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Prosthodontics, Removable Dentures in Selangor, Malaysia

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Prosthodontics, Removable Dentures in Selangor, Malaysia

Dentures Replacing All or Some Teeth in Selangor, Malaysia

Among the most well known but least desired areas of dentistry is removable prosthodontics. However, well-made and fitted artificial dentures can be relatively satisfactory replacements for teeth and surrounding bone and soft tissue for a predictable period. Unknown to many persons is the fact that the jawbones and gum tissues shrink a known amount when teeth are removed, and even more upsetting is that shrinkage continues to occur throughout the remainder of the person’s life. Acceptance of this fact is a major decision for a person considering tooth removal. Frustration with the maintenance of natural teeth can lead a person to think that tooth removal is an easy solution. However, tooth removal usually substitutes other problems for the one you are trying to avoid. Usually, but not always, retention of natural teeth is the best decision. Having your teeth removed can be compared to having an arm amputated. You can get a new artificial arm, but it will never function as well as the original arm. if you have lost some or all of your natural teeth, you should find a general dentist whose practice includes removable prosthodontics or a prosthodontist for acceptable treatment.

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WHAT YOU SEE OR FEEL

Conditions, Signs, or Symptoms Related to Removable Prosthodontics : Dental Implants are among the best ways to replace missing teeth in Selangor, Malaysia.

1. One or More Teeth Missing

Most persons prefer to have one of the fixed prosthodontic options (bridge attached into mouth) when one or many teeth are missing, but for financial or other reasons removable prosthodontic options may be best. All of the treatment alternatives follow, some of which are removable prostheses:

A. Fixed prosthesis (traditional bridge involving at least one tooth on each side of space as abutment teeth)

B. Fixed prosthesis (Maryland bridge) (less prepared [trimmed] teeth on each side of the space, with conservative bridge holding a false tooth, usually leaving the front portion of the abutment teeth intact)

C. Cantilever fixed prosthesis (traditional bridge involving one or more teeth on one side of space only as abutments)

D. Removable partial denture (all plastic)

E. Removable partial denture (traditional metal and plastic) 

F. Removable partial denture, precision or semi-precision (plastic and metal fitted to crowns [caps]) 

G. Implant(s) with crown(s) (caps) or prosthesis fixed on top to replace teeth

H. Implant(s) with removable partial denture placed on top of them

Missing teeth can be replaced well with either fixed or removable prostheses (dentures); most people prefer fixed.
Missing teeth can be replaced well with either fixed or removable prostheses (dentures); most people prefer fixed.

2. All Teeth Missing in Upper and/or Lower Jaw(s) in Selangor, Malaysia

This unfortunate condition occurs less frequently now than in past decades, but it is still relatively common. Your treatment alternatives are the following:

A. Removable complete denture(s)

B. Implants with fixed prosthesis on top of them to replace teeth

C. Implants with removable denture(s) placed on top of them

Removal of all natural teeth produces a sunken, aged look.
Removal of all natural teeth produces a sunken, aged look.

3. All Teeth in Upper and/or Lower Arch Degenerated to the Extent That They Must Be Removed

Numerous conditions cause this situation, including dental caries (decay), gum and bone disease (periodontal disease), accidents, congenital deformities or other abnormalities, cancer requiring radiation and/or chemotherapy, or other conditions. When all of the teeth must be removed, some decisions must be made as to whether the teeth should be:

1. Removed all at once and the bone and gums allowed to heal before placing the denture(s) later. Usually this treatment is not one of the options, because the person must be toothless for several weeks before the denture(s) can be placed.

2. Removed partially (back teeth first), letting those areas heal without any replacements, and then, on the next appointment, removing the remaining front teeth and placing denture(s) to replace all teeth. This treatment is called a staged immediate denture. The person is never completely toothless.

3. Removed completely on one day, and during the same appointment, denture(s) placed to replace all of the teeth. This is a complete immediate denture. All the remaining degenerate natural teeth are left in the mouth until placement of the denture(s). Most people elect the latter two options because the new denture(s) serve as a type of bandage to help the bone and gums to heal.

