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Medical Forum / General / Dentistry / August 2005NTI w/ missing central&lateral?
OK: I know that KellerLabs could make me a custom tray to cover the area of missing teeth (UL central and lateral). That will take time and be $$$. The lady wears a removable (very low quality) denture but I don't want to incorporate it into the mix if I can avoid it. So the question is how to make the NTI cover this extra edentulous space? It should be added that we use the Standard Long NTIs almost exclusively now. But the 'wing' still is not long enough to cover over as far as the left canine. Thanks SP  SignatureFinally: take out the TRASHH OK: I know that KellerLabs could make me a custom tray to cover the area of missing teeth (UL central and lateral). That will take time and be $$$. The lady wears a removable (very low quality) denture but I don't want to incorporate it into the mix if I can avoid it. So the question is how to make the NTI cover this extra edentulous space? It should be added that we use the Standard Long NTIs almost exclusively now. But the 'wing' still is not long enough to cover over as far as the left canine. Thanks SP ________________ There are others on this group who have much more experience than an NTI novice like me. It appears that abutting the upper canine would partially defeat the ability of the NTI to lower the maximum force that can be applied during clenching. The NTI avoids canines and molars for this reason. Perhaps a design which would incorporate the upper right lateral and central, and the edentulous space for the upper left central and lateral, without involving either canine, could be used. Lots of extra acrylic could be used to fill in the edentuous space, without involving the canine. What about moving the discluding element slightly to the right to contact the incisals of the lower right central and lateral, rather than the incisals of both lower centrals? Wouldn't that tend to lessen the leveraged "teeter-totter" effect of having the vertical force of a centered discluding element opposite the edentulous space of the missing upper incisor? That's my speculation so I'd like to hear how others have approached this problem. - dentaldoc > What about moving the discluding element slightly to the right to > contact the incisals of the lower right central and lateral, rather [quoted text clipped - 3 lines] > missing upper incisor? That's my speculation so I'd like to hear how > others have approached this problem. I think you hit the nail on the head Bill: I'll file the wings so they won't touch the upper canines and position it so it hits between the lower central and lateral on the right side. The wings will be unequal on either side, but that's OK. Great! Thanks! SP SignatureFinally: take out the TRASHH Stovie, I am confused as to what this case looks like. Is the patient missing upper and lower incisors, just a central and lateral on one side, just on the upper, just on the lower? Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> What about moving the discluding element slightly to the right to [quoted text clipped - 12 lines] > Great! Thanks! > SP > Stovie, > > I am confused as to what this case looks like. Is the patient missing upper > and lower incisors, just a central and lateral on one side, just on the > upper, just on the lower? She's missing the upper left first molar in the posterior and the upper left central and lateral. These have been replaced by a very ill-fitting plastic partial denture, and I want her to remove it at night. She is in her early 40s and has had parts of her body redone, and doesn't really want to take the partial out. Her anterior hard palate needs to breathe a bit. On the bottom, she's missing both first molars and the lower right second molar as well. There is no partial in the mouth on the lower. Thanks SP SignatureFinally: take out the TRASHH On a model, add the missing incisors and add enough cold-cure acrylic to position it repeatedly into position. Place this into the mouth and build a full-size NTI matrix over it. The denture teeth should get picked up by the NTI. Extend extra clear acrylic over the cuspids with your finger (wet it with the patient's saliva so the acrylic does not stick to your glove). You should end up with an upper NTI which has longer extensions right and left and has two denture teeth in place for esthetics. You might want to block out the side of the transferred denture teeth/block with wax to keep it from locking between her teeth while fabricating the NTI. You can always boil out the wax after fabrication, you can add some clear acrylic here afterwards if you need more retention. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> Stovie, [quoted text clipped - 16 lines] > Thanks > SP > On a model, add the missing incisors and add enough cold-cure acrylic to > position it repeatedly into position. Place this into the mouth and build a > full-size NTI matrix over it. OK. So I take it that you would keep the NTI centered over the lower centrals as if the upper dentition was intact? I'll have her come back to get a mark on the NTI for exact placement in her mouth. If I don't, and the NTI has to be positioned laterally to stay centered over the lower centrals, I could have to re- do the whole thing. Thanks, that is excellent. I hope Bill was listening SP SignatureFinally: take out the TRASHH Dr Steve <nos...@home.net> wrote: > On a model, add the missing incisors and add enough cold-cure acrylic to > position it repeatedly into position. Place this into the mouth and build a > full-size NTI matrix over it. OK. So I take it that you would keep the NTI centered over the lower centrals as if the upper dentition was intact? I'll have her come back to get a mark on the NTI for exact placement in her mouth. If I don't, and the NTI has to be positioned laterally to stay centered over the lower centrals, I could have to re- do the whole thing. Thanks, that is excellent. I hope Bill was listening SP ______________ Yes, this is an interesting case. The inclusion of denture teeth should help the esthetics and encourage the patient to take out her old partial when necessary! I know it's tough for some patients to leave out a partial for even ten minutes, but it's got to be out if she is to benefit from the NTI. I still wonder about the vertical force transmitted to the NTI upon closure. Will there be a teeter-totter, leveraged effect where the NTI has gingival support (the missing upper central and lateral incisors) instead of solid tooth support? Is this concern even clinically important? I don't know. Best regards, - dentaldoc You extend the sides of the NTI to cover the cuspid. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > > Dr Steve <nos...@home.net> wrote: [quoted text clipped - 32 lines] > Best regards, > - dentaldoc |
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