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Medical Forum / General / Dentistry / October 2005

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Quality Of Dentures ? Labs ?

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voicelit - 23 Sep 2005 17:54 GMT
  Me, again.
  I imagine dentures have different qualities. Do dentists have any
inside knowledge of what dentures are worth the money, which are junk ?
What would someone look for in a denture ?
  I read something somewhere about a denture having little vein lines
for realism?
  Any lab better than any other /
  What is it with the acrylic palate, didn't I see somewhere a metal
palate ? Are metal palates thinner - better for phonetics - but acrylic
more aestheticly pleasing ?

Marty
Amatus Cremona - 23 Sep 2005 23:43 GMT
>Me, again. I imagine dentures have different qualities. Do dentists have any
>inside knowledge of what dentures are worth the money,

Have you considered the fact that you are obsessing over this thing
far too much ?

Amatus

>   Me, again.
>   I imagine dentures have different qualities. Do dentists have any
[quoted text clipped - 8 lines]
>
>Marty

..

Amatus

.
JimSocal - 27 Sep 2005 10:07 GMT
>>Me, again. I imagine dentures have different qualities. Do dentists have any
>>inside knowledge of what dentures are worth the money,
[quoted text clipped - 3 lines]
>
> Amatus
I don't think he's obsessing at all. It's a legitimate question. We go
to a dentist and it is just a "given" that we accept his or her
hardware and work, and we are not given any info and have no way of
judging if we are with a good dentist or a bad one.

The last dentist I went to did a bad root canal and now I will have to
lose that tooth. The same dentist caused my wife to have to get an
apicoectomy. The point is, we patients do need to ask questions and
try to determine if the dentist is good or not, and if the hardware
such as dentures he is selling us are any good.

So if denture making is more "art" then "science" and many are done
badly, how does one make sure we get it done right???
Joel M. Eichen - 27 Sep 2005 11:05 GMT
>>>Me, again. I imagine dentures have different qualities. Do dentists have any
>>>inside knowledge of what dentures are worth the money,
[quoted text clipped - 13 lines]
>try to determine if the dentist is good or not, and if the hardware
>such as dentures he is selling us are any good.

Hey Jim!

Its not necessarily so. Many times the doctor does everything
perfectly but the result is still bad. When dealing with the healing
arts there are no guarantees!

How did the dentist cause the need for apicoectomy?

Joel

>So if denture making is more "art" then "science" and many are done
>badly, how does one make sure we get it done right???
JimSocal - 12 Oct 2005 03:31 GMT
I only know what we were told by 3-4 different dentists, that the root
canal was done poorly.

The same dentist did my #18, (before we realized he was a terrible
dentist) and I was also told the root canal was done very badly, thus
leading to my losing the tooth.

However, when pressed, the dentist who said it was bad said, "But not
enough to say it was malpractice". I think it's just a matter of one
dentist not wanting to testify against another.
Amatus Cremona - 12 Oct 2005 15:20 GMT
> The same dentist did my #18, (before we realized he was a terrible
> dentist) and I was also told the root canal was done very badly, thus
> leading to my losing the tooth.

Perhaps I missed part of the story.  I have difficulty seeing how a poorly
done RCT would lead to losing a tooth.  The RCT can always be done over.  If
the root was perforated during RCT, that might be the reason.  If the root
split, it probably had a crack in it before the RCT was ever started.  I
just treated a patient with a previous RCT where one root was not filled
very well.  (This is a molar with 3 roots).  The other two roots are filled
very well and the bone around them looks great.  The root with the poor
filling has a draining abscess associated with it.  After detailed informed
consent and with no promises of fixing the problem, the patient elected to
have the RCT re-treated on  this one root.  It was simple to re-treat the
RCT of this root (after cutting a hole in the crown).  The pain stopped, but
the drainage continued.  After 3 weeks, with informed consent and no
guarantees, we elected to amputate the root that the abscess is draining
from (the one I re-treated).  The root was found to be split down virtually
the entire length of the root.  It came out in little pieces.  Hopefully,
the area will fill in with healthy bone and the tooth will be kept
functional for a few years longer.  This entire tooth may well be lost in
the near future.  However, the problem is not the fault of the dentist doing
the RCT the first time, it is a direct result of many years of clenching
with great force and attempting to grind back and forth with clenching,
PRIOR to ever getting the RCT and crown.

Signature

/

Amatus

/

>
> I only know what we were told by 3-4 different dentists, that the root
[quoted text clipped - 7 lines]
> enough to say it was malpractice". I think it's just a matter of one
> dentist not wanting to testify against another.
Amatus Cremona - 27 Sep 2005 12:32 GMT
> The last dentist I went to did a bad root canal and now I will have to
> lose that tooth. The same dentist caused my wife to have to get an
> apicoectomy. The point is, we patients do need to ask questions and
> try to determine if the dentist is good or not, and if the hardware
> such as dentures he is selling us are any good.

