Cover Page

Contents

Title Page

To our families
And to the memory of Bob Tomlin

Foreword to the First Edition

This addition to prosthetic literature must be widely and warmly welcomed. For a number of years there has been a shortage of British texts for students concerning the edentulous patient. The authors have, correctly, stressed the serious problems that more and more frequently present themselves now that life expectancy is on the increase and the average age of the edentulous is advancing. The dental profession is becoming aware of the particular geriatric situations it now has to face and this book will undoubtedly help in solving many prosthetic geriatric problems.

Emphasis has been placed more upon general principles than upon the minutiae of clinical or technical operative detail. Given a sound basic understanding of the principles to be observed in the treatment of the edentulous, chairside experience rapidly perfects each individual’s manipulative skills.

Being not unfamiliar with the labours involved in producing textbooks, one is conscious of the time and effort that have gone into the preparation of this book. It should achieve all the success that these efforts of one’s former colleagues deserve.

John Osborne
Shalfleet, Isle of Wight, 1975

Foreword to the Fifth Edition

The breakthrough of implant-supported and/or -retained prostheses has revolutionised dental treatment. A great part of the programmes at current prosthodontic conferences includes presentations based on high-tech implant treatment for partially and totally edentulous patients. So successful have the clinical outcomes with implant treatment been that many clinicians have come to believe that implants can solve all problems related to tooth loss. This is of course not true, confounded as it is not only by unfavourable oral situations but also by a number of non-dental factors. Of these, the greatest obstacle is undoubtedly economic. Viewed in a global perspective, poverty is still extremely widespread, and it exists even in many industrialised countries. Sadly, a majority of edentulous people will never be candidates for any type of implant therapy and complete dentures will remain their sole option.

The declining prevalence of edentulism would seem to indicate a reduction in the number of people in need of complete dentures. However, when epidemiological and demographic data are combined, the ongoing large increase in the number of the elderly will counteract the diminishing rate of edentulism. It is therefore likely that the need to rehabilitate edentulous patients will remain considerable for many more decades. Complete dentures will continue to play a central role in the rehabilitation of edentulism; thus, teaching and training in complete denture prosthodontics must continue.

This successful textbook has reached its fifth edition. It combines a straightforward description of well-proven principles and methods for the treatment of an edentulous patient with modern evidence-based examples of solutions for problems and complicated situations. The text is easy to read and the illustrations give excellent explanations of principles and techniques described. The book will therefore be of great value in both undergraduate and postgraduate education, and it deserves a place in the office of any dentist who treats adult and older patients.

Gunnar E. Carlsson
Gothenburg, Sweden, November 2010

Preface

Two of us have had the particular pleasure of welcoming Mark Thomason to the authors’ team. His presence has ensured not only that the text has been brought up to date in a number of important areas, but also that writing a new edition has continued to be a pleasurable and stimulating experience.

Thirty-four years ago, we commented in the preface to the first edition that it was important to adopt a flexible approach to the formulation of treatment plans and to the application of clinical techniques. This opinion was based on the fact that as there is a great deal of variation in the condition of our patients and their mouths a ‘one size fits all’ approach is not appropriate. We see no reason to change this view. Indeed, the recently published work of Professor Gunnar Carlsson (Carlsson 2009) strengthens our opinion. He has drawn the profession’s attention to the lack of randomised controlled trials in many aspects of complete denture provision and has highlighted the fact that there is often a poor correlation between a clinician’s assessment of denture quality and the level of patient satisfaction with a prosthesis. There is surely considerable scope for further research to help to improve the reliability of clinical decision making in this area. In the meantime, we hope that the clinical approaches adopted in this book will play a part in clarifying that choice.

During the last 8 years, there has been an explosion in the number of published papers dealing with implant-supported complete dentures. This development is highly relevant to the all-important stage when decisions have to be made on how to manage the transition from what remains of the natural dentition to the totally artificial one. We have expanded the chapters dealing with this critical period.

Another major change in the UK since the publication of the fourth edition has been the formal registration of two further members of the dental team – the clinical dental technician and the dental technician. The clinical dental technician is a qualified dental technician who is able to provide complete dentures directly to patients. Patients with natural teeth or implants must see a dentist before the clinical dental technician can begin treatment. The dental technician makes dentures to a prescription from a dentist or clinical dental technician. The educational programmes for both newly registered members of the dental team are formally recognised.

We are strongly of the view that there must be good communication between dentist, clinical dental technician and dental technician–the right hand must know what the left is doing or is planning to do. Published work suggests that the level of communication between surgery and laboratory still leaves something to be desired (Juszczyk et al. 2009). At the end of chapters dealing with the clinical stages of denture construction, we have again included short sections on ‘communication with the dental technician’ and ‘quality control and enhancement’. We hope that they will encourage the development of clearer communication.

Throughout the book, the description ‘clinician’ refers to dentist and clinical dental technician.

We have taken the opportunity of thoroughly revising the text and, with the encouragement of our publishers, of introducing colour into the book.

Although there has been a major reduction in total tooth loss in many countries, the edentulous population is living longer. Thus, the demand for prosthetic care will remain at a significant level for the foreseeable future, and the challenges this presents to the clinician will increase in difficulty as the patients become older.

Leeds, Birmingham and
Newcastle upon Tyne, 2010
RMB, JCD and JMT

References

Carlsson, G.E. (2009) Critical review of some dogmas in prosthodontics. Journal of Prosthodontic Research, 53, 3–10.

Juszczyk, A.S., Clark, R.K. & Radford, D.R. (2009) UK dental laboratory technicians’ views on the efficacy and teaching of clinical-laboratory communication. British Dental Journal, 206, E21.

Acknowledgments

We are most grateful to the many friends and colleagues whose support over the years has encouraged and influenced our thinking on the care of the edentulous patient. We are also indebted to our students and young colleagues in training who have challenged our ideas, shaped our thinking and shared our learning.

Our grateful thanks are extended to Professor John McCabe, Professor Jim Ralph, Dr Chris Watson, Mr Francis Nohl and Mr Stewart Barclay for the generous loan of photographs, to Dr Rachel David and Mr Simon Littlewood for their most helpful comments on those sections of the book dealing with speech and orthodontics respectively, and to Professor Damien Walmsley for helpful discussion.

We would like to acknowledge the friendly expertise of the staff of the British Dental Association’s Information Centre in helping with the literature searches.

We are most grateful to the members of the Medical and Dental Illustration Unit of the University of Leeds and the Photographic Department of the Dental School at the University of Birmingham for their skill over the years.

We are most grateful to Lucy Nash and Nick Morgan at Wiley-Blackwell and Amit Malik at Aptara for their support, understanding and encouragement throughout the production of this book.

We acknowledge with thanks the permission of the Editor of the British Dental Journal to reproduce figures which have appeared in that journal.