17: Prosthodontics, Removable: Dentures Replacing All or Some Teeth

CHAPTER 17 Prosthodontics, Removable

Dentures Replacing All or Some Teeth

Among the most well known but least desired areas of dentistry is removable prosthodontics. However, well-made and fitted artificial dentures can be relatively satisfactory replacements for teeth and surrounding bone and soft tissue for a predictable period. Unknown to many persons is the fact that the jawbones and gum tissues shrink a known amount when teeth are removed, and even more upsetting is that shrinkage continues to occur throughout the remainder of the person’s life. Acceptance of this fact is a major decision for a person considering tooth removal. Frustration with the maintenance of natural teeth can lead a person to think that tooth removal is an easy solution. However, tooth removal usually substitutes other problems for the one you are trying to avoid. Usually, but not always, retention of natural teeth is the best decision. Having your teeth removed can be compared to having an arm amputated. You can get a new artificial arm, but it will never function as well as the original arm. if you have lost some or all of your natural teeth, you should find a general dentist whose practice includes removable prosthodontics or a prosthodontist for acceptable treatment.

WHAT YOU SEE OR FEEL

Conditions, Signs, or Symptoms Related to Removable Prosthodontics

Implants are among the best ways to replace missing teeth, and Chapter 10 on implant dentistry should be read in addition to this chapter.

1. One or More Teeth Missing

(FIG. 17.1). The signs and symptoms of one or more teeth missing are described in the section on fixed prosthodontics. Please refer to that information about what you see or feel (p 140). Most persons prefer to have one of the fixed prosthodontic options (bridge attached into mouth) when one or many teeth are missing, but for financial or other reasons removable prosthodontic options may be best. All of the treatment alternatives follow, some of which are removable prostheses:

A. Fixed prosthesis (traditional bridge involving at least one tooth on each side of space as abutment teeth) (p 149)
B. Fixed prosthesis (Maryland bridge) (less prepared [trimmed] teeth on each side of the space, with conservative bridge holding a false tooth, usually leaving the front portion of the abutment teeth intact) (p 152)
C. Cantilever fixed prosthesis (traditional bridge involving one or more teeth on one side of space only as abutments) (p 151)
D. Removable partial denture (all plastic) (p 162)
E. Removable partial denture (traditional metal and plastic) (p 162)
F. Removable partial denture, precision or semi-precision (plastic and metal fitted to crowns [caps]) (p 162)
G. Implant(s) with crown(s) (caps) or prosthesis fixed on top to replace teeth (p 72)
H. Implant(s) with removable partial denture placed on top of them (p 70)
image

FIG. 17.1 Missing teeth can be replaced well with either fixed or removable prostheses (dentures); most people prefer fixed.

2. All Teeth Missing in Upper and/or Lower Jaw(s)

(FIG. 17.2). This unfortunate condition occurs less frequently now than in past decades, but it is still relatively common. Your treatment alternatives are the following:

A. Removable complete denture(s) (p 163)
B. Implants with fixed prosthesis on top of them to replace teeth (p 69)
C. Implants with removable denture(s) placed on top of them (p 66)
image

FIG. 17.2 Removal of all natural teeth produces a sunken, aged look.

3. All Teeth in Upper and/or Lower Arch Degenerated to the Extent That They Must Be Removed

Numerous conditions cause this situation, including dental caries (decay), gum and bone disease (periodontal disease), accidents, congenital deformities or other abnormalities, cancer requiring radiation and/or chemotherapy, or other conditions. When all of the teeth must be removed, some decisions must be made as to whether the teeth should be:

1. Removed all at once and the bone and gums allowed to heal before placing the denture(s) later. Usually this treatment is not one of the options, because the person must be toothless for several weeks before the denture(s) can be placed.
2. Removed partially (back teeth first), letting those areas heal without any replacements, and then, on the next appointment, removing the remaining front teeth and placing denture(s) to replace all teeth. This treatment is called a staged immediate denture. The person is never completely toothless (see Fig. 17-16).
3. Removed completely on one day, and during the same appointment, denture(s) placed to replace all of the teeth. This is a complete immediate denture. All the remaining degenerate natural teeth are left in the mouth until placement of the denture(s). Most people elect the latter two options because the new denture(s) serve as a type of bandage to help the bone and gums to heal.
image

FIG. 17.16 A, Person requiring removal of all teeth; back teeth had been removed previously. B, Day of tooth removal. C, Immediate placement of dentures on day of tooth removal.

