The denture delivery appointment is a day that both the patient and the dental team look forward to. It marks the moment when the dentures are finally ready to be placed in the patient’s mouth.
However, despite all the careful planning and work that has gone into creating the dentures, there is often some level of anxiety present for everyone involved.
Ideally, the dental team would love to hand the dentures to the patient and have them fit perfectly without any adjustments or adaptation needed. But in reality, that is rarely the case. There are usually some adjustments and fine-tuning that need to be done to ensure the best fit and comfort for the patient. This is a normal part of the process.
During the denture insertion appointment, the dentist will carefully evaluate and make any necessary adjustments to the dentures. This is done to create the best chance for the patient to adapt to wearing the dentures comfortably. It is a step-by-step process to ensure that everything fits properly.
The dentist will evaluate various aspects of the dentures, such as the fit against the gums, the alignment of the teeth, and the overall comfort. They will make any necessary adjustments to eliminate any errors or discomfort.
While the denture insertion appointment may seem straightforward, it requires careful attention to detail. The goal is to provide the patient with dentures that fit well and are as comfortable as possible. By carefully evaluating and adjusting the dentures, the dental team aims to create a successful outcome for the patient.
Steps for correcting denture problems during insertion
Step 1: Adjust Denture Intaglio (the inside surface of the denture)
The first step in the denture delivery process is to ensure that the denture has a stable and comfortable fit against the gums. This evaluation and adjustment are typically done one arch at a time, starting with either the upper or lower denture.
To assess the fit, a pressure indicating paste is used. This paste helps the dentist see where the denture is putting pressure on the gums. There are commercially available pastes for this purpose, or the dentist can create their own paste by mixing lanolin and zinc oxide powder. This custom paste can be stored in a disposable syringe until it is needed. It works best when applied to a dry denture surface.
The paste is applied to the inside surface of the denture, and then the dentist carefully inserts the denture into the patient’s mouth, making sure to apply gentle pressure around the area of the first molars. This allows the dentist to see any areas where the denture is causing discomfort or pressure.
Common adjustments may need to be made in areas where there are bony or soft tissue undercuts, such as:
- The maxillary tuberosities (bumps on the upper arch)
- The hauler notch (a depression behind the upper front teeth)
- The retromylohyoid areas (behind the lower back teeth)
By evaluating and adjusting the denture intaglio (the inside surface of the denture), the dentist ensures that the denture fits well and doesn’t cause any discomfort or pressure points on the gums. This step is crucial for the patient’s comfort and ability to wear the dentures effectively.
Step 2: Flange Extension
Once the denture is fitting well on the gums, the next step is to evaluate and adjust the areas of the denture called the flanges.
The flanges are the parts of the denture that extend out and make contact with the surrounding tissues in the mouth. It’s important to make sure that the flanges are not extending too far, as this can cause problems with the stability and retention of the denture. Over-extended flanges can also lead to the development of ulcers in the space between the denture and the gums.
Evaluating the extension of the denture into this space, known as the vestibular sulcus, can be challenging. The pressure indicating paste mentioned earlier is not very effective in this case, as the movable tissues easily wipe it away, giving false results. However, disclosing wax can be used with better success.
To use disclosing wax:
- The dentist dries the border area of the denture being evaluated and applies the disclosing wax.
- The denture is carefully placed in the patient’s mouth, ensuring it fits well.
- The patient is then asked to move their mouth in certain ways to allow the wax to accurately mold to the tissues as it warms up.
- Afterward, the denture is removed and inspected. Any areas where the wax has been removed indicate over-extended borders.
- These marked areas are then adjusted and smoothed using a carbide bur, a tool used for shaping and polishing dental materials.
- Another technique described by Haeberle and colleagues involves using a fast-setting silicone bite registration material to identify overextended denture flanges. This technique is similar to using disclosing wax but offers easier clean-up.
Any adjusted areas of the denture flanges must be smoothed and polished before the patient is allowed to leave with the new dentures. This ensures that the denture is comfortable and won’t cause any irritation or discomfort in the mouth.
Step 3: Occlusion
The final step in the process is evaluating the occlusion, which means checking how the upper and lower dentures come together when the patient bites down. Up until this point, the dentures have been tried individually and the teeth have not been allowed to touch their counterparts on the opposing denture. Ideally, a more detailed evaluation and adjustment of the occlusion would be done with a clinical remount, which is a separate procedure.
In the absence of a clinical remount, it’s best to evaluate the denture occlusion after the tissues in the mouth have had a chance to settle. The dentist will ask the patient to bite firmly onto cotton rolls placed over the first molars for a few minutes. Then, the cotton rolls are removed, and the patient is asked to slowly close their mouth. Sometimes, the dentist may need to provide some finger pressure to stabilize the lower dentures during this step.
Final thoughts
The completed dentures are the result of the dentist’s and dental technician’s expertise and judgment. Despite using good techniques, there may still be some inaccuracies in the dentures. Following a consistent sequence of steps during the denture insertion appointment helps streamline the process for dentists.
It’s important to set realistic expectations for success with complete dentures. Patients should be informed and reminded that it will take some time for them to adapt to the new dentures. Even with well-made dentures, there is usually a period of adjustment.
After the denture insertion appointment, there will typically be follow-up appointments at 24 hours, one week, and one month. These appointments will follow the same sequence of adjustments to ensure the dentures fit comfortably and function properly.
Reference
https://www.drrafetto.com/surgical-instructions/insertion-of-an-immediate-denture/
