Blog | Finlay Sutton - Denture Education

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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Positioning artificial teeth relative to the edentulous ridge

The upper artificial teeth are usually positioned outside of the ridge arch because the resorption pattern causes the outside of the ridge to move in a palatal direction. The labial aspects of the upper central incisal edges are positioned within a 5.5-12mm range anterior to the centre of the incisal papillae. This is easiest to assess using the Alma Gauge, an instrument specifically designed for that purpose. Apart from assessing patients’ existing dentures, the gauge is used when shaping the upper wax rim at the registration appointment to provide optimum lip support and anterior tooth visibility.

Lower teeth are set on the ridge as the resorption pattern is vertical leaving the crest of the ridge in the centre of where the natural predecessors were.

Not only does this place the artificial teeth in an aesthetically pleasing position, but it leads to stable dentures as the artificial teeth sit within the neutral zone (denture space).

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Making new dentures comfortable with silicone fit check

When fitting I check the comfort of a new denture by first asking the patient - “Is it sore?” when I push down on it in the mouth. If it is sore, I ask – “please point to the area “. Light-bodied silicone impression material is placed on the fitting surface and the denture reseated in the mouth until it sets. If the denture fitting surface pushes through the impression material in a place the patient has identified as being sore, mark with pen, peel off the silicone and grind down the pencil mark. I repeat this until it is comfortable.

This method has reduced the number of postoperative adjustments at the review visit by 50%.

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