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Journal of Academy of Dental

Education

Review Article

Pre-extraction records in edentulous patients: A literature

review
Hashmi Mujibullah1, S. Hemamalini1, N. Vidhyasankari2, Dheepika Kittuchami3
1
CRRI, 2Professor, 3Senior Lecturer, Department of Prosthodontics and Crown and Bridge, KSR Institute of Dental Science and Research, Tiruchengode,
Tamil Nadu, India.

ABSTRACT
Success of a treatment lies in proper examination and treatment planning. Pre-extraction records have
significant part in deciding the treatment plan. They help us determining progressive changes that would
have taken place after exfoliation of natural tooth, guide us in determining the vertical dimension, teeth
positioning, and also establish a harmonious relationship between teeth and lips. This review article enhances
*Corresponding author the importance of pre-extraction records and various methods that can be used in treatment planning for
N. Vidhyasankari, edentulous patient.
Department of Prosthodontics Keywords: Pre-extraction record vertical dimension, Complete denture, Profile photograph, Speaking space
and Crown and Bridge, KSR
Institute of Dental Science and
Research, Tiruchengode,
Tamil Nadu, India. INTRODUCTION
[email protected]
Complete denture service restores the stomatognathic system, thereby improves the general
health of the patient. The face expresses the fullness of life and soul. The effect on facial
Received : 26 April 2021
appearance due to loss of teeth often causes psychological trauma. Vital areas of expression
Accepted : 27 May 2022
are located in the region of the mouth and it is the teeth which impact character to impression.
Published : 30 June 2022
Pre-extraction records are required for all the patients. These records will serve as a template
DOI in the construction of dentures and will also be of importance for any subsequent denture.
10.25259/JADE_4_2021 Pre-operative records can provide information about the shape, form, color, placement of the
natural teeth, the support the lips, and the relationship of the teeth to the lips for the design
Quick Response Code:
of the complete denture. Pre-extraction records act as a base for construction of complete
denture. Pre-extraction records have been most abandoned topic but it plays a meaningful
role in treatment planning. This literature review focuses on the significance of pre-extraction
records in edentulous patients.

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 Mujibullah, et al.: Pre-extraction records in edentulous patients

CLASSIFICATION 2. Profile method Profile template[1]

I GENERAL CLASSIFICATION [1] Cardboard profile[1]
Wire profile[3]
1. Pre-extraction diagnostic casts[2-6]
3. Measurements From photographs[4,10]
2. Instruments The Dakometer[1]
Interfrenal distance[6]
Profile template[3,7]
Closest speaking space[9]
Willis’s gauge[1]
Tattoo dots on gingival[6]
Sorenson profile scale[6]
Orofacial device[8] 4. Gauge oriented on palate[3]
5. Facial template[13]
3. Measurements Tattoo points[6]
Interfrenal distance[6] 6. Old dentures[11]
The closest speaking space[9]
PRE-EXTRACTION DIAGNOSTIC CASTS[2-6,14,15]
4. Photographs [4,10]

5. Radiographs[2,4] Roentgenograms Pre-extraction casts are a life size reproduction of

6. Others Old denture[11] the part of the oral cavity and facial structure for the
II BASED ON METHODS purpose of study and treatment planning (Glossary of
1. Extraoral methods The Dakometer[6,12] Prosthodontic Term - 9). Mounting the upper and lower
Sorenson profile scale[6] cast acts as an important source of information for the
Cardboard profile[6] study. They provide information about the teeth and
Orofacial device[8] inter-ridge distances in case of opposing edentulous
The profile tracer[7] spaces. Pre-extractions diagnostic cast acts as important
Facial template[13]
pre-extraction records and is used in selection of the
The closest speaking space[9]
2. Intraoral methods The interfrenal distance[6]
anterior teeth and measuring the arch width. They
Measurement between are also used in measuring the overjet and overbite
tattoo dots on gingival[6] [Figure 1].[6]
Measurement of nose-chin
distance[6] THE DAKOMETER[1,6,12]
III BASED ON USES [1]

