Types of Dentures

There are many types of dentures available. Only your dental professional can tell you which denture is right for you, based on your particular needs.

Complete (Standard) Dentures

A complete denture is made for people who are already missing all their teeth and it is therefore the artificial replacement of these teeth and sometimes soft tissues and bone that have disappeared over time. You could have a complete upper denture (on the roof your mouth) and/or a complete lower denture.

Complete dentures rely on suction to retain it and the hardness of the underlying tissues for its stability. The back of a complete upper denture ends just behind the hard bone in the roof of the mouth. Complete upper dentures are made this way because they require as much surface area as possible to maximize retention and stability.  For people with a strong gag reflex, the back of the denture may be altered (thinned or shortened) to address this issue. However, the more it is altered, the less stable and retentive it may be.

Complete lower dentures must be made with the tongue in mind and are U-shaped as a result.  This significantly reduces the surface area for suction and stability, and as a result may need to be extended in other areas to achieve this.

Typically, it takes at least four appointments to make and fit your set of complete dentures. Below, we have outlined the steps that usually take place at each appointment.

Appointment 1

Consists of an oral exam, which might also include x-rays. Your dentist will make an impression of your upper and lower gums, which are called edentulous ridges. The impressions will be used to make accurate plaster models of the shape and size of the edentulous ridges. At this time your dentist will also determine other considerations, such as shade, size and shape of the teeth that will be placed on the new dentures and will discuss any risks and benefits associated with your oral health.

Sometimes, your dentist will recommend surgical alteration of the ridges to remove flabby tissue or to reshape the underlying bone to enhance your dentures fit and function.  While often not required, surgery may be worth considering.

Appointment 2

At your second appointment, the dentist will determine (with your input/old photos) the size and shape of teeth to be used and their position on your arch in three dimensions. This is designed to provide the smile and esthetic result you are looking for and that can be reasonably delivered given your oral situation.   This is done using a loose-fitting denture base and a rim of wax to approximate the position of the teeth edges.

In addition to the esthetics of your denture, your dentist will make several adjustments and take a variety of measurements to make sure they function properly.  Ideally, the wax rim should be visible slightly below your lip when the lip is at rest. When you smile, the position of the lip is marked in the wax to help the lab decide which set of teeth is appropriate for you. Once all of these relationships have been established including the phonetics, the rims are sent to the lab where they are used to fabricate the wax try-in, which includes teeth.

Appointment 3

This is an exciting part of the process! You will be able to see how the denture looks and functions before committing to the setup. This is the same loose-fitting tray that was used to make all the adjustments and markings, but now it has the actual plastic teeth in it, lined up along the outer edge of the wax rim. The wax try-in looks just like a real denture, except that the base fits loosely on the gums and the teeth are embedded in wax instead of plastic.

Using the wax try-in, you will be able to see what your final dentures will be like. At this point, if something is wrong, or you aren’t happy with the look or function, it can still be changed. The denture simply needs to go back to the lab for reworking.

When you finally have a wax try-in that looks right, feels right and has optimal phonetics,  it will be sent back to the lab to be finalized.

Appointment 4

At this appointment you will be able to leave with your new dentures! The plastic material used to make the dentures will shrink somewhat while being processed, so some adjustment is usually necessary. However, at the end of your appointment, you should have comfortable and attractive new teeth – get ready to smile!

Immediate Dentures 

Immediate dentures are actually started BEFORE your natural teeth are removed. You walk into the office with teeth and walk out with false teeth on the same day, once the teeth requiring removal are gone. This is possible because after your teeth are removed, a prefabricated denture is inserted directly over the bleeding sockets. At this time, you will still be numb from the freezing used for tooth removal, so it is not painful to insert the denture. In fact, in most cases, the immediate denture acts like a band-aid and reduces pain when the freezing finally wears off.

The appeal of immediate dentures is that there is no point between having teeth removed and having dentures made in which you will be without teeth. The bone that supported the original teeth is still intact and the gum tissue is usually firm. For the first week or so, the denture remains stable and reasonably retained.