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A.Person requiring removal of all teeth; back teeth had been removed previously. B, Day of tooth removal. C, Immediate placement of dentures on day of tooth removal.
A.Person requiring removal of all teeth; back teeth had been removed previously. B, Day of tooth removal. C, Immediate placement of dentures on day of tooth removal.

4. Conditions Involved With Partial or Complete Denture(s) in Selangor, Malaysia

Patient dissatisfaction with removable dentures is known to be one of the highest of any area of dentistry. The facts are that natural teeth are meant to remain in the mouth, and that artificial removable dentures replace natural teeth to only a small portion of their original effectiveness. Also, we all have varying abilities to tolerate the many challenges of removable complete dentures. Some of the following conditions can be corrected easily, whereas others may not have simple solutions. The conditions listed are followed by alternative solutions described in the next section of this chapter, What Your Prosthodontist or General Dentist Can Do.

A. My dentures collect food under them. SOLUTION: Reline, rebase, or make new dentures.

B. My denture bases (pink portion) are discoloured. SOLUTION: Clean and polish denture, rebase, or make new dentures 

C. The denture teeth are discolored. SOLUTION: Clean and polish denture, replace teeth, or make new denture.

D. I can’t chew well. SOLUTION: Make new denture or repair denture by sharpening existing teeth.

E. My gums have sore spots. SOLUTION: Adjust denture, reline, rebase, or make new denture.

F. My gums hurt when I chew. SOLUTION: Adjust denture, reline, rebase, or make new denture.

G. I bite my cheeks or tongue. SOLUTION: Repair denture by recontouring teeth, or make new denture.

H. The dentures won’t stay in place. SOLUTION: Reline, rebase , or make new dentures .

I. The dentures have missing or broken teeth. SOLUTION: Repair denture by replacing teeth, or make new denture.

J. The dentures are broken. SOLUTION: Repair, or make new dentures.

K. My nose and my chin are too close together when I bite down with the dentures in place. Solution: Make new dentures.

L. My dentures have worn the teeth or crowns on my opposing jaw. SOLUTION: Make new dentures using less abrasive denture teeth  and repair natural teeth, repair, or make new crowns (caps).

M. My dentures have a poor bite. SOLUTION: Repair dentures by selective grinding or sharpening teeth, or make new dentures.

N. My removable partial dentures cause pain in the supporting natural teeth when I chew. SOLUTION: Adjust retaining clasps of removable partial denture, or make new partial denture.

O. The clasps (retaining wires) on my partial denture show too much. SOLUTION: Make new partial denture.

P. The supporting teeth for my removable partial denture are loose. SOLUTION: Treat supporting teeth if necessary, and repair or make new removable partial dentures.

Q. A supporting tooth for my removable partial denture is broken or decayed. SOLUTION: Repair supporting tooth and retrofit partial denture to repaired tooth.

R. My dentures are too tight. SOLUTION: Adjust dentures.

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WHAT YOUR PROSTHODONTIST OR GENERAL DENTIST CAN DO IN SELANGOR, MALAYSIA

Treatment Available

Several types of treatment are available in the area of removable prosthodontics. Most general dentists accomplish some removable prosthodontic procedures, but if your condition is especially complex, or if you have had difficulty with previous prosthodontic treatment, then you may want to seek the services of a prosthodontist (a dentist specially educated in prosthodontics.

1. Repairing Previous Removable Partial or Complete Prosthesis

(Denture)

Repair may be a choice, but it will probably be only a temporary remedy that will require more comprehensive therapy later. Consult your dentist to determine the desirability or feasibility of repairing your current prosthesis (denture). The following are relatively simple, common maintenance or repair procedures for dentures that may satisfy your needs without requiring a new denture:

i. Cleaning and polishing: Stains, food, tartar, and accumulation of dental plaque can make a denture disagreeable in appearance and uncomfortable. Dentures need to be cleaned and polished often to remove these accumulations. This procedure is simple, fast, effective, and inexpensive.

