A New Denture and an Overdenture for Sharon

Sharon’s dentures were old – 15 years to be exact – and were worn out.  The teeth were worn and yellow. She was having difficulty chewing and the dentures were loose. We made her a new set of dentures – this took no more than three weeks.  She was thrilled. No adhesives needed.  She was comfortable and she looked great. New teeth took several years off of her age. Note how her lip has filled out, wrinkles diminished.  She can eat again! She was so happy that she decided to add two implants to her lower arch. We attached Locator abutments, creating an overdenture. The attachments on the denture snap into the abutments and create a snug fit.  Now this lower denture was a struggle to remove.

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Old denture, teeth worn flat, stained yellow.

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New upper denture and lower overdenture – lifelike teeth, bright color

This is absolutely my favorite transformation. Rita had smoked for many years – not good for teeth and gums. What happens is that the bone resorbs, leaving long and loose teeth. Eventually these teeth fall out. The process can be delayed or halted with proper dental and periodontal treatment but, like so many people, Rita was afraid of having dental treatment. She also had a serious gag reflex. She was very happy to learn about us and about the care that we take with our patients and their dental health. She was very unhappy with her smile,  with her displaced and missing teeth. She would not smile – and Rita was a beautiful woman. Her teeth were beyond repair, and she was afraid to wear a denture because of her gag reflex.

 

Upper and lower hybrid implant bridges were the best solution to give her a beautiful smile without the embarrassment of removable dentures. The hybrid implant bridge is screwed into bone supported implants and functions like natural teeth. We call it a hybrid because the dentist can remove it, but the patient cannot. Some people call it “teeth-in-a-day” because the teeth are removed, implants are placed and the hybrid can be seated immediately. Sometimes we will seat the hybrid the following day for better cosmetics. This is a temporary hybrid – once the implants are integrated into the bone in approximately three months, we take impressions and measurements for a final hybrid. We give the temporary hybrid to the patient as a spare in case a repair is needed. All-around a wonderful service. Rita did beautifully; the result is spectacular. What you see in her photos below is the temporary hybrid. The final one will look even better! She is thrilled to have teeth again. Read what she says on our testimonials page at http://drterryshapiro.com/testimonials/.

 

Look what we can do in a day to change your smile!

 

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Thursday: Loose and displaced teeth

 

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Friday: Temporary screw retained upper and lower hybrid bridges

My son, an Assistant Professor of Anthropology, is an expert in Bombay’s alternative economy. He has spent much time in India studying the vast street economy.  This week he was there to deliver a paper at a conference. As is his habit, he strolled about the city investigating the vast array of vendor stalls. He emailed me that he had met a man who makes acrylic dentures in “a tiny informal workshop.”  They sell for $10 each; “basically, they are dentures for the poor.”

I was very interested in the photos that accompanied the email. I wonder what training this man has. Did he train as an apprentice? or more formal training? I carefully studied the photos. The methods are primitive compared to the sophisticated computer technology that we in the U.S. have available and the sanitation is surely lacking: rubber bands to hold the upper and lower teeth together, a stapler and lighter lying nearby, a broken air vent. But this man is supplying teeth so poor people can chew better and look better and at a price they can afford. What can be better than that?  My son asked me in his email: “Not sure if you will be impressed or horrified!!”  Impressed! for sure!

 

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It was late afternoon Friday – I wasn’t in the office when I received a frantic text message from my answering service: “I just moved to L.I., my son is getting married in two weeks and my dog ate my denture – help!”  I called Marie right back and she was so relieved that I offered to see her the next morning.  When she came to the office the next day, we did a complete examination, took a few xrays and began the denture process by taking careful impressions and charting a schedule so the new dentures would be ready just in time for the wedding.  We scheduled a records appointment, a try-in appointment and delivery.

So how did the dog get a hold of the denture? Marie had had a long day and was ready for a nap. She took out her denture, laid it on a nearby table and promptly fell asleep. Her dog grabbed the denture and took a few bites, chopping off several pieces of the device.  By the time Marie caught the culprit, the damage was done. She tried gluing the denture together but that at best is only a stopgap measure. The denture was old and brittle – easily broken. The teeth were worn and the denture was overdue for replacement.  Marie was missing all of her upper teeth but she was also missing her lower back teeth. I recommended that we make a lower partial denture in addition to a new upper denture. That way she would have back teeth for chewing and that support would help stabilize her remaining lower front teeth.

She is thrilled with the result and ready for wedding photos. She said she was grateful to her dog for forcing her to replace her denture which she had been putting off. Now she had a denture that looked fabulous, was secure without adhesive, and functioned well.  Just a reminder to always place your dentures in a denture box – if they fall on a hard surface, they can break. If wrapped in a napkin, they can inadvertently be thrown out. I have seen this.

