Removable Partial Dentures P4

Feb
2014
26

posted by on Uncategorized

No comments

Now, many times, depending on where this has extruded to, it’s way above where the reasonable plane of occlusion ought to be so I’m smoking that puppy down just like you would if you were going to adjust the wax rim on a denture. So, the denture stuff really does come back to help you even when you’ve got teeth there. Look at your landmarks.

So, the reason one might consider making a partial like this is this side of the mouth is extruded. The mouth, perhaps, was endodontically treated.  So, we cut this puppy right down even below the height of the gums at the distal marginal ridge.  We smoke that, too, and then I put a bevel around this whole.  Then, all I have to do is hog out the whole pulp chamber so when I get this coping back, this post and coping, it looks like a mushroom with this mushroom stem coming down the center of it. It sort of goes down to where the pulp chamber was.  People following me okay?

The occlusal is just a flat occlusal that doesn’t try to go much higher than the gums. It just covers the occlusal of the tooth, and it goes down to the bevel that I created out of it.  Now, I’ve got this thing that’s about the height or a little below the height of an ideal plane of occlusion.  Then, I can take my partial and just rest it over the top of it.  I have no intention of putting a tooth on top of this.  My teeth are going to be above this, but my plane of occlusion will now be even and level. It won’t be going way the heck uphill on the side where the toot was extruded.

So, look at some of those things when you’re thinking about these.  So, here’s a class III all tooth-supported with an anterior modification space.  Here’s another class III in a maxillary case. So, you basically got teeth over here.  You can see it come across the palate. Sometimes you refer to these things as a closed palate or a toilet seat for obvious reasons.

So, you can go ahead and not cover too much of the palate, but the thing here is if you look at this and say, “Why wouldn’t I just choose to use to do that longer span?”  We’d have three [40:27].  Can anybody give me some reason why I might not choose to do that as a fixed partial denture? Why wouldn’t do it like a bridge?  Do people feel comfortable about that length of span?  It’s getting pretty long.

Now, you’re going ahead and putting a crown on a cuspid and you’re putting a crown on a molar. Again, the thing that you remember is that way back in the depths and the recesses of your brain in Dr. May’s lecture, something called Ante’s Law. Anybody vaguely remember what Ante’s Law talked about? Number of square millimeters of root surface in contact with bone.  I’m not talking about anatomical root surface. I’m talking about clinical root surface.

So, if a person has lost some attachment and they’ve lost some bone height, can you see that they’ve still got the same anatomical root surface, but they don’t have the same clinical root surface?  You people follow the difference between those two?  So, suddenly if you lose bone, your clinical crown gets taller, and your clinical root gets shorter.  So, you’re starting to look at how many square millimeters of tooth do I have here, and how many millimeters of root tooth do I have here in bone.  Is that equal to or greater than, preferably greater than, the square root of all the teeth that are being replaced?

Now, the other thing that happens when you have a longer span bridge in the upper or the lower jaw.  What do you suppose one of the forces that happens on a fixed partial denture here is that just really beats the periodentin up a lot?  It’s not straight down vertical forces.  It’s buccal lingual forces, forces that try to rack this thing buccal-lingually, and can you see that if you do this with a partial denture, this is what we talk about when we talk about cross-arch stabilization?

So, the fact that the arch comes over here and gets a good grip on this tooth on the other side of the arch, can you see this is now like a three-legged milk stool? It’s pretty stable so if any forces try to take this and wiggle it buccal-lingually, it gets braced off this.  So, longer span from front to back is not always ideally treated as as fixed partial denture.  If you can put implants in there, not a problem, but long span with a fixed partial denture can spell heartache especially if you ever get a long span in this anterior tooth. I see it over and over again, a cuspid that has been endodontically treated and has a post end corum in it.

So, I can’t tell you, over the years, how many of these long span fixed partial dentures I’ve seen in which the anterior abutment is a cuspid that was endodontically treated that had a nice cusp gold post end corum and a really nice PF fitting crown. What do you suppose I see happen to these teeth three to ten years down the road?  Vertical root fracture.  Now, we are in the vernacular, screwed because now I no longer have a cuspid to hold on to.  I’m up to a lateral incisor. A lot of support there, isn’t it?  That’s a really peach.

Now, it’s even a longer span bridge using a lateral as our primary abutment. Doi. Well, because the lateral’s not too good, let’s just pull the lateral and let’s splint the two centrals together. Now, you’re just getting insane.  Don’t even come to me with that.  Now, you’re thinking really hard about implants.  You’re thinking really hard about some sort of a partial. So, longer spans are not always the best treated with fixed partial dentures because of the buccal-lingual force that will go on those longer span bridges, and the partial can give us cross-arch stabilization.  So, it really helps mitigate the buccal-lingal forces on those teeth.

So, basically, here’s just another example of a class III tooth-supported all the way around.  Again, we try to keep getting these things done. I ‘m much happier if they’re tucked around the distal, labial, or the distal-labial corner.

Then, we get to the class IVs.  Class IVs are always tough because your replacement teeth area always in front, and sometimes, these tend to be tippy and really hard to get the tippiness out of these. So, over your practicing lives, what you may want to consider is a lot of these class IV partial denture cases can really be treated successfully if you can find one spot somewhere under this anterior area to put a single implant, and the advantage of doing it with a partial denture is the location of the implant doesn’t have to line up exactly with the tooth.

Now, if you’re in practice for a very long time, what you’re going to see is some genius with no planning put some implants in the anterior area, and the location of the implant is exactly in the interproximal embrasure area of where the tooth ought to be. So, now how do you get that so it looks pretty when you’re trying to put fixed work on it?  So, on these, if you’re doing it with a partial denture, you can just put a single implant anywhere across here, and it’s going to work really well.

Very seldom to show you this one.  It doesn’t happen often.  If you have one of these people that’s got class III lower arch.  It’s seems like all the teeth toe in lingually. When you survey, you can fit anything on the lingual of the teeth. Not very often, but, occasionally, we will do a labial bar.  So, all the teeth are fitting so far in lingually, we can’t fit anything bilingually.  So, the partial goes out here, and as luck would have it with most of these cases, bone lip conceals that pretty well.  Most of the time now, would we just choose to do that as an implant? Absolutely, you would choose do it as an implant.  On these big cases, the more teeth you’re replacing up here, the more difficult it is not to have that anterior tipping phenomenon.

In your practicing lives, unlike mine, one of the things I try to tell anybody with this situation is to try to get an implant somewhere in here somewhere to brace the anterior aspect of this.  Many times with class IVs when they come back for recalls, this is what you see because of that tippiness.  You can beat yourself up about this, but you can’t always get rid of this try as you might.

Leave a Reply

Current day month ye@r *



Promoted by: San Diego SEO & Dental Marketing
All Copyright © 2024 newyorkdentalexpert.com or its affiliates.