The construction of an immediate denture requires one or two preliminary appointments before the insertion date. The number of appointments depends on how many natural teeth you have at the start, and how many need to be removed.

For most people, the immediate dentures become permanent dentures, but will likely require a reline to improve suction and fit 3 to 6 months following their insertion.  Sometimes problems associated with immediate dentures might cause you to want new dentures made after your gums have healed if a reline will not address the concerns.  In this case, the immediate denture is considered to be a “temporary denture during healing”.

Some problems that may arise include:

1. If a change of tooth position is required to improve esthetics or function, this cannot be “tried in”, such as complete dentures can, because the natural teeth are still present.  Once healing has occurred, a new complete denture can be tried in for esthetics and function prior to completion.
2. After your natural teeth are extracted and the immediate denture is inserted, there is relatively fast loss of bone that used to hold the natural teeth in place.  This leads to increasing looseness and sore spots that must be addressed.  Your dentist will sometimes include a free temporary soft reline about one month after the extraction/insertion date if required. This is a simple way to tighten the denture against the gums. Since the material is a bit rubbery, and frequently medicated, it makes the denture more comfortable until enough healing has taken place to do a permanent hard reline.
3. At the end of four to six months, the immediate denture should be relined with the same acrylic that the denture is made from.  You will likely be charged for this hard reline as it is not typically included in the original cost of the dentures.

Overdentures

An overdenture is a removable tooth replacement device that is inserted over existing teeth or their remnants, replacing these teeth with false teeth.  

Prior to modern dentistry, overdentures were very nearly the universal tooth replacement device since surgical removal of teeth was painful, dangerous, and frequently impossible without modern anesthetics.  In those days, dentures were made to fit over the rotting stumps of decayed or broken teeth.  

Today, non-restorable teeth are generally removed prior to the placement of a removable prosthesis, however, there are still instances where these teeth can be maintained to the patient's advantage. The most frequently seen overdenture today involves teeth that have had root canal therapy. If the roots of these teeth are still serviceable, the crown may be cut off at gum line and a removable appliance may be placed over the stumps.  Sometimes, the stumps are themselves covered with filling material or cast metal copings in order to protect them from decay. The advantage to this is that the roots of these teeth can maintain the bone that supports them. This bone would otherwise resorb away leaving less tissue to support the denture.  In addition, the root itself can serve as a "rest", or a vertical support for the denture allowing for more stability than would otherwise be available. 

The addition of a soft denture material such as Cu-Sil on the denture surface that immediately overlies the rigid root stumps allows the overdenture to nestle more snugly into the soft tissue on the roof of the mouth.  This allows for more suction to develop and can frequently improve the retention of an overdenture.

Implant Supported Dentures

An implant-supported denture is a type of overdenture that is placed over and attached to implants rather than teeth. Your dentist might recommend an implant-supported denture when you have no teeth in the jaw, but enough bone in the jaw to support implants. Because it has extra support, implant-supported dentures fit more firmly in the mouth than a regular denture, which rests on the gums.

The implants consist of titanium screws that your dentist will place into the bone of your jaw. After several months, the implant should be attached to the bone. Your dentist will then uncover the implant and attach a post that pokes through the gums into the mouth. This post supports an attachment which inserts into another attachment inside the denture.

Implant-supported dentures are usually made for the lower jaw because regular dentures tend to be less stable there. Upper dentures are often done as regular dentures because in the upper jaw it can be quite stable on its own and doesn't need the extra support offered by implants. However, it is possible to have implant-supported dentures in either the upper or lower jaw.

Although the dentures that fit over implants are considerably more expensive than complete dentures, they offer the added advantage of allowing upper dentures to be built in the shape of an arch instead of covering the entire palate. If you have a strong gag reflex that prevents you from wearing a complete upper denture, this may be especially important to you.

Most implant-supported dentures can be removed easily. Some people prefer to have fixed dentures or fixed crown and bridgework that can only be removed by your dentist. Your dentist will consider your particular needs and preferences when suggesting fixed or removable options.

