Fifty years of removables, the long and short

AJEL

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John you are far braver than I, 2 years ago I took on some new grads best thing was to get rid of them. They came out of school without having any removable, but the attitude that they knew all. Some business coach at their school told them they could renegotiate the price after product delivery. I have layout sheets for the procedures required for various phases of removable. They felt custom trays were not required, and that I should fill in the sponge models they provided! They did not like me charging when I returned unsuitable models (delivery is not free). I have a statement on my work contract that the DDS is responsible for court costs if it comes to that, the judge asked them if they read the statement directly above their signature. (yes I got full & interest as stated on work contract & court costs & 1 day pay). The judge took note of their Italian suits vs my clean cotton shirt & Uniform slacks. I truly feel empathy for anyone who has to do their work now, and they were talking about doing all on 4! But maybe it's China, they were looking for cheap.
My customers are starting to retire (their in their 50's & 60's with 1 70) I'll miss them but do not look forward to this new crop of greedy, ignorant, self absorbed, bull headed barely trained DDS in name.
The old timers is sad leaving but then I went to 2 peers funerals last year I miss chatting late at night with them.
 
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rkm rdt

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Ah Ajel , my fellow dinosaur.

I feel your pain. Remember my friend, for this new crop of greedy, ignorant, self absorbed, bull headed barely trained DDS in name, there is a similar new crop of greedy, ignorant, self absorbed, bull headed barely trained dental techs in name.

The world is balanced.
 
AJEL

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RMK
I feel your pain. Remember my friend, for this new crop of greedy, ignorant, self absorbed, bull headed barely trained DDS in name, there is a similar new crop of greedy, ignorant, self absorbed, bull headed barely trained dental techs in name.
True and there are only 93 accredited schools for dentists in the USA
Compared to 12 certified schools for Dental Technicians if you don't count the 2 in prisons.
In Canada you do have the option of Denturism, where the technician shares more fairly in the profit, as opposed to the 5-15% down here. I'll admit to being bull headed, self absorbed, maybe even ignorance, but with 1 foot in front of bankrupsy I can't admit to greed.


Go Blackhawks acontent.sportslogos.net_logos_1_7_full_p18vqre4e2mnliddgg5phcvgg.gif
acontent.sportslogos.net_logos_1_7_full_p18vqre4e2mnliddgg5phcvgg.gif
 
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JohnWilson

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Ah Ajel , my fellow dinosaur.

I feel your pain. Remember my friend, for this new crop of greedy, ignorant, self absorbed, bull headed barely trained DDS in name, there is a similar new crop of greedy, ignorant, self absorbed, bull headed barely trained dental techs in name.

The world is balanced.

I beg to differ, its still very much lopsided!
 
rkm rdt

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Yes,how could I forget California ;)
 
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I agree. There are those young prima donnas out there. They don't get far with me either. But I've picked up a few of those young dentists that just wanted some help and were treated like they were stupid by some lab. They realize that removable techs, like us, with over thirty years of removable experience, might have some information they could use.

I speak to study clubs full of young dentists that want to learn. I show them Ivoclar's Smile design kit. It has calipers, a Fox plane, a rim former, papillameter and a DVD that shows them how to use the stuff. I ask for photos, just a full face/eyes open photo with the baseplate and occlusion rim in place. Then, I can select denture teeth, and SEE if they've missed the midline or screwed up the plane of occlusion. They may have trouble taking an impression but they all have smart phones and know how to email a photo.

I've seen the jerks too. They can be someone else's problem. I just think that if you teach them, you get two things in return. You get what you to need to do your job correctly, and a loyal customer. In my world, I don't need a lot of those to keep me busy. my $.02
 
AJEL

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Rick
I speak to study clubs full of young dentists that want to learn. I show them Ivoclar's Smile design kit. It has calipers, a Fox plane, a rim former, papillameter and a DVD that shows them how to use the stuff. I ask for photos, just a full face/eyes open photo with the baseplate and occlusion rim in place. Then, I can select denture teeth, and SEE if they've missed the midline or screwed up the plane of occlusion. They may have trouble taking an impression but they all have smart phones and know how to email a photo.
I have started using I pad for this, the facetime is a boom. I supply a papilla meters, (they don't want to do their own baseplates) I have picked up 1 new DDS with an open mind from the local study group, but he has the advantage of his father being a good removable DDS. (He sold me his gen III when he got his gen IV I Pad) I think I can use Google chat as some use android smart phones, more for a dino to try & learn.
awww.enchantedlearning.com_tgifs_Trexskelanim.gif
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AJEL

