Complete Denture – An Overview

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A complete denture or full denture is a removable application used when all teeth within a jaw have been lost and need to be prosthetically replaced. In contrast to a partial denture, a complete denture is constructed when there are no more teeth left in an arch. Therefore, it is an exclusively tissue-supported prosthesis. A complete denture can be opposed by natural dentition, a partial or complete denture, fixed appliances or, sometimes, soft tissues. So, Complete dentures are basically full-coverage oral prosthetic devices that replace a complete arch of missing teeth. 

Indications for Complete Dentures

Complete dentures are full-coverage oral prosthetic devices that replace a complete arch of missing teeth. The following are indications for complete denture prosthesis: 

  1. A full arch of missing teeth
  2. Dental implants that have been deemed inappropriate by patient or doctor because of financial constraints, a medically compromised status that contraindicates surgery, or inevitable damage to vital structures such as maxillary sinuses, nerves, and vessels
  3.  Intraoral cancer that has caused a loss of gross intraoral tissue, resulting in an edentulous dental arch; the complete denture prosthesis would then not only replace teeth but also fill in the portion of missing tissue (E.g.: nasopharynx, hard palate)

What Are The Types Of Dentures? 

A denture is a removable replacement for missing teeth and surrounding tissues. There are several ways to replace the missing teeth. The dentist will be able to recommend the best option for the patient, whether it’s a denture, bridge, or implant. Here are the types of dentures one must know to select the best:

1. Complete Dentures

Complete dentures can be either "conventional" or "immediate” done after the teeth has been removed and the gum tissue has begun to heal, a conventional denture is ready for placement in the mouth about eight to 12 weeks after the teeth have been removed.

Unlike conventional dentures, immediate dentures are made in advance and can be positioned as soon as the teeth are removed. As a result, the wearer does not have to be without teeth during the healing period. However, bones and gums shrink over time, especially during the healing period following tooth removal. Therefore, a disadvantage of immediate dentures compared with conventional dentures is that they require more adjustments to fit properly during the healing process and generally should only be considered a temporary solution until conventional dentures can be made.

2. Partial Dentures

A removable partial denture or bridge usually consists of replacement teeth attached to a pink or gum-colored plastic base, which is sometimes connected by metal framework that holds the denture in place in the mouth. Partial dentures are used when one or more natural teeth remain in the upper or lower jaw. A fixed bridge replaces one or more teeth by placing crowns on the teeth on either side of the space and attaching artificial teeth to them. This "bridge" is then cemented into place. Not only does a partial denture fill in the spaces created by missing teeth, it prevents other teeth from changing position. A precision partial denture is removable and has internal attachments rather than clasps that attach to the adjacent crowns. Partial denture is a more natural-looking application one can go for.

3. Temporary Dentures

Temporary dentures, also called immediate dentures are dentures that can be fitted right after the teeth have been removed. They are an option to help one carry on as normal while waiting for the new permanent dentures to be fitted. One can return to eating the foods they love, without putting too much pressure on the remaining natural teeth. They may be recommended by the dentist as a way to help ease one’s mouth into wearing dentures, or if one has previously had issues with sensitive teeth or gums. By reducing the pressure on the remaining natural teeth when eating, temporary dentures will let one’s mouth heal without needing to make any major changes to the lifestyle. The dentist will take measurements and models of one’s teeth beforehand so the dentures are ready to wear while the jaw is healing. 

4. Flexible Dentures

Flexible dentures are a kind of partial denture, but they are made of different materials from ordinary partial dentures. Most flexible dentures are made of a thin thermoplastic such as nylon, compared to the thicker, more rigid acrylic used in full dentures. One might find that flexible partial dentures are a more comfortable fit than other removable partials, especially if one is still new to wearing replacement teeth. Not only that, but most partial dentures are usually made with metal parts that can sometimes show. Flexible dentures do not use any metal parts so they tend to look and feel a lot more natural.

5. Fixed Bridge

A fixed bridge is used to replace missing teeth by surgically cementing an artificial tooth, known as a crown, to the remaining natural teeth on each side. Like all surgically fixed dentures including implants, implant–supported dentures, and Snap-on dentures, fixed bridges tend to cost more than removable dentures.

6. Cantilever Bridge

A cantilever bridge is recommended when a molar is missing and there are no teeth on one side of it to support the bridge. One or more teeth on the other side are instead used for support.

7. Implants

Dental implants mimic the roots of your teeth. They are surgically placed into the bone and fuse with it over time for a natural fit. The implants are then “loaded” with a prosthetic, either immediately after surgery or within 6 months.

8. Implant-Supported Fixed Dentures

Implant-supported fixed dentures feature a crown that is secured to surgically inserted implants in your jawbone. It is then fixed in place with screws.

9. Snap-On Dentures

Snap-on dentures are removable crowns that snap on and off of surgically inserted implants in the patient’s jawbone. They fasten securely so the patient can chew the foods without worrying about the dentures coming loose.

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What Materials Are Used For Denture?

Many materials are necessary to fabricate a complete denture. These include spatulas, wax, casting ovens, impression material, adhesives, dental trays, border molding compound, shade guides, and a torch. The finished complete denture is composed of the following:

  • Acrylic resin, which serves as the base of the complete denture, retains the denture teeth, and emulates the gingiva of supporting teeth.

  • Porcelain or acrylic denture teeth to emulate natural teeth

  • A cast metal base as part of a denture base

How Are Dentures Made?

The denture development process takes a few weeks and several appointments. Once the dentist or determines what type of appliance is best for the patient, the general steps are followed: 

  • A series of impressions of the patient’s jaw is made and measurements is taken of how the jaws relate to one another and how much space is between them.

