quality of care they deserve.
Outstanding esthetics can be achieved by simple guidelines, using tooth molds specifically
sculpted for males and females, arranging prosthetic teeth to correspond with personality and
age and sculpting the matrix (visible denture base) with more natural contours. There is no
reason for edentulous individuals to be provided with care of any less quality than that avail-
able with other procedures, such as crowns, bridges, veneers, or implant restorations. Provid-
ing this upscale product can be rewarding and satisfying to patient and operator alike. This
concept produces superior results no matter what posterior occlusal scheme is employed
but, in the opinion of the author, works best when used in conjunction with a noninterceptive
linear occlusion approach (not to be confused with lingualized occlusion), which precludes
anterior contact.
CLINICAL SIGNIFICANCE
Dentogenics provides an approach to esthetics in prosthodontics that enables the dentist to create
a restoration in harmony with the patient’s objective personality. This concept considers gender,
age, and personality to restore the patient’s dignity and unique individuality that has been miss-
ing in far too many prostheses.
(1Esthet Restor Dent 14:139-149,2002)

A new approach to esthetic con- Traditionally, most dentists were

T here exists a natural desire on
the part of edentulous individ-
uals to avoid an appearance of
cepts, known as the dynesthetic
concept, was suggested by Frush
taught to arrange anterior teeth on
a “silver dollar” curve with their
aging or “the denture look” associ- and Fisher over 40 years ago when incisal edges straight across and
ated with old age. Current society is they authored a series of articles long axes radiating from a common
obsessed with the need to appear that presented a concept of esthet- point of origin. This was done with
youthful, to avoid any appearance ics based on gender, personality, molds that could be used for both
of inevitable aging1 Unfortunately, and To achieve a more males and females (Figure 1).A
as pointed out by Donovan and col- natural-appearing denture, three perceived need to place anterior
leagues: it is their opinion that the ingredients were necessary: the teeth over the crest of the residual
majority of complete dentures fab- right teeth, placed in the proper ridge for mechanical stability thus
ricated do not achieve the esthetic position, and held in place by a produced a truly “false teeth” look.
potential currently possible. This is natural-appearing matrix (visible Besides crowding the tongue, this
an esthetic need that is not being denture base). approach made it necessary to use
met by the profession.

*Consultant,Department of Veterans Affairs, Tucson, Arizona

VOLUME 14, N U M B E R 3 , 2002 139
 DYNESTHETIC AND DENTOCENIC CONCEPT REVISITED

the patient’s skin tone, satisfy the

needs of the vast majority of
patients. Rather than attempting
to select an appropriate mold from
all those available, its use not only
speeds the process but also ensures
a greater margin of accuracy for
Figure 1 . A thin upper lip with all incisal edges straight and dentists with limited experience.
even, typical of “false teeth * dentures.
Frush and Fisher also advocated
rotational and positional variance
smaller teeth to fit within the space Frush and Fisher advocated use of with individual anterior teeth to
available, which resulted in lack of appropriate molds for males and achieve different light deflections,
normal upper lip support. Introduc- females rather than attempting to enhancing the appearance of vital-
tion of the influence of gendeq per- make a single mold work for both. ity in nonvital substances. This
sonality, and age on arranging ante- To simplify this decision-making produces natural asymmetry, as
rior denture teeth was revolutionary process, a pictorial guide (Mold seen in nature. Positioning of lat-
in light of what was being practiced Selection Guide, Geneva Dental, eral incisors either softens or pro-
by the profession. Inc., Beverly Hills, California) of duces ruggedness depending on the
these three personality categories patient’s gender. Canines are
In a dentogenic restoration, embody- of men and women, as well as a arranged with their long axis posi-
ing gender, personality, and age, suggested mold for each category, tioned vertically. The neck is more
gender and physiologic age are is available (Figure 2 ) . These six prominent than the incisal edge
readily determinable. But personal- molds, in shades appropriate for for women, and from the front,
ity, the most difficult to determine,
is the best measure of each patient’s
priceless individuality. It is the
objective physical personality that
is unique for each individual. In the
course of normal social activity, the
smile is the primary objeaive per-
sonality of a human being.

An individual falls into one of three

categories: delicate, moderate, or
vigorous. By selecting a mold cate-
gory of artificial teeth that corre-
sponds with a patient’s objective
personality, it is possible to restore
harmony between the personaIity of
artificial teeth and the personality Figure 2. Three male and female personality types with their
of an individual. compatible tooth molds.