Dakometer is an instrument that records the vertical

1. Recording vertical dimension Pre-extraction diagnostic
dimension and position of the upper central incisors.
of occlusion cast[2-6]
The Dakometer[6,12]
Recordings can be obtained with an error of ±1 mm.
Profile template[7]
Facial template[13] THE WILLIS GAUGE[6,12]
Willis guide[1]
Sorenson profile scale[1] It is used for recording vertical dimension before extraction.
Orofacial device[8] The arm (A) contacts the base of the nose, the arm (B) moves
Photographs[4,10] along the slide (D) touching the lower border of the chin. It
Radiographs[2,4] is locked by the screw (C). The distance on the scale (D) gives
Old dentures[11] the vertical height.
2. Recording centric relation Pre-extraction diagnostic
casts[2-6] Disadvantages
3. Arranging upper anterior teeth Pre-extraction diagnostic
for a completely edentulous cast[2-6] This is not a very accurate measurement. The same
patient The Dakometer[6,12] degree of pressure is applied when the instrument
Profile template[7] contacts with the base of the nose and under surface of
Wills guide[1] the chin.
Incisor point locator[6]
3-dimensional THE SORENSON PROFILE SCALE[6,14]
photography[4]
Photographs[4,10] The Sorenson Profile Scale is used to obtain a pre-extraction
Old dentures[11] occlusal vertical dimension. This is done by placing the
IV BASED ON MEASURING METHODS nasion locator at the bridge of the nose and the chin seat is
1, Special gauge Wills guide[6] raised slightly as it touches the most inferior and anterior
Sorensen profile scale[1] border of the chin. The patient is asked to bring posterior
The Dakometer[6,12] teeth in centric.

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 Mujibullah, et al.: Pre-extraction records in edentulous patients

CARDBOARD PROFILE RECORD[6] TATTOO DOTS

This method was given by Ballard. This record gives the This was given by Silverman where tattoos (India ink)
occlusal vertical dimension and the facial contour (median are placed in the upper and lower gingiva. They are
plane). This is the record of the patient with natural placed between attached gingiva and depth of vestibule.
profile. This could be taken by the dentist once in 4 years Dividers are used to make three measurements while the
and adjust the dentures to restore the normal profile. The patient is speaking, and mean of those measurements is
cardboard profile is used similar to the Sorenson Profile used.
Scale.
Limitations
INTERFRENAL DISTANCE[6]
1. Tattoo points are not a permanent point because
Interfrenal distance is the distance between the maxillary sometimes it may disappear.
labial frenum and mandibular labial frenum, from which 2. As it is a soft-tissue measurement, changes in soft tissues
it is measured when the teeth are in occlusion before would occur after tooth extraction. This could lead to
extraction. This is used for the determination of occlusal errors during complete denture fabrication.
vertical dimension during complete denture fabrication.
Pair of dividers is used to measure the interfrenal distance.
NOSE-CHIN DISTANCE[4,6]
This measurement could not be used if surgery was done on
any of the labial frenum and the highly resorbed maxillary The nose-chin distance is given by Smith. This is used to
and mandibular ridge leads to the displacement of a frenum determine which acts as a pre-extraction record. The distance
[Figure 2]. between the base of the nasal septum and the inferior
contour of the chin is measured. This is done with a plastic
ruler. Since chin is a soft-tissue area, the pressure applied to
this area is not same all the time.

Advantage

This is a simple, convenient, inexpensive, and accurate

method which does not require sophisticated instruments.

INCISOR POINT LOCATOR[6]

This method was introduced by Smith in 1971 which records
the incisor point. An instrument is used to transfer the
incisor point location from a pre-extraction diagnostic cast
to the edentulous occlusal rim.

Figure 1: Pre-extraction record. FACIAL TEMPLATE[4,7,13]

Facial template is the outline form, pattern, or mold of the
face used for the construction of complete denture; this acts
as a permanent record. It is easy to fabricate a denture with
previously recorded intermaxillary space, predetermined jaw
relationship, size, and shape of teeth.

PROFILE RECORD[3]
By adapting wire to the facial contour and using radiographic
techniques or using photographs, profile records can be
obtained. Profile records obtained before surgery help us
in determining the exact position of anterior teeth and lip
support to be provided by the dentures to obtain a desired
Figure 2: Interfrenal distance. esthetic result.

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 Mujibullah, et al.: Pre-extraction records in edentulous patients

DETAILS FROM PREVIOUS/OLD DENTURES[11] The proportion is arranged as:

This method is only applicable if existing denture is present Interpupillary distance

and they are within a normal limit. The old denture can be of patient x
inserted, thereby horizontal and vertical relationship can =
Interpupillary distance on Width or length of central
be examined. Since we have the measurements of previous
photograph incisor on photograph
denture, occlusal rims can be constructed with same
dimension thereby saving time [Figures 3 and 4].
ROENTGENOGRAMS[18-21]
THE PROFILE TRACER [6,7]
They are used for selecting anterior teeth. They help in
The device has been made to allow the dentist to trace rapidly selecting crown form, width, and length. It shows impacted
and accurately, a profile record for a patient with minimal or impacted teeth, residual roots, and quality of alveolar
difficulty. The initial device, developed in 1931, has been used bone.
to record the profile of patients who are to have all remaining
teeth removed and dentures constructed. ANTHROPOMETRIC MEASUREMENTS[17]

PHOTOGRAPH[4,12,14-17] Width of the upper central incisors can be obtained by

dividing the bizygomatic width by 16. The width of the upper
Photograph of the patient can be used in selecting size, form close six anterior can be obtained by dividing the bizygomatic
to that of natural teeth and necessary modifications can be done. width by 3.3. They help in selection of artificial teeth.

