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Fitting dentures as a student

12 July 2023

Uwais Joosub, fourth-year dental student at University of Western Cape, recalls how he fitted a new pair of dentures for the very first time. Instagram: uwais_joosub_

I am currently a BDS IV student at the University of Western Cape. I am from Pretoria and have travelled to Cape Town as I am very passionate about dentistry and wished to study this degree at the best dental faculty in the country. I have a interest in prosthodontics and hope to specialise in it one day.

A female patient by the name of Angela approached us on the 21st of February 2022 with the main complaint that her previous dentures were broken for a year and she was struggling to eat, therefore we concluded she needed a new set. The last time the patient visited the dentist was 16 years ago. Upon further analysis it was surprisingly discovered that the patient was completely healthy and had no medical conditions or allergies for a 78 year old pensioner. I proceeded to do an extra oral examination and the only discrepancy was that the patient had swollen ankles which could indicate oedema but further analysis is required.

The intra-oral examination revealed the following:

1. Tongue: Plaque on dorsum
2. Floor of the mouth: Good salivary flow
3. Lips and vestibular area: Good pigmentation
4. Cheeks and buccal mucosa: N.A.D
5. Palate and tonsillar area: Healthy and ruggae is present
6. Periodontium: Loss of stipling, slightly resorbed lower ridge
7. The patients previous dentures were cracked and the teeth were withered away.

My final diagnosis:

1. Edentulous patient in need of dentures
2. Slightly resorbed lower ridge
3. Loss of speech
4. Loss of function
5. Loss of mastication

Aetiological factors:

1. Poor Oral Hygiene Information & Oral Hygiene
2. Education
3. General wear of Dentures
4. Denture is old
5. Wearing of teeth of dentures

Comprehensive treatment plan:

Systemic: Nothing applicable

Initial: Oral Hygiene information and education, Primary Impressions, Secondary Impressions, Jaw Registration, TryIn, Delivery, Recall.

Re-evaluation: 4-6 weeks

Maintenance phase: Routine check ups every 6 months.

Prognosis: Upper ridge- good
                    Lower ridge- poor

That concludes our history and diagnosis, on the same day primary impression were taken using alginate, the mouth was assessed and an appropriate stock tray was chosen. I applied periphery wax on the borders of the tray. The next step is to spray adhesion spray, combine alginate and water, spread it on the tray and then place it in the patients mouth until it dries and an impression is taken. This impression is then sent to the lab to make the special tray.

On the 28th of February 2022 I received the special trays, The upper and lower special tray had to be adjusted using greenstick and both upper and lower special trays were reduced after overhangs and undercuts were evaluated by an alginate wash. SS white and Kelly's were used to take the impression and both secondary impressions were completed on this day.

Two weeks later the record blocks were completed by the lab, they were assessed and fitted into the patients mouth, they seemed to have good retention which was a satisfactory result for me as the clinician. I reduced the upper and lower record blocks to occlude and completed what we call jaw registration. I allowed the patient to select her desired shade and mould of her teeth and then recorded the bite using Aluwax. 

The first try-in with the teeth did not go as planned the bite was incorrect and had to be practiced and retaken. The denture in progress was sent back to the lab where the bite and teeth were adjusted onto the record block. The second try-in had the correct bite and the record block fit well into the patients mouth. The record block also had perfect occlusion of its teeth. The model was thereafter sent to the lab for flasking, which is a process of making the denture firm using acrylic, finishing and polishing the denture. 

Delivery day was on the 25 of April after my 1st term holidays. The denture was comfortable inside the patients mouth and no grinding was necessary. Occlusion, speech and aesthetics were all satisfactory to the patient.

On recall the patient was extremely happy with the denture. Some pain was felt on the lower denture lingually, so I adjusted the denture accordingly. The patients treatment was completed successfully.

The procedure of making my first denture for a patient was an exciting yet challenging experience. The patients exact treatment altered as the procedure went on, although I must state that my patient was compliant through the whole treatment. Her oral hygiene practices really helped me in reducing complications and making the process easier than expected. The most difficult of all steps was taking the lower impressions due to the slightly resorbed ridge although I persevered and eventually | was able to succeed. It was a fun and informative task that I know I would love doing throughout my dental career. I am so pleased with my supervisor, that taught me so many tips and tricks that I can eventually carry with me forever. All the complications, long sessions, hard work and patience was all worth it when I caught a glimpse of the patients smile in the mirror when she saw her beautiful new set of teeth.