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This article was written and published by Tri-Lakes Printing for their Health Issue (similar to the pamphlet with just a bit more info!):

Why Dentures Don’t Work

Brent J. Nielsen, DMD

    This isn’t an article to convince you that you need thousands of dollars worth of implant bridge work to be comfortable and free of your current ill-fitting denture. Or to convince those that are in need of a denture to opt for the more expensive implant solutions. But, that seems to be the way the dental industry is moving. Most denture patients get the speech from their dentist that they will never be happy or truly comfortable with a conventional style denture and that it is just a stepping stone (or stumbling block depending on how you look at it) to an implant retained denture or, inevitably, full implant supported bridges. While it’s true that a denture will never be exactly like natural teeth, very few people actually need implant work to be comfortable. Most denture patients can be completely comfortable and happy with a conventional denture as long as it is made well. Furthermore, in an economic environment like the one that we are currently experiencing, it may not be a possibility for many people to come up with 50K to restore their mouths with implants when a well made denture for 3K will easily do the trick. The purpose of this article is to educate you, the patient, of what you should be looking for when having a denture made.

    There are mistakes that are easily made by both dentists and labs when it comes to denture fabrication, which could be readily detected by an educated patient. Due to high lab costs associated with dentures and low fee schedules of typical insurance companies, many dentists and labs must cut corners to make denture fabrication profitable. The following is a list of clinical and lab mistakes that should be avoided to ensure proper denture fabrication.

Clinical Mistakes:

1.) Faulty impression technique: conventional dentures must be made with a series of two different impressions, one for an initial study model that acts as a template for a customized impression tray, and a second highly accurate final impression that will record the soft tissue (gums) in your mouth and how they respond when in function (talking and chewing). Many dentists will take a single impression in an effort to save time and money, which sacrifices an optimal fit and accuracy.

2.) Inaccuracy in determining vertical dimension: Vertical dimension is a vague term, even to dentists, that describes how far apart the ridges of your upper and lower jaw should be when the teeth are touching. Generally there is approximately 2-4mm of space to play with here, if that space is not found you could find yourself unable to close as far as you need to or closing too far resulting in a very uncomfortable “jaw relation” or “bite”. This puts unneeded stress on your jaw joint which may cause muscle fatigue, headaches, and/or joint pain. This is what the dentist is attempting to find when you are having the wax rims tried in.

3.) Neglect of surgical options: Most uncomfortable dentures are uncomfortable because the bone below your gums is irregular and as the denture moves under normal function (talking and chewing) these irregularities are rubbed and pushed on, becoming bruised and tender. Many times these irregularities can be compensated for by adjustments in the denture, but every time the denture is adjusted the fit becomes less and less adapted to your gums resulting in loss of denture retention. The solution?- adjust the bone not the denture. A skilled dentist or oral surgeon can anticipate where these bony interferences will be and remove them leaving the bone smooth and preserving the adaption of the denture to your gums resulting in less denture adjustments and overall better fit.

Laboratory Mistakes:

1.) Setting of teeth to a proper Vertical Dimension: Denture teeth have a certain height and thickness and many labs do not want to adjust that. When a denture case is mounted to the vertical dimension that the dentist chooses, there is occasionally not enough room to fit the denture teeth and bases in the space between the ridges without significant adjustment by the lab. To compensate, lab technicians open the bite indiscriminately to fit the teeth. Many times the dentist will not notice the issue until the denture is completed and it is too late to resolve without remaking the entire denture. This problem should be resolved prior to the lab receiving the case by recognizing the surgical options to avoid these issues. If these issues are not resolved you may experience the same symptoms described in the Vertical Dimension paragraph above: muscle fatigue, headaches and joint pain, with an uncomfortable bite. It just won’t “feel right.”

2.) Injectable vs. Heat and Pressure Cured Acrylics: This is a main time and money saving point for laboratories. This has to do with the pink part of the denture (the acrylic) and correlates heavily with the strength and comfort of the denture. Injectable acrylics are cold cure (set up fast and get hard in a matter of minutes) and cannot be put under pressure. Heat and pressure cured acrylics must have the denture invested in dental stone. The acrylic is then mixed and packed into the denture flask and clamped to put them under pressure. To set the acrylic the denture flask is then put in a heated water and left for 6-8 hours. There are definite advantages to a heat and pressure cured acrylic denture base. When a denture acrylic is placed under heat and pressure microscopic bubbles are forced out of the denture base creating an extremely strong, compact material. Most denture failures are attributed to fractures along these bubble lines, so the less number of bubbles the longer lasting and stronger the denture will be. Also due to the greater strength and density of the material, the denture base can be thinner, providing for less need for surgical alterations of the bone and increased comfort during wear.

