Removable Dentures

Dental procedure
Overview

Removable dentures (sometimes referred to as false teeth or plates) are a common treatment alternative for missing teeth (edentulism). Removable dentures 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.

Four views of a set of removable complete dentures.

Figure 1: Different views of a removable complete denture.

Figure 1 shows different views of a complete removable 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 patients with no teeth (completely edentulous). This provides the best chewing efficiency and esthetics.

A completely edentulous upper jaw (maxilla).

Figure 2: Complete tooth loss (edentulism) of the upper jaw (maxilla) requiring a removable complete denture.

Complete removable dentures are an option for the completely edentulous patient, while partial removable dentures (partials) are an option for the partially edentulous. Partial removable 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, like bridges or dental implants—both of which are usually good solutions for the replacement of single teeth as well.

Dental implant supported lower overdenture and traditional removable complete upper.

Figure 3: The removable 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.

Complete removable 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 removable dentures can be a challenge, as with any prosthetic device. Dental implants can also be used to help stabilize dentures, and often significantly improve a patient’s quality of life.

A partial removable denture for the lower jaw.

Figure 4: A swinglock partial removable denture is one option for tooth loss (edentulism). This one is for the lower jaw.

Figure 4 shows a partial removable 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 materials can be used.

The process

Before the removable dentures are made

Although not an invasive procedure itself, having removable dentures made may require other procedures to be performed. Some are considered to be part of the denture fabrication process. Others are separate billable procedures from the denture (for example, preliminary surgery, dental implants, etc.). It’s important to understand any costs involved before undertaking treatment. Your dentist can provide a detailed list of the procedures he/she recommends. Some of the related procedures may be surgical, and require the use of local anesthetic.

For any before-dentures (pre-prosthetic) procedures which are surgical, the dentist will review your health history. If you have replacement joints (for example, total knee replacement, hip replacement, etc.), you may be pre-medicated with antibiotics for the procedure. If you have certain types of heart murmurs or replacement heart valves, you may also need to take an antibiotic pre-medication prior to the procedure.

If you are anxious about dental procedures, your dentist may recommend sedating you for the procedure. There are several methods of relaxing patients for dental treatment, including oral anti-anxiety pills like Valium®; inhaled anti-anxiety medication like nitrous oxide; and intravenous anti-anxiety medication, such as Versed®. Your dental plan may not pay benefits toward sedation.

With a wide degree of variation, the following paragraphs summarize the steps involved in having dentures made. Your procedure may vary from these steps, depending on your individual needs.

Step 1: The diagnostic records appointment

In order to produce a good treatment plan, diagnostic information must be gathered. When dentures are an option, the dentist will often expose a panoramic radiograph or cone beam (CBCT) scan to visualize the amount of remaining bone that is present on which to support the dentures. Periapical radiographs may be exposed of any abutment teeth to evaluate their structural worthiness for anchoring partial dentures. Bitewing radiographs may be exposed to rule out tooth decay.

Close attention is paid to the location of the mental nerves in the lower jaw (mandible), because it can be very painful to wear dentures that place pressure on or near these nerves (one per side). The radiographs are also studied for signs of disease process (for example, cysts, tumors, etc.). An evaluation is made of the shape of the palate and oropharynx. Preliminary impressions of the edentulous arches are made and poured in dental stone to produce cast replicas of the teeth and edentulous arches.

A facebow indexes teeth of maxilla for accurate dental study model positioning in articulator.

Figure 5: A facebow is used to transfer the location of the patient’s upper teeth (relative to their jaw joint) to an articulator, a jaw simulation device.

An interocclusal bite record is produced that indexes how the upper and lower jaws are positioned relative to one another. A measuring device called a facebow (Figure 5) is sometimes used to determine the relative positions of the upper jaw (maxilla) and the jaw joints. This device is used to accurately mount the plaster cast replicas of the dental arches in a jaw simulation tool called an articulator (Figure 6).

Articulator (dental jaw simulation tool).

