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Dentures and implants

Technically speaking, a denture is any prosthetic use to replace a partial, or a complete dentition....

Posted by Zev Kaufman, DDS

Technically speaking, a denture is any prosthetic use to replace a partial, or a complete dentition. It can be fixed (permanent), such as a bridge between two teeth to replaced a missing tooth, or a removable denture to replace one or more teeth.

This discussion will focus on the REMOVABLE, partial and complete dentures and the used of implants.

There are two parameters by which dentures are evaluated:

Resistance form--the ability of the denture to absorb and transfer the masticatory (chewing and biting) forces to the underlying bone and tissue. This transfer of forces should allow a person to function comfortably, without pain or sores. It is generally governed by the quality of the denture making process from impression, to laboratory fabrication, to fitting and upkeep.

Retention form--the ability of the denture to stay in place while in function. This parameter is mostly determined by the remaining oral structures used to secure the denture in place. The construction of the denture is very important, however, if there are teeth present to hold the denture in place, it will stay put far better than a complete (full) denture which rests on limited bone (low ridge).

This is where implants (mini, or conventional) come into play.

In the early 1980's a predictable way to place "root form" implants was introduced to dentistry, and we never looked back.
Dental implants, as we know them today, are titanium screws/anchors, which are placed into the human jaw bone. These implants can be used to anchor a variety of prosthetic devices in place. At first, they were use to anchor a complete lower fixed bridge. Four to six implants were placed into the lower jaw, and a metal structure covered with pink acrylic (plastic) and denture teeth was screwed in place into the implants. As the confidence in the implants grew, the use of implants to replace single, free standing, not connected, teeth, became common. Today, the restoration of choice, when a tooth, or multiple teeth are missing, is the implant supported and retained prosthesis.

The standard of care has evolved, as well. Whereas in the past, the implant retained prosthesis was the "alternative" treatment, today, it is the treatment of choice, mostly due to the fact that the implant retained prosthetic does not involve the used of adjacent teeth for anchorage. When it comes to complete (full) lower dentures, using two implants with "snap" attachments to the denture is considered the standard of care. All the studies of biological factors and psychological factors point to the fact that the implant retained removable denture is an excellent restoration, allowing people to function in a higher capacity and preserving the remaining oral structures.

The most common misconception I have encountered in removable denture is "once the implants are 'in', the denture will be comfortable."

The most important factor to the success of implant retained denture therapy is the proper fit of the denture--the Resistance Form. Only when a denture is evaluated and is deemed satisfactory in function, should implant therapy begin. This holds true especially in situations where one does not have dentures at all. The placement and position of the implants are determined by the position of the teeth and the shape of the well-fitting denture. Placing implants prior to the fabrication and evaluation of a denture can result in problems and improperly placed implants.

Proper implants treatment should START with the final prosthetic (denture).View Thread

Posted by Zev Kaufman, DDS

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Help Our Experts Help YOU - PLEASE READ

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Hurting Gums and Teeth

What would cause my gums to hurt really bad and also my bottom wisdom tooth hurts and I know it...

Posted by NicoleRoseMatthews

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Reply: Root canal pain for a year and a half

Dear Beatlegurl: Sorry to hear about our troubles. I sounds as if this tooth of yours has been...

Posted by Zev Kaufman, DDS

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Reply: White spot on tonsils

Hi Nate and welcome to WebMD, I encourage you to repost your message (though there's no need for...

We never touch people so lightly that we do not leave a trace. ~Peggy Tabor Millin

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WebMD Healthy Mouth Checklist

http://www.webmd.com/oral-health/tool-oralcare-checklist/...

Need to brush up on your dental care habits? Keeping your teeth and gums healthy is good for your...

We never touch people so lightly that we do not leave a trace. ~Peggy Tabor Millin

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Reply: Hard swelling in cheek after wisdom teeth removal

Dear An_245262: Sorry to hear about your trouble. This could be an infection, but if it hasn't gone...

