Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article, with detailed images of dentures, provides an in-depth explanation of dental temporaries, premium, partial and full dentures.
Not all removable appliances are created equal nor should they all be called "plates".
On the contrary, removable partial or full dentures can be part of a complete "makeover". Any denture, even the most economical and temporary variety, will provide a better look than multiple missing teeth or rampant decay and infected gums.
While temporary, first dentures placed immediately after extractions are certainly an improvement over the previously poor teeth and gum conditions, they are only average compared to what can be created when a second, customized appliance is made. Once the gum and bone tissues have adequately healed, new impressions are made which assure a better fit to the current conditions. When the second denture is made there are several benefits that were not feasible when the initial denture was made:
1. Impressions made with the "guess work" removed on how the fit will be after tooth extractions.
2. Second denture can be made without rush and tried in before completion.
3. Time is allowed for treatment of other remaining teeth and problems within the same arch as well as the opposing arch.
4. Some changes in the bite (occlusion) are possible (and highly desired for optimum stability) when the mouth is now considered as a whole and modifications are planned.
5. Some changes in shade and size and arrangement of the teeth are possible.
All of the above can be possible with standard dentures.
When even more customization and best possible fit and durability are desired, a
premium full or partial denture is the right choice.
Premium dentures include higher quality tooth material and details in the pink gum area to look most natural.
Standard dentures are nice but ordinary when compared with the premium option.
(Above) Another view of a premium full upper denture showing the nicely finished and detailed work in the base as well as the setting of teeth. Attention is paid to adequate thickness for strength while making optimum room for the tongue to feel comfortably at home. Speech as well as chewing and smiling are all considered.
The tooth size, shape, color and arrangement can be varied within a range. Custom made removables can create a nice natural look with a personal touch. This means that teeth match other existing teeth and the arrangement of the teeth is fairly straight and definitely assuring a balanced bite. However, there are minor imperfections making a realistic result. When there are no other teeth that need to be matched, then a nice clean but neutral shade is chosen. On the other hand, if desired by the patient they can be made very white and very straight (supernatural).
Here are the main features of premium denture appliances:
1. Quality teeth with greater durability and natural variations in opacity and translucency Varied shade and contour of the artificial gums ( rather than very smooth and very pink)
2. High quality lab work
3. Minimum two step custom impression technique for optimum fit
4. Additional time and attention by your dentist in planning and tooth set-up
5. Even greater ability to correct cosmetic problems, stabilize bite and correct alignment when entire mouth (both upper and lower arches) are being considered.
Additional time and steps are taken during the transition period from initial dental problems through final restoration. Temporaries are made and modified as needed in order to accommodate additional extractions, fillings, healing and cosmetic changes.
When there are cavities, gum problems, etc. with the anchor teeth or the opposing teeth then these problems are addressed prior to making the final restoration.
In order to create the best possible esthetic results and create long term stability, the bite is refined in all dimensions in order to obtain greatest chewing ability while assuring the least amount atrophy of ridge bone.
Teeth are best able to withstand normal chewing forces (and abnormal clenching forces) when there are many teeth with long roots firmly embedded in bone and with no spaces between them. Having roots in vertical alignment is also a key factor.
Bone can be lost from too much force as well as from lack of use. Ridge bone also lost due to the same two reasons. Atrophy is loss of bone due to lack of use - since there are no longer teeth with roots supported within bone, the bone weakens and "melts away" from disuse. Resorption of jaw bone happens due to too much force such as when dentures are rocking and rubbing causing irritation. In order to maintain healthy bone for as long as possible the following are needed:
1. Optimum fit from the start
2. Refitting via relining as needed and as early as needed
3. Establishing an optimum occlusion (bite) Dentures must have balanced forces to prevent tipping. Denture teeth must be aligned over the bony ridge to reduce adverse leverage:
4. The bite must be maintained and checked for uneven wear periodically. This is extremely important when there are a variety of tooth materials - natural enamel, porcelain, metal or plastic.
Dentures work best when the bite is well balanced. Missing teeth in one area causes overload and tipping forces. Teeth that are irregular like "mountains and valleys" will also cause very unstable conditions.
Bone is lost around teeth due to periodontal infection. Habitual clenching due to stress especially happening during sleep also contributes to recession of gum and bone. When some teeth are already missing the amount of force upon the remaining teeth is increased.
Sometimes it is recommended to have a night guard retainer when a patient has a full or partial denture. The Denture is worn during the day for normal eating and speaking. The retainer worn while sleeping protects from damage due to night clenching. This is especially beneficial when a patient has only a few remaining teeth. Without a night retainer, they are highly likely to grind the remaining teeth loosening more bone and also frequently bite their tongues and cheeks while asleep.
More time and quality materials are used in every step.
See the image below: the denture on the left is average while the right one shows excellent
fit that can only be possible with custom impressions.
Lower dentures are notorious for being loose and easily dislodged by the tongue. Note how the borders are established to avoid interference with muscles. Also note how the denture is fashioned with a "cavern" to accommodate the tongue. The tongue actually helps weigh down the denture instead of constantly lifting the denture upward.
Examples of customized partial dentures
Use of flexible nylon denture bases and silicone retention surrounding natural teeth have many benefits including: Easy to place by first time denture patients and patients who have limited strength and dexterity in their hands. Effective but gentle retention on the anchor teeth. Little or no preparation of anchor teeth required compared to traditional metal frames and clasps. They are light weight and easily modified. The disadvantage is being less strong than a partial with a metal framework.
See these images of customized partial dentures:
CuSil Silicone retention (left)
Flexi Nylon base and clasps (right)
Nylon tooth shade clasps on standard frame partial denture:
When there are only a limited number of remaining teeth that are strong enough to serve as anchor teeth, traditionally a partial denture is made that has visible metal clasps. As an alternative, tooth shade nylon clasps can be placed in areas that would otherwise show metal. Nylon clasps have the additional benefit of being gentle to the anchor tooth. Flexible partial dentures can be made that are held in place by the necks of the teeth so that there is virtually no artificial material above the gum line. Another method of saving worthwhile teeth, few in number and giving more support to a denture than resting solely upon the gum tissue is to make an over denture. In this case the anchor teeth and anchors are completely invisible under the denture base.
In many cases, a patient wears a partial or full denture as a temporary when they ultimately plan to have implants as their long term tooth replacement. Having good fitting and nice appearing partial or full dentures prevents further damage to remaining teeth and also protects implants as they heal within the bone. Having a good partial or full denture and also a dentist who knows how to customize and modify them, can be a great advantage when a patient desires implants but will need a year or even much longer before completion.
We will be happy to show further examples and give you further information.
We can provide you with an estimate for comparison when you have the ability to choose between Economy, Standard and Premium restorations for your individual situation.
Thank you for reading,
Dr. Ray
Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.
