I admit it. I have relied FAR too much on my lab technicians to help design my chrome partial dentures. This needs to change! I realised that I want to take control of the denture design process – who better than the King of Removable Prosthodontics education Dr Finlay Sutton to help us ‘Make Dentures Great Again’!
In this episode, Dr. Finlay Sutton clarifies the philosophy behind Scandinavian Chrome Dentures. He also explains what each appointment entails to help those earlier in their career.
The Protrusive Dental Pearl: DENTURE DESIGN CHEAT SHEET! Dr. Finlay came up with a Universal Design Sheet. It covers all aspects of missing teeth – all different combinations and patterns of tooth loss. It covers teeth with good prognosis and also teeth with dubious prognosis
Highlights of this episode:
- 2:15 Protrusive Dental Pearl
- 4:05 Dr. Finlay Sutton’s Introduction to Partial Denture
- 6:31 The Scandinavian Partial Dentures vs other designs
- 11:24 Scandinavian approach for Chromework
- 12:56 Acrylic-based Partial Dentures
- 18:04 Indications for Chrome Palate on Complete Denture
- 21:17 Acrylic dentures with a wire mesh inside?
- 22:49 Cast Partial Dentures Protocol – Appointment by Appointment
- 32:13 Patient Reviews
- 34:39 Average treatment fees
Join us for The Scandinavian Approach to Partial Dentures with Dr. Finlay Sutton in Reading, UK on the 13th of January OR the 14th of January
If you enjoyed this, you may also like another episode with Dr. Finlay about Chrome Dentures Made Easier
Click below for full episode transcript:Jaz's Introduction: I love restorative dentistry. But the thing I always enjoyed the least I guess is DENTURES, complete dentures because I had a bit of experience. And I did a restorative post and I did loads of complete dentures I quite enjoyed.
But chrome dentures, for whatever reason, demographics exposure, didn’t get enough chance to practice the art of chromed dentures. And to be honest with you, I never got on with surveyors and I never really understood denture design. Now fast forward many years, and I started to get a more elderly patient base and the demand for good quality denture work increased. So, I had to match that demand. And I’ve been relying too much on my technicians to help me with the denture design and touchwood, I’ve had some good results so far. And what that did, it inspired me to learn more, I want to take control of the denture design now, hence why I’ve got Finlay Sutton coming next month. So, now it’s December. In January 2023, he’s coming to Reading I’m bringing him down south because I’m allergic to the north. And I’m just so excited to start implementing everything he’s teaching, but this episode will go a long way in teaching you about the philosophy of SCANDINAVIAN CHROMED DENTURES as well as for the younger dentists, every single sequence of Chrome Denture Provision, what is done at each appointment and why you do it in that order.
Hello Protruserati. I’m Jaz Gulati, and welcome back to the Protrusive Dental Podcast. It’s almost coming to the end of 2022. It’s been a crazy year for the podcast. We’ve had so many episodes, we launched the app this year. Like I am so proud of what our team put together. Thank you for hundreds of you who’ve been downloading on iOS and Android and sending the feedback and good vibes overall. So, really appreciate that. This episode like 98% of the episodes of Protrusive are eligible for CE or CPD certificates. All you have to do at the end is answer a few questions to validate your learning. And my team will email you a certificate, you also get early access to the episode. You get exclusive monthly content. So, last month it was the full mouth case discussion with Alan this month is through the loop view of fitting for ceramic units. This is not found anywhere. But on the app only. And the future, we’ve got Vertie prep for plonkers course exclusively on the app and loads more to look forward to. So if you’re a true Protruserati, download the app right now on iOS or Android. Or if you’d like to consume it all from the web, go to protrusive.app.
The Protrusive Dental Pearl
Today’s Protrusive Dental Pearl is actually going to be read out and spoken by Fin himself first ever Protrusive Dental Pearl, which is spoken to by my guest. Fin, take it away.
Okay, so I think one of the most difficult things with partial dentures are designing them. And so what I’ve come up with this a universal design sheet and sequence. So, it covers all aspects of missing teeth. So, all of the different combinations and patterns of tooth loss, I’ve got two sheets, which you can laminate, just print it off, laminate, put it in the surgery, and then you can apply that to any case that comes in. So, it covers both teeth with good prognosis, the good support teeth, and it also covers teeth with dubious prognosis that may need to be added on to.
