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Medical Forum / General / Dentistry / August 2006Only four top teeth left. What to do?
Hi all, I am 52, wear a partial upper and have only the four incisors left in my upper jaw after just having a cracked canine tooth removed. (My lower teeth have quite old bridgework, but are OK.) Several dentists had told me that if the canine comes out, I will have to have the incisors out too and start wearing a full denture, as incisors are too weak to support a partial denture on their own for any length of time. Now that the cacnine tooth is out, my dentist seemed to have changed his mind and says the incisors are OK for now, and the gums are alo fine, so I needn't go for a full denture. The lateral incisor and central incisor on one side have had root canal treatments and are splinted together with a connected pair of crowns. The other central incisor and lateral incisor are "virgin teeth". All four incisors are apparently in good condition. Excluding implants, which are too costly for me, what would you suggest: (a) Continuing with the same partial, which has had the canine tooth added, (b) root-canal plus splinting for the other pair of incisors as was done with the first two, (c) full denture, or some other treatment? How long could any of these treatments delay the need for a full denture? Also, will I find a full denture much more difficult to use than my current partial or am I worrying unduly about having to start wearing a full denture. Also, how likely is it that my face will age very quickly after moving to a full denture? I don't think I will have a gagging problem but I am most worried about my speech changing and about the denture falling out in public. Also, if I leave things as they are (keep my current partial) is it likely that one of the incisors could suddenly fail (crack or whatever) needing it to be extracted urgently, and I will then be unable to wear a partial because there is not enough support, while it would take a few weeks to prepare a full denture, meaning that that I would end up going around with only three teeth for a few weeks. (I'd rather start the preparations for a full denture now, while I still have a partial denture solution, than find I can only wear a full denture after another tooth comes out and I can't wear a partial any more while I wait for the full denture.) I should mention that I have been perfectly satisfied with my partial and can eat and speak without any problems. I don't know if this is any indication of how I'll be with a full upper denture. Roy > Hi all, > [quoted text clipped - 35 lines] > and can eat and speak without any problems. I don't know if this is any > indication of how I'll be with a full upper denture. R E P L Y Generally true, however a Valplast partial may prove to be useful without the normal supply of anchor teeth ...... Joel > Roy >(a) Continuing with the same partial, >which has had the canine tooth added, (b) root-canal plus splinting for [quoted text clipped - 3 lines] >denture much more difficult to use than my current partial or am I >worrying unduly about having to start wearing a full denture. You may consider having a 'transitional' partial made. Perhaps Roy will weigh in on this case. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com W_B: 1. From my skimming through posts on this site I can see that (the other) Roy is the expert denturist? Yes, it will be interesting to see what he has to say. 2. By a transitional partial, do you mean an acrylic-only partial covering the whole palate and still connected to the remaining four front teeth, but which can easily be converted to a full immediate denture by removing the clasps and adding the four teeth? Thanks, Roy >W_B: > >1. From my skimming through posts on this site I can see that (the >other) Roy is the expert denturist? Yes, it will be interesting to see >what he has to say. Yes, exactly. >2. By a transitional partial, do you mean an acrylic-only partial >covering the whole palate and still connected to the remaining four >front teeth, but which can easily be converted to a full immediate >denture by removing the clasps and adding the four teeth? Right again. >Thanks, > >Roy -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Excellent posts. I've been treating scores of denture patients for 30 years. Keep the teeth. And, I gotta say this, any DDS who tells you the incisors have to come out 'cause they "can't support a partial" is either misguided or ignorant. Cu-sil type denture might be an option too if you get down to a couple isolated teeth. | >(a) Continuing with the same partial, | >which has had the canine tooth added, (b) root-canal plus splinting for [quoted text clipped - 12 lines] | Take out the G'RBAGE | wubbabubbazG@RBAGEyahoo.com I will respond to the original post. Comments in text below.  SignatureRoy rem NADA to reply | Hi all, | [quoted text clipped - 4 lines] | incisors out too and start wearing a full denture, as incisors are too | weak to support a partial denture on their own for any length of time. Don't know what your original partial looks like, but if you have or switch to full palatal coverage, there is more denture support and retention provided from the roof of the mouth which puts less of a load on the remaining teeth which extends their life. You want to keep the teeth to prevent bone resorption that will occur when you lose them. | Now that the cacnine tooth is out, my dentist seemed to have changed | his mind and says the incisors are OK for now, and the gums are alo [quoted text clipped - 5 lines] | for me, what would you suggest: (a) Continuing with the same partial, | which has had the canine tooth added, Good option for 6 months or so while the initial rapid stage of bone resorption occurs. Then have a new partial made that gives full