Should permanent dentures (all on four) be placed with the anterior teeth 2 to 3 mm from the gum line or should they follow the gum line? Is this a common procedure or the dentist’s choice? I have bulky lips as a result.
Thank you.
Luis from Florida
(see Dr. Hall’s response below)
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Dear Luis,
This is the gumline
I think we have a terminology problem. The word gumline refers to the edge of the gum where it meets the tooth. When the teeth are extracted, there is no more gumline. If the teeth are replaced with a complete denture, then the gumline would refer to the edge of the pink acrylic on the denture where it meets the false tooth. So where the teeth are placed defines the gumline, making it impossible to place the teeth anyplace else than right at the gumline.
I think what you are talking about is the placement of the teeth in relation to the ridge of the jawbone under the denture, so let me address that.
When you get a complete removable denture, the front lower teeth should be placed directly over the bony ridge. This is important for the lowers particularly because if they are too far forward, the denture will tip up in the back whenever you bite anything with your front teeth.
In your case, however, you are talking about an All-on-4 denture, which is implant-retained. An implant-retained denture isn’t going to tip when you bite. And then you are saying the teeth are only 2-3 millimeters from the ridge, which isn’t much. That is close enough to be within range even for a removable denture. So their placement sounds fine from the point of view of being able to chew. However, there are other considerations in the placement of the teeth, such as the appearance of your lips. What should be done, with quality dentures, is there should be a wax try-in of the denture before it is made in acrylic. When I made a set of dentures, I would always have the teeth set up in pink wax on a plastic plate made to fit the patient’s mouth. With this wax try-in, I would evaluate the appearance of the teeth, the patient’s speech, fullness of the lips, vertical dimension, and bite to make sure everything was correct before the denture was processed.
If your denture is already made, there may still be an easy remedy. If your implant-retained denture is made so that it is attached to the implants with screws, it can be removed and teeth re-set. It isn’t that difficult a procedure to have the front teeth drilled out and re-processed into the denture in a new position. Some dentists might even do this for free, but I suspect that many would charge some for this revision after the denture is made. But it shouldn’t be expensive.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.