Yesterday I delivered my first set of dentures. I delivered a lower partial denture and an immediate complete upper denture. The final result turned out very well for my first set of dentures. Getting to the final result took a lot of extra hours outside of clinic time and classes. I will quickly review the steps we took to get to the final result:
- Extracted multiple retained roots.
- Prophy, cleaning, fluoride
- OL composite restoration (very small) to fix small chipped enamel on LL PM.
- Preliminary impressions
- Lower partial denture designed and rest seats prepped into mouth – new impression made, poured up in pink stone and submitted for framework fabrication.
- Framework returned and tried in – perfect fit (PHEW!)
- New impression taken of maxillary arch and bite registration taken with framework in lower arch.
- Facebow and bite registration used to mount the stone models.
- Teeth #6, 7, 8, 9, 10, 11 were removed from maxillary arch and wax rims made to replicate excursive movements and protrusive movements set into the articulator prior to tooth removal.
- Teeth set into lower partial framework (Replacing #30, 31)
- Teeth set into upper denture. ***Note how I write this down so nonchalant! In fact this was the most time consuming process – setting teeth, making the wax look good and festooning.
- Submitted both upper and lower to lab to get processed at the same time. Because this is an immediate upper denture we could not do a wax try-in.
- Received the processed dentures. Removed residual resin, polished the denture and removed a few undercuts.
- All in the same day: Extracted #6, 7, 8, 9, 10, and 11 and tried in denture. Fit was good, so we headed over to the removable clinic. PIP paste was used to check for excess spots and the denture was adjusted in a few areas.
- 24hr f/u resulted in some soreness in the maxillary labial vestibule. The denture was adjusted and lowered in these areas. The lower partial denture did not need a single adjustment.
Overall the whole process took about 20 appointments! We still have a few more follow up appointments and some relines to do for the maxillary denture. The immediate dentures never fit quite as well because of the guesswork being put into the process (teeth are still present in the mouth when you are making the denture). My biggest tip would be to self regulate your work and be as anal retentive as possible while doing an immediate denture. The smallest mistake can easily be compounded into a large mistake by the time all the steps are done. I wish I had taken some before shots, but here is the final product:
The astute observer may notice a few things:
- The upper teeth do not match the shade of the lower teeth: This is due to patient preference.
- There is a space between the upper and lower anterior teeth: I wish I had a pre-operative photo! The patient had a much larger open bite and this is the best we could do clinically to close the gap.
- Do you see anything else?
Please share your comments!
