Background Information:

What are the other Names for the Procedure?

• Complete Denture Insertion
• Complete Denture Placement
• Denture Placement Procedure

What is Denture Placement procedure?

• Dentures are prosthetic dental devices having frames that contain false teeth that are used to take the place of missing teeth (usually) or weak teeth. Denture Placement involves the evaluation, fabrication, and placement of dentures
• The dentures may be of two types - partial or complete (comprising full set of teeth). They may involve the upper jaw or lower jaw, and be of conventional/removable type or implant-supported type (fixed prosthodontics)
• Partial dentures are generally more stable, since they are smaller and are supported by the remaining/existing teeth. Complete dentures are held in place only by the shape of the dental arches, suction, and muscular coordination, and hence more unstable
• All teeth may be missing from either the upper jaw (maxillary arch) or lower jaw (mandibular arch), or from both the jaws. The lower set of dentures is less stable compared to the upper set. For stability, retaining as many natural teeth as possible (for partial dentures) can help provide adequate grip for the synthetic dentures

What part of the Body does the Procedure involve?

A Denture Placement procedure involves the mouth including the gums, teeth, and underlying jawbone.

Why is the Denture Placement procedure Performed?

A Denture Placement procedure may be recommended by dental professionals for the following reasons:

• When all the teeth are missing due to old age, severe gum disease, or genetic disorders, a set of complete dentures are worn
• Dentures help in improving eating and chewing process, speech and word pronunciation, enhance one’s appearance by making up for lost teeth, and thereby improving one’s self-esteem

What are some Alternative Choices for the Procedure?

When it comes to missing teeth or ‘bad teeth’, there are no alternatives to wearing dentures. However, the type of dentures required will vary on a case-by-case basis, and they may be full or partial, implant-supported or removable.

Since, removable dentures result in movement-associated problems and increased risk for gum infection, dental implant-supported dentures may be recommended.

• Implanted-supported dentures can avoid the problems of movement and do away with palate arches (curved piece of the denture that attaches to the roof of the mouth); the denture-wearers can feel more comfortable
• They have more advantages over conventional dentures including better chewing function and speaking abilities
• However, these are generally more expensive and time-consuming to prepare (make ready)

What are the Recent Advances in the Procedure?

The advances in the field of Denture Placement procedures are more to do with use of reliable and long-lasting materials including techniques to place/fit the dentures well into the upper and lower jaw.

What is the Cost of performing the Denture Placement procedure?

The cost of Denture Placement procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Denture Placement procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

https://www.colgate.com/en-us/oral-health/cosmetic-dentistry/dentures/what-types-of-dentures-are-right-for-you-1015 (accessed on 01/09/2018)

https://www.washmosmiles.com/types-of-dentures-explained-and-what-is-best-for-you/ (accessed on 01/09/2018)

Prior to Denture Placement procedure:

How is the Denture Placement surgical procedure Performed?

Denture Placements may be undertaken in the following manner:

• A visual examination of the mouth is made and X-rays are taken. The requirement of full or partial dentures is assessed
• Impressions are initially taken to create a temporary template denture of both the upper and lower arches
• The template is used to make a custom impression, which helps then create a more detailed and exact impression of the jaws
• Various measurements are noted using this, including several bite impressions, to capture the position of the jaws with respect to each other
• Using these, a replica of the denture is made with correct position of each tooth. These are tested on the patient and then a final set of dentures fabricated
• Several visits are necessary to make adjustments to the denture fitting, till the user is comfortable using them
• The dental professional may send the mold impression to a dental laboratory or send the individual to a denturist (a dental prosthetist)

Where is the Procedure Performed?

Denture Placements are usually performed in a dentist or an oral surgeon’s clinic or office.

Who Performs the Procedure?

A dental professional typically performs the Denture Placement procedure.

How long will the Procedure take?

A Denture Placement procedure may take anywhere from 3 to 6 months, depending on type of dentures required. It may be carried out over numerous sessions/visits to the dental clinic.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Denture Placement procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication, food items, or the filling material used in the procedure
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Denture Placement procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Denture Placement procedure?

