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Missing teeth can have negative effects on your ability to chew, your ability to speak clearly, and your appearance. It can also contribute to changes in your nutrition, obesity, diabetes, heart disease, and even some forms of cancer.¹ When many (or all) teeth are missing in your lower or upper arch, dentures are typically the most cost-effective solution to restore your teeth to their most natural state possible and help address these effects.

While dentures are often thought of as a full replacement of all the teeth in your upper or lower arch, the term denture actually refers to a variety of appliances. A denture that replaces all of your teeth in your upper or lower arch is called a complete denture. A denture that replaces the function of a few consecutive teeth or multiple teeth in different areas of your upper or lower arch when some of your natural teeth remain is called a partial denture. Partial dentures come in two categories: removable partial dentures and bridges.

The benefits of removable partial dentures

• By replacing missing teeth you can restore your ability to chew properly, which allows for better nutrition. Tooth replacement also helps prevent shifting teeth and bite collapse.
• Removable partial dentures are much more stable than removable complete dentures.
• Your ability to remove a partial denture allows you to better clean your natural teeth and gums. It will also enable your tongue and saliva to stimulate and clean your gum tissue.
• Removable partial dentures are easier to clean than bridges.
• Partial dentures can help restore the appearance of your mouth.
• Removable partial dentures can be a short-term solution for patients who are expecting to lose their remaining teeth due to oral disease, cancer, or other conditions. As more teeth are lost, the partial denture can be expanded to contain more prosthetic teeth until your natural teeth can no longer provide support.

What are removable partial dentures made of?

Dentures generally consist of "the teeth," and "the base" to which the teeth are attached. Each part can be made of various materials. Most commonly, denture teeth and denture bases are made of acrylic resin plastic, but each part can be made of various other materials. There is also a type of denture made of zirconium dioxide (zirconia) that is one solid piece consisting of both the teeth and the base. Your dentist will help you make the best choice of materials based on your specific needs.

In a standard removable partial denture:

• The teeth are typically made from porcelain or acrylic resin.
  • Porcelain teeth are typically more durable and last longer than acrylic resin teeth. They also feel similar to natural teeth and can be closely colored-matched to any remaining natural teeth. They can break if they hit a hard surface, and their hardness may more quickly wear natural teeth that they bite against.
  • Acrylic resin teeth adhere more securely to the denture base and are easier to adjust than porcelain teeth. They are also lighter in weight, and less expensive to create than porcelain. However, since they are not as hard as porcelain, they tend to wear faster, which can change how they contact other teeth. They may need to be replaced more often.² Because they may wear more quickly if functioning against natural teeth, those natural teeth can begin to move from the jaw, which changes the shape of the dental arch. The jawbone beneath the denture can also resorb significantly, creating a challenging condition to treat called "combination syndrome." The base can be made from acrylic resin or a flexible nylon polymer that is color-matched to resemble your natural gums.
• Zirconia dentures are made as a single piece including both the teeth and base. The shape of the prosthetic gum line, along with the angle and color of the teeth, can be adjusted to suit your preference. When attached to dental implants, they tend to allow less food to accumulate underneath them. They are also stronger and more durable than any other type of denture. While they are more expensive, they may save you money over time since they require less maintenance. These types of dentures are often most appropriate if you have not lost a significant amount of tooth-supporting bone to resorption or don't need as much lip support from the denture.

How removable partial dentures stay in place

Partial dentures require healthy natural teeth, crowns, or dental implants to provide sufficient anchor points for the denture. These anchor points are called abutments. Your abutments will be prepared with guide planes and/or rest preparations. These preparations reduce the forces on your gums and hold the denture securely in place. They also help reduce food accumulation under the denture and provide for a better fit.

Lower partial dentures are held in place using tissue-colored, flexible plastic or rigid metal clasps that hook around your abutments and gums on either side of the appliance. Upper partial dentures can be constructed using the same type of clasps but may also include a framework that fits into the roof of your mouth. In some cases, a "swing lock" that connects both ends of the removable partial denture to your teeth can be used. The metal lock rests below your lips and cannot be seen. There are many variations in denture design and clasping mechanisms. The variation that is appropriate for you will be based on the number and location of the missing teeth.

Before the procedure

While most denture treatment — preparation, placement, and maintenance — can be done by a general dentist, in some cases you may be referred to a specialist (prosthodontist). You and your dentist should discuss your specific situation and desired outcome before developing a treatment strategy.

The removable partial denture options available depend on where the denture is needed, and how many teeth are missing. If any natural teeth need to be removed, your denture will be placed after the gum tissue has healed. The typical healing time for gums is about 8-12 weeks. This generally provides enough time for the underlying bone to fill in and start to mature.

