Download the embouchure denture — “a double reed musician`s delight”

THE EMBOUCHURE DENTURE — “A DOUBLE REED
MUSICIAN’S DELIGHT”
1
2
! "#$%&!' &()
*!+&"%
3
+!"(
,!(&-.
)&)
4
5
6
&%/($$'&
&'&(%&!,$#&%
*.(.!0#&%1(&,$#&%
ABSTRACT
Wind instrument players are the ones who put their mouth, lips, jaws, teeth, tongue and face to a use
which is different from the normal functions of eating, speaking and expression. Hence there is a clear
need for an understanding of the dental requirements of players of wind instruments.1 The problems
that may arise for the dental surgeon who is treating a wind instrument player are due to the fact that
the eligibility of the musical sound produced and how he produces it while playing a musical passage
is directly related to muscles of facial expression, during blowing. Hence it is necessary to design a
prosthesis that would well adapt to the functional demands of the wind instrumentalist. The purpose
of this article is to create an awareness among dental practitioners, about their role in rehabilitating
a completely edentulous wind instrumentalist and also describes the technique to fabricate a specially
designed prosthesis for wind instrument players — “The Embouchure denture”.
Key Words: embouchure, wind instrumentalist, reed, inclined planes.
INTRODUCTION
<52>8AB75>!<2!F45F7857@K!+37!877@!4D!>37!<52>8AB75>:!
which rests on the lip is the sound generator of wind
instruments. The reed must be allowed to undergo
a series of regular vibrations to produce a musical
tone. Therefore the objective is to construct for these
E6><75>2!X<>3!F4BE97>7!7@75>A94A25722:!F4BE97>7!@75tures which will not hinder the lower lip to vibrate; the
artificial palate and teeth which would not hamper
>37!E96G78O2!F45>849!4D!>37!6<8!F49AB5!65@!E7836E2!>37!
B42>!<BE48>65>!4D!699:!>37!87>75><45!4D!>37!E842>372<2!
should be as rigid as possible to resist the dislodging
forces imposed by the mouthpiece and the individual
embouchure adaptation.2
!
W,A2<F!<2!>37!B7@<F<57!4D!6!>84AI97@!B<5@OK!,A2<F!<2!
E84@AF7@!IG!BA2<F69!<52>8AB75>2:!X3<F3!687!4D!Y68<4A2!
types. One among them are the wind instruments.
Playing a wind instrument places exacting function69!@7B65@2!45!>37!9<E2:!C6X2:!>45?A7!65@!>77>3K!&5G!
disease or loss of these vital structures can adversely
6DD7F>!>37!<52>8AB75>69<2>O2!E78D48B65F7!65@!<5!24B7!
instances prematurely end his career. The problems
that may arise for a dental surgeon who is treating a
wind instrumentalist are mainly due to the exacting
functional demands on the oral and perioral structures
especially the muscles of facial expression during
blowing. The problems of complete denture prosthesis CLINICAL REPORT
assume a unique character where playing of the wind
!
&!ZV!G768!49@!B697!E6><75>!87E48>7@!>4!>37!17E68>B75>!4D!'842>34@45><F2!4D!"877!,44H6BI<H6!.52><>A>7!
1
! ! 23456!'7689:!;<569!=768!'42>!?86@A6>7!">A@75>
4D! 175>69! "F<75F72:! JA9627H686B:! J655<G6HAB68<!
2
! +62577B!(6C<!*:!;<569!=768!'42>!?86@A6>7!">A@75>
3
1<2>8<F>:!+6B<9!%6@A:!.5@<6:!X<>3!>37!F3<7D!F4BE96<5>!
! +!"877969:!'84D72248!65@!#76@!4D!>37!17E68>B75>
4
! &5A844E6!&:!(76@78
of complete loss of all the teeth and that he was unable
5
! &E6856!,4365:!"75<48!)7F>A878
>4!E96G!>37!X<5@!<52>8AB75>![!W%6@62X686BO!X<>34A>!
6
! *<8<!0365@86B4365:!(76@78:!17E68>B75>!4D!'842>34@45><F2!65@!
.BE965>494?G:! "877! ,44H6BI<H6! .52><>A>7! 4D! 175>69! "F<75F72:! >77>3K!#7!X62!6!X<5@!<52>8AB75>69<2>:!X34!E96G7@!>37!
X<5@!<52>8AB75>!W%6@62X686BOK!$5!7\6B<56><45!>37!
