Friday, December 7, 2012  
 
 
 

DR. PADGETT : Over the years of seeing patients I have noticed frequent common frustrations and concerns that patients have with their dental conditions. Some of these are as follows :

1) Poorly fitting full dentures

2) Missing back teeth and worn front teeth

3) Denture and Implant

Here are some solutions to these problems:

 
2) Front Teeth Esthetic Makeover – over many years of use, we frequently see a change in the color of teeth as well as wearing (flattening) of the edges. It usually ends up with teeth darker along with the shape of the tooth looking flatter and straighter. Many times we can reverse this look by esthetic re-contouring (reshaping the enamel) of the edges of the teeth providing the patient with a more youthful rounded shape tooth and then bleach the teeth to lighten the color. Many times this can result in a dramatic effect for a minimal amount of time and procedures.
Poorly fitting full dentures :     3) If we want to accomplish more than what recontouring can achieve, then we start to consider bonding the teeth and/or crowing in addition to reshaping to achieve the desired goal.

4) Replacing missing back teeth for support and more chewing can be accomplished several ways. Removable partial dentures can be anchored on existing teeth. Fixed bridges can be supported by existing teeth that simulate natural teeth.

Problem: When patient loses their teeth the bone slowly reduces over time. If a patient is wearing a denture, the result will be the dentures getting looser as time goes by. The patient also may start to notice their lip contours disappearing and the distance from their nose to chin decreasing as the teeth in the dentures wear down.

 
Treatment and solution : This can be solved by creating new dentures that restore the patient to their original vertical length from before the teeth started wearing down and the bone reshaping. The problem of poor fitting dentures is also resolved since the new dentures are fabricated to the current contours of tissue and bone.

A newly fitted upper denture usually has suction against the roof the mouth that aids in the retention of the upper denture. When a patient has a gagging problem then frequently we will incorporate implants into the treatment so that the denture can be designed to eliminate the gagging problem.

A lower denture never has suction or retention. The only predictable way we have for stabilizing a lower denture is to place implants in the bone and then place attachments in the lower denture so the denture snaps or is fixed to the implants. We can do this so it is removable by the patient or so that it is not removable.

When no back teeth are present implants can be placed in the bone, then used to anchor removable or fixed teeth on them. Sometimes these are used to provide additional support for a removable partial where the patients existing teeth are not strong enough. Many times implants are used to enable the patient to have teeth that they do not remove and feel and look like natural teeth. We accomplish this by fabricating the custom bridgework on the implants.
Denture & Implants : 
This is without question one of the greatest benefits we offer to patients in dentistry today. For patients with full dentures, we can place 2 to 6 implants in the bone which are then used to anchor the new denture prosthesis. This provides stability so that the patient can function with confidence and comfort. The new denture can be designed to be removable.

 

Missing back teeth & worn front teeth:
 

The next step up in comfort and a more natural feel in replacing lost teeth is to place 4 to 6 implants in the bone and then design the denture so it is fixed on the implants and not removable by the patient. We call this is a screw retained over-denture or Hybrid denture. In this design we are able to eliminate the plastic flanges and mimic, a more natural teeth form and tissue form while reducing the bulk of the prosthesis.

At this point in time this represents the best value when comparing the cost to benefit ratio. By using a high quality tooth and acrylic material with an embedded metal framework, we reduce the bulk while increasing the strength.


Problem : when a patient loses support in the back teeth the front teeth start to wear down excessively and many times chip and break apart. This is because front teeth are for tearing food and rear teeth are for chewing and support due to their angled relationship to each other.
  Treatment and solution :
1) If you just try to restore the front teeth, they eventually break down again. The correct solution is to provide some kind of support with the back teeth by using implants and bridges or partials, then restore the front teeth. The newly created rear teeth will then support everything which then prevents the front teeth from breaking down. Because you have distributed this biting forces throughout the mouth.
             
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