140 J O U R N A L OF E S T H E T I C A N D R E S T O R A T I V E D E N T I S T R Y
 JAMESON

only the mesial half is visible. This

is consistent with the divine or
golden proportion ~ o n c e p t , ~ - ~ ~
which, although not a scientifically
valid c o n ~ e p t , ’has
~ been proven
to be an excellent artistic approach
upon which to build. From a
frontal view, central incisors are
longer than lateral incisors and Figure 3. Typical dentogenic female arrangement and smile
canines slightly higher than later- line following curvature of lower lip.
als, creating a curve of the incisal
edges that follows that of the
lower lip when the individual appearing mandibular “sky line” in prior to treatment, this approach
smiles (Figure 3). This became reality is actually as important as is readily accepted by patients.
known as the “smile line.” the smile line, since an individual
talks considerably more than he or With linear occlusion, mandibular
Using noninterceptive linear occlu- she smiles. It is natural for anterior teeth, which are intended
sion posterior teeth (Auto-Centric mandibular anterior teeth to show more for esthetics than function,
Posteriors, Geneva Dental, Inc.) during speech, while the upper lip, can be placed with their labial
and the bilateral fulcrum of protru- which is relatively inactive, hides surface falling within the labial
sive stability,14J5 maxillary anterior the maxillary teeth. Arrangements vestibule. Long axes can be varied
teeth are positioned where they in either arch that are too perfect (Figure 5), as well as their position
were prior to loss, anterior to the tend to be monotonous and appear labiolingually (Figure 6 ) ,creating
ridge crest. Thus, functional ante- false, lacking in asymmetry that irregularities and asymmetry. Since
rior rotational contacts are avoided creates an illusion of naturalness.’ this occlusal concept avoids ante-
(Figure 4). This promotes stability When presented and explained rior contact, any horizontal overlap
and positioning that enhances both
phonetics and esthetics.

Previously published articles

regarding esthetics have concen-
trated on the maxillary anterior
six and achieving a pleasing smile
line. Little attention was given to
arrangement of the mandibular
anterior teeth.ld18 Irregularity in
the arrangement of these teeth
results in staggered, uneven incisal
edges, similar to a metropolitan sky
line. Thus, the too perfect monot- Figure 4. The bilateral &lcrum of protmsive stability. Only
the blade of the lower second premolar contacts the upper
ony of straight, even incisal edges first premolar occlusal surface edge, preventing anterior rota-
is avoided. Creation of a natural- tional contact.

VOLUME 14, NUMBER 3 , 2 0 0 2 141

 DYNESTHETIC AND DENTOCENIC CONCEPT REVISITED

and absence of vertical overlap neck and peripheral border are duplicated no matter how natural
become nonfactors. Stability of the actually more conducive to restor- they might appear. It might look
mandibular prosthesis is greatly ing lost tissue contour on the pol- totally in harmony with an individ-
improved, and trauma, which ished surface of the denture. Stip- ual's personality and age but be dif-
causes most resorption of anterior pling helps break up light reflection ficult to keep clean and produce
residual ridges, is eliminated or as well as prevent food adherence, undesirable food traps.
reduced. With no actual anterior but should never be done in areas
contact, use of porcelain anterior of attached gingivae near the necks Since technicians must arrange
teeth, which possess greater translu- of teeth. Mimicking nature always anterior teeth on a wax occlusal
cency and luster than their acrylic works best; therefore, detailed casts rim without benefit of seeing the
resin counterparts, is not only pos- of dentate mouths produced from patient,19 accurate communication
sible but recommended. accurate, irreversible hydrocolloid between dentist and technician is
impressions are an excellent source essential in complete denture
The other ingredient is the matrix for guidance in contouring.' Also, prosthodontics. The bridge between
(visible denture base). When using half-moon gingival contouring at the laboratory technician and patient
teeth with longer proximal contact necks of teeth is unnatural and is the wax occlusal rim. It is critical
areas (Geneva 2000 Porcelain Ante- should be eliminated. As with nat- that this communication vehicle
rior~,Geneva Dental, Inc.), it is pos- ural dentition, contour of the gingi- possess those qualities that effec-
sible to produce tear-drop contoured val crevice is determined by root tively transmit the desired informa-
interdental papillae (Figure 7). This prominence. The more prominent tion. There are many types of wax
sheds food particles more efficiently the area, the more root exposure occlusal rims, but the one preferred
than high, sharp, depressed inter- created (Figure 8). Even though by the author is the esthetic control
proximal spaces. Deep festooning spaces beneath contact areas may base (ECB) used with linear occlu-
or depressions accentuating root be present in periodontally involved sion.14 It is fabricated using alameter
prominences should be avoided. natural dentition, this should not be and papillameter (Geneva Dental,
Smoother, more subtle depressions duplicated. Unsightly or unattrac- Inc.) measurements derived from
and convex contours between tooth tive characteristics should never be the patient. When critiqued at the

