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14-September-2008 18:38:48 - Dentures Redirected from Denture This article may require cleanup to meet 's quality standards. Please improve this article if you can. August 2007 A maxillary denture. A maxillary denture. Occlusal view of the same maxillary denture. Occlusal view of the same maxillary denture. Dentures are prosthetic devices constructed to replace missing teeth, and which are supported by surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable, however there are many different denture designs, some which rely on bonding or clipping onto teeth or dental implants. There are two main categories of dentures, depending on whether they are used to replace missing teeth on the mandibular arch or the maxillary arch. There are many informal names for dentures such as dental plate, false teeth and falsies. Contents 1 Causes of tooth loss 2 Advantages 3 Types of dentures 3.1 Removable partial dentures 3.2 Complete dentures 4 History 5 Problems with complete dentures 6 Prosthodontic principles of dentures 6.1 Support 6.2 Stability 6.3 Retention 6.4 Complications and recommendations 7 Conclusion 8 See also 9 External links 10 References Causes of tooth loss Patients can become entirely edentulous without teeth due to many reasons, the most prevalent being removal because of dental disease typically relating to oral flora control ie:periodontal disease and tooth decay. Other reasons include tooth developmental defects caused by severe malnutrition, genetic defects such as Dentinogenesis imperfecta, trauma, or drug use. Advantages Dentures can help patients in terms of: 1. Masticatory - improving chewing ability by replacing the edentulous area with acrylic teeth. Thus enable better mastication and pleasure to enjoy food. 2. Aesthetic - providing the visual appearance of having natural teeth, providing support for their lips and cheeks, and correcting the collapsed appearance commonly seen between the nose and the chin. 3. Phonetic - Replacing the toothless area, especially the anteriors, to help patients to speak and pronounce certain words properly without air escapes. Types of dentures Removable partial dentures Removable partial dentures are for patients who are missing some of their teeth on a particular arch. Fixed partial dentures, better known as crown and bridge, are made from crowns that are fitted on the remaining teeth to act as abutments and pontics made from materials to resemble the missing teeth. Fixed bridges are more expensive than removable appliances but are more stable. Complete dentures Conversely, complete dentures or full dentures are worn by patients who are missing all their teeth in an arch i.e the maxillaryupper or mandibularlower arch. History Around 700BC, Etruscans, in northern Italy, made dentures out of human or other animal teeth. These deteriorated quickly but, being easy to produce, were popular until mid 19th century1 The first European sets of dentures date from the 15th century and most probably existed before that time. They were carved from bone or ivory, or made up of teeth sourced from graveyards, the recent dead or living donors who exchanged their teeth for profit. These dentures were uncomfortable, attached visibly to a base supported by any remaining teeth with a thread of metal or silk. The false teeth were often made with ivory from the hippopotamus or walrus, and usually rotted after extended use.citation needed London's Peter de la Roche is believed to be one of the first 'Operators for the Teeth', men who fashioned themselves as specialists in dental work. Often these men were professional goldsmiths, ivory turners or students of barber-surgeons.2 The first porcelain dentures were made around 1770 by Alexis Duchâteau. In 1791 the first British patent was granted to Nicholas Dubois De Chemant, previously assistant to Duchateau, for De Chemant's Specification, a composition for the purpose of making of artificial teeth either single double or in rows or in complete sets and also springs for fastening or affixing the same in a more easy and effectual manner than any hitherto discovered which said teeth may be made of any shade or colour, which they will retain for any length of time and will consequently more perfectly resemble the natural teeth. He began selling his wares in 1792 with most of his porcelain paste supplied by Wedgwood.citation needed Single teeth in porcelain were made since 1808. In London in 1820, Claudius Ash, a goldsmith by trade, began manufacturing high-quality porcelain dentures mounted on 18-carat gold plates. Later dentures were made of rubber vulcanite Claudius Ash's company was the leading European manufacturer of the dental vulcanite into which porcelain teeth were set, and then, in the 20th century, acrylic resin and other plastics.3 In Britain in 1968 79% of those aged 65-74 had no natural teeth, by 1998 this proportion had fallen to 36%.citation needed Problems with complete dentures This section does not cite any references or sources. Please help improve this section by adding citations to reliable sources. December 2007 Problems with dentures include the fact that patients are not used to having something in their mouth that is not food. The brain senses this appliance as food and sends messages to the salivary glands to produce more saliva and to secrete it at a higher rate. New dentures will also be the inevitable cause