When a full denture is the best option?

Picture of smiling denture patient

Please don't get the wrong idea.  I have spent most of my professional life striving to help my patients save their teeth. When they have a tooth extracted I usually recommend an implant replacement. That being said, sometimes less is more, literally. When a patient requires extensive treatments and financial sacrifice in order to allow for an implant supported restoration sometimes it still makes sense to go the implant route, but sometimes it isn't the best option

For some, including implants in their treatment plan , makes no sense. Patients can have conditions that make treatment planning an implant supported restoration a poor choice. These can include financial, mental or physical limitations. Health issues  can often make treatment planning implants more complicated since debilitated patients aren't the best candidates for extensive dentistry.

 Just because full implant case is  possible,  doesn't mean that they are better for a patient. The first reason is that they require an investment of time and money. Spending  $50,000 on an implant supported fixed appliance is certainly with in reach of many, but keep in mind that these types of restorations require maintenance and do not come with a life time guarantee. Further more "All on 4 cases" can require the removal of extensive amounts of alveolar bone that could be used to support a full denture.

I recently attended a seminar touting a type of "All on four dentistry" (4 implants placed properly that can hold a full arch of fixed restorations) and it was clear that this can be a great option for some  who have neglected their teeth to the point where their only good option is to have all their teeth in one arch removed, but it is also  provides a financial windfall to the dentists advocating this sort of treatment.

A well fabricated denture can be an extremely viable alternative for most edentulous patients. That is assuming that their dentists makes the appropriate effort in designing and fitting their denture. Fabrication of dentures is a little bit of a dying art and most dentists are not enthusiastic about making their patients dentures. Even when it is good dentistry for some patients, most dentists don't find it financially rewarding, especially when they are accepting a managed care fee schedule. In these instances the resulting denture can end up being inadequate and not a stellar example what a denture can truly be.

I have made dentures for some of my own elderly friends and family and none of them ever came back and asked me about having a full implant restoration  to replace their denture. Most had on going health problems and having a good looking and well fitted denture was a excellent solution. Their new dentures improved both their smiles and the quality of life. Many patient's with diabetes are prone to infection and are not necessarily the best candidates for implants. Similarly smokers can have problems with implants as well.

For patients like these who end up becoming edentulous, I often advocate fabrication of a full denture first. I explain that  if they feel that they want to explore the implant option after, we can always go forward at that point. An implant supported overdenture can be an affordable option for most edentulous patients. The truth is that most of my denture patients end up satisfied and opt to go no further .

This is not to say that all dentures are great, but the adage "it's not what you do but how you do it", is often true with dentistry .  In my hands full dentures are  a viable option for most edentulous patients since they require minimal upkeep and from a financial stand point can offer a patient the biggest esthetic bang for the buck. Implant supported options are not necessarily better looking and as I have written in the past the road to implants can be a long and winding one .



from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/12/when-full-denture-is-best-option.html - http://lspindelnycdds.blogspot.com/

Comments

Post a Comment

Popular posts from this blog

Help! My Child is Terrified of the Dentist

Image
If you’re the parent of a young child, you know their brains are similar to sponges that soak up everything around them—especially in their first five years, which neuroscientists say is when they’ll do the most learning and developing in their entire life. At this formative time, your child may amaze you with what they notice: your facial expressions, the different tones of your voice, and your habits. If your habits include regular dental visits and an excellent oral hygiene routine, they’ll notice and want to emulate you. If you happen to feel anxious about your dental visits, or you groan when you’ve got to floss and brush, they may synchronize and feel your dread. This could lead to dental fears that stick with them for years—potentially a lifetime! Kids Can Be Courageous If you’re feeling guilty right now, go ahead and put that away as it won’t serve you or your little one. Everyone has some room for improvement, and Coastal Pediatric Dentistry® is here to help show you an
Read more

Going for the Gold?

Image
On the left is the older allow, on the right the new one that my lab has chosen to use The cost of a penny weight of pure gold is currently $79.53. The cost of a penny weight of pure palladium is $130.6. It used to be that palladium was added instead of gold to the precious metals often used for pfms, but now laboratories are finding that palladium is no longer affordable. The lab that I am using has just changed the formulation of the metal it's using to one that has more gold than palladium. I really do not mind, but metals with more gold are softer and often easier for a dentist to accidentally polish off delicate margins. It is important when polishing "higher gold" formulations to exert less hand pressure when performing the final polishing of the crown's margins. Other wise there should be no problem with this change. Traditionally labs have chosen alloys with higher gold percentages for optimal esthetics, since alloys with higher concentrations of
Read more

Tongue Ties: What Parents Need to Know

Image
For a long time, people just didn’t seem to know much about tongue ties. In the early years of my practice, few of my patients had ever heard of a tongue tie. When I pointed out that they or their children might be tongue tied, I was often the very first practitioner who’d mentioned it to them. When I told them that a tongue tie might actually be the root cause of their oral myofunctional issues, or even their sleep apnea , I’m sure that some of them thought I was crazy. But in the last few years, things have changed so much! Initially, there was a small increase in the number of patients who were contacting me specifically about tongue ties. Dentists and orthodontists also began reaching out more frequently to discuss the application of myofunctional therapy exercises to tongue tie treatment. But in the last year or so, that little bit of interest has become a surge of awareness. Tongue ties and their effects on health and craniofacial development are finally becoming mainstream.
Read more