How many appointments does it take to make partial dentures in private practice?

[Mauricio45]

I know at school it takes forever. What steps do you do at each appointment for private practice to make cast partial dentures?

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[Daurang]

I know at school it takes forever. What steps do you do at each appointment for private practice to make cast partial dentures?

1st...impression
2nd...framework trying
3rd...wax rim added
4th...teeth trying
5th...insertion
6th...adjust
7th...adjust
8th...adjust
9th...adjust
10th...adjust
11th...give up and give their money back. Best not to do removable dentures. Too much headache and you'll lose more patients than you gain.

 

[Faux]

1st...impression
2nd...framework trying
3rd...wax rim added
4th...teeth trying
5th...insertion
6th...adjust
7th...adjust
8th...adjust
9th...adjust
10th...adjust
11th...give up and give their money back. Best not to do removable dentures. Too much headache and you'll lose more patients than you gain.

lab doesnt do that?

 

[DrJeff]

lab doesnt do that?

Lab does the lab work in between the visits. You as the dentist, still have to do the clinical steps after the lab does their thing

So far I just have a sample size of 2, but I've now made 2 partials (all acrylic) using my Trios digital scanner, where after full arch scans of both arches and the patients bite, I've gone from visit 1, digital scan, to visit 2, delivery, and have found that the number of post delivery adjustments I've had to make has been both less in quantity, and also surface area needing adjustment as well. I am cautiously optimistic about using my scanner for removable prosthetics more in the future based on my first few!

 

[Faux]

Lab does the lab work in between the visits. You as the dentist, still have to do the clinical steps after the lab does their thing

So far I just have a sample size of 2, but I've now made 2 partials (all acrylic) using my Trios digital scanner, where after full arch scans of both arches and the patients bite, I've gone from visit 1, digital scan, to visit 2, delivery, and have found that the number of post delivery adjustments I've had to make has been both less in quantity, and also surface area needing adjustment as well. I am cautiously optimistic about using my scanner for removable prosthetics more in the future based on my first few!

wow a scanner for partials too? thats awesome.

 

[CanaDMD]

1st...impression
2nd...framework trying
3rd...wax rim added
4th...teeth trying
5th...insertion
6th...adjust
7th...adjust
8th...adjust
9th...adjust
10th...adjust
11th...give up and give their money back. Best not to do removable dentures. Too much headache and you'll lose more patients than you gain.

How are you producing enough if you aren't doing RPDs? From my dental student/unexperienced eyes, they seem to be pretty high production no?

 

[DrJeff]

How are you producing enough if you aren't doing RPDs? From my dental student/unexperienced eyes, they seem to be pretty high production no?

The production upfront is indeed good.

The headaches that often follow in the form of adjustments and/or other issues that pop up where the patient has neglected care on abutment teeth and what you end up going through trying to fix them, becomes the long term issue that overtime you really don't feel like dealing with to be honest with you.

Plus remember, the vast majority of time, you're NOT getting paid for those follow up denture adjustment visits if you were the one who made the denture/partial in the recent past.....

 

[Mackchops]

1st...impression
2nd...framework trying
3rd...wax rim added
4th...teeth trying
5th...insertion
6th...adjust
7th...adjust
8th...adjust
9th...adjust
10th...adjust
11th...give up and give their money back. Best not to do removable dentures. Too much headache and you'll lose more patients than you gain.
12th...refer to your friendly neighborhood prosthodontist

 

[CanaDMD]

The production upfront is indeed good.

The headaches that often follow in the form of adjustments and/or other issues that pop up where the patient has neglected care on abutment teeth and what you end up going through trying to fix them, becomes the long term issue that overtime you really don't feel like dealing with to be honest with you.

Plus remember, the vast majority of time, you're NOT getting paid for those follow up denture adjustment visits if you were the one who made the denture/partial in the recent past.....

How long are you expected to offer free follow up adjustment visits?

 

[OhioDMD]

How long are you expected to offer free follow up adjustment visits?

I tell my patients that three months of adjustments are included. I would rather adjust their problem areas than have them using a nail file, pocket knife, dremel, emory cloth or any other implements I have been told over the decades. In my reality (small isolated city general practice) I have no charge tightened clasp arms and adjusted sore spots as a good will builder. I am not referring to the pia patients (those get referred to the prosthodontist.....lol) but my regulars or family members of my regulars.