J65G6HAB68<!1<2>8<F>:!+6B<9!%6@A:!.5@<6K
Address for correspondence:! ! 23456!'7689:!LMNML!&:!'76892O! patient was completely edentulous and he had severely
"3799:! J6@6G69:! J69<G69! '$P! QRSLTL:! J65G6HAB68<! 1<2>8<F>:!
87248I7@!8<@?72K!&D>78!>6H<5?!6!@7>6<97@!F627!3<2>48G:!
+6B<9!%6@A:!.5@<6K!!!!!!!!!!! B6<9P!723456E7689U?B6<9KF4B
>37!>876>B75>!E965!X62!D48BA96>7@:!6FF48@<5?!>4!X3<F3!
Received for Publication:
-65A68G!LL:!RTLQ
we decided to rehabilitate the patient with two types
Approved:
-65A68G!VT:!RTLQ
Pakistan Oral & Dental Journal Vol 36, No. 1 (January-March 2016)
172
The embouchure denture
;<?!LP!-6X!8796><45
;<?!bP! BI4AF3A87!@75>A87!]/EE78!65@!)4X78^!6D>78!
processing
Fig 2: Inclined planes for embouchure denture. (Pic
F4A8>72GP!"<5?97!877@!<52>8AB75>2![!+37! BI4AF3A87!@75>A87K!_8!175>!-!LSQ`a!LRbP!VbcVQ
Fig 3: Wax trial for Embouchure denture
4D!@75>A872P!65!W7BI4AF3A87!@75>A87O!X3<F3!X62!>4!I7!
used as a professional denture ; that is the denture to
be used only during the playing of the wind instrument
- Nadaswaram and the other a conventional complete
denture to be used at the other times.
Primary impressions of both the maxillary and
mandibular edentulous arches were made using imE8722<45!F4BE4A5@!]&2<65!6F8G96>72:!,ABI6<:!.5@<6^!
;<?!MP! BI4AF3A87!@75>A87!<5!>37!E6><75>O2!B4A>3!
after finishing and processing
Pakistan Oral & Dental Journal Vol 36, No. 1 (January-March 2016)
173
The embouchure denture
This would allow for differences in vertical and
horizontal relationships between the upper and lower
and yet permit contact between them during playing
which will prevent either of them from being dislodged.2
Single reed
Double reed
;<?!QP!"<5?97!877@!65@!14AI97!877@
and primary casts were poured with dental stone
]">457! '962>78:! %779H65>3! ,<57F37B:! (6C62>365:!
.5@<6^K!$5!>37!E8<B68G!F62>!R!27>2!4D!AEE78!65@!94X78!
special trays were fabricated using autopolymerising
872<5! ]1'.c((! F49@! FA87:! 175>69! '84@AF>2! 4D! .5@<6:!
+37!_4BI6G!_A8B63!>86@<5?!F48E486><45!)>@^K!_48@78!
B4A9@<5?!X62!@457!A2<5?!94X!DA2<5?!F4BE4A5@!]1'.!
'<556F97!+86F<5?!"><FH2:!>37!_4BI6G!_A8B63!+86@<5?!
048E486><45:! ,ABI6<:! .5@<6^:! >4! 87F48@! >37! @7E>3! 4D!
the functional sulcus and secondary impressions were
B6@7!A2<5?!d<5F!4\<@7!65@!7A?7549!<BE8722<45!E62>7!
]1'.!.BE8722<45!'62>7:!>37!_4BI6G!_A8B63!+86@<5?!
048E486><45:!,ABI6<^!<5!I4>3!>37!>86G2K!,62>78!F62>2!
X787!E4A87@K!+3A2!R!E6<82!4D!B62>78!F62>2!X787!4I>6<57@:!
one for the conventional denture and the other for
embouchure denture. Occlusion rims were fabricated
],4@799<5?!X6\!54K!RK!+37!#<5@A2>65!175>69!'84@AF>2:!
#G@786I6@:!.5@<6^!65@!B6\<994B65@<IA968!8796><4523<E!
was recorded separately for both the dentures.
Wax trial for conventional complete denture was
done as usual. The embouchure denture is unique from
the other denture after maxillomandibular relationship.
The distance from the incisal edges of lower central
incisors to the lower border of the mental protuberance of the mandible was recorded using calliper. In
>37!E42>78<48!>77>3!87?<45!4D!>37!@75>A87:!6!2G2>7B!4D!
inclined planes were included between the upper and
lower dentures.
The posteriormost part of the lower occlusion rim
was cut backward so that it presents a downward and
I6FHX68@!<5F9<57@!E9657!4D!6I4A>!McLT!BBK!&54>378!
