Case #1:
If she can pay for implants, you could make an implant supported
partial (design and options are many). If the patient can't afford
that, then you might consider a Valplast partial or a Cu-Sil partial.
Case #2:
If teeth 7 to 10 have to be extracted, you can make crowns with
Equipoise C and L attachments on 6 and 11 for the partial, or you could
make crowns with a dolder bar in between that would help retain the
partial. If you want esthetic clasps, you could have tooth colored
clasps (Invisi-clasps) or combine a metal framework with Valplast base
and clasps. You could also just leave the canines alone and place
implants in both posterior areas and a couple more in areas 7 and 10.
Then make an implant supported partial with ERA or with ball
attachments.
Jorge Bonilla, DMD

Raph wrote:

Case #2.

Male in his mid 50s presents with canine to canine anteriors presnet on
his
uppper arch. His lower arch is stable with an almost complete set of
teeth.
He was interested in extractions of his 6 anterior teeth and a complete

uppper denture. His primarly concern was esthetics and to eliminate any

future problems with his teeth.  The four incisors are in poor shape
and
need extensive restorative and possible endodontic therapy, but the
canines
are in great shape.

I'm interested in getting some opinions on this case. Is it
advantageous to
leave the canines and fabricare a partial denture as to the stability
stand
point? If so, would clasps on the canines be the only way of attaining
retention? What about the design on the partial?

---------------
Thanks a whole bunch for your input. I'm a new graduate that just
started in this field. I do realize that the education does not stop
once
the degree is attained and thus would really like to expand my
knowledge by
using this group. I have been an on and off reader of this news group
for 5
years. thanks

Raph
_______________________

You can consider extracting the upper incisors and making a removable
partial, but that often involves a bit of a compromise on esthetics. If
his main concern is esthetics, it is difficult to envision any sort of
removable partial, as any removable appliance next to full retained
canines will show the disconnect between the natural teeth and the
prosthesis. This is true even if you retain the partial with implants
or hidden clasps.

If your patient really wants a full denture (and he should have full
informed-consent counseling before any irreversible treatment) that can
also be accomplished with an overdenture over the two canines retained
as endo-treated roots. That helps denture retention and maintains bone.

The overdenture could also be made with attachments to the retained
canine roots. I especially like the Zuest Locators for that purpose,
but there are other attachment systems as well.

Are the incisors clinically restorable? When a patient says they want
such teeth extracted for esthetics, sometimes their real intent is to
save money, and esthetics are only a secondary concern.

For other patients the esthetics are the main concern and money is no
object. Where does this patient fall in that spectrum?

Remember that if the patient intends to save money by extracting his
incisors instead of restoring them, his savings can evaporate when he
starts getting implants or fancy attachments. Keep yourself out of
trouble by detailed informed-consent discussions with him, as there are
so many options for this patient's treatment.

Best regards,
dentaldoc

Case #1
Allergic to metals and a has a metal clasp? Psychogenic allergy or metal
specific e.g. nickel?
What were you thinking of crowning with, Porcelain Fused to METAL?
Does the patient wear any jewellery?
What's the lower partial made of?

Your best stability will be achieved with a full palatal coverage and full
border extensions. With the 3 teeth remaining you have the potential for 4 guide
planes. Each guide plane reduces the need for clasping by 25%.
Then there a lot of tricks using different materials.

Case #2
Your best stability will be achieved with a full palatal coverage and full
border extensions.
Can't design a case without surveying it and seeing study models.
The canines could be advantageous.

Raph, designing partials is a no brainer. They gave you all the rules and tools
in school, all you have to do is use them and most cases will design themselves.
Both cases are bilateral free end saddles, that makes them more tissue supported
than tooth supported. Design them to preserve the tissue.

Where did you study? Did you keep your surveyor?

If you are posting from Cogeco, my guess is that you are somewhere in the Golden
Horseshoe. If so, we could get together and go over these cases.

How can you chew your cud without teeth ?

--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com