I have no personal knowledge about the case and you may be right in your
description above.  However, we find that virtually all failed RCT cases (in
this day) are due to fractured roots.  This is something the dentist has no
control over.  Yes, it is possible to crack a root by obturating too hard or
by not placing a post properly, but it has been many years since I have seen
such an occurrence.

Signature

/

Amatus

/

>
>>>Me, again. I imagine dentures have different qualities. Do dentists have
[quoted text clipped - 18 lines]
> So if denture making is more "art" then "science" and many are done
> badly, how does one make sure we get it done right???
Dartos - 27 Sep 2005 13:34 GMT
 However, we find that virtually all failed RCT cases (in
> this day) are due to fractured roots.  

I've seen enough crappy endo to disagree.  I just re-treated a
case this summer that had been done just two years previously.

The lower first molar had *one* silver point in the mesial root
and one short gutta percha fill in the distal root.  Absolutely
inexcusable.

JME,
Dartos
Amatus Cremona - 27 Sep 2005 14:02 GMT
> The lower first molar had *one* silver point in the mesial root
> and one short gutta percha fill in the distal root.  Absolutely
> inexcusable.

How long ago do you think the RCT was done?

Signature

/

Amatus

/

>
>  However, we find that virtually all failed RCT cases (in
[quoted text clipped - 9 lines]
> JME,
> Dartos
Dartos - 27 Sep 2005 21:02 GMT
As per the first paragraph, 2 years.

<G>
Dartos

>>The lower first molar had *one* silver point in the mesial root
>>and one short gutta percha fill in the distal root.  Absolutely
>>inexcusable.
>
> How long ago do you think the RCT was done?
Amatus Cremona - 27 Sep 2005 21:08 GMT
> As per the first paragraph, 2 years.

Someone is still using silver-points?  Amazing !  That alone would be cause
for concern in my book.  When you mentioned silver-points, I just figured it
was done back in the 1960's.

Cool screen-name BTW.  I am only a little bit embarrassed by it.

Signature

/

Amatus

/

> As per the first paragraph, 2 years.
>
[quoted text clipped - 6 lines]
>>
>> How long ago do you think the RCT was done?
Dartos - 27 Sep 2005 22:50 GMT
I was shocked and amazed to see one that had been placed in
recent history myself.  The guy is over 60, but geez, I'm
almost 53 and I know better.

Dartos (too risque?  it was the name of my intramural basketball
team during dental school, my one and only dunk)

>>As per the first paragraph, 2 years.
>
[quoted text clipped - 3 lines]
>
> Cool screen-name BTW.  I am only a little bit embarrassed by it.
Roy Brown - 24 Sep 2005 03:44 GMT
The 5 most important things about dentures are (in no specific order):

1. The vertical height (jaw to jaw spacing) is correct
2. The teeth are placed in the neutral zone and properly arranged
3. The bite is correct
4. The denture bases intimately fit the tissues with the borders (edges) @ the
proper length.
5. The plane of occlusion is correct.

If your dentures don't meet these basic requirements, everything else does not
matter. Believe it or not 95% of the dentures that come into my office fail on
at least one of the basics.

What good is a turbocharged sports car with fancy rims, wide tires, cool paint
job, leather interior blow your mind stereo if the tranny is dysfunctional? Same
thing goes for dentures.
Signature

Roy
rem NADA to reply

|   Me, again.
|   I imagine dentures have different qualities. Do dentists have any
[quoted text clipped - 8 lines]
|
| Marty
spondee@cox.net - 24 Sep 2005 16:35 GMT
Thanks for this one, am saving the info for when I am 'flush', I am
absolute SURE my dentures don't pass this criteria!!!

>The 5 most important things about dentures are (in no specific order):
>
[quoted text clipped - 12 lines]
>job, leather interior blow your mind stereo if the tranny is dysfunctional? Same
>thing goes for dentures.

spondee@REMOVEcox.net
Mark & Steven Bornfeld - 24 Sep 2005 16:44 GMT
> The 5 most important things about dentures are (in no specific order):
>
[quoted text clipped - 8 lines]
> matter. Believe it or not 95% of the dentures that come into my office fail on
> at least one of the basics.

    To be fair, most or all of these can change over time.  Awful dentures
may well have satisfied these requirements 20 years before!

Steve

> What good is a turbocharged sports car with fancy rims, wide tires, cool paint
> job, leather interior blow your mind stereo if the tranny is dysfunctional? Same
> thing goes for dentures.