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Look at what the dog did!

Suppose you had lost all of your upper or lower teeth. What are the options?

1. The simplest, least costly but most prone to problems, is the conventional denture.

2. An improvement is the overdenture in which the denture snaps into two or more implant attachments. See my blog entry and video of  April 14, 2015.

3. Even better is the hybrid denture. For the hybrid denture, several implants, (typically six) are placed in the arch.  A prosthesis that is screwed into the implants is constructed. It is a fixed prosthesis as far as the patient is concerned, but the dentist can remove it for maintenance.  Thus we call it a hybrid, or fixed/removable.

     The hybrid is a wonderful service. The teeth function like natural teeth. However the hybrid and surrounding tissues need to be kept clean.  Calculus and plaque can lead to gingival inflammation and peri-implantitis with eventual loss of the implants. I instruct the patient to use a water pic from outside and inside, as well as running floss under the hybrid denture and use of an end tufted toothbrush.  The patient also needs to return to the office at six month intervals so we can professionally clean the hybrid and remove it as necessary.  The acrylic teeth can also chip or fracture. We supply a temporary hybrid so the patient can wear this if the denture needs to be repaired. Acrylic teeth may have to be repaired in five to seven years. If the hybrid opposes natural teeth, we may also make a night guard to protect the hybrid from breakage.

     Alan had upper and lower hybrids that were made seven years ago in another office. The teeth had chipped and they were heavily stained as well as being a vehicle for heavy calculus and plaque.  I removed the hybrids and constructed new ones.  This took several visits but look how wonderful he looks now!  He is more comfortable and can function better too. He promises to return regularly.  He went back to Florida for the winter, his spare hybrids in hand.

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New hybrids

Two lovely stories told to us at the office.

 

First story: Jaime sat down in our chair and said she had something exciting to tell us – but Linda, May and I all had to be present. What could it be? We had known Jaime for over two years and knew her to be a lovely person but she had never confided in us the story she was about to tell us now. She began: in 1963 she had a daughter out-of-wedlock. She gave the child up for adoption. She thought of the child every day for over 50 years and always wanted to know how she was and what kind of person she turned out to be. In those days the adoption records were sealed and she had no way of knowing who adopted the child.

 

Speed forward to 2015 when adoption records have been unsealed.  Jaime was contacted by a woman born on the same date in 1963 and at the same hospital. This was her daughter. They met each other and caught up. The daughter had been adopted by loving parents and grew up to be a wonderful, loving adult, married with two children. Jaime, who didn’t have any other children, now has a ready made family. It is a lovely story!

 

Second story: Michael came to the office for a new patient consult. Right away I saw that he did not have any teeth and was not wearing dentures. He had lost his teeth over the years from decay and periodontal disease. He never had dentures made because he had a dental phobia.  But he had a story he wanted to tell me. He grew up in the United States but was born in England.  Recently he received a call from an English woman who turned out to be his sister. He never knew that he had a sister living abroad.  The story is complicated about why he did not know this. He wanted to skype her but he wouldn’t do so as he was without teeth.

 

He wanted dentures so he could meet his long-lost sister.  He was anxious to get started so we took impressions that evening and three weeks later he had teeth. He was so happy that he could taste food again and smile broadly. This amateur artist drew my picture and wrote me a lovely note: “I wanted to thank you and your staff for improving my life – so much. I don’t have the words to articulate how grateful I am so I thought a drawing of you. Have a great holiday season with an even better New Year.”  Thanks Mike – you make my day!

 

Funny how both of these stories have to do with lost relatives. One story has everything to do with teeth; one has nothing to do with teeth. Both stories show how important family is! Happy New Year!

Michael’s teeth were removed one by one over the years until all were missing. Out of fear, he never had dentures made. He grew a long and wide mustache to hide the fact that he had no teeth. He never smiled. He ate only soft foods. But recently he learned that he had a sister living in Europe whom he had never met.  He was anxious to meet her through skype but he was embarrassed that he had no teeth. He contacted me and we sat down to talk. He was excited to begin the process of getting dentures (implants were not an option for health and financial reasons.) We scheduled four appointments over four weeks and we delivered his new dentures on time. He couldn’t have been happier! The dentures were very tight – almost difficult to remove. They were comfortable – he wore them all day and he said that he didn’t know he had anything foreign in his mouth. He was amazed at all he could eat and that he could taste food again. He was so appreciative that he wrote me a lovely review in Google:

“From my first appointment which was about five appointments ago I can tell you by far Dr. Shapiro is the best Dentist you would ever meet. Doctor Shapiro and her staff Linda & May are extremely professional.  My first impression – I was excited to find such a technically up-to-date Dentist. Before my first visit was over it was clear to me Doctor Shapiro and her staff not only possess superb dentistry skills. They understand patients’ needs which (in addition to doing a great job on my teeth) they provide really well. The information they provide and the way it is communicated is so comforting. Scheduling appointments and billing was easy and well thought-out.   I have to tell you the truth. I never dreamed in a million years that I would be saying these words but after my first appointment I said to my wife “I am looking forward to next week’s dental appointment”. I want to thank Doctor Shapiro, May and Linda for all that they have done but for now all I can do is smile.” Michael Serrano

Dentistry is a wonderful profession. How often does a person get the chance to change someone’s life?

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It is a truth universally acknowledged (thank you Jane Austin) that a lower denture is difficult to stabilize and difficult for the individual to wear comfortably.  In my office I work hard to provide a lower denture that fits well, functions well and is comfortable. But if a person has excessive bone loss or strong musculature, the lower denture may be a problem.  Today the standard of care for a person without lower teeth is really the implant overdenture.  Minimally we place two implants in the lower jaw, let them integrate with the bone for several months, then attach what are called Locators. A housing is then added to the denture base that snaps into the Locators. Since the denture snaps into the Locators, the denture is very stable. It takes some strength to remove! No more wobbly lower denture, no more denture adhesive!

I always discuss the advantages of the overdenture and let the patient make the decision. The implants do add to the cost of the denture service. Sometimes people elect to try to wear the denture and add the implants later, if needed. Often cost is a factor. But when we do add the implants, the “wow” factor is amazing. People love the overdenture and it is a life-changer.

Betty had been wearing dentures for many years and had significant bone loss. She was ready for an overdenture. She had bone grafts, then healing, then placement of the implants, then more healing until we placed the Locators and housing. She is thrilled. For the first time, she has a comfortable, secure lower denture.  Listen to what Betty has to say about her overdenture on our youtube channel.

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A model of four implants on the lower jaw showing how a denture fits over the implants.

Rita has been wearing dentures for over 30 years.  She is 74 years old, fit, healthy and very active. She wanted her dentures to be comfortable, look natural, and she wanted to be able to eat out with her friends.  I’m impressed that she managed to keep her existing dentures in her mouth – even with a tube of denture adhesive, they flopped all over.

When dentures don’t fit properly, the lower jaw moves forward and the face collapses so the chin and nose begin to approach each other.  If you look at Rita’s original lower denture teeth (below), you can see how the jaw has moved forward. The lower teeth overlap the top teeth, instead of the top teeth overlapping the lower teeth. This is not attractive and it is not comfortable for the jaw.  Over time, as the upper and lower teeth rub against each other, the teeth begin to wear. As they wear, the teeth shorten and not enough tooth shows.  The face collapses. This is an aged dentition.

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Old Dentures

We made a new set of dentures for Rita.  See (below) how much tooth shows now.  See how the upper teeth overlap the bottom teeth. See how the teeth are not worn down. All of this increases her facial height so her chin and nose are at nearly normal distance from each other, her face is filled out, and she has fewer wrinkles around the mouth.  She also has whiter teeth as a bonus!

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New Dentures

Marilyn is 87 and lives in an assisted living home.  She is active and feisty: loves to play cards and billiards. She dresses with great care, but she had a habit of removing her denture – probably because it didn’t fit or wasn’t comfortable. So last week she removed it in the dining room and placed it in a napkin (NEVER do this, I tell my patients!). A denture wrapped in a napkin is looking to get discarded – and that is just what happened. Marilyn was without her teeth and she was, understandably, very upset.

 

Her daughter read on the internet that I make great fitting dentures in just four visits. She called me and she asked if I could make a denture in even less time so Marilyn could have teeth sooner rather than later. I told them to come in the next day, and I would have a new denture for her in four days. They were both thrilled. I condensed the fabrication process into one visit but I couldn’t guarantee that we would be happy with the result. I explained to them that if we weren’t happy with the teeth, then this denture would be counted as a temporary denture, and it would take just a few more visits to make a denture that satisfied us all.

 

The next day mother and daughter came in for mom’s visit – I took impressions and measurements. I consulted with my fabulous denture laboratory. Four days later I delivered a new denture, and the result was spectacular – looks great, fits snugly and functions well. Let’s just hope Marilyn doesn’t take this denture out and place it in a napkin! But if it is lost, at least I always put the owner’s name on the inside.

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Marilyn lost her upper teeth!

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Now Marilyn can smile again!