ii. Adjusting base or other portion of the denture: The most common need in removable prosthodontics is adjustment of the base of the denture (the portion that sits on the gums). Even a slight amount of extra denture length, and the associated pressure on the gums and bone, can cause mild to severe pain for the denture wearer and dissatisfaction with the denture. Usually these sore spots are located on the denture base and are found by using pressure pastes inside the denture while moderate biting pressure is placed on the denture by the wearer. Removal of the pressure spot in the denture provides almost instant relief. Denture wearers who are in good health should have no difficulty having dentists locate and treat denture sore spots. Chronic sore spots that do not respond to repeated denture adjustments may require other treatment, such as relining or rebasing the denture or making a new one.

iii. Adjusting retentive metal clasps (wirelike portions) of a removable partial denture: Partial dentures usually become looser as they are worn for a period of months or years. As they loosen, they are often difficult to keep in the mouth, which is annoying, and food tends to collect under them. Your dentist can accomplish adjustment of the retentive clasps to make them tighter. This procedure may look simple to you, but even experienced dentists find it threatening, since the clasps are often brittle and can be broken relatively easily. Over-tightening can cause pain in the supporting teeth. Adjustment should be accomplished when needed, but it should not be overdone.

iv. Repairing a tooth that supports removable partial denture: An abutment tooth that is painful or broken cannot support a partial denture well. Repair of that tooth may be very simple or complex. It can require something as simple as a small restoration (filling), or as complex as an endodontic procedure (root canal) followed by a new crown (cap) that is fitted to the already existing partial denture. Occasionally a supporting tooth for the partial denture must be removed because of some non-repairable situation. In such a case, new retentive clasps (wires) may be fitted to the existing partial denture to salvage it for additional use. Your dentist can tell you about the complexity of repair for a partial denture (supporting tooth). Infrequently, if supporting tooth removal is required, a new partial denture or other treatment must be accomplished.

v. Repairing cracked, broken, or ill-fitting complete or partial denture: If a denture is cracked or broken, undue stress usually has been placed on it, or the fracture has occurred accidentally. Dentures that crack while chewing may be subjected to too much stress, or may require more thickness or reinforcement during construction. The repair of such stressed dentures may not be the preferred treatment, since repair usually weakens the original denture. Occasionally, additions to dentures are required for improvement of retention. Consult with your dentist on such conditions. Dentures that have been broken accidentally or need additions can usually be repaired easily, successfully, and relatively inexpensively.

vi. Replacing tooth (teeth) on a removable partial or complete denture: This type of denture problem is a simple one that requires minimal time and cost. If other aspects of the denture are acceptable, there is usually no reason to do anything other than replace the missing tooth (teeth).

vi. Reshaping or reforming denture teeth on a removable partial or complete denture: Patients complain occasionally about biting their lips, cheeks, or tongue. Sometimes this problem is difficult to overcome. Often it is related only to past chewing habits that wear the teeth into a flat plane, thus pinching and biting the lips, cheeks, or tongue. Reshaping the teeth to eliminate flat surfaces usually corrects this annoying and painful problem. Denture teeth shaped with points, grooves, and valleys can help make chewing more efficient also.

vili. Relining removable partial or complete dentures:

Dentures that have been worn for months to years may not have. adequate tight adaptation to the mouth soft tissues because these tissues have shrunk. This is a continuing process that is normal and should be expected. Relining a denture means that the internal portion of the denture is relieved (ground out) by the dentist, an impression is made inside the denture, and the internal surface of the denture is replaced with new plastic material that is the same colour as the original pink denture base.