Before a Denture Placement procedure, the patient may have to undergo certain tests such as:

• Visual examination of the gums, teeth, and jaws
• Routine blood and urine analysis, as required
• X-rays of the mouth

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Denture Placement procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Denture Placement procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia may be administered for the procedure, if necessary.

How much Blood will you lose, during the Procedure?

Typically, no blood loss is involved during a Denture Placement procedure. However, in the case of implant-supported dentures, there may be some blood loss experienced.

What are the possible Risks and Complications during Denture Placement procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during Denture Placements include:

• Anesthetic complications
• Allergic reaction to the material used in the denture
• The denture does not fit properly
• Damage of existing tooth, gum, or jawbone during the procedure

What Post-Operative Care is needed at the Healthcare Facility after the Denture Placement procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Denture Placement procedure:

What are the possible Risks and Complications after Denture Placement procedure?

The possible risks and complications that may arise after a Denture Placement procedure are:

• Increased salivation due to foreign material in the mouth, which typically stops after a day or so
• The contact surfaces of the denture with oral mucosa may show irritation and soreness
• Loss of taste, mostly in those who wear upper dentures
• Some individuals experience a sensation of gagging (vomiting reflex), especially if the dentures extend a little towards the back of the mouth or throat
• Infection of the gums and infection below the denture (palate) arch
• Movement of dentures up to down, side to side, or front to back, if these are not stable

What is the Prognosis after the Procedure?

The prognosis after a Denture Placement procedure is usually good, in a majority of individuals. However, the following factors may be considered:

• Since the mouth contains living cells and tissues, the constant growing/changing tissues and remodeling of bone, necessitates making adjustments to the dentures regularly over time
• Dentures that fit for a few years initially, may not fit well later
• If the dentures do not fit well, it can cause chewing difficulties and abnormal skin growth (such as epulis fissuratum)
• Prolonged usage of poorly-fitting dentures also tends to wear out its chewing surfaces
• The life of a good denture may be about 5 years or more

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain or swelling around the gums and teeth; jaw pain
• Bleeding or fluid drainage from region
• The dentures keep falling-off or getting dislodged
• Signs of an infection
• Headache
• Fever, feeling sick
• Dizziness

What Post-Operative Care is needed at Home after Denture Placement procedure?

At home, the following post-operative care is recommended after a Denture Placement procedure:

• Avoid hard food items and only eat soft food items until you get used to the dentures
• Avoid very hot or cold food items after the procedure
• It takes a little while to learn to use the dentures - chewing must be balanced on both the left and right sides by applying uniform pressure. One-sided chewing will unbalance the denture
• The chewing action must be performed up and down and not from side to side
• Also, biting using the front incisors (of the dentures) may dislodge it from the back
• Avoid smoking or chewing tobacco
• Brush and floss regularly after taking food, or twice daily

Good denture care and maintenance:

• Use dentures optimally (only when really necessary) and avoid wearing them continuously
• DO NOT wear dentures while sleeping, or during the entire night
• Clean and disinfect dentures following prescribed norms; clean dentures twice daily
• Use soft-bristled brush to clean dentures (so as to not damage them)
• Soak dentures overnight in plain water (or any recommended solution)
• Follow any other instructions given by the healthcare provider

How long does it normally take to fully recover, from the Procedure?

There is no recovery time involved, although individuals may take a while to learn to use the dentures properly. Adjustments may be made to the denture to reduce discomfort, and to fit comfortably in the mouth, from time to time.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Generally, the procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Usually, no tissue is sent for a pathological analysis.

Who will you receive a Bill from, after the Denture Placement procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• An out-patient surgery center facility, the dentist or oral surgeon’s clinic/office, or a hospital
• An anesthesiologist (if anesthesia was administered)
• A dentist care professional

The patient is advised to inquire and confirm the type of billing, before the Denture Placement procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA