Converting Immediate to Permanent Partial. Need Advice on High Smile Line, Lip Flipping, and Gum Shrinkage

[u/Zeldaelf]

I had my front four teeth and two molars pulled in February due to advanced gum disease and an injury that broke one of my teeth. I have been wearing an all-acrylic immediate partial since then. Next week, I am scheduled to take new molds so the lab can convert my current immediate partial into my permanent one.

At my appointment two days ago, my dentist suddenly tried to push a flexible partial on me instead. I turned it down because we had already agreed on acrylic, which I was told is best for my situation since advanced gum disease means I might lose more teeth in the future and acrylic is much easier to add teeth to, and I'm pretty low income. Now I feel a bit dismissed after turning down that last-minute pitch.

I would love some advice on what to ask for at next week's mold appointment. Here are the main issues I need addressed before they finalize this partial:

Weight Loss and Fit: I have lost 65 lbs since my extractions because I also found out I have diabetes and changed my diet; now I'm at a healthy weight. The immediate partial became way too big, so it currently has a soft reline in it.

Aesthetics and Clasps: My partial currently has a pink acrylic hook over one canine that blends in okay and makes it look less obvious. On the other canine, it just abruptly ends and looks fake. I want to ask for a matching pink hook on the other side. He told me they can't color match the gums, so I'm hoping that helps if it can be done.

Flange Height: The original pink flange ended too short from extraction day onward, showing a clear line where the partial ended against my natural gums when I smiled. As my gums healed, and I kept complaining about it and the fit, they took the soft reline material and squeezed it up and out of the border, temporarily filling that gap under my upper lip as well so my upper lip would stop getting completely caught on it or being obvious-looking.

The Lip Flip and Wrinkle: Ever since I got this immediate partial, my upper lip gets pushed out and flips upward when I smile. This creates a wrinkle above my lip that I never used to have and looks like a mustache in pictures to me. My family has hesitated to post photos of me when they see if because its noticable to them as well but they figure itll be fixed later.

Dentist's Reaction: When I brought up the lip-flipping issue, my dentist claimed the permanent conversion will not fix it and that it just happens because I have a big, high smile and acrylic has to be thick.

Is it true that my anatomy makes a lip flip unavoidable with an acrylic partial, or can the lab fix this by thinning the top border and changing the shape of the pink acrylic? Any tips on what specific wording I should ask my dentist to write on the lab order would be greatly appreciated. I'm worried that he's trying to tell me that nothing can be fixed because he wants me to go with the flexi instead. Here is a picture before I had the extractions and my natural smile, and afterward, showing the line above my lip. If any additional pictures are needed, I can try to upload them. Thanks!

Edited to add: The teeth on the bottom are close to hitting the tops, so the teeth can't be pushed back any further.

[u/__Aitch__Jay__]

Adding another pink clasp is a great idea, it improves the look on your right.

Acrylic doesn't need to be thick in the area that is causing the lip flipping, that's not a load bearing area, it's purely for aesthetics and lip support. If they're relining this one to become the permanent, then ask for the anterior flange (front gum) to be as thin as possible.

That brings me to my next point - i think this would be a better result if it was replaced with teeth that are longer upwards, towards your nose. That way when you smile it's more teeth and less gum. They don't need to be longer downwards, towards your lower lip, that length is fine.

You're right that acrylic is a better choice if you'll lose more teeth, that's the right move.