Dentures and Dental Implants
To help you understand what is involved in providing complete denture care, we have outlined some of the many procedures that we incorporate to help you obtain denture success.
- Examination, radiographic interpretation, pre-prosthetic procedures when necessary, treatment planning, soft tissue conditioning when required
Examination of your mouth includes assessing the jaw joints, muscle function and co-ordination, the extent of jaw bone resorption (shrinkage) and irregular bone contours, the condition of the gums, an assessment for oral (mouth) cancer or any infection as well as many other conditions that can affect denture success.
A radiograph (x-ray) of your upper and lower jaws and jaw joints will be evaluated to rule out pathology (disease) and other complicating factors such as unremoved teeth or tooth fragments. If dental implants are to be considered, it is critical to know the shape of jaw bone.
The shape of the jaw bone or gum can become very distorted when poorly fitting dentures are worn. Sometimes it is possible to restore a normal shape by temporarily removing the dentures but sometimes soft tissue conditioning is required (a type of temporary soft denture liner) and in severe cases a minor surgical procedure is necessary. Proper correction is necessary to ensure a snug fit and to avoid unwanted compromises of your new dentures. If your dentures could be made to fit better, be more comfortable or look better, you would probably want to know about this.
Based on clinical and radiographic examination, recommendations will be made outlining the prosthetic options and any other procedures required that will best address your concerns.
- Preliminary impressions
Preliminary impressions of your jaws are an important start to obtaining a proper fit for your dentures. These impressions are carefully made to capture the basic shape of the entire jaw. It is from these preliminary impressions that a customized tray will be specially made to fit your jaw which will facilitate the making of an accurate final impression.
- Final impressions
An improved fit of the new dentures can be achieved if you remove your existing dentures as much as possible for the 24 hours prior to making the final impressions. If you normally leave your dentures in your mouth during sleep we highly recommend removing the dentures during sleep for at least the week prior to your final impression. In general, dentures are best not worn during sleep at any time.
The better the final impression, the better the fit of the denture. Your final impression is made using a custom made tray for you, which is far superior to the common use of a standard tray. Your final impression is then made in several steps, carefully ensuring that the planned new denture is the correct size and shape and has the best fit in all the different areas of the mouth. Your final impression is also made ensuring that your lips, tongue and mouth can make normal movements without interfering with the denture. Making your impression in this manner requires additional time and expertise but will result in a better denture.
- Determination of denture base shape and tooth position using facial dimensions, bite relationships, esthetic and phonetic evaluation.
You are encouraged to bring photographs of yourself that clearly show your natural teeth to aid in regaining this appearance. If you prefer, you can bring pictures of any smile that you feel reflects the kind of smile you want. Consider bringing photographs of family members, friends or pictures from magazines of anyone whose smile you like.
During this appointment, the general position and alignment of the teeth will be determined as well as the approximate height of the teeth. The position of the teeth will influence your facial appearance and your opinion and preferences are reflected in how the denture is made. The tooth position is also determined by phonetics, or how you speak and the natural alignment of your jaws. Muscle movement and activity must also be properly assessed during tooth positioning to avoid muscle soreness.
The reason most dentures look like dentures and not like real teeth is that the denture teeth are too small, too closely matched in shape, not aligned like natural teeth and the height of the teeth is inadequate making the person look older than they really are. Some patients know precisely what look they are after and some just like having an opportunity to see what we can come up with, the decision is yours. Many of our patients want their dentures to look completely natural but some want to have a ‘Hollywood’ or other ‘look’. Again, the decision is yours.
- Try in of wax denture prior to completion and patient approval
Before the denture is actually finished, once the denture teeth are held in position by pink wax, they can be tried in your mouth to assess your appearance and phonetics (speech). In many regards, what you see, is what you get and you can tell for yourself how the final denture will be. It is at this stage, that you have an opportunity to view and request changes to the appearance of your denture prior to processing (completion).
Please feel welcome to bring your spouse, other family member or a friend from whom you might want an opinion at this time. Small changes can be completed during this appointment, but if more significant changes are required, additional appointments will be arranged, as you require. Because the teeth are held in position by wax, it is not possible for you to eat anything or leave the office with the dentures. Your approval of denture appearance and phonetics (speech) is necessary before the dentures are processed (completed) because it is not possible to alter tooth position or denture design after this stage.
