Clasp/retainer location problem for partial denture

[albert@]

Please help Nearly 3 months ago I had my upper left central and upper left lateral incisor ( #9 & #10 ??) extracted. Im basing the tooth numbers from this site FAQ - Tooth Number All my other upper and lower teeth are complete and well

I want removable partial dentures . At first I wanted the flexible type ( valplast or duraflex ) but im told long term its more likely to cause gum stripping/receeding compared to non flexible frame . So Acrylic it is. My reservation on the non flexible acrylic partial is aesthetics. My dentist said the clasp would appear on and around tooth # 12 & # 5 ( upper left and upper right 1st bicuspid ) .This is unacceptable for me as when I smile , one can see up to my teeth # 14 & # 3 ( upper left and upper right 1st molar ). If the clasp are to be on and around teeth #14 & # 3 ( edge of my smile ) and thus unnoticable or barely noticable then Im fine but with clasp at 12 & 5 , or even 13 & 4 , they would be noticable to someone standing close to me, be the clasp be made of metal or tooth colored . Im not okey with that. So I said I want to think about it first.

Considering I have a full set of upper teeth except as mentioned tooth #9 & 10, is it possible to make a acrylic partial denture to have its metal or tooth colored clasp/retainer be made that far out ( # 3 & 14 ) to be not visible ? Considering there is very little space under and between the upper 2nd bicuspid and upper 1st molar, can a clasp be made to go under and between them without having a bite problem. ? If such is possible can be made to work , can someone please describe or better yet if you have a picture/photo on how this could be done to please post it in this thread. If not possible what alternative do I have other than just settiling for a flexible (valplast) denture .

Going for a Fixed bridge is not an option at least for now as its not yet 6 months after extraction and even so if I can satisfy my needs with a removable denture then I would prefer it over the last option of a fixed bridge

Thank You

 

[CYNOSURER]

If not possible what alternative do I have other than just settiling for a flexible (valplast) denture .

You may want to talk to another dentist about Valplast. I disagree with what you've heard about "gum stripping/receeding" being caused by a properly made Valplast. That notwithstanding, the 'acrylic' option with tooth colored clasps or even wire clasps is still a tissue bearing appliance which would make it just as likely to cause that same "gum stripping/receeding" as any Valplast...if that claim were, indeed, true.

 

[albert@]

You may want to talk to another dentist about Valplast. I disagree with what you've heard about "gum stripping/receeding" being caused by a properly made Valplast. That notwithstanding, the 'acrylic' option with tooth colored clasps or even wire clasps is still a tissue bearing appliance which would make it just as likely to cause that same "gum stripping/receeding" as any Valplast...if that claim were, indeed, true.

Sir , may I kindly know your opinion of the statement below that Ive seen on internet that has added to my reservation on flexible

Quote :
Valplast partial look great, and work quite well provided that the appliance fits properly when FIRST inserted. The difficulty involves adjusting the framework so that no sore spots develop. This can be a very difficult task . I have discovered over the course of the years that the number of followup visits and the time spent in trying to remove sore spots and make them fit comfortably can be excessive, and I have regretfully made the decision in my own practice to use them only for exceptional cases.

This notice does not apply to Flexite denture bases, which are much more dentist friendly

End Quote

Thank you

 

[CYNOSURER]

Sir , may I kindly know your opinion of the statement below that Ive seen on internet that has added to my reservation on flexible

Quote :
Valplast partial look great, and work quite well provided that the appliance fits properly when FIRST inserted. The difficulty involves adjusting the framework so that no sore spots develop. This can be a very difficult task . I have discovered over the course of the years that the number of followup visits and the time spent in trying to remove sore spots and make them fit comfortably can be excessive, and I have regretfully made the decision in my own practice to use them only for exceptional cases.

This notice does not apply to Flexite denture bases, which are much more dentist friendly

End Quote

Thank you

If you analyze the statement it explains itself.