294E<5?!B487!?86@A699G!X62!@4X5X68@2!65@N48!6I4A>!
6!369D!<5F3:!>375!6!>3<8@!FA>!X62!B6@7!X3<F3!X62!E6869979! X<>3! >37! D<82>! <5F9<57! E9657:! >37! D4A8>3! FA>! X62!
parallel with the second. The upper block was then
built to interdigitate with the lower inclined planes.
These planes appeared from the side as two inverted
eO2!X<>3!2348>!E42>78<48!68B2!65@!945?:!B487!?86@A69!
anterior arms.2
!
&@CA2>B75>2!4D!>37!<5F9<57@!E96572!<2!>4!I7!@457!
during the wax trial of the denture. Where high notes
687!@<DD<FA9>!>4!87?<2>78:!>37!I94FH2:!<5F9A@<5?!>37!<5F9<57@!
planes are trimmed down until the notes may be satisfactorily produced. The wax blocks can be built up a
little on the back or the incisal portions of the wax can
I7!87@AF7@!29<?3>9G:!X375!94X!54>72!687!54>!8762456I9G!
clear.5! +37! AEE78! 65>78<48! >77>3! ]'87B6@75>:! "AE78!
175>69!'84@AF>2:!1793<:!.5@<6^!X787!68865?7@!6FF48@<5?!
to glass plate relation and the lower is adjusted slightly
D48!E84Y<2<45!4D!>37!877@K!_A>!<5!>3<2!F627!:!>37!E6><75>!
36@!6!F9622!..!B6\<994B65@<IA968!8796><4523<E:!24!37!
had to bring his mandible more forward for playing
3<?3!54>72:!X3<F3!X62!@<DD<FA9>!D48!3<B!65@!>37!54>72!
produced were also not efficient with the anterior teeth
<5!E96F7K!"4!X7!87B4Y7@!>37!94X78!65>78<48!>77>3!65@!
wax was built again till the musical notes produced
were eligible. Posterior should be narrow buccolingually.
Then it was processed and finished.
DISCUSSION
The way in which the lips and mouth are applied
in the blowing of a wind instrument is known as emI4AF3A87:!]*84Y7!LSMb^K1 Playing a wind instrument is
a complex neuromuscular task that requires increased
ventilation and increased orofacial muscle activity.
Embouchure varies with the different classes of in2>8AB75>!65@!2<5F7!54!>X4!B4A>32!687!69<H7:!<>!Y68<72!
in detail with each player.1
!
+3787!687!I846@9G:!D4A8!F962272!4D!X<5@!<52>8AB75>2!
65@! >3727! B6G! I7! I627@:! D48! >37! F45Y75<75F7! 4D! >37!
dental surgeon according to where the mouthpieces
are applied and on the types of mouthpieces as 1:
.^! .5>86c4869!B4A>3E<7F72P
L^! "<5?97!877@!<52>8AB75>2!cK! ?P!F968<57>:!26\4E3457K
R^! 14AI97!877@!<52>8AB75>2c! ?P!4I47:!I622445K
..^!
Pakistan Oral & Dental Journal Vol 36, No. 1 (January-March 2016)
\>86c!4869!B4Athpieces:
174
The embouchure denture
V^! ;9A>7!65@!E<FF494K
b^! _8622!<52>8AB75>2![!>37G!36Y7!FAEc236E7@!B4A>3E<7F72K! ?a!F4857>:!>AI6!7>FK
The embouchure is also determined by the suitability of the lips. The suitability of the lips is dependant
mainly on the position and form of the teeth (natural
48!68><D<F<69^:!>37!I45G!48!68><D<F<69!2>8AF>A87!2AEE48><5?!
them and the maxillomandibular relationship. The
tongue must be free to articulate against the reed or
plalate in single reed and double reed instruments.
87E84@AF><45!4D!65!W7BI4AF3A87!D4226O!<5!@75>A872!<5!
X3<F3!>37!6FF75>A6>7@!IAFF69!E6@!F65!9<7:!X<99!379E!>4!
retain the dentures in position.
!
"AFF722!4D!>37!7BI4AF3A87!@75>A87!F65!I7!6F3<7Y7@!
only with co-operation from the patient as all the procedures involved in the fabrication of this denture has
to be done with great care and concentration.