So, I think that’s the main Pearl here. And but the other thing I think is really important with top tips and things like this is, it really is attention to detail. So, getting really good at dentures does take training and practice and dedication and reading, you know, so it’s not going to happen overnight. But like anything that is hard to do. That’s worth doing. It’s hard to do, really. So really go for it. Thank you.[Jaz]
So if you want to access to this PDF, there’s two ways to get it. One, is if you have the app already, you go to the Protrusive Vault, it’s been uploaded to the Protrusive Vault already. And number two, is if you go on www.protrusive.co.uk/denture-design, that’s denture-design. You’ll be able to download this very comprehensive design document that I heavily encourage laminating and using as an aide memoire when you’re designing your dentures, let’s join the main episode with Finlay Sutton.
Finlay Sutton, welcome again to the Protrusive Dental Podcast! How are you my friend?
I’m really good. Thank you. It’s great to be here. [Jaz]
It’s so nice to have you after that really epic episode. We did Episode 56, which you covered so much ground really like we talk everything from Chrome dentures for bruxists to ideal design to immediate dentures, and we had lots of questions from the community and that was just brilliant. And I am super excited Fin to be learning from you next month. It’s been one of my, in terms of courses, on my bucket list to make sure I get to see Fin and I want to learn partial dentures because I’ll be honest, a little confession I’m really bad at them. But, so that’s why I wanted to come to you to learn, but you’re too far away from you, Lanarkshire. So I’m bringing you down to Reading, it’s a sold out course. And we are just absolutely buzzing to host you. [Finlay]
Absolutely. So, well thanks very much Jaz, I’m super excited about doing that. And it’s gonna be really, really practical. Because I think that’s the end of the day, that’s what we do is a subject. You know, we are dentists, and we treat people, patients. So and that’s what it’s all about. It’s just case, after case, after case, there’ll be shown was a little bit of work done by you and the delegates too because what I’ll be wanting you to do is to design the case before actually show it. And then I’ll then show the case and tweak the whole thing. Because at the end of the day, what I’m really wanting is for every delegate to go away, knowing how to design a partial denture, a really good partial denture, for any patient that comes in through the door. It’s as simple as that. That’s what I want to do. [Jaz]
And that’s exactly what I need. Because although I’ve been doing a lot more chrome work and partial dentures over the last three years, just patient demographics has changed over my career the last 9, 10 years, I am relying far too much on my lab, to do the designing for me, and I’m going by their best judgment. And so I can’t wait for that all to change when I am a little bit more savvy on designing so that practical exercise that you’ve got inside that course that you plan, I think that’d be really key for learning. And I know you’ve been teaching all over the world for so many years. And you refine the art of education and personally from seeing your speak more didactic, like big, you know, 400 plus kind of sessions, by the way, we have me and Fin we’re just talking.
Fin recently lectured an IMAX theater, which is mind blowing. But even then you are just so such a brilliant educator, your energy is wonderful. So, thanks again for coming on. Today, we’re talking about Scandinavian Partial Dentures. Now, I always having to think about this Fin and I was thinking, a dentist who scores across on Spotify or on the app or on YouTube and and comes across his term. What could that mean to them? And maybe some dentists might think like IKEA, let me think does the patient just build their own partial denture? Is this like the smile direct club for chrome dentures? What are Scandinavian Partial Dentures? What makes it Scandinavian?[Finlay]
Okay, so I’ve thought about this. And it’s something that people ask me all the time. What I think is really important is that if we go right back to basics, and the way that I was educated in the UK, here that my textbook was this, which was the Davenports, and Heath. Basker, Davenport, and Heath, and this is very, very much like the British dental journal textbook on it. And if you notice here, in this design there, we’ve got a few of these little struts coming up. They’re little minor connectors.
And these sorts of things are in the Scandinavian principle, crossing the gingival margin like that, in the interproximal area, these are areas that patients can’t actually clean. It really is a no, no, it’s breaking the rules completely. So, the overall concept about that it’s a hygienic approach to design. And the other thing is, the other Bible I used when I was doing my specialist training was McCrackens here. And this is the latest edition or it certainly may be a new edition, but look at this partial denture on here. And this partial denture there.[Jaz]
And just describe it for our audio listeners, if you don’t mind just describing it. [Finlay]
That has a plate on it. So, there’s a plate design. And if you imagine a plate, if you’ve got a free-end saddle, bilateral free-end saddle on a lower denture, if there’s a plate covering the gingival margins, what’s going to happen underneath that plates whilst it is worn. Just think about the plaque retention, the accumulation, the inflammation that causes and the Scandinavians have got 50 years of research to show that if things are covered like that, on the gingival margins like a plate, it really increases periodontal problems and also caries too. So, the whole concept about the Scandinavian approach is to keep it open.