Posted by Zev Kaufman, DDS

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Reply: Regenerative Periodontal Endoscopy

Californiadenizen, Thank you for your post. Your situation is similar to others I have read about online....

Posted by aggies93

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Reply: Wisdom Teeth havent come in can i get braces?

Dear Jossiec87: Wisdom teeth are usually not a problem when it comes to orthodontics. If they are,...

Posted by Zev Kaufman, DDS

1 Reply | Reply | Watch This Discussion Report This | Share this:Wisdom Teeth havent come in can i get braces? Dear Jossiec87: Wisdom teeth are usually not a problem when it comes to orthodontics. If they are,...

Reply: I have an inflammation of my gums and no idea how ...

To start with you should see a dentist right away. If that is not possible, get some salt and baking soda....

Posted by Chrissy4605

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Reply: Orange Tongue?

I've had the same issue without any good advice from MD's, some even asking me if I've eaten anything...

Posted by An_245260

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Reply: (2 laterals) bridges vs implants - replacing Maryl...

Dear Jay556: I just realized that your question was never answered. I apologize for that. However, I...

Posted by Zev Kaufman, DDS

1 Reply | Reply | Watch This Discussion Report This | Share this:(2 laterals) bridges vs implants - replacing Maryland Bridges Dear Jay556: I just realized that your question was never answered. I apologize for that. However, I...

America Asks About Oral Health

http://www.webmd.com/oral-health/america-asks-12/default.htm

Check out this new WebMD resource! Oral Health Care: Questions and Expert Answers

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Reply: Recurring tooth pain after root canal

Dear An_245125: It is nearly impossible for one to diagnose over the internet without looking at...

Posted by Zev Kaufman, DDS

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Reply: Gum Fistula?

Hi landyboosmommy, I think that it is probably time to see an oral surgeon who can...

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Reply: Burning Lips

Hi galway 2012, I am sorry to hear your husband has been having a difficult time....

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Reply: Receeding gums

Hi An_245097, The most likely reason people develop receding gums is periodontal...

Posted by Gwen Cohen Brown, DDS, FAAOMP

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Reply: Tooth Pain

Dear Brighteyeslover: It is not uncommon for a root canal to be performed and a while later for the...

Posted by Zev Kaufman, DDS

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Reply: Pain After Root Canal and Filling?

Dear An_245060: Pain is not normal. It is our bodies' indication of "something is wrong". You must go...

Posted by Zev Kaufman, DDS

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Tooth Decay from the inside of the tooth

My 24 year old son is a Ewings Sarcoma survivor. He is having some dental problems and the dentist told...

Posted by supplyofficer

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Reply: I HAD MY WISDOM TEETH PULLED

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Posted by Zev Kaufman, DDS

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Reply: Pain not relieved by inplant

Dear An_24507: I am so sorry to hear about your wife's problem. However, what bothers me is that in...

Posted by Zev Kaufman, DDS

1 Reply | Reply | Watch This Discussion Report This | Share this:Pain not relieved by inplant Dear An_24507: I am so sorry to hear about your wife's problem. However, what bothers me is that in...

Root Canal

I had a root canal performed by an endodontist yesterday late in the afternoon and followed it up by going to...

Posted by Seamusin

I had a root canal performed by an endodontist yesterday late in the afternoon and followed it up by going to the pharmacy immediately after to pick up a prescription for codeine. The doctor was very nice and told me I behaved very well throughout the procedure. When I asked her what I could expect in terms of side effects and recovery time afterwards she told me it varied from patient to patient depending on issues such as pain threshold/tolerance, possibility of infection, etc. I discussed with her the fact that I had taken time off of work to have the procedure done that day and had arranged to take the next day off as well and have someone cover my shift as a precaution for any pain, discomfort, or other issues I might experience. She thought it was normal. In fact, most of my friends and colleagues had advised me to do so in anticipation of any effects from the procedure.