If it fits; it works. If it doesn't fit; they will try to make it fit.

It is easier to get a Flexite partial, that doesn't fit, to seat than it is to get a Valplast partial, that doesn't fit, to seat. But the bottom line is you've got a partial that doesn't fit. Here's a fine example:




They couldn't get this partial to seat. The partial was made on the green model. The new model is the yellow one. Note the size difference with just this one tooth.

As you might expect, they were never going to get it to fit. If it was made out of something 'more dentist friendly' then they might have seated it (and sold it). Because this was Valplast (and a bitch to adjust) this poor patient will have to come back to get a partial that FITS! If only they had used Flexite! All the work they did (trying to get it to 'seat') would have been easier...and possibly successful.

As much as I'm all for making things easier, making it easier to sell partials that don't fit...isn't one of them.

 

[JohnWilson]

Albert,

Like most things in this world its advantageous to educate ourselves on things we want to purchase. Although I defer to specialists often that have more experience than I do and at that point I put my trust in them. I see you are trying to do the same thing. I suggest you look to a Dentist that will listen to your concerns and will address them in a manner that is acceptable to you.

As I have evolved as a tech and a laboratory owner over the past now 23 years I have gained much knowledge on many subjects as they relate to dentistry. In that time I have had many family members and staff rely on my suggestions as it relates to dental care. In the beginning I would always feel very impressed with myself as to my ability to address their questions. I knew in my heart that they were scared of treatment and wanted to make sure they were being serviced in the most advantageous manner.

Today when these situations arise I ask them "what goals do you have"? Save money? Long term solution? Patch me up? Best possible restoration? Then I defer them to a client that will meet that need and address their concerns

My advice is put your trust in a dentist you feel comfortable with. Get referrals from family and friends and realize SHOPPING around for dentistry is not like shopping for a pair of pants.

The analogy I use if you needed open heart surgery would you read up on the INTERNET to see if thats what you really needed, or would put your trust in the Dr and realize he has your best interest at heart.

I wish you luck

 

[thetoothfarie]

Albert,

Advice #1
to John Wilson.

Advice #2
Ask your Dr. about clear flexible clasp's on metal frame with acrylic saddles.

Best Wishes,

 

[albert@]

Thanks for the advice. Im from and in the Philippines by the way. Ive actually seen 2 dentist. I was comfortable talking to both of them .

The first , late 40's said of the asthetic beauty of flexible but that flexible denture are commonly frowned upon by prosthodontists and periodontists that she personally knows of due to long term concerns of its tendency to make the gums receed and long term constant pressure of clasp on the gums will have as opposed to clasp on tooth. That its not as biologically compatible and less friendly to gum tissues. She even told me to do a simple experiment . With 1 finger put pressure on one healthy tooth for 30 seconds , then repeat ( using same pressure and duration ) on the gum area just above that tooth . Which is more comfortble ? The tooth. More so when putting pressure on the gums as a clasp would you are restricting some blood flow in that area and thats what you'll be doing for hours in a day for weeks months and years which is not good long term. To end she says as a dentist she stands to earn more from making valplast or similar type flexi . She just wanted me to understand the long term implication of such and that denture which comine flexible with metal is better for support , retention and most importantly gum health. She will earn less and I spend less but its okey coz her patients health comes first for her.

The 2nd dentist around mid 30's, didn't say much contering the concerns of flexible and only said that it may be true if the adjustments are not done well .He admits that at times the first fit of flexible are not right on but just a FEW extra visit to adjust and get sore spots corrected .Also some blood flow restriction by the clasp on the gums is no health concern on the long term basis as long as the area does not hurt or feel sore

when I visited both dentist they had other patients waiting in line so its not like any of them were desperate to have me as a patient. One might say one is a bit more old school and the other new school. Confused and concerned is what Im left with now. So Im seeking foreign opinion from lab techs before making my final choice.

