"How many types of dentures are there? Which one is best, and how do they differ?" Dentures or artificial teeth are prosthetic devices designed to replace missing natural teeth. Their shape, size, color, feel, and strength are very close to natural teeth, helping patients chew food, speak comfortably, and smile confidently once again.
What Happens If You Do Not Wear Dentures?
Without 'teeth,' patients lose their confidence and feel hesitant when speaking. Eating also becomes difficult, which can impact the digestive system since food cannot be chewed thoroughly. This is particularly concerning for the elderly, as adjacent teeth can begin to shift into the empty spaces, and opposing teeth may over-erupt. This makes it easy for food debris to get trapped between teeth, leading to bad breath and making cleaning difficult. If left untreated for a long time, it can also cause jaw joint (TMJ) problems.
Types of Dentures
Dentures can be broadly categorized into 2 groups based on their usage:
1. Removable Dentures
This type of denture can be inserted and removed for cleaning by the patient themselves. They are available as either complete or partial dentures.
They can be classified by the base material as follows:
1. Metal Framework Removable Dentures
Made from a metal alloy that does not corrode or rust. They are designed with a thin base to fit snugly against the gums and teeth. They are strong, resist warping, allow patients to chew effectively, and retain the ability to feel the temperatures of hot and cold food.
2. Acrylic Base Removable Dentures
Available in both rigid and flexible acrylic bases. They are typically used temporarily while waiting for wounds to heal after tooth extraction before transitioning to a metal framework or fixed denture, though they can also be used permanently depending on individual conditions.
3. Fixed Dentures
Generally divided into 2 types, requiring the natural teeth to be reshaped to serve as supports.
- Crowns: A fixed dental prosthesis for individual teeth.
- Bridges: A fixed dental prosthesis that spans across and connects multiple natural supporting teeth like a bridge.
Fixed Dentures Supported by Dental Implants
When choosing fixed dentures supported by dental implants to replace missing teeth, the dentist may require the patient to wait about 2 months for the bone to fuse securely with the implant. After that, the dentist will place the abutment, crown, and connecting parts so the patient can use them efficiently, mimicking natural teeth.
Material Considerations for Dentures
The dentist will select the denture material based on several factors, such as occlusion (bite), chewing force, aesthetics, and the patient's preferences to make a shared decision.
The types of materials are broadly classified as follows:
- Full Metal: Made entirely of metal alloy. It is suitable for posterior (back) teeth that withstand heavy chewing forces, or cases with limited tooth height where it is impossible to reshape the biting surface thick enough for other types of crowns.
- Porcelain Fused to Metal (PFM): Suitable for all tooth positions, provided there is enough thickness after tooth preparation. It offers a good balance of natural appearance and chewing durability.
- All-Ceramic: Highly suitable for anterior (front) teeth or premolars that do not experience heavy chewing forces. It offers excellent aesthetics closest to natural teeth.
- Zirconia: Suitable for both front and back teeth that require high strength along with a natural appearance close to real teeth.
Advantages and Disadvantages of Dentures
1. Removable Dentures
Advantages
- Can replace a single tooth or multiple teeth using a single denture base.
- Patients can remove, insert, and clean them by themselves.
- In cases where the jawbone has resorbed significantly due to long-term missing teeth, the denture base thickness can be increased to support and improve the appearance of the lips and mouth.
- Lower cost compared to fixed dentures.
Disadvantages
- May feel bulky or annoying due to the thickness of the denture base on the palate (upper teeth) or next to and under the tongue (lower teeth).
- Speech pronunciation may sometimes be unclear.
- Food might not be chewed as thoroughly because chewing force is less than fixed dentures.
- Dentures can become loose over time due to jawbone resorption, as chewing force transfers directly to the gums and underlying bone.
- Visible metal clasps used for retention can be unappealing.
- Must be removed daily for cleaning and should not be worn while sleeping.
