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  1. 1. Dentures From the Office of Dr. Michael J. Guy 511A Lakeshore Drive, North Bay ON, P1A 2E3We have recommended a plete lower denture wear is very difficult be- Complete upper denture (CUD) cause there is nothing to hold a lower denture Immediate Denture Complete lower denture (CLD) down while you chew. One of the significant If you still have remaining teeth that will be Partial upper denture (PUD) disadvantages of dentures is resorption of the removed to make a complete or partial den- underlying bone. The bone is normally main- ture, so you are not without teeth at any time Partial lower denture (PLD) tained by the stresses of chewing. When the we can utilize the Immediate Denture tech- Overdenture teeth have been removed, the bone is no nique. An impression is made before your Immediate Denture longer subject to the same stress, and there- teeth are removed, and the denture is created Other ______________________ fore begins to shrink. A successful complete and inserted immediately after the extraction. denture can be made but it is always a com- If your remaining teeth are so loose theyWHY YOU NEED A DENTURE promise. As with other types of dentistry, if would not be able to withstand the impressionWhether you are missing all or some of your proper time, care, skill and judgment are exer- process, you cannot receive an immediateteeth it is important to replace these teeth for cised, a denture that functions well and looks denture. The advantage to an immediate den-quality of life and health reasons. A denture natural, can be constructed. ture is that you are not left without teeth.fills in the space created by missing teeth and However, we will not be able to try-in thefills out your smile. A denture helps you to Partial Dentures denture before it is inserted to check for es-properly chew food, a difficult task when you Partial Dentures are made when you still have thetic, phonetic and functional problems.are missing teeth. In addition, a denture may some remaining natural teeth. You can have a Upon insertion if there are problems they willimprove speech and prevent a sagging face by partial denture on your upper or lower jaw, or have to be corrected later. Usually there areproviding support for lips and cheeks. no significant problems and your estheticWhen you are partially edentulous it is espe- result will be more than satisfactory. Oncecially important to replace the missing teeth. healing from the extraction has occurred, afterWhen teeth are missing, the remaining ones approximately three (3) months, the bonescan change position, drifting into the sur- and gums will have shrunk. You will eitherrounding space. Teeth that are out of position need to have the denture relined or have ancan damage tissues in the mouth. In addition, entirely new denture fabricated. At this timeit may be difficult to clean thoroughly be- we are then able to make any esthetic, pho-tween crooked teeth. As a result, you run the netic and functional changes that may be nec-risk of tooth decay and periodontal (gum) Partial denture with essary.disease, which can lead to the loss of addi- tooth-coloured claspstional teeth. Overdenture An Overdenture is a denture that uses preci-TYPES OF DENTURES Flexite Denture sion dental attachments to hold the denture down. The overdenture attachment can be placed in tooth roots that have been savedComplete or Full Dentures (Conventional Overdenture), or placed intoComplete or Full Dentures are made when all dental implants which have been placed toof your natural teeth are missing. You can receive them (Implant Overdenture). Becausehave a full denture on your upper or lower Cu-Sil Dentures lower complete denture wear is very difficultjaw, or both. for some, overdentures are most often utilizedA complete denture is considered an op- on the lower jaw to better secure a loose,tion of last resort so if you still have re- both. Sometimes it is in combination with a floppy denture. Patients who have overden-maining teeth we will always recom- complete denture. tures, particularly implants overdentures, aremend, if possible, you KEEP at least Removable partial dentures usually consist thrilled by the improvement in their quality ofsome or all of these teeth. This is espe- of replacement teeth attached to pink or life.cially the case with your lower jaw. Com- gum-coloured plastic bases, which are con- nected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps or devices called preci- sion attachments. Precision attachments are generally more aesthetic than metal clasps and they are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usu- ally required with attachments. Dentures with precision attachments generally cost Complete Upper Denture more than those with metal clasps. Overdenture