 

[Daurang]

How are you producing enough if you aren't doing RPDs? From my dental student/unexperienced eyes, they seem to be pretty high production no?

In the beginning when you're slow and building up a practice, RPD helps pay the bill. As you get busier over time, you lose time and money to other vastly more profitable procedures. For example, lab cost for RPD usually costs 3-4 times more than lab work for a crown; not counting the extra time required for adjustments.

 

[CanaDMD]

In the beginning when you're slow and building up a practice, RPD helps pay the bill. As you get busier over time, you lose time and money to other vastly more profitable procedures. For example, lab cost for RPD usually costs 3-4 times more than lab work for a crown; not counting the extra time required for adjustments.

I always figured crowns wouldn't be enough of an occurrence to fully replace rpd

 

[CanaDMD]

In the beginning when you're slow and building up a practice, RPD helps pay the bill. As you get busier over time, you lose time and money to other vastly more profitable procedures. For example, lab cost for RPD usually costs 3-4 times more than lab work for a crown; not counting the extra time required for adjustments.

Thanks for your answer

 

[xkc9126x]

1st...impression
2nd...framework trying
3rd...wax rim added
4th...teeth trying
5th...insertion
6th...adjust
7th...adjust
8th...adjust
9th...adjust
10th...adjust
11th...give up and give their money back. Best not to do removable dentures. Too much headache and you'll lose more patients than you gain.

when i saw this, i thought this was hilarious because I totally agree from working at a private practice stand point lmao


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[DrJeff]

Just an update on my personal evolution of how I'm starting to change how I'm fabricating full and partial dentures now, using my Trios intra-oral digital scanner and literallly going from initial scan to final delivery with no intermediate steps.

As of 5 minutes ago, I just delivered my 4th arch made using my scanner verses traditional impression techniques, wax rims bite registration, try in visits, etc. All 4 arches I've done so far (3 partials replacing anywhere between 3 teeth in a row in one quadrant to 8 teeth in multiple locations in both quadrants of the arch to 1 full denture where I was making a new one for an existing full denture that was about 20 yrs old) have all just dropped in without any fit issues and with the exception of having to slightly adjust the posterior extent of the full I made where it was just slightly past the vibrating line and some minor gagging was occurring, I haven't had to pick up an acrylic bur at the delivery visit, and hardly at all at the post delivery follow up visit! Very impressed!!

What my lab, who does a bunch of digital dentistry is doing, is 3-D printing the full arch scans, which also registers the patients occlusion, and then fabricating a full acrylic, flexible partial and/or full arch denture off the 3-D printed master cast and going right to finish.

It takes a lab and a lab tech who are willing to see what technology can do, as well as a clinician who at times is willing to see what technology can do, but I have to say, that will my limited sample size so far, I am quite excited and impressed with what technology can do for removeable units!

 

[THS]

Just an update on my personal evolution of how I'm starting to change how I'm fabricating full and partial dentures now, using my Trios intra-oral digital scanner and literallly going from initial scan to final delivery with no intermediate steps.

As of 5 minutes ago, I just delivered my 4th arch made using my scanner verses traditional impression techniques, wax rims bite registration, try in visits, etc. All 4 arches I've done so far (3 partials replacing anywhere between 3 teeth in a row in one quadrant to 8 teeth in multiple locations in both quadrants of the arch to 1 full denture where I was making a new one for an existing full denture that was about 20 yrs old) have all just dropped in without any fit issues and with the exception of having to slightly adjust the posterior extent of the full I made where it was just slightly past the vibrating line and some minor gagging was occurring, I haven't had to pick up an acrylic bur at the delivery visit, and hardly at all at the post delivery follow up visit! Very impressed!!

What my lab, who does a bunch of digital dentistry is doing, is 3-D printing the full arch scans, which also registers the patients occlusion, and then fabricating a full acrylic, flexible partial and/or full arch denture off the 3-D printed master cast and going right to finish.

It takes a lab and a lab tech who are willing to see what technology can do, as well as a clinician who at times is willing to see what technology can do, but I have to say, that will my limited sample size so far, I am quite excited and impressed with what technology can do for removeable units!

So do you scan a "virgin" mouth and send it off to the lab to design and fabricate? Or do you have a design in mind and prep the rest seats/guide planes from the start and scan that?

EDIT: Just saw you are using full acrylic RPDs. Any problems with those over metal framework in terms of fit, finish, comfort, and post-delivery adjustments on your part?

