Fifty years of removables, the long and short

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sas

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I am new to this forum and am excited to find there are dentists/technicians interested in advancing our services and sharing with others. I am going to post my observations of 50+ years with what I consider some observations, facts, opinions, with hopefully not causing any ill will. I am not bragging or complaining.

I am one of the few dentists that has considerable time in at the bench. For 50 years I have done heavy duty doing crown and bridge, full and partials, and other procedures that are fading from most offices. During that period I have had 2 different, very fine technicians as well as using commercial labs. I realize full well that there continue to be problems in our field, some the fault of the dentist, some of the technician. The technicians are often unfairly the scapegoat because that is the American way, to blame someone else. especially if they are not there.

We have placed roughly around 20,000 units over the years. That is 10,000 original and 10,000 remakes. Just kidding, but I have certainly had my share. This figure is not astronomical but I am proud of the fact that I have made every impression, bite, insertion, and adjustment on these cases. If we get smarter by our mistakes, I am a genius.

If we take implants out of the discussion, I believe the last real, meaningful studies that have been done in conventional denture construction were done in the 40s, 50s, and 60s. Certainly everyone knows the work of Dr. Pound and his associates which has been a guiding light for me. The other name that is not so well known is Nathan Kaye. Nathan was not a dentist but developed Adaptol. He was a mentor of mine and we spent many hours on the phone Saturday mornings discussing removables and it has been one of the highlights of my dental life. Both of these had a wealth of knowledge and we could all profit from studying their methods. One of the things that stands out in my mind was their notion that a removable should imitate what was there before the teeth were removed. I think all too often we call a denture with a chunk of plastic and teeth a replacement for lost tissue, that is wrong. These two men dealt with replacing what was missing as close to original as possible, including the external shape of the denture. It seems we are so bent on making the teeth look pretty that we overlook the flange design that needs to work with the shape and pressures of the surrounding soft tissue and muscles. I don't mean just the flange length but also the shape, convexity, concavity, etc. Naturally, these can all be impressed but we just don't take the time. So, we make our dentures "mechanistic" instead of "physiologic". We can carve all the beautiful anatomy, fullness, stippling, etc into the base but if it is not compatible with the existing anatomy then something has to give. As dentists we can do better to give our technicians a true picture of the area other than the ridges.

I see lots of bad dentures. Some of them are mine, unfortunately. The "average" denture of today is much worse than in was 50 years ago. I have seen patients that were wearing dentures made in the 30s when I started practice. Many were vulcanite with porcelain teeth. Ugly, but they worked. I believe there are several reasons why our removable service is declining. In the old days, the dentist did the impressions, etc. Expanded duties were yet undiscovered. Now, the critical work may be done by a lovely little thing that was running the drive in window at McDonalds last week. They have no idea what they are doing and it is a shame, but it goes on every day. Second, the high speed handpiece has helped cause a decline in removable proficiency. There was a time when dentures were one of, in not the highest, procedures in our practices for profit. Now, not many dentists are going to take the time to make dentures when they can cut down a quadrant of crown preps. The impression techniques have changed in an effort to "speed things" up for the operator. I hate to be old fashioned but I see very few impressions that I think wouldn't be improved if they had border molded with compound or Adaptol. I cannot see the logic in using a chemically setting material when we can alter a thermoplastic material a few times until we get the desired impression. I know there are people who use the polyvinyls exclusively and are happy with the results. That is great but I believe that most of us should stick to the "old way." And last, when I go to the dental school I just don't get much warm and fuzzy feeling talking to the students about removables. It is veneers here, CAD-CAM there, digital, whitening, blah, blah, so there is not much interest. Edentulous patients are kind of second class citizens, kicked to the curb.

Many practitioners believe that they can skip over the pertinent conventional procedures and go straight to an implant practice. I can't see it. If you can't get an acceptable grade on flange design and occlusion then you are going to get in trouble. One day that patient will come in with the implants in their hand and want an explanation. Those things do come out.

It is great to be able to get on this site and learn more about my passion. Best of luck to all.
 
Betalab

Betalab

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Welcome aboard sas. Awesome first post! In Australia I'm a prosthetist and USA and Canada I'm a denturist so I can see where you are coming from.would you believe that in Australia the universities don't even teach removable prosthetics now. It is the job of the denturist here. Don't worry we are the second class citizen working for the meek and humble. I don't mind I love the oldies. They give me a great insight on life and I try to give them great dentures. Welcome to DLN.

-patrick
 
rkm rdt

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Edentulous patients are not second class citizens ,they just have less options .