palatal coverage |(b) root-canal plus splinting for | the other pair of incisors as was done with the first two, I assume by splinting you mean having crowns made. Not a good option since the teeth are "virgin" and healthy. If one was concerned about the lateral incisor taking too much of a load, it could be "splinted" or tied to the central using a fine wire or mesh ribbon type material and some composite material without cutting into the teeth. One could even bond a set of "Maryland" type wings to the lingual surface. |(c) full denture, or some other treatment? Full denture, not recommended. You might get away with 2 implants in the canine region and some attachments but 4 or more implants are usually recommended on the upper. The latter most likely being the recommended treatment of choice for someone in your situation. That is because you will have decreased bone loss using implants and less of a load on the remaining teeth. |How long could any of these | treatments delay the need for a full denture? Also, will I find a full | denture much more difficult to use than my current partial or am I | worrying unduly about having to start wearing a full denture. Most people that tolerate a partial are accepting of a full denture. You are worrying unduly. |Also, how | likely is it that my face will age very quickly after moving to a full | denture? "Face aging" is usually due to a lack of maintenance. Reline or rebase the denture when loose (usually about every 3-4 yearsfor an upper). Replace when teeth are showing wear. |I don't think I will have a gagging problem but I am most | worried about my speech changing and about the denture falling out in | public. If you could tolerate the impressions for the partial or already wear a it is highly unlikely you will gag. A well made, well maintained complete denture is less likely to come loose than the partial you will wear. | Also, if I leave things as they are (keep my current partial) is it | likely that one of the incisors could suddenly fail (crack or whatever) [quoted text clipped - 6 lines] | another tooth comes out and I can't wear a partial any more while I | wait for the full denture.) You are worrying unduly. Unless you live in a remote area. One could add a tooth, clasp and convert a partial to a full palate in the same day, sometimes next day depending when you start. Either before or after your tooth was extracted. Done before the denture acts like a bandaid. It is possible to go in first thing in the morning. have the impressions taken. Make the necessary alterations to the denture and have it ready to wear when the tooth is extracted at the end of the day. How long did it take to add the canine you just lost? | I should mention that I have been perfectly satisfied with my partial | and can eat and speak without any problems. I don't know if this is any | indication of how I'll be with a full upper denture. A very good indication of success. With one caveat. That being - if your email addy is any indication you are located in the UK and you are receiving treatment via the NHS, the generally accepted dental principles I've provided may not necessarily apply. BTW, thanks for signing for me. | Roy Hello Roy, I am very grateful for your detailed comments. Here are some further remarks. > Don't know what your original partial looks like Metal framework - covers about half my palate. An open part of the framework rests against the lingual side of my incisors and there are clasps conmecting it to each of my lateral incisors. The clasp on the side of my denture that has just had a canine tooth added to it is made of very thin wire and looks as if it could easily become detached after a while by slipping out of the acrylic area. The partial is very retentive indeed, and actually needs a bit of effort to remove, and some manipulation (rotation while inserting) to replace in my mouth. , but if you have or switch to > full palatal coverage, there is more denture support and retention provided from > the roof of the mouth which puts less of a load on the remaining teeth which > extends their life. You mean I should have my present partial replaced by an acrylic partial that covers all of my palate like a full denture, but is still connected o my incisors with clasps? This will help prolong the transition to a full denture? Roughly how long can I expect to be able to stay with my front teeth if I keep my present partial, and how long could this be extended by migrating to a full-palate partial? >You want to keep the teeth to prevent bone resorption that > will occur when you lose them. I realize that bone resorption will take place once the incisors come out, but is this more of a problem than with the rest of my teeth that I have lost? Doesn't it just mean that I will need to have my full denture relined or rebased from time to time? If I am going to need a full denture within a few years (is this a correct guess) anyway, then will it make a big difference to postpone it for that length of time? (a) Continuing with the same partial, > | which has had the canine tooth added, > > Good option for 6 months or so while the initial rapid stage of bone resorption > occurs. Then have a new partial made that gives full palatal coverage An acrylic one? Sounds like a good idea as it will get me used to having my palate completely covered ready for a complete denture. > I assume by splinting you mean having crowns made. Yes, like with the lateral incisor and central incisor on the other side. > Not a good option since the > teeth are "virgin" and healthy. If one was concerned about the lateral incisor > taking too much of a load, it could be "splinted" or tied to the central using a > fine wire or mesh ribbon type material and some composite material without > cutting into the teeth. One could even bond a set of "Maryland" type