How long does it take to make dentures in private practice

[Dental916]

because it takes F O R E V E R in clinic. We have so many steps we have to do.

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[aphistis]

Everyone's mileage will vary, but here's how it goes for me. I'm writing this under the assumption the patient is a new patient getting conventional full dentures, they're already edentulous, they don't need any preprosthetic oral surgery, and all steps are successful on the first attempt. All appointments in this scenario are one week apart.

1. Exam, radiographs, patient interview, primary alginate impressions. My assistant does most of the actual work (shooting the films & taking the alginates). The most important part of the first appointment for me is the patient converation--spending 10-15 minutes here, establishing some early rapport and making sure the patient's expectations are in line with reality, can save you literally hours of tweaking before delivery and post-op adjustments afterward. ~45 minutes, alginates to lab for custom tray fabrication.

2. Master impressions: Custom trays back from lab, try them in and adjust as needed, quick border molding as needed, PVS master impressions taken (I know, I know. The VA buys my materials right now, though, and I like the way PVS handles). 30 minutes, impressions to lab for wax rim fabrication.

3. Wax rim try-in & interocclusal record. Try in wax rims, check OVD/smile line/lip support/arch form & alignment/occlusal plane. Adjust as needed. When satisfied, take interocclusal record, mark upper midline, and select teeth. Probably 2/3 of these are 15-minute appointments because everything looks good as delivered from the lab. The other 1/3 can take anywhere from 15-60 minutes depending on how busy I am overall and how extensively I have to monkey with the wax rims. Back to the lab for tooth placement and wax-up.

4. Final try-in. Reheck everything from #3 plus tooth alignment & occlusion. Triple-check with the patient that everything is exactly the way they want it to look & feel, w/any small chairside adjustments indicated. 15-30 minutes, back to the lab for final processing.

5. Delivery. Recheck everything from #4 and a couple other things, adjust as necessary. Give the "so you've got a brand new set of dentures" talk, tell them they look like a million bucks, make sure they have the office phone number in case they need a post-op adjustment, and reschedule them for annual recall exams. 15-30 minutes depending on adjustments and patient questions.

Total chair time for the scenario I just described is a couple hours and some change, and total treatment time is about a month. It can get more complicated for more challenging cases, but hopefully this gives you at least a rough idea.

 

[Regmata]

Most dentists really send out impressions for custom trays? They are so easy to make, is it really worth it? I would think that is something an assistant could do. I am surely naive here as I am only a first year. Will I be sending out pretty much everything, even whitening trays?

 

[Daurang]

Partials can take 10 minutes. Take impression, pick tooth color, pick gum color on first visit. Two weeks later, insert valplast and patient is happy even without adjustment.

Full dentures takes from one hour to four hours in four to ten visits. Sometime the patient is ridiculously hopeless so you just hand back the patient their money and refer them to your worst enemy.

 

[aphistis]

Most dentists really send out impressions for custom trays? They are so easy to make, is it really worth it? I would think that is something an assistant could do. I am surely naive here as I am only a first year. Will I be sending out pretty much everything, even whitening trays?

If you have an assistant who reliably does a good job making them, then it can be feasible to do them in-house. If not, however, paying the lab $20 to get custom trays you don't have to spend a half hour shortening and/or border molding can be money very well spent (because you were smart and set your denture fee to reflect the added lab cost).

In a lot of (most?) busy offices, pretty much anything that can't be done chairside goes to the lab simply because it's most economical. Yes, you can save $50 by making the trays yourself, but the hour you spend making them equates to hundreds of dollars of lost production because you're spending that time at your lab bench instead of treating patients.

 

[Dental916]

Thanks for the info. Knowing that it can be done in a timely fashion in private practice is very comforting...thanks.

In your first step, you send the alginate impression to the lab...we were told that they should be poured in a timely manner. How long does it take the lab to get it?

