Dentures and Dental Implants
Complete denture care, when combined with specialized knowledge, skill and experience can restore for most people a natural appearance, reasonable chewing ability, normal speech, health and comfort. Successful dentures require not only the technical aspects of a well made denture but also appropriate evaluation and treatment of the gums and bone taking into account oral physiology such as saliva, mouth movements and functions such as speech and mastication (chewing). Your health, comfort and appearance are dependent on all these factors. Your comfort and ability to function with dentures is also dependent on the amount of your remaining jaw bone or ridge and your ability to accommodate to new dentures. While proven techniques and extensive efforts are used, the final result can not be known in advance and no guarantee of success can be made. We will, however, use our best efforts as we have in the past for many satisfied patients.
To help you understand what is involved in providing immediate 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 remaining teeth, jaw joints, muscle function and co-ordination, the extent of jaw bone resorption (shrinkage) both around remaining teeth and any missing teeth and other 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 and as an essential aid to facilitate the proper removal of the remaining teeth. If dental implants are to be considered, it is critical
to know the shape of jaw bone.
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 and any remaining teeth. 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
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 (prior to their deterioration), 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.
- Patient review and approval of wax set up prior to completion
Before the denture is actually finished, once the denture teeth are held in position by pink wax, they can be seen on our equipment and instrumentation so you can have an idea and some reassurance of the appearance. 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). Because an immediate denture is made on models of your mouth prior to actually removing your teeth, it is not possible to try in the denture prior to its completion to fully verify appearance or function. Despite this, an immediate denture fulfills the basic need to not have to go without teeth. Although an immediate denture can often be made to meet most patient's expectations, if changes (other than adjustments or a reline) in the denture are needed, a new denture will likely need to be made.
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. Your approval of denture appearance 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, tooth removal and insertion
Prior to this appointment, the completed dentures will have the bite refined by returning the dentures to a specialized machine for fine adjustment. 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. Primarily, during this appointment, the remaining teeth are removed and any desired changes in the shape of the bone and gum are completed at the same time. The dentures are placed in the mouth immediately after the teeth are removed and you will be provided with additional information to assist in healing and maximizing your comfort.
- 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 healing and learning to fully use new dentures will take months, at the one week point many aspects of adjustment and accommodation will already be evident. Most people will return to their regular home and work schedule at the one week mark although allowance must be made for a modified diet.
- Three week post insertion evaluation and first soft liner
At three weeks following the removal of the teeth and start of denture wear, all swelling will have disappeared and the denture can be have a temporary soft reline to increase stability, improve comfort and chewing. The cost of this first soft liner is included with the cost of the denture.
- Additional soft liners and reline
Periodically, the soft liner is removed and new soft liner added as the gum and bone progressively heals and shrinks. This is often completed at the two month and four month marks. The gum and bone healing and shrinkage will likely slow by about the six month mark and therefore it becomes cost effective to complete a longer lasting hard acrylic reline at that time. Additional fees, separate from the denture will be charged for these procedures and they can be outlined for you.
- 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 a few months, 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.
Usually, during the first six months after your teeth are removed, the new denture must be periodically refitted (relined) to your healing and shrinking gums and ridge. This requires placement of a soft liner inside the denture. No additional fee is charged for the first soft liner in each immediate denture. There is a fee charged for subsequent soft liners and longer lasting hard acrylic relines.
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 even when teeth were removed years prior, dentures still 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 regularly evaluated approximately every 12 months.
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. B.N. was 45 years old when she came to our office wanting to get some replacement teeth because she had many missing and deteriorated teeth, especially in her upper jaw. Because her finances were limited, she decided to proceed only with treatment for the upper jaw which consisted of completing an immediate upper denture at the same as the upper teeth were removed. This approach allowed her to regain her smile and buy some time before proceeding with other more involved treatment for the lower teeth.
Mr. G.B. was retired when he presented to our office in 2003 with the primary concern that he couldn’t chew well. He also explained that he had a pronounced ‘gag’ reflex, that he was missing lots of other teeth and several of the remaining teeth were loose. Despite the potential inability to wear a denture due to the gag reflex there was little alternative to removing the remaining extremely compromised upper teeth and their hopeful replacement with an immediate complete upper denture. A number of the lower teeth were recontoured to be more level in height for a more even bite and improved appearance. The remaining 8 upper teeth were then removed and the mouth prepared for the denture that had been made in advance and which was placed at the same appointment that the teeth were removed. Despite the grave concerns about gagging, Mr. G.B. adjusted very quickly to the denture and his most notable comment was that he should have done this a lot earlier. In the event that gagging would have become problematic, or even if Mr. G.B. just wanted improved comfort and stability beyond what a denture can provide, dental implants would have to be considered.
Miss. J.B. was unfortunate to have inherited a genetic condition which causes the adult teeth to develop abnormally and then deteriorate almost as soon as they appear in the mouth. This young lady was only 12 years old in 2000, when we first met her. She thought her teeth looked kind of weird and sometimes they hurt her. She wanted to have her teeth fixed. Her lack of a normal smile because of her teeth must have been an extreme concern socially. This can have a devastating effect of the development of good self esteem at such a critical time in social development. Without good teeth, most of us would also have a lot of problems talking and eating as well. In addition, it was of great concern to find a positive way to explain not only to this young lady but also her parents that all of her teeth had to be taken out and she would need dentures because there was no way to fix her teeth. We found a way to develop her trust and she now has a beautiful smile and a great deal more self confidence. She had adapted very well to her dentures and she is now looking forward to getting dental implants to improve her function closer to what natural teeth would provide. Miss. J.B. has an older sister with the same dental problems and treatment.
Mr. J.D. at age 36, was referred to our office in 2001 by his general dentist because his teeth were in very poor condition and required removal. An additional problem was that Mr. J.D. wasn’t sure he was ready to have all his teeth removed and yet he was having difficulty chewing, speaking and didn’t like his appearance. There was also a great deal of infection around every tooth. At his initial consultation and examination, we definitely confirmed that there was no way to save the teeth and then we carefully explained the benefits and reasons why the teeth should be removed and immediate dentures made. We also reviewed the disadvantages and limitations of dentures because it’s important to have a realistic idea of what to expect. This builds trust. For this particular gentleman, the upper very back teeth were removed initially, followed by the lower very back teeth to facilitate a better fitting immediate denture and to reduce the number of teeth that had to be removed in a single appointment when the immediate dentures were inserted. Temporary relines were completed to help maintain comfort and improved denture stability during the healing period followed by a longer lasting reline. Mr. J.D. definitely has a much improved appearance and some improvement in chewing and talking but just as important, he has eliminated a very extensive infection that no one should leave untreated.