There are two types of
appliances: conventional and immediate.
conventional appliance is made and placed in the patientís
mouth after the remaining teeth are removed and tissues have
healed. It is a process that can take several months. An immediate
appliance, on the other hand, is inserted as soon as the remaining
teeth are removed. With an immediate appliance, the patient
does not have to be without teeth during the healing period.
An immediate appliance may require basing or relining to fit
properly during the healing period (6-8 weeks) due to bone and
gum shrinkage. After the healing period, a conventional appliance
is then made.
Fabricating a Complete Denture
are many factors involved when designing this type of appliance
and if one factor is overlooked, it can lead to failure of the case.
In many instances, the appliance should fit comfortably soon after
being inserted. One of the most critical aspects of the process
is that the impression must be perfect and with a flawless technique,
used to make a model of the patient's gums. The dentist must use
a process called border molding to insure that the denture edges
do not hit aggressively into the edges of the mouth. An endless
array of never-ending problems with this appliance may occur if
the final impression is not properly made. Designing it takes a
considerable amount of patience.
full upper appliance is usually easier to design so that it is stable
without slippage. The lower appliance tends to be more difficult
because there is no "suction" holding it in place. For this reason,
most dentists have come to strongly recommend that a lower denture
be supported by 2-4 implants placed in the lower jaw for support.
This is a far superior product than a lower appliance without implants
that is held in place with weak lower mouth muscles. The ability
to bite into an apple or corn-on-the-cob with a lower appliance
anchored by implants is possible. The ability to bite into this
same apple or corn on the cob with a lower appliance that is not
supported with implants, is a difficult, if not impossible task
patients, believing full denture appliances are in their best interest,
extract all of their teeth and have the appliance inserted. Yet,
statistics show that the majority of patients who received the appliance
in this manner come to regret their decision. They come to find
that there is a decrease in their chewing ability (full dentures
have only 10% of the chewing power of natural teeth) and they experience
difficulty with the appliance sitting properly. They do not realize
that while a full upper tends to be very stable, the lower appliance
needs as much help from the natural teeth as possible for stability
to be successful. If one tooth is retained on the lower area of
the mouth, that tooth can contribute to the appliance's stability.
It is advised that patients keep their natural teeth as long as
possible, especially the lower teeth.
new appliance may feel awkward for a few weeks after they are inserted.
They may feel loose while the muscles of the cheek and tongue learn
to keep them in place. It is also not unusual to experience minor
irritation or soreness. You may find that your saliva flow also
increases. As the mouth becomes accustomed to the appliance, these
problems should diminish. One or more follow-up appointments with
the dentist are generally needed after an insertion.
takes practice with a newly inserted appliance. It is advised that
patients begin with soft foods cut into small pieces, chewing slowly
using both sides of your mouth at the same time to prevent the appliance
from tipping. As you become accustomed to chewing, you can add other
foods until you return to your normal diet, being very cautious
with hot or hard foods and sharp edged bones or shells. Continue
to chew food using both sides of the mouth at the same time.
certain words may require practice. Reading out loud and repeating
troublesome words will help. If your appliance "clicks" while you
talk, try to speak more slowly. It may occasionally slip when you
laugh, cough or smile. Reposition the by gently biting down and
swallowing. If any of these problems persist, consult your dentist
for further help.
We will provide instructions about how long the appliances should
be kept in place. During the first few days, you may be advised
to wear them most of the time, including while you sleep. After
the initial adjustment period, you may be instructed to remove them
before going to bed. This allows gum tissues to rest and promotes
oral health. Generally, the gum tissues should not be constantly
covered by the appliance.
with Complete Dentures
of the problems associated with removable appliances include an
overproduction of saliva, sore spots, gagging, gingivitis and movement.
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. Patients must become
accustomed to having an appliance inside their mouth that is not
Newly installed appliances
may cause sore spots in many individuals as they tend to rub and
press on the mucus membranes of the mouth. Subsequent adjustments
for the weeks following their insertion should take care of this
Gagging is another issue
encountered by some patients. The cause of this may be due to a
loose fitting or to a appliance that is too thick or not extended
far enough back on the palate. Some suggest that at times, the gagging
may be attributed to some sort of psychological denial of the appliance.
