Citizen Article – Removable Prosthetics – Not Glamorous But Very Necessary

The American Dental Association commissioned a study back in the early part of this decade to look at tooth loss in this country. The results were quite impressive. In 1960 the average 65 year old American had 7 of their natural teeth left in their mouth. In the late 1990’s that number of natural teeth in a person’s mouth had jumped to 20. This study was very revealing that we as Americans are much more dental conscious and value our own teeth much more. As the population increased in number of teeth that they were keeping our dentistry became much more sophisticated. Missing teeth were replaced with the thought in mind that they would be there for a long time. The mindset that everyone was a future denture patient has left the profession.

There are a multitude of reasons for this sharp increase in the number of retained natural teeth including better periodontal care, better caries prevention and better materials for restoring these teeth. People were replacing teeth with fixed bridgework and implant supported teeth. This led at least one author to comment that the removable denture, either partial or complete, was a dying part of dentistry. I am making the statement that I disagree with the premise that removable dentures are dying in our profession. The techniques of removable prosthesis fabrication have evolved and changed right along with the rest of dentistry. It is important that we as dentists respect and recognize the fact that not everyone is interested in the amount of work that fixed prostheses or bridgework entails. The removable prosthesis is still a very valuable part of our treatment armamentarium for the prosthetic replacement of missing teeth.

Let’s start by examining the removable partial denture. In the past these were made with a metal framework to give the prosthesis rigidity. This framework is still a necessity but the improvements in the metals make it so the metal does not have to be as thick or as wide as in the past. An image comes to mind from my childhood of a family friend who had an upper partial denture. The image I recall is that of the metal clasp arms gleaming around the outside of the teeth as she smiled wide. There are several advancements in today’s dentistry that would have made it so the clasp arms were not the first thing my eye saw. We can use acrylic clasps that are flexible and either tooth colored or gum colored as one choice to make the clasps invisible. Another option would be to have an attachment built into a crown on the anchor tooth. This option eliminates the need for a clasp arm at all! The overall design of the partial can also be made as to eliminate the visible clasps.

How about the complete denture? You may be thinking how much can really be changed and updated with a set of complete teeth. Well there is plenty so hang on. The first thing that comes to mind is the teeth themselves. In the earlier part of this century the denture teeth were made of porcelain. Soon manufacturers were touting acrylic denture teeth as the next latest and greatest. The acrylic teeth work well but as anyone with an older denture with acrylic teeth can attest to they wear down considerably thus affecting the bite and the forces on the underlying bone. The notion that porcelain teeth caused more wear on the underlying bone became commonplace. As it turn out this notion was thought to be brought about by the manufacturers of acrylic teeth since they wanted to sell more teeth. A review of the dental literature reveals not one peer reviewed article giving proof to this notion that porcelain teeth wear down the bone faster. This needs further clarification which will be the topic of a future article. I’m getting on a roll here so the remaining improvements in complete dentures will be discussed as well. Thank you for reading!