I followed up with the dental office for a doctor's note this afternoon as I planned to return to work tomorrow, two days after the root canal. The receptionist stipulated they would only give me a note for the day of the procedure and not for today as well, the day after the procedure. She asked me if I was still in pain whereupon I said yes and explained that I was up until nearly 5am this morning before going to sleep due to the pain and discomfort I was feeling and finally fell asleep only after taking a second codeine tablet to relieve the symptoms. She told me there aren't any side effects and that I should have been able to return to work immediately. I am better now and feel comfortable to return to work tomorrow but only after enduring a full night of sleeplessness and discomfort. She told me it was the office manager's decision to refuse my request and when I politely asked to speak with her, the receptionist refused and told me it wouldn't change anything. I calmly insisted and waited in the waiting area only to be told a few moments later by the receptionist that the office manager had left for the day. I doubt the validity of this since she had only spoken with her a few minutes after initially producing the letter but I decided to peacefully leave the office at that point feeling rather frustrated and upset with how I had been treated. Is all of this normal, or did I merit better treatment for something which I felt was quite reasonable and understandable?View Thread

Posted by Seamusin

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Reply: Dental X-rays frequency

Dear niko78: The first thing to do is to stop paying attention to "sensationalism" type research. ...

Posted by Zev Kaufman, DDS

Dear niko78:

The first thing to do is to stop paying attention to "sensationalism" type research.

Telling you that dental X-rays are safe, effective, and have prevented many problems with tooth decay, periodontal disease, and early diagnosis of jaw bone cancer, etc. IS NOT SEXY! it is a daily event, and it is NOT news. However, it is far more exciting to tell you that some people who had a rare brain tumor reported having dental x-rays taken (and who hasn't had X-rays taken?)

The news media did not tell you that the X-rays used over twenty years ago used greater radiation as well.

If you are under the age of 40-45, this study does not apply to you at all. This type of research is at best a proof of association, and not causation. I could have as well concluded that the people with the brain tumor had bad teeth and had to go to the dentist more than the average.

The American Dental Association has guidelines for the quantity and type of X-rays to be taken and your dentist should be following the recommendation based on your susceptibility to caries and periodontal disease.

The general guide lines include:

Four bitewing x-rays (that show the teeth in a closed mouth position every year.

Full mouth series of 18-21 X-rays every three years.

This frequency is typically adjusted based on your genetics, susceptibility to caries and periodontal disease, and home care.

Digital X-rays are better. They give us excellent diagnostic features as well as a much reduced radiation dose.

It is better is your records are taken digitally, however, if you have a dentist whom you trust and he/she still uses conventional x-rays, you need to decide if your trust is more important than the minor radiation that you get.

Maybe you should talk to your dentist and explain your concerns... who knows, you might sway him/her to go digital.

Best of luck,
Dr. Zev KaufmanView Thread

Posted by Zev Kaufman, DDS

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Reply: White line on roof of mouth normal?

Hi An_244829,I am going to try to give you a simple answer - if your boyfriend has ever...

Posted by Gwen Cohen Brown, DDS, FAAOMP

Hi An_244829,I am going to try to give you a simple answer - if your boyfriend has ever had a cold sore (HSV 1 Herpes Simplex Virus 1) then no you cannot give him herpes. If he has never been exposed to HSV then you can give him herpes but it won't present as a cold sore. Now I am going to give you the longer more complicated answer.

I order for this to make any sense I must give you more information. Oral herpes, genital herpes and the virus that causes chicken pox are all alpha herpes viruses, meaning that behave in a similar fashion, once exposed to the virus it remains with you for the rest of your life sleeping (dormant) in either your spinal cord (chicken pox) trigeminal root ganglion (oral herpes) or the dorsal root ganglion (genital herpes).

