Even though there has been a 10% decrease in edentulism each decade for the last three decades, the huge increase expected in the population group over 55 years of age will actually increase the demand for denture fabrication. And when patients desire dental implants to assist or support their prostheses for the treatment of edentulism, a well-fitting, esthetically pleasing and functionally stable set of dentures, which also allow for good phonetics, must be made first to determine the definitive tooth positions prior to planning the dental implants.
After being taught and mentored by Dr. Walter “Jack” Turbyfill (Dr. “T”), we have implemented and follow his denture technique to a “T”. From the preliminary impressions and the “training” denture (it’s actually a provisional denture) to the functional impressions and porcelain teeth to hold the patient’s vertical dimension, his technique produces the most esthetically pleasing and functionally stable dentures possible. The end result can be a long-term success for the patient (and he shows many cases where patients have had their dentures for decades) or it can be a starting point to plan implant supported or implant assisted prostheses.
Let’s focus our attention to just one component of Dr. Turbyfill’s technique, the training denture.
For the dentate patient with a mutilated dentition, a critical part of the reconstructive procedures to rehabilitate the dentition is to fabricate provisional restorations to “test drive” the occlusion, the envelope of function during mastication, the esthetics, patient comfort with the vertical dimension of occlusion and the phonetics. Why, for a patient undergoing complete denture fabrication, would one not fabricate a provisional denture?
What are the advantages of fabricating a training denture?
Patients that present for new dentures typically have old dentures with aberrant tooth positions, lost vertical dimension, poor esthetics, discomfort and, if their old dentures have plastic posterior teeth, there are heavy occlusal forces in the anterior due to the wear of the plastic teeth. Even worse, if the patient who presents for new dentures has no old dentures or teeth, there are no reference points to start from and denture fabrication can seem even more daunting for the practitioner.
The training denture allows the dentist and the patient the opportunity to evaluate all the factors mentioned above. Prior to the fabrication of the definitive dentures, any alterations deemed necessary from the “test drive” can be made. This ensures dentures of the highest quality for the patient.
In addition, when the training dentures are fabricated from the preliminary impressions, there is relief in the intaglio surface of the denture that provides room for a functional impression material (Hydrocast – Sultan Dental). Hydrocast is essentially a soft acrylic material that takes weeks to set and will record the differing redundancies of the various soft tissues in the mouth in function. It makes a very accurate final impression and border molds beautifully.
Certainly, the cost of fabricating a set of dentures in this manner will be greater, but there are many advantages of this technique. First, of course, is the quality of the final product for the patient. Second, the patient will have a back-up set of dentures that will fit beautifully if repairs are ever necessary to the definitive dentures.
There are also advantages with patient management using the training denture technique.
When making tooth position changes to idealize esthetics and function, many times patients don’t feel comfortable with such a dramatic change in their appearance. It sometimes takes a while for them to realize how much better they look with their lips supported or their vertical dimension opened back to where it had been previously or both. Fabricating a training denture allows the practitioner to get the patient most of the way to where he thinks the patient should be, and then additional changes can be made going from the training dentures to the definitive dentures.
The training denture also provides a cut-off point of patient acceptance. Because of the additional lab fees (second set of dentures) the fees with this process are higher. The fee for the entire process is quoted, but the patient can be told that a portion of the fee will cover treatment through the end of the training denture. Then, if they don’t see the value of the treatment, they can stop treatment at the end of the training denture. Likewise, the dentist can decide if the patient has unrealistic expectations and would be best not proceeding with treatment.
Future topics relative to complete denture fabrication will cover:
- Making great preliminary impressions.
- Esthetically positioning the anterior teeth.
- Using photography to communicate with the laboratory technician to predictably and efficiently achieve great esthetics.
- Denture occlusion and tooth design – where and why.
- Making a bite registration with a central bearing point – easy and unbelievably accurate.