• Your dentist will assess your health history and current health status. Be sure to tell your dentist if you are allergic to any specific types of metals or plastics.
• Existing dental conditions such as tooth decay, periodontal disease, grinding or clenching, and the quantity and density of your remaining jaw bone will also be considered. Your dentist may take X-ray images to help make these determinations. Keep in mind that any other treatments needed prior to placing your dentures will likely extend the time and overall cost of finalizing your treatment.

During the procedure

Once you and your dentist determine which type of removable partial denture is best for you, and necessary preparations for your existing teeth are completed, the general steps to build and place your dentures are:

• Make a series of impressions of your gums and jaws, and take measurements of how your jaws relate to one another. Digital scans of the gums and remaining teeth may be used instead of or in addition to traditional impression materials.
• Create models, wax forms, and/or plastic patterns in the exact shape and position of the denture to be made. The dentist will trial fit you with these models. The models may need multiple adjustments for color, shape, and fit before the final denture is cast.
• The contours of your natural abutment teeth will be modified to provide the best fit. The most common modifications are rest preparations and guide planes.
• The final denture will then be created in the dental office or a lab.
• When it is ready, your dentist will place the denture in your mouth and make any necessary adjustments.

After the final procedure

Additional appointments are generally needed after your denture is placed so that if sore spots develop the fit can be checked and adjusted. If any problems persist, be sure to consult your dentist.

• Your dentist will instruct you how long to wear your dentures and when to remove them. During the first few days after receiving your denture, you may be asked to wear them all the time, including while you sleep. While this may be uncomfortable, it is the quickest way to identify areas that need adjustment.
• At this point, you will likely be instructed to remove your dentures before going to bed. This allows your gum tissues to rest. It will also enable your tongue and saliva to stimulate and clean your gum tissue.
• New dentures may feel awkward for a few weeks until you become accustomed to them. As you become used to your dentures, these problems should subside.
  • It is not unusual to experience minor irritation or soreness.
  • You may find that saliva flow temporarily increases.
  • Dentures, especially upper dentures that include a framework that fits into your upper palate, may temporarily affect your sense of taste. The extent of impact to your taste depends mainly on how much of your palate is covered by the denture and how thick the denture is. Thin metal denture plates typically don't alter your taste because they don't cover the entire palate. Thicker acrylic denture bases may alter your sense of taste more. This is because they alter the path food takes when it is being broken down in the mouth. It is also because the tongue plays a greater role in holding this type of denture in place, which may alter how food passes over your taste buds.
  • Eating with new dentures may be uncomfortable for a few weeks. To get used to your new denture, start with soft foods cut into small pieces. Chew slowly using both sides of your mouth. Over time, you can add other foods until you return to a normal diet. Be cautious with hard or sticky foods, including candy and gum. Removable partial dentures, which have abutment teeth in three to four separate areas of the dental arch are generally more stable than those that have only one or two anchor points. The more stable the denture, the more rapidly chewing typically returns to normal.
  • It is common for food and plaque to accumulate under areas of the denture that aren't as stable or well supported. If you're experiencing significant plaque accumulation under your denture, talk to your dentist to see if there are ways to minimize this.

Additional considerations

Cleaning removable dentures

• Dentures should be cleaned daily by soaking and brushing with an effective, nonabrasive denture cleanser to reduce levels of biofilm, bacteria, and fungi.
• Place your denture in water or a denture cleanser when they are not in use. This helps ensure your denture retains its shape, remains pliable, and keeps from drying out.
• Dentures should never be placed in hot or boiling water, which can cause them to warp.
• You can often successfully remove stains with hydrogen peroxide, denture cleaning solutions, mouthwash, or baking soda. If your partial denture has metal components, don't soak it in bleach or acids (including vinegar). These can cause corrosion. Be sure to rinse your dentures thoroughly before placing them into your mouth.
• Usually, the spaces between denture teeth are filled with pink acrylic denture base material unless the denture was specifically designed to have spaces. Using floss or interdental brushes can help to remove stains between the denture teeth if they have spaces between them.

Dental adhesives

• Removable partial dentures, particularly those that don't attach to at least one back tooth, can be held in place with a denture adhesive to prevent them from slipping or moving around. Adhesives come in many forms, including creams or gels, liquids, powders, pads, or strips. If you use one of these products, use them exactly as directed. Your dentist can recommend appropriate adhesives for your specific needs. They can also help if you experience temporary or permanent dry mouth. Be careful not to use excessive amounts of denture adhesive, as it may alter the fit of your dentures and how your teeth bite together. This may also contribute to accelerated bone loss.
• You should not use adhesives to 'fix' poor-fitting dentures. This can lead to gum sores and bone damage. If your dentures fit poorly or have been damaged, you should visit your dentist to have them adjusted or replaced.

