Dentures are prosthetic devices constructed to replace missing teeth; they are supported by surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable; however there are many different denture designs, some which rely on bonding or clasping onto teeth or dental implants. Dentures can replace missing teeth on either the mandibular (lower) arch or the maxillary (upper) arch.
Support is the principle that describes how well the underlying mucosa (oral tissues, including gums and the vestibules) keeps the denture from moving vertically towards the arch in question, and thus being excessively depressed and moving deeper into the arch. For the mandibular arch (lower), this function is provided by the gingiva (gums) and the buccal shelf (region extending laterally) from the posterior (back) ridges), whereas in the maxillary arch (upper), the palate joins in to help support the denture. The larger the denture flanges (part of the denture that extends into the vestibule), the better the support.
Stability is the principle that describes how well the denture base is prevented from moving in the horizontal plane, and thus from sliding side to side or front and back. The more the denture base (pink material) runs in smooth and continuous contact with the edentulous ridge (the hill upon which the teeth used to reside, but now consists of only residual alveolar bone with overlying mucosa), the better the stability. Of course, the higher and broader the ridge, the better the stability will be, but this is usually a result of patient anatomy, barring surgical intervention (bone grafts, etc.).
Retention is the principle that describes how well the denture is prevented from moving vertically in the opposite direction of insertion. The better the topographical mimicry of the intaglio (interior) surface of the denture base to the surface of the underlying mucosa, the better the retention will be (in removable partial dentures, the clasps are a major provider of retention), as surface tension, suction and just plain old friction will aid in keeping the denture base from breaking intimate contact with the mucosal surface
Implant technology can vastly improve the patient’s denture-wearing experience by increasing stability and saving his or her bone from wearing away. Implant can also help with the retention factor.
Complications and recommendations
The fabrication of a set of complete dentures is a challenge for any dentist, including those who are experienced. In the vast majority of cases, complete dentures should be comfortable soon after insertion, although usually at least two adjustment visits will be necessary to remove sore spots.
The maxillary denture (the top denture) is usually relatively straightforward to manufacture so that it is stable without slippage. The lower full denture tends to be the most difficult because there is no “suction” holding it in place.
Some patients who believe they have “bad teeth” may think it is in their best interest to have all of their teeth extracted and full dentures placed. However, statistics show that the majority of patients who actually receive this treatment wind up regretting they did so.
Different types of dentures:
An immediate denture is made prior to your teeth being extracted. Once teeth are removed, the denture is placed immediately following the oral surgery. Your mouth changes as it heals, often times causing the denture to loosen or not fit as well; this is to be expected with this type of denture. Approximately 6-12 months after initial placement of the denture a rebase or the fabrication of an entirely new denture (complete denture) will be required. A rebase or new denture is at an additional cost to the initial denture cost.
A complete denture is made once teeth are missing. It can be made to replace a current denture or can be made once a patient’s mouth heals following the removal of all teeth (ideally 12 months heal time). This option is less costly overall, but not as popular due to the fact that you are without teeth for a period of time.
A complete denture replaces all teeth on an arch.
A partial denture replaces one tooth to several missing teeth on an arch. Clasps are necessary to help stabilize and support the partial denture. These clasps will “hug” the natural, remaining teeth and will also help prevent food from getting through the openings and under the partial denture. Partial dentures can be made with cast metal framework or with a flexible acrylic framework.
An over denture is a denture that is supported by implants or the roots of natural teeth. This type of denture has greater retention as it is held in place by dental attachments which provide the retentive strength that patient’s desire. An attachment retained implant overdenture will provide maximum retention, increase in function, and added health benefits.
An implant supported denture is a fixed denture that is supported by dental implants. This type of denture is held in place by abutments that are threaded into your implant, and the denture cap which is retained in the underside of your denture. An implant supported denture is a good option for patients who may no longer have the option of using their own natural teeth as the abutments/attachments. Like the overdenture, this denture will provide maximum retention, increase in function, and added health benefits when compared to a removable denture.
Common questions about dentures/partial dentures:
Handling a denture requires care. It’s a good idea to stand over a folded towel or a sink of water just in case you accidentally drop the denture. Brush the denture each day to remove food deposits and plaque. Brushing your denture helps prevent the appliance from becoming permanently stained. It’s best to use a brush that is designed for cleaning dentures. A denture brush has bristles that are arranged to fit the shape of the denture. A regular, soft-bristled toothbrush is also acceptable. Avoid using a brush with hard bristles, which can damage the denture.
Your dentist can recommend a denture cleaner. Look for denture cleaners with the American Dental Association (ADA) Seal of Acceptance. Products with the ADA Seal have been evaluated for safety and effectiveness.
Some people use hand soap or mild dishwashing liquid to clean their dentures, which are both acceptable. Other types of household cleaners and many toothpastes, are too abrasive and should not be used for cleaning dentures.
Clean your dentures by thoroughly rinsing off loose food particles. Moisten the brush and apply the denture cleaner. Brush all denture surfaces gently to avoid damaging the plastic or bending the attachments.
A denture could lose its proper shape if it is not kept moist. At night, the denture should be placed in soaking solution or water. However, if the appliance has metal attachments, they could be tarnished if placed in soaking solution. Your dentist can recommend the proper method for keeping your dentures in good shape.
It can be difficult to speak clearly when you are missing teeth. Consequently, wearing a denture may help. If you find it difficult to pronounce certain words with your new denture, practice reading out loud. Repeat the words that give you trouble. With time, you will become accustomed to speaking properly with your denture.
Your dentist will give you specific instruction about how long the denture should be worn and when it should be removed. Initially, you may be asked to wear your denture all the time. Although this may be temporarily uncomfortable, it is the quickest way to identify those denture parts that may need adjustment. If the denture puts too much pressure on a particular area, that spot will become sore. Your dentist will adjust the denture to fit more comfortably. After making adjustments, your dentist will probably recommend that you take the denture out of your mouth before going to bed and replace it in the morning.
For the first few weeks, your new denture may feel awkward or bulky. However, your mouth will eventually become accustomed to wearing it. Inserting and removing the denture will require some practice. Follow all instructions given by your dentist. Your denture should fit into place with relative ease.
Over time, adjusting the denture may be necessary. As you age, your mouth naturally changes, which can affect the fit of the denture. Your bone and gum ridges can recede or shrink, resulting in a loose-fitting denture. Dentures that do not fit properly should be adjusted by your dentist. Loose dentures can cause various problems, including sores or infections. See your dentist promptly if your denture becomes loose.
You can do serious harm to your denture and to your health by trying to adjust or repair your denture. A denture that is not made to fit precisely by a dentist can cause irritation and sores. Using a do-it-yourself kit can damage the appliance beyond repair. Glues sold over-the-counter often contain harmful chemicals and should not be used on a denture. If your denture no longer fits properly, if it breaks, cracks or chips, or if one of the teeth becomes loose, see your dentist immediately. In many cases, dentists can make necessary adjustments or repairs, often on the same day. Complicated repairs may require that the denture be sent to a special dental laboratory.