Complete dentures

[ItsGavinC]

Well, today is our first day back at school and we start off our wonderful year with complete dentures. Booooo.

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[UNLV OMS GUNNABE]

Call me crazy but I liked removable pros. I really enjoy setting teeth.

 

[DDSSlave]

Dang, first of Aug. That stinks. We have a couple more weeks. I actually enjoyed complete dentures in preclinic. When clinic starts back up in the fall I'll start my first cd/cd. Just extracted 20+ teeth earlier this summer in preperation. I hope she has a ridge left.

 

[UBTom]

I did several complete denture cases and those I felt were easy... Partial dentures on the other hand (especially those that require crown abutments) can be a PITA because of the additional work required such as surveying and the need for pretty exacting labwork.

I can do CU/CLs all day but I really dread RPDs.

 

[gpg]

.....with UBTom........any no of complete dentures will do....but RPD>....god save me....

Gavin,relax and enjoy what ever you are doing.....try reading each step before you do it.....helps a lot.....if you can read border moulding from a book called Halperin........its described awesome there.......read tray adjustment from Winkler......

I have done 24 complete dentures till now.....18 in school and 6 in private clinic....other than that 2 immediate and 4 over dentures.

 

[aphistis]

Well, today is our first day back at school and we start off our wonderful year with complete dentures. Booooo.

I'm right there with ya, Gavin.

 

[toothcaries]

i HATE CDs..

my #1 least favorite procedure.
...soooo much time spent in lab and with the patient to make that little piece of acrylic.

curious, anyone care to share their complete denture pearls of wisdom?

 

[Energon]

i fcuking hate complete dentures, I will either never make one when I practice or the most i'll do is make impressions and then send it out to a kickass lab, ill take RPD's any time of the day.

 

[DrRob]

I hated dentures and was so confused by partials in dental school but now I find them easy, partial dentures are even easier. Complete dentures would take 6 - 7 appointments in dental school. The best was the 3rd appt - where you would do jaw relations (plane of occlusion, vertical dimension, facebow and Centric relation) and then at the try in stage you would have to take a new CR record and try to find it different. Give me a break. I pretty much do complete dentures the same but have eliminated bordermolding with wax, facebow, anterior tryin (I only do a final try in) and Patient remount. Usually just 3/4 appointments because I still have custom trays made. Although there is an accugel system that comes with there own trays which would cut out a step. Basically I do primary impressions, final impressions, Jaw relations (now only a 10 min appt), tryin and insertion.

 

[DrJeff]

As much as complete dentures can be a royal PITA, especially when you're doing all the lab work yourself, they do force you to learn one of the true fundamentals of this profession, occlussion! Dentures really forces you to get a three dimensional concept of working and balancing side contacts and canine guidance. True, it really can suck when your spending what seems lime days inthe lab setting and resetting and resetting and resetting teeth to get the occlussion perfect, but its that exact concept that will dictate almost everything else we do in dentistry.

BTW, I'm with Dr Rob with how I do dentures in private practice:

Visit 1: Consult, take primary impressions(actually have my assistant take the primaries). This is actually the most important visit IMHO, where you need to lay out the limitations and what expectations your patients can expect with respect to retention, chewing ability, and the likely need for future relines. Total time 20 to 30 minutes (most of me talking). Re appoint patient in 1 week after my lab tech has made custom trays

Visit 2: Final impressions(I take them). I use Impregum (an addition silicone) in a custom tray. Reiterate again the limitations and expectations the patient should have. Total time 15 minutes. Re appoint the patient in 1 week after my lab tech has made record bases and wax rims

Visit 3: Jaw realtions + tooth mould/color selection. Once again reiterate final expectations. Total time 15 minutes. Re appoint the pateint in 1 week after my lab tech has set the teeth.

Visit 4: Wax try in, again reiterate expectations (also remind them to bring their checkbooks next time ). Total time 15 minutes. Re appoint in 1 week for delivery after my lab tech has processed the dentures.

