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News Bulletin : ADA News Bulletin August 2010
42 AUGUST 2010 Hands up everyone who has constructed a set of full dentures in the last twelve months. Hmm -- not as many as say, ten years ago, but still quite a few. All right then, let's try another question. Who actually enjoyed the experience? Just as I suspected, even fewer still! Most of us are uncomfortable making dentures these days. Dental students do not receive as full a training as decades earlier and those clinicians with experience risk their skills atrophying due to lack of practice. Too often the exercise is time consuming and frustrating. The reality is though; the need for full dentures has not yet quite disappeared. THE PROBLEM Full denture work is increasingly seen as yesterday's dentistry. Responsible dentists obviously avoid full clearances wherever possible. The number of patients requesting full dentures is rapidly declining, while, of these, the demographic is ageing. Many people seeking dentures do not, in fact, attend dental clinics but rather visit advanced dental technicians or prosthetists. Nevertheless, dentists are still occasionally asked to construct full dentures and have an obligation to be competent. What is needed is a method that reduces chairside time and is simple and reliable. The classical technique basically involves selecting stock trays, taking preliminary impressions, having customized special trays constructed and then taking final impressions. Occlusal rims are then constructed on the resultant master casts and a jaw relationship recorded. All steps are important but the impressions are especially critical, particularly in the lower arch where a number of factors must be managed. Retention can not be achieved with any sort of suction but rather a balance of forces of the tongue and lip/cheek musculature. Ridge height is invariably disappointing, especially with the older patient, so stability is likewise a challenge. Conceptually an impression of an edentulous arch is different from that of a dentate one. When teeth are present the structures being recorded are mostly fixed so there is basically one correct impression that is being strived for. With an edentulous arch many of the landmarks move according to the function the mouth is performing at any given moment. The ideal impression is a composite of all the components' different positions. An analogy might be a photograph. A snapshot of a roadway can be accurate at one instant, but not another, while a 24 hour time-lapse photograph may give a more realistic representation of how it is used from day to day. In other words there is a strong argument for lower impressions being functional rather than static. Special trays do not lend themselves to functional impressions. They are supported with handles, which in the lower automatically tend to place soft tissues in an unnatural position. Furthermore, despite conscientious laboratory work, they are rarely the shape of real dentures, which it is hoped will harmonize with the mouth. They can not place tissues in the position they would be under masticatory loading and can not record the tissues during speech and swallowing. A TECHNIQUE TO CONSIDER Most patients present for replacement of dentures, already having a set. While these are usually deemed unsatisfactory, they are worth examining closely. If they are more accurate and their basic contour better than that of envisaged special trays, they may be used as a basis for new dentures. opinion page Full dentures BRINGING THE DINOSAUR INTO THE 21st CENTURY
ADA News Bulletin September 2010