And since the psychosis is difficult to treat by the dentist, as
it is beyond the scope of their expertise, both a psychologist referral
or an implant supported palate less may be offered as alternative
to helping a patient.
Gingivitis can develop
underneath the appliance, a result of accumulating dental plaque.
Gingivitis can involve gum inflammation and mouth sores. The condition
is generally reversible. Denture wearers are advised to clean the
thoroughly. The removal of plaque and calculus is usually not painful,
and the inflammation of the gums should be gone between one and
two weeks. A dentist or dental hygienist can also perform a thorough
cleaning of the teeth and gums areas of the mouth. Following a professional
service, patients must be persistent with their oral hygiene care.
Oral hygiene including proper brushing and flossing is required
to prevent the recurrence of gingivitis. Anti-bacterial rinses or
mouthwash may reduce the swelling and local mouth gels which are
usually antiseptic and anesthetic can also help with the problems
associated with gingivitis.
Movement: Support, Stability
Some patients experience problems
with keeping their appliances in place. There are three rules which
dictate the existence of removable oral appliances: support,
stability and retention.
Support describes how well
the underlying oral tissues keeps the appliance from moving. Recently,
dentists have been looking to increase the stability of this appliance
by using implants. After many years of wearing dentures, the ridges
upon which the appliance rests deteriorates and can easily all but
disappear. The insertion of implants into the bone below the appliance
can help to keep it from occurring. The implants are strategically
placed to bear the brunt of the pressure when the appliance is used
for chewing, keeping the bone from melting away. When implants are
integrated into treatment, the appliance is now referred to as being
an implant supported overdenture and the implants are referred to
as overdenture abutments.
Stability describes how well
the appliance base is prevented from sliding side to side
or front and back. The more the base runs in smooth and continuous
contact with the ridge area upon which the teeth used to reside,
the better the stability.
Retention describes how well
the appliance is prevented from moving in the opposite direction
of insertion. The better the inside surface of the base to the surface
of the underlying mucus membranes, the better the retention will
be. The most critical element in the retentive design of a full
upper appliance is a complete and total border seal in order to
Dentures and Implants
has been an increase in dental practitioners incorporating the use
of full dentures with implants. The use of implants when designing
a full denture appliance has increasingly shown to improve a patient's
denture wearing experience by increasing its stability, as well
as saving the patient's bone from wearing away. Implants used with
full appliances has also been shown to help with appliance retention.
fabrication of a complete denture appliance is a challenge for any
dentist, including those who are experienced. At least two follow
up visits for an adjustment to remove sore spots will also be necessary.
The upper appliance is fabricated to work in harmony with the lower
appliance. If the only variables in the equation are the patient's
ridges and two full appliances, the dentist sets the teeth to help
prevent dislodgement during opening, closing and swallowing. But
once food enters into the picture, the stability of the appliances
can be disrupted. During chewing, the appliance bases will sometimes
move. In a perfect world, a patient with a perfect edentulous ridge
with a perfectly fitting appliance would require no adhesive, as
the actual form of the appliance base should work without moving
in any way, shape or form. But alas, this is not a perfect world.
Therefore, an adhesive is recommended as a way to provide additional
retention for well-fitting appliances.
adhesive products should not be used for old, ill-fitting dentures.
A poorly fitting appliance can cause constant irritation over a
long period of time, and contribute to the development of sores.
The appliance may need to be relined or replaced. If, at any point,
your dentures begin to feel loose, or cause pronounced discomfort,
contact your dentist for a consultation.
time, dentures will need to be relined, rebased, or remade due to
normal wear. To reline or rebase the appliance, the dentist uses
the existing teeth on the denture and refits or makes a new base.
The appliances may need to be replaced if they become loose and
the teeth show signs of significant wear. This usually occurs as
a natural progression of aging. Bone and gum ridges can recede or
shrink, causing jaws to align differently. Shrinking ridges causes
dentures to fit less securely, making chewing more difficult and
changing facial features. Loose appliances can also contribute to
sores and infections. Therefore, it is important to replace worn
or poorly-fitting appliances before they cause serious health problems.