I am one of the few dentists who enjoys making dentures. Many dentists do not enjoy making dentures. During my residency, I was fortunate to study under skilled dentists and lab technicians who taught me techniques that have made this a rewarding part of my practice.
A complete denture is what most people think of when they hear the term “denture”. Someone has all of their teeth missing on the upper arch, lower arch or both and the denture is replacing those teeth. We often need to remake a patient’s existing complete denture for various reasons:
An immediate denture is a denture that will be inserted at the time the patient’s teeth are extracted. There are times when numerous teeth cannot be saved due to decay or periodontal (gum) disease and the person does not wish to go any period of time without teeth. When this is the case, we can often extract the teeth and the patient can leave the office the same day with their denture. In the four to six months after the teeth are extracted, the bone and tissue will shrink considerably, and the denture will get more and more loose. Once that process has stabilized after approximately six months, we can perform what is called a “hard reline” where we flow a hard material similar to what the denture is made out of onto the denture and seat it in your mouth while it hardens, this helps to again snug up the denture.
In some instances, the periodontal (gum) disease is so severe that an entirely new denture has to be made. In these cases, there is so much remodeling as the diseased bone and gums heal that a hard reline cannot compensate for the amount of material that needs to be added to allow for an acceptable fit. Oftentimes, we can tell in advance that this is going to be the case, but there are individual variations and everyone heals differently.
An over-denture is a denture made over something, either the roots of certain teeth or implants, most of the time it is implants. The most common roots used to make an over-denture are the roots of lower canines. In this instance, you must have very good canines with strong root support and minimal to no decay. Root canal therapy is performed so that posts can be placed and attachments are added which engage the over-denture so that the over-denture “snaps” into place. This helps to stabilize the over-denture.
By now, most people have heard of implants. Implants are medical grade titanium posts or screws that are placed in the jaw bone. They act like substitute roots of the teeth. The body treats them like the roots of your teeth, and bone attaches onto the implants in a process called “osseointegration”. Implants are placed in certain key locations to engage the denture.
This type of partial denture is supported by a solid metal framework. Indentations are made on certain teeth, which allow the metal framework to rest onto those areas when the partial denture is in the mouth. This helps disperse pressure between the teeth and the gum tissue. The clasps that wrap around certain teeth are also part of the solid, metal framework, which means very little adjusting is possible without the risk of breaking the clasps. While the metal framework gives strength and durability, it can make adding additional denture teeth difficult or impossible. If a patient looses a tooth, it may be impossible to add that tooth onto a metal framework partial denture.
This type of partial has no metal framework. It is ideal for patients with periodontal disease where tooth loss may not have stabilized or is uncertain as denture teeth can be added much easier to this type of partial denture versus a metal framework partial denture. This type of partial denture rests entirely on the gum tissue; it does not disperse any load onto the teeth. The lack of a metal framework means the denture is more prone to breaking. The clasps are a thin wire that easily adjust but are not as retentive as the clasps on a metal framework partial denture.