Figure 6: A semi-adjustable articulator allows the envelope of motion of the jaws to be closely simulated. Fully adjustable articulators allow even more refinement in simulating a patient’s jaw movements.

These preliminary study casts can help to determine whether preliminary surgical procedures will be required, where alterations to the remaining teeth may need to be made, whether and where dental implants may be recommended, and a variety of other treatment-planning information. They are also used to make custom impression trays for the final impressions, which need to be very accurate.

Step 2: The second appointment for removable dentures

The second appointment covers custom tray impressions, rest preparations, guide planes, and tooth selection.

If either of the dentures is a partial denture, rest preparations and guide planes may need to be milled into the abutment teeth (the ones that anchor the partial).

Generally the rest preparations are made after using the study casts to plan where they should go. Denture tooth shade and shape will be determined. A procedure called border molding may be completed. Basically, this involves determining how far to extend the denture for maximum retention, and to provide correct support for the lips and cheeks (how far it should extend, and how bulky it should be). A final impression of the jaws will be made using custom trays made from the preliminary impressions at the first appointment.

Step 3: Wax try-in / Frame try-in

A wax version of the removable dentures will be tried in the patient’s mouth (the teeth are set in rigid pink wax). The tooth position, bite plane location (where the upper and lower denture teeth will contact), phonetics and appearance will be evaluated while it’s still possible to move the teeth and re-shape the bite plane. If the denture is a partial, its supporting framework is evaluated for passive fit (to be sure it’s not putting pressure on teeth); retentiveness (to see whether the clasps will hold it in place effectively); and function with the opposing teeth (to be sure the patient won’t be biting down on the metal framework).

When everything is adjusted properly, the denture will be returned to the laboratory for processing in acrylic. If the patient is completely edentulous, Step 3 may require two appointments—one to establish the proper facial contours and vertical separation of the jaws, and one for the wax try-in.

Step 4: The delivery of removable dentures

On the date of delivery, the denture will be placed in the mouth, and the bite will be adjusted. Pressure spots will be eliminated and specific instructions given on the wear and care of the removable denture(s). Frequently, your dentist will recommend a 24-hour follow-up to inspect the dentures and oral tissues. Multiple follow up appointments are commonly necessary over several months time.

Advantages and benefits
  • Excellent cosmetic results can be obtained with dentures.
  • Dentures are a cost-effective way to replace numerous teeth.
  • Having teeth to clasp makes removable partial dentures much more stable and retentive than removable complete dentures.
  • Being able to remove a denture allows better access for oral hygiene, and allows the tissue under the denture to rest. Dentures are easier to clean than fixed bridgework, which is not removable by the patient.
  • Chewing efficiency with a partial denture can approach that of natural teeth, allowing for proper nutrition.
  • Chewing efficiency with complete dentures, although significantly compromised from that of natural teeth, is far better than that of the untreated edentulous patient.
  • Replacing missing teeth with a partial denture can help to avoid problems associated with teeth shifting and loss of vertical dimension of occlusion (bite collapse), a condition in which the lower jaw rotates further closed than normal following the loss of multiple back teeth.
  • Dentures can be used to restore proper facial contours, eliminating the sunken cheeks and "purse-string" wrinkles commonly seen around the mouths of edentulous patients.
Disadvantages and risks
A dental implant with a standard ball abutment.

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

Frequent adjustments to the bite, the denture framework, clasps, or relines of the tissue bearing surface of the denture may become necessary.

Improperly adjusted removable partial dentures can apply leverage to the remaining teeth, which can damage or break them. Even well-adjusted partial dentures can apply leverage through chewing that can loosen or damage the abutment teeth.

Food can lodge under the denture, requiring frequent removal for cleaning.

Retention clasps can break or bend, requiring repairs/adjustments.

A removable complete denture attached to two dental implants.

A removable complete denture (1) can be stabilized completely by attaching it to the abutments (2) of as few as two dental implants, although four implants may provide better stability and long term protection against bone shrinkage (resorption).

Some individuals have an especially difficult time adapting to removable complete dentures. With complete dentures, chewing efficiency is greatly reduced compared to natural teeth. Depending on how much bone remains following removal of the teeth, even dentures that fit the jaws well may be difficult to keep in position.

Dentures apply pressure to the underlying soft tissues and bone, which may shrink (resorb) over time. This can make the denture fit poorly, and may make future dental procedures more difficult.

Other care that may be needed
Metal partial denture framework extends under replacement teeth to reinforce the base.

This photograph shows a stone cast of the patient’s teeth, being used to make a metal framework. The framework will form the structural backbone of a removable partial denture for the patient’s lower dental arch (mandible). The pink acrylic base and denture teeth have not been added yet. Metal rests engage rest preps that have been milled into the teeth (see arrows). The teeth on the ends (abutments), which anchor and support the denture, have had their bulbous contours flattened on the side facing backward (toward the top of the photograph) to allow intimate adaptation of the metal framework to those teeth. These adjustments are called guide planes.
If the anchor teeth (abutments) are too heavily restored with fillings, or are otherwise structurally compromised, your dentist may recommend that they be protected with crowns prior to making the framework. The crowns can be made with rest seats and guide planes built in, and are thus referred to as survey crowns by dentists. These additional characteristics may add to the laboratory cost of making the crown(s). Once the framework has been checked for passive fit in the patient’s mouth, the denture teeth can be added. It is critical that the framework fit passively so that no leverage is placed on the abutment teeth.

Alveoloplasty

Recontouring of the alveolar bone around tooth extraction sites can be performed when the teeth have already been removed, and healing of the extraction sites has already taken place. It can also be done at the time of tooth removal (extraction). Alveolar bone is bone that formerly housed the tooth roots. The procedure is typically prescribed to eliminate undercuts, and any surface irregularities in the bone that would lead to problems wearing a removable denture. It is also done to level the edentulous ridge prior to placement of dental implants. Alveoloplasty is generally considered a separate billable procedure from the denture, and generally adds to the cost of having dentures made.

Vestibuloplasty

This procedure is prescribed when the edentulous ridges are too short to allow adequate extension of the denture flanges (the part that fills out the cheeks and lips) for good denture stability and proper facial contours. Vestibuloplasty is a surgical procedure in which the point of attachment from the lips/cheeks to the gums that cover the edentulous ridge is moved to allow longer, more retentive denture flanges. Vestibuloplasty is considered a separate billable procedure from the denture(s), and can add considerably to the overall cost of having dentures made.

Bone grafting

Bone grafting is a surgical method of adding bone volume in areas where it is deficient. Bone grafting isn’t a typical preparatory procedure for dentures, unless the denture(s) will be stabilized by dental implants, and there isn’t enough bone present to place dental implants into. Bone grafting is considered a separate billable procedure from the denture(s), and does add to the overall cost of having dentures made.

Dental implants

Your dentist may recommend stabilizing your denture(s) with one or more dental implants. Essentially, these consist of titanium screws placed into the jaw bone to which denture retaining anchors can be attached. Dental implants are separate billable procedures from the denture(s), and typically add considerably to the overall cost of having dentures made. Moreover, the attachment fittings that connect the denture to the implants are usually billed separately, so to avoid billing surprises, discuss these costs with your dentist.

Even with the additional cost, most people who elect to have dental implants placed to stabilize their dentures express great satisfaction—especially those who have struggled to adapt to loose-fitting or poorly adjusted dentures.

In the case of partial dentures, the contours of the abutment teeth are nearly always modified to allow the partial denture framework to nest snugly on the teeth. The following modifications are the most frequently performed, and they are not considered separate, billable procedures in addition to making the denture(s):

Rest preparations

Using a dental handpiece, shallow divots (rest preps) are milled into the biting surface enamel of the teeth onto which metal rests from the denture’s framework will nest. Normally this is not a painful procedure, and no anesthetic needs to be used. Insetting the rests prevents the patient from biting on the framework with the opposing teeth, and allows chewing forces on the denture to be transferred to the teeth instead of being applied to the soft tissues and underlying bone, which will cause those tissues to shrink (resorb) over time).