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

voicelit - 26 Sep 2005 18:11 GMT
Me again. Voicelit / Marty / original poster.
  Yea, of course I'm " obsessing ". It's a big outlay of monies ; it's
a hugely depressing moment / Rubicon in my late life ; it's this
(possibly grotesque ) appliance that'll be in my mouth, defining some
percentage of my personality.
  Just so incredible that one can research a coffee maker, a vacuum,
an automobile , even a movie but not get reviews, facts, opinions on
dentists or something that's going to become your mouth .
   I hear many nightmare stories of badly fitting dentures, weird
gumlines, endless discomfort.
   Would just like to keep as close to a minimum the amount of lurid
comedy this may entail.

Marty
Dartos - 26 Sep 2005 20:42 GMT
Shopping for dentures is not like shopping for a manufactured
item.

You have virtually no way of finding out if a particular
dentist will make you happy until you are finished with treatment.

Each denture is a product of technique plus artistry.  There is
no assembly line.  There are no precise measurements and machinery
to construct the finished product.  Impressions, bite relations,
tooth selection, tooth placement, and even trimming and polishing
are as much art as science.

Cheap dentures are usually just that.  Moderate to expensive dentures
are usually made of better materials and with a little more attention
to detail.  There is no such thing as a sure thing.

Dartos

> Me again. Voicelit / Marty / original poster.
>    Yea, of course I'm " obsessing ". It's a big outlay of monies ; it's
[quoted text clipped - 10 lines]
>
> Marty
Joel M. Eichen - 26 Sep 2005 23:40 GMT
>Shopping for dentures is not like shopping for a manufactured
>item.
>
>You have virtually no way of finding out if a particular
>dentist will make you happy until you are finished with treatment.

..... and the dentist himself is often unsure of the outcome ..... it
was easier when the doc knew his patients .... "Mrs. X, no way will I
remove those last three teeth. I know the teeth look like crap (sic!)
but that's what standing between you and noit being able to function."

Many people, most of my patients, do not have the $$$ to get it done
right, implants, the rest. So what to do?

Be a kind compassionate, perspicacious dentist!

Gotcha with that word, right?

Joel

>Each denture is a product of technique plus artistry.  There is
>no assembly line.  There are no precise measurements and machinery
[quoted text clipped - 22 lines]
>>
>> Marty
Roy Brown - 27 Sep 2005 02:31 GMT
After 20 years it's possible.

The borders, plane of occlusion, the relationship of the teeth to the ridge and
their arrangement give a pretty good idea of how well the dentures were made in
the first place.

Once a Lada, always a Lada.

Signature

Roy
rem NADA to reply

| > The 5 most important things about dentures are (in no specific order):
| >
[quoted text clipped - 17 lines]
| > job, leather interior blow your mind stereo if the tranny is dysfunctional? Same
| > thing goes for dentures.
spondee@cox.net - 27 Sep 2005 04:20 GMT
>To be fair, most or all of these can change over time.  Awful dentures
>may well have satisfied these requirements 20 years before!

Or they can start out awful - hehe

spondee@REMOVEcox.net
Mark & Steven Bornfeld - 27 Sep 2005 17:27 GMT
>>To be fair, most or all of these can change over time.  Awful dentures
>>may well have satisfied these requirements 20 years before!
>
> Or they can start out awful - hehe
>
> spondee@REMOVEcox.net

    Yes--as Roy said.  I would have said Yugo though.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

voicelit - 27 Sep 2005 19:27 GMT
Me , Voicelit, Marty , Original poster of this.
  I think I've done enough reading up on this so that I understand a
few things. For instance, a dentist might be against a certain approach
just 'cause he/she may not have purchased that equipment or taken that
course. Problem is : not all will just tell you that they're not up to
speed on certain techniques; instead - who knows why; maybe they need
the business -  they will involve you in some " jive " verbosity .
   So, people ( DDS ) have either bought the equipment or taken the
courses , kept up with advances in their field or not.
   I'm getting the impression ( pun ? ) that when it comes to just
plain old dentures that one's gonna get alot more weirdness. There's
just not that much money in it for the dentist ; and more trouble than
probably most procedures : fittings, adjustments, complaints
;  even the emotional reward is most often less : what percentage (
like myself ) just resent that it's come to this. It would seem ( and
this is my experience so far ) that the temptatation to skimp on the
time ( labor ) and materials would be greatest down here in the dank
world of dentures . Also, that a shoddier form of DDS winds up bottom
feeding among the Edentulous. The clients are mostly people like myself
whose lives have led to this. Uneducated, drug addicts, recovering
alcoholics : me  , mony less : kind of me . Must be a small percentage
of the better educated , better financed that wind up needing dentures.
 Still, you'd think there would be someway to put the work into
researching etc so a person could know what they're getting. C'mon,
it's just insulting to ask people to believe that no one has any idea
what dental lab might be better than others or which are a must to
avoid.

