Natural looking complete dentures: the whys & hows
Most dental schools are currently reducing the amount of teaching hours devoted to complete dentures. However, there is still a desire for excellence in this area, as demonstrated by a recent course entitled ‘Natural Looking Complete Dentures, the whys and hows’. This was presented by Dr John Besford and Mrs Ruth Bourke and placed the physical and emotional needs of edentulous patient’s centre-stage. It was sponsored by Schottlander, who with Dr Besford have developed the Award Winning Enigma Teeth and Denture System.
To put the course in context, Dr Besford described how some denture wearers endure a state of self-imposed house arrest because of an inability to eat, speak or smile with confidence. Others turn down invitations to social gatherings, preferring to opt out rather than suffer the indignity of having dentures fall down while trying to talk or laugh. However the majority of patients aspire to prostheses which are completely undetectable to the casual observer, creating a state of ‘prosthodontic privacy’.
Viewed in this context, dentures can be considered to be ‘social appliances’ which confer qualities on their wearers’ way beyond the mere mechanical ingestion of food. These can include the restoration of a sense of being attractive, the building of confidence and a sense of wholeness. I found myself warming to the subject in a new way as I considered the contribution we as dentists can make to the quality of patients’ lives.
Dr Besford’s approach was certainly compassionate, but also very innovative, introducing techniques and practical wisdom which were new to me despite working with several different prosthodontic departments over the years.
While many edentulous patients can cope remarkably well with dentures produced quickly and inexpensively, treating more demanding cases requires a different approach. In these situations patients are encouraged to come to the surgery with a ‘shopping list’ of needs, with the aim of establishing objectives and identifying potential limitations of treatment.
Photographic records of the patient’s natural dentition often provide clues to the most suitable tooth positioning in relation to the soft tissues, while calculations of tooth size, arrangement, spacing and crowding make for a more natural appearance. Corrections for ‘plausible aging’ e.g. wear, tooth colour and gingival recession are all aspects of attention to detail that add authenticity to the case.
Light bodied silicone impression material is favoured over alginate, Which tends to lead to an overextended impression because of its viscosity. Rather than using stock or special trays, acrylic replicas of existing dentures are used as trays after border moulding of peripheries to improve seal.
Where no lower existing dentures are suitable, a functional impression technique for the lower arch (‘the French impression’) captures the denturebearing area And neutral zone. No tray is used and instead consecutive layers of silicone impression material are supported by a wire strengthener.
The use of the Schottlander Alma Gauge enables the technician to shape record blocks more appropriately. Its template provides information about the shape of the upper arch and the position of the incisal edge in relation to incisal papillae. Wax record blocks are mounted on acrylic bases with post dam for better retention, permitting better assessment of speech and soft tissue support. A chairside set-up of the eight front teeth by the clinician greatly enhances the aesthetic outcome and almost completely eliminates retry on the grounds of aesthetics.
When employing the techniques described it is necessary to find a technician who has undergone the same training, and then to develop a good working relationship with him or her. The high degree of collaboration between dentist, technician and patient as illustrated on the course came as something of a culture shock.
The contribution made by technician Ruth Bourke greatly enhanced both the function and appearance of the cases presented. Among the characteristics which were exceptional were the detail of gum contouring and the variegated gum colouring of the denture. Just as more attention has been devoted to soft tissue management in the dentate, in recent years, so more effort has been devoted to pink work in prosthetics with the development of gingival colours. The Enigma Colour Tone System from Schottlander, a life-like gingival colouring system, uses eight different shades of acrylic to produce the most accurate representation of the soft tissues. Non-anatomical flat, pink dentures can now be a thing of the past.
No one expects anything other than the natural dentition to look as good as the results achieved using these techniques, so if you and your technician wish to protect your patients’ most closely guarded secret their complete dentures then this is the course for you.