Blog | Finlay Sutton - Denture Education

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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Big clear designs for partial dentures

I love designing partial dentures. I make them big, bold, clear and colourful. This gives me a good mental representation of the denture before starting.

Most importantly though, it assists the dental technician to produce the denture exactly to requirements.

The ‘literalness’, in shape, colour and detail makes it much easier for the patient, too, to visualise what is being proposed.

Fewer chances of misunderstanding all round.

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Take the try-in home

What happens if at the end of the try-in visit (of the denture teeth set in wax) the patient remains unsure of the aesthetics?

I encourage the patient to take the try-in home, along with the photographs and videos taken during the try-in appointment. They can assess this at home without time pressure and show it to close friends and family as they wish. The things they would like to change in the try-in dentures are discussed at their next visit. Alterations are made and the process repeated until the patient is completely happy with the aesthetics. Only then are the dentures finished.

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The patient is team leader in deciding their smile appearance

The decisive role in creating and approving the appearance of their dentures is made by the patient. The dentist, the dental nurse and the dental technician help to facilitate this. In fact, the nurse is best cast as the patient’s ally and advocate in aesthetic matters, rather than automatically supporting the clinician’s view.

This involvement of the patient brings a feeling of connection with the rest of the dental team and with it a sense of responsibility.

This is why the aesthetic try-in visits for the prototype dentures cannot be rushed.

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Where to position the upper incisal plane

The incisal plane (occlusal plane viewed from the front) of the upper artificial teeth generally looks correct when parallel with the interpupillary line.

If the patient’s eye position is asymmetric lining up the incisal plane with the interpupillary line may look wrong and experimentation is required.

The incisal plane shown in a photograph of the patient when they had natural teeth can be mimicked when trimming the wax rim. The rim prescribes the position of the denture teeth.

In the accompanying photograph the incsial plane of the patient’s natural teeth was NOT parallel to the interpupillary line. We copied this in the complete upper denture at her request. The patient guides this process and is the final arbiter.

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The dental nurse/assistant is the patient’s advocate

Their part helping us deliver successful dentures cannot be overestimated.

This list of roles is not exhaustive but helps to highlight their importance;

• Patient comfort

• Patient relaxation

• Patient understanding

• Clinician understanding the patient

• Aesthetics

• Mixing impression materials

Claire (my nurse) translates what I say so that the patient fully understands the full nature of wearing dentures. In addition, the patients can be truly honest with the dental nurse regarding the function and appearance of the dentures.

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Immediate dentures are rarely definitive dentures

I advise patients that immediate dentures are an interim/prototype/temporary denture. Immediate dentures are rarely satisfactory functionally or aesthetically. Changes are (almost) always needed.

Immediate dentures make excellent diagnostic appliances, improving both the functional and aesthetic outcomes of the definitive dentures.

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