  2. 2. Conventional OverdentureTo have a conventional overdenture you must Denture Appointmentsstill have some healthy remaining teeth The following is the typical appointments appointments are scheduled(usually canines or premolars are selected for sequences and times for the dentures we dotheir root length and position in the jaw). most common . Sometimes complications COMPLETE DENTUREThese teeth will be shaped to fit the denture arise that will prolong the process. In addi- If all your teeth are already gone, a com-and since the shaping may expose the tooths tion if you are receiving a partial in combi- plete denture will take about six appoint-living pulp, the teeth usually need root-canal nation with a complete denture– the number ments over about a one month period.treatment. The teeth are covered with thin and length of appointments may be different. The following are the typical appoint-metal castings called copings, which fit into ments.openings in the denture. Attachments also can Before any type of denture is constructedbe put on the copings so the denture is better whether it be complete dentures, immediate Appointment 2 (1 hour)retained in the mouth. dentures or partial dentures it is important that Accurate Impressions (or moulds) of yourMaintaining some natural teeth has several a proper exam be performed so we can prop- upper and lower mouth are taken usingadvantages: erly diagnose your needs. If you are new to special trays. These impressions are than• Your natural teeth help preserve bone. the office or have never had a complete exam sent to a dental laboratory which than• Your remaining natural teeth bear some of this will be your first appointment. makes models of your jaws and wax bases the chewing pressure, which reduces pres- From this examination, if we find any pathol- or blocks for measurements at the next ap- sure on other areas of the jaw. ogy or active disease, we will try to resolve pointment.• Your remaining teeth improve the stability this first before the construct of new den- of the denture and make it less likely to tures. For example, if you have an existing Appointment 3 (1 hour) shift in your mouth. denture and your denture ridges are unhealthy Measurements are taken of how your jaws we may reline your existing denture with a relate to one another and how much space is• Your sense of where your jaw is in space soft liner and ask you to follow the “tissue between them (bite relationship). Dr. Guy and the pressure you are placing on the conditioning” instructions below. In addition, will modify the wax bases to capture the denture is better than the sense you have if other dental work such as gum therapy, jaw relationship. Next the teeth will then be after losing all of your teeth. TMD therapy, fillings or crowns are required selected for your denture. The size, shape• Keeping some teeth can help you psycho- they should be completed before any denture and color of the teeth will depend on many logically accept your denture. factors, including reference points in your TISSUE CONDITIONING mouth, remaining natural teeth, your skinImplant Overdentures tone and the shape of your skull, photo-Dental implants are essentially " artificial For best results when making a denture, the denture-bearing tissues or gums must graphs, etc. The modified wax bases and theroots" cylindrical in shape and made of pure mould and shade information are given totitanium. They are surgically placed and be healthy and free of inflammation. If the present condition of these tissues are poor the dental laboratory so the teeth can beintegrate with your bone. The denture will placed into the wax bases for the next ap-either fit directly onto the implants, or to a they need to be brought back to health before proceeding with the new set. pointment a week later.metal bar that links the implants together,providing support for the denture. Appointment 4-Wax try-in (20 min.)While a minimum of two dental implants may To return your gum tissues back to health, a soft tissue conditioning liner will be The teeth are held in the base with waxbe inserted for an acceptable outcome, a per- while you have a trial fitting. You can seeson can receive three or more. Basically the placed in your existing denture. We also ask that you follow these instructions: how the denture looks and feels in yourmore dental implants the better the support mouth, and Dr. Guy can make sure it fitsand retention to the implant denture. With and functions correctly and harmonizes withtwo implants the denture will stay in place 1) Keeping the dentures out of the mouth as much as possible before we take the rest of your face. If the denture is satis-during chewing and speaking. However factory we will send it to laboratory forwith four implants there is even more of a the final impression for the upper (it is absolutely necessary to take the den- processing and you will receive the denturedramatic improvement in denture function. (s) at the next visit booked three or fourWhile two attachments hold the denture in tures out at night), 2) Gently massage the gum tissues with working days later. If it is not satisfactoryplace biting pressure is still on the soft tissues will have additional try-ins until you areof the gums. Four to six implants allow a toothbrush, twice a day for about 5 minutes at a time, to re-establish happy.placement of a sturdy metal bar that bothholds the denture in place and supports it blood flow, 3) Rinse with a warm salt-water mixture Appointment 5- denture insertionduring chewing. The result is excellent func- We will fit the processed denture into yourtion and comfort that rivals the natural teeth twice daily during the treatment pe- riod. mouth and make whatever minor adjust-that have been lost. ments are necessary for comfortable fit. At If you adhered this routine, in about two to this time, we will also go over the instruc- three weeks, your denture bearing tissues tions for eating, speaking, denture care and should return to health. At this point, we oral hygiene. In some cases if the bite is off will be able to proceed with the final im- we will sent it back to the laboratory for a pression. Because the inflammation or bite adjustment. swelling of your gums has been reduced or eliminated your present dentures may not Follow-up visits fit. I can have you come in so I can check Over the first few weeks or month with the tissue. your new denture you may require minor Implant-retained den- adjustments appointments for better fit and
  3. 3. Denture Appointments Cont. after he last extraction appointment. Gener- ally, it is similar to appointment 2 of stages, and the second is a prosthetic phase “Complete Denture” except the you will (making the implant denture).comfort. When you call we try to get you in The Surgical Phaseas soon as we can for what we expect will be still have your remaining front teeth in place. Surgical Insertion Stagea short 5 to 10 minute appointment. • Dental implants are completely inserted Appointment 3 (1 hour) into precise preparations in the jawbone.PARTIAL DENTURE After dental implants are inserted into theThe fabrication of a partial denture is very Same as with the “Complete Denture”. jawbone, gum tissue over the dental im-similar to a complete denture with the excep- plant is closed with sutures.tion of a few appointments Appointment 4-Wax try-in (20 min.) This appointment is similar to appointment Healing and Surgical Exposure Stage 4 of the Complete dentures except it is only • During healing, an existing or temporaryAppointment 1 (1 hour) a partial try-in. Because you still have your denture may continue to be worn afterSame as with the “Complete Denture”. front teeth you will only see what they look adjustments have been made to adapt it to like on the model and not in your mouth. the surgical site. If the existing dentureAppointment 2 (40 to 60 min.) The back teeth of the denture can be re- cannot be altered sufficiently, a provi-For optimum fit, shallow preparations are moved and tried in to check the bite. This is sional prosthesis should be fabricated.made on the teeth that support the denture.No anesthesia is necessary because they are a major limitation of immediate dentures • Implants are left undisturbed beneath gum because we are unable to check if there are tissue for at least several months as deter-shallow there is little sensitivity. Then accu-rate impressions (or moulds) of your upper any esthetic, phonetic and functional prob- mined by the surgeon. During this time, lems will the denture before processing. If bone reorganizes and grows around theand lower mouth are taken. These impres-sions are than sent to a dental laboratory there are any problems they will have to be dental implant surface, anchoring it se- corrected later. curely into the jaw (this is called osseoin-which will fabricate cast metal frameworks.Wax bases will also be added to this frame- tegration).work. Appointment 5- denture insertion • At the end of the healing stage, the top of At this appointment your remaining front the dental implant is exposed by removingAppointment 3 (1 hour) teeth are removed and the denture is they gum tissue directly over it. An extensionAfter the framework is tried in and checked inserted Depending on the fit of the denture that is then screwed into the exposed den-for fit the appointment is very similar to ap- it may be relined with a soft liner. We will tal implant projects slightly above thepointment 3 for “Complete Dentures”. In also review post-operative instructions. It is gum tissue.some situations we may have to adjust the bite very important that you follow them very • After adjustments, an existing denture canso the teeth meet better with the frameworks carefully. Typically, after the extraction of be worn over an dental implant extensionin place. As with the Complete Dentures, the teeth, there may be some swelling. By plac- while the gum heals. However, the den-partials are sent to the dental laboratory so the ing your denture in immediately, this swell- ture must be reshaped to conform to surgi-teeth can be placed into the wax bases for the ing can be kept to a minimum. If you did cal site contours in order to avoid unnec-next appointment a bout a week later. not place the denture immediately, the essary pressure areas on the newly in- swelling that occurs might not allow you to serted extensions and the surgical area.Appointment 4-Wax try-in (20 min.) wear your denture until the swelling sub- The Prosthetic Phase (Making the Im-Same as appointment 4 of the Complete den- sided. You must wear you new immediate plant Denture)tures denture for three (3) days, after the surgery, • A precision superstructure is fabricated without removing it. This will help to con- and is screwed into the dental implantAppointment 5- denture insertion trol the swelling. extensions. This superstructure may haveSame as appointment 5 of the Complete den- various interface configurations, rangingtures. Follow-up appointments from interconnecting metal bars to spe- We will ask you to come back within 48 cially shaped singular extensions.Follow-up visits hours of the insertion visit to check healing • The denture is fabricated with specialSame as “Complete Dentures” and make any additional adjustments to the provisions on the inside surface to receive dentures. various types of attachments (interlocks).IMMEDIATE DENTURE Depending on the attachment, they inter-Appointment 1 (1 hour) Once healing from the extractions has oc- act in various ways with the superstruc-Same as with the “Complete Denture”. curred, after approximately three (3) ture. For example, a metal or plastic at- months, the bones and gums will have tachment may clip onto metal superstruc-Dental Extraction Appointments shrunk. You will either need to have the ture bars, a nylon receptacle may receive aAll back teeth (or teeth that don’t show as denture relined or have an entirely new specially configured dental implant exten-much when you smile or talk) will be re- denture fabricated. At this time we are then sion, etc.moved before any of the denture fabrication able to make any esthetic, phonetic and The attachment/superstructure configurationappointments. The number of appointments functional changes that may be necessary. helps to securely maintain a denture whilewill vary from 1 to 4 depending on the num- At this time you will be responsible for any eating and speaking, and still allows a per-ber of teeth that are to be removed. laboratory charges due to change made to son to comfortably and easily remove the the denture prosthesis for cleaning purposes.Appointment 2 (40 to 60 min.)This appointment is for moulds of your upper IMPLANT-RETAINED DENTUREand lower jaws and is normally a few days There are two phases to this process. The first is a surgical phase consisting of two
  4. 4. Instructions, Tips and Care For Your Dentures From the Office of Dr. Michael J. Guy 511A Lakeshore Drive, North Bay ON, P1A 2E3ADJUSTING TO YOUR DENTURES Nausea- If you experience motion sickness, gums and the bone of your jaw.For the first few weeks, your new dentures nausea or vomiting, remove your dentures at • If your denture no longer fits properly, ifmay feel awkward or bulky.Your speech may once and keep them in a safe place until you it breaks, cracks or chips, or if one of thebe altered and eating with your new dentures recover. teeth becomes loose, see us immediatelya problem. This is especially the case if this so we can make the necessary adjust-is your first set of dentures or if it is an imme- The tongue- If you have a full lower denture ments or repairsdiate denture. Please be patient as you will develop the habit of resting your tongue in theeventually become accustomed to wearing floor of your mouth so that the tip just touches MAINTAINING YOUR DENTALthem. If you have any soreness please call the the lower front teeth. This will keep the den- HEALTHoffice. Your new denture, may require some ture in place, particularly when you open your Remove your dentures for about six toadjustments. Soreness occurs when the den- mouth widely. If you practice this position eight hours every day. It is recommendture is placing too much pressure on a particu- with your new dentures, correct placement of you sleep without your dentures in place.lar area. So we can identify those denture the tongue will become automatic in a short If you cannot sleep without them we rec-parts that may need adjustment, we ask that time. ommend you have them out for at least