Dentist here.. lets say I get to the final denture delivery appointment, and there's poor retention, any tips?

[lobstermobster]

Hey guys, admittedly I'm not great with dentures. I can normally help the lab make a denture that looks great with a proper bite, it's just whether or not there's going to be much retention on delivery day.

I get to that final delivery appointment and sometimes it stays in great, other times it's falling out. Is there anything I can do to try to salvage the denture if there's not much retention that far into the process? Maybe another impression inside the denture with a certain material or some other technique to send it back to the lab and get it altered/relined in any way?

Any input would be greatly appreciated. Thank you.

 

[mario5636]

Hi friend,
You could try relining the denture with light body silicone, and making the physiologic movements again as you ask the patient to bite in the correct oclussion. Note that you have to prepare the inner surface of the denture with tray adhesive previously as well as a little grinding with a carbide bur at low speed. Sometimes it is possbile to achieve good retention. Next you send the denture again to the technician and you ask him to process again the denture with acrylic. This is an indirect relining, as the denture will be again inside a muffle and the new material (light silicone) will work as wax.

Hope it helps and I didnt confuse you.

 

[tehnik]

Hi, Do you have any pictures of the models or dentures with problems?

 

[bigj1972]

Hey guys, admittedly I'm not great with dentures. I can normally help the lab make a denture that looks great with a proper bite, it's just whether or not there's going to be much retention on delivery day.

I get to that final delivery appointment and sometimes it stays in great, other times it's falling out. Is there anything I can do to try to salvage the denture if there's not much retention that far into the process? Maybe another impression inside the denture with a certain material or some other technique to send it back to the lab and get it altered/relined in any way?

Any input would be greatly appreciated. Thank you.

There isn't really a one answer fit all with dentures. There are lots of variables involved in the process

 

[TheLabGuy]

Hey guys, admittedly I'm not great with dentures. I can normally help the lab make a denture that looks great with a proper bite, it's just whether or not there's going to be much retention on delivery day.

I get to that final delivery appointment and sometimes it stays in great, other times it's falling out. Is there anything I can do to try to salvage the denture if there's not much retention that far into the process? Maybe another impression inside the denture with a certain material or some other technique to send it back to the lab and get it altered/relined in any way?

Any input would be greatly appreciated. Thank you.

You can always 'salvage' the denture. You just have to diagnose the reason why you aren't getting retention. Atrophic ridge should of been noticed before denture prescribed. The borders are extended posterior far enough - see this all the time...to save it, pull out the green border molding and extend with a new reline impression. Post Dam's correctly placed. The undercuts aren't completely blocked out. If doing an immediate denture, make sure lab is providing a bite block - this is important because immediately after extractions, and once immediate is confirmed seated all the way, place bite block in place and have patient bite down for ten minutes. This adapts that hamburger'd tissue into the proper place and begins the healing process and i've seen great results using this technique. Tons of great books out there on the clinical side for getting better at Dentures...I still go back to the old one Dr. Earl Pounds which goes into so much great depth, also Dr. Turbyfill and Dr. J. Mossad have wonderful techniques as well. Once you figure out the why's, dentures will be your favorite delivery.

 

[Cleo]

If it is 100% a fit/impression issue a reline impression should fix it. Bigj1972 is right and it could be many one of many variables. In general I do the following when I seat a denture. Hold it in place make sure it is not rocking and it seats fully. Adjust any sore spots they might feel. Check the bite and make sure when they hit in centric that there is not an interference that causes a shift or loosening of the denture, even if it is minor. If it is still loose I check the extensions. Last of all I will try a lite body wash in the denture. If that wash improves it I send it for reline or rebase. When I get called to check loose dentures it is usually a bite issue. We try to catch the poor impressions early in the process.

 

[Doris A]

You can always 'salvage' the denture. You just have to diagnose the reason why you aren't getting retention. Atrophic ridge should of been noticed before denture prescribed. The borders are extended posterior far enough - see this all the time...to save it, pull out the green border molding and extend with a new reline impression. Post Dam's correctly placed. The undercuts aren't completely blocked out. If doing an immediate denture, make sure lab is providing a bite block - this is important because immediately after extractions, and once immediate is confirmed seated all the way, place bite block in place and have patient bite down for ten minutes. This adapts that hamburger'd tissue into the proper place and begins the healing process and i've seen great results using this technique. Tons of great books out there on the clinical side for getting better at Dentures...I still go back to the old one Dr. Earl Pounds which goes into so much great depth, also Dr. Turbyfill and Dr. J. Mossad have wonderful techniques as well. Once you figure out the why's, dentures will be your favorite delivery.