CONCLUSION
The Embouchure denture is a prosthetically designed special professional denture that can be used by
There are two types of embouchures depending a wind instrumentalist during the blowing of his wind
45!>37!>GE7!4D!877@!65@!>37!E96G78!LK!"<5?97!9<E!7BI4A- instrument. The most common wind instrument played
chure is the type of embouchure the upper or lower lip <5!.5@<6:!72E7F<699G!<5!"4A>3!.5@<6!<2!g%6@62X686BhK!
is curled over the edges of the upper or lower incisal Many nadaswaram players must have lost their career
7@?72!872E7F><Y79GK!14AI97!9<E!7BI4AF3A87!<2!X3787<5! @A7!>4!>37<8!7@75>A94A25722:!>3<2!@75>A87!X4A9@!E7836E2!
the upper lip is curled inwards under upper incisors provide hope of a continued career for such musicians.
as well as lower lip curled inwards over lower incisors. +3<2!@75>A87!F65!6924!E84Y<@7!>37!X<5@!<52>8AB75>69<2>:!
Players with long upper lips often prefer double lip protection and maintenance of the most important asset
embouchure.3
4D!3<2!E84D722<45a!>37!699!<BE48>65>!W7BI4AF3A87OK
In making impressions it is advantageous to allow REFERENCES
>37!E6><75>!>4!B65<EA96>7!3<2!9<E2:!F377H2!65@!>45?A7!
'48>78! ,,K! 175>69! E84I97B2! <5! X<5@! <52>8AB75>! E96G<5?KLK!
<5!E96G<5?:!E87D786I9G!X<>3!3<2!B4A>3E<7F7!<5!E42<><45K! L! 175>69!62E7F>2!4D!7BI4AF3A87K!_8!175>!-!LSQZa!LRVP!VSVcSQK
f375!B6\<994B65@<IA968!8796><4523<E!<2!87F48@7@:!I7'48>78! ,,K! 175>69! E84I97B2! <5! X<5@! <52>8AB75>! E96G<5?KMK!
2<@72!87F48@<5?!>37!F4887F>!F75>8<F!4FF9A2<45:!>37!X6\! R! "<5?97!877@!<52>8AB75>2![!;A99!@75>A872K!_8!175>!-!LSQ`a!LRbP!
should be trimmed to labial and buccal contour and to
30-33.
such relative vertical dimension between lip line and V! '48>78! ,,K! 175>69! E84I97B2! <5! X<5@! <52>8AB75>! E96G<5?KVK!
incisal line in each jaw as will permit comfort while
"<5?97!877@!<52>8AB75>2c!(72>486><Y7!175><2>8GK!_8!175>!-!LSQZa!
123: 489-93.
playing. Calliper measurement of the overall vertical
dimension from the base of the septal cartilage of the b! '48>78! ,,K! 175>69! E84I97B2! <5! X<5@! <52>8AB75>! E96G<5?KQK!
"<5?97!877@!<52>8AB75>2![!+37!7BI4AF3A87!@75>A87K!_8!175>!
nose to the bottom of the mental protuberance or ref-!LSQ`a!LRbP!VbcVQK
erence to clinical photographs will be a valuable guide
M! '48>78!,,K!175>69!E84I97B2!<5!X<5@!<52>8AB75>!E96G<5?K!ZK!
in all these respects.
14AI97!877@!<52>8AB75>2K!_8!175>!-!LSQ`a!LRbP!Z`c`LK
!
&5>78<48! >44>3! 9422! A2A699G! B68H7@9G! 6DD7F>2! >37!
embouchure and replacement should duplicate the ab275>!>77>3!<5!D48B!65@!E42<><45:!87>75><45!>4!872<2>!I4>3!
inward intraoral and extraoral pressure is extremely
difficult. Complete dentures should allow adequate
provision in the incisor region for the lips to be curled
backwards in the mouth to support the double reed.
The incisor teeth should be set without protrusion of
individual incisors. Overbite should be minimal and
incisal edges of artificial teeth should be blunt and
smooth in order not to irritate the lips which will be
2>87>F37@!4Y78!>37BK!1A8<5?!E96G<5?!>37!7BI4AF3A87!
BA2FA96>A87:!65@!E68><FA9689G!>37!IAFF<56>482!65@!>37!
B4@<49A2:!<2!F45>86F>7@!<5!65!A5A2A69!X6G:!24!>36>!>37!
Q!
#78B65! K!.5iA75F7!4D!BA2<F69!<52>8AB75>2!45!>44>3!E42<><45K!
&B!-!$8>34@!LS`La!`TP!LbMcMMK
Z!
;<57!)K!175>69!E84I97B2!<5!>37!X<5@!<52>8AB75>69<2>K!097Y79!
Clin Q 1986; 53: 3-9.
