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The Perfect Denture

Denture treatment experiences range from having new prosthetics that are completely unusable, even from the first day.... all the way to patient's feeling they have new prosthetic teeth that can't be distinguished from real teeth or high priced porcelain bridgework.

Denture Pain - Discomfort - Loose - Horse Teeth

The general areas of complaints for many denture wearers involve reports of pain, discomfort, bleeding, healing times that have become extended (e.g., 6 months), loose fitting, the feeling of having horse-like or mule teeth that feel too large or make the upper lip bulge out and lastly, denture teeth that look like dentures (which nobody really likes).

Cosmetic Dentures

The aesthetic value of a denture is dependent upon the fabrication process and the type of denture teeth used. Many "affordable denture clinics" that use low cost pricing strategies often use simple acrylic teeth that look like plastic teeth. Although some nice color choices are possible, the acylic composition of the teeth, which is typically porous, these dentures can discolor very quickly.

Special denture teeth made of acrylic hybrids and even porcelain are the components commonly used to make a denture look as good (sometimes better) than expensive porcelain bridgework. The "tell tale" translucency that good quality crowns have can now be created in denture teeth.

Basic Jaw Preparation versus Total Preparation

Edentulation Pre Op picture
Pre Op: Lower Jaw Edentulation
Denture wearers who have the greatest number of denture fit, feel and function problems, as a group, tend to have jaw edentulation (extracting all teeth) with a minimum or no additional tissue treatments.

Some patients receive an immediate denture to wear while tissues heal. Depending upon what is contained within the treatment plan, the immediate denture becomes the permanent denture for some patients.

Serious Bone Loss Mandible Picture
Note Existing High and Low Areas of Ridge
Patients who seek dentures at minimal cost are often provided a treatment plan that provides the basic extraction service, impression services and the fabrication of a basic denture. Since the patient has sought denture treatment based on a low price, there are no incentives to explore a "prosthodontic grade" of treatment.

The average patient is expected to have a good treatment result. This assumes however there are no issues that arise during the extractions that can affect the jawbone and bony ridge (the area of bone that the denture rests on).

Serious Bone Loss Mandible Picture
Note New Areas of Jagged Bone Loss
The problem, however, is that most denture patients discover, after the fact, they are NOT an average patient.

Pockets of bone loss, difficult extractions, gum disease, bone porosity issues and personal medical histories routinely complicates what is supposed to be the basic denture treatment.

Bone Leveling Dynamics

Serious Bone Loss Mandible Picture
Bone Height Requires Modification
The adjacent series of photos shows what can commonly occur during the extraction treatments for preparing the mandible for a non implant supported denture.

Caverns of bone loss exist (see picture #2) in both posterior (rear most) areas of the arch, along with a significant gap between the remaining two teeth.

The seemingly simple removal of the two remaining teeth caused additional bone loss. Jagged levels of bone remain.

Serious Bone Loss Mandible Picture
Horizontal Bone Trimming Begins
A non implant supported denture "ideally" requires a uniform level of bone all the way around. Even the smallest variation in bone height will create a rocking denture, gum sores, loose fit, speech issues, etc.

Sensible Leveling

To create a solid platform or ridge of healthy bone that will be "home" for the new denture, the high spots of jagged, compromised bone are leveled down to where the ridge have uniform height from one end of the arch to the other.

The adjacent picture shows how a horizontal cut is being made to get rid of the damaged, obtrusive bone material.

Perio Flap Surgery and More Leveling

Serious Bone Loss Mandible Picture
Level Bony Ridge Symmetry
Our last picture shows how a continuous Perio Flap is created to reveal the entire bony ridge. Special instruments are used to precisely level the bone that will serve as the foundation for a tight denture fit.

Once leveled, additional tissue graft material is added throughout, to assure healthy regeneration of new plump gum tissue that the denture prosthetic will rest on.

Editorial Staff

Photography and material provided by:

Ara Nazarian, D.D.S.
Michigan Reconstructive Implant Dentistry
1857 East Big Beaver Road
Troy, MI 48083
(248) 457-0500

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