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Denture needs a thorough cleaning by the dentist; this denture has been stained with a red dye. B, Cleaning by a patient, which will prevent gross accumulation of debris but cannot remove severe deposits.
Denture needs a thorough cleaning by the dentist; this denture has been stained with a red dye. B, Cleaning by a patient, which will prevent gross accumulation of debris but cannot remove severe deposits.
A, Metallic clasps hold removable partial dentures in place. B, Removable partial dentures are held in by metallic clasps (right), whereas complete dentures fit on the gums only (left).
A, Metallic clasps hold removable partial dentures in place. B, Removable partial dentures are held in by metallic clasps (right), whereas complete dentures fit on the gums only (left).
A, Three teeth support the removable partial denture. If one of the abutment teeth breaks, it can be removed and will still fit the partial. B, Note that the partial denture in place does not show metal.
A, Three teeth support the removable partial denture. If one of the abutment teeth breaks, it can be removed and will still fit the partial. B, Note that the partial denture in place does not show metal.
Replacement of a removed natural tooth that supported a removable partial denture (A) is possible by adding an artificial tooth to the denture, along with a new clasp (B).
Replacement of a removed natural tooth that supported a removable partial denture (A) is possible by adding an artificial tooth to the denture, along with a new clasp (B).
Arrow shows area of repair to the denture, providing better seal and retention of the denture (schematic cross section drawing).
Arrow shows area of repair to the denture, providing better seal and retention of the denture (schematic cross section drawing).
Roughening the surface of old plastic denture teeth (A) may allow rebuilding of the teeth with new plastic (B).
Roughening the surface of old plastic denture teeth (A) may allow rebuilding of the teeth with new plastic (B).
Relining dentures should be expected every few years because of shrinkage of oral soft tissue and bone (schematic cross section drawing).
Relining dentures should be expected every few years because of shrinkage of oral soft tissue and bone (schematic cross section drawing).
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This procedure may be accomplished either in one appointment while you wait in the office, or in two appointments- one to make the impression and another one to place the denture. This second type of reline (laboratory reline) is usually the preferred type because of better fit; it is also more expensive than the in-office type, and it requires you to be without the denture for up to 24 hours.

Another variable in denture relines is the availability of both hard and soft relining material. Some clinical situations require soft reline material, but most denture relines may be accomplished well with hard material similar to the original denture base. If soft relines are placed in the denture, they provide a cushion for the biting forces and are then usually more comfortable than hard denture relines. However, soft relining material lasts only a few months to a few years.

ix. Rebasing removable partial or complete dentures: Frequently, when considering relining or rebasing dentures, the teeth (tooth-coloured portions), the occlusion (bite), and the tooth positioning are still acceptable. Only the fit, positioning, and extension of the denture bases are unacceptable. In such cases, a rebase of the denture may be suggested. In this situation, all of the pink material of the denture is replaced, compared with denture relining, in which only the internal portion of the denture is lined. Rebasing a denture is more expensive than relining the same denture, but it is still less expensive than making a new denture. A properly rebased denture can look and feel like a new one. Rebased dentures may have soft or hard internal portions, with a shorter longevity for the soft liner.

A. Advantages of Repairing Previous Removable Partial or Complete Prosthesis: If the prosthesis is basically satisfactory to you and is only broken, missing some teeth, cracked, or ill-fitting, repairing it is less of a physiological or psychological shock than remaking the denture. The cost to repair the denture is also less than to remake it.

B. Disadvantages: Only infrequently can repair of a denture make it better than it was before it needed repair, whereas making a new denture can potentially make a more acceptable prosthesis in both appearance and function. Sometimes, repaired dentures are weaker than the original denture. Your dentist will be able to advise you concerning the desirability of repairing versus remaking your denture.

C. Risks: Repairing an existing denture is similar to placing a new sole on a shoe you still have part of the old shoe remaining, with unknown internal defects and longevity. Nevertheless, repair of existing dentures is often a wise decision.

D. Alternatives: Only one alternative is present if change is desired-making a new denture.

E. Cost: You should expect a relatively low cost for these services compared with the cost of making a new denture. Small repairs or replacement of missing teeth is inexpensive, whereas relining a denture is moderate in cost, and rebasing a denture is the most expensive of the repair procedures.

F. Result of Non-treatment: Minor need for repair can be tolerated without significant handicap, whereas broken or ill-fitting dentures require immediate attention. Avoiding a reline or rebase when a denture is ill fitting can cause significant damage to the gums and remaining bone support.

2. Removable Partial Denture in Selangor, Malaysia

Removable partial dentures, replacing teeth and missing gum tissue, can be functional and highly pleasing in appearance, or they can be unacceptable, depending on the patient’s clinical situation. These prostheses must be taken out of the mouth daily for cleaning. They usually attach to the remaining natural teeth for retention, and the clasps (wires) holding them in place may or may not be acceptable in appearance, depending on the situation. There are three major types of removable partial dentures:

i. All plastic, no metal: tooth-coloured teeth, with a gum-coloured, all-plastic base 

ii. Conventional removable partial denture: tooth-coloured teeth and gum-coloured plastic base, with metal framework and clasps resting on and gaining support from remaining teeth 

iii. Semi-precision or precision removable partial denture: tooth-coloured teeth and gum-coloured plastic base supported by metal framework and precision-fitted attachments into crowns (caps) on remaining teeth

Removable partial denture replacing several upper teeth.
Removable partial denture replacing several upper teeth.
An all-plastic denture blends with the oral environment well, but it does not have the same strength or support as a denture reinforced with metal.
An all-plastic denture blends with the oral environment well, but it does not have the same strength or support as a denture reinforced with metal.
A, Upper arch with all back teeth missing. B, Removable partial denture. C, Denture in place.
A, Upper arch with all back teeth missing. B, Removable partial denture. C, Denture in place.
A, Patient requiring upper rehabilitation. B, Semi-precision removable partial denture. C, Six front crowns (caps) and removable partial denture in place.
A, Patient requiring upper rehabilitation. B, Semi-precision removable partial denture. C, Six front crowns (caps) and removable partial denture in place.
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A. Advantages: All-plastic and conventional partial dentures replace missing teeth in the easiest and least expensive way. They usually do not require alteration of remaining natural teeth. Precision or semi- precision partial dentures can be highly functional and pleasing in appearance.

B. Disadvantages: Removable partial dentures must be removed several times per day for cleaning. Food collects under them occasionally, and they may be broken while out of the mouth. Generally, as judged by patients, removable partial dentures are much less successful than fixed partial dentures. Also, certain designs may be less pleasing in appearance than desired.

C. Risks: Supporting teeth can be broken, loosened, or weakened. Partial dentures may be lost occasionally. A few patients have swallowed small removable partial dentures, causing significant problems.

D. Cost: All-plastic partial dentures are inexpensive, while conventional partials are intermediate in cost, and semi-precision and precision removable partials are expensive (often about the cost of fixed partial dentures).

E. Alternatives: Fixed partial dentures, crowns (caps) over implants, or removable partial dentures over implantscan be made.

F. Result of Non-treatment: Persons who elect not to replace missing teeth continue to have an abnormal appearance and smile, have difficulty chewing in direct relation to the number of teeth that are missing, and experience movement of teeth over a period of time and resulting malocclusion (poor bite).

3. Removable Complete Dentures in Selangor, Malaysia

Millions of people wear complete dentures because their natural teeth have been lost for various reasons. The functional success, comfort, and appearance of these dentures vary enormously. Many people are satisfied with their artificial dentures, but most patients have occasional to constant discomfort, reduced chewing efficiency compared with natural teeth, and some facial collapse. Upper dentures are tolerated much better than lower dentures. Total removal of teeth is a shock to the body and leaves the chewing system handicapped in most situations. The degree of handicap relates directly to the type and quality of the prosthesis (denture) made. Quality of complete denture prostheses varies significantly, and it is often related to fee. Additionally, the dentist and technician making the denture relate to its acceptability. Many general dentists do a fine job with standard uncomplicated dentures, but if you have had significant problems with your denture in the past, or you know that you have a difficult case, you may want to seek the services of a prosthodontist.

A, Patient's smile before new dentures. B, Old dentures, worn and discoloured. C, New dentures. D, Patient's smile with new dentures.
A, Patient’s smile before new dentures. B, Old dentures, worn and discoloured. C, New dentures. D, Patient’s smile with new dentures.
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Construction of removable complete dentures usually requires several non-objectionable appointments, during which the dentist determines the optimal function for your specific situation, as well as the most acceptable appearance for your facial and dental areas. 

A. Advantages: Removable complete dentures are better than no teeth at all, restoring at least some of the original pre-extraction form and function of natural teeth. They can be cleaned outside the mouth. Repair of natural teeth has been eliminated by the extractions, but constantly changing soft and hard oral tissues require that the artificial dentures and your remaining mouth tissue have continued observation and therapy.