Marty
Dartos - 27 Sep 2005 21:26 GMT
I don't think that saying I have had mainly satisfactory results with
Myron's Dental Lab in Kansas City is going to be of much help.

If the dentist doesn't take a good impression, it won't matter what lab
is used.  I also still have to carve my own post-dams or the lab will
over extend the palate and the post-dam is almost non-existant. (gagging
and poor suction)

A correct bite relation is also the dentist's responsibility.

My solution to the denture problems in my office was to raise the fee.
That way I know I'm getting paid to put up with the difficulties
involved.  I also do not make 'cheap' dentures, nor do I have any
bait and switch gimmicks.

JME
Dartos

> researching etc so a person could know what they're getting. C'mon,
> it's just insulting to ask people to believe that no one has any idea
> what dental lab might be better than others or which are a must to
> avoid.
>
> Marty
JimSocal - 14 Oct 2005 01:38 GMT
>Me , Voicelit, Marty , Original poster of this.
>   I think I've done enough reading up on this so that I understand a
[quoted text clipped - 9 lines]
>just not that much money in it for the dentist ; and more trouble than
>probably most procedures : fittings, adjustments, complaints

I think you have a lot of good points. As a patient trying to get
cheaper implants, like via dental school, I agree that finding a
reasonable and good dentist is almost impossible, even in a big city.
If you live in a smaller city, forget it.

There should be a web site where people can talk about their
experiences with dentists, good and bad.

However, it has been my observation that any kind of "review"
situation on the web always ends up attracting the people with the
worst experiences, not the best. The people who had great experiences
don't bother to write. The people with bad experience will look for a
place to express their anger/disappointment.

So I don't know that even a web site of Dentist Recommendations would
be any good.

In my opinion your ONLY real recourse is to find recommendations of
good dentists who make good dentures. It totally sympathize with you.
I am close to getting dentures myself, except that I am holding out
hope of getting implants one way or another - mostly with borrowed
money, and finding a dental school to do it.

I used to think dental schools were a bad idea, but I have been told
my a number of people that they can be a very good idea. After my
experience with several bad dentists in the private sector, I can't
imagine that it could be much worse risk at a dental school. At least
there they have someone overseeing the work. (supposedly)

I would say, try to find someone who has had successful dentures made
in your area, or the nearest big city to you. Maybe call the
professors at the nearest dental school near you and ask who makes
good dentures; or try to get a recommendation from the ADA - not a
paid recommendation, but a real one from someone who has had dentures
made and liked them. Ask your prospective dentist if you can call one
or two of his patients he made dentures for, if you can call and talk
to them about his work.

I think recommendations are the only way to insure getting good work
done. It can be frustrating, I  know, trying to find anyone to give
you a recommendation of a good dentist, especially for specific work.

I know how you feel and I think you are right not to just go to any
dentist and "hope for the best". Keep researching it and see what you
can come up with. Maybe a dental school might be a good idea? What do
the dentists here think of that idea?
Charlie - 29 Sep 2005 17:00 GMT
Hey Roy

You do any CE?
Roy Brown - 30 Sep 2005 06:14 GMT
About 200 hrs a year.

Signature

Roy
rem NADA to reply

| Hey Roy
|
| You do any CE?
Charlie - 02 Oct 2005 00:05 GMT
I asked that wrong.  I meant: do you teach public CE courses?
Roy Brown - 02 Oct 2005 07:13 GMT
To date I've only done closed group functions. You're the 3rd to ask me this
year about going public. Maybe I should try putting something together. What did
you have in mind?

Signature

Roy
rem NADA to reply

|I asked that wrong.  I meant: do you teach public CE courses?
Charlie - 03 Oct 2005 17:47 GMT
Your  "5 most important things about dentures" - which I think is great -
brought to mind how tough it is to get  decent CE on denture fabrication.  

The manufacturer-sponsored courses are OK , I guess, in terms of telling you
how to implement their particular system (like Ivolcalr's ESP).   But they
are trying to sell materials and equipment and the focus is too biased and
limited.

The best info comes from seasoned denture providers with a passion for
excellence who talk about what works for them.  I'd think a course on what
you do and how you do it would raise the bar for any denture jockey.
Amatus Cremona - 03 Oct 2005 18:38 GMT
> The best info comes from seasoned denture providers with a passion for
> excellence who talk about what works for them.  I'd think a course on what
> you do and how you do it would raise the bar for any denture jockey.

I have nothing to add to that !

Signature

/

Amatus

/

> Your  "5 most important things about dentures" - which I think is great -
> brought to mind how tough it is to get  decent CE on denture fabrication.
[quoted text clipped - 8 lines]
> excellence who talk about what works for them.  I'd think a course on what
> you do and how you do it would raise the bar for any denture jockey.
 
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