So, where the gingival margins of the teeth are, then we don’t want, I don’t want any component crossing the gingival margin, because any component sits there increases inflammation. So, I think the best way to try to visualize this is that if we’ve got any missing teeth there, we’ve got underneath that we’ve got the bass so we could call that the sublingual bar or the lingual bar or the palate, the plates at the top, the major connector at the top so that the basis and all the bits for the denture, come off that base. So, when we’ve got the base there, if we’ve got a missing teeth saddle, we just want the minor connector to come up into that saddle area, and then rest on the teeth either side of that saddle area. So, everything sweeps up into the saddles and onto the teeth. So with the Scandinavian concept, if the denture is made really well, we should be able to get TePe Interdental Brushes between all of the teeth with the denture in place with it in place. So-[Jaz]
I think that’s brilliant. I think that the data that I used to come across as a DCT and restorative, when I wrote the paper on resin bonded bridges many years ago, it was that partial dentures in the literature are likely to increase your caries or incidence by three times. And it’s been shown that there’s conflicting studies, but some studies show that you’re more likely to get periodontal disease, or caries. But I guess it depends a lot on how you design it. And one lecture I remember going to was an implant based lecture even though I don’t do implants, I just remember very clearly a really good point, the educator made Fin, he said that, you have to be very careful with a patient who is edentulous, because what they have gone through in their life to get to that stage is like a lot of disease processes, a lot of neglect to some degree to be able to end up in that position.
So, when you’re doing your implants, be mindful of that. And maybe that’s why we’re in a peri-implantitis happens. And if you apply that same concept to partial denture wearers, then maybe part of the reason why they lost the teeth is the reason they may lose the teeth again, so just make sense to make them as cleansable as possible. Do you also apply a Scandinavian approach to acrylic partial dentures? Or is this philosophy exclusive to chrome work?[Finlay]
So, it is exclusive to chrome work, and I 100% agree with what you said previously about patients that have got multiple missing teeth, you know, they’ve suffered disease processes, but the beauty about the Scandinavian approaches, and you touched on it perfectly, then because they are removable, resin bonded bridges. That’s what they are. And this is the other difference between Scandinavian and the way that was taught in Britain, the rest seats in the Scandinavian approach, a much bigger and wider, smoother. And we have backings and support on the anterior teeth too. So, they are just like a resin bonded bridge wing, like the retainer parts. And the beauty about these and it’s very important for these patients that are going to be potentially losing teeth in the future. Because, you know, we don’t have a crystal ball, how long everyone’s teeth are gonna last.
The prognosis is quite often dubious for these cases, I don’t like taking teeth out. And I know you love teeth as well, natural teeth are fantastic. Let’s keep them even if they are not great teeth, we can put a backing on them, we can add to it in the future. So, these things are totally future proof. Now, if we then move on to acrylic based dentures and my personal opinion about acrylic based dentures are they are temporary appliances, I totally get that. If we’re working in healthcare system like say the NHS, we may not be able to provide a metal based denture for a patient. So, I think it’s important to retain good prosthodontic principles. So, for instance, if we’ve got a free end saddle, and we’re going to be providing an acrylic base denture, then extend it fully, right up the retromolar pad, so you’ve got a good support on the lower. Same for the upper use the palate, it’s brilliant for support, and use the tuberosity for support too. That’s really important.