Guide planes

The bulbous contours of the abutment teeth are flattened to allow a more intimate adaptation of the partial’s framework to the teeth, and establish a plane for the insertion and removal of the denture. This reduces food accumulation between the framework and the abutment teeth.

Other procedures that are related to the denture fabrication process include the following (you may or may not require them, but it’s good to know in advance so that there are no surprise fees):

Local anesthetic

If you require any survey crowns, or surgical procedures to prepare your dental arches for dentures, local anesthetic will most likely be used. It is normally not billed separately from procedures that would normally require it.

Other treatment options

Fixed partial removable dentures (fixed bridges) may be an option if you are missing several teeth, or are expected to lose several. Another option may be dental implants restored with individual crowns, fixed bridges, or removable dentures. Your dentist might suggest other options, or combinations of the options listed.

What if I do nothing?
Biting trauma to the lower jaw.

Complications of tooth loss in edentulous patients include gum (gingival) and bone trauma due to biting forces, here in the lower jaw.

Poor chewing efficiency due to tooth loss (edentulism) leads to improper nutrition and may contribute to poor general health.

Trauma to the edentulous ridges may occur and can alter their shape. In the adjacent photograph, loss of the lower teeth and a failure to replace them led to this unfortunate situation in which molar imprints from the upper teeth can be seen on the lower edentulous ridges. Note how pressure on the edentulous ridges has caused the underlying bone to be pushed aside, widening and shortening the ridges.

The soft tissue trauma was not perceived as a problem to the patient because it did not hurt. Fortunately, this situation was intercepted while the patient still had enough remaining bone to support a lower denture. Surgical recontouring of the bony ridge beneath the soft tissues (alveoloplasty) was required to remove undercuts, and smooth out surface irregularities prior to making the denture.

Not replacing missing teeth causes greater stresses on any natural teeth that may remain. Remaining teeth can move, tip, crack or chip—often leading to loss of vertical dimension of occlusion (bite collapse), and TMJ disorders (jaw joint problems, TMJ Dysfunction, or TMD).

Author: Thomas J. Greany, D.D.S. / Editor: Ken Lambrecht

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This page was last updated on July 6, 2016.

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Links to dental and medical journals

Intended for dentists and dental students, ToothIQ.com links to additional information from over 100 U.S. and international dental and medical journals. Disclaimer: Full-text articles are linked to, when available. Some links lead to content requiring payment. Symbyos is not compensated by the organizations or authors whose articles are linked to. Symbyos is not responsible for the content linked to from ToothIQ.com.

Information you may wish to read before making a decision on treatment

A technique to fabricate a cast metal crown for an existing removable partial denture using an acrylic resin template
Lee, Heeje, DDS and Shirakura, Akihiko, RDT, DDS
The Journal of Prosthetic Dentistry
2007 97 (3): 181-182

The use of endodontically treated teeth as abutments for crowns, fixed partial dentures, or removable partial dentures: A literature review
Goga, Radu, BDS and Purton, David G., MDS, FRACDS
Quintessence International
2007 38 (2): 106-111

Clinical measurement and evaluation of vertical dimension
Toolson, L. Brian, and Smith, Dale E.
The Journal of Prosthetic Dentistry
2006 95 (5): 335-339

Evidence-based considerations for removable prosthodontic and dental implant occlusion: A literature review
Taylor, Thomas D. DDS, MSD, et al.
The Journal of Prosthetic Dentistry
2005 94 (6): 555-560

Occlusion in removable partial prosthodontics
Henderson, Davis, DDS
The Journal of Prosthetic Dentistry
2004 91 (1): 1-5

