Lip Support Research Articles

Treatment planning for the management of selected dento‐facial abnormalities

Existing treatment planning aids for the management of dento-facial abnormalities do not adequately assess the neuromuscular status of the oro-facial soft tissues. Where an element of mandibular overclosure exists the patient assessment technique provides a reproducibile and clinically acceptable occlusal vertical dimension of occlusion. In the three cases treated a functional impression technique for establishing the upper lip support produced a reproducible profile which was both aesthetically and functionally satisfactory.

Denture esthetics is more than tooth selection

The selection of the proper mold and shade of denture teeth is but one part of denture esthetics. Compensating for lost alveolar bone, correctly positioning anterior teeth for lip support, and reestablishing the correct vertical dimension of occlusion, in combination with proper tooth selection, creates good denture esthetics. Proper contour and normal physiologic movement of the muscles enhances an esthetic denture, whereas improper support can severely detract from it. Even though denture construction requires a step-by-step progression, these steps cannot be isolated but rather must be integrated to produce an optimal result.

Severe mandibular retrognathism: Orthodontic versus surgical orthodontic treatment

1. 1. Treatment of Class II, Division 1 malocclusions should be accomplished by normalization of the abnormal structures that are identified diagnostically. 2. 2. In the presence of mandibular retrognathism and unfavorable growth potential (limited amount, undesirable direction), surgical mandibular lengthening should be incorporated into the treatment plan. 3. 3. Compensation for mandibular retrognathism by conventional orthodontic and facial orthopedic treatment incurs the risk of (a) increase in nasolabial angle, (b) reduction in upper lip support, (c) increase in lower facial concavity, (d) excessive proclination of lower incisors with compromise of labial periodontal support, and (e) protracted duration of appliance therapy and accompanying detrimental periodontal and root resorption effects.

The Trial Denture

1. Many difficult situations can be avoided if the dentist keeps constantly aware of the physiologic, the psychologic, and the artistic factors involved in the construction of dentures, whether they be partial or complete. 2. No one would think of buying an automobile without getting adequate instruction in how to drive; neither should a patient expect to wear artificial restorations without training and practice. 3. The dentist at the try-in should check: a. The bases for fit and extension. b. Thin labial flange at frenum area. c. Posterior palatal seal and length of upper. d. Posterior tooth position for height of plane, relation of plane to alatragus line, tongue room, and ridge relation. e. Anterior tooth position for lip support, length, and relation to lower lip. f. Entire setup for vertical dimension of the face, test balance and simultaneous tooth contacts in all desired positions. If discrepancies exist between the articulator and the mouth, make new jaw relation records. g. Check palatal contour and incisor positions in speaking. “F” and “V” sounds to test the upper incisors, sibilant sounds for vertical dimension and lower-to-upper incisal relationships. h. Wax-up for support and proper external form. If tori exist on upper or lower, be sure there is sufficient thickness to allow relief later on. i. Be sure to repeat and continue instruction of the patient in his understanding and handling of the new dentures. Now, in addition to all these checks the dentist makes, he must constantly anticipate the thoughts and attitudes of the patient and interpret them for better rapport and ultimate patient understanding. No stage in complete dentures is anticipated with such mixed emotions as is the try-in. No stage is so significant to the future success or failure of the patient to take dentures in his stride. No stage has so much potential for making the person happy or sinking him into the depths of despair. The return of self-confidence, the pride in appearance, the sparkle and drive that return to a patient when the restorations are enthusiastically accepted are a wonderful reward for dentistry well done.

The Try-in

1. Many difficult situations can be avoided if the dentist keeps constantly aware of the physiologic, the psychologic, and the artistic factors involved in the construction of dentures, whether they be partial or complete. 2. No one would think of buying an automobile without getting adequate instruction in how to drive; neither should a patient expect to wear artificial restorations without training and practice. 3. The dentist at the try-in should check a. The bases for fit and extension. b. Thin labial flange at frenum area. c. Posterior palatal seal and length of upper. d. Posterior tooth position for height of plane, relation of plane to ala-tragus line, tongue room and ridge relation. e. Anterior tooth position for lip support, length and relation to lower lip. f. Entire setup for vertical dimension of the face, test balance and simultaneous tooth contacts in all desired positions. If discrepancies exist between the articulator and the mouth, make new jaw relation records. g. Check palatal contour and incisor positions in speaking. “F” and “V” sounds to test the upper incisors, sibilant sounds for vertical dimension and lower-to-upper incisal relationships. h. Wax-up for support and proper external form. If tori exist on upper or lower, be sure there is sufficient thickness to allow relief later on. i. Be sure to repeat and continue instruction of the patient in his understanding and handling of the new dentures. Now, in addition to all these checks the dentist makes, he must constantly anticipate the thoughts and attitudes of the patient and interpret them for better rapport and ultimate patient understanding. No stage in complete dentures is anticipated with such mixed emotions as is the try-in. No stage is so significant to the future success or failure of the patient to take dentures in his stride. No stage has so much potential for making the person happy or sinking him into the depths of despair. The return of self-confidence, the pride in appearance, the sparkle and drive that return to a patient when the restorations are enthusiastically accepted are a wonderful reward for dentistry well done.

TREATMENT OF THE LIP AND CHEEK IN CASES OF FACIAL PARALYSIS

A new simple method of supporting the lip and cheek in cases of Bell's palsy or facial paralysis has been found to be successful in a number of instances. It is necessary to give this support to prevent the droop and loss of tone that is so characteristic of these tissues in facial paralysis. This method consists in cradling the lip and cheek in a translucent plastic support and connecting that support by rubber band tension to a metal hook that is fastened to the last upper molar on the affected side (fig. 1). The lip support or cradle (A-B) is the part that actually lifts the lip and cheek under tension from the rubber hand. It consists of two flanges and a connecting bar that is shaped to conform to the closed lips (fig. 2). The flanges should be large enough to keep the tissues from bunching at the