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Procedures

Removable dentures

Procedure overview

Learn about the dental procedure, when it is generally prescribed, and other information which can increase your knowledge of the topic.

Alternate terms: Dentures, removable; False teeth; Partials; Plates.

Removable dentures (sometimes referred to as "false teeth" or "plates") are a common treatment alternative for the condition known as "edentulism" (i.e. missing teeth). They are versatile in their ability to replace any number of missing teeth and to fill out the contours of the face and lips, which shrink inward when multiple teeth are lost. Typically the denture base is made of acrylic plastic that can be tinted to match the patient's natural gum tissues. The teeth are made from either acrylic or ceramic.

Complete dentures are an option for the completely edentulous patient, while partial dentures ("partials") are an option for the partially edentulous. Partial dentures are held in place in the mouth by wire clasps and/or other means of attachment to the remaining natural teeth. Partial dentures can be a temporary means of treating patients who are expecting to lose the remaining teeth. As more teeth are lost, they can be added to the partial. At some point, as the natural teeth being used to anchor the partial denture ("abutments") are lost, it becomes necessary to completely remake the denture, or explore other treatment options (see "Treatment options").

Four views of a set of removable complete dentures

Figure 1: Different views of a removable complete denture for the patient's upper jaw ("maxilla"). The upper left photograph shows the side of the denture that is worn against the patient's gums, where their teeth used to be. Note that the denture "base" (the pink part that holds the teeth and rests on the gum tissues) covers the roof of the mouth ("palate"), and adds bulk on the side towards the lips and cheeks to give the face proper contours. The lower right photograph shows how the denture will function with the patient's lower denture. Ideally, upper and lower dentures are made in sets for completely edentulous patients. This provides the best chewing efficiency and esthetics.

Complete tooth loss or edentulism of the maxilla requiring a removable complete denture

Figure 2: A completely edentulous "maxilla" (upper jaw)

Complete dentures are held in place by some combination of "suction cup effect", denture adhesive (best if used very minimally), and the patient's controlled use of their tongue and facial muscles. Learning to function with complete dentures can be a challenge, as with any prosthetic device. Dental implants can be used to help stabilize dentures, as discussed further below.

Dental implant supported lower overdenture and traditional removable complete upper

Figure 3: The dentures shown in the previous photograph are shown here in the patient's mouth. The lips are being retracted for the photograph. Note that the dentures fill the space left by the missing teeth and shrunken underlying bone and gum tissues, to provide the correct amount of vertical spacing between the upper and lower jaws, and to fill out the cheeks and lips.

A swinglock removable partial denture is one option for tooth loss (edentulism)

Figure 4: A removable partial denture for the lower jaw ("mandible"). Note that the denture replaces all but three of the patient's natural teeth, which will be used to retain the denture in place in the mouth. This denture has a "swing lock" clasping feature, consisting of a hinged bar, shown in the open position. The swing lock will not be visible behind the patient's lower lip when the denture is placed in the mouth. The ability to remove the denture makes it much easier to clean such retention features. Not evident from the photograph is that the metal framework which serves as the denture's skeleton extends under the pink plastic gum "tissue" and denture teeth to strengthen them. Generally the framework is made of an extremely hard nickel-chrome alloy; however, for those with nickel allergies, other metals can be used.

Getting used to wearing dentures

Learning to wear dentures takes time. Just as recent amputees don't immediately run marathons on a prosthetic leg, denture wearers shouldn't expect normal, tooth-like function from a new denture. This is especially true if the teeth have recently been removed. A generality that serves to illustrate this fact is that the wearer of a traditional removable denture should expect a month adjusting to a new denture for every decade of life. If you're sixty years old, the "break-in" period would roughly take six months. This is the length of time necessary for the soft tissues to "toughen up", and for the denture wearer to learn how to function with the denture(s).

Denture wearers chew food differently than those with teeth. The tongue may be used to help hold the denture(s) in position, and the food is chewed on both sides at once. Implant supported complete dentures have a shorter adjustment period, as do partial dentures which have solid anchor teeth. The more stable a denture is, the less time it takes to get used to.

Adjusting to the taste of food also takes time, especially if an upper denture that covers the palate is worn. Many other factors play a role in determining how long it will take to adjust to denture use. The age of the patient, the patient's attitude about denture wear, and the size and shape of the edentulous ridges are other important factors. Your dentist can tell you more about your unique edentulous situation, and how it may affect your ability to wear dentures.

Bone resorption, Loose Fitting or Poorly Adjusted Dentures

Wearing dentures applies pressure to the underlying bony ridges that causes the bone to dissolve away ("resorb") over time. The resorption process doesn't usually occur uniformly, however, so the result is a denture that no longer fits the ridge it was built to fit. The denture will then rock, tip, and apply enough contact pressure in certain areas to cause pain and denture sores. How quickly the dentures come out of adjustment depends on several factors, including the amount of chewing force the patient can develop, the size and shape of the underlying bony ridge, and the patient's unique skeletal biology. Thin, sharp ridges resorb the fastest, particularly in patients who can develop heavy muscle contraction forces. Patient's whose bone density is low (e.g. women with osteoporosis) will experience a greater rate of bone resorption.