Physiologic vertical dimension and centric relation
Shanahan, Thomas E. J.
The Journal of Prosthetic Dentistry
2004 91 (3): 206-209

Occlusion-Based Treatment Planning for Complex Dental Restorations: Part 1
Keough, Bernard, DMD, CAGS
The International Journal of Periodontics & Restorative Dentistry
2003 23 (3): 237-247

Occlusion-Based Treatment Planning for Complex Dental Restorations: Part 2
Keough, Bernard, DMD, CAGS
The International Journal of Periodontics & Restorative Dentistry
2003 23 (4): 325-335

Patient Satisfaction with Mandibular Implant Overdentures and Conventional Dentures 6 Months After Delivery
Thomason, J. Mark, BDS, PhD, FDSRCS(Ed), et al.
International Journal of Prosthodontics
2003 16 (5): 467-473

Congenitally missing teeth: Orthodontic management in the adolescent patient
Kokich, Vincent O., DMD, MSD
American Journal of Orthodontics & Dentofacial Orthopedics
2002 121 (6): 594-595

Prosthetic rehabilitation of extremely worn dentitions: Case reports
Cura, Cenk, DDS, PhD, et al.
Quintessence International
2002 33 (3): 225-230

Time to go for the end-game: mandibular 2-implant overdentures for older people (Editorial)
Heath, R.
Gerodontology
2002 19 (1)

Oral Health Impact on Daily Performance in Patients with Implant-Stabilized Overdentures and Patients with Conventional Complete Dentures
Melas, Fotis, DDS, et al.
The International Journal of Oral & Maxillofacial Implants
2001 16 (5)

The speaking method in measuring vertical dimension
Silverman, Meyer M.
The Journal of Prosthetic Dentistry
2001 85 (5): 427-431

Using the neutral zone to obtain maxillomandibular relationship records for complete denture patients
Alfano, Stephen G., DDS, LCDR, USNR and Leupold, Richard J., DDS, CAPT, USN
The Journal of Prosthetic Dentistry
2001 85 (6): 621-623

Integrated Electromyography of the Masseter on Incremental Opening and Closing with Audio Biofeedback: A Study on Mandibular Posture
Gross, MD, et al.
International Journal of Prosthodontics
1999 12 (5): 419-425

Restoration of the Severely Worn Dentition Using a Systematized Approach for a Predictable Prognosis
Stewart
The International Journal of Periodontics & Restorative Dentistry
1998 18 (1): 47-57

Background information

Centric relation: A historical and contemporary orthodontic perspective
Rinchuse, Donald J., DMD, MS, MDS, PhD and Kandasamy, Sanjivan, BDSc, BScDent, DocClinDen, MOrthRCS
The Journal of the American Dental Association
2006 137 (4): 494-501

Contact stomatitis due to palladium in dental alloys: A clinical report
Garau, Valentino, DDS, MS, PhD, et al.
The Journal of Prosthetic Dentistry
2005 93 (4): 318-320

Early prosthetic treatment of patients with ectodermal dysplasia: A clinical report
Tarjan, Ildiko, DMD, PhD, et al.
The Journal of Prosthetic Dentistry
2005 93 (5): 419-424

Evaluation of the sanitization effectiveness of a denture-cleaning product on dentures contaminated with known microbial flora. An in vitro study
Glass, R. Thomas, DDS, PhD, et al.
Quintessence International
2004 35 (3): 194-199

Oral candidiasis
Akpan, A. and Morgan, R.
Postgraduate Medical Journal Online
2002 78: 455-459

Principles of biocompatibility for dental practitioners
Wataha, John C., DMD, PhD
The Journal of Prosthetic Dentistry
2001 86 (2): 203-209

Biocompatibility of dental casting alloys: A review
Wataha, John C., DMD, PhD
The Journal of Prosthetic Dentistry
2000 83 (2): 223-234

Forces and moments on Branemark implants
Rangert, B., et al.
The International Journal of Oral & Maxillofacial Implants
1989 4 (3): 241-248

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