Types of Implant-Supported Dentures

There are two types of implant-supported dentures: bar-retained and ball-retained. In both cases, the denture will be made of an acrylic base that will look like gums. Porcelain or acrylic teeth that look like natural teeth are attached to the base.

1. Bar-retained dentures

   A metal bar that follows the curve of your jaw is attached to two to five (usually) implants that have been placed in your jawbone. Clips or other types of attachments are fitted to the bar, the denture, or both. The denture fits over the bar and is securely clipped into place by the attachments.

2. Ball-retained dentures (stud-attachment dentures) 

   Each implant in the jawbone holds a metal attachment that fits into another attachment on the denture. In most cases, the attachments on the implants are ball-shaped (male attachments), and they fit into sockets (female attachments) on the denture. In some cases, these attachments are reversed, with the denture holding the male attachments and the implants holding the female ones.

Process

The implants usually are placed in the jawbone at the corners of your mouth because there tends to be more bone in this part of the jaw than in the back. This usually is true even if teeth have been missing for some time. Once you lose teeth, you begin to lose bone in the area. Also, this area of the jaw doesn't have as many nerves or other structures that could interfere with the placement of implants.  Implant placement at the corners of the mouth also tends to be a more functionally desirable area for placement and stability of the appliance.

The time frame to complete the implant depends on many factors. The shortest time frame is about five months in the lower jaw and seven months in the upper jaw. This includes surgeries and the placement of the denture. However, the process can last up to a year or more, especially if you need bone grafting to increase bone volume, or other preliminary procedures.

Two surgeries usually are needed: one to place the implants in the jawbone under your gums and a second surgery to expose the tops of the implant. The second procedure comes three to six months after the first.

A one-stage procedure may be used sometimes. In this procedure, your dentist can place the implants and the supporting bar in one step. The success rate of this procedure is moderately less successful than the more conventional two-stage procedures in some cases.

Step 1 - Initial Consultation 

Before any work is done, you will visit either a dental specialist called a prosthodontist or a general dentist who has advanced training in the restoration and possibly the placement of implants.  The purpose of this appointment is to plan the finished appliance.

During the exam, the dentist will review your medical and dental histories, take X-rays and create impressions of your teeth and gums so that models can be made. In some cases, the dentist may order a computed tomography (CT) scan of your mouth. This allows the dentist to see the exact position of your sinuses (located above your upper teeth) or nerves and other structures, and to make sure they will not be affected by the implant placement. A CT scan also may be done to see how much bone is available and to determine the best locations for the implants.

If you are not already wearing a complete denture to replace your missing teeth, your dentist will make you one. You will use this temporary denture until the implant-supported denture is placed. It will take about four visits, spanning several weeks, to complete this denture. By making this temporary denture, your dentist is able to determine the best position for the teeth in the final denture. The temporary denture may also be used as a backup if something happens to the final implant-supported denture.

Once the temporary denture is finished, the surgeon will use it as a guide to help place the implants in the proper positions. Holes may be drilled in a copy of the denture so that the surgeon can see where the implants should be placed.

You will have your first surgery in about one month if no denture needs to be made. It will take place in approximately two months if a denture does need to be made.

Step 2 - First Surgery 

The first surgery involves placing the implants in the jawbone. During the first surgery, an incision is made in the gum where the implant will be placed. A hole is drilled in the bone, the implant is placed into the hole, and the incision is stitched closed. After this surgery, you should avoid putting pressure on the implants. You will not be able to wear your temporary denture for about four weeks and you should avoid eating hard foods during this time.

After four weeks, you will be able to wear your temporary denture again. The temporary denture will, however, need to be modified, to make sure it fits properly. It will also be given a soft reline (new lining next to your gums) to help to reduce the pressure on your gums.  Your general dentist or prosthodontist will arrange for and complete these alterations as required.

It will now be three to four months before the next surgery, if implants were placed in the lower jaw. It will be five to six months if they were placed in the upper jaw. During this time, the bone and the implants integrate (attach and fuse).

Step 2 - Second Surgery

Once the implants have become fused with the bone, the second surgery can be scheduled. Your dentist will assess whether the implant is ready for the second surgery by taking an X-ray which will be sent to the surgeon for their review. The second surgery is simpler than the first. A small incision is made in your gums to expose the tops (heads) of the implants, and the surgeon ensures integration by torqueing the implant to a specified minimal pressure.

A healing abutment (collar) is placed on the head of each implant after it is exposed. This encourages the gums to heal correctly. The collar is a round piece of metal that holds the gums away from the head of the implant. The collar will be in place for 10 - 14 days. The dentist will adjust your temporary denture again and it may be given another soft reline. The reline material will secure the denture to the healing abutments.

About two weeks after the second surgery, the healing abutments will be replaced with regular abutments. Your gums should now be healed enough for your dentist to make an impression of your gums and implants. The impression is used to make a working model of your implants and jaw, which is used to make the denture framework and teeth.

Step 3 - Denture Try-in and Insertion

At this point, the metal bar is placed on the implants and the first try-in of your new denture framework is carried out to see if it fits properly.

Once the metal bar and the denture framework have been fitted together properly, the teeth are temporarily placed on the framework in wax often at a separate appointment(s). The whole denture (still in wax) is then tried in your mouth. If everything works well, the denture is returned to the laboratory and the teeth are secured in the denture framework permanently. The bar or ball attachments also will be secured.

Step 4 – Final Visit

When the finished denture is inserted by your general dentist or prosthodontist, the denture is clipped onto the bar or snapped onto the ball attachments.

At this point, your temporary denture will be given a new reline. This will allow it to be used as a backup denture in case you lose or break your new implant-supported denture.

Caring for Your Implant-Supported Denture

You will need to remove the denture at least twice a day for cleaning. You also should carefully clean around the implants and attachments.

For the first year, as a general rule, you should visit your dentist every three months for a cleaning and checkup. Your dentist will test all the parts of your new denture to see if they are secure. Even though your denture is stable, it still can move slightly when you chew. This slight movement can cause the denture to rub against your gums, which may cause sore spots. Your dentist will check your gums and also will check the way your top and bottom teeth come together (your bite).

The clip or other attachments on the bar-retained denture usually will need to be replaced every 6 - 12 months. They are often made of a plastic material (nylon) and will wear after continued use.

Mini Implant Supported Dentures

Mini implants were first introduced in the late 1990s.  Since that time, their use and success rate has increased and may present a favourable option in certain cases. These implants are similar to standard implants in terms of shape and size but are shorter in length.

Unlike standard implants, the surgical placement doesn’t require as much bone, is a simpler surgery generally, and there is generally no need to wait three to six months before these implants can be loaded and function with the denture in place.   

The entire procedure, from placing the implants and retrofitting the old denture can often be done in 1 a one-hour appointment and as a result is often less expensive.

Speak to your dentist to see if this type of appliance is suitable for you.

Partial Dentures

Replacing missing teeth is an important step in maintaining a healthy smile. When teeth are missing, the remaining ones can change position, drifting into the surrounding space. Teeth that are out of position can damage tissues in the mouth. In addition, it may be difficult to clean thoroughly between crooked teeth. As a result, you run the risk of tooth decay and periodontitis (gum disease), which can lead to the loss of additional teeth.

A removable partial denture fills in the space created by missing teeth and fills out your smile, in addition to distributing the biting forces over a larger surface area than just your remaining teeth in an attempt to prolong their life and enhance chewing.  A denture may also improve speech and provide support for lips and cheeks maintaining a more youthful appearance.

Removable partial dentures usually consist of replacement teeth attached to pink or gum-coloured plastic bases, which are connected by a metal framework. Removable partial dentures attach to or sit on your natural teeth with metal clasps or devices.  A specific type of metal clasp is called a “precision attachment”.   Precision attachments are generally more esthetic than metal clasps and they are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with these attachments. Dentures with precision attachments generally cost more than those with metal clasps. Consult with your dentist to find out which type is right for you.

