Among the most challenging operatory procedures to conduct successfully is a maxillary full arch reline. In many cases, once the denture is returned to the patient, somehow or some way the VDO and anterior teeth have changed and the patient complains that they don’t “feel” or “look” the same. “Why is my denture feeling and looking Bucky?” is often remarked by the patient.
Crucial operatory steps conducted to ensure reline accuracy and patient comfort in the end:
Dear Doctor, about half the cases I receive in my lab that are in need of a set-up arrive without a mid-line mark on the bite-rim. There are three main purposes of using a lab fabricated bite-rim and using it correctly to relate crucial chair-side information to the technician:
(1): Most bite rims, as they are made to a cast of the patient’s mouth, often must negotiate undercuts that are sometimes quite severe. This means that the technician must “block-out” these undercuts prior to bite rim fabrication; especially when light-curing material is being used for the bite rim. Once cured, light-curing material becomes ridged. Once cured in to any undercut on the cast, it would be virtually impossible to remove without breaking the bite rim. So, block out material is used to fabricate the bite rim. As a result, the bite may be loose at the time of records and teeth confirmation.
a. Check that the bite rim is stable bi-laterally and anterior posteriorly. If no stability is evident, retake the final impression in the bite-rim itself for the lab to establish the cast of the patient’s mouth. If so, then all is good. Continue with records or try-in. The looseness will change to tightness once the denture is processed in acrylic, as it will re-engage all available undercuts on the cast.
b. Some clinicians will use denture adhesive to stabilize the bite rim. Remember that bite rim stability prior to using adhesive is fundamental.
(2): The bite rim is used not only to establish the maxillary and mandibular relationship as portrayed in the patient’s mouth but to relate that relationship to the technician to help them do their work.
a. Running through phonetics and comfort are important too and must be done early-on to avoid reset or even remake charges.
b. This is also a great time to establish patient expectations of how the denture will feel and look. Choose teeth shade and shape but more importantly, for replacement dentures: What would you like to see different Mrs. Smith? Would you like straighter, lighter, longer, shorter, smaller teeth?
(3): Marking the mid-line on the bite rim as well as the horizontal line are crucial steps to not only ensure proper teeth position but to minimize the cost of fabrication of the denture by minimizing the number of “resets” needed to achieve the final goal.
Both the Mid-line and Horizontal lines serve a purpose:
In proper order to align the “centrals” for the try-in, the horizontal line MUST BE perpendicular to the vertical line represented. The patient’s two front teeth should be in proper relationship to: the face’s center line, the chin, the canine teeth, the nose etc.
The only time the exception exists is when there is a specific request by the patient to set the front teeth differently, to make them appear “out-of-line.”
Some patient’s believe this LOOKS more natural and in some cases this is true.
In most cases, this request is non-existent and the rules preceding should apply as stated.
Doctor, thank you for taking the time to take the appropriate steps and make the appropriate marks on those bite-rims because it makes all the difference in how that denture will service the patient. Fit, accuracy, bite attainment and mid-face alignment marks are all so important in delivering a denture to your patient successfully the First Time. Eliminate the need for additional try-ins and laboratory resets. Use the bite-rim for what it is made for…Sharing the information of what you see chair-side, to the bench of the technician.
The question always comes up about cleaning dentures and what method should be used. Although there are a few important guide-lines that are recommended and a few dangerous chemicals to avoid, I have always firmly stood with the belief that each denture wearer should embrace the regimen that works best for them.
The most important element in denture or partial hygiene is consistency!
As a daily regimen, dentures or partials should be cleaned well. Most denture wearers haven’t adopted a well regimented daily habit of cleaning. We’ll go through what might be a daily regimen that you can adopt:
Chemicals to avoid as cleaners:
Bleach Efferdent Polydent
If your dentures fit poorly or give you soreness, immediately make an appointment with your dentist to have them adjusted. Dentures shouldn’t hurt and if they do, they were either made improperly or are in need of adjusting.
Lower denture comfort is now available through the use of a new product called Novus™ DENTURE LINER. Novus is a custom made denture liner that helps a lower denture fit better, feel better and function better for a longer period of time.
Novus™ is a PNFTM based denture liner. PNFTM is made from dichloropolymer ("DCP") and is an inorganic polyphosphazene material. The material was manufactured and sold in the 1980's and 1990's. PNFTM based products were originally developed and manufactured on a commercial scale by Firestone Corporation with US Department of Defense funding. Novus™ was developed with a National Institute of Health grant and funding. Hygenic Corporation first commercially introduced the product into the international dental market in the late 1980's.
The need for a comfortable denture is in more demand today than ever. The advancements of technology coupled with the tremendously high number of dentists coming out of school has propelled a failure rate in the fabrication and fitting of lower dentures like never before. Two thirds of all denture wearers are unhappy with the fit of their dentures. Novus has come along at just the right time: Hypo allergenic, Hydrophilic, antifungal, radiopaque, low surface tension, low water absorption, firm yet a permanent resiliency, no hormonal or carcinogenic concerns, absorbs shock while chewing, completely adjustable with traditional rotary dental instruments and finally, supported by the FDA.
On the part of WSQ – White Square Chemical, and the Novus team, the mission is simple. To bring back the comfortable lower denture and change the way denture wearing is experienced.
The application of Novus™ to an existing denture or during the creation of a new denture is routine and similar to what dentists and technicians already know about the clinical protocol and laboratory application of soft liners. Like with any new product, there is a slight learning curve to understanding the proper application of Novus™ but once learned the process becomes ho-hum, with lasting and life changing benefits for the denture wearer.
I’ve been in the denture laboratory industry for many years. I started as a child. I would visit my Father’s lab as a very young boy. I remember the sights and sounds of the lab. There were smells of all sorts of chemicals and boiling pots of water that threw copious amounts of humidity in to the already wax laden air. Today I’m 51 years old and I think back to my sensory experiences and I remember Dad tending to patients with doctor in the operatory over dentures and the usual complaints that accompanied them, and Dad always had a way to resolve the problem. The patient always left happy. Well…happier anyway. The problems with lower dentures never really went away completely for most patients. Oh, there were a few that arrived at comfort but not a majority.
I’ve since taken over the dental lab from my parents, Nick and Carmen DeAngelis and even 30 years later I still see the same issues with patients and their lower denture concerns. Of course today, with the advances of dental implants, many of today’s denture problems have gone away for the few that can afford it. For those that cannot however, there’s Novus™. We spend much time applying Novus™ to lower dentures mostly and some upper dentures as well. Upper denture Novus application I will visit and explore various applications and techniques in later blogs. As for now, here are some of the direct questions and quotes; conversations that have taken place between doctor and patient concerning the Novus™ liner as it pertains to comfort and function:
Q = Doctor asking A = Patient response
Q. So, how do you like the Novus liner?
A. I like it a lot. Never really felt anything like this before.
Q. What’s different about Novus compared to your other denture?
A. It’s just more comfortable all around.
Q. Give me an example please.
A. Well, when I eat, it doesn’t move around on me like my other denture. And the pain isn’t there either. I’m very comfortable.
Q. How often are you wearing your dentures?
A. I use to wear them only when I needed to: going to the store or out and about in general, having company over or just to get through a meal and that would be it, out they’d come.
Q. We’re going to conduct a test. I’d like to remove Novus™ from your denture and see how well you do, better or worse. Are you okay with that?
Q. So, it’s been a week now. How are things with your denture?
A. Could you please put that stuff back on my denture? I would really prefer it. This denture is too hard and uncomfortable.
Doctor: Sure Mrs. Smith. Right away.
For years patients have complained about their lower dentures. Across America the statistics are in. More than two thirds of all denture wearers are unhappy with their teeth. TWO THIRDS!!! Wow..