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Medical Forum / General / Dentistry / July 2007Giving up on my teeth
I am 51 years old and have had problems with my teeth all my life. I grew up in a rural area with no fluoride in the water and perhaps that contributed to the massive dental decay I had. I had all my teeth filled as a child and then at 21, I changed dentists. He said all my fillings had leaked, so I had to get them re-filled again. My teeth were just shells by then. As time has progressed, I have had most of my molars crowned, but guess what! I visited a new dentist and learned I need EIGHT crowns and it is going to set me back another $10,000. By the way, this is a second opinion and it is almost identical to the first. I give up. I am strongly considering extraction for some of these teeth and living with a partial. I am tired of sinking thousands of dollars and spending my vacation time in the dentist chair. Does anyone have anything good to say about dentures and partials? Of course, dentists are not going to defend them because it decreases their incomes. I am desperate. Thanks in advance for your advice. Trudy > I give up. I am strongly considering extraction for some of these > teeth and living with a partial. I am tired of sinking thousands of [quoted text clipped - 5 lines] > > I am desperate. Thanks in advance for your advice. Partials are fine as long as you understand they can't do everything your natural teeth can. If you're willing to put the time and patience required for a first-time denture user to adjust to a partial there's no reason why you shouldn't be able to live a fully satisfactory life with a partial. In the end, you will have to do what you think is best for yourself and prepared to accept the outcome whatever that is. Just make sure you think about it twice, as any teeth you have out are not coming back. Best of luck, George Bullshit comment, Trudy. If you want a partial you'll get it. We don't need unhappy patients. Especially those who think we're out only for profit. AAMOF, why don't you have 'em all out and just gum it. Works for a lot of people. We're not sellin' cars ya know. I can relate. I've been spending a bunch of money on crowns over recent years (I'm 47). One thing I can say: my dentist, who I like, never mentioned the possibility of gold crowns. I did a bunch of web research, and determined that they commonly far outperform PFM crowns. I went back and said I thought I'd like them, and he said "great choice, they're the best." I think that people are so concerned about the appearance issue, they don't even consider them often. Most of my current crowns have been for molars, but I'm getting one on a premolar, and am probably going with a ceramic-coated gold (Captek) crown. I'm actually not COMPLETELY happy with this, but I realized, as my mouth slowly filled up with shiny gold crowns, that I might want to draw a line somewhere. I didn't really think I was so concerned about the aesthetics, but there you have it. I'm a little concerned since I think the harder/more brittle ceramic coating of these crowns might cause problems, but I think the gold substructure might mitigate that. I'd be interested in hearing what any dentists/technicians have to say on these topics. Sorry I haven't searched The performance difference between PFM and gold crowns, according to some studies, was vast: the mean time to failure in one study of PFM's was just a few years. I see some interesting info here, he estimates 10-20 years for PFM, but up to 40 for gold: http://jada.ada.org/cgi/content/full/136/2/201 I hope this is helpful. Keith >Most of my current crowns have been for molars, but I'm getting one on >a premolar, and am probably going with a ceramic-coated gold (Captek) [quoted text clipped - 6 lines] >I'd be interested in hearing what any dentists/technicians have to say >on these topics. Sorry I haven't searched Am now routinely using Captek for almost all posterior restorations. Believe they have a superior fit and strength as opposed to other types of porcelain fused to metal. In anterior situations or where esthetics are paramount am using all ceramic (Chromatech) *bonded* in place with Calibra. These are incredibly strong since the restoration becomes an integral part of the tooth. Machine milled ceramic is also an excellent choice. I need EIGHT crowns > Thanks in advance for your advice. > > Trudy Much can be done with epoxy bonding material; I, too, need caps, I want caps made of denture material: acrylic. G. >I need EIGHT crowns >> Thanks in advance for your advice. [quoted text clipped - 4 lines] >want caps made of denture material: acrylic. >G. Caps go on beer bottles and baseball players' heads. Crowns go on teeth and royalty. And acrylic would be a very poor choice for materials used for beer, heads, or teeth. ;-) D >>I need EIGHT crowns >> [quoted text clipped - 9 lines] > > Crowns go on teeth and royalty. I have one patient who is my worst isometric clencher. He breaks EVERYTHING. He can snap off thick metal posts, snap off whole teeth, and crack any type of porcelain I have put in his mouth. No caries or erosion. Oligocentric facial form with normal sized muscles. Go figure. Self-equilibrated occlusion. NTI every night and most of the day; (obviously not enough). Anyway, I am now trying composite (3M Z-100) crowns/onlays on him to see if they hold up any better. I ultimately want to do a pair of "overdentures". I plan to make RPD skeletons over his existing worn down teeth with acrylic occlusals on this. This way, any further damage would be to the appliance and easily repaired. I would do a diagnostic horseshoe on the lower to make sure he can tolerate a change in vertical first. I am hoping the composite crowns (machine milled--of course) will wear down rather than shear, and I know I can easily add to them or repair them as needed. We shall see how this works.  