`!
;A38<B655!":!"F3AEI6F3!&:!+3A78!/:!.5?78Y699!_K!%6>A869!9<E!
DA5F><45! <5! X<5@! <52>8AB75>! E96G782K! A8! -! $8>34@! LS`Za! SP!
216-23.
S!
=74! 1J):! '36B! +':! _6H78! -:! '48>78! "&+K! "E7F<jF! 484D6F<69!
E84I97B2!7\E78<75F7@!IG!BA2<F<652K!&A2>869<65!175>69!-4A8569!
RTTRa!bZ]L^P!RcLLK
LT! kA7<84l!-(0:!,499<F6!;_:!_757>><!':!&86AC4!,&,:!e69786!,0K!
17?877!4D!F3845<F!484D6F<69!E6<5!6224F<6>7@!>4!>37!E86F><F7!4D!
BA2<F69!<52>8AB75>2!<5!48F372>86O2!E68><F<E65>2K!RTLba!RM]L^P!
28-31.
Pakistan Oral & Dental Journal Vol 36, No. 1 (January-March 2016)
175
OBITUARY
'84D!18!+68<m!%<23>68
!
18!+68<m!%<23>68!2>68>7@!3<2!F68778!<5!'6H<2>65!<5!LSQQ!X375!37!C4<57@!J3GI78!,7@<F69!
04997?7!62!&22<2>65>!'84D72248!4D!,7@<F<57!6D>78!mA69<DG<5?!62!6!B7BI78!4D!>37!(4G69!04997?7!4D!
'3G2<F<652!4D! @<5IA8?3K!#7!I7F6B7!'84D72248!4D!,7@<F<57!<5!LSZL!65@!X62!"7F87>68G!#769>3:!
"4F<69!f79D687!65@!'4EA96><45!'9655<5?!D84B!LS`S!>4!LSSL!65@!87><87@!D84B!?4Y785B75>!278Y<F7!
in 1995 but his contribution to the medical profession and medical services go well beyond his
government service.
!
18! %<23>68! X62! 6! E<45778! 4D! B65G! B7@<F69! 278Y<F72! <5! J3GI78! '6H3>A5H3X6! E84Y<5F7!
D48! 69B42>! D<Y7! @7F6@72K! #7! X62! >37! D<82>! E3G2<F<65! >4! E78D48B! 87569! @<69G2<2! <5! >37! J3GI78!
Pakhtunkhwa province and was the driving force behind the establishment of the Lady Reading
#42E<>69!.5>752<Y7!0687!/5<>!65@!96>78!>37!0484568G!0687!/5<>:!X3<F3!X787!>37!D<82>!<5!>37!
E84Y<5F7K!#7!X62!>37!D<82>!1<87F>48!4D!'6H<2>65!,7@<F69!(72768F3!04A5F<9!65@!X62!>37!D4A5@78!
4D!>37!'42>!*86@A6>7!,7@<F69!.52><>A>7!<5!J3GI78!,7@<F69!04997?7!]'*,.^!65@!;845><78!#769>3!
Foundation and served as managing director of both institutions.
!
&D>78!87><87B75>:!18!%<23>68!278Y7@!62!036<8B65!4D!;845><78!(7@!0872F75>K!#7!X62!6X68@7@!
>37!2>6>A2!4D!'84D72248! B78<>A2!IG!J3GI78!,7@<F69!/5<Y782<>GK
!
+37! 8497! 4D! '84D! +68<m! %<23>68! ]X375! 37! X62! "7F87>68G! #769>3^! <5! AE?86@<5?! 175><2>8G!
17E68>B75>!>4!J3GI78!04997?7!4D!175><2>8G!X62!F4BB75@6I97K!#7!X62!>37!B4><Y6><5?!D48F7K!
#7!X62!6!D8<75@9G!65@!Y78G!@7F75>!E78245K
!
#7!X62!I485!45!RM>3!,6G:!LSVM!6>!'7236X68!65@!37!X62!245!4D!96>7!"68@68!&I@A8!(6I!
%<23>68K!#7!@<7@!45!VT>3!17F7BI78:!RTLM!6D>78!E84>86F>7@!<995722K!,6G!>37!_9722<5?2!4D!&9963!
I7!AE45!3<B!]&B775^K!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!f7!7\>75@!4A8!3768>D79>!F45@4975F72!>4!>37!I7876Y7@!
D6B<9GK!,6G!&9963!?<Y7!>37B!>37!2>875?>3!>4!I768!>3<2!?876>!9422!]&B775^K