I wish Dr Turbyfill hadn't retired. He was a great dentist and instructor. We do a lot of the branching technique dentures.

 

[TheLabGuy]

If it is 100% a fit/impression issue a reline impression should fix it. Bigj1972 is right and it could be many one of many variables. In general I do the following when I seat a denture. Hold it in place make sure it is not rocking and it seats fully. Adjust any sore spots they might feel. Check the bite and make sure when they hit in centric that there is not an interference that causes a shift or loosening of the denture, even if it is minor. If it is still loose I check the extensions. Last of all I will try a lite body wash in the denture. If that wash improves it I send it for reline or rebase. When I get called to check loose dentures it is usually a bite issue. We try to catch the poor impressions early in the process.

Good point, Occlusion and Phonetics are one of the biggest things to address...and you're right, even the slightest interference or premature high spot will dislodge that denture and present with bad retention.

 

[MarkDT]

Hey guys, admittedly I'm not great with dentures. I can normally help the lab make a denture that looks great with a proper bite, it's just whether or not there's going to be much retention on delivery day.

I get to that final delivery appointment and sometimes it stays in great, other times it's falling out. Is there anything I can do to try to salvage the denture if there's not much retention that far into the process? Maybe another impression inside the denture with a certain material or some other technique to send it back to the lab and get it altered/relined in any way?

Any input would be greatly appreciated. Thank you.

Do your border mold your dentures that can really add a custom effect to getting a final impression. As an in house tech for years te Doc would take an initial impression and then I would create a custom impression from that. In the operatory he would add border molding before placing his impression material. The border mold would help to create a deeper and more accurate impression for denture retention.

 

[MarkDT]

Hey guys, admittedly I'm not great with dentures. I can normally help the lab make a denture that looks great with a proper bite, it's just whether or not there's going to be much retention on delivery day.

I get to that final delivery appointment and sometimes it stays in great, other times it's falling out. Is there anything I can do to try to salvage the denture if there's not much retention that far into the process? Maybe another impression inside the denture with a certain material or some other technique to send it back to the lab and get it altered/relined in any way?

Any input would be greatly appreciated. Thank you.

Also if you send it back to the lab you might give the patient tissue condition for a day or two and then border mold the existing denture with a new impression around it using the denture as an impression tray and then getting a new model to reline from. Check the post dam if its an upper denture make sure that is okay if its a lower denture make sure that you have sufficient flange. Are their photos of the denture and or models that we could look at?

 

[bigj1972]

You can always 'salvage' the denture. You just have to diagnose the reason why you aren't getting retention. Atrophic ridge should of been noticed before denture prescribed. The borders are extended posterior far enough - see this all the time...to save it, pull out the green border molding and extend with a new reline impression. Post Dam's correctly placed. The undercuts aren't completely blocked out. If doing an immediate denture, make sure lab is providing a bite block - this is important because immediately after extractions, and once immediate is confirmed seated all the way, place bite block in place and have patient bite down for ten minutes. This adapts that hamburger'd tissue into the proper place and begins the healing process and i've seen great results using this technique. Tons of great books out there on the clinical side for getting better at Dentures...I still go back to the old one Dr. Earl Pounds which goes into so much great depth, also Dr. Turbyfill and Dr. J. Mossad have wonderful techniques as well. Once you figure out the why's, dentures will be your favorite delivery.

Long time since I've heard Dr. Earl Pounds mentioned...

 

[bigj1972]

For removable, if you want predictable results, you must develop a protocol, and then stringently follow it. Skipping steps, that's how you introduce variables.

And also, you could do good work in the office, and then some lab can screw up the fit of the denture. I see that equally as much.

It takes both parties to be at their best to make a predictable, consistent, and successful case.

 

[Flipperlady]

Border molding, function,proper teeth,psychology, poly-grip.

 

[davidJ]

As a dentist, the easiest answer would be if you can do chairside soft reline and it stays, you could make a denture that stays. If not, tell the patient about overdenture. you can't fix the anatomy issue or lack of it