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I treat no-one as stupid, you have to earn stupid from me (although it seems I grant that with less effort as I age.)
As I think on it this would not be a good area for someone greedy to get into. There is a lot of work and it is habit forming but profit is thin at best. It is not so much fun anymore, even though there is still a lot to learn, I only wish this old dino could remeber much of what I had forgotten. well this was fun back to the bench those teeth won't set them selves.

achumpette.se_wp_content_uploads_2013_01_14525_1_v12_TP.jpg

achumpette.se_wp_content_uploads_2013_01_14525_1_v12_TP.jpg
 
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AJEL

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Reread this and thought so much good stuff here maybe time to rebump it and get the thoght going again.
 
CoolHandLuke

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dentures to me are simply one method of treatment.

i don't understand why the fuss about making CADCAM dentures? if the purpose was to mimic what was already in the mouth, a computer can compute that much faster than any normal human - and as a control measure, a human is required to oversee and approve.

its not as though you push a big red button and a denture pops out of a machine.

there is a lot of thinking going on and the software is always being improved. it is altogether true that a properly trained denturist should be able to use CADCAM to make dentures JUST AS EASILY as if he/she were doing it with wax and plastic.

if anything the process of creating dentures has improved to be more Time efficient, as well as material efficient. less time lost cutting, adding, realizing you were right the first time, and cutting. all that lost time and material is solved with CADCAM.

implants are yet again another means of treatment. its the right thing to do in some cases. the bone is healthy. it will work.

if a patient doesnt NEED to go though a 4 visit process to replace a tooth with a denture, why would you prescribe it?

all these treatment options cater to a wide variety of needs, for a wide variety of incomes, and a wide variety of problems.

but it has not changed the dental practice, only allowed it to have greater flexibility. allowed more patients to come in, and allowed some doctors to specialize.

dentures were a new, hot commodity when they were invented; in an era where peasants trode the battlefield to pluck teeth from dead soldiers, and on their own, hammer them into their faces.

dentures were a sign of affluence once.

we will come full circle soon - the advent of stem cell grown teeth will be implanting teeth into people's faces again but this time their own teeth, and not someone else's. this occurs in a highly sterile, very high tech process involving a lot of computer power (to map genomes and chart stem cell growth, and code stem cells).

imagine what comes after stem cell teeth.
 
Cbite Dental Products

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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.

SAS,

I don't know if you are still around since this thread is from last year, but thanks for sharing. I have 35+ years in crown/ bridge, and I am now learning dentures...I will be sure to read up on Dr. Pound and Mr. Nathan Kaye.
 
Doris A

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SAS,

I don't know if you are still around since this thread is from last year, but thanks for sharing. I have 35+ years in crown/ bridge, and I am now learning dentures...I will be sure to read up on Dr. Pound and Mr. Nathan Kaye.
Also read up on Dr Jack Turbyfill, he has expanded on what Dr Pound started.
 
Cbite Dental Products

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I treat no-one as stupid, you have to earn stupid from me (although it seems I grant that with less effort as I age.)
As I think on it this would not be a good area for someone greedy to get into. There is a lot of work and it is habit forming but profit is thin at best. It is not so much fun anymore, even though there is still a lot to learn, I only wish this old dino could remeber much of what I had forgotten. well this was fun back to the bench those teeth won't set them selves.

View attachment 6297

View attachment 6297

Nice video.
 
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glor_bry

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SAS,

I don't know if you are still around since this thread is from last year, but thanks for sharing. I have 35+ years in crown/ bridge, and I am now learning dentures...I will be sure to read up on Dr. Pound and Mr. Nathan Kaye.
 
G

glor_bry

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New here and not sure about how to reply. I have information about Nathan Kaye's work and also the product Adaptol which is available through the major dental suppliers.
 
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glor_bry

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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.
 
G

glor_bry

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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.
 
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glor_bry

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I know the work of Nathan Kaye and his product Adaptol. Adaptol is still being used by savvy dentists and denturists. Someone posted here that it is hard to find...not so. It is available.
 

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