Ooops… not a great denture…

I visited a friend of mine who is a dental technician when I saw one of the dentures being worked on. I couldn’t help but comment on the unattractive design of the denture, which was not driven by the anatomy of the patient’s mouth (a dental technician works for the dental providers and follows their directions, so he or she has no influence on the cosmetic aspects of the denture – the provider works with the patients and makes those design decisions).

The upper cast shows the existing denture made a while ago; now the patient is having the lower immediate denture made. The occlusion line (bite) is highly distorted on the upper arch (the transition between the front and the back teeth should be smoother). Sometimes the natural teeth dictate the design, but in this case, on the upper arch was an existing denture which could be altered; for the fraction of the price of the new denture, back teeth could be replaced and re-set correcting the occlusion, and the new, lower denture would then follow the correct occlusion. The result would not only look much better in the patient’s mouth, but also function better.

In my practice I make sure that every possible solution is explored in order to achieve the best results for the patient – cosmetic and functional.

Denture Repair

Every once in a while a denture may need a repair. Sometimes it is the tooth that falls out; sometimes the denture falls on a hard surface and breaks the plate or chips the tooth; sometimes the family pet gets a hold of the denture, accidentally left on the night stand, and thinks it is a chew toy... (In some cases the damage done by pets can not be repaired and the new denture has to be made. This would be an expense that could be easily avoided by keeping the denture away from pets)

Another situation is when the patient is wearing a partial denture and one or more of the natural teeth have to be extracted. Usually the artificial tooth can be added to the existing partial denture. The process of adding an artificial tooth to the existing denture is easier in the acrylic partial dentures, but also possible in the metal frame partials.

In one case or another denture repairs are sometimes needed. Most can be done the same day, but in some complex cases they may take longer.

Denture Reline

A permanent denture reline is recommended when the denture does not fit properly. In most cases this is due to the gum and tissue changes in the patient’s mouth. The immediate denture usually needs to have a permanent reline done 2-4 months after the teeth extractions, when the gums are fully healed. In some cases, when the patient has other health conditions, it may take longer for the gums to heal and that fact would delay the permanent reline on the immediate denture.

A regular denture should be checked for fit by the provider about once a year. In most cases a permanent reline is recommended every 2-5 years, depending on the individual patient. The permanent denture reline will not change the look of the denture; it will change the fit of the denture and improve its function. The permanent denture reline is therefore recommended, when the condition of the teeth in the existing denture is good or better.

In some cases a soft permanent reline is done when the patient has extremely sensitive gums or tissues. Even though the soft reline is called “permanent” the reline material will usually last 1-2 years depending on wearer’s care and whether the wearer is a smoker or not. A soft permanent reline requires slightly different fabrication process and is usually a little more expensive than a hard permanent reline.

How to Clean the Denture

1. The best way to clean the denture is over the sink. A denture can break when dropped on a hard surface, so always fill the sink with water.

2. Rinse your denture thoroughly to remove loose food particles. Use cool or warm water. Never use hot water, as it can warp your dentures.

3. Use a soft bristled denture brush or soft bristled toothbrush. Apply mild soap to a brush. Do not use ordinary toothpaste, bleach or vinegar. Toothpaste is an abrasive and will create micro scratches on the surface of the denture that will attract the bacteria; using harsh chemical solutions will cause porosity on the surface of the denture which will also attract the bacteria.

4. Brush all surfaces thoroughly. Try not to brush the inner surface of your denture too hard. A light brushing is sufficient. Remember that tartar or calculus can form on the denture just as on natural teeth, so it is very important to clean your denture daily.

5. After brushing, rinse your denture well under the running water to remove all traces of soap.

6. Brush your gums, tongue and palate with a soft-bristled regular toothbrush to remove plaque and stimulate circulation. Repeat that at least twice a day (morning and night). Rinsing your denture after every meal is highly recommended.

7. Always remove your denture for the night. Your gum tissue needs time to relax and rejuvenate. While you sleep at night, soak your denture in a container filled with water.

8. Keep your dentures away from children and pets. Cats and dogs are attracted to dentures left exposed around the house. At least 1% of dentures need repairs due to the damage done by pets. Sometimes the excess of the damage is so big, that the repair can not be done and the new denture has to be made. The expense can be easily avoided.

