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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.
