Blog | Finlay Sutton - Denture Education

Soreness of the lower during denture construction procedures

This can be a problem during each visit, particularly in patients who are elderly with friable denture bearing tissues. Making the definitive impressions and doing the registration with the central bearing apparatus can be sore on the lower denture-bearing tissues. Soreness at these visits can be an indication to use a soft lining such as Molloplast B/Permaliner on the base of the definitive denture.

In these circumstances, I explain to the patient that these appointments may be uncomfortable and I encourage them to push through this, emphasising that these stages do not reflect how the final denture will fit or feel.

Denture Blog 43

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk

Consent letter – containing all factors a patient should be aware of before treatment

All of my patients receive a treatment plan letter before proceeding with treatment.

There is a part of the letter which explains everything that a patient should be aware of before embarking on treatment and what to expect. This list gets bigger and bigger over time, as new patient experiences get added to this list.

If these factors are discussed with the patient prior to starting, they are seen as a diagnosis; if they are explained once the problem arises after denture provision, they can be seen as “an excuse” (meaning I am on the back foot).

Examples of topics worth discussing are:

1. The dentures will be sore

2. The dentures may cause alteration to speech

3. The dentures are a prosthetic replacement – analogous to a prosthetic hand

4. Adaptation is required (neuromuscular control is discussed)

5. Saliva flow changes

6. Chewing and eating

7. Cheek, lip and tongue biting

8. Potential feeling of unaccustomed fullness

9. One year warranty

This above list is not exhaustive. Examples of treatment plan letters in Word format can be downloaded from https://www.finlaysutton.co.uk/resources.

Denture Blog 42

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk

Impressions for cobalt chromes – avoiding air blows

Alginate is an excellent impression material for producing definitive casts for cobalt chromium frameworks.

To obtain the detail of the support teeth, avoiding air blows and allowing the framework to fit, I do the following:

1. Dry the teeth thoroughly with the 3-in-1 air syringe

2. Rub alginate into the occlusal surfaces with your finger

3. Glaze the surface of the unset alginate in the impression tray with water

4. Take the impression

5. Use a timer to ensure you leave the impression in place for the correct length of time

Alginate is dimensionally stable for up to 5 days when kept moist and sealed in a plastic bag.

Denture Blog 41

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk

Watching my body language with patients

I learn a great deal about my body language, facial expressions and general communication with my patients through watching video recordings of my interactions.

The videos, made with patients’ consent, provide immediate feedback which is sometimes uncomfortable. I am surprised how much I frown, look serious and avoid eye contact. This must be off putting for a patient, particularly when many are anxious about being “at the dentist”.

The recordings make me mindful of and help me improve all aspects of my patient communication.

Denture Blog 40

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk

Good retention of the upper wax rim helps assess the aesthetics accurately

A post dam is cut onto the working upper cast at the start of the registration appointment. The posterior border of the wax rim is warmed and pushed into the post dam on the cast. This ensures that the upper rim has good retention when assessing the aesthetics of the lip support, incisal plane, occlusal plane, centre line and buccal corridors.

Without the post dam on the upper rim, the rim may tend to drop down, making assessing the appearance impossible to judge.

If the anatomy prevents retention, such as extremely flat maxilla a small amount of fixative is used.

Denture Blog 39

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk

Dealing with our patients, staff and ourselves compassionately

Our patients are often traumatised by their loss of teeth and dignity. This can mean they react in hostile ways towards us as they may be communicating through their reactive and unsophisticated part of the brain sometimes known as the “lizard brain”, “chimp” or “child brain”. In doing so they can trigger defensive systems in our own brains, meaning that we feel hostile in return. I find it helpful to recognize these feelings both in my brain and body, as well as in my patients, acknowledging these feelings with compassion.

Developing a compassionate mind towards our patients, our staff and ourselves helps me treat them better and produces a much-improved treatment outcome. There is good research to back this up and I have found this book very useful in the process: The Compassionate Mind by Paul Gilbert.

Denture Blog 38

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk

Handle working casts with care

Taking care of working casts for partial dentures is essential if the final denture is going to fit accurately. The teeth on the cast are particularly prone to damage. It is easy to inadvertently chip the teeth on the cast, when carving the wax rim, for example. This can prevent the metal and acrylic components of the partial denture fitting later.

Isolated teeth with long necks are at greatest risk of breaking off.

My dental technician identifies damage to working casts coming back from the surgery and requests a new working impression if needed. Being open to feedback from the dental technician is important.

Denture Blog 37

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk

Getting the plates parallel on the gothic arch tracing

The central bearing /gothic arch tracing apparatus works properly when the two plates are approximately parallel to each other, and the central bearing point is contacting with the jaws at the optimum vertical dimension.

One way to ensure this is to use interim wax rims at the second impression stage. The rims, made entirely of wax including the bases, are trimmed in the clinic roughly to the correct occlusal vertical dimension and centric relation. The dental technician trims back the wax sulcus extensions of these preliminary rims so that they will sit nicely on the new working casts, allowing the central bearing plates to be correctly positioned, vertically and horizontally. These are used to generate the jaw relation record in retruded jaw relation at the chosen vertical dimension, and thus for mounting the working casts. Conventional wax rims are then made in the lab and trimmed in the clinic to indicate tooth position, lip support, test speech, etc, as usual, ideally with the help of Alma Gauge readings.

Denture Blog 36

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk