PERMANENT DENTURES

There are about 864,000 out of 10.5 million edentulous people are wearing dentures according to NOHSA (2000), National Oral Health Survey. This accumulates up to only 10% out of the actual population who needs denture. Are you amongst the 10% are  aware of the importance of wearing dentures or the remaining 10 million who are still in doubt.

THINGS THAT CAUSES LOST TEETH?

When a tooth is lost, in general it is probably due to one of these reasons:

• caries
• gum problems (periodontal diseases)
• trauma or accident
• congenital (e.g.: anadontia, hypodontia)
• supernumerary (extra teeth)
• impacted tooth

There are several aspects that are affected once we loose our teeth: psychologically and oral health in general.

A denture is constructed to improve social life, overall well-being, to avoid depression and most importantly to improve appearance as well as to restore self-esteem. These are all essential to increase quality of life.

Though psychological aspect is important, what most people neglect to see is the importance of maintaining oral health in general. Wearing a denture can minimizes bone resorption and trauma to the remaining oral structures while performing function such as eating and talking. Replacement of the missing teeth is crucial to avoid the remaining teeth present from rotating, over eruption and moving towards the space of the missing teeth (may cause misalignment and occlusion instability).

OPTIONS TO REPLACE LOST TEETH?

There are several options that you can choose to replace the missing teeth:-

• Denture
• fixed prosthodontics

Dentures

Dentures are removable appliance to replace and restore one or more teeth and its adjacent tissues. Complete denture also known as full denture are worn for complete edentulous on a single arch i.e. either on upper jaw (maxillary), lower jaw (mandibular) or both. Partial dentures are meant for patients who are missing one or more teeth on a particular arch. It can either be a removable partial denture (RPD) or a fixed partial denture. Fixed partial dentures are also known as ‘crowns and bridges’.

Function of dentures:

• improve aesthetic
• to allow mastication (eating)
• to assist tongue and lips during speech
• to support other important face structures such as lips and cheeks in expressing emotions

Fixed prosthodontics

Is a technique used to restore single or multiple teeth using fixed restorations also referred to as indirect restorations which include crown, bridges, inlays, onlays and implants. Main advantages are superior strength when used in large restorations, aesthetic and more comfortable than removable prosthesis such as removable dentures. Down side to it is that this technique is not conservative as it cuts good tooth structure for its preparation. Apart from that,  this method is much more expensive compared to dentures and overload stress can cause tooth fracture and sometimes pulp death.

NATURAL TEETH VS DENTURES

Every denture candidate must understand and accept the fact that though replacement of their missing teeth is very important but must not be evaluated the same as our natural teeth. Even the best and skillful denturist may not be able to replicate exactly the size, shape and alignment of the missing teeth.

• natural teeth are strong and able to withstand very high forces as they are embedded into the bone. Thus our natural teeth can function during eating (able to crushes and tear food easily).As for dentures, they are placed on top of the residual ridge (remaining bone that used to keep teeth in place), therefore the risk of the denture being dislodged from the mouth during function if proper adaption is not achieved during stages in denture construction, is present.
• aesthetically both natural and porcelain teeth are almost the same. In the case of carious teeth, misalignment and hypoplastic teeth, porcelain teeth used in denture construction can correct and make the denture wearer have better set of teeth than before.
• as stated above, natural teeth is very stable as they are embedded within the bone. Since the denture is only placed overlying the residual ridge, the stability of the denture is a bit compromised.

These are several criteria’s that can be taken into account during evaluation of a good denture:

Stability

The denture must be able to sit properly in the mouth without moving sideways during function. The more denture base covering the edentulous area, better stability will be achieved. This is subjected to the patients’ oral anatomy.

Retention

Is described as how well the denture will be able to resist vertical forces (opposite the direction of insertion). In complete denture, note that a critical element for a good retention is by achieving suction i.e. shares the same principle as a suction cup. Though sometimes trying to get ‘suction’ can be quite difficult, another option is by inserting retentive components in the denture design.

Physical anatomy

Anatomical structures may also contribute in stability and retention of a denture such as undercuts and retromolar pads. Other contributing structures are our masticatory and facial muscles. Muscles help to exert external force on the denture to keep it in place

“seek to preserve what remains than to replace all that is lost” - De Van 1956