I think today's patient has benefited from improved dental hygiene education and procedures. Is extraction still considered a primary option today?

Sorry but implants and endodontists are here to stay.
 
cheadlemick

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You've got way too much time on your hands with long posts like that! Lol! however i agree with much of it and it is good to hear a dentists' take on things.
 
AJEL

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SAS welcome, I agree with much of your first post, I am comming up on 50 years soon, but must admit I do not miss plaster impressions or Vulcanize dentures (I have done my share of brown with a pink strip. And not getting that smell off my hands.)
I do enjoy the really nice teeth, although Dr. French & Universal had quite nice autonomy, even though the shades were not consistent, and fractures frequent. My father (Joe Luckow) was a technician starting in 1944, I still use his thoughts on flange design, and am not big on stippling. His constant, reminder was; " we can copy Gods work, but only copy. The product we do should replace, and try to not take more tongue space than necessary. We need to think how the bolus will travel and not cause interference. To remember that the removable is part of eating and speech, as well as appearance. "
This year & next my last 3 DDS who custom tray border mold and use rubber base or hydrocast will retire, and to a degree I will miss working on those nicely worked casts, and full technique to produce a quality removable.
The corporate dental that have purchased their accounts have contacted me with an e-mail" if I don't match this price list they will send to the lab that does. (it is off shore I have the list with the lab name on it)." Now the DDS want to do 3 appointment removable, I do my best but dads words echo (back in the cerebellum) , this could have been better.
My father worked with Gordon on early implants (1970's spades & subframes & early Branemark 1980's, he would have I think enjoyed the possibilities that new implant's afford us today in restoration construction.
AJ Luckow
 
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araucaria

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The corporate dental that have purchased their accounts have contacted me with an e-mail" if I don't match this price list they will send to the lab that does.

same 5hit going on here too, and some insist on cashback deals/discounts in addition to the stupid prices being quoted, I cant believe how many give in to the pressure. bloodsuckers!
 
AJEL

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Originally Posted by AJEL
The corporate dental that have purchased their accounts have contacted me with an e-mail" if I don't match this price list they will send to the lab that does.
same 5hit going on here too, and some insist on cashback deals/discounts in addition to the stupid prices being quoted, I cant believe how many give in to the pressure. bloodsuckers!

Karl I only wish a requirement of disclosure of point of origin was required here. There is much unemployment pain right now from firms that are using off shore as their oldest profession workers. The corporate have the power though, and those who have to work to pay the taxes for those who have had their votes purchased with the promise of a free lunch are suffering, I suspect the same in London.
AJ
 
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Twice in large corporate labs I've seen lay-offs due to increased outsourcing to China. Some of my co-workers/managers had anywhere from 15 to 29 years with the same company. Production requirements doubled and QC became crippling. All the while being told, "Don't say a word, we'll just send your units to China". This is not the industry I entered in 1982. It is what it is. Fortunately there is still room for those who focused on there skills, and they can still make a good living.
 
DentureDude

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nice post sas. very insightful.
welcome.

yeah its defiantly gone downhill.
im so sick of getting custom trays back with no border molding. its ridicules. whats the point?
sometimes ill even throw some border wax in the pan when i deliver the tray hoping they may get the hint.

the old timers are pretty good but the new docs.. forget about it.

and you are dead on. when it comes to removables.. they think the girls can handle it.
is that even legal?


i really feel for the denture wearers these days.
 
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You guys are discussing about many things including implant I want to know from you that have you done completely fixed denture implant? If yes, what it costs? Tell me the minimum price band?
 
AJEL

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kouis
You guys are discussing about many things including implant I want to know from you that have you done completely fixed denture implant? If yes, what it costs? Tell me the minimum price band?
As this is a public forum, most people will not post pricing, far to many civilians will use google and find this and every time it will bite you where you need to sit and work (ok at the plaster bench when you stand).
A complete fixed denture would not work are you asking about all on four? if so there is a lot for you to learn before trying to do one. Check some of JohnWilson or drobert posts, I think Theresia TWAITE has posted some of the trials with this procedure. I have only done 6 so far.
 
DMC

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Flouride.

Implants.

Patient education.

This is why removable numbers have dropped.

Very obvious to me?

Dentures are terrible. Who the heck would really want One (good or bad)?
 
Flipperlady

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Peridontal disease, #1 reason why removable #'s haven't dropped. If you live in the big city you are going to think the #'s have dropped because of more affluent areas, they can afford implants. Even so not all implants work so even these pt's will have to switch over to dentures. Dentures aren't terrible for everyone.
 
