Both maxillary complete denture’s labial flange and anterior artificial teeth play important roles in re-establish major support for the upper lip of elderly patients. However, whether the labial flange can be removed and still perceived as aesthetic remain unclear. Objective: To determine the perception of young adults toward the effect of a labial flange and anterior teeth on lip support of an elderly with maxillary complete dentures. Methods: A total of 64 young adults were recruited to evaluate the lip support for facial aesthetics of 30 full-face photographs in 3 different states: with an original complete denture (CD), with a flangeless duplicated denture and without the complete denture. They were rated using a Visual Numerical Scale (VNS) of 10, with 1 being the least attractive and 10 being the most attractive and repeated twice in random order. Soft-tissue profile analysis was performed to determine which facial anatomical landmarks were most important for lip support and aesthetics. Results: The overall VNS rating with CD (6.33 ± 0.58) was significantly higher (p < 0.001) than images with flangeless (5.58 ± 1.01) or without CD (5.23 ± 1.30). The landmarks that showed the most significant changes were in the subnasale area and NLA with original CD (p=0.060, p=0.072) and in frontal lip thickness with flangeless (p=0.082). There are strong correlations between subnasale and NLA and the mean total aesthetic VNS rating of images with CD, but not statistically significant (r=0.708; p=0.118, r=-0.835; p=0.078). Conclusion: The labial flange of a maxillary complete denture plays an important role in lip support and results in the aesthetic perception of the dentures wearer. The anterior teeth alone provide fullness to the lips, but not enough for labial support.


1. Sutton DN, Lewis BR, Patel M, Cawood JI. Changes in facial form relative to progressive atrophy of the edentulous jaws. Int J Oral Maxillofac Surg. 2004; 33(7):676-82.

2. Tallgren A. The continuing reduction of the residual alveolar ridges in complete denture wearers: A mixed-longitudinal study covering 25 years. 1972. J Prosthet Dent. 2003; 89(5):427-35.

3. Kamashita Y, Kamada Y, Kawahata N, Nagaoka E. Influence of lip support on the soft-tissue profile of complete denture wearers. J Oral Rehabil. 2006; 33(2):102-9.

4. Neves FD, Mendonça G, Fernandes Neto AJ. Analysis of influence of lip line and lip support in esthetics and selection of maxillary implantsupported prosthesis design. J Prosthet Dent. 2004; 91(3):286-8.

5. Bidra AS, Zapata G, Agar JR, Taylor TD, Grady J. Differences in lip support with and without labial flanges in a maxillary edentulous population. Part 1: Objective analysis. J Prosthodont. 2018; 27(1):10-16.

6. Zitzmann NU, Marinello CP. Treatment plan for restoring the edentulous maxilla with implantsupported restorations: Removable overdenture versus fixed partial denture design. J Prosthet Dent. 1999; 82(2):188-96.

7. Jivraj S, Chee W, Corrado P. Treatment planning of the edentulous maxilla. Br Dent J. 2006; 201(5):261-79.

8. Nordenram G, Davidson T, Gynther G, Helgesson G, Hultin M, Jemt T, Lekholm U, Nilner K, Norlund A, Rohlin M, Sunnegårdh-Grönberg K, Tranæus S. Qualitative studies of patients’ perceptions of loss of teeth, the edentulous state and prosthetic rehabilitation: A systematic review with meta-synthesis. Acta Odontol Scand. 2013; 71(3-4):937-51.

9. Hernández EL, Alvarez A, Abou-Ayash S, Att W. Effect of complete dentures on facial soft tissue volume: A 3D comparative study. Int J Prosthodont. 2022; 35(2):208–18.

10. Wen YF, Wong HM, Lin R, Yin G, McGrath C. Inter-ethnic/racial facial variations: A systematic review and Bayesian meta-analysis of photogrammetric studies. PLoS One. 2015; 10(8):e0134525.

11. Ab Talib M, Abdul Aziz NS, Khursheed Alam M, Basri R, Purmal K, Rahman SA. Linear and angular cephalometric measurement of lip morphology among Malaysian Malay. Int Med J. 2014; 21(1):41-4.

12. Lin CS, Shaari R, Alam MK, Rahman SA. Photogrammetric analysis of nasolabial angle and mentolabial angle norm in Malaysian adults. Bangladesh J Med Sci. 2013; 12(2):209-19.

13. Fitzgerald JP, Nanda RS, Currier GF. An evaluation of the nasolabial angle and the relative inclinations of the nose and upper lip. Am J Orthod Dentofacial Orthop. 1992; 102(4):328-34.

14. You L, Deng KH, Li WW, Zhao YJ, Sun YC, Zhou YS. [Visual sensitivity threshold of lateral view of nasolabial Angle changes in edentulous jaw patients]. Beijing Da Xue Xue Bao Yi Xue Ban. 2020; 52(1):107-12.

15. Samorodnitzky-Naveh GR, Geiger SB, Levin L. Patients’ satisfaction with dental esthetics. J Am Dent Assoc. 2007; 138(6):805-8.

16. Tortopidis D, Hatzikyriakos A, Kokoti M, Menexes G, Tsiggos N. Evaluation of the relationship between subjects’ perception and professional assessment of esthetic treatment needs. J Esthet Restor Dent. 2007; 19(3):154-62.

17. Tole N, Lajnert V, Kovacevic Pavicic D, Spalj S. Gender, age, and psychosocial context of the perception of facial esthetics. J Esthet Restor Dent. 2014; 26(2):119-30.

18. Bid ra AS, Ur ibe F, Taylor TD, Agar J R, Rungruanganunt P, Neace W P. T he relationship of facial anatomic landmarks with midlines of the face and mouth. J Prosthet Dent. 2009; 102(2):94- 103.

19. Nomura M, Motegi E, Hatch JP, Gakunga PT, Ng’ang’a PM, Rugh JD, Yamaguchi H. Esthetic preferences of European American, Hispanic American, Japanese, and African judges for softtissue profiles. Am J Orthod Dentofacial Orthop. 2009; 135(4 Suppl):S87-95.

20. Oliveira PL, Motta AF, Guerra CJ, Mucha JN. Comparison of two scales for evaluation of smile and dental attractiveness. Dental Press J Orthod. 2015; 20(2):42-8.

21. Fanibunda KB, Allcock GC, Thomason JM. Changes in the facial profile following insertion of complete dentures. Eur J Prosthodont Restor Dent. 2002; 10(4):143-9.

22. Reeson MG, Jepson NJ. Achieving an even thickness in heat-polymerized permanent acrylic resin denture bases for complete dentures. J Prosthet Dent. 1999; 82(3):359-61.

23. Feghali J, Khoury E, Souccar NM, Akl R, Ghoubril J. Evaluation of preferred lip position according to different tip rotations of the nose in class I young adult subjects. Int Orthod. 2019; 17(3):478-87.

24. Rahman MMU, Dwivedi P, Tiwari RVC, Virk I, Lahoti A, Kumar S, Pandey PR. Aesthetic in complete denture-A review. J Adv Med Dent Sci Res. 2020; 8(1):187-9.

25. Uhlendorf Y, Sartori IA, Melo AC, Uhlendorf J. Changes in lip profile of edentulous patients after placement of maxillary implant-supported fixed prosthesis: Is a wax try-in a reliable diagnostic tool? Int J Oral Maxillofac Implants. 2017; 32(3):593-7.

26. Azad LCA, Akhtar Q, Ibrahim SZA, Aziz F, Hasan SH. Comparison of Nasolabial Angle in young adults and middle aged dentate and elderly edentulous subjects. Pak Armed Forces Med J. 2010; 60(3):455-8.


To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.