Blog | Finlay Sutton - Denture Education

Chrome framework try in visit

Method for adjusting chrome frame works to fit passively in the mouth

Cobalt chromium frameworks never fit perfectly when tried in the mouth.

Some frameworks fit closely when tried in straight away. However, some frameworks seem to be a long way off (a mile off) – do not despair, as precise adjustments often make them fit.

This is my method.

I use arti-spray indicator spray which I apply to all of the fitting surface of the frame to mark where it touches the teeth, preventing full seating. I carefully spot grind the places where the occlude has rubbed off using a diamond tapered crown preparation bur. I reapply the arti-spray indicator spray and reseat the frame in the mouth and repeat the process of adjustment until the frame fully seats.

IMPORTANT - I avoid adjusting where the framework touches the surface of the tooth nearest the occlusal surface. Any adjustment here can create a gap between the tooth and the framework which the tongue can feel.

This can take me from 5 minutes to 1 hour depending upon the complexity of the framework. Patience is required.

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Thinking Time

Occasionally a patient I have been treating comes back to the review appointment having a problem with a denture I have not encountered before (a ‘curve ball’). Often when this happens the patient is upset. This makes me feel anxious and start to doubt my professional abilities, meaning my judgment and diagnostic skills are impaired.

In these situations, I have found the best thing to do is to explain to the patient that I do not have an answer to the problem right now and I require some thinking time. I see them again a few days later which gives me time to carefully consider their problem and come up with a well-considered strategy to help.

I find these situations, although stressful at the time, are a great opportunity to learn and improve my service.

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Staying present during every patient contact

Staying present and focused on the procedure and technique is essential during every moment of each patient visit.

In addition, staying present helps my engagement and empathy with the patient too, making a visit which may be uncomfortable, more enjoyable and fun for the patient.

Practising mindfulness and mediation has strengthened this side of my clinical practice helping me to enjoy my clinical work much more.

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Under promise and over deliver = success

The success of denture treatment is dependent on fulfilling our patients’ expectations.

When I over promise and under deliver I have an unhappy patient.

A successful outcome with a satisfied patient occurs when I have over delivered on my promise. This is where time spent at the beginning so the patient understands the pros and cons of the denture treatment is absolutely crucial.

The patient’s wish list

For the initial consultation appointment, my patients’ produce a numbered wish list of what they would like to achieve following treatment. Once I have heard their story, examined the patient and made a diagnosis, I use the wish list as the basis for their treatment options discussion and consent. I go through each of the wishes with the patient and say whether I can:

1. Fulfil the wish

2. Not fulfil the wish

3. May be able to fulfil the wish to some degree

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Working with a great technician

Finding and keeping a great dental technician is an essential element to produce beautiful looking and well-fitting and functioning dentures for our patients.

It is a relationship that requires nurturing through our generosity, kindness, love, time, patience, empathy and encouragement.

It is rather like a marriage, being a wonderful and exciting part of our professional life. Clear, two-way communication and respect is the secret.

The technician should have equal status to the clinician.

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Rehearse everything with the patient

Rehearsing each stage at the start of the patients’ appointment improves the technical quality of the desired outcome. Having a “dry run” - showing the patient the impression tray and practicing the insertion and positioning helps to relax the patient and importantly allows me to practice the positioning of the tray. Talking and rehearsing the process through with the patient really helps them relax and keep calm and is particularly helpful with sensitive gag reflexes.

In addition, rehearsal, helps me to visualise what you are trying to achieve so that you have a clear “mental representation” of the completed step. This is very important.

This also has the effect of recruiting the patient’s active help and promoting their role as team leader

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Finlay is lecturing in Las Vegas in October 2022

In a few weeks, I’ll be in Las Vegas speaking at the NDA 2022 Annual Conference. What are you most looking forward to learning about during this session? If you’re not already registered, you can still do so and skip the lines onsite by visiting: https://nationaldenturist.com/annual-conference-2022