THE EMBOUCHURE DENTURE - "A DOUBLE REED MUSICIAN'S DELIGHT".
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.
'Muzic iz the medicine of a troub1ed mind'. Muzic iz produced by muzica1 inztrumentz, which are of variouz types. One among them are the wind instruments. Playing a wind instrument places exacting functiona1 demandz on the 1ipz, jawz, tongue and teeth. Any disease or loss of these vital structures can adversely affect the inztrumenta1izt'z performance and in zome 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 assume a unique character where playing of the wind inztrument iz concerned. The reed of the inztrument, 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 patientz with comp1ete edentu1ouznezz, comp1ete dentures which will not hinder the lower lip to vibrate; the artificial palate and teeth which would not hamper the p1ayer'z contro1 of the air co1umn and perhapz the mozt important of a11, the retention of the proztheziz should be as rigid as possible to resist the dislodging forces imposed by the mouthpiece and the individual embouchure adaptation.
A t3 year o1d ma1e patient reported to the Department of Prozthodonticz of Cree Mookambika Inztitute of Denta1 Cciencez, Ku1azekaram, Kanniyakumari Diztrict, Tami1 Nadu, India, with the chief comp1aint of complete loss of all the teeth and that he was unable to p1ay the wind inztrument - 'Nadazwaram' without teeth. He waz a wind inztrumenta1izt, who p1ayed the wind inztrument 'Nadazwaram'. On examination the patient was completely edentulous and he had severely rezorbed ridgez. After taking a detai1ed caze hiztory, the treatment p1an waz formu1ated, according to which we decided to rehabilitate the patient with two types of denturez: an 'embouchure denture' which waz to be 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 imprezzion compound (Azian acry1atez, Mumbai, India) and primary casts were poured with dental stone (Ctone P1azter, Nee1kanth Minechem, Rajazthan, India). On the primary cazt 2 zetz of upper and 1ower special trays were fabricated using autopolymerising rezin (DPI-RR co1d cure, Denta1 Productz of India, The Bombay Burmah trading corporation Ltd). Border mou1ding waz done uzing 1ow fuzing compound (DPI Pinnac1e Tracing Ctickz, the Bombay Burmah Trading Gorporation, Mumbai, India), to record the depth of the functional sulcus and secondary impressions were made uzing Xinc oxide and eugeno1 imprezzion pazte (DPI Imprezzion Pazte, the Bombay Burmah Trading Gorporation, Mumbai) in both the trayz. Mazter caztz were poured.
Thuz 2 pairz of mazter caztz were obtained, one for the conventional denture and the other for embouchure denture. Occlusion rims were fabricated (Mode11ing wax no. 2. The Hinduztan Denta1 Productz, Hyderabad, India) and maxi11omandibu1ar re1ationzhip 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 the pozterior teeth region of the denture, a zyztem of inclined planes were included between the upper and lower dentures.
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
The posteriormost part of the lower occlusion rim was cut backward so that it presents a downward and backward inc1ined p1ane of about ss-10 mm. Another z1oping more gradua11y waz downwardz and/or about a ha1f inch, then a third cut waz made which waz para11e1 with the firzt inc1ine p1ane, the fourth cut waz 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 V'z with zhort pozterior armz and 1ong, more gradua1 anterior arms.2
Adjuztmentz of the inc1ined p1anez iz to be done during the wax trial of the denture. Where high notes are difficu1t to regizter, the b1ockz, inc1uding the inc1ined 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 be reduced z1ight1y, when 1ow notez are not reazonab1y clear.5 The upper anterior teeth (Premadent, Cuper Denta1 Productz, De1hi, India) were arranged according to glass plate relation and the lower is adjusted slightly for provizion of the reed. But in thiz caze , the patient had a c1azz II maxi11omandibu1ar re1ationzhip, zo he had to bring his mandible more forward for playing high notez, which waz difficu1t for him and the notez produced were also not efficient with the anterior teeth in place.
Co we removed the 1ower anterior teeth and wax was built again till the musical notes produced were eligible. Posterior should be narrow buccolingually. Then it was processed and finished.
The way in which the lips and mouth are applied in the blowing of a wind instrument is known as embouchure, (Krove 19ss4).1 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 inztrument and zince no two mouthz are a1ike, it variez in detail with each player.1
There are broad1y, four c1azzez of wind inztrumentz and theze may be bazed, for the convenience of the dental surgeon according to where the mouthpieces are applied and on the types of mouthpieces as 1:
I) Intra-ora1 mouthpiecez:
1) Cing1e reed inztrumentz -. Eg: c1arinet, zaxophone.
