Adult teeth may be lost for a variety of reasons, such as periodontal disease, decay or trauma. If missing teeth are not replaced, the position of the remaining teeth in the arch can shift over time. If teeth on the lower arch are missing, upper teeth may drift downward. This is called Super Eruption and can interfere with the patient's bite or cause damage to the lower gingival tissue. Removable Partial Dentures (RPD) are appliances designed to fit a patient's arch, replacing one or more teeth. If a patient is missing all their teeth in one or both arches, a Full Denture is required to rebuild their bite and smile. Advancements in dentistry have helped Dentures become better fitting and more comfortable to the patient. Custom made dentures are carefully constructed to fit the patient's mouth and fashioned to look much like natural teeth. Their design takes into account jaw movements and the underlying muscular tissue.
The patient must have a complete oral exam with x-rays to determine if additional extractions or restorative work is needed. All dental work must be complete prior to the first impression to ensure the denture will fit the patient for years to come. Minor contour adjustments are then made to the remaining teeth. The initial impressions are taken, and the shape and shade of the Denture teeth are selected. An acrylic shade is matched to the patient's gingiva. When making a Partial Denture, the Lab will send back a Framework for try-in. This verifies that the metal frame on which the denture is based fits properly. With the Framework in place, the Dentist will make detailed measurements concerning the height of the patient's bite and the mid-line of the anterior (front) teeth. The Lab will then place the teeth onto the Framework using wax. At the Wax Try-In the patient will be able to focus on the appearance and bite of their new teeth. Next, the lab processes and polishes the Denture. At final delivery, minor adjustments are made chairside. The patient is given instructions and products concerning the care and maintenance of their new smile.
Please know, the need for Denture Adjustments to correct minor areas of irritation are expected. The patient should never feel as if they are bothering our office with requests for adjustments. It is best done by the Dentist, than by the patient at home.
Type Of Dentures
Cast Metal Framework Partials
Metal Framework Partials are considered by some to be the "Cadillac" of partial dentures. Based on a light-weight, custom metal frame, Cast Clasps are used to hold the Partial in place. Cast Clasps are small, custom-designed wings which wrap around the remaining teeth in the arch. They are the strongest of this type of retention and are constructed as part of the metal framework. Partial Dentures can also be retained with Precision Attachments. Precision Attachments are Laboratory Fabricated attachments where a part of the Framework mechanically locks into a specially designed crown. This can add a great amount of retention to a Partial: however, the patient should be aware of the increased cost involved. Due to the strength of the Cast Metal Framework, this style of RPD requires fewer repairs, and if designed correctly, additional teeth can be added if the need arises.
Hard Acrylic Partials
Hard Acrylic Partials are similar in shape to Cast Metal, but the frame is a tissue colored acrylic, and Wrought Wire is used as clasps surrounding the adjacent teeth. Wrought Wire clasps are not as strong as Cast Clasps, and often require more frequent adjustments. The acrylic material does save the patient on cost and often can be produced quickly by the Lab. Much like Metal Frameworks, additional teeth can be added: however, the Acrylic Framework is not as strong and may split due to heavy chewing forces or accidental drops. Acrylic Partials are often used as temporaries in cases where patients need esthetics while waiting for an implant or bridge.
Valplast® (Flexible Acrylic) Partials
Valplast is one of the newest products available to patients. Made of a very thin, semi-transparent acrylic, a Valplast Partial allows the patient's own gingiva to influence the color of the base, helping it blend into its surroundings. Valplast is light-weight and flexible, and its Clasp system is made from the same material. Once processed, however, flexible clasps can not easily be tightened chairside. At this time, only several Dental Labs are skilled in manufacturing Valplast. The need for repair or an additional tooth is difficult, and often requires the lab to fabricate an entire new unit.
When a patient is missing all their teeth on either one or both arches, a Full Denture is required. The process of creating a full denture is very similar to that listed above: however, instead of a Metal Framework, the Lab starts with an Acrylic Base Plate. Patients receiving Full Dentures for the first time may find it difficult to adjust to wearing them: however, with continual effort, the benefits of being able to chew and having a new smile helps them overcome the hurdle.
As one ages, bone continues to resorb causing a Denture to rock and shift. A patient may choose to use a Denture Adhesive, but eventually a more permanent solution must be found. A Lab Reline is when a new impression is taken using the existing denture as the impression tray. A special rubber based material fills the voids where bone has resorbed and contours to the existing gum. The Denture Lab then replaces the impression material with new acrylic forming an entirely new base to the Denture. If scheduled in advance with our Denture Laboratory, a Reline can be done in one day, minimalizing the time the patient is without teeth.
For patients with minimal bone support or those who demand the greatest retention, Dental Implants can be used to anchor Partial and Full Dentures, preventing the irritation and pain associated with "floating" dentures. Implants eliminate the use of adhesives and allow the patient to enjoy eating foods they previously avoided. With Implants, Dentures are firmly anchored to bone, allowing them to act and feel more like natural teeth. In the bone, the Implant replicates natural root structure and helps to prevent further resorption and the look of premature aging. Along with these benefits, however, the patient should be aware of the increased cost involved.
A Partial or Full Denture can attach to Implants in several different ways depending on the patient's case. An Implant Bar may be attached to the Implants for the Denture to clasp to, or Denture Locators may be placed inside the Denture acrylic which attach to a reciprocating device on top of the individual implants. 4 or more implants are needed for a well secured case, but often, 2 Implants can add enough retention for the patient to be happy and satisfied.