Essentially, though, acrylic dentures are temporary appliances, they are gum strippers, unfortunately, because it’s hard to get to support. This is the important concept for the Scandinavian approach to support is king. If we can rest the denture on the teeth, and it’s not sinking into the soft tissues, stripping the gums, then that’s brilliant. Now, and this is really important having a great technician, sometimes a very, very occasionally have made a long term acrylic denture for a patient. Now-[Jaz]
You mean like long term partial acrylic denture, right? [Finlay]
Long term partial acrylic, and this chap had missing two to two. He had retained three, four and then missing posterior teeth. So, this nice sort of symmetrical situation. So, we made an acrylic based denture. But Rowan fashioned, little metal rests outs of 0.9 millimeter wire, which you’d use for normally for making clasps with. But if you bash the end, you can flatten it. And then, we had little rest seats on both sides. So, one on the four, one on the three on both sides, which meant that acrylic based denture had a rest. So, it stopped it from sinking in as much obviously the main- [Jaz]
And in that scenario what made you then continue with that long term partial acrylic denture rather than either going for chrome in the outset? Was it periodontal reasons? Was it prognosis reasons? Or was it support reasons? [Finlay]
No, it was actually because of finance for this particular patient. So, it is less expensive to do this. But I don’t normally have my arm twisted with that type of thing. It’s normally the acrylic is a temporary and generally they are immediate dentures, which are used for one, I’ve taken out, hopeless teeth. And then we’ve placed them and then that immediate denture then becomes a definitive, which is a metal based Scandinavian concept. So, that’s it’s a really important thing. And the reason that I don’t do there’s two big reasons I don’t do acrylics as long term partials is that number one, they break and snap and crack. And patients come in for repairs, if a patient and when they come to see me that. So, I would say if I was doing an acrylic based denture, then it would maybe be four to 5000 pounds to do that. So, a patient will be cross if that breaks. So, they are very much a temporary appliance for the patient. And secondly, they’re just really good as a diagnostic tool as well. The great you know, if we’re taking out a load of teeth, I can put this immediate mark one in. I call them mark one dentures. Mark one goes in. [Jaz]
I love that. [Finlay]
That’s a diagnostic appliance, and then we can move on to mark two later on. So when patients come to see me, that’s how I planned them, they’re always mark one and mark Two, if we need to extract teeth. [Jaz]
Amazing. And when I come to your course next month, I’ve got a couple of cases on the go, who are wearing mark ones. And I’m going to design my mark twos the chromes when I come to see you and learn from you. And really interesting ones, an eight year old chap who I did an alveoloplasty because he had severe over eruption of his anteriors with too much bone, not enough space for the teeth aesthetically with the teeth. So, I did an alveoloplasty, bit of surgery, and now he’s wearing the mark one, he’s very happy with. But he needs a lot of general dentistry, crown work, restorative work. And so, I’m really looking forward to that fun case, and a few others, which I’ve had an honest conversation with him, I said, ‘Look, I’m gonna go to this guy called Fin, I’m gonna learn from him, give me a couple of months. When I come back from the course let me design you a denture.’ And they’ve been fine with it.
They’ve understood that what they have in this acrylic partial denture is a mark one. And I show them an example of a chrome and discuss the benefits and patients are on board with that. I digress a little bit, but I just want to ask you, because this is a thought that I’ve had is upper complete acrylic dentures, which I know you lots of education on and it’s a beautiful art and your videos on suction from them. Your upper and lower is just amazing. When would you consider an upper complete denture with a CHROME BASE? What are the indications because I’ve seen a few those I’ve done one in the past. I couldn’t tell you what the reason rationale was behind at the time, but I’d like to hear from you.[Finlay]
Okay, quite simply, the metal base strengthens the denture, it reduces the potential for it to fracture, and it reduces the potential for an unhappy patient. Because if the denture breaks, it’s quite easy to fix, but it’s quite difficult to repair the patient’s confidence in it. And, you know, so as a rule, this is how I go and I always break the rules because there are certain circumstances that we have to- But anyway, generally, as a rule, if I’m doing a complete denture opposing natural dentition, which is called the combination syndrome, I’ll use a metal reinforcing base in the denture. So, that’s number one.
Number two, I do it for implant supported dentures. So if I’ve got an implant supported lower, you know, with two lovely locators, really secure bottom denture biting onto a complete upper, again, metal reinforced to the upper. And also, obviously the lower two, you know, the Implant Supported Denture, if there are any implants in the maxilla, as well, and I’m doing full upper overdenture on implants, metal reinforce always because of particular. And then the other. I think the fourth reason is history of breakage. If a patient comes in and they’ve got an old denture that has got this wire in, because they fractured it previously, and maybe they’re very warm the teeth, bruxists tendencies, because bruxism still occurs in patients that have got no teeth. So, it’s really just to add that extra strength, just as a little caveat just at the end. Why don’t I do it for everybody?
