Introduction to complete dentures

Introduction to complete dentures

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As a clinical teaching and professional activity, complete denture prosthodontics requires a knowledge of applied basic sciences, biomaterials, occlusion, esthetics, performed with technical excellence. In a public health context complete denture prosthetics remains a relatively simple and inexpensive treatment method. Nevertheless, it is not a panacea for the edentulous predicament. Outcomes measurements of healthcare treatment are only partially defined by technical excellence and are not exclusively dentist determined. It is not surprising that many patients may be described as unable to wear dentures. This occurs despite the dentist’s technical ability and humanitarian concern. Patients originally considered adaptive may become maladaptive due to degenerative effects. As a result the outcome of complete denture prosthodontics is unpredictable. Edentulism is due to a variety of cultural, financial, educational, and dental disease determinants as well as the treatment received in the past. Despite evidence that the incidence of edentulism is declining, the need for complete denture service is expected to remain high. The complete denture is supported by mucosa and residual bone, unlike teeth with a periodontal ligament. The eentulous state represents a compromise in the integrity of the masticatory system accompanied by adverse functional and aesthetic sequlae. Maximal bite force is five to six times less in the denture patient, which may lead to decreased masticatory efficiency. Pronounced differences also occur in movement of the dentures, with dislodgement and resulting tissue irritation. In complete denture prosthodontics, the position of planned maximum intercuspation is established to coincide with centric relation. This coincidence is referred to as centric relation occlusion. Progressive changes in this maxillo- mandibular relationship occur with ridge resorption and migration of the denture. Tooth loss adversely affects a person’s appearance, as noted in the diagram. Early communication with respect to the patient’s cosmetic expectations should be established to avoid misunderstanding. The patient must understand also and accept that learning to use the denture is an important part of achieving successful outcome. The dentist must also seek to determine the patient’s motivation in seeking prosthetic care. The success of prosthodontics treatment is predicated not only on technical excellence but on the dentist’s ability to relate to patients and to understand their needs. The risk of oral cancer is increased among indigenous denture wearers simply because many are poor and make little use of screening services. Residual ridges continue to resorb after tooth extraction, yet older people are less likely to seek treatment. Older people are less adaptable to new dentures so whenever possible, modify or improve familiar dentures rather than make new ones. Aging, in addition to medications can adversely affect the quantity and quality of saliva produced with a loss of perception of smell and taste. Aging affects muscle tone with sagging and wrinkling of the face. Teeth can take on darker tones with aging and many patients are concerned about their self-image. Prosthodontics treatment for older people requires accurate diagnosis of systemic and local problems prior to the fabrication of the denture. The placement of a removable prosthesis produces profound changes in the oral tissues. Various conditions such as mucosal reactions, altered taste, gagging and denture irritation may occur. It is important to have a recall system in place to monitor patients for these changes. Patients should be instructed to return for regular follow-up care, should leave the denture out while sleeping, and should keep the denture clean with a soft brush and mild soap. The patient should massage their gums with a soft brush. Dentures may be soaked in a 2% chlorhexidine as disinfectant. The denture should otherwise be constructed to minimize areas which can retain plaque and food debris. These considerations become even more important in the immunocompromised hosts. Temperomandibular disorders is a collective term used to designate a group of musculoskeletal conditions affecting the temporomandibular area. In the absence of a true understanding of the condition and until the development of specific therapies, correct and prudent conservative symptomatic management of TMDs in denture wearers should be similar to management strategies prescribed for most patients. This includes patient education and reassurance, self-care, short term pharmaco-therapy and cognitive and behavioral intervention. Denture wearers are vulnerable to compromised nutritional health. Early in treatment the dentist can assess and address major deficiencies or refer the patient for care. Patients should be instructed to chew more slowly. The patient must participate in nutritional goals if dietary improvement is to occur. An immediate denture is a complete denture or removable partial denture fabricated for placement immediately after the removal of natural teeth. A primary advantage of an immediate denture is the maintenance of the denture wearers appearance. A disadvantage is that no tooth try-in prior to extraction can be performed to determine what the denture will look like. The overdenture is a restoration which rests on supporting tooth structure or dental implant. Advantages of the over denture are maintenance of residual ridge integrity, enhanced stability, and retention and positive patient perceptions. A disadvantage is possible eventual loss of abutments due to caries and periodontal disease and space limitations imposed in placing the overlying denture tooth. The implant supported overdenture is a prosthesis retained by implants. Many variations are possible in the number and arrangement of the implants. Disadvantages of this approach are the additional surgical intervention and expense incurred, plus there is a serious risk of ignoring the merits of traditional treatment modalities in the management of extensive partial edentulism An enormous amount of success has been achieved through incorporating implants. for managing the edentulous patient. It is easy to conclude that it is no longer necessary to spend countless hours with patients discussing how to adapt to a removable prosthesis. It is worth reiterating that dentists are very adept at providing quick solutions to problems, however many practice problems require significant commitment to PATIENCE with PATIENTS. Effective techniques of communication remain an indispensable determinant of favourable management outcomes. The dentist should possess sufficient knowledge of materials used in prosthodontics so that they can exercise prudent judgment in their selection. Typically complete denture prosthodontics uses a number of heat, light, and chemically activated acrylics. Plastic or porcelain teeth may be used on occasion. Various models such as titanium and chrome cobalt may be employed. It requires approximately eight three-hour appointments to fabricate a set of complete dentures. At the first appointment you will conduct an examination of the patient. If the patient has an old injury, examine it closely. Preliminary impressions are then made. Custom impression trays are then fabricated from the diagnostic casts. At the second appointment you will use a functional impression technique to fabricate definitive casts. From these casts you will make a record base and wax rims to record the patient maxillo- mandibular relationship. The MMR at the third appointment, you will adjust the record-base/ occlusion rim to fit the patient. You will acquire the MMR and face bow registration at this time. You will determine a tooth form and shape appropriate for the patient. In the laboratory you will mount the definitive casts and set the teeth and contour a soft tissue simulation. At the fourth appointment you will try in the teeth. You will verify the vertical dimension, verify the MMR, verify the aesthetics, and phonetics. In the laboratory you will finalize waxing the denture. The denture is invested and processed. The processed denture is retrieved and returned to the articulator. You will then equilibratE THE occlusion to eliminate processing error. It is a good idea at this time to preserve the face bow mounting. The denture is then removed from the definitive cast and polished. This procedure will destroy the definitive cast, therefore remount casts should be made at this time. At the 5th appointment you will insert the finished denture. You will verify the vertical dimension, the MMR, the aesthetics, and the phonetics. If there are extensive discrepancies or at the request of the instructor you will be prepared to perform a clinical remount procedure. Appointment 6 through 8 basically consists of follow-up care. Here you will examine for traumatic ulcers, discrepancies in the fit or occlusion of the denture, and any concerns the patient has. Proper home care and the need for regular follow-up care is reinforced.

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