Tips for patients considering dentures:

1.) A cheap denture isn’t necessarily a good denture and in most cases is the opposite. To make a quality denture takes precision and large amounts of time. Cheap dentures mean that the dentist cannot spend the time needed to properly make a denture. Most dentists do not enjoy making dentures either. So, corners are cut and costs are lowered, generally at the expense of the patient’s comfort.

2.) Beware of the denture-in-a-day concept. Again this comes down to the time it takes to properly make a denture. It can be done even with heat and pressure curing, but chances are it won’t be. In my experience, to make a heat and pressure cured denture takes approximately 16-20 hours from start to finish. So unless you are receiving the denture the next day... it will, most likely, not be made to the highest standards.

3.) If you are going to spend the money on implants, spend it on the lower jaw.  They have higher success rates and patients are much happier with them. Lower dentures are significantly more difficult to get a good fit. Two implants on the lower arch will help retain a lower denture much better than gravity does (which is the main source of lower denture retention). Upper dentures are held in place by surface area and suction. Most everyone can have a well retained upper denture without implants. Don’t be fooled into believing that an upper denture can have the palate removed if a few implants are placed for denture retention. I’ve seen more implants torn out of patients mouths this way, especially with the new mini implants. There are specific places where mini implants can be successful and this is not one of them.

4.) If your desire is to have implant work done in the future, dentures can be retrofitted to implants. It isn’t an either or situation.

Over time dentures have proven again and again to be a very reasonable and affordable way to replace missing teeth. Patient education is the only way to ensure that you are getting the most out of your investment. As the patient it is important to followup with your dentist to be sure that he/she is taking your specific needs to heart and giving you a quality product that will hold up over time, function properly, and provide the esthetics that you desire.

About the author:

Dr. Brent Nielsen currently maintains a private practice in the north western area of Colorado Springs. He grew up in Highlands Ranch, Colorado graduating from Highlands Ranch High School prior to receiving his undergraduate degree at Brigham Young University in Provo, Utah. Following his education in Provo, He made his way to Fort Lauderdale, FL, where he earned his Doctorate in Dental Medicine (DMD) at Nova Southeastern University’s College of Dental Medicine. Dr. Nielsen then completed his formal dental education at Yale University School of Medicine’s prestigious General Practice Residency. While at Yale, Dr. Nielsen studied denture fabrication techniques with some of the most well respected specialists in the world. Dr. Nielsen is currently accepting new patients for all aspects of dentistry. To schedule a free denture consultation with Dr. Nielsen please call 719-599-3999.

Dentures are an area of dentistry that most dentists do not enjoy, understand or do well. There aren’t very many continuing education classes for dentists to take to refine their abilities in this area and as a consequence most of their “education” in this area comes from whatever minimal experience they received in dental school or clinical “tricks” they have picked up over time. Many of these “tricks” result in weaker, poorly fitting, and uncomfortable dentures that patients are dissatisfied with. While I was at Yale, I was able to work with Dr. Gary Horblitt. Dr. Horblitt is one of the most well respected prosthodontists out there. I was able to spend countless hours working with him, picking his brain on a wide variety of prosthetics cases. My fellow residents and myself were able to make our own dentures in his office thereby ensuring proper technique. This experience led me to the decision not to use laboratory support to fabricate my dentures. Every denture made in our office has been hand made by me utilizing the most sound clinical and laboratory techniques. As a result, the dentures that we make are the strongest, best fitting, most comfortable dentures money can buy. There are no “tricks” being used, no corners cut, and no justifications made in the fabrication of your denture. The following is a pamphlet that I made for patient education on dentures. There are a lot of things that patients can pick up on, red flags and general knowledge that can help you determine how well a denture is made. Please feel free to read it and ask any questions you may have!

Dentures: