The need for removable edentulous solutions
Hussein Hassanali talks about the need for removable edentulous solutions.
As patients continue to keep their teeth for longer, the number of edentulous patients is slowly decreasing. This is good for the general dental health of the population. Although, there is still a need for providing removable edentulous solutions.
The mandibular suction denture and the Ivoclar BPS system are probably the gold standard in removable complete dentures. These both require precise clinical stages complemented by experienced dental technicians to get the desired end outcomes for both patients and clinicians.
Traditionally, complete dentures have been something that young dentists have struggled with. Little experience is gained in both undergraduate and postgraduate training. One way of easily making new dentures for patients is to copy the previous well tolerated dentures. Then open the bite on an articulator to increase the vertical dimensions where the occlusion has worn down over time.
But when there is nothing to work with or the previous dentures are unsuccessful, recreating patient satisfaction, aesthetics and function can be very challenging. Ivoclar advocates the use of the gnathometer and gothic arch tracing in determining the occlusal vertical dimension and position of the occlusal rims. However, this isn’t available at everyone’s disposal and not all dentists are familiar with their use.
Using average values can be one way of simplifying the clinical phases of the edentulous bite stage. An improvised gnathometer can be made using a Willis Guage, impression putty and a full arch three-in-one impression tray. This can be carried out at the same time as secondary impressions with instructions to the lab requesting articulated models and wax rims fabricated to average values.
While average values are a good guide to work with, one must remember that these are average values. The wax rims must be checked in the patient’s mouth and adjusted as necessary. However, the use of the improvised gnathometer can reduce the amount of adjustment required, which can decrease the chair time to do this.
Once the dimensions, planes and angles have been checked and centrelines and canines marked, a bite registration material can be used to provide the detail for the correlation and position of the upper and lower rim. This is returned to the laboratory to proceed to the try-in stage in the usual way.
This improvised gnathometer is in no way a replacement for the real thing. But it can go some way to streamline the processes required for complete denture fabrication. Also, to lessen the frustrations for both dentists and dental technicians.
The author would like to give special mention to Westwood Laboratories Ltd in Driffield. They carried out the laboratory stages in this clinical case.