Dental Tribune United Kingdom Edition

January 24-30, 201120 United Kingdom EditionClinical W hen I was in dental school, one of the teachers who was known to be very successful professionally, revealed that the key of his success was his knowledge over the “se- crets of the dentures”. It did not make sense to me at the time as good denture making was thought to be a process shared between the ritual of the sequence of the production stages and a “good technician”. A non-successful denture was always to be blamed on the ability and/or willingness of the technician or perhaps the lower standards of their cheaper serv- ice. Having gained experience as a dentist, I now know that my teacher was right. Patient Experience From the beginning of my prac- tice, I have seen patients re- questing a new set of dentures while they were already hold- ing a relatively new set which they never actually managed to use. Despite the fact that this set would appear to have rea- sonable suction and restore some of the lost features, such as vertical dimension, teeth to show when they smiled etc., the patient would find it uncomfort- able and would therefore not use it. Chatting about their problem, they would talk about the various other sets made which had simply ended up in the bed side drawer. Most bizarrely and invari- ably they would end up wear- ing their old set with the com- pletely worn down teeth, badly discoloured, without any trace of stability and teeth “miles” drawn under the lips. Features such as angular cheilitis, deep diagonal lines from the corners of the mouth to the chin and massively reduced vertical di- mensions were overlooked as part of the ageing process. In some instances these sets had even been used for two decades, without any maintenance be- ing done to compensate for the gradual changes of the underly- ing tissues and in particular the bone resorption. Problems were usually more dramatic with the lower denture due to the centrif- ugal pattern of resorption. The denture was left with unnec- essary long flanges to sit over the melted away ridge, causing sores over the coronally mov- ing muscle attachments. The result was: unhappy patients who were unable to maximise the use of the - anyway limited - potentials of the full dentures. In many cases problems like social avoidance and varying degrees of eating disorders would follow. As for the aes- thetics, premature ageing oc- curred due to unsupported re- modelling with deep lines at the peri-oral region and dentures would move even when the pa- tient was talking. The list of the facts causing frustration is end- less. So, what can be done? Is there something that could al- leviate or - even better - remove all the frustration? Well, the answer is that a lot can be done. For those patients who are unfortunate enough to lose all of their teeth at one or both jaws, the answer is to start as a minimum with a good set of dentures. This set should then have to be maintained every two-three years by means of a reline. It should eventu- ally be replaced with a new set every six-seven years. This is the minimum to compensate for changes that naturally oc- cur due to bone resorption and the space gradually develop- ing between the tissues and the denture base. Following these guidelines, you can maximise the maintenance of the origi- nal facial features and mus- cle functionality. Do not forget that the changes occur slowly but steadily and, before you know, those teeth have disap- peared under the lips, the low- er jaw moving forward as the body adapts. Implant Placement The only way to maintain the alveolar bone is the placement of dental implants which ,by stimulating, will be kept there with a much slower rate of change. Using dental implants we can retain a denture. Over-denturesDr Anagnostopoulos presents an interesting case