Well, getting retention on an upper denture with a metal base is slightly more difficult because it is marginally heavier. It’s just only few grams, we’re talking like a metal reinforced upper complete dentures 25 grams, whereas the acrylic base is usually around about 19-20 grams-ish. So, that can just slightly offset retention, if we’ve got a very flat maxilla. And also, if we’ve got a patient who’s got high frenal attachments, that means when they smile and talk, that frenum exposes the edge of the denture and the seal, the peripheral seal breaks. So, it’s those two cases where I’d say to them, ‘Look, I’d prefer to do an acrylic based denture for you is more likely to break. Would you like a spare as well?’ So, I then offer a spare. So, then they can wear one on a Monday, different on a Tuesday and swap it and then wearing them together.[Jaz]
I think that was an emphatic answer for that question. That was absolutely brilliant. I really love that. So, when you have a metal base, how does that compare to an acrylic upper complete denture with a WIRE MESH inside? Is that just a waste of time? Or it does not have some benefit in terms of giving it rigidity? [Finlay]
The only benefit of a wire mesh is that if the denture snaps or cracks the acrylic, then the two edges are still held together. So, it’s not a catastrophic failure for the patient, they’ll still be very uncomfortable and not great. But let’s say they’re on holiday. And it happens they can probably limp along until they get it sorted. But they don’t offer anything other than that. And sometimes we, Rowan, I think they actually weaken it. And then the other aspects of a metal base in the opera is what’s really important is to have an acrylic post down. That’s crucial. So the denture has a better peripheral seal. And also we can realign the denture should it need it as well, which just makes it future proof, much better suction. [Jaz]
Lovely little gem there. The next question I have, as we get towards the end the questions is quite a big high level question. And I think to to make it tangible. This is aimed more at the young dentists who are starting to make their first few dentures or slightly more experienced dentists like me who just doesn’t get to make enough volume of chrome dentures, and it’s nice to revise. We can make like a little handout for this is what are the STAGES in general? Obviously, there are nuances and we have to deviate away from the rules, but a very standard patient for a partial denture, what are the titles or sequences of the appointments? And how many appointments would you typically take? [Finlay]
So, I think if we look at it, really, I’m looking at a list here, and on average, to fit a chrome, it’s seven visits for a metal base denture, talking about metal base dentures. So, let’s go visit one. So, we’ve got our consultation with a patient and we have a look in the mouth, we make a diagnosis, I’d take a photo. And from that I then do my first design because that goes into the patient’s letter. And that’s my first thing, I get my first design done, number one, the first active treatment is a visit two and that is primary impressions.
‘So, I do my primary impressions to record the whole thing. And from that, I then Rowan post those models, we cast them up and then we can have a look at it and we can finalize that design. So, I say to Rowan this is what I want to do. This is my aim and design. This is the model here. And then we put it on the surveyor and we have a look at it. And Rowan says to me, ‘Yes, we can do that.’ Or, ‘No, we need to make minor changes.’ He’ll say, ‘Look, sometimes it’s just not possible.’ I’ll say something that he can’t actually do, he might not have enough space to put a tooth in place. Anyway, it’s just a good discussion.
So we do the definitive design then, and they will tell me, ‘Right Fin, I want you to take a little bit off the teeth here for the guiding surfaces, or make some space for rest seats in these areas. Because just like with resin bonded bridges, they have to fit in an hour.’ So, sometimes we’ll have an undercut, you know, the lingual surfaces of the lower teeth go inside like that, I might just have to shave a little bit off to make your level[Jaz]
I just want to make a point there, Fin. Sorry to interrupt but that’s such a huge point. Because a path of insertion often dentists thing that path of insertion is applicable to removable dentures, we think of denture as part of insertion, path of removal, but resin bonded bridges and indirect work also needs a path of insertion. And it becomes extra important with rigid materials like chrome denture work to visualize that path of insertion, and it doesn’t often need much prep, it just needs a little bit. I like red flame diamond burs, soflex discs, just to get those planes, is that what you use as well? [Finlay]
Absolutely all the time. Just little tickles. I call it a dusting of the teeth, more than grind to shaving a touch off to fit. So, absolutely. So, visit one is design prelim exam. Visit two is primary impressions, definitive design. Visit three is then definitive impressions. So, my working impressions and I always say to the patient, this is the most important, this is the most important visit of the whole thing. Because I’m wanting this thing to fit and I need to record your mouth exactly as it is. So, I’ll do my adjustments. And I’ll then do my working impressions. And then visit four will be jaw registration. So, that’ll be you know, wax rims, or a gothic arch tracing. If I want to find CR, I’m either making the dentures in intercuspal position, or I’m making them in centric relation. So that’s my jaw. Number four- [Jaz]
At that stage, do you take a face bow record? Do you personally? [Finlay]
Yes, I do. [Jaz]
Do you take a face bow record? [Finlay]
Yeah, I do face bow as well. So now, just going back to intercuspal position. And this is really important. This is why there’s not a set rule of thumb in terms of visits, sometimes I can actually skip a stage, if I’m doing my working impressions, and the patient’s got a really stable intercuspal position. And those models can be mounted really easily, then I don’t need to do a jaw reg, at that. I don’t need an extra jaw reg visit. I can put a bite in. And just do that if need be or quite often they just fit together beautifully just by wrist articulating you know so and a – It was really good. It all everything fits together beautifully like that. So normally though, I will do a bite, a jaw registration at visit four isn’t it? I think we’re at now I’ve gotten the list, and then visit five- [Jaz]
I’ve lost track as well. [Finlay]
So, let’s do so primary says one, definitives in, two. Bite at three. Number four, will be try-in. Tooth try in at this point. [Jaz]
This is with the chrome and the wax attached together? [Finlay]
No. Definitely. And this is a common sort of misconception the chrome is made after the trial is done. [Jaz]
Got it. [Finlay]
And the reason being just like we wouldn’t put implants in randomly in the mouth without having knowing where we’re going to put the teeth to start off with. I want to engineer the chrome to be in a perfect position to where the teeth are going to be placed. So, the chrome try-in comes after just purely the chrome try-in comes after the tooth try-in. So it’s tooth try-in and then it’s chrome try-in and then it’s finish after that. [Jaz]
Now, with the chrome is tooth try-in to check the aesthetics and make sure the chrome will be in the right place. I guess there is a place for the chrome you might modify the design based on the tooth try-in but then when you go to the stage after the tooth try-in and just to clarify, the tooth try-in is wax and acrylic teeth. That’s it right? [Finlay]
Yes, it is. [Jaz]
And then the visit after it chrome, wax and teeth together? [Finlay]
No, no, it isn’t. It’s purely bare chrome try-in without teeth. [Jaz]
Got it. [Finlay]
And with these Scandinavian dentures, there’s lot of tooth to contact. So, you got multiple contacts. So, I don’t want to have wax teeth getting in the way of me just checking that this chrome framework, the metal bases fits in beautifully. [Jaz]
Your visualization is improved? [Finlay]
Yeah, it is. It’s visualizations improved, everything. So, so once I know the chrome fits, I’ve already done the to try in, I can just go late to finish. [Jaz]
Would you recommend for a less experienced colleague, a younger dentist to at that stage, if they’re following your principles, and they’re learning from this? And they want to apply, what they’re learning. The tooth try-in make sense, the chromework try-in a lot of dentists would do that earlier on in the chain, perhaps off the definitive straightaway. Would you recommend that the less experienced dentists or for a tricky patient maybe to do a chrome and tooth trying together? Everything’s in wax still? Or do you truly feel that has no benefit, and rather, is better to go to the fit if you’ve already done a separate tooth trying and a separate chrome trying? [Finlay]
Yeah, so the only circumstance that I would do, add in an extra stage of doing the chrome and teeth would be if Rowan one is setting the teeth up and arranging them feels that there may be a little change in the tooth positions from the first try in to the finished denture. If he feels that, there may be some very important retentive elements on front teeth along a bit of front, is the aesthetic zone stuff, if there may be some changes that he has to make, or we have to thin the teeth down so much, that the color may change as well. Because when we, you know, when the ground out of the back, the chord changes. It’s really, if there’s going to be an aesthetic change. That’s when we do metal try with teeth on trying. So- [Jaz]
Got it. Got it. [Finlay]
Yeah, that’s just purely. So, essentially, if we go back, we just need to recap this, this is quite an important concept. So, normally, and I’m just doing it on my computer here, because I’ve got it here. So, we’ve got number one, primary impressions, number two working impressions. Number three is the jaw registration to prescription. Number four is tooth try-in. Number five is metal base try-in, bare metal base try-in. And then number six is fit. And then it’s reviewed after that. That’s the my general rule of thumb approach. [Jaz]
I take, since all everything I picked up from you, from Episode 56, about trying in dentures and using occlude spray, you taught us so much. And I took a lot away from that. And even just from that, the last four chrome’s I fitted, the patients come back at review. And there’s no ulcer. There’s no adjustments, the occlusion’s spot on, everything’s been really good. So, either it’s got lucky, or I really implemented everything you told me from that short podcast episode. And I’ve gained a lot from that. So tell me, what do you usually see? Because you take so much care and time to get these right in various stages. And for those who need it a gothic arch tracing, if you’re repositioning the the bite, do you often have to do much adjustments at the reviews? And how many appointments are included? When you when you quote a patient for a fee, in terms of quoting correctly, how many review points do you build into that fee? [Finlay]