- Processing, remount procedures and insertion
During this appointment, the completed dentures will be checked for proper fit and any areas of increased pressure adjusted to reduce the chances of getting sore spots. Most importantly, the denture bite will be adjusted by remeasuring and placing the dentures on a specialized machine for refinement. Small changes that occur with every processing technique can therefore be eliminated. Denture stability is determined to a large degree by how even the bite can be made.
During the time that the denture bite is being refined, information and instruction will be provided on how to care for your new dentures that will help you obtain the maximum enjoyment and minimize the adjustment period. You will be provided with written instructions, a denture cleaning brush, denture cleaning tablets and a storage container.
- One day and one week post insertion evaluation
The benefit of routine follow up one day after providing the new dentures has proved invaluable in providing required minor adjustment before sore spots become a problem. This is also the perfect opportunity to answer any questions that arise.
Although learning to fully use new dentures will take many weeks, at the one week point many areas of improvement will already be evident. By one week, any problems that are going to arise will usually have become evident and can be addressed.
- Denture adjustment
Should the need ever arise, you are always welcome to return for assessment of any denture concerns. Once you have worn the dentures for several weeks, adjustments are rarely required. Sore spots that might occur after this time, usually will be the result of a hard piece of food that got under the denture and will usually go away in less than a week and no adjustment is recommended. A cause of persistent sore spots is heavy biting or clenching forces which requires you to eliminate these habits or removing the dentures during these clenching or grinding habits. Another cause of persistent sore spots is fragile gums especially when the jaw bone is very resorbed (shrunken). This situation requires eliminating the large forces if possible by modifying diet or improving denture stability through the use of dental implants. A sore spot that doesn’t go away should be assessed. No fees are charged for routine denture adjustment.
- Annual denture and mouth reexamination
Once a year you should have your mouth and dentures reexamined to ensure that the dentures fit adequately and the bite is still even. The mouth will be examined for oral cancer, something which is unfortunately more common than most people realize, but can usually be treated successfully if detected early. At the same time, your dentures will be professionally cleaned. You will also be advised of the need for any reline and eventually the need for new dentures.
The best results are obtained when patients are informed about the dental services they require, are provided with proper care and have an opportunity to participate in the decision making process. We will provide help and guidance to help ensure a successful result.
Learning to use new dentures will take time and patience. We will do everything possible to help you through the transition phase. You are always welcome to contact our office.
It is important to realize that dentures do not last forever. Changes are always taking place in the bone and gums under the dentures as well as with the support in the lips and cheeks. Experience shows that dentures need to be refitted to the soft tissues of the mouth approximately every one to three years to help maintain stability and a good fit. When changes within the mouth are more significant or if the dentures have worn, the dentures will require replacement. Many people will state that they have worn their dentures successfully for far longer periods than 5 years. What these people do not realize or know, is that ill fitting dentures cause damage to bone and gum tissue and may also promote mouth infection, despite occasionally being comfortable. It is important to have your mouth and denture periodically evaluated.
The benefit to you of having your dentures made inside our laboratory is quality and no shipping delays or damage that can occur with the use of off site, commercial laboratories. Our laboratory technicians are fully trained and only use quality materials, equipment and techniques. The biggest advantage of our office laboratory is the personal communication, training, and supervision with the technician as your teeth are being made that only an office laboratory can achieve.
Many patients have been misled to believe that a denturist is a ‘doctor’ or a specialist in dentures. To avoid confusion, you should realize that a denturist’s formal training consists of about sixteen months in a technical program. Denturists are not trained or allowed to treat many problems of the mouth that if left uncorrected can cause problems with the dentures or general health.
A prosthodontist is a dentist who has received seven years of extensive training in prosthetics including complete dentures and is the only recognized specialist providing complete denture care. Dentists also provide needed treatment for any remaining teeth and can place dental implants.
Overdentures: An overdenture can be made if you have one or more teeth remaining that are healthy enough to be reshaped and retained under your denture. These teeth will help prevent the shrinking of the jaw bone and therefore provide greater stability for the denture, especially in the future. Occasionally, a snap attachment can be added to these teeth and the underside of the denture so that the denture will be held in place by the snaps, which will improve denture stability and retention for greater chewing function and comfort.
Implant Overdentures: An overdenture can often be made even if no teeth remain, by using two or more dental implants in the lower jaw or usually four or more dental implants in the upper jaw. The implants will be anchored in the bone of the jaw and a framework attached which protrudes above the gums that the denture snaps onto. The implants and framework are completely hidden by the denture. The denture is removed with a snap whenever desired by the wearer for cleaning or sleeping. In every aspect, this is the best that a denture can be.
Implant Hybrid Prosthesis: An implant hybrid prosthesis is more like real teeth than a denture because it is fixed into place and allows normal chewing and complete comfort just like natural, real teeth. Usually five dental implants are placed in the lower jaw onto which a framework and natural looking teeth are attached. The implants will easily and solidly support the teeth and because of this the gums are not relied on for support and therefore no gum sore spots or pinching occurs. The hybrid prosthesis is not removable from your mouth and is made so that it is cleaned similarly to natural teeth.
Ms. J.B. came to our office in 2002 when she was 51 years old. Her first and only set of dentures were 25 years old and only the lower denture had been relined once, 24 years ago. She was complaining of constant sores in constantly different areas of her mouth, unable to eat or bite and a dislike of her facial appearance. She had been told that she had almost no lower jaw bone. She was aware of grinding and clenching her teeth, especially when she was tired and was wearing her dentures during sleep. We recommended the dentures be removed during sleep, that she try to stop her clenching and grinding habit and that once the inflammed and ulcerated gums had healed with the use of temporary soft liners, that new dentures be made and implant support then be considered. Mrs. J.B. has completed the new dentures and she agrees with her family and friends that not only her smile but her whole facial appearance is normal again. Mrs. J.B. still needs implant support to further secure her teeth but in the mean time is doing much better than before.
Mrs. R.W. came to our office when she was 39 years old in 2002 interested in dental implants because she had seen in the media that implants help to prevent bone shrinkage. She also felt that her dentures moved when she ate and she was self conscious that she didn’t have her natural teeth. She used denture adhesive and wore her dentures all the time, never removing them. Following examination, we explained that the dentures didn’t fit very well and that the gum was extremely swollen underneath because of the constant wear. We outlined a way to eliminate the gum swelling and explained that new dentures would then be required that fit properly. Following that, dental implants could be placed to provide further comfort and security. As we went through the process of designing the new dentures and getting the teeth properly lined up, it became evident that there would be a tremendous positive improvement on her profile and overall facial appearance. Her inner beauty was now evident visually. Mrs. R.W. is very happy with her appearance. She wants to proceed with the implants next.
Mr. G.V. presented to us in 2003 at age 59 wearing his second set of dentures that were then 20 years old and had never been relined. Mr. G.V. said the lower denture was loose, he felt his nose and chin looked like they were too close together and he had heard about the benefits of dental implants. Both his dentures had holes in them and he had crazy glued and taped fractured areas back together. He also thought that there wasn’t enough space for his tongue and this interfered with his speech. Examination revealed that the dentures fit so poorly that the gum under the dentures was very swollen, so much so that an extra fold of skin had developed in one area. The existing dentures were temporarily modified with temporary soft liners and the excess gum was removed. After a few weeks, the new dentures were fabricated incorporating a completely different design and incorporating the new denture teeth into the position that his natural teeth would have been. There was a big immediate improvement in appearance, but as normal, the speech and eating also improved but took a little longer to get used to. Mr. G.V. immediately arranged to proceed with dental implant support in the lower jaw. We received a call about a week after the dentures were completed from his neighbor wanting to see us for similar concerns.
Mrs. A.R was 79 years old in 1994 and had received her first and only set of dentures in about 1947 which had never been relined. Her main concern was that she was getting shooting pains from the lower right jaw over the past month with the result that she couldn’t eat and had lost weight. She went to her dentist who started to make new dentures but she experienced lots of pain during her appointment and that is when she was referred to our office. It wasn’t difficult to determine that she in fact did need new dentures. Her facial appearance was compromised as was her speech, denture fit and bite. The new dentures were soon completed and Mrs. A.R. and her family were very happy with the pain having gone and the dentures working and looking much better.