B. Disadvantages: Dentures provide only some of the original chewing efficiency and beauty of natural teeth. The bone of the jaws and gum tissues continue to shrink and change for the duration of your life, requiring relining, rebasing , or remaking of the denture periodically. Although many persons wear the same set of dentures for many years, a dentist easily observes the damage to the denture-wearer’s jawbone caused by the ill-fitting denture. Dentures should be refitted every few years by relining or rebasing, and new dentures should be made every 5 to 10 years because of the significant oral shrinkage that is always present.

C. Risks: Shrinkage of oral tissues continues throughout life when natural teeth are not present. If dentures are not refitted as described above, damage to the mouth can occur, ranging from chronic sore spots to oral cancer.

D. Cost: Fees for artificial dentures range from low to high. Generally, cost relates directly to denture quality and its ability to serve with comfort. Don’t select a dentist based on lower cost; usually you will pay for that decision eventually.

E. Alternatives: Only two alternatives are possible. Placement of several implants followed by a fixed denture provides function nearly as acceptable as that of natural teeth. The other alternative is placement of at least two implants followed by a removable denture attached to the implants. This treatment significantly improves the satisfaction enjoyed by complete-denture wearers.

F. Result of Non-treatment: Failure to wear complete dentures results in impaired chewing and nutrition, intestinal distress, abnormal aged facial appearance, altered speech, and overall lowered self-esteem.

A, Shape of lower jaw soon after teeth have been removed. B, Shrinkage of lower jaw several years later.
A, Shape of lower jaw soon after teeth have been removed. B, Shrinkage of lower jaw several years later.
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4. Removable Immediate Complete Denture in Selangor, Malaysia

Immediate dentures were previously discussed in this article. When teeth and/or supporting oral structures have degenerated to the extent that complete dentures must be considered, most people elect to have the natural teeth removed and the dentures placed on the same appointment. All of the teeth may be removed on the day the immediate dentures are placed, or some teeth in the back portion of the mouth (molars and premolars) may be removed on one day, allowing healing for about 6 weeks before the front teeth are removed and the dentures placed during the second appointment on another day. After initial healing of the jawbones and gums, the same slow shrinkage of these structures continues to occur throughout life, as described in the section on removable complete dentures. When a removable partial denture is indicated and some teeth must be extracted, the removable partial denture may be made also as an immediate partial denture.

A. Advantages: There is no time when you do not have teeth. You either have your own teeth or the removable complete immediate denture. The immediate denture serves as a splint for the healing oral tissues, thereby decreasing the discomfort during the healing process.

B. Disadvantages: The change from natural teeth to dentures in one day is a shock. Patients report that chewing, speech, and overall awareness of teeth change significantly, requiring a period of psychological and physical adjustment to the new situation. The immediate denture must be relined about 6 weeks or more after removal of the teeth to fit the denture to the initially healed gums. This requires the patient to be without teeth for anywhere from 8 to 24 hours.

C. Risks: In addition to the risks described under removable complete dentures, only the normal surgical risks are involved with immediate dentures. Most people feel that having their dentures constructed on an immediate basis is far better than having their teeth removed, staying toothless for 6 or more weeks, and having a removable complete denture made at that time.

D. Alternatives: Teeth may be removed and the tissues allowed to heal for 6 weeks before placing the dentures. (Removable complete denture) Teeth may be removed and implants placed, thereby allowing a fixed or removable implant prosthesis to be made.

E. Cost: The cost of this therapy is based on the following factors: 1) surgical removal of the teeth, 2) making the denture, and 3) relining the denture after the oral tissues have healed. The overall cost of this therapy is moderate to high for most situations.

F. Result of Non-treatment: If your teeth need to be removed and you do not do so, infection, pain, continued discomfort, reduced function, and unpleasant appearance will gradually occur. These factors will force you to have the teeth removed eventually.

Note shrinkage of lower jawbone on right, which cannot be avoided after teeth are removed.
Note shrinkage of lower jawbone on right, which cannot be avoided after teeth are removed.

SUMMARY

Removable prosthodontics, which usually involves removal of some or all of the natural teeth and replacement with dentures, is one of the most feared treatments for most patients. It is also among the least acceptable of all areas of dentistry. However, if it must be done, well-constructed and properly fitted removable partial or complete dentures can serve you well, with your cooperation 

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