Aug
2013

Q&A: Is there really such a thing as a 'natural' looking denture?

Ask A Doctor Question: 

About two years ago I got an upper denture. The dentist left some top teeth in for support (I guess) of that denture. However, because of this, the denture extends out like an awning above my lower teeth, and looks terrible. All you see coming at you is big teeth on top. Now it doesn't even fit well, and I would like to get it re-done. I wonder if I should have those 5 remaining upper, natural teeth of mine removed before trying to re-do it? Is there really such a thing as a "natural" looking denture? Sometimes you can spot them a mile away, but on others you are surprised to find out they are wearing dentures. What makes the difference exactly in a natural look VS I'm wearing dentures and hate that you know. I can afford a "good" denture, but cannot afford implants unfortunately. Thank you, 

Answer: 

Christian Yaste, DDS - LocateADoc.com

L. Burns,
 
 
It is hard to give you an exact answer without more diagnostic data about your particular case.  It would be necessary to have a complete examination and some films, like a panorex xray, or ct scan.  However, based on the information you have provided I would say that for most patients having all of the teeth removed is going to make your final denture easier to modify and get the esthetic results you are looking for.  At this point your teeth are a determining factor for where the denture teeth are set.  Without your teeth there is generally more freedom to create a denture that will not only look more natural, but be less protrusive.
 
I recommend bone grafting at the time the teeth are extracted in most cases to preserve as much bone as possible for support of the new denture.  Also, it does give you a better chance of being an implant candidate in the future, although you feel you cannot afford implants now.  
 
In many cases my patients will complete what I call Phase I of treatment, which is to remove the teeth, graft, and then make them a denture.  We make the denture keeping in mind that implants may be an option in the future.  Then this denture can be retrofit to implants at that time.  With as little as two dental implants the retention of an upper denture can be increased dramatically.  With three or four implants the palate can be completely removed and you would be able to have less material in your mouth and taste your food much better.  Some of these options may be less expensive than you might think.  The Zest Locator  is an implant retention system that works incredibly well for almost anyone who wears a denture.   Here is a link to the Zest site with a short clip on how they work.  
 
http://www.zestanchors.com/products/products-locator
 
Dentures can be made to look very natural.  Most of this is dependent on having an experienced dentist with a cosmetic background or focus in their practice and an excellent dental laboratory.  The communication between the dentist and the laboratory is very important.  It takes several visits to make a natural looking denture.  We call these, "smile makeover dentures".  These types of dentures are made of higher quality materials and more life like teeth.  Also, the laboratory puts more time into small details that create more realistic looking gums.  You want a dentist who can also plan a denture that you may want to retrofit with implant locators at some point in the future.  These type of dentures are much different than the ones you get from a "denture clinic".   Don't be fooled by clinics that will make you a denture for less than $1000.  Smile makeover dentures can cost anywhere between $3000-$5000.  
 
If you are interested, you can contact my office and we will email you a special report I wrote in digital format, on the subject of dentures and implants.
 
Best Regards,

--Christian Yaste, DDS
Charlotte, NC

Answer: 

David Vierhus, DDS - LocateADoc.com

Hello L. Burns,
 
Here's a short general answer. Every case is unique so a face to face consult would benefit you. It sounds like you got a "immediate partial denture on the top." In most cases it is preferable to keep solid teeth to help support and retain the partial denture versus a full denture that replaces all teeth on top. However, if your natural teeth prevent the dentist from making an ideal denture than you might consider removal of the remaining teeth and a new full denture made. As far as "looking natural", the answer is yes, dentures can look natural. Usually a wax try-in is done to evaluate the esthetics prior to making it permanent. Hope this helps.

--David Vierhus, DDS
San Jose, CA

Answer: 

Martin J Cisneros, DMD - LocateADoc.com

Hello L. Burns,
 
I'll answer as best I can with the information I have. Trying to assess a condition without actually seeing it is like diagnosing a car problem over the phone.
 
If the remaining teeth are in good shape, you certainly want to keep them. This will enable the preservation of bone and will certainly help keep the partial denture in place. 
 
As far as the fit is concerned, over time, the bone and gums will resorb away from the denture. When this happens, there will be spaces between the denture and the soft tissue of the mouth making retention much more challenging. Either a new partial denture will need to be fabricated to fit better, or you can also reline the internal surface of the denture to improve the fit. In your case since you don't like the appearance, I suggest you get a new one so that you can have a more aesthetic prosthesis.
 
I certainly hate dentures that you can spot a mile away. I want things to look completely natural. When you get a new partial denture, have a discussion with your dentist on how you want them to look. This will eliminate the guesswork. The position, shape, color and overall aesthetics can be changed to get the look you're looking for. 
 
Hope this helps!

--Martin J Cisneros, DMD
Columbia, IL

Answer: 

It is an unfortunate reality that full removable dentures become the fall back restorative solution for many people. As with any dental restoration many compromises have to be made to compensate for the replacement of missing or damaged oral structures. Dentures are an example of this to the extreme. Having said that, in most cases these compromises can be made in a way that achieves an esthetically pleasing result that the patient can adapt to and function with in a comfortable if not natural way.
 
The retained tooth roots can be an advantage not so much to support the denture but to maintain the alveolar bony ridge of the maxillary process. This bone can shrink down (resorption) following the removal of the teeth especially if the denture is matched against lower natural teeth. This technique in most cases doesn't cause any excessive protrusion of the upper or maxillary denture. The cause of the excessive protrusion could be due to your jaw relationship. You mayhave a Class II jaw position where the lower jaw is retrusive, or a Class III where it is prognathic. Another case may be that the lower facial vertical height may be to closed down (the distance between your nose and your chin). There are other physiologic conditions as well.
 
Ultimately you will need to be evaluated for the reason your existing denture is protrusive beforeyou have your remaining teeth removed. Hopefully it is only due to a poorly constructed restoration. You may want to find a Prosthedontist in your area for this evaluation. This is a dentist specializing in more complicated denture construction.

--Howard L Rowe , DDS
Hixson, TN

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