With oral herpes one of two things occurs following your first exposure to HSV1, either you develop something called primary herpetic gingivostomatitis - blisters all over your mouth lips and throat that resemble the blisters of chicken pox only more localized, with fever and malaise. Primary herpetic gingivo stomatitis take about three weeks to heal once you start developing blisters - or much more likely you do not develop any blisters (a sub acute response) but you do develop antibodies to the HSV 1 virus. After this inital exposure, visible or subacute, the HSV1 virus goes to sleep waiting to be woken up usually during times of stress, fever or exposure to cold weather.

Primary exposure to HSV 1 tends to be seen in children under five with a small peak during the first two years of college. So more than likely your boyfriend has already been exposed to the virus way before you met each other and the virus is at this moment waiting to wake up and when it does then he will develop a cold sore.

So this is the actual response, if has never been exposed to HSV1 before he met you and you kiss him most likely nothing visible will occur or very unlikely he will develop primary hermetic gingivostomatitis stomatitis. If in fact you have a cold sore and you kiss him he may develop a cold sore, not because you gave him the virus but rather because he got stressed out and reactivated his own sleeping HSV1.

By the way, although less common secondary herpes can also occur in the mouth in the gums and the palate.

The way you described your mouth seems to be within the range of normal but please remember that I cannot diagnose on line and if you still have questions you should speak with your dentist or physician.

I hope this helps. If you need clarification fell free to post back.

And lastly, this is not a sexually transmitted disease!

Dr. Gwen Cohen BrownView Thread

Posted by Gwen Cohen Brown, DDS, FAAOMP

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Reply: Toothache and Ear Pain

Hi An_244789, I am sorry you are having such a difficult time. Although I cannot...

Posted by Gwen Cohen Brown, DDS, FAAOMP

Hi An_244789, I am sorry you are having such a difficult time. Although I cannot diagnose on line what you are describing is consistent with one or two clinical situations.

Infections in the mouth due to cavities or teeth that have broken can most definitely cause pain in the area of the affected tooth and/or referred pain, meaning that the pain can be felt away from the tooth. Referred pain is more likely to occur with infections of the mandibular molar teeth, the ones in the back on the bottom jaw. If your pain is tooth related seeing a dentist is your best bet. If you don't have an active infection (pus and severe pain) you can wait but it is in your best interest to have it looked at.

The other possibility is that the pain is not coming from the ear or the teeth rather it is coming from the temporal Mandibular joint, the TMJ. If this is the case and your lack of an ear infection with an earache suggests that it may be you should see a dentist trained specifically in treating TMJ disorders or a pain management doctor. Often times massaging the muscles around the joint, behind the ear and in front of the ear can help. You can also alternate heat and cold locally, a heating pad then an ice pack, five to ten minutes each on and off for fifteen to twenty minutes a day on both the right and left TMJ.

Speak with your dentist or physician to see if they can recommend an anti inflammatory medication which will decrease the swelling around the joint and relieve some of the pain at the same time.

You may be a good candidate for a nightguard however they can be quite expensive. Check with yiour local hospital to see if they have a dentist on staff as hospitals sometimes have a sliding fee schedule. Don't let anyone alter your bite while you are in pain, if they do it may feel better at the time but it can also alter your bite so that it always feels a little off.

I hope this helps,

Dr. Gwen Cohen BrownView Thread

Posted by Gwen Cohen Brown, DDS, FAAOMP

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Reply: Brown spots on tongue

Hi An_244763, I apologize for the delay in getting back to you. Although I cannot...

Posted by Gwen Cohen Brown, DDS, FAAOMP

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Reply: Husbands Gums Look Black/Blue.

Hi An_244934, Patients often present with intraoral pigmentation, it tends to be...

Posted by Gwen Cohen Brown, DDS, FAAOMP

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Reply: Tongue/Lip

Hi IMHERE1949, I am glad you are feeling better! Please be careful when you are swishing...

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Reply: Floating lump in lower lip

I have this same thing in my upper lip and it has been there before but I dont know if it went away or I...

Posted by legalamanda06

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