This is a great question and I am glad for two reasons:
- That your friend is so happy with the outcome of her work and
- That your question gives me a chance to explain something that I, too, am very excited about.
The type of dentistry your friend has is not your everyday type of dentistry. It typically is done by someone who has dedicated themselves to providing a high caliber of care. My hat comes off to your friend's dentist.
There are a few reasons that your friend is so excited. They are as follows:
- There are no clasps showing and, therefore, her smile is enhanced.
- The retention of a denture like this one is superior to that of one that has clasps. Therefore, she doesn't have to worry about the denture slipping out.
- Her dentist probably told her that there are fewer forces on her own teeth and she will, therefore, hold onto her teeth longer than if she wore the denture with the clasps.
- Her dentist probably also told her that when dentistry is done like this, and it is maintained properly, there is usually very little need for additional care, except for regular maintenance visits with the hygienist and examinations with her dentist.
- When designed properly, there is very little chance that food gets stuck under the dentures.
- The dentist has the ability to do what I call smile design. By that, I mean that, within reason, both the patient and the dentist can design the smile that best suits the patient.
- If her dentist treated both the top and bottom teeth at the same time, he or she had the opportunity to make some changes to the bite and jaw position if they were necessary. If this was the case, this alone could have made your friend excited.
What I pictured your friend having is as follows:
Like you, she probably had her front six teeth on the top. Let's assume that she didn't have any back teeth. Her dentist probably crowned, or capped, the remaining six teeth. In the back of the last two teeth, he or she probably put some kind of precision attachment that keyed into the partial. Depending on the type of attachment that is used, one half is the female and the other the male. By using this type of system the forces on the teeth are greatly reduced and the clasps that you spoke about are eliminated.
On the bottom, she probably had the same scenario, but let's assume that she also had one molar on each side. If this were the case, her dentist probably used a regular type of clasp because it is out of the smile line and the forces generated here are different.
If you are considering having treatment like this I would certainly encourage you to go ahead with it. The benefits are outstanding and can be enjoyed for a lifetime.
I think that the relines you had done could very likely cause you to experience the change in tone you mentioned. When a dentist relines a denture he or she should grind away the same amount of acrylic that will be taken up by the impression material used for the reline. In some cases, this may not be done. If this were the case in your scenario you would end up with less space between your upper and lower dentures than before the relines. As you are aware, tones are made through the use of air in a defined amount of space. Since you may now have less space between your dentures, the way the air resonates from your lungs and through your mouth has changed - hence a difference in the tones you hear.
Another thing that can happen after a reline is a difference in the way certain words are pronounced. The "S", "F" and "V" sounds are usually most affected. The reason for this is that the position of the teeth is very important in the pronunciation of the "S", "F" and "V" sounds are said. And finally, another thing that might happen is a sudden clicking of the back teeth when you speak. This is again caused by the decrease in space between the dentures.
As you can see, there are many variables to think of when doing a reline. Still another consideration is the fact that when your dentures were made they were probably processed overnight under heat and pressure. When a lab or dentist does a reline and processes the acrylic in less than 2 hours, the type of cure is not the same. Ideally, you would not want to have a reline processed in 2 hours. Please realize that this is probably not the cause for your scenario; however, it is still an important consideration when having your dentures relined.
Not knowing exactly what it is that you would like to see different, I feel confident in saying that you can expect an improvement in a new set of dentures. Some of the most common things we see happen to someone in your situation are as follows:
- Decreased lip support making it difficult to put on lipstick properly.
- Fewer teeth showing upon smiling, sometimes to the point that no teeth will show and,
- Too much space between the upper and lower teeth causing your chin to come closer to your nose upon closure and chewing.
- Due to the age of the teeth and the materials that were used you often see teeth that do not appear natural.
There are solutions to each of the above conditions that, depending on the severity, can be dealt with quite nicely. The best way to find out if you can expect improvement is to see your dentist and bring along a list of things you would like to see changed. He or she will be able to tell you whether or not these changes are possible.
Because you cannot have implants, that really only leaves us with making a new set of dentures that address your specific set of problems. I would suggest that you make a list of things that you would like to see different and bring that to your dentist. He or she should be able to tell you which of your requests are possible and which are not. One specific suggestion I can make is that it would be a good idea to have a soft reline done on the lower denture. A soft reline is a soft, pliable material that will act somewhat like a shock absorber. It can also help hold the denture in better for a few reasons. I have seen this work for many patients. As for some of the other things that you have mentioned, there are things that can be done to address them. One of the most important things is the list I suggested before. I have found that if the dentist knows up front what the goals of the patient are there is a very good chance that they are all met unless they are unrealistic. If they are unrealistic, both you and the dentist at least have the opportunity to discuss them before anything is done.
It is very hard for me to comment on this scenario without seeing you with your denture. I too feel that there is something the can be done to help you. I would suggest that you bring your situation to another dentist and see what he or she thinks. Tell the dentist what you told me and he or she should be able to give you an opinion. Some of the methods to determine what is causing the problem are as follows:
- Visual examination of the problems present.
- Check the intimacy of contact between the denture and the tissues with a paste that indicates pressure.
- You can also mark the position of the sore on the denture with a special pencil and make the necessary adjustments.
This is a good question that not only you are facing. There are many people in the same shoes or very similar ones. It sounds as though the top denture is going fine except for esthetics. If that is the case have no worries. With the new technology in denture esthetics having a set of teeth that look great is not a problem. There are new lines of teeth that have what I call the Hollywood smile, as well as teeth that are modeled after naturally aged teeth. There are also teeth that fall in between these extremes. It really depends on what your goals are. If you communicate your goals to your dentist I am confident that he or she can make you happy providing they are up to date with denture esthetics.
As for the lower situations - there are a couple of solutions that come to mind. I am at a disadvantage not knowing which teeth are missing but I will assume that they are front ones. To follow are some possibilities:
- The simplest, least costly and most straight forward solution is to extract the remaining four teeth and make you a new immediate denture. What this means is that a denture will be fabricated before your teeth are extracted and upon extraction, the denture will be placed. The advantage to you is that you will not be without teeth at any time. You will be seen after the extractions for some adjustments and will need to have the denture relined in about 3-6 months. The disadvantages to this are that you have nothing left to hold the denture in except for denture adhesive. Some people get used to lower dentures quickly and some are simply more comfortable with them out. It is hard to say where you will fall in this scenario.
- The second option is to save the remaining teeth and utilize them to hold in a partial denture. You may or may not need to do something to these teeth in order to save them. Only an examination can give you this information. If the teeth are okay you can have a conventional partial denture made that has clasps that hold onto the teeth. For some people, this is unacceptable due to esthetics.
- You could crown these teeth and join them together so they help support each other. Your dentist can then place attachments on the two ends of the splint that have two halves (much the same as a lock and key). One half of the attachment is in the denture and the other half is on the splint. This eliminates the clasps and decreases the pressure transmitted to the teeth. This is a great way to restore someone. It is very comfortable and esthetic. It can last a lifetime if maintained properly.
- The last scenario is to do something identical to option 1 but also place 5 implants in the jaw that will eventually be used to hold a bar in that a set of teeth are clipped to. This is an excellent alternative when the teeth are not savable and the patient wants something to hold their denture in. We also use this route when a patient states that they just do not want to save their teeth. The neat thing about implants is that they do not decay. They still need to be maintained regularly by your dentist and hygienist.