wings to > the lingual surface. OK. Interesting why I've always had root canals and connected crowns rather than the method you recommend, which sounds so simple and avoids grinding teeth and taking out the central core, which must make them weaker (and these ARE the teeth that have always had problems, and end up cracking or developing caries under the crowns. > |(c) full denture, or some other treatment? > Full denture, not recommended. Why not a full denture? You keep telling me not to be unduly worried and that I shouldn't expect to have any problems with a full denture. So why is it not recommended? Especially, if I'm nearly there one way or the other? If I could delay the process by, say, ten years, then it makes sense to me, but if it's going to be a year or so anyway, then what difference does it make. > You might get away with 2 implants in the canine > region and some attachments but 4 or more implants are usually recommended on > the upper. The latter most likely being the recommended treatment of choice for > someone in your situation. That is because you will have decreased bone loss > using implants and less of a load on the remaining teeth. I understand, but I can see that the cost would be very high. > |How long could any of these > | treatments delay the need for a full denture? Also, will I find a full [quoted text clipped - 3 lines] > Most people that tolerate a partial are accepting of a full denture. You are > worrying unduly. I'm not unduly worried as I have been told quite a few times that it's not so different from my partial. I worry that my speech will be strange for a few weeks and that my lips will jut out or whatever for a few weeks and give the game away, which does concern me as I'm a bit embarrassed about people finding out or asking questions. I suppose I will no longer be able to bite with my front teeth, so uncut apples and the like are out. But I guess I can get used to that. > "Face aging" is usually due to a lack of maintenance. Reline or rebase the > denture when loose (usually about every 3-4 yearsfor an upper). Replace when > teeth are showing wear. Good. > If you could tolerate the impressions for the partial or already wear a it is > highly unlikely you will gag. A well made, well maintained complete denture is > less likely to come loose than the partial you will wear. I agree about gagging not being a problem. It's good to hear that a complete denture won't keep falling out. > You are worrying unduly. Unless you live in a remote area. One could add a > tooth, clasp and convert a partial to a full palate in the same day, sometimes [quoted text clipped - 3 lines] > alterations to the denture and have it ready to wear when the tooth is extracted > at the end of the day. How long did it take to add the canine you just lost? I got the canine added to my denture within just a few hours. You mean if I lose one of the four remaining teeth, I could still have it added to my partial and have only three incisors left without having to go to a full denture? You also mean that if I have an acrylic partial that covers my palate completely, this can just as quickly be converted to a temporary complete denture as adding one tooth? Am I right in believing that my present metal-framework partial could not be so converted if I needed a complete denture, so that this is an advantage of switching to a full-palate acrylic partial? > | I should mention that I have been perfectly satisfied with my partial > | and can eat and speak without any problems. I don't know if this is any [quoted text clipped - 4 lines] > via the NHS, the generally accepted dental principles I've provided may not > necessarily apply. OK. Actually I am from the UK but currently living in a country where the dental services are good (no NHS-like service for dental treatments, only private), but quite expensive. I have dental insurance which covers quite a lot, but not exotic treatments like attachments, Valplast and the like, and not of course implants. Thank you again for taking the time to give me such detailed answers, which have been quite reassuring. Knowing what to expect takes the worry out of the whole thing. I think my greatest worry is having people ask me why I'm not speaking normally during the initial period of wearing a complete denture. Apart from that, I am not very concerned. Roy >Hello Roy, > >I am very grateful for your detailed comments. Here are some further >remarks. Roy is a great guy and a terrific denturist. I have been to his clinic and he bas been to mine. >You mean I should have my present partial replaced by an acrylic >partial that covers all of my palate like a full denture, but is still >connected o my incisors with clasps? This will help prolong the >transition to a full denture? Roughly how long can I expect to be able >to stay with my front teeth if I keep my present partial, and how long >could this be extended by migrating to a full-palate partial? That design would provide wore bracing to the denture and result in less "wiggling. >I realize that bone resorption will take place once the incisors come >out, but is this more of a problem than with the rest of my teeth that >I have lost? Doesn't it just mean that I will need to have my full >denture relined or rebased from time to time? If I am going to need a >full denture within a few years (is this a correct guess) anyway, then >will it make a big difference to postpone it for that length of time? the more bone you have the more retention and resistance the denture has. >Why not a full denture? You keep telling me not to be unduly worried >and that I shouldn't expect to have any problems with a full denture. >So why is it not recommended? Especially, if I'm nearly there one way >or the other? If I could delay the process by, say, ten years, then it >makes sense to me, but if it's going to be a year or so anyway, then >what difference does it make. Full denture is seldom as comfortable as a partial denture. >I got the canine added to my denture within just a few hours. You mean >if I lose one of the four remaining teeth, I could still have it added [quoted text clipped - 5 lines] >needed a complete denture, so that this is an advantage of switching to >a full-palate acrylic partial? You can easily add a tooth to the acrylic transitional denture until if becomes a full denture. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. > >I got the canine added to my denture within just a few hours. You mean > >if I lose one of the four remaining teeth, I could still have it added [quoted text clipped - 8 lines] > You can easily add a tooth to the acrylic transitional denture until > if becomes a full denture. Why can't he get the present denture extended with arcylic in the post-dam area and to give adequate vestibular support. He could thus have modes ready for the articulator if the 4 remaining uppers go kaput, and he would have better support of the existing dentition, assuming that the existing partial can be extended as a full palatal coverage partial. This would be a logical transition, in my humble opinion. Jest my scratchin's SP SignatureFinally: take out the TRASHH >> >I got the canine added to my denture within just a few hours. You mean >> >if I lose one of the four remaining teeth, I could still have it added [quoted text clipped - 19 lines] >Jest my scratchin's >SP Perhaps. Depends on the shape of the metal. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. | >> >I got the canine added to my denture within just a few hours. You mean | >> >if I lose one of the four remaining teeth, I could still have it added [quoted text clipped - 26 lines] | | I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. I'll agree with both. Stove Pipes got a good idea with the mounted models that I'll carry 1 step further . There is no reason why one could not take preliminary impressions and a bite. Set up the missing teeth on an acrylic base plate. Try it in and wait if everything is OK. Once Roy knows he is going to lose more teeth, all one has to do is do a reline impression in the prefabricated try in and an overall alginate impression to pick up the remaining teeth and the final denture could be finished in a day or two. -- Roy rem NADA to reply > I'll agree with both. Stove Pipes got a good idea with the mounted models > that I'll carry 1 step further . There is no reason why one could not take [quoted text clipped - 3 lines] > the prefabricated try in and an overall alginate impression to pick up the > remaining teeth and the final denture could be finished in a day or two. There ya go... Sounds reasonable to me... SP SignatureFinally: take out the TRASHH Remember this: The lateral incisor and the central incisor do not have sufficient curvature to create the undercut area required for a decent metal clasp locking in many cases. That is where Valplast the the flexible clasps come in. Joel > >> >I got the canine added to my denture within just a few hours. You mean > >> >if I lose one of the four remaining teeth, I could still have it added [quoted text clipped - 26 lines] > > I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. Roy, You are welcome, more comments in text below | Hello Roy, | [quoted text clipped - 23 lines] | connected o my incisors with clasps? This will help prolong the | transition to a full denture? With 1/2 palate coverage you should be OK for a while. Remember a partial is only meant to last 5-8 years. When are you due for a replacement? When replacing you can have a full metal palate (The new titanim ones are light and fit well) . Properly designed with the future in mind to add questionable teeth and relines for where the bone will shrink you could have this ready to convert to a metal based full denture. Getting the best of both worlds and extending the anticipated life span. | Roughly how long can I expect to be able | to stay with my front teeth if I keep my present partial, and how long | could this be extended by migrating to a full-palate partial? I can't say to the first question, but usually longer to the second one. I'm not being evasive, it is like asking a mechanic how long will your brakes last and how much longer will they last if you use heavy duty pads. The answer depends on what you drive and how you drive it. | >You want to keep the teeth to prevent bone resorption that | > will occur when you lose them. [quoted text clipped - 3 lines] | I have lost? Doesn't it just mean that I will need to have my full | denture relined or rebased from time to time? Bone loss occurs can be described using the graph below: http://www.necc.mass.edu/mrvis/mr2_14/figure2.gif Where you can substitute the amount of bone (at approx 1/10 mm per value) on the vertical axis, substituting time in months on the horizontal using the scale to get an approximate idea of the rate of loss. The more recent the extraction them more rapid the loss. If you don't reline to compensate for the areas of rapid resorption you put a greater load on the areas that have already been through this phase. The greater load increases the rate of resorption for those areas under pressure. Using the same graph, load is on the vertical and bone loss on the horizontal. Hence the recommondation for full palatal coverage. | If I am going to need a | full denture within a few years (is this a correct guess) anyway, then | will it make a big difference to postpone it for that length of time? Not if you reline when needed. | (a) Continuing with the same partial, | > | which has had the canine tooth added, [quoted text clipped - 27 lines] | weaker (and these ARE the teeth that have always had problems, and end | up cracking or