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Second Opinion: Everyone Wants to be a Cosmetic Dentist but No One Wants to do Dentures Charles S. Barotz, DDS

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Everyone Wants to be a Cosmetic Dentist
but No One Wants to do Dentures


Second opinions are common in health care; whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dentists to share their opinions on various topics, providing you with a "Second Opinion." Perhaps some of these dentists' observations will change your mind; while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession.

— Thomas Giacobbi, DDS, FAGD
Dentaltown Editorial Director
















 by Charles S. Barotz, DDS

Full dentures are one of, if not the most, maligned procedures by the dentists of the world. Many dentists do not choose to do them. Of those who do dentures, few do them well. Yet all you need to do is to look at the Yellow Pages to see that most dentists claim to be experts in cosmetic dentistry. This is a contradiction. I allege that you cannot purport to be an excellent cosmetic dentist without having the ability to do dentures excellently. Everything that all of the cosmetic gurus of the day teach about smile design came from the granddaddy of all cosmetic procedures – dentures. Long before bonding and porcelain crowns, patients desiring cosmetic enhancement would use dentures to accomplish the task.

There are two basic reasons why dentists choose not to do dentures. First, is the dentist who knows how to make a fine set of dentures, and indeed takes the time and pride to do so, but charges little more than the fee for two crowns to make a set. This dentist has probably taken a comparable amount of time as it would take to prep, impress and bond eight veneers, yet has been compensated only one fourth what he or she would make if they did the veneers or crowns. For this dentist, making dentures becomes impractical. There is no fiscal motivation to continue to do so. Therefore, the dentist stops doing them.

The second scenario involves either the dentist without the knowledge to make a fine set of dentures or the dentist who chooses not to take the time to do them right. Both individuals look for shortcuts and end up with a result that is troubling to the patient and unsatisfying to the doctor. After doing enough cases like this, these dentists brand denture patients as “basketcases” or “loonies” and choose not to continue to offer the service as well.

My experience with denture patients is that they are the most adaptable and appreciative patients that I have had the pleasure to help. While making a fine set of dentures can be challenging, the cosmetic improvement that you can make for the patient is far greater than what you can do with crown and bridge or bonding. With crown and bridge your improvement is restrained by tooth position. This is not true with dentures. Cosmetic improvements for gummy smiles and overclosure, achievable with dentures, can and do improve the overall look of the lower third of the face. In addition to a wider range of cosmetic improvements, a well made set of dentures can do much to improve the patient’s ability to function, whereas eight units of bonded veneers or crowns does nothing in this regard.

So what is the solution? Dentists should treat dentures as a cosmetic procedure and charge accordingly. If it takes the same time to fabricate a fine set of upper and lower dentures as it does to accomplish an eight-unit smile makeover, the charge should be identical. That means if you are charging $1,000 dollars per unit of crown and bridge, you should be charging $8,000 dollars for a set of dentures. You are correct that insurance companies will not cover this fee, but they also won’t cover the fee for other cosmetic procedures. You have to change your paradigm about what you are doing for the patient. Are you making cheap replacements for missing teeth or are you doing a cosmetic makeover that restores some semblance of function? It would be correct and proper to encourage a patent to have at least two standard implants or four mini implants placed in the lower jaw. The fee for those should however be extra.

Once you have changed the way you think about dentures the next step is to be able to deliver what you promise. If you cannot fabricate a set of dentures worthy of the increased fee you would be ripping the patient off. It can plainly be stated that there is no way to ensure excellent cosmetics and fit in a two-step denture appointment. That should be reserved strictly for immediate dentures, which should always be replaced if exquisite cosmetics and function are the goal of treatment. Immediate dentures are almost always imperfect in some way. I use them as diagnostic aids for the final “Drop Dead Gorgeous” dentures I provide. Setting of the maxillary teeth with the patient present ensures that this is accomplished. In addition to giving the patient a preview to approve or disapprove of; there is the added benefit of them being there to give input as you custom craft their smile. They take ownership of the results and the importance and benefit of this cannot be overstated. Furthermore, your laboratory will love you for this; since what you have effectively done is to eliminate the need for “resets” due to cosmetics.

The subject up until this point has been focused on the fabrication of dentures to accomplish a cosmetic makeover. Not every denture patient requires the time and effort required to accomplish this. If a patient is looking to replace a set of dentures that have worn out, but they are relatively happy with the cosmetics and fit of the denture, a new technique by Altadonics will allow replacing these dentures in minimal time with minimal effort. Obviously the fee for this procedure is significantly less than fabrication of a custom set from scratch. This procedure involves doing a reline impression and archiving the denture with an impression flask provided by the company. They will then set the teeth in the same position as the old denture and return a newly fabricated denture base with the teeth in wax for a try in. In most cases no adjustments to the cosmetics are necessary because the appearance of their “old friends” has been reproduced. The denture bases are the actual denture bases that the teeth will be processed to. This is a very easy and predictable way to get to an end point when you are not starting from scratch. I ask patients at the beginning of treatment how comfortable they are with the fit and cosmetics of their old denture on a scale from one to 10. If they answer eight or above for both fit and cosmetics I use this technique and only charge about 40 percent of what I charge for the custom set.
Author's Bio
Dr. Charles S. Barotz is a 1980 graduate of Georgetown University School of Dentistry and has dedicated his life to provide you with the best that dentistry has to offer. Dr. Barotz is continually educating himself and his staff with the newest dental techniques and approaches, in order to provide you with advanced, state of the art, comfortable, personalized, and antiseptic dental care. Dr. Barotz has been published and lectures internationally on numerous subjects relating to excellence in dentistry. There comes a time when a doctor must decide, “How good is good enough?” I personally prefer to have implants placed in the very best locations possible. The smile design accomplished with the custom denture facilitates this.
Denture patients are not the psychotics that many dentists make them out to be. Many of these patients do have social issues due to the embarrassment of being seen with horrendous teeth in public or because of their inability to eat in public. My most dramatic cosmetic transformations are with denture patients who are the most grateful patients I see and are the most gratifying cases I do. Even when I am doing full mouth fixed implant restoration, the biggest cosmetic change occurs with the fitting of the initial custom denture. This denture (a duplicate) is also the template that I use when taking CT scans. I cannot imagine having implants placed in precisely the correct place for a fixed ceramometal restoration without a finely made denture to begin with.

Doing dentures properly requires time and attention to detail for which you should be well compensated. To shun the procedure is to be an incomplete practitioner. Even prosthodontists doing a technically excellent job will fall short on an exquisite final outcome if they do not set the teeth in the cosmetic zone, as I suggest. So, take the time to do them right and charge an appropriate fee. Change the way you think about the procedure by focusing on the changes you can make in someone’s life as opposed to the procedure itself. You might surprise yourself and find that you enjoy it!
Dentaltown Magazine
September 2025
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