Frame design help

[John in Canada]

It's rare, but I am at a loss. Patient has teeth 4,5,6. They are solid. Is there as a stable design for this situation? Patient cannot afford to sink a couple implants on the other side of the arch. Upper partial will oppose lower partial, to be fabricated at the same time.

 

[JMN]

It's rare, but I am at a loss. Patient has teeth 4,5,6. They are solid. Is there as a stable design for this situation? Patient cannot afford to sink a couple implants on the other side of the arch. Upper partial will oppose lower partial, to be fabricated at the same time.

A cast definitive will be an extraction device no matter how you do it just because of the torque that will be generated from 11-15 especially.

The standard argument that a tooth borne prosthesis is desired to eliminate bone resorbtion as the teeth are intended to take the force just doesn't work here as the entire bone will not be saved at all on the pt left no matter what you do to the clasping arrangement.
And unless they are going to come in for a reline every six months there is no way any rigid clasping design will not end up with the good teeth being pulled out of their current state.

If you can get them to be okay with a tissue borne solution, using something like either Keystone's It-So-Clear clasp (fairly rigid and basically need flame work) or Flexite's Clasp-eze in clear, pink, or tooth shade clasps (less rigid and work well with a heat gun) and having a proper pps, that'd be what I'd try to push. The less rigid clasps will help with orientation, but not hold enough in this situation for retention. Basically perfect for this application.

Flexite's are a acetyl resin thermoplastic. https://flexitecompany.com/pre-formed-clasps/ I use a super hot hair dryer and a glove with textured fingers to give them a pattern which prevents the super shine from any angle as would normally happen from a perfect sphere portion. You'll want to have enough room pure for mechanical retention.

Keystone's are another thermoplastic. Same stuff as their ClearMet rpd cartridges which their marketing says are up to metal replacement duty.

ItSoClear

Itsoclear Clasps | Keystone Industries

Itsoclear Clasps provide the ability to produce and repair a clasp in less than four minutes with cosmetic appeal unlike any other clasp.

dental.keystoneindustries.com

I expect you likely knew about at least one of these clasps, but wanted to make sure.

As @kcdt has said "Now little partial, don't you cry. You'll be a denture by and by."

 

[TheLabGuy]

Make a denture ...you want to save those three teeth, that's fine. Put a cusil or gasket around them but at this time, design as the patient is edentulous, tissue retentive appliance.

 

[JMN]

Make a denture ...you want to save those three teeth, that's fine. Put a cusil or gasket around them but at this time, design as the patient is edentulous, tissue retentive appliance.

Can I enroll in your next brevity indoctrination class?

 

[denturist-student]

It's rare, but I am at a loss. Patient has teeth 4,5,6. They are solid. Is there as a stable design for this situation? Patient cannot afford to sink a couple implants on the other side of the arch. Upper partial will oppose lower partial, to be fabricated at the same time.

If this is an upper with a unilateral situation in the upper arch it will seldom work. Gravity will take over eventually working against it. Lower is noo problem but upper will never be stable. I usually in a unilateral case of upper arch get the patient to extract the rest...

 

[John in Canada]

If this is an upper with a unilateral situation in the upper arch it will seldom work. Gravity will take over eventually working against it. Lower is noo problem but upper will never be stable. I usually in a unilateral case of upper arch get the patient to extract the rest...

I am always against extraction of solid teeth. I have seen single cuspids and single bi cuspids last for several years before requiring extraction. Patient may go for an implant placed in the 2-3, 2-4 area. Using a locator and he will be solid once again. If no implant(s),the ultimate demise of these teeth will be loss no doubt.
Perhaps I am out of the loop here, but I have never heard of 3 remaining teeth in a quadrant called a unilateral. I have always known a unilateral to be a small partial in one quadrant to replace one or two teeth with no cross arch attachment.

 

[rkm rdt]

They speak a funny language down there John.
They even have to count teeth on their fingers and toes.

 

[TheLabGuy]

Can I enroll in your next brevity indoctrination class?

Lol...you think I'm being a little too short these days with my words?

 

[JMN]

Lol...you think I'm being a little too short these days with my words?

Just that your paucity of verbiage contained the same suggestion as my verbose post and did so with much greater clarity.

 

[TheLabGuy]

Just that your paucity of verbiage contained the same suggestion as my verbose post and did so with much greater clarity.

I blame that on my crumb snatchers...when they were younger, it was, "why Dad", "but why Dad"... they are all teenagers now, the 'why' game is over with. Be very specific, small sentences, even point if you have too, then just maybe it might get done that way...lol

 

[denturist-student]

I am always against extraction of solid teeth. I have seen single cuspids and single bi cuspids last for several years before requiring extraction. Patient may go for an implant placed in the 2-3, 2-4 area. Using a locator and he will be solid once again. If no implant(s),the ultimate demise of these teeth will be loss no doubt.
Perhaps I am out of the loop here, but I have never heard of 3 remaining teeth in a quadrant called a unilateral. I have always known a unilateral to be a small partial in one quadrant to replace one or two teeth with no cross arch attachment.

I suppose that requires some explanation. When the only remaining teeth are in a single upper quadrant it usually doesnt work.Ie when the canine and two bicuspids are ony remaining int he arch on one side, it usually doesnt work.