Predictions exist that by the year 2020 we will have 38 million edentulous adults with 61 million edentulous arches in the United States (Douglass, et. al.). Chances are they will be looking for a dentist at some point to help determine restorative dental treatment options. Socioeconomic data provide insights where if a patient is 65 or older, without a high school degree, “poor” and a smoker, then this patient is completely edentulous.
What are the options for complete dentures?
- Dental implant-related restorations: fixed or removable, one arch or both
- Conventional complete removable denture prostheses
- Refer to another office
What if you are in a position where the only option is #2 - complete dentures?
Check this out - in a study published by Walton & MacEntee in 2002, 36 percent of older edentulous participants refused FREE mandibular dental implants. While socioeconomic factors likely played a role, there is apparently a segment of the population with either a fear of the procedure involved or a general lack of belief that dental implants will work for them. Certainly, a patient might have a contraindication relative to the healing potential required for dental implants to integrate, resulting in the decision for a complete denture.
Are there factors in the technique that make a difference in your office?
- Patient Selection - This is probably the most important “technique.” This is specific to each dentist and may be different at various points along the course of a career. The key is to work with a patient that has the potential to adapt to something new and different. There exists a group of people that fit in the category of “mal-adaptive” denture patients. It is important to identify challenging patients as soon as possible. One of the classic articles by Dr. Koper classifies patients into categories that add a little humor into what can be a tough situation. The categories related to difficult denture birds include: Karate Hawk, Myway Magpie, Minewere Mallard (aka: I Usta Duck), the Forever Flicker and the Tipsy Pipit, Rummy Robin, Martini Meadowlarck, etc. Recommendations or suggestions pertaining to the topic of patient selection describe the relationship with the patient as being more important than the technical expertise applied to making a well-crafted prosthesis.
- Impressions - This is always a great topic of discussion. The traditional technique involves a two-stage approach with a primary impression and a secondary or final impression making use of a custom tray and border molding. A technique involving irreversible hydrocolloid as a final impression has been published as a technique used with dental students where the key is an opportunity to check the impression using a processed acrylic denture base. Another technique is a layered impression made of vinyl-polysiloxane (VPS) to allow for the opportunity to evaluate and refine the retention and stability over time. All of the techniques work. It’s really the attention to detail that makes a difference, although it’s nice to have a few options when working with our patients. How do you make a decision on technique?
- Denture Occlusion - This is typically a hot topic related to complete denture technique. Would you incorporate canine guidance into your occlusal design? The technique often associated with denture occlusion relates to “balanced” contacts in eccentric positions. Anterior balance, cross-arch balance and cross-tooth cross-arch balance all fit in the category, with much more precision with each option, at least on the articulator. Cusp height comes in as a decision: flat plane, 15 degree, 30 degree or any variation depending on the manufacturer. Tooth position and denture occlusion really begins with the position of the two maxillary central incisors. Facially generated treatment planning applies as much here as in any restorative dental treatment plan. What types of decisions here influence your strategy?
Strategy: Enhancing your esthetic practice through denture patients
Every patient thinking about a new denture is looking for an “esthetic” result ... something that at least doesn’t have the look of a denture. Think about all of the detail involved with tooth position (incisal edge length, incisal edge position, vertical midline, tooth proportion AND gingival levels, occlusal plane, etc.) that we can “practice” with teeth set in wax to optimize the final result. It's facially generated treatment planning where the restorative dentist can influence the variables related to the appearance of our patient's smile.
Beyond the technical aspects of denture construction, the interpersonal skills involved in patient selection and relationship-building are skills that transfer to the patient looking for an esthetic enhancement of their existing smile, whether with veneers or full-coverage restorations. This is true for not only the restorative dentist, but also for the staff associated with the dental practice. And ... there is an opportunity for dental implants to become a higher priority for your complete denture patients at some point in the future. That is a great opportunity for a growing practice!
What is your complete denture strategy?
Douglass, et. al. Will there be a need for complete dentures in the United States in 2020? Journal of Prosthetic Dentistry. 2002;87:5-8. Koper, A. Difficult Denture Birds. Journal of Prosthetic Dentistry 1967;17:532-539.
Walton J, MacEntee MI. Choosing or Refusing Oral Implants: A Prospective Study of Edentulous Volunteer for a Clinical Trial. International Journal of Prosthodontics 2005;18:483-488.
Douglas G. Benting, DDS, MS, FACP, Spear Visiting Faculty and Contributing Author. www.drbenting.com