The process
Now
this varies depending on who the dentist is and on the situation so I will talk
a bit about how it SHOULD be done (i.e. the way we are all taught in dental
school) and split it up into categories – dentures when you have healed gums,
and dentures for when you are planning to have teeth out. There is also a bit
of variation depending whether you are having purely plastic or metal dentures.
Healed gums
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Need to have
teeth taken out
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1)
Generic
impression
This involves
loading a dental tray with a load of gooey stuff and placing it in the mouth.
It is on the list of everyone least favourite “things a dentist can do to
you”. We are aware of this so please don’t feel that you have to tell us you
“hate them impression things” – we know.
We have to do
top and bottom impressions whether you are having 1 or 2 dentures because
otherwise we won’t know how your teeth fit together.
I refer back to
,my favourite dental forum purely because it amused me:
“I
seem to remember reading about dentists in America who used laser scanning
and a 5 axis milling machine to duplicate extracted teeth. Allegedly a
titanium duplicate of an extracted molar could be machined and fitted into
the tooth socket within 30 minutes of the decayed tooth being extracted.
Maybe such technology will arrive in Britain in the next couple of hundred
years. Present dentistry seems to be in the Stone Age - if you can find any
that is!"
Sadly, we are light years behind our American cousins and so will remain in the stone age with out seaweed/silicone based impressions.
It looks a little like this
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Same as with
healed gums
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2)
This
step only applies for metal dentures.
As I showed you
in the first part of my blog, metal dentures have clasps etc to hold them in
place. These clasps have to fit around the teeth snugly and in order to do
this we have to modify the shape of the teeth slightly. We do this by
removing a tiny bit of the enamel (the outer layer of the tooth) to make a
small dent where the metal bit of the denture can slot in. Like a lock and
key type thing. We deliberately don’t numb you up for this because we only
want to be in the enamel of the tooth and not into the dentine. The dentine
is extremely sensitive so if you feel uncomfortable during this preparation,
we know we are encroaching on this dentine and therefore can stop before we
go too far!
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As a side note -
it is highly unlikely that anyone will make you an immediate metal denture as
they are expensive for the lab to produce and if you will be needing a new
one in a few months then you’ll be forking out a lot of money twice. Therefore
expect your immediate denture to be a plastic one.
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3)
Special
impression
The first
impression is sent to the lab to the poor “down trodden” (inside joke – if
you don’t get it then you should read part 1 shouldn't you!) dental
technicians who cast up the impression to make models of your mouth/teeth.
These models look like your mouth but are in stone. From these the
technicians make tailor made trays which fit your mouth much better than the
“one size fits all” trays that we have to use first
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Same as with
healed gums
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4)
Bite
This varies
slightly depending whether you are going to have a full or a partial denture.
The basic premise of what we are trying to do in this stage is work out where
we want the teeth to go. In full dentures this is just the ideal
anatomic/text book position which we work out by looking at the lines of the
face etc so that it is symmetrical and so on.
With partial
dentures however we just need to show the lab where the other teeth are and
how we want the false teeth to fit in with this.
This is done
using wax blocks and is basically a process of trial and error. We soften the
wax using something warm like fire, then get you to bite together. We do this
until the 2 wax blocks/your natural teeth and the blocks come together in a
good position then these get sent to the lab and the height of the block
determines the height of the teeth.
We also mark on
things like where we want the centre line (in between your front teeth) to be
because not everyone has a perfectly symmetrical face and so where the technician
assumes is the middle may not coincide with your nose etc.
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The process for
immediate dentures depends on the person.
If the teeth to
be taken out and replaced by a denture are the only missing teeth, then there
is no need for a bite stage as the technician will know where the teeth need
to be as they can work it out from the models. They then cut the stone teeth
off the models (hopefully the ones that are due to be taken out but I have
had several dentures come back with the opposite side on) and make the
dentures to fit the space.
The problem with
this is clear. Where the technician decides to cut the teeth dictates the
fitting bit of the denture. In real life, this could be completely different.