of sore spots as they rub and press on the mucosa denture bearing soft tissue. A few denture adjustments for the weeks following insertion of the dentures can take care of this issue. Gagging is another problem encountered by some patients. At times, this may be due to a denture that is too loose fitting, too thick or extended too far posteriorly onto the soft palate. At times, gagging may also be attributed to psychological denial of the denture. Psychological gagging is the most difficult to treat since it is out of the dentist's control. In such cases, an implant supported palateless denture may have to be constructed or a hypnotist may need to be consulted. Sometimes there could be a gingivitis under the full dentures, which is caused by accumulation of dental plaque. Another problem with dentures is keeping them in place. There are three rules governing the existence of removable oral appliances: support, stability and retention. Prosthodontic principles of dentures Support Support is the principle that describes how well the underlying mucosa oral tissues, including gums and the vestibules keeps the denture from moving vertically towards the arch in question, and thus being excessively depressed and moving deeper into the arch. For the mandibular arch, this function is provided by the gingiva gums and the buccal shelf region extending laterally beside from the posterior back ridges, whereas in the maxillary arch, the palate joins in to help support the denture. The larger the denture flanges part of the denture that extends into the vestibule, the better the support. More recently, there has been a move to increase denture stability with implants. When pressure is applied to alveolar bone bereft of teeth alveolar bone is the bone in which teeth normally reside, the bone reacts to this pressure by resorbing. After many years of denture wearing, the ridges upon which the dentures rest deteriorate and can easily all but disappear. The insertion of implants into the bone below the dentures can help to seriously combat this unfortunate occurrence. The implants are strategically placed to bear the brunt of the pressure when the denture is used for chewing, keeping the bone from melting away. When implants are integrated into treatment, the denture is now referred to as being an implant supported overdenture and the implants are referred to as overdenture abutments. Stability Stability is the principle that describes how well the denture base is prevented from moving in the horizontal plane, and thus from sliding side to side or front and back. The more the denture base pink material runs in smooth and continuous contact with the edentulous ridge the hill upon which the teeth used to reside, but now consists of only residual alveolar bone with overlying mucosa, the better the stability. Of course, the higher and broader the ridge, the better the stability will be, but this is usually just a result of patient anatomy, barring surgical intervention bone grafts, etc.. Retention Retention is the principle that describes how well the denture is prevented from moving vertically in the opposite direction of insertion. The better the topographical mimicry of the intaglio interior surface of the denture base to the surface of the underlying mucosa, the better the retention will be in removable partial dentures, the clasps are a major provider of retention, as surface tension, suction and just plain old friction will aid in keeping the denture base from breaking intimate contact with the mucosal surface. It is important to note that the most critical element in the retentive design of a full maxillary denture is a complete and total border seal complete peripheral seal in order to achieve 'suction'. The border seal is composed of the edges of the anterior and lateral aspects AND the posterior palatal seal. The posterior palatal seal design is accomplished by covering the entire hard palate and extending not beyond the soft palate and ending 1-2mm from the vibrating line. As mentioned above, implant technology can vastly improve the patient's denture-wearing experience by increasing stability and saving his or her bone from wearing away. Implant can also help with the retention factor. Instead of merely placing the implants to serve as blocking mechanism against the denture pushing on the alveolar bone, small retentive appliances can be attached to the implants that can then snap into a modified denture base to allow for tremendously increased retention. Options available include a metal Hader bar or precision balls attachments, among other things. Complications and recommendations The fabrication of a set of complete dentures is a challenge for any denturist, including those who are experienced. There are many axioms in the production of dentures that must be understood, of which ignorance of one axiom can lead to failure of the denture case. In the vast majority of cases, complete dentures should be comfortable soon after insertion, although almost always at least two adjustment visits will be necessary to remove sore spots. One of the most critical aspects of dentures is that the impression of the denture must be perfectly made and used with perfect technique to make a model of the patient's edentulous toothless gums. The denturist must use a process called border molding to ensure that the denture flanges are properly extended. An endless array of never-ending problems