Visit 5: Deliver the dentures Total time 15 minutes Re appoint them for a follow up in 1 to 2 days.

I do alot of explaining of the patients expectations as you can see, this gets the patient to have a realistic view and if and when they can eat a steak or corn on the cobb or an apple without a problem, you look like a hero. I tend to spend alot more time explaining to patients for whom I'm kaing immediate dentures for than for those who are getting their 2nd, 3rd or 4th set of dentures

 

[aphistis]

As much as complete dentures can be a royal PITA, especially when you're doing all the lab work yourself, they do force you to learn one of the true fundamentals of this profession, occlussion! Dentures really forces you to get a three dimensional concept of working and balancing side contacts and canine guidance. True, it really can suck when your spending what seems lime days inthe lab setting and resetting and resetting and resetting teeth to get the occlussion perfect, but its that exact concept that will dictate almost everything else we do in dentistry.

BTW, I'm with Dr Rob with how I do dentures in private practice:

Visit 1: Consult, take primary impressions(actually have my assistant take the primaries). This is actually the most important visit IMHO, where you need to lay out the limitations and what expectations your patients can expect with respect to retention, chewing ability, and the likely need for future relines. Total time 20 to 30 minutes (most of me talking). Re appoint patient in 1 week after my lab tech has made custom trays

Visit 2: Final impressions(I take them). I use Impregum (an addition silicone) in a custom tray. Reiterate again the limitations and expectations the patient should have. Total time 15 minutes. Re appoint the patient in 1 week after my lab tech has made record bases and wax rims

Visit 3: Jaw realtions + tooth mould/color selection. Once again reiterate final expectations. Total time 15 minutes. Re appoint the pateint in 1 week after my lab tech has set the teeth.

Visit 4: Wax try in, again reiterate expectations (also remind them to bring their checkbooks next time ). Total time 15 minutes. Re appoint in 1 week for delivery after my lab tech has processed the dentures.

Visit 5: Deliver the dentures Total time 15 minutes Re appoint them for a follow up in 1 to 2 days.

I do alot of explaining of the patients expectations as you can see, this gets the patient to have a realistic view and if and when they can eat a steak or corn on the cobb or an apple without a problem, you look like a hero. I tend to spend alot more time explaining to patients for whom I'm kaing immediate dentures for than for those who are getting their 2nd, 3rd or 4th set of dentures

Dr. Jeff, do you have an in-house lab, then? How does that compare to sending stuff out to an external facility?

 

[Midoc]

Dr. Jeff, Dr. Rob I'm curious if either of you have ever made complete interim dentures for a patient in real life? We have a rule at school that we don't do any definitive work for patients unless they have been caries free for 12 months. For some reason that I completely don't understand this includes complete dentures as well. I could understand doing immediate interims but other than that I'm at a loss as to why we would do that.

 

[DrJeff]

Dr. Jeff, do you have an in-house lab, then? How does that compare to sending stuff out to an external facility?

No in house lab in my office. My removable lab tech's office is about 5 minutes from my office. When I have something to go there, my receptionist calls the lab and they send someone over to pick up the case. Having thew lab really near my office allows me to be able to do most repairs (i.e. fractured out tooth, broken RPD clasp, broken denture base) in 1 day. (the patient drops the denture to be fixed off by 9AM and my lab tech has it back to me by 3:30ish that afternoon.

If I had an inhouse lab, I'd likely just count that(ie.e lab techs salary+materials and equipment) as part of my office overhead. I'd also encouage the lab tech to likely seek outside business to bring in (unless there was so much work that my tech had a 2 week backlog) to generate income for the lab and thus decrease my overhead.

 

[DrJeff]

Dr. Jeff, Dr. Rob I'm curious if either of you have ever made complete interim dentures for a patient in real life? We have a rule at school that we don't do any definitive work for patients unless they have been caries free for 12 months. For some reason that I completely don't understand this includes complete dentures as well. I could understand doing immediate interims but other than that I'm at a loss as to why we would do that.