For this reason immediate dentures are usually not so great however we are
prepared for this and usually book you several appointments so we can see how
you are getting on and make as many changes as we possibly can so that they
are comfortable.
The second
situation is if you are due to have teeth taken out but also have various
gaps around the mouth. In this case we will record the bite using the wax
blocks in all the other spaces.
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5)
Try
in
This involves
“trying in” of the denture(s). They are in wax but with plastic teeth. They
give an idea of what they will look like but the fit might not be perfect
because the dentures are in wax not the final acrylic material so don’t worry
too much if they are dropping down a bit at this stage.
Now, when the
dentist says “what do you think” please tell us. If you don’t like the
colour, please tell us, because after this stage there is nothing we can do
about it and we don’t want to be the ones to dash your aspirations of
becoming a Simon Cowell lookalike by giving you less than tippex white
denture teeth.
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This stage
cannot be done with immediate dentures as the teeth you are attempting to
“try in” are still in the mouth waiting to be extracted. Of course if you
have several other gaps, you can have a wax denture made with teeth in those
areas so that you can check the colour/bite there.
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6)
Fit
of the dentures
Fairly
self-explanatory really
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At the fit stage
for immediate dentures, the teeth to be extracted are removed. We then check
to see that you have stopped bleeding etc then fit the dentures straight
away.
It is really
important that you leave the dentures in day AND night for a week – which is
the opposite to what we advise otherwise.
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7)
Follow
up appointments
We
will usually book an appointment in to check that you are happy with the
dentures, that there is no rubbing anywhere etc.
If
you find your dentures too uncomfortable to wear because they are rubbing,
please feel free to leave them out however a good few hours before your
dental appointment; please put them back in so that we can see the red area
where they are rubbing. Otherwise it’s just a case of you pointing to
somewhere that used to be sore and us looking gormlessly back at you.
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We like to see
immediate denture patients 2 days after they are first fitted to check that
things are healing ok and to ensure the denture is fitting as well as can be
expected on what is effectively a giant scab.
LONG TERM FOLLOW UP.
Obviously the mouth changes gradually over time however after extractions the bone that holds the teeth in place is no longer needed. Your body therefore removes that "excess" bone and so the scaffolding under the gum changes shape very rapidly over the 3 months following having teeth extracted. For this reason, dentures that fit straight after teeth were taken out will not fit over the next 3 months. In this case you will therefore have to have a new set made after these 3 months have passed/healing where the teeth were extracted has occurred. You must bear this in mind in terms of cost and expectations.
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Aftercare
If
you have worn dentures for a while, then you will be used to the concept of
wearing them and can just treat them like your old pair. If you are new to
dentures, whether you have healed or non healed gums then you have to treat
them slightly differently.
Week
after fit of immediate or your first set of dentures:
Leave
the dentures in for the week, only taking them out to clean them. This is
important. I see a lot of people come back for their review a week after the
dentures are fitted and the denture resembles the inside of a rotting sandwich.
PLEASE CLEAN YOUR DENTURES AND MOUTH AND THEN REPLACE THE DENTURES BACK IN YOUR
MOUTH.
After
the first week
Leave
your dentures out at night. Clean your remaining teeth and/or gums, clean the
denture(s), leave them out. They don’t need to be kept in a glass of water but
if you want to scare your partner/children then feel free. You can keep them in
some sort of denture cleaner if you like but do check with your dentist because
some cleaners can damage the denture material or cause staining. In the
morning, clean the dentures and your teeth/gums and replace them. You can then
go about your daily business.
As
I mentioned briefly in my last post, eating and talking will take a while. Cut
up your food into very small pieces, don’t expect to be able to eat steak or
crunch into apples. Similarly, expect to lisp and slobber a bit for a while. It
can take up to a month to adjust to what is “normal” for you.
As
always, if you have any other questions please feel free to ask. Dentures are a
bit of a mine field and every case is different so I would be more than happy
to give any personal advice if I can.
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