I’m Darin Dichter.
I’m a prosthodontist and a member of the resident faculty here at Spear Education.
In this team meeting, we’re going to talk a little bit about complete dentures; some
of the problems that our patients have with complete dentures and then look at some of
the treatment options for problematic lower complete dentures.
Historically, complete dentures were really the only treatment options available for edentulous
patients.
As a matter of fact, dentists would frequently advise patients to have all their teeth removed
while they were still young and strong and healthy and as a result the most able to heal
following the extraction procedures and ultimately and hopefully adapt to the new dentures.
Lots of patients had their teeth removed in their twenties and then went on to live through
adulthood with complete dentures.
Some of these patients did remarkably well with their dentures.
Others, well they had a little more trouble.
You may have heard stories or maybe you even know someone who only wears their dentures
for special occasions, leaving the dentures out for most of their everyday life including
things like eating.
Well it turns out that successful patient outcomes with conventional complete dentures
rely not only on technical skill of the dentist and the dental technician but also the patient’s
individual ability to adapt to their denture.
In fact, the patient’s neuromuscular control may be the biggest factor in whether or not
a patient will become successful with their complete dentures.
If we look at some common problems with complete dentures, it’s usually the lower denture
that patients will have trouble with.
So typical technical problems include problems with the bite, problems with the adaptation
of the denture base or problems with the extension of the denture base.
What can we do for our patients who are having difficulty adapting to a troublesome lower
denture?
Well, the first thing that we might try is really ruling out any technical problems.
If the problem with the denture is the result of a problem with the adaptation or the extension
of the denture base, well we could attempt to reline the denture.
If the denture is adapted well though but it’s still too lose or moving too much for
the patient, we might try something like denture adhesive.
What if all the technical problems with the denture have been ruled out?
These are cases that can really benefit from dental implants.
And we can use dental implants in a lot of different ways.
One way that’s been really successful in the lower jaw is to use two implants and resilient
components that attach the implants to the denture.
In the United States the Two Implant Overdenture will most commonly use locator attachments
in order to help keep the denture from moving.
In general, Two Implant Overdentures have demonstrated really wide patient acceptance
and that’s thanks to improved retention and stability in the prosthesis.
And really, just a minimum number of implants are required.
Typically, we won’t need any augmentation making this restoration financially favorable
for lots of patients.
And, finally, the implants are placed in the anterior mandible which is a very predictable
location.
So, sure there are lots of other ways to restore an edentulous arch yet the Two Implant Overdenture
really provides a lot of bang for the buck especially for patients who don’t mind having
a removable complete denture.
So how can we begin to talk with our patients about this treatment approach?
Well, in my practice it might sound something like: “You know, Jerry, I’ve noticed that
your lower denture appears to be moving around on you and we’ve had some really good success
with improving that for some of our other patients.
Would you be interested in knowing your options for improving the stability of your lower
denture?”
So, what I’d like for you all to do is this.
Discuss how you would approach your patients in the doctor’s operatory, in the hygiene
operatory and maybe even at the front desk.
Roll playing can be really useful with this exercise.
I hope you have fun and I’ll see you next time.