Blog | Finlay Sutton - Denture Education

Be brave with your tooth positioning

To make the denture tooth positioning look natural, it essential that the clinician and technician are brave, to overcome any stereotype conditioning about tooth position. Setting up denture teeth unevenly and ‘wonky’ in the laboratory, on the bench, does not look as obvious when tried in the mouth.

Exaggerating tooth imbrication, irregularity and gaps are necessary for them to be visible in the mouth.

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Don’t treat the patient if you don’t want to

If a patient makes me feel uncomfortable and anxious, I do not treat them. This is much easier said than done.

Sometimes, I only find this out after I’ve seen the patient for a few appointments.

It is much better and less emotionally painful to not treat a patient than to try and fulfil unrealistic expectations. Also, some patients are difficult to form a happy working relationship with, regardless of their expectations.

For the treatment to work the patient must trust me.

I tell the patient or write to them stating “I don’t think I can meet your expectations.”

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Mental representations

Before embarking on each treatment visit, I want to have a clear mental image of its outcome. For example, if I’m taking an impression, I want to picture it in my mind before creating it. This means forming a mental map of the topography of the mouth, the teeth and sulci resulting in a mental representation of the final impression.

Doing this for each stage improves the quality of every denture I provide.

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The patient’s breathing during impression making

Impression taking

I rehearse the procedure thoroughly first before doing the impression – this involves showing and talking through the process. I then take the impression. I talk in a low calm voice (hypnotically) and ask the patient to breathe through their nose (and wiggle their toes) – as distractors.

This helps reduce gagging during the procedure.

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Straight white and boring or age appropriate?

Giving patients dentures which look just like age appropriate, natural teeth with lifelike gums is an inspiring job. When done well, the dentures ‘disappear’ into the patient’s face and become part of the person.

I find out exactly what the patient wants through discussion, reference to dentate photos and prototype try-ins. What patients want in terms of dental appearance can range from age appropriate and individual to them all the way to straight white ‘piano keys’. That really is the patient’s prerogative.

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How to get good at making dentures – Deliberate practice

No one is naturally gifted at making dentures. It is difficult and takes deliberate practice (described beautifully by Anders Ericsson). Here is a method of achieving denture mastery:

1. Provide 5 to 10 dentures a month. Enough to practise the skills.

2. Be completely open to feedback from the patient, the dental technician, the dental nurse and from your mentor

3. Read widely on the subject - textbooks and papers

4. Seek out and learning from experts on courses – really listen

5. Put into practice what you learn for each patient

All of the above require a genuine interest in this branch of dentistry.

There are no quick fixes or easy way, it takes effort, focus and time

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Wax try in – gaining patient acceptance of their new dentures using video

The patient sees a much more realistic appearance if they observe a video (with the sound turned down) of themselves talking, smiling and communicating with the denture try in – in place.

I have found the use of video to be very helpful in gaining patient acceptance. Since using video at the try in from 2013 nearly all my patients have been happy with the aesthetics of their dentures, keeping remakes to a minimum.

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My most important piece of kit – the camera

My camera is the most important piece of equipment I use. I use it constantly for all of my patients. It helps with the following things and more:

1. Diagnosis and treatment planning – particularly helpful for looking at high smile line and aesthetic problems

2. Checking the quality of my work – particularly when I am doing the end of treatment letters

3. Communication with the dental technician

4. When trying to mimic old dentate photographs for a person requiring full or almost full dentures

5. Patient education – showing them evidence of what I can do

6. Teaching colleagues and dental students

7. Communication with referring colleagues

8. A picture tells a thousand words

I use standardised orthodontic views. In addition, I use a few other extra oral views too which help aesthetically.

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