Figure 5. Typicul linear occlusion maxillary and mandibular Figure 6. Incisal view of mandibular arrangement. Irregulari-
trial denture. Dentogenic irregularities of upper anteriors are ties and asymmetry contribute to natural appearance.
mimicked in lower anteriors.

142 J O U R N A L O F ESTHETIC A N D R E S T O R A T I V E D E N T I S T R Y
 JAMESON

Figure 7. Maxillary and mandibular prostheses immediately Figure 8. Natural dentition exhibiting gingival contouring
following cementation of lower porcelain-fused-to-metal influenced by root prominences. Note the gingival crevice of
restorations. Maxillary complete denture with the type of both maxillary central incisors inclines upward from the mesial
gingival matrix recommended in dentogenics (i.e., rounded, toward the distal root prominence of these rotated teeth.
tear-drop interdental papillae).

relation record appointment, the sibility of the dentist to become accomplished by a dentist, person-
anterior portion is verified to be knowledgeable regarding how and ally, rather than a technician they
parallel to the desired horizontal where to arrange at least these two never see and who never sees them.
occlusal plane and even with the teeth, preferably during the relation
upper lip at rest. Midline and high record appointment. Normally, for Creating an esthetically pleasing
lip line are marked after determin- females, the labial surfaces of these composition does not necessarily
ing proper lip support to be present two teeth are located approxi- depend entirely on one’s artistic
in both a frontal and profile view. mately 7 mm from the middle of ability. Creating a one-of-a-kind
It is also possible to verify presence the incisive papilla.20Males have a masterpiece with each setup is
of a proper buccal corridor lateral thinner, more muscular upper lip.21 not necessary. Following simple
to canine markings on either side Placement of their central incisors guidelines for arranging male and
(Figure 9 ) . Given this information at a position 5 mm from the middle female molds, selected according
and the patient’s age, either opera- of the incisive papilla is an excellent to personality, results in outstand-
tor or technician can arrange the starting point in achieving desired ing esthetics.
maxillary anterior teeth. With lin- lip support. This difference results
ear occlusion, maxillary central in males showing less of the incisal Principles of arranging artificial
incisors are key elements in estab- portion at rest than females, prosthetic teeth in removable
lishing the horizontal occlusal which is normal. It is far less time- prosthodontics are applicable to
plane. Their proper positioning is consuming and more cost efficient fixed prosthodontics as well (Figure
essential, not only for esthetics and for dentists to properly accomplish 10).Unless the arrangement is made
phonetics but also in determining this procedure than having to have asymmetric, the resulting composi-
the proper posterior occlusal plane. a reset and retry of the trial denture tion of multiple porcelain-bonded-
one or more times. Experience has to-metal restorations takes on a flat,
No matter what posterior occlusal demonstrated that nothing builds solid, artificial appearance. Even
concept is used, proper positioning more value into the service being exceptional talents of highly skilled
of maxillary central incisors is para- provided than for patients to see technicians in blending and shading
mount. Therefore, it is the respon- this particular procedure being are overshadowed by such a monot-

