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Extract vs Treat
Cost of Dentures
Diseased Gums #1
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TMJ - Occlusion
Choosing a Denture Dentist or ProviderDentures are a popular economical treatment for replacing an entire arch of teeth for either the upper arch, lower arch or both. The success of the procedure is dependent upon the existing bone being of sufficient height, width and health.
Given that all conditions are equal, for the sake of discussion, what determines what or who constitutes the best resource for a denture product or prosthetic is based on the patient's primary criteria for making the selection, which is followed by a longer list of several criteria.
The Cost GroupFor some patients, cost, and only cost, may be the primary factor. Patients in this group may be older and not concerned with cosmetic values, they may be members of a large family where financial resources are tightly managed... or they may be looking for something that is temporary and expect to upgrade to something later that they want for better cosmetics or improved function.
Denture clinics, typically operated by dentists and dental laboratory specialists and technicians, offer excellent value for patients who do not have significant tissue concerns. Cost control is achieved by using fabrication processes that can be standardized as much as possible for large groups of patient types.
Because of the standardizations that enable denture clinics to deliver a product of good value, the choices of of style, coloration, tinting effects, tooth size and overall whiteness will be limited to perhaps a few or maybe several choices. Small mouth, large mouth, female smile line, male smile line, brighter shades of white for younger patients, darker for older patients, etc.
Stated more simply: the time spent on a denture product is reflected in the cost. Economical dentures are often made in 1-2 visits with no try-in visits and/or virtually no patient input.
Summary for patients focused only on cost:If (and perhaps only if) oral health conditions are reasonably good or better and the requirements of having a perfect set of teeth (the definition of what is perfect varies for each patient) are either held to a minimum or can be flexible, denture clinics can represent an excellent choice for service and product.
Unexpected events:Unfortunately there are large number of people who don't obtain the value they were originally seeking. The value may be directly related to cost... but more often is related to the inconveniences of unanticipated surprises during treatment.
Bone problems, soft tissue issues, occlusal factors, cosmetic values, involuntary gag response problems, undiagnosed oral health needs and other events that don't appear until after treatment has begun all tend to sour the advantages of working with value oriented clinics.
Dentists operating in these types of practices aren't able to individualize treatment and treatment outcomes to the degree patients wish they could when their needs become specialized.
You get what you pay for. If you want input, customized fit and great cosmetics ... this is not the right denture resource to provide this service.
The Function GroupThese are, for lack of a more entertaining term, the practical people. The loss of teeth has occured for whatever reason or teeth have been extracted to overcome a history of undefined dental problems (genetic factors, cosmetic, bite characterstics, etc).
Patients who focus primarily on function want to have a new bite (or something close to what they once had) that allows them to move on with their daily lives and get re-focused on things that are not teeth related. The ability to eat well, eat whatever is desired, speak without difficulty or without unwanted noises (clicking, clacking of dentures), having dentures stay where they are supposed to and of course, to look pretty good with something that looks fairly natural (age and face characterisics sometimes accounted for).
The practical people however, have a tendency to attend to things when they really need to be attended to. This characteristic often applies to how they respond to routine dental health needs. As a result, these patients may be at risk of accumulating one or more of the conditions mentioned above that could require specialized attention to assure a good match and fit for a denture product.
Uneven bone, (sometimes too much bone - requires shaving), soft tissue loss due perhaps to old extractions, tissue sensitivities, bite collapse, occlusal dysfunction and tmj dysfunction are samples of treatment needs that can require special attention.
There are no automated assumptions made of anything. Individualized technical data derived from occlusal studies, stone models, diagnostic waxups, selection of denture materials and denture try ins generate ALL patient specific criteria that are used in the fabrication process (non automated, reduced shrinkage, flexible selection of materials, tinting, shading, sizing, etc) of the final denture product.
Because the entire fabrication and fitting process of a denture product created by the dentist is unique to the patient, nearly all of the functional issues are accommodated at the outset. Final adjustments or modifications to the denture prosthesis are performed as needed..if needed at all.
Advice for the Functional GroupIf overall oral health conditions are reasonably good and the potential for unanticipated surprises are minimal or don't exist... a denture clinic could be the perfect solution for obtaining an acceptable denture product that performs as expected.
Patients who are unsure or suspect they have issues that go beyond basic teeth replacement would do well to undergo xrays or a cone beam catscan (3-D unsurpassed precision) and a comprehensive examination to assess the need for any specialized treatments (bone-tissue grafting, bone shaving, occlusal adjustment, stabilizing oral health, etc).
Objective information acquired during the comprehensive examination can be used to aid the decision making process of whether to select a denture clinic or a dentist or prosthodontist to create custom teeth replacements. The cost will be higher, but only in dollars and cents. In terms of "sense"....the benefits are immeasurable.
Longevity ConsiderationsPatients who are focused on maintaining good long term bite function should be aware that a denture worn for 10 years will result in a loss of overall biting force that will go from 250 lbs/sq. inch to 20 lbs per square inch.
If unsupported or non anchored denture products are chosen, over time function will decrease as bone tissues shrink. Relines and remaking of dentures will need to occur every 3-5 years to maintain optimal denture chewing.
The Cosmetic GroupThis patient group is growing and growing as each month goes by. Today's advanced technologies in dental as prosthetic cosmetics enables discriminating and even the most demanding patient to have denture teeth that don't feel like, function like and most importantly... don't look like dentures.
Makeover or cosmetic dentures are available for those patients who have the time and resources to get everything they want in "new teeth" imaginable... all in the form of a denture.
Who are these people?A large number of patients who are opting for the best denture product possible are those who have been dissatisfied with performance (function) or are tired of having teeth that look "false." Long time denture wearers who have reached the point of knowing what they don't want. Dissatisfaction with performance or function trails the concern for having a really beautiful smile, irrespective of what and how the teeth are made.
These patients, both young and old are aware of the "makeover experience" commonly associated with cosmetic dentistry and seek a similar experience with cosmetic denture products.
The Turbyfill Denture, named after it's creator, has nearly become the defacto protocol standard that incorporates a lengthy, algorithmic (step by step) methodology of using a training denture that functions similarly to using temporary crowns and veneers in cosmetic dentistry, in that the doctor and patient test and retest each level of accomplished change.
Cosmetics, feel, snugness, eating behaviors, occlusion, vertical dimension (height of teeth-bite), lip movement, smile behaviors (showing teeth), speech, overall tissue comfort and finally... the cosmetic gestalt or overall appearance of the denture ... as part of the patients facial features.
Patients seeking the most with the best... go a few steps further and opt for a variety of implant supported or implant retained (mini implants) denture products, combined with a palateless upper denture. Teeth that stay in for an entire day that don't budge... even when eating an apple or thick steak.... or teeth that stay in for weeks at a time.
How Do I Decide: Who is the Best Denture Dentist?Hopefully this generalized summary aids people in determining how to balance budget or cost with expectations. People with excellent oral health conditions and history have reduced or no risk of treatment surprises that can make denture treatments and fittings miserable.
Patients with high expectations or a strong desire for absolutely great function or cosmetic impact should be better aware that the talents and resources needed for technical accuracy and/or cosmetic creativity requires someone special .... not an average dentist.
The WhoGeneral dentists, restorative-cosmetic dentists or prosthodontists who have a rock solid track record of talented creativity (they actually enjoy the challenges of difficult teeth replacement) are in the best position of meeting most of the demands of even the pickiest patient.