Your dentist may recommend any of the following treatment options to stabilize and/or better retain loose or poorly adjusted dentures:

  • Chairside denture reline—this procedure is done in-office, to record the current position of denture-supporting soft tissues, and fill any gaps between the denture and the soft tissues with denture acrylic.
  • Laboratory denture reline—this procedure involves grinding away a few millimeters of acrylic from the soft tissue interfacing portion of the denture base, placing impression material in the denture, and inserting it into the mouth to record the current soft tissue contours. The denture is then sent to a laboratory, where a stone cast is poured from the impression. The impression material is removed, and replaced with heat-processed acrylic.
  • Denture rebase—this procedure, completed in the laboratory, uses your existing denture teeth, but replaces all of (not just the surface portion of) the acrylic denture base with a new base. The procedure is indicated if you need more lip or cheek support to fill out your facial proportions, in addition to filling in the gaps between the denture and underlying soft tissues.
  • Dental Implants—Your dentist may recommend placing one or more dental implants into the jawbone under your denture. Standardized and custom hardware is available for attaching the denture to the implant(s). Custom hardware generally comes at a greater cost—ask your dentist. Implants can greatly stablilize dentures, decrease the rate of bone resorption under the denture, and dramatically improve a denture patient's oral function.
    Learn more: Procedures › Dental implants
A removable partial denture can be stabilized by attachment to a dental implant with a standard ball abutment

Figure 5: A removable partial denture can be stabilized by attachment to a dental implant with a standard ball abutment.

A removable complete denture can be stabilized completely by attaching it to as few as two dental implants

Figure 6: A removable complete denture can be stabilized completely by attaching it to as few as two dental implants.

Denture Pain and Denture Sores

There are many causes of denture pain, and a full discussion of this subject is beyond the scope of ToothIQ. Here are a few of the more common ones:

  • Poor fitting, or poorly retained (i.e. "loose") removable dentures can rub on the gum tissues causing sore spots. Complete dentures apply pressure to the supporting alveolar bone, which can cause it to resorb away over time. When this occurs, the dentures rock back and forth, creating pressure points and more pain. Minimizing the number of pressure points and keeping chewing forces evenly distributed on the soft tissue requires good adaptation of the denture to the edentulous ridge. This is why it is so important to have your dentures evaluated for proper fit and bite adjustment by a dentist on regular intervals.
  • Removable partial dentures, that are held in the mouth by attachments to teeth or implants, and supported by the soft tissues where teeth are missing, can also get out of proper adjustment. This happens when the soft tissue and underlying bone shrink away from the denture after a period of time, and cause the denture to be suspended only from teeth. The supporting anchor teeth may crack or loosen, the denture may begin to rock, and the denture will no longer function properly against the teeth of the opposite jaw. Again, it is very important to have removable partial dentures evaluated for proper fit, retention, and bite adjustment by a dentist on regular intervals to avoid these sorts of problems.
  • When bone resorption under a lower denture becomes severe, the denture may begin to place direct pressure on the mental nerves. This can be extremely painful, and typically happens after many years of complete denture wear. The pain is generally felt in the area just behind the missing canine teeth, and is worst when applying biting pressure in that area. If you are experiencing these problems, review the section on "Mental Nerve Pain", and see a dentist as soon as possible.
  • Another potential source of pain with dentures is a condition called candidiasis, a fungal infection which can cause painful erosions of the soft tissue under the denture. If you have painful mouth sores of any kind, see your dentist as soon as possible. Not all forms of candidiasis are painful, so if you notice changes in the appearance of your soft tissues, see your dentist as soon as possible to have it evaluated.
    Learn more: Diagnoses › Oral candidiasis
  • Over-the-counter remedies for denture pain and loose dentures seldom offer long-term solutions to the problem, and can even aggravate it. As an example, applying excessive amounts of denture adhesive to a denture changes its physical position in the mouth, and the teeth no longer engage properly with the teeth of the opposite dental arch. The resulting imbalance in chewing force distribution can cause further resorption of the edentulous ridges.

Mental Nerve Pain

Severe atrophy (shrinkage of) the lower jawbone following loss of the teeth and long-term denture wear can lead to problems stabilizing a denture, and extreme pain on biting. The pain is caused by direct pressure to the mental nerves, which are no longer encased in tooth-bearing bone. The following case illustrates what may be the only viable option for stabilizing the denture and eliminating the pain:

Panoramic X-ray shows radiographic markers to measure distortion in implant planning

Figure 7: The right mental nerve foramen (see arrow). This is where the mental nerve exits the lower jaw and goes into the lip to give it sensation. Normally, the foramen is situated on the side of the jaw, with the tooth and plenty of tooth supporting ("alveolar") bone situated above it. With the loss of the teeth and subsequent resorption of the bone, the nerve now emerges from the top of the bony ridge, where a denture can place pressure on it and cause severe pain or numbness. Also, note how delicate the atrophic mandible has become. Patients like this are at increased risk for jawbone fractures.

Dental implants in atrophic mandible to attach overdenture to relieve mental nerve pain

Figure 8: For the patient from the previous radiograph, four implants were placed in an area where sufficient bone remains. A removable denture can be held in place with as few as two implants. A gold bar (Figure 7) was then fabricated that attaches to the implants and extends out over the mental nerve area. The denture snaps onto the gold bar, giving it excellent stability and retention. All biting forces are directed away from the mental nerve, with some of the forces going into the implants and the jawbone, and the balance of the force being distributed over the toughened gum tissues in the molar regions.

Gold bar attached to dental implants will support lower overdenture replacement teeth

Figure 9: Gold bar attached with screws to the four implants shown in the previous radiograph. The white "female" attachment snaps are shown snapped onto the gold bar. These will be housed in the patient's denture (Figure 8). The lack of teeth and retraction of the tongue makes it difficult to appreciate where in the mouth this photograph was taken—the implants are located in the front part of the patient's lower jaw bone just behind her chin and lower lip.

Precision attachments for holding lower denture to implant supported gold bar

Figure 10: Snaps shown housed in the patient's denture.

An implant-supported lower overdenture seated on a cast gold bar

Figure 11: The denture is shown snapped onto the gold bar. Any bite stresses are now transferred safely away from the patient's mental nerve, and the lack of a bony ridge on which to set the denture is no longer a problem for retention of the denture. If you are a denture wearer, and suffer from pain in your lower canine areas when you bite, or simply cannot keep your lower denture stable, ask your dentist if dental implants might solve your problem.
Learn more: Glossary › Mental nerve

Additional information

Variations

Many variations of removable dentures are possible, combining different clasp designs and other features, limited only by the imagination of the patient and dentist. One variation is the "Flipper". Normally "flippers" replace only one to a few teeth, (usually front, or "anterior" teeth). Although they can be quite esthetically pleasing, it can be difficult to eat with them in place, and they are generally not built on a rigid metal framework, so their strength and durability is limited. Frequently, "flippers" are used as a transitional step, such as to temporarily replace a missing tooth when a dental implant is to be placed in the position of the lost tooth. They resemble an orthodontic retainer, with one or more teeth added. If their limitations are understood, they can be used successfully as a longer term solution.

Essix appliance

This type of removable partial denture is intended to be temporary. Normally used for front teeth, the Essix appliance offers several advantages over the "flipper". First, it is entirely tooth supported, with no soft tissue coverage. Second, they generally don't break but they rapidly become stained, and may feel "flimsy". Essix appliances consist of thin, pliable clear vinyl shells which are worn over the remaining natural teeth. They are formed over a stone cast of the patient's teeth, using a vacuum former. If the cast is missing the tooth to be replaced, a denture tooth can be substituted.

More commonly, the dentist will sculpt a tooth from composite resin filling material directly on the cast before forming the vinyl shell. The missing tooth is incorporated into the plastic shell. The patient wears the Essix appliance like a bleach tray, and (for best longevity) removes it to eat. The vinyl shell is necessarily soft and flexible so that the appliance can be inserted and removed easily; however, it lacks the durability to be functional long-term.
Learn more: Glossary › Essix appliance

Immediate dentures

Frequently, patients with advanced periodontal disease or extensive dental caries are aware they will lose their teeth, and can plan for the event. Immediate dentures involve removal ("extraction") of the remaining back teeth well in advance of the front teeth. Usually about three months of time is allowed to elapse for the extraction sites to heal, and for the bony edentulous ridge contours to stabilize before beginning denture procedures. All dental records (establishment of the correct vertical separation of the jaws, etc.) except for the wax try-in can be obtained without removing the front teeth.

The denture is then delivered on the day the front teeth are removed, such that the patient never has to go without teeth (the major advantage of immediate dentures). Without the opportunity to visualize the denture in the mouth (i.e "wax try-in"), there can be disappointment in the appearance of an immediate denture on delivery. Most often however, the improved appearance over the patient's unsalvageable natural teeth is so dramatic that there is seldom disappointment.

The main disadvantage of immediate dentures is that they need to be relined or rebased within a few months of removing the front teeth, because the ultimate shape of the edentulous ridge where those teeth were housed cannot be predicted ahead of time. Your dentist may or may not include the price of the reline / rebase procedure in his/her fee for the immediate denture, so be sure you understand the billing policy in advance.