What Things may Need to be Done to your Partial Denture?

During the life of your denture, things happen- clasps break off, you drop them, eat something hard, sit on them… you get the picture. Let’s look at the most common things that might happen.

Some denture wearers have very stable mouths and look after their dentures and teeth really well. As with complete dentures, an average life span may be expected to be 8-10 years but again this does vary and isn’t the same for everyone or indeed every type of denture.

I have seen (not made, because I’m not that old) cobalt chrome partial dentures that are totally supported on the teeth, looking and functioning well after 25 years. That’s not the norm, but possible in certain situations with the right care.

Partial dentures that get support from resting on your gums, are more likely to see changes occurring, as the ridges resorb somewhat under the pressure. Relines may be necessary, to ensure the fit continues to be good after a number of years.

Adding a Tooth?

How simple it is to add a tooth depends on the location of the new tooth and the design of the denture. If the base of the denture, extends near to the tooth that needs to be added, the procedure is generally quite easy.

It is easiest to add a tooth to a simple acrylic denture and most difficult to add to a flexidenture due to the nature of the material. This is why, when planning the most suitable denture, it is important to make a judgment on whether your mouth is likely to change, and what potentially will need to be done. You don’t want to have a nice new flexidenture, then find out you need a tooth adding after just two months (which can’t be done) and end up needing a completely new denture. I can assure you the dentist doesn’t want this either. Happy patient equals happy dentist, remember that!

Adding teeth to a cobalt chrome denture can be easy or tricky depending on the type of connector and its design. If the tooth to be added, is some way away from your existing cobalt chrome base plate, then the technician must solder an extension onto which the tooth can be attached.

This is quite an involved process, and will be reflected in the fee the lab charges, the dentist and ultimately the price you end up paying. If you lose a tooth that has been supporting the denture and it has clasps around it, the base of the denture is already in the right place for adding a tooth making it quite easy. The grip and support of the denture may be affected, having lost the tooth- this will depend on the rest of the design and which of the other teeth are missing.

Occasionally, if it is a tooth right at the back and doesn’t have a tooth opposite to bite on, nothing may need to be done. If the clasp that was holding the tooth, is now redundant and clutching thin air, the dentist may remove this and smooth the denture off, so that food doesn’t get trapped and it won’t catch your tongue or cheek.

Extractions and adding a tooth- what else do I need to consider?

When you have an extraction, the bone that was supporting the tooth becomes redundant and so shrinks a little over the following few months. Most healing and changes have occurred by around the 3 month mark, with smaller less noticeable ones from 3 to 6 months after; by which time the bone is largely stable. Yes, it will continue to resorb a touch over the years but only very slowly.

It is important you know and understand the changes that are likely to happen and what will need to be done. Imagine the dentist doesn’t tell you about this natural process and after 1 month your plate is beginning to rock- you’re not going to be thinking too highly of their workmanship (no pun intended). If however, you know to expect such changes- everybody’s happy.

So here are your choices:

• Extract the tooth and do nothing

Be aware of the potential consequences of the missing tooth and that this isn’t always a sensible option.

• Extract the tooth wait for 3-6 months then have a new tooth added to your denture

This is most commonly done where the tooth is at the back (i.e. not in your smile) and not crucial to the stability of the denture. The main advantage lies in the fact, that you only pay for adding the denture tooth, not a reline as well, and you only have to be without your denture on one occasion, not two.

• Extract the tooth and wait a couple of weeks for the main healing to occur then add the tooth

This takes a large portion of the guesswork away from the lab technician. However, because only early changes have taken place, the denture will still need a reline after the bone levels have stabilized in a few months. The advantage is you have a tooth sooner, which will make chewing easier and the aesthetics better, but means you are going to be without the denture on two separate occasions.

• Extract the tooth and put the new denture straight in immediately

This is what we term an ‘immediate tooth addition‘ and tends to be reserved for cases where extracting the tooth will greatly affect your smile e.g. for one or more of your top 6 teeth- or in patients for whom aesthetics is a particular concern.

The advantage of this, is you never go without a tooth. Once your bone level has settled a standard reline can be done to improve the fit. Sometimes a temporary reline may be necessary in the interim if a visible gap develops underneath the denture.

Like an immediate denture, an impression is taken with the tooth to be extracted still in the mouth (and the denture in place). This is sent to the dental technician, who grinds that tooth off the model to simulate the extraction and adds a tooth in its place. When you return to the dentist, they will numb you up, perform the extraction and then put the denture straight in.

This process is the same for someone who fractures a front tooth, (usually a post crown– but not always) and needs to have it extracted. It is a way of getting something in there temporarily, whilst all the options for replacing a missing tooth are considered and healing occurs. It is generally completed during a single day where possible, though this may depend a little on the lab. i.e. you go in the morning for impressions to be taken- you return later that afternoon for the extraction and denture to be issued.

Relining Partial Dentures?