Maintenance and repairs

• Your gum tissue and jaw bones will change over time. This will lead to changes in how your dentures fit. In addition, your dentures will eventually wear out. You should visit your dentist routinely so they can ensure your dentures are fitting and functioning properly. If you are experiencing discomfort or problems, contact your dentist immediately.
• Common denture repairs include a denture reline, denture rebase, or replacement. You should visit your dentist to have your dentures examined if you have any of the following issues:
  • Ongoing inflammation beneath the denture base.
  • Adhesive is needed to keep your denture in place when you eat.
  • Your dentures will not remain in place by themselves.
  • Adhesive must be used more than once daily.
  • You will not, or cannot, wear your dentures.
  • Your denture has degraded so significantly that it is no longer stable in your mouth.
  • Your denture does not align properly with your other teeth.
  • The denture is discolored, cracked, broken, or missing.
  • There is a change in the teeth or implants supporting your denture.
  • It has been more than 5 years since your denture was first built.

Issues with a removable partial denture

• Removable partial dentures are the most popular and least expensive treatment to compensate for missing teeth. However, they are typically less functional and require a greater level of maintenance than bridges.
• Your denture may rest on your gum tissue. This can lead to tissue loss and/or bone resorption, which can cause them to fit poorly, and cause gum sores and irritation. This risk is reduced, but not eliminated, by the support provided by your abutments.
• Food can lodge under the denture requiring frequent removal for cleaning. If this food is not eliminated at least daily, the abutment teeth may develop decay. If the decay becomes significant, it can be difficult or impossible to repair the denture in a way that allows the partial denture to continue fitting properly.
• Retention clasps can break or bend, requiring adjustments or repairs.
• Adjustments and repairs will be required throughout the lifetime of your denture. If you don't visit your dentist regularly for exams, cleanings, and denture maintenance, you risk requiring a premature full denture replacement. Replacement may also be necessary if the base and/or the teeth are worn, cracked, or missing, or if the clasps holding the denture to the abutment teeth break.

Issues with abutments

• Removable partial dentures require your dentist to remove tooth structure from the natural abutment teeth to provide proper support and create a more comfortable fit. Although unlikely, treatment on the abutment teeth may cause tooth sensitivity, gum inflammation, and tooth abscesses. Inflammation and/or infection can occur before, during, or after they are prepared to hold your denture.
• Chewing forces place a heavy load on abutments. Natural abutment teeth that have been heavily restored may be unable to withstand this load over time. This may cause them to be damaged beyond repair, resulting in the need for additional treatment.
• Removable partial dentures always lead to additional stress on your remaining natural teeth. This can lead to damage, or even cause the teeth to break. Even well-adjusted partial dentures can loosen or damage abutment teeth.

Tooth preparation

There are risks and considerations associated with preparing your mouth for dentures. These include the need for additional tooth removal, and the potential need for survey crowns to stabilize weakened abutment teeth. Dental implants may also be necessary to stabilize a removable partial denture if your existing natural teeth cannot. A local anesthetic may be used during these treatments. You should be aware of any risks prior to starting your course of treatment.

• Bridges may be an alternative if your remaining natural teeth are sufficient to support the bridge. If not, dental implants can be used to stabilize the bridge. Not everyone is a good candidate for implants, and there are physical and cost implications as well. You should be aware of these considerations before pursuing a course of implant treatment.
• A flipper can be used to temporarily replace one or more missing teeth while other more permanent options are considered.
• Some companies produce a temporary appliance that consists of a replacement tooth or teeth adhered to a plastic tray that fits over your upper or lower arch like an orthodontic retainer. The replacement matches the color and shape of your missing tooth or teeth. They are intended to create the appearance of a full set of teeth, but need to be removed while eating. Discuss with your dentist whether this would be a viable solution for you.
• In some cases, orthodontic treatment may be able to close spaces created by one or more missing teeth.

Delaying the replacement of missing teeth with dentures or other appropriate options can lead to many physical and social issues, including:

• Poor oral hygiene.
• Problems with your jaw joints.
• Bone resorption or bone loss.
• Soft tissue trauma that may require additional treatment such as aveoloplasty or other jaw bone procedures.
• Accumulation of bacteria that may cause periodontal disease.
• Gastrointestinal or nutritional problems resulting from an inability to chew food properly or avoiding food altogether.
• Poor nutrition resulting from avoiding certain foods.
• Shifting teeth.
• Misaligned teeth.
• Bite collapse.
• A decline in your speech, self-esteem, and quality of life.

• What denture or other options do I have? What are the pros and cons of these options?
• Are my abutment teeth that will anchor the partial denture solid enough to support the chewing forces the partial will introduce? Will they need any procedures to stabilize them before a denture is made, and what will be the added cost, time, and risk?
• What issues may result from placing a removable partial denture?
• Am I a candidate for implants? What would that entail? What would it cost?
• How many visits will I need to complete this process?
• What is the best way to take care of my dentures and my gums?
• If I need to use an adhesive, what do you recommend? How do you use it?