S
sas
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I read with great interest the comments on this forum as removables have been a big part of my life for over 50 years. My practice is limited to them and I also do my own lab work so I have a great deal of exposure to all the phases. I also participate in a couple of CE programs as a lecturer each year so I get to feel out the more or less thoughts and techniques of the practicing dentists and technicians. I have come to several conclusions which I think we need to consider in our chosen profession.
Although I am not "down" on the younger population, that segment of the dental profession, by and large, lack either the knowledge, skills, or desire to make acceptable removables. Why? First of all the curriculum is moving farther and farther away from full dentures and partials. Secondly, the students themselves don't seem to have much interest in them. We are bombarded with too much digital, cosmetic, implants etc so that getting their sleeves rolled up and digging in is not fashionable. Third, too much treatment being done by assistants, and not the dentist.
Well, so what? It means that the quality of the models, bites, etc that reach the lab tech are not going to be what is needed to fabricate a functional prosthesis. Grossly overextended alginate impressions, putty bites on unstable base plates, vertical and centric not even close, etc will not render a result that is acceptable. Thank goodness, we can always blame the lab, or global warming, or a solar eclipse, just about anything that comes to mind. I think it would be very impressive to have a dentist sit down and make a nice set of dentures using the junk many of them send to the lab. And likewise, it would be interesting for the technician to deal face to face with the patient who is ready to proclaim "they don't fit" when you haven't even got them fully inserted at delivery time.
There is a subtle thought going around that implants and digital impressions will save the day for laziness and lack of proper technique. Can we talk? Implants as we know them now are wonderful. But expensive. Lets be practical. Loss of teeth is suffered more by those in the lower economic status that higher status, for the most part. These people flat out can't afford implants. Food, shelter, and medicine are taking their bucks. I am convinced that we are going to need conventional dentures for a long, long time.
And who is going to make them? The removable technicians are getting along in age as well. IMO there will one day be a designation of Denture Therapist or some exotic sounding name for a non-dentist to provide removables. This may be the same Denturist we have today but it will be recognized as someone who has completed formal training, perhaps apprenticeship, and passed an exam to provide directly. The dentist will do the first phase of examining, extracting, etc and this Therapist will make the dentures. Since the oncoming dentists don't appear to care about removables there will be very little opposition and the technicians will have a good argument that they are doing most of it now. There will still be some dentists who will make the impressions etc. and some technicians who do not like to deal directly with patients.
Until that day if you have a dentist you like to work with I hope you both will have a team effort and pool your knowledge and skills to do the patient the best that you can. In spite of all the technical knowledge and technique we have and adhere to, the final result will depend greatly on the attitude and adaptability of the patient. The most underestimated factor in denture construction is the mind set of the patient. I have seen countless patients with no ridge, no saliva, no muscle control wearing dentures and getting along very well. And many with text book mouths just won't accept them. Given a prosthesis that is made correctly the problem between the ears is the deciding factor.
I see some beautiful work displayed on this web site. I wish I had the ability to do some of these cases as presented. They are truly gorgeous. One thing I do see is overkill on some wax ups. I just do not see all of these bony areas protruding past the cuspids as indicated on some wax ups. And the first upper bic should be waxed with the clinical crown a little shorter than the cuspid and not as short as the second bic. The two bics are not the same length and will look too short in a smile situation.
Best wishes to all in your chosen field as it is highly important to a dental cripple.
SS
Although I am not "down" on the younger population, that segment of the dental profession, by and large, lack either the knowledge, skills, or desire to make acceptable removables. Why? First of all the curriculum is moving farther and farther away from full dentures and partials. Secondly, the students themselves don't seem to have much interest in them. We are bombarded with too much digital, cosmetic, implants etc so that getting their sleeves rolled up and digging in is not fashionable. Third, too much treatment being done by assistants, and not the dentist.
Well, so what? It means that the quality of the models, bites, etc that reach the lab tech are not going to be what is needed to fabricate a functional prosthesis. Grossly overextended alginate impressions, putty bites on unstable base plates, vertical and centric not even close, etc will not render a result that is acceptable. Thank goodness, we can always blame the lab, or global warming, or a solar eclipse, just about anything that comes to mind. I think it would be very impressive to have a dentist sit down and make a nice set of dentures using the junk many of them send to the lab. And likewise, it would be interesting for the technician to deal face to face with the patient who is ready to proclaim "they don't fit" when you haven't even got them fully inserted at delivery time.
There is a subtle thought going around that implants and digital impressions will save the day for laziness and lack of proper technique. Can we talk? Implants as we know them now are wonderful. But expensive. Lets be practical. Loss of teeth is suffered more by those in the lower economic status that higher status, for the most part. These people flat out can't afford implants. Food, shelter, and medicine are taking their bucks. I am convinced that we are going to need conventional dentures for a long, long time.
And who is going to make them? The removable technicians are getting along in age as well. IMO there will one day be a designation of Denture Therapist or some exotic sounding name for a non-dentist to provide removables. This may be the same Denturist we have today but it will be recognized as someone who has completed formal training, perhaps apprenticeship, and passed an exam to provide directly. The dentist will do the first phase of examining, extracting, etc and this Therapist will make the dentures. Since the oncoming dentists don't appear to care about removables there will be very little opposition and the technicians will have a good argument that they are doing most of it now. There will still be some dentists who will make the impressions etc. and some technicians who do not like to deal directly with patients.
Until that day if you have a dentist you like to work with I hope you both will have a team effort and pool your knowledge and skills to do the patient the best that you can. In spite of all the technical knowledge and technique we have and adhere to, the final result will depend greatly on the attitude and adaptability of the patient. The most underestimated factor in denture construction is the mind set of the patient. I have seen countless patients with no ridge, no saliva, no muscle control wearing dentures and getting along very well. And many with text book mouths just won't accept them. Given a prosthesis that is made correctly the problem between the ears is the deciding factor.
I see some beautiful work displayed on this web site. I wish I had the ability to do some of these cases as presented. They are truly gorgeous. One thing I do see is overkill on some wax ups. I just do not see all of these bony areas protruding past the cuspids as indicated on some wax ups. And the first upper bic should be waxed with the clinical crown a little shorter than the cuspid and not as short as the second bic. The two bics are not the same length and will look too short in a smile situation.
Best wishes to all in your chosen field as it is highly important to a dental cripple.
SS