  • Models, wax forms, or plastic patterns are created in the exact shape and position of the denture to be made. The patient will "try in" this model several times and the denture will be assessed for color, shape, and fit before the final denture is cast.

  •  A final denture is then casted and adjustments are made as necessary.

What Is Denture Fabrication Protocol?

Various protocols and techniques are available for processing complete dentures. Protocols vary by clinician preference and the technology being used. 

  • Initial impression

A standard tray is used in recording the existing anatomy through an impression. The stock tray may need to be manipulated to accommodate for anatomical variances and constraints.

A study cast is synthesized from the impression.

The cast is evaluated for anatomical constraints, including, but not limited to, tori and undercuts.

A custom tray is fabricated from the study cast.

The custom tray circumscribes and accommodates for anatomy needed in the fabrication of the final denture.

  • Master impression

Border molding techniques are used for the recording of constraints imposed by muscular movements.

A custom tray applying balanced pressures registers the master impression. A custom tray mitigates distortions to the mucosal surface through accommodations for the impression material. The master cast is fabricated from the recordings of the custom tray.

  • Wax rims

Wax rims are fabricated on the baseplates through the master cast. The wax rims are used for the recording of the centric relationships in vivo. Other anatomical landmarks such as the midline are marked on the wax. Phonetics and esthetics are evaluated. A facebow record is taken to triangulate and register the relationship of the maxillary cast to that of the mandibular transverse horizontal axis (terminal hinge axis). Casts are mounted on an articulator, which emulates dynamic occlusal relationships. Based on the registered information, denture teeth are installed on the wax rims.

  • Wax teeth try in

The patient and doctor examine the dentures’ ability to support extraoral tissues. Phonetics are examined. Occlusal relationships are evaluated. The patient evaluates the esthetics.

  • Delivery

The processed denture is delivered to the patient. Phonetics and occlusion are tested. Pressure-indicating paste is used to identify excess or disproportionate pressures on mucosa. Infringements on the neutral zones are relieved.

  • Follow-ups

Follow-ups are conducted at 24 hours, one week, and one month. The denture is cleaned and examined, along with the patient’s oral health, every 6 months. The denture is refabricated in 5-7 years.

What Does New Dentures Feel Like?

New dentures may feel a little odd or loose for a few weeks until the muscles of the cheeks and tongue learn to keep them in place and the patient gets comfortable inserting and removing them. Also, it is not unusual for minor irritation or soreness to occur and for saliva flow to increase when one first start wearing dentures, but these problems will diminish as the mouth adjusts.

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Denture Retention

The retention of a complete denture depends on several factors. The relative strengths of each retentive mechanism are debated in the literature. For the most part, surface tension and viscosity is seen as most vital for retention. Cohesion, adhesion, friction, gravity, surface roughness, and atmospheric pressure are regarded as playing a lesser to no role in retention. 

The surface-tension model describes the interactions of a thin layer of fluid between two surfaces. In the case of a complete denture, the behavior of saliva along the denture-mucosa interface is theorized. As the complete denture is being drawn away from the mucosa, a liquid bridge develops along the periphery of the denture and mucosa. Such liquid bridges are similar to those that form when a water droplet is held between the fingertips.

Attempts had been made to model and approximate the capillary forces involved. A retentive pressure within the liquid-filled space develops and facilitates denture retention. This mechanism is independent and not related to that of atmospheric pressure differentials.

The surface-tension model is only one of many potential retentive forces, as it alone cannot account for retention from sheer-related displacements. In addition, capillarity would not apply when a denture, particularly a mandibular complete denture, is fully immersed in saliva.

Postoperative Denture Care 

Immediately after completion of a complete denture, it is strongly advised that patients return for follow-up adjustments. In most cases, the first adjustment should occur within 24 hours of delivery of the complete denture. This allows the practitioner to make finely tuned adjustments in areas where sore spots are noticed and to assess the patient’s psychological adjustment to the new prosthesis.

It is not unusual for additional adjustments to be necessary after the first follow-up. Once adjustments have been completed, patients should see their dentist at least twice a year to evaluate the adequacy of the prosthesis.

Additional Instructions That Patients Must Observe

  • Dropping the complete denture may cause fracturing of teeth or the acrylic base. Therefore, care must be taken when removing, cleaning, and reinserting the denture. When hovering over a sink, it is recommended to fill the sink with water or to have a towel placed underneath in case the prosthesis falls.

  •  It is recommended to brush denture teeth with a soft bristled denture brush or soft bristled toothbrush after every meal to avoid stain and food debris accumulation. Hand soap or dishwashing soap may be used, but toothpastes are generally regarded as being too abrasive and should be avoided. 

  • Phonetics may change after insertion of the complete denture. It is advised that patients practice reading out loud to allow quicker accommodation to the new prosthesis.

  • To allow for optimal functioning with the complete denture, it is recommended that patients place food bolus on both sides of the mouth and to chew with both sides. This will permit a more even distribution of stress throughout the masticatory system.

  • Avoid forcing the complete denture to seat in the mouth. If one finds that removing and inserting the denture is challenging, a follow-up appointment must be made with the dentist for further instruction.

Contradictions To Complete Dentures

Contradictions to complete dentures have not been reported. However, the following factors should prompt a dentist to reconsider the use of a complete denture:

  • Patient does not desire to have a removable appliance to replace missing teeth.

  • Patient has an allergy to the acrylic used in the fabrication of the complete denture.

  • Patient has a severe gag reflex.

  • Patient has severely resorbed dental alveolar ridges, which would compromise retention with a complete denture alone.

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