 

[Dental916]

Partials can take 10 minutes. Take impression, pick tooth color, pick gum color on first visit. Two weeks later, insert valplast and patient is happy even without adjustment.

Full dentures takes from one hour to four hours in four to ten visits. Sometime the patient is ridiculously hopeless so you just hand back the patient their money and refer them to your worst enemy.

valplast are the ones that do not require rest seats, the frame is made from acrylic correct?

 

[OceanDMD]

If you have an assistant who reliably does a good job making them, then it can be feasible to do them in-house. If not, however, paying the lab $20 to get custom trays you don't have to spend a half hour shortening and/or border molding can be money very well spent (because you were smart and set your denture fee to reflect the added lab cost).

In a lot of (most?) busy offices, pretty much anything that can't be done chairside goes to the lab simply because it's most economical. Yes, you can save $50 by making the trays yourself, but the hour you spend making them equates to hundreds of dollars of lost production because you're spending that time at your lab bench instead of treating patients.

If you have a problem paying 20-50 bucks for a lab to make custom trays, RAISE YOUR FEES 20-50 bucks. Hell, I raise my fees for a denture patient if I know she/hes going to be a pain in the *** (which you know within about 5 minutes during the consultation).

 

[OceanDMD]

valplast are the ones that do not require rest seats, the frame is made from acrylic correct?

Partial dentures are a poor option in general, valplast/anything all acrylic is usually garbage as well. If you can take an impression, and have it finished and ready to go, its likely garbage.

 

[aphistis]

Thanks for the info. Knowing that it can be done in a timely fashion in private practice is very comforting...thanks.

In your first step, you send the alginate impression to the lab...we were told that they should be poured in a timely manner. How long does it take the lab to get it?

Alginates go into a plastic baggie wrapped in moist paper towel. As long as they're poured at the lab later that day, they'll be fine. Remember, we're just talking about custom trays at that point. You don't need submicron-precise models.

 

[Dental916]

must have submicron-precise models

 

[BuckeyMcGee]

No need for submicron particle capturing impression trays, you'll be making adjustments after getting the denture back from the lab. The reason it takes you forever to do it in clinic is simply b/c it is school, they are teaching you all the steps and it seems like your school makes you do the tedious lab work which we all love so much, 😎, I know our school (Nova) loves to push our buttons with this. We had a dentist lecture us on practice management who was making over a million in Miami and was asked how many complete denture cases he does a year, the answer was usually 2. Dentures have a lot of drawbacks, they will most likely never be totally comfortable, they hurt, there will be continual ridge resorption underneath, and the patient is going to love drinking that hot cup of coffee and not feeling it until it hits the back of their throat. I'd prefer to place implants but of course they aren't advised in every situation. In reality if you must do a denture in practice, you'll just take the impressions, send it off to the lab, then make minor adjustments, considering everything goes as planned...which never really happens, .

 

[DrJeff]

If you have a problem paying 20-50 bucks for a lab to make custom trays, RAISE YOUR FEES 20-50 bucks. Hell, I raise my fees for a denture patient if I know she/hes going to be a pain in the *** (which you know within about 5 minutes during the consultation).

Dead on true here! In my office, with the practice management software we just switched to recently (Dentrix), as I'm entering the treatment plan into the computer chairside, we have it so that for these "special" Pain In The A$$ patients, all I have to do is in the "notes" section I just type Code X patient, where x = 1 through 5 and my front desk knows to put a 10% surcharge on for a code 1, 20% fpr code 2, etc - works great!

 

[toofshucker]

Dead on true here! In my office, with the practice management software we just switched to recently (Dentrix), as I'm entering the treatment plan into the computer chairside, we have it so that for these "special" Pain In The A$$ patients, all I have to do is in the "notes" section I just type Code X patient, where x = 1 through 5 and my front desk knows to put a 10% surcharge on for a code 1, 20% fpr code 2, etc - works great!

Copying and Pasting this to the "things to remember to save me a future headache" file.