When considering full or partial dentures to replace missing teeth, clinicians must decide which option will be most suitable for their patients. Important considerations include: relevant anatomical, psychological, and physiological factors and the patient’s medical history. Previously existing dentures must be carefully assessed while planning treatment. Ideally, the selected course of treatment for patients with existing dentures will improve upon current dentures. Establishing a good rapport with the patient is essential to discover their expectations and learn about possible complaints regarding appliances that are currently being used. Complaints may include appearance, speech impediments, problems while eating, or loose fittings. Soft and hard tissues must be carefully assessed, as should retention and stability.
Dentures can be implant-retained or supported by the oral mucosa, while partial dentures may be supported by dental clasps or special attachments. Partial dentures can be constructed with lightweight metal framework or made entirely from acrylic or plastic. Some dentures will use more than one type of material, combining the very best aspects of each to create a functional, yet aesthetically-pleasing appliance. Several points must be evaluated when deciding which type of denture will be most suitable.
Partial or Full Dentures?
Many patients will have natural teeth still in place. The longevity of these teeth should be estimated, with particular consideration for their susceptibility toward caries¹ and the potential costs required to restore and maintain these teeth. Sometimes the condition of remaining teeth is impaired by loss of supporting alveolar bone, which can create problems if a partial denture were to be fitted. One possible option is to splint the remaining teeth- a potential choice for patients who wish to retain existing natural teeth or who are prepared for additional cost and time required for treatment.
Improved endodontic and periodontal care is increasing the numbers of people who are partially edentulous. Teeth that previously would have been removed are now being saved. Unfortunately, this isn’t always the case; there will still be people for whom further tooth loss is inevitable. In this case, a partial denture may be a good way for them to become accustomed to the idea of eventually wearing full dentures.
Removable or Implant-Retained?
Implant-retained dentures offer patients improved stability and retention. Greater patient awareness and demand for these prostheses has increased their popularity. Research² has found that implant-retained prostheses can improve patients’ quality of life and confidence, and that most people, when given the choice, would choose fixed prostheses over removable options. Patients who have have lost their natural teeth due to neglecting oral hygiene will need oral hygiene education prior to implant placement³. Those unwilling to change their routine should be advised that this will greatly affect the long-term success of treatment. In addition to oral hygiene habits, the amount of bone present will also determine appropriate treatment. A patient should consider whether they can tolerate bone augmentation and the higher costs involved if bone is inadequate. The overall health of a patient is always an important consideration and medically-compromised patients may not be able to undergo this treatment.
Metal or Plastic?
Acrylic full dentures can be aesthetically-pleasing, especially when using the highest-quality denture teeth. However, for partial dentures, it is often preferable to have a lightweight cobalt chrome framework. This provides strength, structure and comfort- removing some of the bulk from the prosthesis results in a more comfortable wear. Alternatively, flexible denture materials can be used, conforming closely to the natural shape of the mouth and creating a comfortable and discreet appliance. Cobalt chrome framework can also be combined with flexible denture materials like Valplast and CustomFlex. This combination gives partial denture wearers the best of both worlds: a strong, lightweight, aesthetically-pleasing denture with good overall stability.
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