Blog | Finlay Sutton - Denture Education

Simple tool for taking fantastic impressions

My dental nurse helps me when I’m impression making by holding the patient’s lips forward and out with small lip retractors. These help me to visualise the ridge and see more clearly where I need to position the tray. They help with accurate tray positioning and allowing flow of the impression material to the depth of the labial sulcus before border moulding.

Two photographic retractors were cut down and polished to do this. This video shows how they are used.

They are brilliant!

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No photographs available showing natural teeth

If the patient can’t find a dentate photograph with their natural teeth visible, it is still useful to have an unsmiling photograph of their face, taken when they had their natural teeth. These photographs are still an excellent reference giving lots of information about lip support, lower face height and indirectly their natural teeth positions.

It is much more useful than having no photograph at all.

Failing any photographs of themselves, photographs of a near family relative – parent, sibling or offspring – can be helpful if the patient thinks their teeth were similar.

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Burning mouth syndrome and other peculiar symptoms

I sometimes have patients who have strange symptoms such as burning mouth sensation BMS, tingling tongue etc. associated with their dentures. Often these symptoms are linked to psychological problems. Sometimes these sensations can be linked to other causes such as deficiencies in iron, vitamins and folate etc. and as such I recommend that their physician is involved in eliminating these as a cause.

Before providing the patient with new dentures it essential that they understand that the new dentures may:

1. Help improve their symptoms

2. Make their symptoms worse

3. Have no effect on their symptoms

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Palatal extension – gag reflex

95 percent of upper complete dentures I make extend to just in front of the vibrating line. This position is generally within 1 mm of the fovea palatini and produces the best suction. Before treatment I show the patient a denture as an example and explain it with photos in the treatment plan consent letter.

Sometimes the patient cannot tolerate this extension as it makes them heave or feel sick. This will normally occur at the registration rim stage or denture try in stage. I explain that this normally resolves itself once the denture is finished and worn. Adaptation to the extension normally occurs. Occasionally though, this does not happen. In these cases, I bring the posterior border forward by approximately 10mm at the midline keeping the full extension around the tuberosities. A post dam is added along this border to form a posterior seal by the technician using the working cast.

The retention is often not quite as good as with a fully extended posterior border, but it generally is sufficient for the patient to manage well with the new denture. It is particularly important that the other denture parameters are correct, such as sulcus extension, tooth positions and the occlusion.

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Preserving land area for complete dentures and free end saddles

My dental technician preserves a land area on the border when pouring working casts of definitive impressions. A record of the peripheral roll of the impression is preserved in the cast. This enables waxing up of the denture periphery to the same functional movements moulded during impression making in the patients’ mouth.

This results in the polished surface of the denture having optimum border extension, maximising retention (peripheral seal), support and stability.

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Using a timer to be sure that the dental material has set

A visible timer is handy to let the clinician, the dental nurse and the patient and know when an impression material or bite registration material has set fully. A kitchen count-down timer with large, illuminated numbers is ideal. It curbs the temptation to take the material out before fully set. This reduces inaccuracies and the need to redo impressions. It is particularly necessary in the case of making impressions with implant abutment mushroom pick-ups (Locator™ and the like) and prevents them from pulling out of a not completely set impression (such as Impregum).

In addition, a timer positioned in the view of the patient, is psychologically helpful for the patient to know how much longer he/she needs to endure the procedure.

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Remake for aesthetic reasons

I once had a patient in for her first review following fitting of new complete dentures 1 week previously. She liked the function and comfort of the dentures; however, she wanted to show more upper teeth and less lower teeth.

The big problem with this change, namely dropping the upper teeth by 2mm and the lower teeth by 3 mm required a remake of the dentures. This was the first time I had to remake a set of dentures for aesthetic reasons in 8 years since introduced videoing of the try-in. The mistake I made was not advising taking the try-in home. I assumed she was 100 percent happy with the try-in.

To make this patient happy required remaking the dentures. Rowan (technician) and I keep all the articulated master casts which allowed us to go straight to the wax rim registration stage for this patient’s next visit to prescribe the new teeth positions. Once the teeth were set up the patient took the try in home to make sure she was 100 percent happy.

If a remake of dentures is required for aesthetic or functional reasons, within 1 year after fitting, I do this free of charge. I use the Mk 1 denture as a diagnostic guide to make the Mk 2 denture a success.

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Putting myself in the patient’s shoes

I always try to listen to understand the patient in all circumstances. This can be difficult if I feel that the patient is criticising me directly and my lizard brain (amygdala) is provoking me. In these circumstances, I try to be compassionate towards my thoughts and the patient.

Understanding the patient’s concern fully is not enough. The patient has to know that I understand their concern too.

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