Blog | Finlay Sutton - Denture Education

Litigation and tone of voice

Our tone of voice when talking to our patients can influence the likelihood of litigation. If our voice sounds dominant, we are more likely to be sued, than if our voice is less dominant and more concerned.

The most corrosive tone of voice that we can assume is a dominant tone. We must be careful to communicate respect for our patients through our tone of voice.

Blink by Malcom Gladwell

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Method for adjusting the occlusion on immediate partial dentures – at the extraction visit

Checking the occlusion can be tricky at the fit appointment for immediate dentures. The local anaesthetic swells the soft tissues preventing the Immediate partial denture from seating fully as it does on the on the master cast. This results in the partial denture appearing high and propping the bite opening, particularly if the denture has been made to conform to the intercuspal position with the remaining natural teeth.

I adjust the occlusion on the partial denture to a point where the natural teeth come into contact when the patient bites firmly together in their intercuspal position. I use 40 micron articulating paper to adjust the denture occlusion until I see the same marks on any antagonistic opposing natural teeth:

a) with the immediate partial denture in place

b) without the partial denture in place

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Removable partial dentures become less retentive over time – “less grippy”

Partial dentures which are retentive at fit become less retentive over time when worn. Retention in this context means the grip of the denture on the teeth.

This occurs mainly because of:

• settling of the supporting teeth

• clasps deforming slightly

I warn the patients that this will occur.

In most circumstances, this goes unnoticed by the patient as their adaptation and neuromuscular control offset this gradual reduction in “grip". It happens less quickly when a major part of the retention is from friction (guide surfaces and accurate dentures) rather than clasps’ resistance to deflection.

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Being good at removable prosthodontics is directly relevant to fixed implant prosthodontics

All the of the principles required for producing aesthetically superb complete dentures apply equally to large scale fixed dental implant restorations. In edentulous patients, it is considered essential in making full arch implant-stabilised fixed restorations, to carry out a full three-dimensional prototype ‘dress rehearsal’ with complete dentures. Only then can the positioning of implants be planned, and surgical guides made.

This has the further advantage that in some cases the patient may be happy to settle for good removable dentures and be saved the considerable effort and expense of implants, etc.

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Path of insertion for partial dentures

The path of insertion is critical for developing good aesthetics in partial dentures, particularly in the anterior regions when the artificial teeth sit next to natural teeth.

In addition, having a path of withdrawal differing from the path of displacement improves retention and stability when eating sticky food which could pull the denture out.

Another aesthetic benefit of having a well-planned path of insertion is that it may reduce the need to have ugly clasps on anterior teeth.

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Maxillary Tori – complete dentures

Maxillary midline tori are quite often present in the palate. They are hard bony lumps which can lead to poor complete denture retention denture as they prevent the denture from sinking into the soft tissues fully. In addition, the denture can rock on the torus during functional loading (chewing).

Relieving the denture over the tori to prevents these problems.

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Appointments and timings for complete dentures

In general, these are the timings I require to complete each stage for a set of complete dentures satisfactorily.

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Spacing of custom trays for complete dentures

In general, these are the spacing requirements I use for custom trays for complete dentures:

Maxillary definitive impressions I make in alginate. The custom tray is spaced using two layers of wax (3mm) over the primary cast. The spacing is recreated with greenstick during impression making in the three following areas: a layer on the posterior border and two pieces in the canine regions on the crest of the ridge.

Mandibular definitive impressions I make in zinc oxide and eugenol. The custom tray is close fitting.

If there are support problems on the denture bearing area such as mobile or flabby ridges the custom tray design is relieved with spacing or windows.

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