So, I’ve built in two, because on average, and I’ve reviewed my cases since introducing the Scandinavian concept. And on average, I’ve 1.7 reviews for patients with metal based dentures. So quite often, it’s just like one review, and then we’re off we go. So, it really worked beautifully. And interestingly, the way that I was taught the British standard approach, the reason that I changed to the Scandinavian approach was that I wasn’t getting good consistent results. And it wasn’t predictable, and not on average, in my specialist practice. And I was a specialist at this stage. I was reviewing my patients four times, I had to see them four times with the sort of RPI system and that sort of system that I used to learn approach so it’s much better. So, I just find it remarkable that virtually it’s between one and two review visits. It’s amazing like- [Jaz]
Well, I think I definitely need to buy my technician a bottle of wine because I think kudos to my tech because he’s been doing a great job and he’s helped me a lot with my design, Fin. I’m hoping to change that so I can I can lead the design held by. [Finlay]
You know what, it makes me really happy that you have that success from this. It’s really wonderful that you know, your patients are benefiting from this. It’s lovely. So, great. [Jaz]
Oh, it’s great. I have so much more and more confidence in delivering partial dentures and it’s a really important thing to cover. I’m starting to get a reputation now, Fin to help drive the areas of dentistry which are not perceived as sexy, so treating TMD in general practice, occlusal appliances, or recently hosted an acupuncture course in Reading with David Johnson who came by did a wonderful thing. Now with occlusion, we were doing a lot work with occlusion, so things that aren’t considered sexy. And now obviously, one of the reasons I bring you on is because some people, a lot of dentists, they’ll go on the composite course, they’re gone the Botox at facial aesthetics, but partial denture education, I feel it’s something that’s so necessary of dental school. And I think guys like you, and my good friend, Rupert are really and Mark Bishop, you guys are making removable prosth, sexy.
So, I have so much respect for all of you, and keep doing what you’re doing. But I think young dentists need to appreciate that we need to charge appropriately for these amazing devices that are just a miracle. We look at it as a work of art, it surely is art. How much if you don’t mind disclosing do your cases typically cost into it for patients in terms of your fee for an average, but like you describe the average sequence. And I think this will help people realize that we’re under charging, just like I teach we under charge for clothes appliances, grossly. I think we undercharged for partial dentures, but you probably have a stronger opinion on that than me.[Finlay]
Absolutely. So, I think that my average fee for a metal base denture for one single is it’s about 10,000 pounds. And I think that it’s really, first of all, they are worth it. And you’ve touched on this beautifully, just then when you were talking about they are works of art. Now, I strongly believe and I’d love to stand up and with these implants, people that just really are extremely dismissive of partial dentures. And I’d like to have a battle with them. And say that I’m actually right. Okay, which looks better, you know, a really good partial denture, what is aesthetically superior, when someone’s got a high smile line, and missing teeth.
So, the best way to replace the missing tissues is with a partial denture, if we have a really, really skilled technician, and there’s a great clinician, they’re working together as a team, I think we can beat hands down, fixed prosthodontics, you know, with with this, I think the detracting factor of a partial is we’ve got other clasps, and, you know, those clasps have to be hidden some way, you know, we use gold and we put them back as far as possible. That’s the main detracting factor. And, and also, the thing is removable, so the patients do have, you know, within the dental profession, we have negative connotations about dentures, and also within the general, too, so, but, you know, like, we’re both both of us are pushing these non sexy areas of dentistry because I think they are sexy. I do, I think, you know, we, I restore patients lives, I totally changed their life with these lumps of plastic and metal. And I probably changed them better with these sorts of things than with, you know, with fixed restoration, where it’s extremely hard to engineer gum work to look like natural gums, the white is not too bad to deal with, you know, the teeth themselves, but the gum work is. And I do believe that we should charge for these sorts of things, too.
And I think, the ultimate testbed, and I used to work in the hospital system, I was a consultant at Manchester dental hospital, and I was, will be treating patients with cleft lip and palate and with missing, you know, big defects and that type of thing. And also normal patients who would be referred in as in patients without these problems, but were difficult denture cases, I’d get to the end of the road with them. And some of them may be weren’t totally happy with the outcome. But I could say to them, ‘Look, we’ve tried everything here.’ And the patient would buy that because they’re not paying directly for the, you know, actually say, okay, consultant, you know, professional, I know you tried your best, and they’d accept that. Now, it totally changed when I went into practice and worked as a high street specialist making referrals that patients would come in, and then I’d be charging, you know, between five and 10,000 pounds for a denture. If the denture wasn’t totally right, and the patient wasn’t totally happy with it. I couldn’t say to them, ‘Oh, we’ve tried everything. I’m really sorry now’, and then off they go. And they’re a happy camper. Not at all.