PRE-EXTRACTION PROFILE RECORDS[22]

Profile record is a registration or record of the facial
profile of the patient. These records contain valid pre-
extraction information. They can be stored in patient’s
chart [Figure 5].

Figure 3: Measurement of vertical height on old denture.

Figure 4: Adjusted vertical height on occlusal rim. Figure 5: Traced soft-tissue profile.

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 Mujibullah, et al.: Pre-extraction records in edentulous patients

Advantages 3. For the study and research purposes.

4. Establishing vertical dimension of occlusion and to
1. Recording of clinical data is done before extraction of the maintain the jaw relationship that existed in natural
natural teeth; hence, it is easy, quick, and inexpensive. tooth.
2. Pre-extraction record can be stored in patients chart. 5. To determine the correct profile of the upper and lower
3. Once natural teeth are extracted, these records can be lips, placement of upper central incisor with proper
used to compensate for changes that occur. inclination, and occlusal plane angle.
6. Used for incisal placement of the upper and lower
THE SPEAKING METHOD[23,24]
anterior teeth with horizontal and vertical overlap and
Before the loss of natural teeth, this method can be used to appropriate positioning of maxillary and mandibular
measure the vertical dimension and can be reproduced in central incisors labiolingually.
complete denture. 7. For the selection of anterior teeth using photographs and
shades of the extracted natural tooth during complete
Advantage denture fabrication.
8. Date of fabrication of the pre-extraction record is noted
1. Measurement of vertical dimension using this method is for the future reference.
simple and requires less time. 9. Articulator guidance can be adjusted using occlusal
2. Measurement can be made in <1 min and hence it is facets present in natural teeth.
very practical.
3. This method is accurate. Limitations

THREE-DIMENSIONAL PHOTOGRAPHY[4] 1. Error of ±1 mm is obtained during recording of vertical

dimension of occlusion using Dakometer and Wills
Pre-extraction records are a necessity for the discriminating gauge. In severely resorbed ridges, the pre-extraction
dentist. Specifically, designed equipment and different records are less valuable for the construction of dentures.
cameras are used for this purpose. They contain series 2. In any facial fractures, trauma, or maxillofacial cases, the
visual images of the patient and hence they help in tooth pre-extraction records are less important because of the
arrangement. This helps in exact reproduction of the natural loss of facial structures.
appearance. 3. Very difficult to maintain these records for a long time
as the diagnostic cast and materials get abraded or
NATURAL TEETH [19] accidental fall fracture may occur. Photograph gets faded
if kept for a long time.
The natural teeth are collected after the teeth have been 4. The tattoo dots, interfrenal, or soft-tissue measurements
extracted and preserve it or before extraction by taking are more prone to change their position after extraction
hydrocolloid impression, extracted teeth were positioned and can cause error in fabrication.
in the impression and pour a cast. This gives the arch size,
shape, and form of natural teeth, but is not used to identify CONCLUSION
tooth color because extracted teeth are unreliable as they
dehydrate and become lighter. The pre-extraction records are simple, effective, practical,
and time saving during complete denture fabrication. The
ESTHETIC OCCLUSAL RIMS[2,5] pre-extraction record is used for teeth arrangement similar to
natural teeth, thereby achieving excellent patient confidence.
They help in reproduction of natural teeth in the occlusal Casts of the upper and lower teeth can be mounted and used
rims. It uses various pre-extraction records and study casts. for the study. Anatomic characteristics can be preserved and
used for the study by making pre-extraction records.
OROFACIAL DEVICE[8]
Declaration of patient consent
This is used for determining and establishing the occlusal
vertical dimension and occlusal plane. Patient’s consent not required as there are no patients in this
study.
USES OF PRE-EXTRACTION RECORDS
Financial support and sponsorship
1. For diagnosis and treatment planning.
2. Pre-treatment and post-treatment evaluation. Nil.

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 Mujibullah, et al.: Pre-extraction records in edentulous patients

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