sixyou initially wear your denture(s) full-time. to eight hours a some point during the day. DENTURE CARE The following health benefits are expectedInserting and removing your dentures, • Handle your denture with care. When from removing the dentures:especially partials and implant-retained den- cleaning your denture stand over a folded a. blood and lymph flow is improved,tures, will require some practice. Generally towel or a sink of water just in case you b. cheek and tongue action will massagedentures will seat in only one direction. Take accidentally drop the denture. the gums,your time. Once you line the denture up prop- • Brush the denture each day to remove food c. It is more hygienic and therefore thereerly it will seat into place with relative ease. deposits and plaque. Brushing your denture will be less chance of gum inflamma-Never force a denture into position by biting helps prevent the appliance from becoming tion, infection and decay.down. This can cause damage to your teeth, permanently stained. Its best to use a brush d. The stress from grinding and clenchingtissues or the denture. Particularly vulnerable that is designed for cleaning dentures. A will not damage your denture support-to breakage are the metal clasps of partials. denture brush has bristles that are arranged ing gums. to fit the shape of the denture. A regular,Eating- Eating with dentures is entirely dif- soft-bristled toothbrush is also acceptable. Practice good oral hygiene- Brushingferent than eating with teeth. It will take Avoid using a brush with hard bristles, twice a day and cleaning between yoursome time to learn how to eat with your den- which can damage the denture. Moisten the teeth daily helps prevent tooth decay andtures. At first, new denture-wearers need to: brush and apply the denture cleaner. Brush gum disease that can lead to tooth loss. Pay• select foods that require little chewing, all denture surfaces gently to avoid damag- special attention to cleaning teeth that fit• Avoid foods that are extremely sticky or ing the plastic or bending clasp or other under the dentures metal clasps. Plaque hard. attachments. that becomes trapped under the clasps will• avoid chewing gum • If you would like to use a denture cleanser, increase the risk of tooth decay. We can demonstrate how to properly brush and• Chew on both sides of the mouth to keep look for those with the Canadian Dental clean between teeth. Selecting a balanced even pressure on the denture. Association (CDA) Seal of Acceptance. Products with the CDA Seal have been diet for proper nutrition is also important.• Cut foods into small pieces, chew slowly, and dont be embarrassed if you take a little evaluated for safety and effectiveness. Some people use hand soap or mild dishwashing See the dentist regularly. It is important longer to finish a meal. to continue with regular dental checkups.When biting into something place the food at liquid to clean their dentures, which are both acceptable. Dont use alcohol, abrasive The frequency of visits will depend onthe corners of your mouth and not in the cen- several factors. For instances, if you havetre of your front teeth, since this produces cleaners, bleaches, whiteners or boiling water to clean or soak your dentures. no remaining teeth (complete dentures)added stress and may cause your denture to yearly checkups are adequate. We willtip. Please be careful you don’t burn yourself • Rinse loose food particles off your denture examine your mouth for signs of diseasewhen consuming hot foods plastic is a good thoroughly after every meal. or cancer and monitor the fit of your den-insulator • When you are not wearing your denture tures. Because your mouth will continue to stored in normal tap water or in denture change as the bone under your dentureSpeech- If you have trouble pronouncing cleaning solution. Dentures can dry out and shrinks or recedes, it may be necessary towords properly, read to yourself in a loud distort if they are left outside a moist envi- adjust or reline your denture or possiblyvoice. When a word doesnt sound right, go ronment. make you a new denture.back and say it over several times until you • Get in the habit of keeping the denture in If you still have remaining teeth we rec-have mastered the sound. the same safe and handy place to reduce the ommend visits anywhere from 3 to 9 likelihood of misplacement. months depending on the health of theseCoughing and sneezing tend to unseat com- • Never attempt to adjust the denture yourself remaining teeth. For example, if you haveplete dentures. A good precaution in this case and do not use commercial relining or repair periodontal problems we will recommend ais to cover your mouth with your hand or products on your dentures. You may ruin 3 to 4 month recall interval.handkerchief. the dentures and cause damage to your