developing caries under the crowns. My guess is that you got crowns because you needed root canals on compromised teeth. | > |(c) full denture, or some other treatment? | > Full denture, not recommended. [quoted text clipped - 5 lines] | makes sense to me, but if it's going to be a year or so anyway, then | what difference does it make. See the graphs. You will have 10 more years of bone. You will have 10 more years of proprioreception through the periodontal ligament. Proprioreception tells you how hard you are biting, which better controls the amount of load you are putting on your bone. The teeth and bone help stabilize the denture. Much like a boat tied to a dock. Lose the teeth and the bone and your denture will be free floating like a boat in the middle of a lake without an anchor. | > You might get away with 2 implants in the canine | > region and some attachments but 4 or more implants are usually [quoted text clipped - 24 lines] | will no longer be able to bite with my front teeth, so uncut apples and | the like are out. But I guess I can get used to that. Here are some tricks. 1. Get your hair done the day you get the denture. People will see something different and think it is your hair. 2. Learn to hold up the back end of your denture with your tongue when biting with your front teeth. Better yet learn to bite with your eye teeth that are usually better positioned to handle this. | > "Face aging" is usually due to a lack of maintenance. Reline or | rebase the [quoted text clipped - 32 lines] | to my partial and have only three incisors left without having to go to | a full denture? There is a pretty good chance of that. Got a digital camera? With a picture of your partial we could better tell. | You also mean that if I have an acrylic partial that | covers my palate completely, this can just as quickly be converted to a | temporary complete denture as adding one tooth? As above, possibly yes. | Am I right in believing | that my present metal-framework partial could not be so converted if I | needed a complete denture, so that this is an advantage of switching to | a full-palate acrylic partial? There is a good chance it could be on a temporary basis for the 1st year. The weak link is where the new acrylic meets the metal. This can be helped by using an acrylic/metal bonding system or welding/soldering some retentive loops onto the metal. | > | I should mention that I have been perfectly satisfied with my | partial [quoted text clipped - 22 lines] | of wearing a complete denture. Apart from that, I am not very | concerned. The quickest way to get your speach up to par is to sit down and read out loud to yourself. Most people normally adapt within the first week or two without reading. If you are having troubles with certain letters after that, then there are modifications that can be done to the denture that will help. -- Roy rem NADA to reply Wonderful advice. Keep the teeth! Another option might be a complete overdenture. They are fraught with potential pitfalls, but could give you a nice result if conditions are right. If your teeth already have root canals it would eliminate this major cost. Biggest problems with complete overdentures are 1. Esthetics (esp. with uppers) - with retained anterior roots, patients (esp. skeletal class II) often - not always but often - look much too protrusive. 2. Fracture - but not difficult to prevent with strong resins and/or metal reinforcement. 3. Maintenance of abutments - any propensity for decay or perio disease will be exacerbated by covering the roots. 4. Inadequate construction - a well- made overdenture will be as retentive as a conventional complete denture (no better unless you're using attachments). If improperly executed and adjusted, however, it will rock on the abutments and retain very poorly. Gotta see a dentist or denturist who knows what they're doing. Most of the dentists I know don't know how to make one. The biggest advantages vs. conventional complete denture are maintenance of bone and proprioception. Also eliminates lateral forces on the abutments, although in a healthy periodontal environment (no gingivitis or perio disease) you don't have to worry about bone loss from "jiggling" forces although there might be some concerns about unplanned/undesired orthodontic movement. You're only 52 (younger than me….). If you were 90 and had good ridge form, a conventional complete denture wouldn't be a bad choice. But you might live another - what - 30 or 40 years? That's a long time and bone loss could easily become extensive and disabling at some point, especially if you have lower natural teeth. I have a lot of older patients who wore complete dentures successfully for decades but then - due to extensive bone resorption - have major problems with comfort and function. Getting old is tough enough without adding that to the pile. Yankee Fan writes I'm a 52 year old male who ha dpoor teeth as a young man with little , or no preventive medicine. Subsequently, I had most of my teeth removed in my 30's and have had a full upper denture and an almost complete lower denture ( one tooth one the left side , and two teeth on the right side as anchors, for the past twenty yerars. I haven't been to a dentist in 15 + years. I loast the top of the left anchor tooth several years ago. Basically, I've worn down the dentures and need ot replace them. I'm reading that implants could cost $20, 000.00 pls. I don't even know if I'm a candidate, but i was hoping for some input or an opinion. New dentures, or implants . Thoughts, please ! Thank you very much !r Oster wrote: >Wonderful advice. Keep the teeth! > [quoted text clipped - 30 lines] >resorption - have major problems with comfort and function. Getting old is >tough enough without adding that to the pile. |
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