with denture may occur if the final impression of the denture is not made properly. It takes considerable patience and experience for a denturist to know how to make a denture, and for this reason it may be in the patient's best interest to seek a specialist, either a Denturist or a Prosthodontist, to make the denture. A general dentist may do a good job, but only if he or she is meticulous and usually he or she must be experienced. The maxillary denture the top denture is usually relatively straightforward to manufacture so that it is stable without slippage. The lower full denture tends to be the most difficult because there is no suction holding it in place. For this reason, dentists in the late 1990s have come to a general conclusion that a lower full denture should or must be supported by 2-4 implants placed in the lower jaw for support. A lower denture supported by 2-4 implants is a far superior product than a lower denture without implants, held in place with weak lower mouth muscles. It is routine to be able to bite into an apple or corn-on-the-cob with a lower denture anchored by implants. Without implants, it is quite difficult or even impossible to do so. Some patients who believe they have bad teeth may think it is in their best interests to have all their teeth extracted and full dentures placed. However, statistics show that the majority of patients who actually receive this treatment wind up regretting they did so. This is because full dentures have only 10% of the chewing power of natural teeth, and it is difficult to get them fitted satisfactorily, particularly in the mandibular arch. Even if a patient retains one tooth, that will contribute to the denture's stability. However, retention of just one or two teeth in the upper jaw does not contribute much to the overall stability of a denture, since a full upper denture tends to be very stable, in contrast to a full lower denture. It is thus advised that patients keep their natural teeth as long as possible, especially their lower teeth. Conclusion As can be expected with any removable appliance placed in the mouth, there will be some problems in respect to the three principles mentioned above with dentures no matter how well they are made. This is because the best the denturist can do is fabricate the upper denture to work in harmony with the lower denture when the patient is at rest. If the only variables in the equation are the patient's edentulous ridges and the two dentures, the denturist can set the teeth in certain ways to help prevent dislodgement during opening, closing and swallowing. Once food enters into the picture, though, the stability of the denture bases is not impervious to disruption. During chewing, the denture bases will sometimes act as class 1 levers, and when the patient bites down on the anterior, or front, teeth, the posterior, or rear, teeth are bound to move away from the ridge. Although the ideals of denture design will have it that the intaglio surface is in perfect, intimate contact with the ridge and the margins of the denture base will create a perfect suction seal the seal is actually only on the maxillary denture, ideals are rarely if ever met in this imperfect world, and thus some movement is to be expected. Denture adhesive can then be utilized to compete against the forces trying to pull the denture base away from the mucosa. In a perfect world, a patient with a perfect edentulous ridge with a perfectly fitting denture would require no adhesive, as the actual form of the denture base should work in tandem with the three principles mentioned above, thus precluding movement in any way, shape or form. See also Dental implant in Dental Implantology Dental crown Dental bridge Gingivitis Dental lab External links Dentures - Information, Resources and Forums Dentures Frequantly Asked Questions Answers Dentures Quest - Personal Experience, Questions and Answers References ^ The inventions that changed the world, Reader's Digest 1982 Portuguese ion of 1983 ^ John Woodforde, The Strange Story of False Teeth, London: Routledge Kegan Paul, 1968 ^ S. E. Eden, W. J. S. Kerr and J. Brown, A clinical trial of light cure acrylic resin for orthodontic use, Journal of Orthodontics, Vol. 29, No. 1, 51-55, March 2002 December 2007 v d e Prosthodontology Fixed Prosthodontic Restorations Bridge - Crown - Inlays and onlays - Post and core - Veneer - Resin retained bridge Removable Prosthodontic Restorations Complete dentures - Flipper - Removable partial dentures Prosthodontic considerations Biologic width - Centric relation - Crown-to-root ratio - Maximum intercuspation - Mutually protected occlusion - Occlusion - Vertical dimension of occlusion Maxillofacial Prosthodontics Ocular prosthesis - Craniofacial prosthesis Other specialties See also Endodontology - Orthodontology - Periodontology Dental implant - Cosmetic dentistry - Dental lab Retrieved from http://en..org/wiki/Dentures Categories: Restorative dentistry | ProsthodontologyHidden categories: Cleanup from August 2007 | All pages needing cleanup | All articles with statements | Articles with statements since February 2007 | Articles needing additional references from December 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Bahasa Indonesia Italiano Magyar Nederlands 日本語 Polski Português Suomi Svenska Ślůnski This page was last modified on 27 August 2008, at 19:03
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