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Dentures
Introduction
Dentures are a solution of last resort. Many
people assume that they will require
dentures as they age, but losing teeth is
not a normal part of the aging process. If
you care for your teeth well and guard
against periodontal (gum) disease, you
should be able to keep your teeth for a
lifetime.
Saving even a few natural teeth is better
than losing them all. Natural teeth or even
portions of natural teeth (roots) can help
you retain bone in your jaw and can act as
stable supports for bridges, overdentures or
removable partial dentures. Your dentist
will try to save as many as possible of your
natural teeth. If that's not possible, you
may have to consider a complete denture or
an implant-supported denture.
The good news is that dentures aren't what
they used to be. With newer materials and
improved technology, dentists can fashion
dentures that fit comfortably, appear
natural and help you stay healthier. Denture
problems, such as clicking, slipping, gum
irritation, staining and odor are signs your
dentures aren't fitting properly and may
need to be adjusted, relined or remade.
Although dentures may look like your natural
teeth, they cannot work like them. Like
artificial limbs, dentures cannot truly
replace their natural counterparts. You will
have to learn how to use your dentures,
which can take several months. Simple
actions like speaking and eating may feel
different, and you may have to learn to make
adjustments.
Types Of Dentures: Complete Or Partial
Complete Dentures
Complete dentures cover your entire jaw,
either upper or lower. Some people refer to
them as " plates" . Complete dentures rest
directly on the gum that covers the bone.
However, a type of full denture, called an
overdenture, fits over a few remaining teeth
that have been shaped by your dentist.
Maintaining a few natural teeth and
replacing the missing teeth with an
overdenture has several advantages:
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Your natural teeth help preserve bone.
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Your remaining natural teeth bear some of
the chewing pressure, which reduces pressure
on other areas of the jaw.
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Your remaining teeth improve the stability
of the denture and make it less likely to
shift in your mouth.
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Your sense of where your jaw is in space and
the pressure you are placing on the denture
is better than the sense you have after
losing all of your teeth.
Keeping some teeth can help you
psychologically accept your denture.
An overdenture usually is used in the lower
jaw where a few teeth can be maintained, and
is an option for almost anyone. However, the
teeth that will be preserved must meet
certain standards of health. Canines and
premolars are the most common teeth selected
because of their root length and position in
the jaw.
The teeth will have to be shaped to fit the
denture. Since the shaping may expose the
tooth's living pulp, the teeth usually need
root-canal treatment, which removes the pulp
and replaces it with filling material. The
teeth are covered with thin metal castings
called copings, which fit into openings in
the denture. Attachments also can be put on
the copings so the denture is better
retained in the mouth.
Overdentures also can fit over implants
instead of natural teeth. In fact, implants
originally were developed to give people "
artificial roots" on which to place bridges
or dentures in the lower jaw. The denture
can fit directly onto the implants, or a
metal bar can link implants together,
providing support for the denture.
Partial Dentures
Removable partial dentures are composed of a
metal framework with plastic teeth and gum
areas. The framework includes metal clasps
or other attachments, which hold the denture
in place. However, partial dentures are
removed easily for cleaning. Fixed partial
dentures, which most people call bridges,
are cemented in place and better simulate
natural teeth. Bridges are more expensive
than removable partial dentures, however,
and require healthy adjacent teeth to
support them Two types of attachments are
used in partial dentures — metal clasps and
precision attachments. Metal clasps are
C-shaped parts of the denture framework that
fit around neighboring natural teeth. These
teeth may require shaping to help hold the
clasps and keep the denture securely in
place.
A precision attachment involves creating a
receptacle within a remaining tooth. The
receptacle usually is covered with a crown,
and an extending part on the denture fits
into the receptacle. Precision attachments
have advantages. The denture is attached
within the crowns of remaining teeth, so
there are no visible clasps and the forces
of chewing are better distributed along the
teeth. However, precision attachments are
more expensive than metal clasps, so most
partial dentures still use clasps for
retention.
Special Types Of Partial Dentures
Nesbit Denture — A Nesbit denture can
replace one or more lost back teeth. Metal
clasps fit around the teeth on either side
of the space. However, because a Nesbit
denture is not also supported by teeth on
the other side of the mouth, it can place
extreme pressure on the clasped teeth. Also,
there is a danger of dislodging or
swallowing a Nesbit denture in an accident.
You should consider a bilateral partial
denture, which is supported by teeth on both
sides of the mouth, even if the missing
teeth are on one side of the jaw.
Flipper Denture — A flipper denture replaces
one or more front teeth temporarily until
another form of treatment (bridge, implants)
can be made or decided upon. Such a denture
can be placed immediately or soon after a
tooth is extracted, but it is not meant to
be a permanent solution.
Getting Your Dentures: Conventional Or
Immediate
Complete dentures are classified in two
ways. They are either conventional or
immediate.
Conventional dentures are made and inserted
after your teeth have been taken out and the
gums have healed. If you are having teeth
removed and getting a conventional denture,
you will be without teeth while your denture
is being made.
A conventional denture takes about six
appointments over one to two months. The
process starts with an appointment with your
dentist for an exam and a discussion of what
will work best for you. In subsequent
visits, your dentist will take impressions
of your mouth and establish the bite (the
way your teeth come together). You and your
dentist will select the teeth for your
denture. The size, shape and color of the
teeth will depend on many factors, including
reference points in your mouth, your skin
tone and the shape of your skull,
photographs, etc.
At a very important appointment, the teeth
are held in the base with wax while you have
a trial fitting. You can see how the denture
looks and feels in your mouth, and your
dentist can make sure it fits and functions
correctly and harmonizes with the rest of
your face. This is your denture preview, or
" try-in." If this goes well, you will
receive the completed denture at the next
visit, along with instructions from your
dentist on eating, speaking, denture care
and oral hygiene. Finally, you will need to
see your dentist for a series of follow-up
visits over the next few weeks and months to
check the fit and comfort of your denture.
Immediate dentures are made while you still
have teeth. An impression is made before
your teeth are removed, and the denture is
created and inserted immediately after the
extraction. If your remaining teeth are so
loose they would not be able to withstand
the impression process, you cannot receive
an immediate denture. Generally, immediate
dentures are used for aesthetic reasons in
people who need to have their upper-front
teeth removed.
The advantage to an immediate denture is
that you are not left without teeth.
However, you will not have a chance to see
and test the denture before it is inserted.
Also, your bones and gums will shrink after
your teeth are removed, and your denture may
need to be refitted (relined) after several
months. You may even need an entirely new
denture.
You will receive your immediate denture at
the same appointment your teeth are removed.
Having the denture in your mouth helps
control some of the post-operative swelling.
Your dentist will tell you not to remove the
denture for one or two days and nights,
except to rinse it. Two days after receiving
your denture, you'll visit the dentist for
an exam to make sure it is fitting properly
and the bite is correct. After this visit
you can remove the denture at night and
treat it like a conventional denture.
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