A denture is a removable replacement for missing teeth and nearby gum tissue. Usually made of acrylic, dentures can replace all of a patient’s teeth (complete dentures) or only some missing teeth (partial dentures).

Denture design and technology has improved, and it is now possible to have aesthetic, functional and well-fitting dentures.

Consequence of missing teeth

There are many reasons why you might be missing teeth; it is a common complaint at the dental office.

Complete dentures have greatly increased the vertical facial height of this patient, as seen in the before and after photos.

Why should you get the missing tooth or teeth replaced though? The most popular reason is appearance. A smile that shows off missing teeth often sends an uncomplimentary message to others. If a considerable number of teeth are missing, your mouth might be over-closing, resulting in a face that appears short. From a dentist's standpoint though, there are greater concerns than just appearance.

When teeth are missing, the above teeth might begin erupting (coming out of their socket) into the empty space. A missing tooth can also result in nearby teeth drifting, or tipping, into the open space. Problems in occlusion (bite) can arise, making it difficult to close the mouth or chew. Speech sounds can also be altered if prominent teeth are missing.

Even with such consequences, not all teeth require replacement. In the case of older patients, most can lead functional lives while missing their second and third molars. Always question your dentist's reasons for wanting to replace a missing tooth that is not affecting your lifestyle.

Available Options For Replacing Teeth/Tooth

Dentists have several options for replacing missing teeth - not all options apply to every patient though. The following are viable options for replacing one or more teeth:
 

· Dental Implants

· Partial or Full Dentures

· Bridges (Fixed, Resin-bonded, or Cantilever)

There are various factors that dentists consider in choosing the best option. Some include:

Number of teeth missing: When only 1 or 2 teeth are missing, implants are the best option. Alternatively, bridges can be placed. Partial dentures are good for cases when more than 3-4 teeth are missing, and complete dentures are for when all teeth are missing.

Cost: Dental implants are very costly, and are not covered by most dental insurance programs. Bridges are usually second in cost, followed by partial or full dentures.

Time: Bridges are usually completed by two appointments in the course of a week. Dentures are made as quickly, but need adjustments over the course of months. Implants involve surgery, and require several months for healing.

Oral health: The biggest dental concern is the condition within the mouth. Few dentists will place implants in patients who are avid smokers, as they are prone to failure. Similarly, bridges need to be supported by nearby teeth, so those teeth need to be of sound health. Dentures have the highest success rate in those with poor oral hygiene.

Comfort: Dental implants are the gold standard for replacing missing teeth, and many patients can hardly tell them apart from real teeth. Bridges are also highly aesthetic and fixed in the mouth, but keeping them clean can be difficult. Dentures can appear natural, but can slip out while eating certain foods, so most patients need to learn to adapt.

Always ask your dentist why they chose a particular treatment in replacing missing teeth. They should be more than willing to explain their reasoning to you.

Denture types

Complete dentures (above) and partial dentures (below).

Two types of dentures are available – complete and partial. Complete dentures are used when all teeth are missing in an arch (upper or lower) and partial dentures are for when some natural teeth remain. If your few remaining natural teeth are mobile, heavily decayed or worn down, your dentist may suggest extracting them and opting for complete dentures – always consider the consequence of tooth extractions though.

Complete dentures are either of the “conventional” or “immediate” type, depending on when they are made. Immediate complete dentures are made in advance so that they can be placed right after your teeth have been extracted. This saves you the embarrassment of being seen without teeth as your gums heal from the extractions. During the healing process though, your bones and gums shrink, so your immediate dentures will require regular adjustments to ensure proper fit – therefore, immediate dentures are a temporary solution. Conventional dentures are made 2 to 3 months after your teeth have been removed and healing is complete. They are better fitting and only need occasional adjustments.

The second type of denture is a partial denture. A removable partial denture consists of replacement teeth attached to a pink or gum-colored plastic base, which is connected by metal framework that holds the denture in place in the mouth. Partial dentures are used when one or more natural teeth remain in the upper or lower jaw.

Clasps built within the partial denture framework circle and hold onto natural teeth for increased retention. They are usually placed around back teeth to keep them hidden.

Complete dentures are designed to adapt perfectly to the mouth contour. Adaptation to the bone and gums, as well as the patient’s unconscious neuromuscular control, helps retain complete dentures in the mouth. Because of the tongue, lower complete dentures are more difficult to keep in the mouth than their upper counterpart.

Partial dentures are removable but have internal attachments, such as clasps, that attach to adjacent teeth, helping to keep them in the mouth. Partial dentures are therefore considerably more retentive than complete dentures.

Implant-supported dentures

Example of lower implant-supported dentures.

A relatively recent development has been the use of implants alongside traditional complete dentures. Complete dentures are aesthetic, cheap, but do not retain well in the mouth (especially lower dentures). Implants are permanently fixed in the mouth, but are too costly to replace all the teeth in a dental arch. Clinicians have combined the best features of both by developing implant-supported dentures.