Signature/ Amatus / > > And acrylic would be a very poor choice for materials used for [quoted text clipped - 16 lines] >> >> Crowns go on teeth and royalty. >I have one patient who is my worst isometric clencher. He breaks >EVERYTHING. He can snap off thick metal posts, snap off whole teeth, and [quoted text clipped - 13 lines] >rather than shear, and I know I can easily add to them or repair them as >needed. We shall see how this works. Have you considered cast gold for say, just the first molars ? Or mebbe the seconds ? Just one pair each side... Just for use as positive occlusal stops and then construct the other restorations out of material of your choice. He has broken off the teeth with cast gold crowns level with the gingiva. His problem is not attrition, but breakage. We placed some cast posts and some pre-formed posts in endo posterior teeth about 15 years ago. He breaks these teeth through the root at the tip of the post. I want something that will break before his teeth do and which can be easily repaired. Signature/ Amatus / > >>I have one patient who is my worst isometric clencher. He breaks [quoted text clipped - 26 lines] > Just for use as positive occlusal stops and then construct > the other restorations out of material of your choice. Are all teeth fractured off at the gumline ? How about an overdenture with a cast frame ? Increase (^) the VDO to lengthen the muscles ? Sounds like a tough case. May be one of those rare indications for a horse shoe. Send me some pix at my yahoo account if you want to brainstorm this one. >He has broken off the teeth with cast gold crowns level with the gingiva. > [quoted text clipped - 36 lines] >> Just for use as positive occlusal stops and then construct >> the other restorations out of material of your choice. He will break a tooth every 8-9 months. My plan is the overdenture with a cast framework with acrylic teeth. I want to fit this to his existing teeth. I would hate to remove most of his teeth to get an CD overdenture in there. I would prefer to spread the load over as many teeth as possible, but with a "shear-pin" effect at the occlusal surface. If he will tolerate an increased vertical, I want to make overdenture type skeletons over the remaining teeth--RPD-ish. We would use a horse-shoe to verify vertical height. The only indication for a horse-shoe that I know of. Signature/ Amatus / > > Are all teeth fractured off at the gumline ? [quoted text clipped - 56 lines] >>> Just for use as positive occlusal stops and then construct >>> the other restorations out of material of your choice. >He will break a tooth every 8-9 months. > [quoted text clipped - 7 lines] >We would use a horse-shoe to verify vertical height. The only indication >for a horse-shoe that I know of. Actually had to make one last month. Made it to prevent further super-eruption after leveling the super-erupted lower anteriors and bonding new incisal edges. Severe class II, NTI wouldn't work and though I prefer it, in this case a SA splint was made. Actually got two small bloodless mechanical exposures 24, 25; bonded right over them. No symptoms to date. > Actually got two small bloodless mechanical exposures 24, 25; > bonded right over them. No symptoms to date. You'll probably hear from them later. ;-) D >> Actually got two small bloodless mechanical exposures 24, 25; >> bonded right over them. No symptoms to date. [quoted text clipped - 3 lines] >;-) >D Yep, but the patient was forewarned. Am taking odds that it will be < 12 mos. If he's like a guy I have had for a patient the last 20+ years, that won't be enough. (Mine also had severe TMJ pain) The cast metal overdentures have metal occlusion on the posteriors and procelain fired to the anteriors (lab first said, "You want *WHAT*?!?!). Not a perfect esthetic situation, but he doesn't wear his teeth down as bad. The last 'partials' made it 15 years before replacement (wearing through the metal). For the last 8 years, he wears a tall NTI at night. A mouthful of full gold posteriors and PFM anteriors would probably work (with dedicated NTI use), but it would cost a ton and repairs would also be more expensive. JME, D >>I am hoping the composite crowns (machine milled--of course) will wear down >>rather than shear, and I know I can easily add to them or repair them as >>needed. We shall see how this works. > Have you considered cast gold for say, just the first molars ? > Or mebbe the seconds ? Just one pair each side... > > Just for use as positive occlusal stops and then construct > the other restorations out of material of your choice. Have place amalgam (gasp!) restorations as occlusal stops in some dentures to slow down the wear. >If he's like a guy I have had for a patient the last 20+ years, that >won't be enough. (Mine also had severe TMJ pain) > >The cast metal overdentures have metal occlusion on the posteriors >and procelain fired to the anteriors (lab first said, "You want >*WHAT*?!?!). Porcelain fired to the anteriors ??? Not sure what you mean. Have heard of gold occlusals on posteriors. Do you have any pictures of this case ? >Not a perfect esthetic situation, but he doesn't wear his teeth down >as bad. The last 'partials' made it 15 years before replacement [quoted text clipped - 18 lines] >> Just for use as positive occlusal stops and then construct >> the other restorations out of material of your choice. >>The cast metal overdentures have metal occlusion on the posteriors >>and procelain fired to the anteriors (lab first said, "You want [quoted text clipped - 6 lines] > > Do you have any pictures of this case ? The patient arrived in my office in the early 80's with very worn max. and mand. dentition. He had a cast metal overlay appliance on the max. arch. He was having lots of TMJ symptoms and he was overclosed. On the mand. arch, he was missing both first molars. I consulted with my lab at the time and we fabricated a nonprecious metal 'partial' that included overlays of the total occlusion with porcelain fired on the anterior overlays similar to PFMs. Four years ago, or so, I had to do the same thing all over. Full mouth C&B would have been the ideal answer (with NTI wear), but the patient couldn't/wouldn't go for that. I had a couple of Poloroids in his chart, but nothing digital. D Clenching hard enough, you flex the mandible and the most carefully adjusted static occlusion does not mean anything. This guy will fracture teeth which are not in occlusion during a static test at rest. Unfortunately, many teeth have RCT now, so we have weakened teeth to deal with. I tried full crowns to support occlusion on 4 posteriors years ago, but he would shear these right off. I strongly believe that what I need is a planed failure point. A "shear-pin" if you will. Signature/ Amatus / > > If he's like a guy I have had for a patient the last 20+ years, that [quoted text clipped - 26 lines] >> Just for use as positive occlusal stops and then construct >> the other restorations out of material of your choice. >Clenching hard enough, you flex the mandible and the most carefully adjusted >static occlusion does not mean anything. This guy will fracture teeth which [quoted text clipped - 3 lines] >these right off. I strongly believe that what I need is a planed failure >point. A "shear-pin" if you will. Can't disagree with you there. Sounds like a tough case. Am sure that you are up to the challenge ;-D We don't use epoxy bonding materials in dentistry.... If you are going to give advice, please get it right. We use composite resins which most are bis-gma.... On Jul 16, 7:44 am, n16...@hotmail.com wrote: > We don't use epoxy bonding materials in dentistry.... If you are > going to give advice, please get it right. We use composite resins > which most are bis-gma.... Thank you for the keywords to search and read results, this from the website of the American Chemical Society chemistry.org, "Composite Resin Filling Chemistry". bis-gma photopolymerizable acrylic composite resin is viscous therefore diluted with TEGMA for the dentist to work with. The polymer resin is cement, the majority of the filling material is harder glass ionomer or a similar material, camphoroquinone (CQ) generates a radical species when exposed to light wavelength of 470 nanometer to polymerize the resin. Challenges facing chemical engineers and dentists using composite resins: A) reducing shrinkage of the filling B) developing a self-adhesive resin to remove a step in the restoration C) increasing the longevity of the restoration D) easing preparation and application of the filling material E) reducing loss of healthy enamel to the drill >Does anyone have anything good to say about dentures and partials? A *well made* partial is comfortable and functional. For some people it is the best treatment choice. Especially in light of rampant decay and projected longevity. > Of >course, dentists are not going to defend them because it decreases >their incomes. Complete and utter bullsh*t. >I am desperate. Thanks in advance for your advice. Can you post x-rays and/or photographs ? >Trudy > I am 51 years old and have had problems with my teeth all my life. I > grew up in a rural area with no fluoride in the water and perhaps that [quoted text clipped - 19 lines] > > Trudy natural teeth have chewing power that is about 10 times greater than denture teeth or partial denture teeth. You would be better off trying to keep the other teeth, especially try to keep lower back teeth, since they are the most difficult to replace. If you are at high risk for tooth decay, you should probably avoid having a partial denture. Partial dentures greatly increase the risk of tooth decay because they allow food to wedge in between the partial denture and the tooth, increasing the contact of teeth with food particles. These food particles break down, feeding bacteria that cause cavities. result: some people with partials can destroy the rest of their teeth via rampant cavities within 2-3 years of having the partials. About a third of the time, patients find their partial dentures too uncomfortable to wear. >> I am 51 years old and have had problems with my teeth all my life. I >> grew up in a rural area with no fluoride in the water and perhaps that [quoted text clipped - 19 lines] >> >> Trudy What a load of buffalo manure. >natural teeth have chewing power that is about 10 times greater than >denture teeth or partial denture teeth. You would be better off >trying to keep the other teeth, especially try to keep lower back >teeth, since they are the most difficult to replace. False, this is done very often with good results >If you are at high risk for tooth decay, you should probably avoid >having a partial denture. Why ? >Partial dentures greatly increase the risk >of tooth decay because they allow food to wedge in between the partial >denture and the tooth, increasing the contact of teeth with food >particles. Horse hockey. Easily rinsed after meals. > These food particles break down, feeding bacteria that >cause cavities. Sugar metabolism producing acid is what causes decay. > result: some people with partials can destroy the >rest of their teeth via rampant cavities within 2-3 years of having >the partials. Rare in my experience. Good hygiene and regular professional care can prevent catastrophic failures like this. >About a third of the time, patients find their partial >dentures too uncomfortable to wear. A *well made* partial is comfortable and functional. If you have trouble making good partials for your patients there is a simple solution: Take a great impression (get lessons if you need them) and pony up for a better lab ! |
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