Types of dentures:
- Conventional. This full removable denture is made and placed in your mouth after the remaining teeth are removed and tissues have healed, which may take several months.
- Immediate. This removable denture is inserted on the same day that the remaining teeth are removed. Your dentist will take measurements and make models of your jaw during a preliminary visit. You don‘t have to be without teeth during the healing period, but may need to have the denture relined or remade after your jaw has healed.
- Overdenture. Sometimes some of your teeth can be saved to preserve your jawbone and provide stability and support for the denture. An overdenture fits over a small number of remaining natural teeth after they have been prepared by your dentist. Implants can serve the same function, too.
Complete dentures are full-coverage oral prosthetic devices that replace a complete arch of missing teeth. The indications for this type of dental prosthesis are:
Back To Top
- A full arch of missing teeth
- Dental implants have been deemed inappropriate by patient and/or doctor because of financial constraints, a medically compromised status that contraindicates surgery, or inevitable damage to vital structures such as maxillary sinuses, nerves, and vessels.
- Intraoral cancer has caused a loss of gross intraoral tissue, resulting in an edentulous dental arch; the complete denture prosthesis would then not only replace teeth but also fill in the portion of missing tissue (e.g., nasopharynx, hard palate).
Contraindications to Complete Dentures
Definitive contraindications have not been reported. However, the following factors should prompt a dentist to reconsider the use of a complete denture:
Back To Top
- Patient does not desire to have a removable appliance to replace missing teeth;
- Patient has an allergy to the acrylic used in the fabrication of the complete denture;
- Patient has a severe gag reflex (although this could be controlled with gag reflex desensitization);
- Patient has severely resorbed dental alveolar ridges, which would compromise retention with a complete denture alone.
Extractions & Surgery â€“ Pre-Prosthetic Surgery
The preparation of your mouth before the placement of a prosthesis is referred to as pre-prosthetic surgery. Some patients may require minor oral surgery treatment before receiving a partial or complete denture in order to ensure the maximum level of comfort. This treatment may involve one or more of the following procedures:
- Extraction of teeth
- Exposure of impacted teeth
- Smoothing and reshaping of bone
- Bony ridge reduction
- Removal of excess gum tissue
- Bone or soft tissue grafting to optimize ridge shape and/or dimensions
In some cases dental implants (link to All-On-4 product page) may represent a more viable treatment option than a denture.
(A more detailed denture preparation...)
Oral surgical and periodontal procedures should precede abutment tooth preparation and should be completed far enough in advance to allow the necessary healing period. If at all possible, at least 6 weeks, but preferably 3 to 6 months, should be provided between surgical and restorative dentistry procedures. This depends on the extent of the surgery. Oral Surgical Preparation The longer the interval between the surgery and the impression procedure, the more complete the healing and consequently the more stable the denture-bearing areas. The important consideration is that the patient not be deprived of any treatment that would enhance the success of the removable partial denture. 1-
- Planned extractions should occur early in the treatment regimen but not before completion of a careful and thorough evaluation of each remaining tooth in the dental arch.
- Almost any tooth may be salvaged if its retention is sufficiently important to warrant the procedures necessary.
2- Removal of Residual Roots
- Generally, all retained roots or root fragments should be removed. This is particularly true if they are in close proximity to the tissue surface or if there is evidence of associated pathological findings.
- Residual roots adjacent to abutment teeth may contribute to the progression of periodontal pockets and compromise the results from subsequent periodontal therapy.
- The removal of root tips can be accomplished from the facial or palatal surfaces without resulting in a reduction of alveolar ridge height or endangering adjacent teeth.
3- Impacted Teeth
- All impacted teeth, including those in edentulous areas and those adjacent to abutment teeth, should be considered for removal.
- Asymptomatic impacted teeth in the elderly that are covered with bone, with no evidence of a pathological condition, should be left to preserve the arch morphology. If an impacted tooth is left, it should be recorded in the patient's record and the patient should be informed of its presence. Roentgenogram should be taken at reasonable intervals.
- Any impacted teeth that can be reached with a periodontal probe must be removed to treat the periodontal pocket and prevent more extensive damage.
- The loss of individual teeth or groups of teeth may lead to extrusion, drifting, or combinations of malpositioning of the remaining teeth.
- In most instances the alveolar bone supporting extruded teeth will be carried occlusally as the teeth continue to erupt.
- Orthodontics may be useful in correcting many occlusal discrepancies, but for some patients, such treatment may not be practical because of a lack of teeth for anchoring orthodontic appliances or for other reasons.
- In such situations individual teeth or groups of teeth and their supporting alveolar bone can be surgically repositioned.
5-Cysts and Odontogenic Tumors
- When a suspicious area appears on the survey film, a periapical roentgenogram should be taken to confirm or deny the presence of a lesion.
6-Exostoses and Tori
- Although modification of denture design can at times accommodate for exostoses, more frequently this results in additional stress to the supporting elements and compromised function.
- Ordinarily the mucosa covering bony protuberances is extremely thin and friable. Removable partial denture components in proximity to this type of tissue may cause irritation and chronic ulceration. Also, exostoses approximating gingival margins may complicate the maintenance of periodontal health and lead to the eventual loss of strategic abutment teeth.
7-Hyperplastic Tissue Hyperplastic tissue is seen in the form of:
- Fibrous tuberosities.
- Soft flabby ridges.
- Folds of redundant tissue in the vestibule or floor of the mouth.
- Palatal papillomatosis. All these forms of excess tissue should be removed to provide a firm base for the denture. This removal will produce a more stable denture, reduce stress and strain on the supporting teeth and tissue.
8-Muscle Attachments and Frena Muscle Attachments and Frena
- As a result of the loss of bone height, muscle attachments may insert on or near the residual ridge crest.
- The mylohyoid, buccinator, mentalis, and genioglossus muscles.
- In addition to the problem of the attachments of the muscles themselves, the mentalis and genioglossus muscles occasionally produce bony protuberances at their attachments, which may also interfere with removable partial denture design.
- The maxillary labial and mandibular lingual frena are the most common sources of frenum interference with denture design. These can be modified easily with any of several surgical procedures. Under no circumstances should a frenum be allowed to compromise the design or comfort of a removable partial denture.
9-Bony Spines and Knife-Edge Ridges
- Sharp bony spicules should be removed and knifelike crests gently rounded.
- These procedures should be carried out with minimum bone loss.
10- Polyps, Papillomas, and Traumatic Hemangiomas
- All abnormal soft tissue lesions should be excised and submitted for pathological examination before the fabrication of a removable partial denture.
- If the lesions not treated new or additional stimulation to the area introduced by the prosthesis may produce discomfort or even malignant changes in the tumor.
11- Hyperkeratoses, Erythroplasia, and Ulcerations
- All abnormal, white, red, or ulcerative lesions should be investigated regardless of their relationship to the proposed denture base or framework.
- The lesions should be removed and healing accomplished before fabrication of the removable partial denture.
12- Dentofacial Deformity
- Several dental professionals (prosthodontist, oral surgeon, periodontist, orthodontist, and general dentist) may play a role in the patient's treatment.
13-Osseointegrated Devices ) (link to implants, All-On-4)
- Implants ( This titanium implant was designed to provide a direct titanium-to-bone interface (osseointegrated).
- Implants are carefully placed using controlled surgical procedures, and in general bone healing to the device is allowed to occur before fabrication of a dental prosthesis.
14- Augmentation of Alveolar Bone
- Considerable attention has been devoted to ridge augmentation with the use of autogenous and alloplastic materials, especially in preparation for implant placement. Larger ridge volume gains necessitate consideration of autogenous grafts; however, these procedures are accompanied with concerns for surgical morbidity.
- Considerable emphasis must be placed on sound clinical understanding that some of the alloplastic materials can migrate or be displaced under occlusal loads if not appropriately supported by underlying bone and contained by buttressing soft tissue.
CONDITIONING OF ABUSED AND IRRITATED TISSUE
Patients who require conditioning treatment often demonstrate the following symptoms:
- Inflammation and irritation of the mucosa covering the denturebearing areas
- Distortion of normal anatomic structures, such as incisive papillae, the rugae, and the retromolar pads.
- A burning sensation in residual ridge areas, the tongue, and the cheeks and lips.
These conditions are usually associated with illfitting or poorly occluding removable partial dentures. However, nutritional deficiencies, endocrine imbalances, severe health problems (diabetes or blood dyscrasias), and bruxism must be considered in a differential diagnosis.
If a new removable partial denture or the relining of a present denture is attempted without first correcting these conditions, the chances for successful treatment will be compromised because the same old problems will be perpetuated.
The patient must be made to realize that fabrication of a new prosthesis should be delayed until the oral tissue can be returned to a healthy state.
The first treatment procedure should be an immediate institution of a good home care program.
A suggested home care program includes:
- Rinsing the mouth three times a day with a prescribed saline solution.
- Massaging the residual ridge areas, palate, and tongue with a soft toothbrush.
- Removing the prosthesis at night.
- Using a prescribed therapeutic multiple vitamin.
Use of Tissue Conditioning Materials
The tissue conditioning materials are elastopolymers that continue to flow for an extended period, permitting distorted tissue to rebound and assume its normal form.
These soft materials apparently have a massaging effect on irritated mucosa, and because they are soft, occlusal forces are probably more evenly distributed.