VOLUME 14, NUMBER 3, 2 0 0 2 143

 DYNESTHETIC AND DENTOCENIC CONCEPT REVISITED

slightly in front of the other. This

holds true for both males and
females. Using the ECB length as a
guide, which is even with the upper
lip at rest, central incisors are arrang-
ed according to patient’s age and
gender. Normally, for mature males,
Figure 9. Esthetic control base exhibiting buccal corridors the incisal edge is even with the lip at
and midline marking with expansive smile; anterior portion rest. A middle-age man would have
parallel to horizon. 1mm of tooth visible below the lip at
rest. For females, age also deter-
onous arrangement. Skillful lapping, of the population that has been mines how much tooth is visible:
rotation, and long axis angulation treated inadequately in the past. more for younger women (2-3 mm)
modification make restorations lit- than for more mature women, but
erally come alive. TECHNIQUE at least 1 mm regardless of age.
When arranging maxillary anterior
The purpose of this article is to pro- teeth, positioning of central incisors The wax is softened and prepared
vide a procedural guide for arrang- is paramount. They are not only the for one central incisor to the midline
ing maxillary anterior prosthetic dominant actors on the stage of mark. It is desirable to have the neck
teeth. By following this guide, a expression, the smile, but are also of the tooth positioned at the high
pleasing, natural-appearing arrange- crucial in determining the plane of lip line to minimize show of base
ment of teeth, in harmony with occlusion for function. The desired material when the lip is raised to its
and satisfying the unique esthetic lip support and position are verified maximum extent. The first central is
needs of each individual, is rou- during the ECB critique. Incisal edges positioned so that its mesial surface
tinely achieved. This makes it possi- should be straight and labial surfaces is contacting the wax, and the pins
ble to satisfy a need in a segment vertical (Figure ll),with one central are sealed to place (Figure 12).Using

Figure 10. A, Maxillary fixed restorations exhibiting female

dentogenic characteristics.B, Anterior restorations exhibit
characteristics that are in harmony with patient’s objective
personality.

144 J O U R N A L O F ESTHETIC A N D RESTORATIVE DENTISTRY

 JAMESON

front of or behind the other central, teeth. Moving central incisors

and then luted to place (Figure 13). labially produces more lip support
Once this wax has chilled, the ECB and raises the lip, necessitating
with the two central incisors is moving them up as well (Figure
placed in the patient's mouth. The 15). How much is needed is best
amount of tooth visible, lip support, determined by the operator while
maximum lip elevation (to check arranging these two teeth, before
position of the necks), and midline proceeding, rather than by written
(location and angulation) are veri- instruction to the technician.
fied as correct prior to proceeding.
If modification is necessary to If the operator elects to arrange the
achieve any of the established goals, remaining maxillary anterior teeth,
it is done before proceeding. lateral incisors are positioned fol-
lowed by canines. Otherwise, the
Frequently, in anterior hyperfunc- ECB with its two central incisors
tion syndrome, there is extensive and the relation record are sent to
Figure 1 1 . Stone cast showing normal loss of the maxillary residual ridge the laboratory for the technician to
anterior crown-root angulation. Used as
a guide in arranging prosthetic replace- (Figure 14).This makes it difficult establish the horizontal plane of
ment teeth this results in positions ante- to determine where the incisive occlusion after mounting the casts
rior to the edentulous residual ridge.
papilla was and, therefore, the in an articulator. Arrangement of
labial extent of the wax rim. the remaining anterior prosthetic
teeth that have a broad contact area, During the critiquing process, if teeth, maxillary and mandibular, is
such as found in the Geneva molds, it becomes evident that major then accomplished. These can be
is preferable. When the wax has changes are necessary, it is more returned to the operator for verifi-
chilled so the tooth is firm, wax in time-efficient for the operator to cation of correctness prior to com-
the adjacent central incisor area is position the central incisors to pletion of the setup or the posterior
prepared and that tooth arranged achieve the desired lip support teeth can be arranged and the com-
using the previously positioned tooth and tooth visibility than to modify pleted trial denture returned for
as a guide for length, but either in the wax rim and then arrange the evaluation and verification.

Figure 12. Wax suficient to accommodate the maxillary left

central incisor has been removed and the replacement tooth 13* The 'ght incisor has
been positioned using the left
positioned contacting the wax midline. The position of the
incisal edge above the wax rim is consistent for the patient, as the detemining guide*
who is a mature female.

VOLUME 14, N U M B E R 3 , 2 0 0 2 145

 DYNESTHETIC A N D D E N T O C E N I C CONCEPT R E V I S I T E D

Figure 14. A, Extensive loss

of maxillary residual ridge
makes determining where to
position replacement pros-
thetic teeth difficult. Proper
position must be verified
with a wax occlusal rim,
such as ECB. B, Example of
incorrect positioning of max-
illary anterior replacement
teeth. Patient has advanced
manifestations of combina-
tion syndrome.

