Removable Dentures

Removable dentures are appliances used to replace missing teeth which can be removed and cleaned by the patients themselves. They are mainly of two types - removable partial dentures which help replace one or more missing teeth and removable complete dentures which are used in patients without any teeth at all.

Out of all of the teeth replacement options, a removable appliance is the most economical option.  A removable appliance is a cheaper procedure to obtain than a fixed bridge or a dental implant and has the advantage of being able to replace multiple teeth with one appliance.  In certain conditions the most practical solution to replacing missing teeth, a removable appliance can range in stability and appearance depending on the material used to make them. However, in comparison with a fixed replacement of natural teeth, it loses heavily with respect to both functional as well as cosmetic considerations. 

Removable Partial Dentures

Referring to something as basic as a budget flipper that is a piece of plastic with a false tooth attached to a metal and acrylic removable partial denture, a removable appliance is also the least aesthetically pleasing missing tooth replacement option.  This is because removable appliances contain clasps that are often impossible to completely conceal.  Additionally, wearing a removable appliance can be uncomfortable for your other teeth. They can also create problems for adjacent normal teeth and cause food accumulation between the appliance and the adjacent teeth. Often removable dentures lead to deterioration / weakening of existing teeth as well as surrounding tissues.

Removable dentures:

Advantages:     * Less expensive (Cast PDs are relatively expensive)
                        * Less working time
                        * New teeth can be added onto existing denture bases

Disadvantages:  * Unable to provide you the natural feel
                          * Often fit is improper or turns out to be improper in due course of time
                          * Not as effective as fixed dentures both functionally and cosmetically
                          * Affect taste sensations
                          * Affects temperature sensations
                          * Less hygienic when compared to fixed replacement of teeth using implants and / or crown and bridgework
                          * Causes bad breath
                          * Causes accumulation of tartar / stains
                          * Wears out faster --> periodic replacement
                          * Clasps – may turn out unfavorable & problematic and rarely life-threatening
                          * Brittle (especially the acrylic variety)
                          * Frequent adjustments, relining, re-basing etc. may be necessary
                          * Very often partial removable dentures tend to weaken the existing teeth and gums from which they often take support / anchorage from gradually shifting the patient from the partial removable denture status to a complete removable denture status.

If a denture substitutes all teeth in the arch, it is called a full removable denture or a complete denture. If some of the natural teeth are still present, than the prosthesis replacing the missing teeth is called a removable partial denture.

Removable complete (full) dentures

Full dentures still remain the most common restoration used today for edentulous (no teeth present) patients. The only other alternative to the complete dentures is dental implant supported prostheses. Dentures are plastic plates custom-made to fit each individual. It is made from pink acrylic simulating gum tissue and plastic or porcelain teeth, custom set for each patient.

How are complete dentures are done?

It is usually takes five appointments to make standard full dentures.

1. Preliminary impression - this is the first impression that the doctor takes of the upper and lower dental arches (the gums devoid of teeth) . These impressions are poured with plaster of paris to form accurate models of the patient’s dental arches. Subsequently, the dental lab technician makes the custom trays for the final impression (trays that accurately  fit the patient's dental arches).

2. Final / Master impression -  is done with custom trays using advanced impression materials. This impression is very precise and accurately records the minute details of the dental arches. The impression is sent back to the dental lab, new models are poured and the base is fitted with wax rims for bite determination.
3. Wax bite registration -    Using wax rims the doctor will determine the size and positioning of the desired teeth in addition to the relation of upper and lower teeth and jaws. The height of the bite (occlusion), direction of smile, fullness of cheeks and lips etc. are also considered. The doctor makes several marks on the wax rims allowing technician to set the teeth correctly in the desired manner. The dental technician subsequently sets the teeth according to doctor’s instructions and is sent back to the doctor the try wax trial.
4. Wax trial - The wax try-in looks like the final dentures, except that it fits loosely in the mouth and the base is made of wax instead of acrylic (plastic). In this stage, the biting pattern, the vertical height of the bite, the fullness of the cheeks, the smile angle, the comfort of the patient etc. are noted and adjustments made accordingly. The wax-up is sent back to the lab and final dentures are processed there.

5. Complete denture delivery - After minor adjustments and correction of pressure spots, the final dentures are inserted in and patient. Thus the patient walks out of the office with his  / her new set of teeth.

   It may take few more appointments for minor adjustments and removal of pressure spots.

Removable Dentures and Implant supported fixed teeth replacement - a comparison

A dental implant is a small man-made titanium fixture that serves as a replacement for the root portion of a missing natural tooth. Titanium is used because it is most compatible with our human body. The dental implant is placed in the bone of the upper or lower jaw and functions as an anchor for the replacement tooth. The advantages of the dental implant supported fixed teeth replacement over removable dentures are as follows:

1) Improved Appearance: Dental implant supported prostheses are more natural than removable dentures in appearance and more attractive. They look and feel like natural teeth. Since implants fuse to bone, the prosthesis is permanent and non-removable.

2) Improved Confidence: Removable dentures become loose and can rock and cause embarrassment for the wearer. With the dental implant prosthesis, a person can feel confident that teeth will not move. All regular activities can be performed without fear of embarrassment.

3) Comfort and Convenience: Removable dentures can cause sore spots in the mouth under the denture. With a dental implant supported prostheses there are no sore spots. Removable dentures can be inconvenient because they require removal at night and for cleaning. They require messy adhesives. Patients with dental implants do not experience these embarrassing situations.

4) Durability: Implants have a high rate of success and durability. They last many years. With good care, implants can last a lifetime. Removable dentures have to be replaced periodically and with each change of removable denture, very often more number of teeth will have to be added to the removable denture as the adjacent natural teeth would have deteriorated (due to the unfavorable actions by the removable partial denture).

5) Improved Eating: Removable dentures can slide during eating and make eating a complicated and unhappy activity. The ability to chew foods improves dramatically with dental implants. While removable dentures are only 20% to 25% as efficient as a person’s natural teeth, implant supported prostheses are 80% as efficient. A prosthesis supported by dental implants functions like natural teeth making eating an enjoyable and easy experience.

6) Improved Taste: A full upper removable denture covers the roof of the mouth. Food is more difficult to taste and enjoy. Temperature changes in food are not easily detected due to the barrier it creates between the food and the oral tissues. With an implant-supported prosthesis, the roof of the mouth is not covered and food can be tasted fully.

7) Improved Nutrition and Health: Many foods cannot be eaten with removable dentures. With an implant-supported prosthesis, people are able to eat a varied, healthful diet that includes all necessary food groups for improved nutrition. Chewy and crunchy foods such as carrots, lettuce and apples can be added to the diet.

8) Improved Speech: Removable dentures can make speaking sound garbled. The teeth can slip within the mouth causing mumbling or slurring of words. With dental implants normal speech is usually not a problem and patients can feel confident that the teeth will not slip during conversation.

9) Reduced Chance of Loss: Removable dentures can be easily lost. Dental implant supported prostheses cannot be removed and misplaced.

10) Bone Growth: One of most devastating problems for patients wearing removable dentures is the loss of bone that occurs over time. Gradually removable dentures become more difficult to wear because of this bone loss. The ridge gradually wears away providing less and less ridge to support the denture. Dental implants act like natural teeth and aid in bone stimulation and growth. 

"One's objective should be to get it right, get it quick, get it out, and get it over. You see, your problem won't improve with age. "  - Warren Buffett