Fabricating dentures has become a lost art. Many clinicians have abandoned the rigors that are required to produce a properly fitting and esthetically pleasing removable denture.

In complete dentures, we have been taught for 100 years to leave the provisionalization step out. We have been taught to take impressions, visualize the outcome, do wax-up try-in and go directly to delivering the denture. This is the reason that dentures are so unpredictable.

In my practice, we make every patient a treatment denture. We call this their training wheels. They wear these training wheels until we have proved all of the things we need to prove, such as ensuring proper vertical dimension, esthetics and phonetics.

We don’t place any lower posterior teeth on these training dentures. We use a chewing block in the posterior and it’s set up in an occlusion that the Pankey Institute used to refer to as a Tanner Splint. It’s set to lingualized occlusion and acts like a repositioning splint for the condyles.

I use Hydrocast, which is a flowable impression material. It flows and forms an impression as the patient chews, talks, and eats. The hydrocast is adjusted for up to two weeks until a beautiful, comfortable impression is taken.

We make sure we have the correct vertical dimension, centric relation and then we use the treatment denture as a blueprint. When we finish, we have about a 98 percent success rate – assuming we make it through the treatment denture. If we can’t make it through the treatment denture, we can discontinue treatment. The patient pays two fees: one for the treatment denture and one for the final denture.

You must recognize that denture occlusion has no anterior contact. The front teeth don’t touch, because if they do, the premaxilla will be destroyed and there will be a big roll of flab across the front of the upper jaw.

If the patient opts for implants, the clear duplicates of the treatment dentures become stents for the surgeon, and after the surgeon finishes with them we make impression trays with them. The impression tray exterior shows exactly where the teeth go, what the vertical dimension is and centric relation.