2. Fixed Dentures
Advantages
- Provides chewing efficiency very close to natural teeth.
- No bulky denture base to cause irritation.
- Shape and color can be tailored to closely match natural teeth.
- Materials are significantly stronger and more durable than removable dentures.
- Aesthetically pleasing with no visible clasps.
- No worry about having to remove them before sleeping.
Disadvantages
- For crowns and bridges on natural teeth, supporting teeth must be reshaped, resulting in some loss of natural tooth structure.
- Cannot be removed for cleaning. Certain areas beneath a bridge can be difficult to reach with a standard toothbrush, requiring special dental floss (floss threaders) as instructed by the dentist.
- Higher cost than removable dentures.
Patients Who Should Consider Getting Dentures Include:
- Patients who have lost natural teeth due to gum disease, Periodontal Disease, or severe tooth decay that cannot be restored.
- Having teeth with periodontal disease or unrestorable decay that have not yet been extracted.
- Teeth fractured or chipped from an accident that require extraction and cannot be restored with normal dental fillings.
Steps for Making Dentures
- Consult a dentist for evaluation and treatment planning.
- Take preliminary dental impressions to serve as models for treatment planning.
- X-ray the teeth and relevant jawbones (if necessary).
- Prepare the oral cavity, which may include tooth extractions, dental scaling, treating periodontal disease, dental fillings, or adjusting the bite (if there are concurrent chewing problems) beforehand.
- For removable dentures, the process moves to dental impressions, metal framework try-in, tooth shade matching, teeth try-in, and final denture delivery, which takes about 4-5 appointments.
- For fixed dentures, which involve reshaping the supporting teeth, taking impressions, and placing temporary and final crowns, the process takes around 3 appointments.
- For dental implants, the dentist will place the implant, attach the healing cap, connect the abutment, and place the crown, which requires approximately 3-4 appointments.
- Additionally, dental implants can be combined with removable dentures to help enhance chewing force and retention for partial or complete removable dentures.
Preparation for Dental Implant Surgery
After completing the treatment plan for dental implants, an appointment will be scheduled for minor surgery to place the implant. Patients should prepare as follows:
- Get sufficient rest before the appointment day.
- Eat a proper meal prior to the appointment time.
- If there are medications that must be discontinued before surgery, consult your personal physician and stop them according to instructions. If you have routine medications that do not need to be stopped, take them as scheduled.
- Bring a list of all your regular and current medications to inform the dentist before treatment begins.
- Inform the dentist of any drug allergies.
- For your peace of mind, it is recommended to have a relative or friend accompany you.
Denture Care
Caring for Removable Dentures
- Remove and rinse them after every meal, and rinse your mouth (if possible).
- Avoid chewing excessively hard or sticky foods, as the dentures may crack or chip.
- Remove dentures and clean them using a soft-bristled toothbrush and mild soapy water, gently brushing all surfaces and the base. Avoid using toothpaste because abrasive agents in toothpaste will cause dentures to wear out quickly and lose their shine.
- While cleaning, place a basin or bowl filled with water underneath to cushion the dentures in case they slip, preventing them from cracking.
- Before going to bed, place the cleaned dentures in a container filled with room-temperature water (with a lid). Ensure the denture is completely submerged. Remember that whenever dentures are not in your mouth, they should always be kept in water. This prevents them from warping due to drying out. You can also use denture cleaning effervescent tablets to help eliminate germs and stubborn stains more effectively.
- Avoid wrapping dentures in tissue paper, as patients frequently mistake them for trash and throw them away, requiring new ones to be made.
Caring for Fixed Dentures
- For individual crowns, brush the sides and biting surfaces normally as you would natural teeth, and use dental floss to clean the areas adjacent to neighboring teeth.
- For dental bridges, follow the same steps as crowns, but use a plastic floss threader to pass dental floss beneath the bridge to clean it thoroughly.
- Avoid chewing extremely hard or sticky food items.
Revised
22/09/2023