Roughly 90% of the complete dentures that I do are immediates, and as much as I hate to admit it, I've had a few arches of immediates where the fit was so poor or the occlusion so far off that I wound up making an entire new set very soon after extractions I guess that you'd classify those dentures as interims Most of the time though I find that with a reline at some time out, that my immediates become full time dentures and I won't have to make a new set 6 to 8 months post extractions.

 

[toothcaries]

great stuff Dr. Jeff and Dr. Rob!

 

[booshwa]

Kind of off the topic, but our cadaver that we are dissecting has complete dentures, and it is amazing how much the mandible has resorbed. It is hardly there at all. So much so that the mental foramen exits vertically through the top of the body of the mandible because there is no bone above it.

 

[tooth_sleuth]

what's a good border molding material? I truly truly hate working with the green stick compound!!!

 

[Dentoman]

Dentures can be very profitable if you know what your doing.
My advice would be to learn as much as you can about them CDs and RPDs!
and if you get into the immediate and crown/partial combinations thats even better!
Dont say to yourself u'll never do dentures when you graduate, why would you rob urself and your patients from the mutual benefits?!

 

[ItsGavinC]

Visit 4: Wax try in, again reiterate expectations (also remind them to bring their checkbooks next time ).

And how large are those checks on average?

 

[ItsGavinC]

We just finished setting our teeth today, and it was pretty cool.

The way we have it set up, we have lab techs, prosthodontists, and lab professors in the room at the same time, so it's been nice to get little tips and tricks here and there from each of those groups.

Our instructor was Dr. El-Gendy from Ohio State and he was awesome (props to him). I'm feeling much better about complete dentures at the end of the week than I was at the beginning!!

 

[toothcaries]

We just finished setting our teeth today, and it was pretty cool.

The way we have it set up, we have lab techs, prosthodontists, and lab professors in the room at the same time, so it's been nice to get little tips and tricks here and there from each of those groups.

Our instructor was Dr. El-Gendy from Ohio State and he was awesome (props to him). I'm feeling much better about complete dentures at the end of the week than I was at the beginning!!

wow.
talk about a small world.
(i frequently schedule to work with dr. el-gendy...my patients love the guy)

anyways, here is his course website.
imo, it's pretty helpful if u are learning CDs.

http://www.dent.osu.edu/completedentures/

 

[DrJeff]

And how large are those checks on average?

In my neck of the woods it in the $2500 to $3000 range depending on if its a set of immediate dentures verses a new set of existing dentures (my immediates are more since I include in the cost relines in the 1st 12 months after exo's).

On the basis of fees per amount of chairtime used, dentures can often be your most profitable procedure

 

[ItsGavinC]

anyways, here is his course website.
imo, it's pretty helpful if u are learning CDs.

http://www.dent.osu.edu/completedentures/

That's our course website as well (I'm studying from it right now).

 

[TX OMFS]

Time for my post. I was trying to think of something crass to say, but I'm surprisingly unable to do so. I agree with Dr. Jeff regarding the importance of understanding CD's. I loved removable pros in school for some reason, and it taught me about occlusion, mastication, and dental anatomy. At first I though border molding and all the other intricacies was BS, espcially since I wanted to be an OMS, but somehow I came to enjoy removeable. I guess I liked dentures b/c it required attention to detail. Attention to detail in any area of medicine is what seperates the good docs from the ones who are just trying to make money. I think learning how to build a good set of dentures goes a long way in your dental education.

 

[DDSSlave]

anyways, here is his course website.
imo, it's pretty helpful if u are learning CDs.

http://www.dent.osu.edu/completedentures/

Good website. I may use it to review CDs when I start them in clinic this fall.

 

[aphistis]

Good website. I may use it to review CDs when I start them in clinic this fall.

I just got home from the school spending three extracurricular hours working on my wax rims, and it hit me about halfway through that working on wax now is a LOT more enjoyable than it was last year. I'd go spazzing out last year on every tooth morph & occlusion project, and now I was having a perfectly relaxing time smoothing things out. I'm looking forward to setting teeth next week (we only meet for CD once a week), and in general second year doesn't seem so bad thus far, as long as you're resigned to putting in the time. Here's hoping it stays that way.