 

[DrJeff]

So do you scan a "virgin" mouth and send it off to the lab to design and fabricate? Or do you have a design in mind and prep the rest seats/guide planes from the start and scan that?

EDIT: Just saw you are using full acrylic RPDs. Any problems with those over metal framework in terms of fit, finish, comfort, and post-delivery adjustments on your part?

Honestly I haven't had any significant issues with the fit, finish, and/or post delivery adjustments with all acrylic partials vs metal framework partials. Yes, longterm the all acrylics don't have the longevity of a traditional metal frame partial, I'm upfront about that with my patients. The vast majority of them when they see the demo RPD's I have in my office (an all acrylic and a metal frame, both with bi-lateral extensions replacing 19-21 and 28-30 with clasps on 18,22, 27 and 31) choose the all acrylic based on aesthetic reasons.

While I've yet to do a scan RPD that had a tooth/teeth with prepped rest seats, I have absolutely no doubt that it wouldn't be an issue for my scanner to pick up and/or the 3-D printer the lab uses to make the master cast from the scan to accurately capture, as long as it was a traditional width/depth rest seat made with a #8 round bur or equivalent, simply based on what my scanner has captured, and then the 3-D printer replicated for some inlays and onlays that I've done.

 

[Faux]

Just an update on my personal evolution of how I'm starting to change how I'm fabricating full and partial dentures now, using my Trios intra-oral digital scanner and literallly going from initial scan to final delivery with no intermediate steps.

As of 5 minutes ago, I just delivered my 4th arch made using my scanner verses traditional impression techniques, wax rims bite registration, try in visits, etc. All 4 arches I've done so far (3 partials replacing anywhere between 3 teeth in a row in one quadrant to 8 teeth in multiple locations in both quadrants of the arch to 1 full denture where I was making a new one for an existing full denture that was about 20 yrs old) have all just dropped in without any fit issues and with the exception of having to slightly adjust the posterior extent of the full I made where it was just slightly past the vibrating line and some minor gagging was occurring, I haven't had to pick up an acrylic bur at the delivery visit, and hardly at all at the post delivery follow up visit! Very impressed!!

What my lab, who does a bunch of digital dentistry is doing, is 3-D printing the full arch scans, which also registers the patients occlusion, and then fabricating a full acrylic, flexible partial and/or full arch denture off the 3-D printed master cast and going right to finish.

It takes a lab and a lab tech who are willing to see what technology can do, as well as a clinician who at times is willing to see what technology can do, but I have to say, that will my limited sample size so far, I am quite excited and impressed with what technology can do for removeable units!

Its been almost a year. Hows the digital scene treating you?

 

[ysrebob]

Tooth-supported partial dentures should be easy and predictable. Acrylic on alloy frame works great just like it always did. Alginate is highly accurate if poured immediately. Good impressions sent to good labs will minimize the adjustments needed to framework or acrylic.

1. 10min: diagnostic casts. Design framework at your leisure.
2. 60min: prep the rests and guide planes; pick shade and mould for denture teeth; impress for master casts ---> out to lab for framework
3. 30min: framework try-in (can also do aesthetic wax try-in at this same visit if replacing anteriors. I enjoy doing my own waxups but it's more efficient to have the lab do it for you; in fact this can be done along with framework fabrication to save time) --> back out to lab for acrylic processing
4. 30min: deliver
5. 10min: followup adjustments, if needed. Have rarely needed to adjust more than once or twice.

Mandibular distal extension RPDs are a little more trouble, but still worthwhile unless patient has badly resorbed ridges (in which case you will be adjusting forever).
Complete dentures can be infinitely more trouble, and I often wonder if they're worth doing. Maybe optical scanner somehow makes this process less painful?

 

[DrJeff]

Its been almost a year. Hows the digital scene treating you?

I've got somewhere between 15 and 20 arches now delivered using just a digital scan and going from scan directly to delivery.

Overall I am quite happy with the results. The fit has been very good, with more often than not less adjustments both at delivery and in the following few weeks post delivery than when I was fabricating arches the traditional custom tray and impression material way.

My patients have been happy, especially those who had a previous arch(es) of removable and didn't need to go through the impression process and multiple visits for fabrication steps.

Overall, roughly a year into "digital dentures", I am quite happy and plan on keep using my scanner for more future cases