A reline for a partial dentures is performed in the same way as acomplete denture reline– there is no difference.

The reason for a denture reline, is that the base of the denture is no longer a good close fit to the gums on which it rests and this can cause rocking, trauma, denture stomatitis, pain and looseness. This occurs primarily because of resorbtion- either as part of a natural ageing/ wear process, or as part of healing after an extraction. Relines are sometimes attempted to improve the ‘fit’, when all the other aspects of the denture appear adequate, so a remake isn’t necessary.

Relines can be performed on acrylic dentures very easily, and are most common on this type of partial denture since they gain support from your ridges (not teeth) and so resorbtion is more commonly seen. If cobalt chrome dentures rest just on teeth, relines are rarely necessary. If part of the chrome denture gets support from your gums (e.g. if you have no back teeth) relines are more likely to be needed and easily done. This is not the same for flexi-dentures, which cannot be relined.

Should I Remake the Denture?

See -‘Do I need a new denture’ below

Denture Repairs?

Patients come in quite frequently with minor issues related to their partial denture.

The most common ones are:

• My clasp broke off

If this happens your denture commonly looses some grip and stability. They are easily replaced. The technician can add a new wrought clasp to an acrylic denture, or sometimes solder a new clasp if appropriate to a cobalt chrome denture. If the clasp doesn’t affect your denture wearing experience, because of the design and support from all the other teeth, nothing needs to be done, unless it is sharp and needs smoothing.

• My tooth fractured or came off

Occasionally a tooth will come off under force, or as a result of continual flexing in the bite. If it does- keep it, and take it with you to the dentist, they can easily send it off to the lab to be reattached. If you don’t bring it with you, the technician must try and find the same shape, mould and colour of tooth to fit in. This will cost you more.

If the tooth fractures from a blow, or biting down on a hard object such as a pip or a seed, then it is a different story and the technician has to match a new tooth as closely as they can- there is no choice.

• My denture fractured

This is most common for full dentures and simple acrylic partial dentures as a result of dropping them, a heavy or deep bite, wear, fatigue or a thin vulnerable design. They are easily repaired.

If it happens repeatedly in the same place- it suggests that the stresses you are placing on the current design, are simply too much and the technician may attempt to incorporate a metal strengthener, or sheet when they repair it. You may want to consider a different design or type of denture.

This very rarely happens with flexi-dentures but if you fall, you could easily fracture a tooth or teeth.

Cobalt chrome dentures are also pretty resistant though you could bend the framework which is notoriously difficult to correct since it is precisely made to fit your teeth. Sometimes the dentist can take an impression of your teeth, send it to the lab and have them try to bend it back to fit- don’t hold your breath- sometimes the only solution is to remake the denture. So store your denture appropriately when it is not in your mouth.

Click here for more information about the procedure for dentures repairs.

Minor Adjustments?

Tightening of your denture clasps, adjusting your bite and areas that are rubbing etc. are most common straight after having a new denture or one of the procedures described above. More details about these adjustments can be found in denture problem solving.

When should I get a New Partial Denture? Do I need a New Denture?

That depends on if the issue, or issues are solvable by other means.

If adjustments can be completed to a satisfactory level, i.e. you are happy with the look and feel comfortable and you can eat, smile and chew happily, then you don’t really need a new denture.

If the current set can’t really be improved upon, then it makes no sense to me to have a new denture made- aside from having a spare set, which of course some people like to have.

Your dentist will advise you if they feel a new partial denture would be in your best interest by examining the current denture for its:

• Fit

• Support

• Grip (Retention)

• Look (Aesthetics)

…And looking for any problems it may be causing.

Then it is a matter of going back to the drawing board to consider which option is the most appropriate for you.

Note: circumstances may have changed for the better (or for the worse) e.g. improved finances may open up some new options that previously weren’t available including implants, bridge work or dentures with precision attachments, which could all help to improve the look and comfort of your dentures.

If you and your dentist decide a new set of dentures is the way to go- it is really important to ask yourself:

(i) What do I like about my dentures (and want to keep)?

(ii) What don’t I like about my dentures (and want to change)?

The dentist is able to change any features you don’t like, and keep those that you do.

Things to consider include:

• The Teeth- position, spacing, colour, shape, height

• The Base– acrylic, cobalt chrome or flexi-denture material. If it’s a cobalt chrome design- how do you feel about the main connector design, would you like it copied?

Times that you might want to consider a new denture:

• Multiple problems exist with the look, fit and function of your current dentures

• The problems can’t easily be solved by adjusting the denture

• The denture is old and worn- are the teeth flat or do they still have a pattern on the top? Have you had them for many years?

• Has work been done- such as fillings or crowns that has affected the closeness of the fit? (most common for a cobalt chrome)

• You have lost multiple other teeth that are now just spaces, or have new teeth that need to be extracted

• The denture has broken repeatedly and has already been repaired multiple times.