To begin, three to four implants are placed in the jawbone. Then, instead of placing artificial porcelain teeth, small “male” abutments are attached on top. The complete denture is separate and has “female” parts underneath that bind and “lock” onto the implant abutments. Dentures made in this manner are held firmly in place and can only be removed in one direction.

Since implants are involved, the cost goes up considerably, and other issues need to be considered. The dental implant portion of the site outlines all major concerns.

Treatment Procedure

Making dentures takes anywhere from 2 weeks to 2 months depending on the number of adjustments required.

During the first dental visit, your dentist will examine your gums, supporting bone, and remaining teeth to make a recommendation. In some rare cases, oral surgery is performed to correct bony ridges that may interfere with the stability of the denture. Your dentist may suggest extracting remaining teeth and using complete dentures, in which case, further oral surgery is required.

Once your dentist has decided that dentures are right for you, he or she will make an impression of the gums to identify every ridge and crevice to ensure the best denture fit possible. This is a crucial step that determines the comfort of the final product. If you are receiving a partial denture, your dentist may drill the surface of certain teeth to create “rests”. The final metal framework of your partial denture will fit into these rests and provide support to the denture through your natural teeth.

Your dentist will then take further impressions of your mouth and take measurements on how your jaws relate to each other. For the following appointment, your dentist will have models, wax forms, and plastic patterns of your future denture ready. You will try them in, and the denture will be assessed for color, shape, and fit before the final denture is cast. You will be given the chance to select the shape, size and color of your denture teeth at this stage.

By the next appointment, your dentist will have the final denture ready. You will try it in, and any major adjustments will be made then and there. Over the next few weeks, you will note small alterations that need to be made, and your dentist will comply in follow-up appointments.

Adapting to dentures

New dentures will feel awkward and loose for a few weeks, especially if they are complete dentures. Over that time, your check muscles and tongue learn to keep them in place, and you become comfortable inserting and removing them. This is a unconscious learned process – your body simply learns to adapt without you placing any effort.

During this time, it is not unusual to have minor irritations or soreness. You may find your saliva flow increases, but these should all disappear in a few weeks time. If there is an obvious problem, where the dentures do not sit properly or impinge on tissue, inform your dentist right away. Frequently, the problems listed above do not resolve on their own and minor adjustments to the denture are required – see your dentist.

Denture care

Denture solutions or tablets help keep dentures clean over-night. Proper denture care is essential to ensure they last long.

Even if you wear full dentures, you still must take good care of your mouth. Too often patients assume that not having any natural teeth means they can forgo good oral healthcare – this is simply not true.  Everything from periodontal disease (gum disease) to fungal infection of the mouth is probable with patients who have poor oral hygiene.

Brush your gums, tongue and palate every morning with a soft-bristled brush before you insert your dentures to stimulate circulation in your tissues and help remove plaque. When removing dentures at night, brush the dentures carefully to remove any loose debris and plaque then soak them in a cleansing solution. Some people keep their dentures in an ultrasonic cleaner, but this does not replace manual brushing.

Cost

Some patients may need teeth extractions, implant placement, or surgery for removing bony protrusions (tori) – these are all additional costs. Fortunately, since dentures are the cheaper alternative for dental bridges and implants, most insurance programs will cover a portion of the costs.

Complete dentures can range from $500 to $2000 per arch (upper or lower) if done by a dental specialist such as a prosthodontist. You can save money by finding a capable general dentist, as they charge from $300 to $1200 per arch, on average.

Depending on how many teeth require replacement, the complexity of the design, and the metal framework material used, the cost of partial dentures can greatly vary. We suggest you shop around, but be aware that poorly constructed dentures mean hours of adjustment down the road and a great deal of added aggravation.

Longevity

How long your dentures last depends on many factors including how you take care of them and also how much you use them in terms of general wear and tear. Over time dentures become loose as your gums shrink and your bite changes. When this happens you may need a new set of dentures or in some cases a simple modification of your existing dentures may solve the problem.

We recommend getting new dentures every 6-8 years since simple adjustments to old dentures are not enough by that time.

Advantages & disadvantages

With proper care, dentures can last long – up to a decade. Compared to other treatments, dentures are non-invasive and cheap. Dentures can replace missing teeth and gum tissue (bridges and implants only replace the tooth, not the tissue) and appear natural to most. They are functional and allow for chewing and speech.

There are some clear disadvantages with dentures though. They take time getting adjusted to, and chewing function will never be as it was with natural teeth. Mouth irritation and sores develop over the years, but are quickly resolved with denture adjustments made during regular checkups. Many patients have trouble keeping lower dentures in place, and since upper dentures cover the palate, taste sensation is somewhat reduced.