So, this is why I had to change from what I was previously taught to something more predictable. And this is where meeting John, he’s a very old dentist now, you know, he’s in his 80s. But he’s probably one of the best British removal prosthodontist ever, who learns off Charlotte Stilwell, who’s the Danish prosthodontist that brought it to Britain. She brought this concept here. She’s a specialist, Charlotte works in London. And I went on a course. And it completely changed the way I did things, you know, so, and that’s why I learned Scandinavian concept. So, my reviews went from four, and not very happy patient to two, and happy patients.[Jaz]
And it was amazing. And also like yourself Jaz, you’ll be understanding that you sort of engineer of practice to the type of work you want to do and the type of patients that you want to treat. And that happens over time, as well. So, there’s something really important as well about this is I only do two clinical days or week treating patients now, I’m 51. I do another day, which will be is today actually, I’m actually doing online, Zoom consults with new patients and phone calls, just to filter them out and make sure they’re okay for coming in.
Now, I find that two clinical days is enough for me, because my patients are referred to me so they’re quite difficult, there may be technically challenging and most attentive, potentially challenging. But also, they do have personality issues, potential personality disorders, were the densest, that’s referred to men, it’s just found them hard to manage. So, they’re quite tricky to cope with. So now, I personally can only really handle two days of working with these types of patients. So each day, I’ll be seeing maybe six patients a day, four of them will be lovely, absolutely great. But two will be really hard to manage, and will really test my metal and my patients.
So, I find that two days is absolutely enough to keep my sorts of mental health good. Now, in order to do that, though, I have to charge a lot of money to sustain, it’s like two days of intense work to keep me in a living. So therefore, my hourly rate is currently 750 pounds per hour of clinical work in order to you know, fund that, that process. So, hopefully that just explains my situation Jaz.[Jaz]
It does wonderfully. And I think we should appreciate the how much care intention experience that you have behind you also having a specialist status. But the reason for asking you that question, and Fin, thanks for answering this, honestly, and giving it all away. I really appreciate that. Because I think dentists need some inspiration that actually everything we do, when we put so much thought and care into it, and to adopt a mindset whereby A) you’re worth it, and B) not to undersell yourself, because these patients are tough. And sometimes the difference you can make, even from a single resin bonded bridge, but I speak to dentists all time, who are just way under charging for a single unit resin bonded bridge. I’m like, forget that it’s a resin bonded bridge, it’s not an implant, you are giving that patient a tooth, you’re restoring the patient’s smile. [Finlay]
And then once they think of it like that, but patients also kind of compare it to an implant and they shouldn’t be that much different today, you know, they shouldn’t be like one is like 300 pounds, or 3000? No, no, it should be a charge much more probably. Now, when you apply that to denture work. I mean, it’s very obvious that you’re restoring someone’s function and aesthetics in a huge way. And you just have to subscribe to Fin’s newsletter to see the amazing work. So, I’ll put a link at the bottom for that. But anyone who would like to join the waiting list for the course in Reading on the 13th and 14th of January, please email me DM me, we’ll get you on that.
So, we’re looking forward to learning from you Fin. And actually one of the reasons I asked you to selfishly. Well, the reason I asked you to come on both Friday and Saturday, and I was really keen to fill those spots is that we can have you to ourselves on Friday night, we go out for a nice dinner with everyone a Christmas themed dinner. No, not Christmas theme, it’s next month. We’ll think of a new visions New Beginnings kind of dinner. And I think everyone’s really looking forward to. Just getting to know the man behind the dentures. So, Fin thanks so much for discussing Scandinavian Dentures. The philosophy, just makes so much sense. And telling us all every little detail, you’re so giving with your information that other episode we did 56. I learned so much from that personally. And then I love the style of education that you developed. So, thanks for making dentures sexy again, once again, and appreciate your time always.[Finlay]
Thank you. It’s a pleasure. Absolutely.
Well, there we have it guys, Finlay Sutton. Thank you so much as always for listening all the way to the end. If you’re listening or watching on the app, you can not only download the full transcript, you can also download the notes. The notes include a sequence by sequence cheat sheet and on the protrusive vault. You can also download the PDF of the Pearl he described which got every single design. So that’s all on the app for you if you want it. Alternatively, you can get the cheat sheet but not the notes on protrusive.co.uk/denture-design. And if you wanted to come and join us for Finlay Sutton live course in Reading UK on the 13th of January or the 14th of January. So, if you just drop me a DM @protrusivedental or email me firstname.lastname@example.org, and let me know, we’ll put you on the waiting list. Thank you, Protruserati and I’ll catch you same time, same place next week.