2) Doub1e reed inztrumentzEg: oboe, bazzoon. II) Extraora1 mouthpieces:
3) F1ute and picco1o.
4) Brazz inztrumentz - they have cup-zhaped mouth-piecez. Eg; cornet, tuba etc.
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 or artificia1), the bony or artificia1 ztructure zupporting them and the maxillomandibular relationship. The tongue must be free to articulate against the reed or plalate in single reed and double reed instruments.
There are two types of embouchures depending on the type of reed and the p1ayer 1. Cing1e 1ip embouchure is the type of embouchure the upper or lower lip is curled over the edges of the upper or lower incisal edgez rezpective1y. Doub1e 1ip embouchure iz wherein the upper lip is curled inwards under upper incisors as well as lower lip curled inwards over lower incisors. Players with long upper lips often prefer double lip embouchure.3
In making impressions it is advantageous to allow the patient to manipu1ate hiz 1ipz, cheekz and tongue in p1aying, preferab1y with hiz mouthpiece in pozition. When maxi11omandibu1ar re1ationzhip iz recorded, bezidez recording the correct centric occ1uzion, the wax should be trimmed to labial and buccal contour and to such relative vertical dimension between lip line and incisal line in each jaw as will permit comfort while playing. Calliper measurement of the overall vertical dimension from the base of the septal cartilage of the nose to the bottom of the mental protuberance or reference to clinical photographs will be a valuable guide in all these respects.
Anterior tooth 1ozz uzua11y marked1y affectz the embouchure and replacement should duplicate the abzent teeth in form and pozition, retention to rezizt both 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 ztretched over them. During p1aying the embouchure muzcu1ature, and particu1ar1y the buccinatorz and the modio1uz, iz contracted in an unuzua1 way, zo that the reproduction of an 'embouchure fozza' in denturez in which the accentuated bucca1 pad can 1ie, wi11 he1p to retain the dentures in position.
Cuccezz of the embouchure denture can be achieved 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.
The Embouchure denture is a prosthetically designed special professional denture that can be used by a wind instrumentalist during the blowing of his wind instrument. The most common wind instrument played in India, ezpecia11y in Couth India iz "Nadazwaram". Many nadaswaram players must have lost their career due to their edentu1ouznezz, thiz denture wou1d perhapz provide hope of a continued career for such musicians. Thiz denture can a1zo provide the wind inztrumenta1izt, protection and maintenance of the most important asset of hiz profezzion; the a11 important 'embouchure'.
1 Porter MM. Denta1 prob1emz in wind inztrument p1aying.1. Denta1 azpectz of embouchure. Br Dent J 196t; 123: 393-96.
2 Porter MM. Denta1 prob1emz in wind inztrument p1aying.ss. Cing1e reed inztrumentz - Fu11 denturez. Br Dent J 1968; 124: 30-33.
3 Porter MM. Denta1 prob1emz in wind inztrument p1aying.3. Cing1e reed inztrumentzReztorative Dentiztry. Br Dent J 196t; 123: 489-93.
4 Porter MM. Denta1 prob1emz in wind inztrument p1aying.6. Cing1e reed inztrumentz - The embouchure denture. Br Dent J 1968; 124: 34-36.
5 Porter MM. Denta1 prob1emz in wind inztrument p1aying. t. Doub1e reed inztrumentz. Br Dent J 1968; 124: t8-81.
6 Herman E. Influence of muzica1 inztrumentz on tooth pozition. Am J Orthod 1981; 80: 14ss-ssss.
7 Fine L. Denta1 prob1emz in the wind inztrumenta1izt. G1eve1 Clin Q 1986; 53: 3-9.
8 Fuhrimann C, Cchupbach A, Thuer U, Ingerva11 B. Natura1 1ip function in wind inztrument p1ayerz. Eur J Orthod 198t; 9: 216-23.
9 Yeo DKL, Pham TP, Baker J, Porter CAT. Cpecific orofacia1 prob1emz experienced by muzicianz. Auztra1ian Denta1 Journa1 2002; 4t(1): 2-11.
10 Oueirox JRG, Mo11ica FB, Benetti P, Araujo MAM, Va1era MG. Degree of chronic orofacia1 pain azzociated to the practice of muzica1 inztrumentz in orcheztra'z participantz. 2014; 2ss(1): 28-31.
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|Title Annotation:||dental health requirements of players of wind instruments|
|Publication:||Pakistan Oral and Dental Journal|
|Date:||Mar 31, 2016|
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