The question of whether an oral surgeon makes or fits dentures is a common point of confusion, stemming from the multidisciplinary nature of modern dental care. An Oral and Maxillofacial Surgeon (OMS) is a surgical specialist, holding advanced qualifications in the diagnosis and surgical treatment of diseases, injuries, and defects involving the functional and aesthetic aspects of the hard and soft tissues of the head, mouth, and jaws. They are strictly surgeons and do not handle the non-surgical steps of creating or adjusting a prosthetic device. While the OMS does not fabricate or fit the final denture, their surgical expertise is often absolutely necessary to prepare the mouth and jaw structure, laying the biological foundation for a successful, comfortable prosthetic fit.
Defining the Oral Surgeon’s Role in Denture Preparation
The primary involvement of an Oral and Maxillofacial Surgeon in denture treatment is through pre-prosthetic surgery, a series of procedures designed to optimize the mouth’s tissues and bone structure. Dentures rely on a smooth, stable ridge of bone, known as the alveolar ridge, for support and retention. If this ridge is irregular, sharp, or uneven due to previous tooth extractions or natural changes over time, the denture will fit poorly and cause chronic irritation.
One common procedure performed by the OMS is alveoloplasty, which involves surgically smoothing and recontouring the alveolar bone after teeth have been removed. This creates a uniformly shaped, non-irritating surface for the denture to rest upon, improving both comfort and stability. Similarly, the surgeon may remove bony growths called tori, which are harmless but can interfere with the denture’s fit, especially on the palate or the lower jaw.
The OMS also manages soft tissue conditions that can compromise a denture’s seal. A vestibuloplasty, for instance, is a procedure that deepens the sulcus, or the space between the cheek or lip and the gum tissue, allowing the denture flange to extend further for better suction and retention. Tissues like the frenum, small folds of tissue connecting the lips or tongue to the gum, may also be surgically repositioned in a procedure called a frenectomy if they are attached too high and would otherwise displace the denture. The overall goal of these surgical interventions is to create a structurally sound, non-irritating environment where the prosthetic can be securely seated and function optimally.
Who Fabricates and Fits the Dentures
The actual fabrication and fitting of dentures fall under the expertise of restorative dental professionals, specifically the General Dentist or the Prosthodontist. These specialists are responsible for the non-surgical phases of treatment, which begin after the OMS has completed any necessary surgical preparation and the tissues have healed. They manage the technical design and placement of the final appliance.
A General Dentist often handles straightforward denture cases, taking the necessary impressions of the patient’s mouth and working with a dental laboratory to design the prosthetic. They are responsible for the try-in appointments, making adjustments, and ensuring the final fit, bite alignment, and aesthetics are correct. They also manage the long-term maintenance of the denture.
For complex cases, such as those involving significant bone loss, intricate bite relationships, or a need for partial dentures that integrate with natural teeth, a Prosthodontist is typically involved. A Prosthodontist is a specialized dentist who has completed three additional years of post-doctoral training focused exclusively on the restoration and replacement of missing teeth and jaw structures. They possess a deep understanding of biomaterials, jaw mechanics, and prosthetic design, allowing them to meticulously plan, design, and manage the laboratory creation of challenging denture cases, focusing on maximum function and aesthetic outcome.
Surgical Foundations: Dental Implants and Dentures
In cases where a patient seeks a higher level of retention and stability than a traditional denture can offer, the Oral and Maxillofacial Surgeon’s advanced surgical skill becomes paramount for an implant-supported denture. This type of restoration, often referred to as an overdenture, is anchored to titanium dental implants surgically placed into the jawbone. The OMS is the most highly trained specialist for this procedure, utilizing their expertise in hard and soft tissue surgery.
The surgical placement involves embedding titanium posts into the jawbone, a process that requires precise planning using three-dimensional imaging to avoid sensitive anatomical structures like nerves and the sinuses. These titanium posts must undergo a natural biological process called osseointegration, where the living bone fuses directly with the implant surface, creating a fixed anchor. This fusion process not only secures the denture but also stimulates the jawbone, which helps prevent the bone deterioration that typically occurs after tooth loss.
If the patient has experienced significant bone atrophy, the OMS may first need to perform bone grafting to augment the jawbone volume. Procedures like a sinus lift in the upper jaw or ridge augmentation are complex surgical interventions that build up the necessary bone height and width to support the implants safely. Only after the successful integration of the implants and the healing of any grafting procedures can the restorative dentist or prosthodontist proceed with attaching the denture to the implant fixtures.
The Collaborative Process of Denture Treatment
Successful denture treatment, particularly when complex surgical needs are involved, relies on a highly coordinated, multidisciplinary effort among the dental team. The patient journey typically begins with the restorative specialist, the General Dentist or Prosthodontist, who assesses the overall need for a denture and identifies any underlying surgical requirements. If pre-prosthetic surgery or implant placement is indicated, the patient is referred to the Oral and Maxillofacial Surgeon.
This collaboration necessitates a shared treatment plan, where the restorative design and the surgical requirements are considered simultaneously. The OMS receives detailed information from the restorative doctor regarding the desired final position of the teeth and the denture contours. This guidance ensures that the surgical preparation, such as the placement angle of dental implants or the extent of bone smoothing, will perfectly accommodate the prosthetic designed by the restorative specialist.
Once the OMS completes the surgical phase, a period of healing follows, which can last from a few weeks for minor soft tissue work to several months for bone grafting and implant osseointegration. The patient is then handed back to the restorative specialist, who takes the final impressions of the now-prepared mouth. This seamless, sequential hand-off between the surgical expert and the restorative expert ensures the final denture is both stable in the mouth and fully functional for the patient.