Increase Your Success with Complete Dentures — Part One of a Two-Part Series

Millions of edentulous people in the United States live with a functional disability (a physical condition that limits their daily activities) and are unsatisfied with their smiles. Well-made edentulous restorations can positively change the lives of many of these people. Dentists can enhance this population’s physical and mental well-being by creating esthetic mouths and smiles, enabling them to chew their food better, and increasing the comfort and health of their stomatognathic system — WOW!

However, fabricating edentulous restorations comes with many challenges. To increase the predictability and success of complete denture services, learning and applying the fundamentals of denture fabrication is very important.

You never know what you are getting into when beginning the restoration of an edentulous patient. Determining acceptable denture teeth positions is often a significant challenge, partly due to the unpredictability of alveolar bone resorption patterns after tooth loss. Utilizing the edentulous alveolar ridges, as many dentists and dental laboratory technicians have been taught, is an unreliable guide for tooth placement because of this irregular resorptive pattern. Also, when starting the fabrication process, we do not know how the mandible moves during speech, what the patient’s class of occlusion is, and how much space there is between the ridges for denture base material and the denture teeth.

Steps for Increased Predictability

Many dentists feel uneasy and anxious when delivering a set of dentures, not knowing if the patient will be dissatisfied or love the complete dentures. A favorable result often depends on the successful completion of each treatment

step.

For increased case predictability, execute the fundamentals of the following steps:

1. Consultation and examination

2. Impressions

3. Records

4. Wax try-in

5. Delivery

6. Adjustments

The Consultation and Examination

During this step, it is important to do the following:

1. Understand the patient’s wants and expectations.

2. Educate your patient on the challenges of denture fabrication.

3. Obtain written and verbal informed consent, including available options.

4. Perform a clinical evaluation of the stomatognathic system, including:

   1. Alveolar ridges (bone loss and ridge form)

   2. Tuberosities, hamular notches, retromolar pads

   3. Movable/loose denture supporting tissues (e.g., tuberosities and alveolar ridges)

   4. Mucosal thickness over alveolar ridges

   5. Muscle attachments (especially near the crest of the ridge)

   6. Condition of the denture supporting tissues including ulcerated areas and inflammation

   7. Presence of tori

   8. Shape of palate

   9. Health and stability of the temporomandibular joints and possibly associated headaches and neck pain

Understand the patient’s wants and expectations as clearly as possible before performing the clinical examination. Take the time to learn about the patient’s history and outlook regarding dentures. Ask open-ended questions and listen to their responses. What if a patient says they think all dentists make bad dentures? Or perhaps, a patient says they have had no concerns with past dentures and want a new set. Which patient would you prefer to treat?

You are not selling an object, like a pencil, but a service. It is important for you to understand, sense, and appreciate the patient’s wants and needs of the denture service.

As you do your clinical examination, you can evaluate whether you think you can meet their desires and expectations with the conditions of their stomatognathic system.

Additional Considerations During the Consultation and Examination

Will this be a teaching and learning case for you to try new techniques and coordinate treatment with the dentist, assistant, and dental laboratory?

How many denture adjustments will be included after delivery of the new dentures? A set number of denture adjustments should be addressed before you start treatment. Inform the patient that many elements of the prostheses cannot be changed after the denture is processed and delivered. Before processing the complete dentures, the patient must approve the shade of the denture teeth, teeth positions, and teeth shapes at the wax try-in appointment.

Also, if the patient does not accept the final prostheses, will you refund all or part of the fee? What if insurance dictates the fee? Is it a fair fee for you?

You will be more successful if you select patients to treat who have a positive and understanding attitude toward the denture service and whose stomatognathic system conditions are healthy and ideal. Success will also increase if you are careful and perform each treatment step well.

The Impressions

Understanding and applying denture fabrication fundamentals includes knowing anatomical landmarks of the edentulous mouth, making accurate final impressions, and clearly showing the dental laboratory the borders of the complete dentures.

The following are important in the complete denture final impression step:

1. If appropriate, ask the patient to leave their existing dentures out of their mouth for 24 to 48 hours before impressions are made to reduce the effects of existing ill-fitting dentures on denture supporting tissues. Also, tissue conditioners can be used in a denture (or in a duplicate denture) to improve the health of the denture supporting areas.

2. Ask the patient not to use denture adhesive in their dentures on the appointment day before the final impressions.

3. Select appropriately sized edentulous impression trays

4. Final impressions should record the following anatomic landmarks:

   1. Maxilla – includes hamular notches, vibrating line, tuberosities, buccal and labial frenums, buccal and labial sulci, residual alveolar ridge, incisive papilla, and tissues of the hard palate

   2. Mandible – includes retromolar pads, buccal shelves, buccal and labial frenums, buccal, labial and lingual sulci, residual alveolar ridge, and genial tubercles.

5. Create final impressions so the denture bases can be fabricated with maximum extension over denture bearing areas without muscle impingement. Muscle impingement can cause dislodgment of the dentures and sore, ulcerated tissues.

6. Clearly mark the posterior extension of the maxillary denture on the upper master cast and the retromolar pads on the mandibular master cast so the laboratory technician can appropriately fabricate the dentures.

Alginate is an often abused impression material which can make accurate final impressions for complete dentures if handled carefully and according to the manufacturer’s instructions. An excellent alginate impression material for complete dentures is AccuDent XD Syringe Colloid and Tray Colloid by Ivoclar Vivadent, Inc. When making alginate impressions, always use tray adhesive, store impressions in a humidor, and pour them as soon as possible to prevent warping. This is the conclusion of our first part of a 2-part series on complete denture fabrication. Our next article will discuss the remaining steps including: records, wax try-ins, delivery, and adjustments.

If you have any questions about Part 1, please contact me here. I look forward to being with you for Part 2.