If the denture laboratory is in casts on the original articulator for placed in the mouth for evaluation.
another city, it is difficult for the evaluation prior to proceeding. It is advisable not to permit patient
laboratory and doctor to send an viewing at this stage. Lack of teeth
articulator back and forth through With either approach, lateral in the posterior changes the patient’s
the mail. A solution would be to first incisors are positioned after the cen- perception, just as viewing teeth on
mount the casts in the doctor’s office. tral incisors (Figure 16). Their posi- a tooth card is difficult for a patient
Prior to mounting, a separating tion is dictated by patient gender to appreciate. The patient’s eyes are
medium is applied to the base of and amount of vigor desired in the accustomed to seeing a completed
each cast after it has been indexed arrangement. Any personality cate- denture with all teeth present, good
to facilitate removal and remount- gory can be made softer or bolder or bad, and the dentogenic arrange-
ing. Relation record and casts are by increasing or decreasing their ment is markedly different.
then removed from their mounting position and rotation. First one side Although patients want to look bet-
and forwarded to the laboratory to is prepared to receive the tooth and ter, they fear looking different and
be mounted anew on another artic- then the opposite lateral incisor is will need to be conditioned for the
uiator. There is a definite advantage positioned. Pins are secured in wax, change. The operator is better quali-
in using an intraoral tracing luted and after the wax has chilled, fied to determine if the arrangement
together with quick-setting stone or canines are positioned (Figure 17). produces the desired harmony with
impression plaster. When the trial the patient’s personality. It is also
denture is returned for verification, Once the canines are arranged in not advisable to allow the patient to
the doctor is able to remount the turn and sealed to place, the setup is view the arrangement with a hand

Figure 15. A, To achieve the desired lip support, the maxillary central incisors have been positioned anteriorly or labially. B,
Incisal edges of the maxillary central incisors are parallel to the anterior portion of the ECB, but below it, for the desired lip
support. C, Lip support and tooth visibility are evaluated before proceeding with remainder of anterior arrangement.

146 J O U R N A L OF ESTHETIC A N D R E S T O R A T I V E D E N T I S T R Y
 JAMESON

Figure 16. A, Maxillary lateral incisors arranged with asymmetry depicting softness consistent with female
characteristics. B, Incisal view reuealing prominence of mesiofacial line angles of maxillary lateral incisors.

mirror at any time. Viewing from a allowed to view the proposed waxing completes the dentogenic
speaking distance, when the trial restoration (Figure 18). restoration, giving dignity and indi-
denture is ready, provides for proper viduality back to the patient.
perspective and allows the patient to Character grinding or “aging” the
view the denture as others will. teeth creates the illusion necessary CONCLUSION
Only when the completed trial den- to harmonize with the patient’s per- For too long, edentulous individu-
ture is ready should the patient be sonality and age. Skillful matrix als have accepted a false paragon

Figure 17. A, Canines arranged with female characteristics-neck more prominent than incisal tip.
B, Canines positioned to reveal mesial half of labial surface only.

Figure 18. A, Completed arrangement of maxillary trial denture exhibiting male dentogenic characteris-
tics. This is a reverse articulation situation with linear occlusion blades arranged in maxillary arch. B,
Completed arrangement of maxillary trial denture exhibiting female dentogenic characteristics.

VOLUME 14, NUMBER 3, 2002 147

 D Y N E S T H E T I C AND D E N T O G E N I C C O N C E P T REVISITED

10. Lombardi RE. The principles of visual per-

ception and their clinical application to
dental esthetics. J Prosthet Dent 1973;
9:358-3 81.

11. Levin EL. Dental esthetics and the golden

proportion. J Prosthet Dent 1978;
40:244-252.

12. Rufenacht C.Fundamentals of esthetics.

Berlin: Quintessence, 1990.

13. Preston JD. The golden proportion revis-

ited. J Esthet Dent 1993; 5:247-251.

14. Jameson WS.Linear occlusion: an alterna-

tive tooth form and occlusal concept. Cen
Dent 2001; 49:374-382.

15. Jameson WS. The use of linear occlusion

Figure 19. A, Patimt with a complete denture she has worn for 30 years conveying to treat a patient with combination syn-
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16. Hardy IR. Problem solving in denture

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148 J O U R N A L O F E S T H E T I C AND R E S T O R A T I V E D E N T I S T R Y