The Complete Denture: A Clinical Pathway Second Edition
Contents
Dedication
Preface
Contributors
Appendix 1: The Complete Denture: A Step-by-Step Summary
Appendix 2: What Should You Expect from a New Denture?
Dedication
To Mary for constant support and encouragement
To my father Patrick J. MacEntee who introduced me to the art of complete dentures
To Stephen Bartlett and John J. Sharry for the direction to master the art
To my colleagues and students who continue to stimulate me
Preface
I began the preface to the first edition of this text by posing several questions: “Why write a book about a dying art, about a skill with little science, or about a service that is no longer in the main purview of the dental profession? Is not edentulism on the decline because the youth today will keep their teeth for life? Have not oral implants transformed the edentulous mouth into a foundation for fixed prostheses?”
I continue to hear these questions, even accompanied by the ring of ageism: “Isn’t tooth loss an old person’s affliction?” Everyone in dental academia knows that the curriculum has moved away from prosthodontics to embrace, it is said, knowledge that is much more relevant to the dentist in the new millennium.1 The seminal question remains on the agenda of most dental faculties: “Why bother with the complete denture?” But, as I explained in the first edition, the art and science of complete dentures provides the foundation for so much of a dental clinician’s day: listening to patients; probing for diagnostic clues; distinguishing healthy from diseased tissues and functional from dysfunctional structures; assessing the arrangement of teeth for patients who are concerned about dentofacial disfigurements and for occlusal contacts that are physiologically unstable; making impressions; using dental articulators; manipulating an array of biomaterials; and communicating their observations and recommendations to others.
There has been remarkably little attention given in either dental education or the related sciences to the management of chronic disorders, yet we know that successful aging is influenced strongly by the long-term skills people develop to adapt and cope with chronic adversities.2,3 As clinicians, we are skilled in the techniques to remove, change, and replace structures in and around the mouth. We can deliver the most exquisite prostheses, far beyond the expectations or demands of most patients. Yet, we are much less skilled at maintaining a comfortable quality of life with minimal effort and expense to patients and ourselves.4
Almost everywhere, there has been an excellent trend away from complete tooth loss, and more people than ever before are retaining some natural teeth for life. However, the epidemiologic data available on the prevalence and incidence of tooth loss is sadly wanting.5 Steele et al6 reported from a 2009 survey of oral health in the United Kingdom that “[a]lthough the percentage of people who are edentate is small, it still accounts for approximately 2.7 million adults across England, Wales, and Northern Ireland.” The 2007 to 2009 Canadian Health Measures Survey found that 6.4% of adults aged 19 to 79 had no natural teeth, which amounts to about 1.5 million adults in Canada, excluding indigenous peoples, who need complete dentures.7 The equivalent number of edentulous adults in Australia is about 1.2 million.8 Therefore, no matter how or where we look, we cannot say with any confidence that patients in the near future will not need or want full dental prostheses.
Oral implants have moved the demand away from complete dentures as described in most of this book, although we have included a chapter on implant-retained dentures. Yet, replacement of missing teeth with an implant-retained denture is not far removed from the main topics of this book. The diagnostic skills are very similar for the clinician who is helping a patient decide whether or not to replace an old prosthesis. The materials available for making either mucosal or implant dentures are much the same—as are the impressions, jaw relationships, clinical trials, delivery, and post-delivery care. In short, it would be impossible to make an implant-retained denture without the skills associated with complete dentures. And so, the question remains: “Where do we learn effectively about the consequences and replacement of missing teeth if not when making complete dentures?” A dental curriculum without complete dentures will be a curriculum challenged for clinical relevance to so much of prosthodontics and dentistry. Ultimately, a clinician without the knowledge, skills, and art associated so directly and obviously with complete dentures will be seriously restricted as a general provider of oral health care.
We see already a decline in prosthodontic services as clinicians focus their practice on less demanding services. Denture wearers do not place a heavy demand on dentists, not necessarily because they are at ease with their dentures, but because they have learned to adapt and cope with this disability. They are reluctant to seek further prosthodontic treatment because they have been dissatisfied with the treatment they received previously.9,10
This text is one among many on the topic of complete dentures. It differs only in that it describes and illustrates a technique that my colleagues and I have found to be relatively straightforward and based on methods without unnecessary frills. It offers a minimally acceptable protocol or clinical path based on the principles of “appropriatech”.11,12 Of course, this path is influenced largely by our own clinical experiences, but, when available, we reference the sources of more objective evidence to provide the biologic, psychologic, technical, and artistic foundations upon which people who are disabled by tooth loss might find relief. We have avoided detailed descriptions of alternative techniques, not because we feel that they are any less effective, but because, in our experience as clinicians and teachers, our students have attained greater success by focusing carefully on one path without the confusion of many crossroads.
References
Acknowledgments
This text evolved initially from the influence of my teachers, Stephen Bartlett, John J. Sharry, and Aiden Stephens, who gave me the solid foundation of their experiences while encouraging me to question everything. It was refined over many years by the advice and experiences shared freely by my colleagues at the University of British Columbia and by the questions raised and sometimes answered by my colleagues in prosthodontics, dental geriatrics, and public health around the globe. I am very fortunate also to have benefited from the friendship of two giants in our discipline—Gunner Carlsson and George Zarb. Gunner has been the most coherent voice of reason in prosthodontics, and in retirement he continues to ask the right questions, which I hope will be evident to readers of this book. George Zarb, in a similar way, has changed the way we all practice dentistry, yet he remains solidly connected to the foundations of our profession. His friendship, erudition, and constant support have been my mainstay in prosthodontics for almost half a century. And, most recently, I have been inspired by Peter Owen in South Africa who, through his concept of “appropriatech,” has shown me that economic stress and quality of care are indeed compatible in prosthodontics and the rest of dentistry if we can look past the technical glitz to find the services most appropriate for the communities we serve.
I acknowledge the manufacturers of the materials mentioned throughout the book. I would like to add, nonetheless, that the products identified in the text reflect my own practical experience, and in no way do I or my colleagues wish to imply that they are superior to materials available for the same purpose from other manufacturers.
Contributors
B. Ross Bryant, dds, msc, phd, frcd(c)
Assistant Professor
Division of Prosthodontics and Dental Geriatrics
Faculty of Dentistry
University of British Columbia
Vancouver, Canada
Caroline T. Nguyen, dmd, ms, frcd(c), facp
Assistant Professor
Division of Prosthodontics and Dental Geriatrics
Faculty of Dentistry
University of British Columbia
Vancouver, Canada
Joanne N. Walton, dds, dip prosth, frcd(c)
Professor
Division of Prosthodontics and Dental Geriatrics
Faculty of Dentistry
University of British Columbia
Vancouver, Canada
Chris C. L. Wyatt, dmd, msc, dip prosth, frcd(c)
Professor
Division of Prosthodontics and Dental Geriatrics
Faculty of Dentistry
University of British Columbia
Vancouver, Canada