Thank You

 

[CYNOSURER]

Interesting experiment.

There are some conclusions I could make. Either: a) she doesn't understand the concept of clasps or b) she is good at sales or c) both.

The concept of a clasp is that it is passive at rest. It sits under a bulge and only applies pressure when it is being pulled over that bulge. Valplast can take advantage of tissue undercuts but, generally, it uses the tooth. Either way, whether that bulge is tooth or tissue or the whether those clasps are metal or nylon or acetyl (tooth colored) there should not be constant pressure.

I don't know what she was referring to when she made the 'biologically compatible' remark. Though there are doctors (and techs) who don't like Valplast, very few will claim that the material, nylon, is not as biologically compatible as acrylic or many of the metals that partials are made of. If anything, it is more bio-compatible than most.

She may have some very good reasons for not recommending Valplast and has found that her 'simple experiment' to be a convincing way to steer patients away from it. I will give her the benefit of the doubt and assume it was just her 'sales technique' and not that she doesn't know what she's talking about but that what she knows can be so difficult to relay that she simply took a 'simple' approach.

 

[albert@]

Interesting experiment.

There are some conclusions I could make. Either: a) she doesn't understand the concept of clasps or b) she is good at sales or c) both.

The concept of a clasp is that it is passive at rest. It sits under a bulge and only applies pressure when it is being pulled over that bulge. Valplast can take advantage of tissue undercuts but, generally, it uses the tooth. Either way, whether that bulge is tooth or tissue or the whether those clasps are metal or nylon or acetyl (tooth colored) there should not be constant pressure.

I don't know what she was referring to when she made the 'biologically compatible' remark. Though there are doctors (and techs) who don't like Valplast, very few will claim that the material, nylon, is not as biologically compatible as acrylic or many of the metals that partials are made of. If anything, it is more bio-compatible than most.

She may have some very good reasons for not recommending Valplast and has found that her 'simple experiment' to be a convincing way to steer patients away from it. I will give her the benefit of the doubt and assume it was just her 'sales technique' and not that she doesn't know what she's talking about but that what she knows can be so difficult to relay that she simply took a 'simple' approach.

Thanks a lot for your help. One FINAL point of clarrification , you say that :

with Valplast whether that bulge is tooth or tissue or the whether those clasps are metal or nylon or acetyl (tooth colored) there should not be constant pressure

my question is, isnt it constat pressure on the clasp area of valplast needed to keep it in place ( retention ). IF not how does a valplast type denture keep/stay in place (retention) without the "grip" that the clasp provides on the gums ?

Thank you

 

[CYNOSURER]

It locks underneath the bulge of the tooth.

 

[CYNOSURER]

Here's a nice parallel:

A ring on your finger doesn't stay on because it is putting constant pressure on your finger. It stays on because it's a tight squeeze over the knuckle.

Suppose you never heard of a ring and I didn't want you to wear one. A simple experiment would be to wrap a rubber band around your finger and watch it turn blue...then declare: Imagine what a ring will do to your finger after a week, a month, a year? You'd lose that finger.

 

[CloudPeakDL]

Has anyone ever heard of a twin-flex clasp?
We used them quite often in the A.F. - I'm having trouble finding a lab that can accuratly fabricate an appliance with one, but the concept is a wire in the anterior region engaging the undercut of the adjacent teeth. It works very well in the anterior if you can engage both sides of the edentulous space. The wires are bent and then soldered or welded to the appliance and major clasps can be placed further back out of sight. The doctor and frame designer need to pay close attention to the path of insertion but if fabricated correctly are great.

 

[CYNOSURER]

Eras and Plunger attachments may the reason they aren't being done by a lot of labs. That and if it's a free end appliance the mesial rest design is critical. Although, plungers and ERA can present with clearance problems, so it's always nice to have these in the tool box. I refer to them as the Poor Patient's Plunger or PPP as opposed to shorter peepee or classic wee wee wee all the way home.