 

[ItsGavinC]

Bill, setting teeth was pretty fun. It took me a while that first time, and although I haven't done it again yet, I'm convinced it is one of those things that I could do in 1/4 the time now that I've done it once.

The best part about making your rims smooth is that you get to tear them up when setting the teeth. It's a ridiculous process.

 

[c132]

Wait till you do it on a real pt. Or better yet a real RPD pt. You will pull your hair out to get them into a class 1 molar relationship!!!!

 

[ItsGavinC]

Wait till you do it on a real pt. Or better yet a real RPD pt. You will pull your hair out to get them into a class 1 molar relationship!!!!

No doubt. And we are starting removable partial prosth. on Monday, so I'm sure that will also hold lots of surprises for me.

 

[c132]

No doubt. And we are starting removable partial prosth. on Monday, so I'm sure that will also hold lots of surprises for me.

OH YEAH!!!! cutting that acrylic tooth to go around the rest seat and still get a perfect occlusal scheme is VERY TIME consuming!!!!

 

[tooth_sleuth]

what is a good CD book? Any suggestions?

 

[ca_dreamin']

Hey Gavin- Sorry to bring up such an old thread, but I was curious...In your courses, did you only have the one complete denture course with Dr. El-Gendy, or did you also have courses that focused on creating a monoplane set-up, etc...

I know your clinical situation of unique, so I did not know if you would be doing your own dentures the next few years, or sending them to the lab. Just curious.

BTW, I agree with you--he is an excellent doc.

 

[lnn2]

... Dr. El-Gendy...
BTW, I agree with you--he is an excellent doc.

never heard of him!

 

[simpledoc]

wow.
talk about a small world.
(i frequently schedule to work with dr. el-gendy...my patients love the guy)

anyways, here is his course website.
imo, it's pretty helpful if u are learning CDs.

http://www.dent.osu.edu/completedentures/

toothcaries, thanks a lot! that link is incredible especially the videos! does any one have any links or video cds/ dvds for fixed prosthodontics? can you kindly share with us? thanks in advance..

 

[DrJeff]

I'm "dentured out" after this morning in my office. Dentures in my office tend to happen in groups, where I'll do a number of arches in a short period of time, and then I might not make another arch for 4 to 6 months, at which point I'll make another 6 to 10 arches in a short period of time.

This was my schedule in my "B Room" (I work out of 2 rooms most of the time with my "A room" schedule containing my crown and bridge, endo, and most of my restorative procedures - i.e. the big ticket items, and my B room having the emergencies, consults, denture patients, and some resorative patients - i.e. the minor procedures/"quick visits")

This was my B room schedule this morning:

8-8:30 denture adjustment on a patient who I extracted 20 teeth on last week and delivered upper/lower immediate dentures

8:45 - 9 Patient in to pick up upper/lower immediate dentures for their visit to the oral surgeon tommorrow for extraction of 25 teeth (mainly root tips) and delivery of immediates

9:15- 10 Patient in for occlussal wax rim adjustment/bite registration and tooth selection for full upper/lower dentures

10:15-11 Patient in for occlussal wax rim adjustment/bite registration and tooth selection for full upper/lower dentures (yup 2 back to back same stage of denture fabrication patients)

All the while in my A room, I did 2 crown preps, 4 composite fillings, and 2 amalgams. Throw in 6 hygiene checks on the side, and it was a busy first 3 hours of my morning. After my last denture patient left my B room, I joked with one of my assistants that I only wanted to see people the rest of the day in the B room that have their own teeth!

And BTW, I also have another 3 patients compromising 5 more arches of removeable at roughly the same fabrication stage right now. I figure in another 2 to 3 weeks when all those arches are inserted, I won't see aother wax occulussal rim or a denture tooth shade guide until well into the summer months(hopefully!)

 

[ItsGavinC]

Hey Gavin- Sorry to bring up such an old thread, but I was curious...In your courses, did you only have the one complete denture course with Dr. El-Gendy, or did you also have courses that focused on creating a monoplane set-up, etc...

I know your clinical situation of unique, so I did not know if you would be doing your own dentures the next few years, or sending them to the lab. Just curious.

BTW, I agree with you--he is an excellent doc.

We had the one course, but we covered monoplane set-ups, etc.

And we have an in-house lab in the clinic building, so they'll get our work.

 

[Dr. Pedo]

As much as complete dentures can be a royal PITA, especially when you're doing all the lab work yourself, they do force you to learn one of the true fundamentals of this profession, occlussion! Dentures really forces you to get a three dimensional concept of working and balancing side contacts and canine guidance. True, it really can suck when your spending what seems lime days inthe lab setting and resetting and resetting and resetting teeth to get the occlussion perfect, but its that exact concept that will dictate almost everything else we do in dentistry.

BTW, I'm with Dr Rob with how I do dentures in private practice:

Visit 1: Consult, take primary impressions(actually have my assistant take the primaries). This is actually the most important visit IMHO, where you need to lay out the limitations and what expectations your patients can expect with respect to retention, chewing ability, and the likely need for future relines. Total time 20 to 30 minutes (most of me talking). Re appoint patient in 1 week after my lab tech has made custom trays

Visit 2: Final impressions(I take them). I use Impregum (an addition silicone) in a custom tray. Reiterate again the limitations and expectations the patient should have. Total time 15 minutes. Re appoint the patient in 1 week after my lab tech has made record bases and wax rims

Visit 3: Jaw realtions + tooth mould/color selection. Once again reiterate final expectations. Total time 15 minutes. Re appoint the pateint in 1 week after my lab tech has set the teeth.

Visit 4: Wax try in, again reiterate expectations (also remind them to bring their checkbooks next time ). Total time 15 minutes. Re appoint in 1 week for delivery after my lab tech has processed the dentures.

Visit 5: Deliver the dentures Total time 15 minutes Re appoint them for a follow up in 1 to 2 days.

I do alot of explaining of the patients expectations as you can see, this gets the patient to have a realistic view and if and when they can eat a steak or corn on the cobb or an apple without a problem, you look like a hero. I tend to spend alot more time explaining to patients for whom I'm kaing immediate dentures for than for those who are getting their 2nd, 3rd or 4th set of dentures

DrJeff, canine guidance on your complete dentures Are you fabricating dentures with mutually protected occlusion or did you mean a bilateral balanced occlusion. Truly no flame intended just wondering.

 

[lnn2]

DrJeff, canine guidance on your complete dentures Are you fabricating dentures with mutually protected occlusion or did you mean a bilateral balanced occlusion. Truly no flame intended just wondering.

I usually try to get the dentures as close to Cl I as possible and also canine guidance. So far none of them has any problem with unstability due to canine guidance.
Procanine guidance:
Comparison between balanced occlusion and canine guidance in complete denture wearers--a clinical, randomized trial.

Pro-equilibration:
Equilibration vs. Canine Guidance in Full Denture Cases: A Patients' Survey

 

[DrJeff]

DrJeff, canine guidance on your complete dentures Are you fabricating dentures with mutually protected occlusion or did you mean a bilateral balanced occlusion. Truly no flame intended just wondering.

No canine guidance for my plastic teeth(or almost never). I'm a bi-lateral group function fan typically with 10 degree posterior teeth (about 75% of my sets will have these including essentially all my immediate denture cases), and on fabrication of a new set of dentures for an existing denture patient who exhibits extensive wear of their "original" dentures, I'll often use monoplane teeth (I've had a few cases like this where I went with 10 degree teeth and basically ended up grinding away any posterior cuspal rise, so I kind of learned my lesson about the concept of esthetics vs. function in this type of situation)

I've also had my CR thought process evolve over the years from a hard, rigid CR = the only way to one that I think of as a "soft CR" where I'll work to manipulate the mandible back to CR (if the patients musculature will COMFORTABLY let me get there), if I can't get them easily back to CR then I'll head more towards a CO, and I find that they end up functioning very comfortably in that location(I'd say that about 1/3 of my denture patients have their teeth set in the "soft CR" position), and its really something where I'll know about 3 seconds into the CR manipulation movements if CR or this "soft CR" will be what I'm doing for my bite registration.

 

[GQ1]

In my neck of the woods it in the $2500 to $3000 range depending on if its a set of immediate dentures verses a new set of existing dentures (my immediates are more since I include in the cost relines in the 1st 12 months after exo's).

On the basis of fees per amount of chairtime used, dentures can often be your most profitable procedure

true say. prosth faculty tell us their average is $6k and thats up there for profitability if you can limit post insertion alterations with good clinical technique.

 

[dudelove]

Do you take protrusive record?

No canine guidance for my plastic teeth(or almost never). I'm a bi-lateral group function fan typically with 10 degree posterior teeth (about 75% of my sets will have these including essentially all my immediate denture cases), and on fabrication of a new set of dentures for an existing denture patient who exhibits extensive wear of their "original" dentures, I'll often use monoplane teeth (I've had a few cases like this where I went with 10 degree teeth and basically ended up grinding away any posterior cuspal rise, so I kind of learned my lesson about the concept of esthetics vs. function in this type of situation)

I've also had my CR thought process evolve over the years from a hard, rigid CR = the only way to one that I think of as a "soft CR" where I'll work to manipulate the mandible back to CR (if the patients musculature will COMFORTABLY let me get there), if I can't get them easily back to CR then I'll head more towards a CO, and I find that they end up functioning very comfortably in that location(I'd say that about 1/3 of my denture patients have their teeth set in the "soft CR" position), and its really something where I'll know about 3 seconds into the CR manipulation movements if CR or this "soft CR" will be what I'm doing for my bite registration.

 

[GQ1]

Do you take protrusive record?

i base tooth selection on 6 factors

1. a-p jaw relationship - class 1 pts = anatomic or semi anatomic, class 2 and 3 rational teeth or mould combination

2.mediolateral jaw relationship - anatomic and semi are difficult to arrange in crossbite, therfore in these pts use mould combo.

3. occlusal concept - balanced occlusion = anatomic or semi anatomic. a non balanced occlusion has to use rational or mould combo teeth.

4. esthetics anything but rational (flat maxillary teeth)

5. neuromuscular control. for anatomic and semi, pts need reasonable control. go for combo if its poor.

6. residual ridge morphology. minimal ridge = 0 degree teeth. this is because with cusp inclination there will be torque in balanced excursion on the ridges as there is little stability which will cause dispalcement and inreased resorption. this has to be balanced against decreased masticatory function with flatter teeth as there are smaller sluiceways, so increased force on the ridges.

 

[dudelove]

I do agree with everything you state though. With severely resorbed residual ridges though, rational teeth would be an option, but a linear occlusion setup would also be a definite option. Also you can have a balanced occlusion using rational teeth by utilizing balancing ramps. Also when you talk about masticatory function, are you relating to ease of mastication or how well you masticate?

i base tooth selection on 6 factors

1. a-p jaw relationship - class 1 pts = anatomic or semi anatomic, class 2 and 3 rational teeth or mould combination

2.mediolateral jaw relationship - anatomic and semi are difficult to arrange in crossbite, therfore in these pts use mould combo.

3. occlusal concept - balanced occlusion = anatomic or semi anatomic. a non balanced occlusion has to use rational or mould combo teeth.

4. esthetics anything but rational (flat maxillary teeth)

5. neuromuscular control. for anatomic and semi, pts need reasonable control. go for combo if its poor.

6. residual ridge morphology. minimal ridge = 0 degree teeth. this is because with cusp inclination there will be torque in balanced excursion on the ridges as there is little stability which will cause dispalcement and inreased resorption. this has to be balanced against decreased masticatory function with flatter teeth as there are smaller sluiceways, so increased force on the ridges.