AJEL

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Baby boomers in this economy how many can afford the 10,000 - 35,00 for full implants? Flouride wasn't instated until 1965 I and millions of my peers were born prior to that date. With the economy and lack of education I just did a Preggyy denture last week, do you know what those were? The removable numbers haven't dropped, just the removable technicians.

And as we all know when the crowns fail patients get partials, then the partialssometimes grabb and supporting teeth are lost, then implants fail and what is left for the patient (especially when the DDS has taken all their money) a Denture and if I'm still here I'll do the best I can for them.
 
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NicelyMKV

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Baby boomers in this economy how many can afford the 10,000 - 35,00 for full implants? Flouride wasn't instated until 1965 I and millions of my peers were born prior to that date. With the economy and lack of education I just did a Preggyy denture last week, do you know what those were? The removable numbers haven't dropped, just the removable technicians.

And as we all know when the crowns fail patients get partials, then the partialssometimes grabb and supporting teeth are lost, then implants fail and what is left for the patient (especially when the DDS has taken all their money) a Denture and if I'm still here I'll do the best I can for them.

Well stated AJEL.
 
droberts

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Removable numbers have not dropped, the techs have in that department as AJEL stated. In these times, I feel it is what the patient can afford, what insurance will pay,
and most important what is presented to them from their doctor. I do not have the exact numbers on hand, there have been many articles on the increase of edentulous
patients in the coming years. As for the economy? Dont listen or watch the news, media does not have control of your business.
 
lcmlabforum

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Nice posts by those involved. The shame is that this is happening to many veterans
and their widows who cannot find a DDS in the area who does general dentistry
to provide them with reasonable removable. And they get referred to a prosthodontist
who is miles away from where they stay.
Schools are under pressure to cut the credit hours on something to add more evidence
based stuffs, new research, implants, etc. Removable lab takes time and manpower
to man, many removable technicians retiring. Something's got to give.
And with the ads touting CAD-CAM dentures that can be completed in 3 visits or
less, we are left wondering where the priorities are?
We are all preaching to the choir here. Maybe the answer is more denturists who
can partner with private clinics to better take care of the patients' unmet needs?
LCM
 
N

nickate

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Nice posts by those involved. The shame is that this is happening to many veterans
and their widows who cannot find a DDS in the area who does general dentistry
to provide them with reasonable removable. And they get referred to a prosthodontist
who is miles away from where they stay.
Schools are under pressure to cut the credit hours on something to add more evidence
based stuffs, new research, implants, etc. Removable lab takes time and manpower
to man, many removable technicians retiring. Something's got to give.
And with the ads touting CAD-CAM dentures that can be completed in 3 visits or
less, we are left wondering where the priorities are?
We are all preaching to the choir here. Maybe the answer is more denturists who
can partner with private clinics to better take care of the patients' unmet needs?
LCM

IF I WANTED MY HANDS IN SOMEONE'S MOUTH I WOULD'VE GONE TO DENTAL SCHOOL.
It'll cost a LOT of money to get me to put my hands in anyone's mouth.
 
Hary

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Being a full service lab in this economy i felt the difference of a switch in the work flow, 80% of my work was crown and bridge and 20% removable ...
now is 60% fix and 40% removable, dentures will always have its place not every one can afford fix prosthesis and i have seen labs that were only crown and bridge they have started removable department.
 
JohnWilson

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I have enjoyed this thread, it has solidified my thoughts on the lack of real training being done for new grads as it relates to removable.

With implants and their role associated with removable and removable concepts we are facing a daunting challenge with these new kids that think they can learn on the fly.

I have 3 new clients all with Fixed hybrids going now and 2 out of the 3 I believe have never done a set of dentures in their life. The 3rd one is marginally more adept but still scares me. It takes an amazing amount of self control and good communication to explain what we the lab need to be on the correct path to a successful case. Since we the lab/client are married to these bigger cases it has been a very slippery slope as to who I partner with based on their skill set. I have been forced to start thinking in a litigious way rather then let my/our artistic talent flow.

Implants have been and ARE the reason for the growth in my lab, I anticipate with the advent of more automated approaches for some of these restorations we will be able to streamline more of the direct labor associated with them. that being said like all things in our industry prices will fall and again our highest end products will have cheaper pricing. Cheaper pricing means less risk and thus I feel the industry will dive deeper into a "Good enough" mentality.

It certainly is sad to see the old timers leave, while many of the products they have used over the years have improved ten fold I can honestly say its the hands and experience of these individuals is what I will miss most.
 

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