cosmetic and anti-aging dentistry
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by Dr Chan Joon Yee
 This middle-aged Filipina lady came to us with a toothache on her upper right incisor. Root canal has been done on the tooth in the Philippines. A fibre post has also been permanently cemented. This makes salvaging the tooth very difficult. At the same time, she was also wearing a very unsatisfacory upper partial denture but was tolerating it. Since she could not afford bridges/implants but was concerned about her appearance, we advised her to do an immediate partial. How is this done and why is it called the immediate partial? Well, an immediate partial is a partial denture that is inserted into the patient's mouth immediately after the planned extraction of teeth.
 Without her old partial, the patient presents with a pair of pretty good canines. By taking out the incisor, we'll have plenty of space to arrange teeth in almost perfect alignment. A week before the denture was to be issued, the patient had an impression of her mouth taken. The tooth on the model was knocked out and 4 artificial teeth were placed in the space between the 2 canines. Once the acrylic denture has been processed, we called the patient back for the extraction and fitting of the denture.
 You can see above that the planned extraction has been done. This extraction was previously simulated on a plaster model of the patient and the denture was constructed as if the tooth was already gone.
 Above is the photo of the patient with her new immediate partial denture inserted just minutes after the extraction of the front tooth. Just compare and note the difference with the patient's old denture.
 A greatly improved smile. This is cosmetic dentistry with immediate partial dentures. This is only suitable for patients who can tolerate dentures. A new immediate denture is likely to be larger than the old denture. Some patients may have problems adjusting. As the denture was made before the gums have healed, a gap is likely to appear between the denture and the gums after a few months. Relining may be necessary. If more than one tooth is extracted, a new denture may have to be redone a few months after the immediate partial has been fitted. Of course, immediate dentures can also be used as interim dentures while the patient is waiting to receive dental implants.
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Acrylic dentures are not the best type of prosthesis for anyone, dentist or patient. Except for the rare, cynical grouch who is constantly in denial, no patient who has swapped his acrylic dentures for a set of shiny chrome dentures has ever regretted it. Chrome dentures are similar to acrylic dentures except in the base or framework of the prosthesis. The teeth and "gums" used in a chrome denture are no different from those used in acrylic dentures. However, chrome, being much stronger than acrylic, allows a slimmer and sleeker design of the denture base. Not only can the base be thinner, it can also cover a smaller area of the mouth. Higher accuracy also provides a better fit. It's not surprising that in most cases, chrome dentures are superior to their acrylic equivalents. If function and durability are what you want in a denture, then go straight for chrome dentures.
 The above denture demonstrates a situation called the free end saddle. When it occurs on both sides of the lower jaw, it is a challenge to the most skilled dentist. I would not advise anyone to have an acrylic bilateral free end saddle denture done. A good set of clasps on the remaining teeth will stop the denture from sliding backwards when the wearer bites. But the sinking force at the unsupported end may cause discomfort or even pain. A chrome denture may lessen the discomfort. Acrylic dentures almost always perform poorly under such circumstances. Are there any disadvantages of chrome dentures over acrylic dentures? Well, first of all, chrome dentures are more expensive and take a longer time to construct. It is also important to note that chrome dentures often show more metal than acrylic dentures with thin wire clasps. Are you OK with the thick chrome clasps and rests? There are patients who deny that they are uncomfortable about the thick metal claps on their chrome dentures but keep complaining about other vague or non-existent problems instead. It is important to be frank with your dentist. However, one real problem with very large full upper chrome dentures, is the weight. In cases where the patient's upper jaw is not well-endowed with a high ridge or deep palate, full chrome dentures will be heavy and unretentive.
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Many people who use titanium spectacle frames will be familiar with the lightness of this very strong metal. Considerably more expensive than chrome, titanium is much light and hence more suitable for the construction of full upper plates. The above denture, made with a titanium base, has the strength of a chrome denture and the weight of an acrylic denture. Titanium dentures are suitable for patients who want a strong metal-based denture that feels as light as plastic.
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You may have heard about a new type of dentures which look almost exactly like acrylic dentures until you try to break them with your fingers. These dentures are actually made from a highly flexible, virtually unbreakable nylon material. The "clasps" on the denture are all made from the same transparent nylon material as the base. They are virtually invisible in the mouth, hence providing aesthetics and retention at the same time.
  The older generation of flexible dentures are now obsolete. The newer version is more comfortable and function, but we would still not recommend them for patients who have lost a lot of teeth. The photos above show the ideal cases for Flexite denture construction. Felxible dentures will set you back about S$600.
Marrying the merits of both Flexite and chrome, this is the type of dentures I would recommend to patients who want function and aesthetics. The chrome portion of the denture provides a rigid base resist any chewing movements. The flexible portion form the invisible clasps and gums. With a chrome base in place, even patients who have lost quite a number of teeth can expect a strong, functional denture.
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Implant supported dentures are well-tested and shown to perform well in an overwhelming majority of cases. The above bilateral free end saddle case would be virtually impossible to construct to the patient's complete satisfaction using conventional chrome or acrylic dentures. Practically nobody regrets placing a couple of implants to support their free end saddles. We have tried using smaller and cheaper implants for denture support. These implants may cost as little as S$900 each, but experience tells us that they often fail after some time. It is better to spend a little more on standard implants which are more reliable. Check out overdentures
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