Blog | Finlay Sutton - Denture Education

Appointments for making acrylic based RPDs – after the consultation visit(s)

In general, these are the visits required to make acrylic based removable partial dentures satisfactorily. I regard acrylic based RPDs as temporary and metal based RPDs as definitive appliances.

To provide a quotation a basic design is performed from photographs taken at the initial consultation. The initial consultation is a crucial part of the process for establishing rapport, trust and generating the all-important wish list.

Denture Blog 62

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk

Appointments for making cobalt chromium based partial dentures

In general, these are the timings I require to complete each stage for a set of cobalt chromium based partial dentures satisfactorily.

To provide a quotation a basic design is performed from photographs taken at the initial consultation.

Denture Blog 61

Post dam position for maxillary complete dentures – the fovea palatini getting a good posterior seal

The posterior border of a maxillary complete denture is positioned at or around the position of the fovea palatini, by cutting a “cupids bow shaped” groove onto the master cast. The post dam groove extends from the right to the left hamular notches and beyond just into the buccal sulcus, enclosing the tuberosities and passing across the midline of the palate within 1 mm of the fovea palatini.

If the patient cannot tolerate this extension, the post dam position is brought forward (away from the soft palate) in the centre by cutting a new post dam on the definitive cast. It is important to maintain coverage of the tuberosities past the hamular notches into the buccal sulcus.

Denture Blog 60

Well engineered lumps of plastic

I say to the patient that "your new dentures will be well engineered lumps of plastic. They look like teeth but don’t work like teeth - like a prosthetic hand/leg, they will not work like natural teeth. I will make them to the very best technical standard, however I am reliant heavily on you getting used to them. Just like learning to drive a car or learning a difficult new skill (like golf, football, using chopsticks (if they don’t use them)….. the analogies vary for patient to patient ) it takes time to get used to them.” The role of neuromuscular control cannot be over emphasised. The adaptability of humans is incredible.

Managing expectations is 50% of the job with dentures. 50% is technical.

Denture Blog 59

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk

Litigation and tone of voice

Our tone of voice when talking to our patients can influence the likelihood of litigation. If our voice sounds dominant, we are more likely to be sued, than if our voice is less dominant and more concerned.

The most corrosive tone of voice that we can assume is a dominant tone. We must be careful to communicate respect for our patients through our tone of voice.

Blink by Malcom Gladwell

Denture Blog 58

Method for adjusting the occlusion on immediate partial dentures – at the extraction visit

Checking the occlusion can be tricky at the fit appointment for immediate dentures. The local anaesthetic swells the soft tissues preventing the Immediate partial denture from seating fully as it does on the on the master cast. This results in the partial denture appearing high and propping the bite opening, particularly if the denture has been made to conform to the intercuspal position with the remaining natural teeth.

I adjust the occlusion on the partial denture to a point where the natural teeth come into contact when the patient bites firmly together in their intercuspal position. I use 40 micron articulating paper to adjust the denture occlusion until I see the same marks on any antagonistic opposing natural teeth:

a) with the immediate partial denture in place

b) without the partial denture in place

Denture Blog 57

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk

Removable partial dentures become less retentive over time – “less grippy”

Partial dentures which are retentive at fit become less retentive over time when worn. Retention in this context means the grip of the denture on the teeth.

This occurs mainly because of:

• settling of the supporting teeth

• clasps deforming slightly

I warn the patients that this will occur.

In most circumstances, this goes unnoticed by the patient as their adaptation and neuromuscular control offset this gradual reduction in “grip". It happens less quickly when a major part of the retention is from friction (guide surfaces and accurate dentures) rather than clasps’ resistance to deflection.

Denture Blog 56

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk

Being good at removable prosthodontics is directly relevant to fixed implant prosthodontics

All the of the principles required for producing aesthetically superb complete dentures apply equally to large scale fixed dental implant restorations. In edentulous patients, it is considered essential in making full arch implant-stabilised fixed restorations, to carry out a full three-dimensional prototype ‘dress rehearsal’ with complete dentures. Only then can the positioning of implants be planned, and surgical guides made.

This has the further advantage that in some cases the patient may be happy to settle for good removable dentures and be saved the considerable effort and expense of implants, etc.

Subscribe to my Newsletter and Blog please email education@finlaysutton.co.uk