Addition of a tooth to a denture chairside immediately after extraction Vanessa Creaven Aslam Fadel Alkadhimi Lisa Creaven Abdulhadi Warreth Dental Update 2024 40:10, 707-709.
Authors
VanessaCreaven
Fifth-year Dental Science Student, Dublin Dental University Hospital
The addition of a tooth to a denture chairside is a practical and handy tip for the general dental practitioner working in a busy practice. In the current economic climate, patients are increasingly searching for economic alternatives to the fabrication of new dentures and, instead, opting to add teeth to their current dentures to reduce cost. With increased numbers of patients retaining their teeth, and with increased numbers of the elderly partially rather than completely edentulous, the addition of teeth to a denture will become a practical necessity in the developing general dental practice.1
In this clinical tip, a 55-year-old partially dentate female presented with mobile left and right maxillary canines. The patient was anxious to get the two teeth extracted as they were aesthetically unpleasant. Clinical examination revealed missing maxillary central and lateral incisors, which were replaced with an acrylic partial denture. The first right and left premolars were removed, as required for orthodontic treatment, which was carried out years ago. However, no space was found between the second premolars and the canines (Figure 1). The left and right maxillary canines had grade III mobility due to severe chronic periodontitis.
Figure 1. Pre-operative clinical photograph.
Different treatment options were discussed with the patient. One option was to extract the two canines and to add two acrylic canines to the denture in the laboratory.2
Procedure
Figure 2. The alginate impression with denture in the mouth. Remove impression with the denture in place from the mouth. If the denture is quite retentive, first remove the alginate impression material and then remove the denture and replace in its position in the impression. Vaseline was applied to the fitting surface of the denture and the impression was then poured up with snow white plaster – Type 2 (Kerr, Switzerland]. The shade of the maxillary left canine was then selected.Figure 3. The upper left canine was extracted under local anaesthetic.Figure 4. The upper left canine was ground down off the cast using a scalpel and a wax knife. The selected acrylic denture tooth was then adjusted to fit the space created. A modelling wax (US Dental Depo, Fort Lauderdale, FL, USA) was used to fix the selected acrylic tooth into its proper position in the dental arch of the cast. The denture was then lifted off the cast and then tried in the patient to verify the position of the added tooth and to check if readjustments were needed.Figure 5. The denture was replaced on the cast and subsequently a vinyl polysiloxane putty index was made to record the position of the left maxillary acrylic tooth in the dental arch. The pink wax was then eliminated. Vaseline was painted on the canine region on the plaster surface. Using the putty index, the maxillary left canine was replaced in the arch and fixed to the denture plate, using pink autopolymerization acrylic (VertexR self-curing, The Netherlands). When polymerization was complete, the index was removed. The denture was then replaced in the patient mouth and checked for fit, aesthetics and occlusion and then polished. The same plaster cast was used for addition of both canines.Figure 6. Post-operative view.
Conclusion
Advantages
Patient will not leave the clinic without her denture (tooth extracted and teeth added clinically).
Whole procedure under clinician control and position of added teeth verified. Disadvantages
More clinical time needed – more permanent treatment may be required in the future.
