The Problem Denture How to turn making dentures

The Problem Denture (How to turn making dentures into a science - rather than a lottery) Dr. Mark Shupac BDS

Current methodology? • Look at the dentures (in a vague, confused sort of way. . ) • Ask patient if they liked the shade (and try to talk them out of the lightest shade on the guide) • Launch into the impressions immediately (usually without thinking) • Hope for the best. • Surely there must be a better way. . . ?

Well there is! 1. What is the problem? Ask the patient. Do not ignore their problem - ever! If you feel you can’t fix it then tell them. 2. Analyse their existing dentures. Find out what is good and what is bad: • Vertical dimension & FWS • Teeth positioning • Aesthetics (your opinion & the patient’s opinion) • Coverage, extension (we can check this: visually and by applying greenstick across the posterior margin) • Occlusion (is it even contact, no interferences etc? )

Vertical Dimension & FWS • OVD (Occlusal Vertical Dimension = vertical dimension when teeth in contact and maximum intercuspation) • RVD (Rest Vertical Dimension = vertical dimension when jaw is at rest & teeth should be apart) • FWS (Freeway Space = RVD – OVD) • It’s the difference, stupid…. . !

Measuring FWS Method 1 Changing angle of bite gauge will change measurement Method 2 Failure to position marks in exactly the same place each visit will change the measurement

Importance of Tooth Positioning • Many problems can be attributed to tooth positioning errors: § Aesthetic problems § Some retention problems § Freeway space problems § Patients struggling to adjust to new F/F because of new shape/teeth positioning § So how can we fix a tooth positioning problem? How can we measure the teeth position?

A helping hand: the Alma Denture Gauge • Measure vertical & horizontal distances from incisal edge to incisal papilla of old denture. • Decide on the design of the new denture (compared to the old). • Write measurements on lab ticket for bite rims. • Get correct bite rims. (see video next slide) • Check measurements at try-in and/or stages (if needed).

Video 1 – Measure Old Denture

Alma Denture Gauge (recap) • Helps to define tooth position by measuring the vertical and horizontal position of the incisal tips in relation to the incisal papilla. • Transfers that information as a numerical reading between surgery & laboratory. (Both dentist and technician have a gauge). • Clinician can analyse dimensions of old dentures to establish good and bad design aspects. • Clinician can properly plan the dimensions and tooth position of the new denture. • Prescribes bite rim size (huge time saver).

Video 2 – Bite Registration

Yes, but why use the gauge? Because it makes us think about our design…. • Vertical dimension (compared to old F/F) • Tooth position • Coverage (extension) • Bite classification (I, III) • Other stuff (teeth shape, size, shade etc. )

So what have we achieved? • Proper analysis of old denture, leading to. . • A real diagnosis of the old dentures (good & bad) • A design (treatment plan) for the new denture. • A method of monitoring the progress of the new denture. • Minimised the need to adjust the bite rims (because it is tedious and boring work) • Work smart, not hard!

Alma Denture Gauge www. astekinnovations. co. uk Alma Denture Gauge Instructions