Before and After

Properly designed denture will make a difference in function and appearance:

Partial Denture – Flexible Partial

A flexible partial is a removable dental prosthesis that restores 2 or more missing natural teeth. It usually consists of replacement teeth set in pink flexible material. There are no wire clasps placed around the natural teeth as in the conventional partials. Instead, the flexible material is molded around the natural teeth to assist in retention of the partial. The rest stops are usually placed on the natural teeth to prevent the partial from putting too much pressure on the gums during chewing. It is worth all efforts to save lower teeth, so they can be used to support the partial denture.

As the flexible partial denture provides the most comfort to the patient, its longevity is in some degree limited. Today’s technology offers few different materials to choose from for the flexible partial denture (some are even repairable) but, it’s only fair to inform the patient that flexible partial dentures do not last as long as the conventional ones; on average, it is about 3 years. They are a great option for some patients though. I would recommend them to the patients with severe bone loss in the lower jaw and having the gum ridge very sensitive to the touch (due to the nerves being exposed after the loss of bone). Still, in most cases a conventional denture with a permanent soft liner may work better and be more economical for the patient. There are no perfect solutions for restoring missing teeth; the job of a provider is to present all options to his or her patients and let them make the decisions they feel most comfortable with.

A flexible partial denture will:
· Replace missing natural teeth to restore your smile.
· Prevent “drifting” of teeth (if the missing teeth are not restored after extractions, the remaining natural teeth will move or “drift” creating spaces between them).
· Improve your bite and speech.
· Make chewing easier and more comfortable.

Advantages of the flexible partial denture:
· Comfort.
· Usually there is no need for the teeth preps as needed for the metal frame rest stops.

Disadvantage of the flexible partial:
· Lower durability than the metal frame partial.
· Possible discoloration of the flexible material.

Partial Denture – Acrylic Partial

An acrylic partial denture can be made when 2 or more of patient’s natural teeth remain in his/her upper or lower jaw, and can be used to anchor the partial. This removable partial denture usually consists of replacement teeth set in pink or gum colored acrylic resin. One or more wire clasps are placed around the natural teeth to assist in retention of the partial denture. Sometimes the metal rests are placed on the natural teeth to prevent the acrylic partial from putting too much pressure on the gums during chewing. It is worth all efforts to save lower teeth, so they can be used to support the partial denture.

An acrylic partial denture will:
· Replace missing natural teeth to restore your smile.
· Prevent “drifting” of teeth (if the missing teeth are not restored after extractions, the remaining natural teeth will move or “drift” creating spaces between them).
· Improve your bite and speech.
· Make chewing easier and more comfortable.
Advantages of the acrylic partial denture vs. metal frame partial:
· Significantly lower cost,
· No need for the teeth preps as needed for the metal frame rest stops,
· Shorter time needed to fabricate.

Disadvantages of the acrylic partial vs. metal frame partial:
· Lower durability,
· Acrylic partial restoring back teeth on the lower jaw, in the beginning may feel a little bulky behind the lower front teeth, as acrylic connector is thicker than a metal frame connector. It usually does not take very long for the patient to get used to it though.

Acrylic partial is many times called a “temporary partial" or a "flipper", but depending on the use and care, and if made well, it may serve the patient many, many years.

See also Acrylic Partial - Part II

Partial Denture – Metal Frame Partial

A metal frame partial denture is a removable partial denture (RPD) that can be made when 2 or more of patient’s natural teeth remain in his/her upper or lower jaw, and can be used to anchor the partial denture. It usually consists of replacement teeth attached to pink or gum colored plastic bases which are connected by a metal framework. In general, the metal framework consists of connectors, rest stops, and clasps built around your existing natural teeth. It is worth all efforts to save lower teeth so they can be used to support the metal frame during construction of a partial denture.

A partial denture will:
· Replace missing natural teeth and restore your smile.
· Prevent “drifting” of teeth (if the missing teeth are not restored after extractions, the remaining natural teeth will move or “drift” creating spaces between them).
· Improve your bite and speech.
· Make chewing easier and more comfortable.

Better durability is a big advantage of the metal frame partial over the acrylic partial. The higher cost, the need for the teeth preps for the metal frame rest stops and longer time needed to fabricate, would account for the disadvantages of the metal frame partial over the acrylic partial.