H. R. Tomlin

An Appraisal of the Complete-denture Situation

Perhaps the most fundamental question to ask in the first chapter of a book on complete dentures is ‘What is the demand for such treatment?’ Fortunately, more and more evidence has become available to provide an increasingly accurate answer and one which enables future trends to be determined with reasonable confidence. Particularly notable are the series of studies of adult dental health in the UK which have succeeded in painting a detailed picture over the last 20 years, a period during which major changes have occurred. The dental health of adults living in England and Wales has been studied on three occasions, in 1968, 1978 and 1988. Scotland and Northern Ireland were not included on the first occasion.

Try-in Procedures

Trial dentures are constructed by setting up teeth on shellac or acrylic resin bases. These dentures are assessed in the mouth so that any errors can be identified and corrected before the dentures are finished. In addition to allowing the dentist to check all previous recordings, this stage also permits the patient to express an opinion on the appearance of the dentures so that modifications can be carried out where necessary.

Recording Jaw Relations — Clinical Procedures

This chapter describes clinical procedures for recording the jaw relationship of an edentulous patient who has no previous dentures. It is necessary to modify the basic approach when constructing replacement dentures; these modifications are described in Chapter 7.

Jaw Relations — Theoretical Considerations

The clinical procedure of recording the jaw relationship enables the dentist to provide the dental technician with the following information: (a) The correct vertical and horizontal relationship of the mandible to the maxilla. (b) The desired shape of the dentures.

The Relevance of Existing Dentures

Patients requiring replacement dentures can be placed in one of three broad groups. In the first are those patients who were provided with immediate dentures. The second group consists of people who have worn complete dentures with satisfaction but seek replacement dentures to overcome symptoms of relatively recent origin. In sharp contrast are those in the third group who have had persistent trouble with a number of sets and for whom consideration will be given to construct new dentures in an attempt to solve their problems.

Fitting Complete Dentures

Although all features of design are checked carefully on the trial dentures, the processing procedure will alter the occlusal and impression surfaces of the finished dentures. Thus, the main objectives when fitting new dentures are: (a) to adjust the impression surface to ensure comfort; (b) to modify the occlusal surface to ensure even occlusal contact; (c) to give advice on the wearing of dentures, to encourage rapid adaptation, efficient usage and the maintenance of oral health.

Stability of Dentures

A stable denture is one which moves little in relation to the underlying bone during function. It is perhaps surprising that dentures stay in place at all, since they simply rest on mucous membrane and lie within a very active muscular environment. They stay in place if the retentive forces acting on the dentures exceed the displacing forces and the dentures have adequate support. This support is determined by the form and consistency of the denture-bearing tissues and the accuracy of fit of the denture. The relationship of these factors is as follows: Open image in new window

The Patient’s Contribution to Prosthetic Treatment

The successful outcome of prosthetic treatment depends upon a three-person effort — that of the dentist in making a diagnosis, preparing a treatment plan and undertaking the clinical work; that of the dental technician in constructing the various items which lead up to the finished dentures; and that of the patient in adapting to the dentures and accepting their limitations. In this chapter, we consider the patient’s contribution.

Preparation of the Mouth

Preparation of the mouth is frequently necessary before dentures are made and may involve the elimination of pathology within the denture-bearing tissues or the creation of a more favourable anatomical situation.

Assessment of the Patient

It is much more common for a dentist to have to provide complete dentures as replacements for old dentures than to provide them for a patient who has not worn such dentures before.