For the first few weeks, your new partial denture may feel awkward or bulky.  Your mouth should eventually become accustomed to wearing it.  Inserting and removing the denture will require some practice, but if you follow all instructions given by your dentist it should fit into place with relative ease.  Remember to never force the partial denture into position by biting down. This could bend or break the clasps.

Initially, you may be asked to wear your partial denture all day, especially during meals. Although this may be temporarily uncomfortable, it is the quickest way to identify those denture parts that may need adjustment. If the denture puts too much pressure on a particular area, that spot will become sore. It is important to see your dentist right away as even a small sore spot can become very uncomfortable quickly.  Your dentist will adjust the denture to fit more comfortably. After making adjustments, your dentist will encourage removal of the partial denture prior to bed in an effort to maintain gum and bone health.  Ensuring you remove your partial denture prior to twice daily brushing and flossing your teeth is also critical to their long-term health.

Once you have a partial denture, eating should be a more pleasant experience. Start out by eating soft foods that are cut into small pieces. Chew on both sides of your mouth to keep even pressure on the denture. Avoid foods that are extremely sticky or hard. You may want to avoid chewing gum while you adjust to the denture.

It can be difficult to speak clearly when you are missing teeth. Consequently, wearing a partial denture may help. If you find it difficult to pronounce certain words with your new denture, practice reading out loud. Repeat the words that give you trouble. With time, you should become accustomed to speaking properly with your denture. 

Included in the cost of your denture is a 3-month post-delivery adjustment period. Don’t hesitate to visit your dentist to ensure proper fit and function of your new dentures.

Caring for your Partial Denture

Handling a partial denture requires care. It's a good idea to stand over a folded towel or a sink of water just in case you accidentally drop the denture. Brush the denture each day to remove food deposits and plaque. Brushing your denture helps prevent the appliance from becoming permanently stained or covered in tartar. It's best to use a brush that is designed for cleaning dentures. A denture brush has bristles that are arranged to fit the shape of the denture. A regular, soft-bristled toothbrush is also acceptable. Avoid using a brush with hard bristles, which can damage the denture. Choose any denture cleaner with the Canadian Dental Association (CDA) Seal of Acceptance.

Some people use hand soap or mild dishwashing liquid to clean their dentures. Both are acceptable. Don’t use other types of household cleaners or toothpaste. They’re too abrasive.

Clean your dentures by thoroughly rinsing off loose food particles. Moisten the brush and apply the denture cleaner. Brush all denture surfaces gently to avoid damaging the plastic or bending the attachments.

A denture could lose its proper shape if it is not kept moist. At night, the denture should be placed in soaking solution or water. However, if the appliance has metal attachments, they could be tarnished if placed in soaking solution. Your dentist can recommend the proper method for keeping your dentures in good shape.

Over time, adjusting the partial denture may be necessary. As you age, your mouth naturally changes, which can affect the fit of the denture. Your bone and gum ridges can recede or shrink, resulting in a loose-fitting denture. Your dentist should adjust your partial denture if it doesn’t fit properly. Loose partial dentures can cause various problems, including sores or infections. See your dentist promptly if your denture becomes loose.

You can do serious harm to your partial denture and to your oral health by trying to adjust or repair your denture. A denture that is not made to fit precisely by a dentist can cause irritation and sores. Using a do-it-yourself kit can damage the appliance beyond repair. Glues sold over the counter often contain harmful chemicals and should not be used on a denture.

If your denture no longer fits properly, if it breaks, cracks or chips, or if one of the teeth becomes loose, see your dentist immediately. In many cases, dentists can make necessary adjustments or repairs, often on the same day. Complicated repairs may require that the denture be sent to a dental laboratory.

Brushing twice a day and cleaning between your teeth daily help prevent tooth decay and gum disease that can lead to tooth loss. Pay special attention to cleaning teeth that fit under the denture's metal clasps. Plaque that becomes trapped under the clasps will increase the risk of tooth decay. Your dentist or dental hygienist will demonstrate how to properly brush and clean between teeth. Selecting a balanced diet for proper nutrition is also important.