Maximum benefit from using tissue conditioning materials may be obtained by:
- eliminating deflective or interfering occlusal contacts of old dentures (by remounting in an articulator if necessary).
- extending denture bases to proper form to enhance support, retention, and stability.
- Relieving the tissue side of denture bases sufficiently (2 mm) to provide space for even thickness and distribution of conditioning material.
- Applying the material in amounts sufficient to provide support and a cushioning effect.
- Following the manufacturer's directions for manipulation and placement of the conditioning material.
Back To Top
- The conditioning procedure should be repeated until the supporting tissues display an undistorted and healthy appearance.
- Many dentists find that intervals of 4 to 7 days between changes of the conditioning material are clinically acceptable.
- An improvement in irritated and distorted tissue is usually noted within a few visits.
- If positive results are not seen within 3 to 4 weeks, one should suspect more serious health problems and request a consultation from a physician. ("Preparation of Mouth for Removable Partial Dentures", Dr. Mazen Kanout)
Common denture repairs include:
Back To Top
- Denture reline A resurfacing of the side of your denture thatâ€™s in contact with soft tissues in your mouth to make it fit more securely.
- Denture rebase When the pink acrylicÂ of your denture, which holds your teeth in place, is completely remade. Your replacement teeth are placed in a new base.
- Adjustment due to a sore spot If you get a sore spot (due to your denture rubbing against your gums or mouth tissues), our team can make adjustments to relieve your discomfort.
New dentures may feel awkward for a few weeks until you become accustomed to them. The dentures may feel loose while the muscles of your cheek and tongue learn to keep them in place. It is not unusual to experience minor irritation or soreness. You may find that saliva flow temporarily increases. As your mouth becomes accustomed to the dentures, these problems should go away. Follow-up appointments with the dentist are generally needed after a denture is inserted so the fit can be checked and adjusted. If any problem persists, particularly irritation or soreness, be sure to consult your dentist.
Even if you wear full dentures, you still have to practice good dental hygiene. Brush your gums, tongue and roof of your mouth every morning with a soft-bristled brush before you insert your dentures to stimulate circulation in your tissues and help remove plaque.
Like your teeth, your dentures should be brushed daily to remove food particles and plaque. Brushing also can help keep the teeth from staining.
- Rinse your dentures before brushing to remove any loose food or debris.
- Use a soft bristle toothbrush and a non-abrasive cleanser to gently brush all the surfaces of the dentures so they don‘t get scratched.
- When brushing, clean your mouth thoroughlyâ€”including your gums, cheeks, roof of your mouth and tongue to remove any plaque. This can help reduce the risk of oral irritation and bad breath.
- When you''re not wearing your dentures, put them in a safe place covered in water to keep them from warping.
- Occasionally, denture wearers may use adhesives. Adhesives come in many forms: creams, powders, pads/wafers, strips or liquids. If you use one of these products, read the instructions, and use them exactly as directed. Your dentist can recommend appropriate cleansers and adhesives; look for products with the ADA Seal of Acceptance. Products with the ADA Seal have been evaluated for safety and effectiveness.
If you have any questions about your dentures, or if they stop fitting well or become damaged, contact your dentist. Be sure to schedule regular dental checkups, too. The dentist will examine your mouth to see if your dentures continue to fit properly.
Chewing with New Dentures
Learning to chew with new dentures will probably take 6-8 weeks. Practice is required to learn to eat with your dentures. At first, limit your diet to soft foods that are easy to chew. Gradually learn to eat foods that are more difficult. Take small bites and chew slowly, trying to overcome the difficulties as they appear. If possible, learn to chew on both sides of your dentures at the same time. The lower dentures rarely have a good retention as the upper. Since the muscles of the cheeks, lip, and tongue will tend to displace your dentures, do not develop the habit of displacing them with these muscles. Rather, train these muscles to assist in keeping your dentures in place. When biting with dentures, place the food between the teeth toward the corner of the mouth rather than between the front teeth. This will help reduce the movement of the dentures on the ridges. If you have trouble keeping your lower denture in place during eating, it may be the result of poor tongue habits. The tongue should touch the inner surface of the lower denture to help stabilize it when eating.
Speaking with New Dentures
Learning to talk with your new dentures in place requires practice and perseverance. Reading aloud is very helpful method of learning to pronounce words distinctly. Practice those words and sounds that seem to give you the most difficulty. It takes time for the tongue to learn the different positions necessary to make good speech sounds with new dentures.
Increased Saliva with New Dentures
Do not be alarmed at the greater amounts of saliva in your mouth during the first few weeks of wearing your dentures. This condition will correct itself as you become accustomed to wearing them.
Back To Top
Back To Top