4. Conditions Involved With Partial or Complete Denture(s)

Patient dissatisfaction with removable dentures is known to be one of the highest of any area of dentistry. The facts are that natural teeth are meant to remain in the mouth, and that artificial removable dentures replace natural teeth to only a small portion of their original effectiveness. Also, we all have varying abilities to tolerate the many challenges of removable complete dentures. Some of the following conditions can be corrected easily, whereas others may not have simple solutions. The conditions listed are followed by alternative solutions described in the next section of this chapter, What Your Prosthodontist or General Dentist Can Do.

A. My dentures collect food under them. SOLUTION: Reline (p 160), rebase (p 161), or make new dentures (p 163).
B. My denture bases (pink portion) are discolored. SOLUTION: Clean and polish denture (p 157), rebase (p 161), or make new dentures (p 163).
C. The denture teeth are discolored. SOLUTION: Clean and polish denture (p 157), replace teeth (p 160), or make new denture (p 163).
D. I can’t chew well. SOLUTION: Make new denture (p 163) or repair denture by sharpening existing teeth (p 160).
E. My gums have sore spots. SOLUTION: Adjust denture (p 158), reline (p 160), rebase (p 161), or make new denture (p 163).
F. My gums hurt when I chew. SOLUTION: Adjust denture (p 158), reline (p 160), rebase (p 161), or make new denture (p 163).
G. I bite my cheeks or tongue. SOLUTION: Repair denture by recontouring teeth (p 160), or make new denture (p 163).
H. The dentures won’t stay in place. SOLUTION: Reline (p 160), rebase (p 161), or make new dentures (p 163).
I. The dentures have missing or broken teeth. SOLUTION: Repair denture by replacing teeth (p 160), or make new denture (p 163).
J. The dentures are broken. SOLUTION: Repair (p 160), or make new dentures (p 163).
K. My nose and my chin are too close together when I bite down with the dentures in place. Solution: Make new dentures (p 163).
L. My dentures have worn the teeth or crowns on my opposing jaw. SOLUTION: Make new dentures using less abrasive denture teeth (p 160) and repair natural teeth, repair, or make new crowns (caps) (p 147).
M. My dentures have a poor bite. SOLUTION: Repair dentures by selective grinding or sharpening teeth (p 161), or make new dentures (p 163).
N. My removable partial dentures cause pain in the supporting natural teeth when I chew. SOLUTION: Adjust retaining clasps of removable partial denture (p 158), or make new partial denture (p 162).
O. The clasps (retaining wires) on my partial denture show too much. SOLUTION: Make new partial denture (p 162).
P. The supporting teeth for my removable partial denture are loose. SOLUTION: Treat supporting teeth if necessary, and repair or make new removable partial dentures (p 162).
Q. A supporting tooth for my removable partial denture is broken or decayed. SOLUTION: Repair supporting tooth and retrofit partial denture to repaired tooth (p 159).
R. My dentures are too tight. SOLUTION: Adjust dentures (p 158).

WHAT YOUR PROSTHODONTIST OR GENERAL DENTIST CAN DO

Treatment Available

Several types of treatment are available in the area of removable prosthodontics. Most general dentists accomplish some removable prosthodontic procedures, but if your condition is especially complex, or if you have had difficulty with previous prosthodontic treatment, then you may want to seek the services of a prosthodontist (a dentist specially educated in prosthodontics) (p 15).

1. Repairing Previous Removable Partial or Complete Prosthesis (Denture)

Repair may be a choice, but it will probably be only a temporary remedy that will require more comprehensive therapy later. Consult your dentist to determine the desirability or feasibility of repairing your current prosthesis (denture). The following are relatively simple, common maintenance or repair procedures for dentures that may satisfy your needs without requiring a new denture:

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Related posts:

  1. 11: Occlusion: Your Bite, Temporomandibular Joints, Temporomandibular Dysfunction
  2. 20: Additional Sources of Information
  3. 7: Endodontics: Root Canals, Dead Teeth, Inside of Teeth
  4. 18: Restorative or Operative Dentistry: Fillings for Teeth
  5. 10: Implant Dentistry: Substitutes for Tooth Roots Placed into Your Jaw
  6. 12: Oral and Maxillofacial Surgery, Oral Pathology, Oral Medicine: Diseases and Surgery Related to the Oral and Facial Areas

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Jan 3, 2015 | Posted by in General Dentistry | Comments Off on 17: Prosthodontics, Removable: Dentures Replacing All or Some Teeth

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