PFM w/ Connector Bar for Denture?

[qlife]

Hi. I got a dentist here requesting for 2 PFM crowns #6 & 12 with a bar connector in between for a denture in the future. We've done bar connectors for overdentures and implants but never with PFM crowns on them. Can this even be done?

 

[amadent]

Hi. I got a dentist here requesting for 2 PFM crowns #6 & 12 with a bar connector in between for a denture in the future. We've done bar connectors for overdentures and implants but never with PFM crowns on them. Can this even be done?

seems like he would be asking alot of the pfms as far longevity of the case
( IMO)

 

[droberts]

Sure. Have seen them done with a Hader, or a Dolder bar on the mand. arch. But 6 thru 12 could be a long span. Why not put an attachment either mesial or distal of the PFM's, if VDO is not an issue? Then have a cast frame horseshoe fabricated.

 

[kcdt]

This used to be a fairly standard thing in days gone by.
The reason it's not really done anymore is that the treatment plan sucks.
The bar creates a situation that CLEARLY violates Ante's law, ie, too much dentition anchored by too little root surface area.
On top of this, the crowns represent an unfavorable crown/height ratio that will allow lateral forces to "fencepost" the roots right on out of there.
The only way to retain a denture with only 6 & 11 is to decapitate at the gingiva,endo, and sink a stud attachment in the root to create an overdenture.
Otherwise you will lose the teeth.
Tell your doc to get some CE, for Christ's sake, and stop with 20 year old bad ideas.

 

[kcdt]

Sure. Have seen them done with a Hader, or a Dolder bar on the mand. arch. But 6 thru 12 could be a long span. Why not put an attachment either mesial or distal of the PFM's, if VDO is not an issue? Then have a cast frame horseshoe fabricated.

I still think he's better off with a stud overdenture. The lateral forces will be murder, and the horseshoe won't occupy enough real estate to stop the denture from fishtailing.....

 

[Daniela]

Tell your doc to get some CE, for Christ's sake, and stop with 20 year old bad ideas.[/QUOTE]

We need a "LIKE" key on this site or better yet "agree" "disagree"

 

[labmanmike]

I Have not done one for years but strangely enough I just got a 22 abut to 27 abut Hader Bar case today. This is not a difficult challenge. I've done many this way. As long as the bar is not too long compared to the supporting abutment teeth. On my case the teeth are healthy cuspids the Doctor did not want to root canal. A hader bar is just as good as ERA on single abutments in my opinion. Proper measurements between the abuts (abutments crowns) to make sure the denture teeth will have properr spacing is important. The root issues are the Doctors respossibility,not yours. If the Dr feels there is supporting bone, well then he pays the bills. Good luck my friend...

 

[denturist-student]

We classify long span as Class IV and beyond a cuspid....Class IVs are treated as a reverse Class II or III and would need some sort of stress breaker. Perhaps a softer nylon gasket would do...Also maximum tissue coverage would be necessary...Still there may be too much load for the abutments to reccomend a full span dolder or hader bar....which are usually reserved for canine to canine spans....Would depend upon the support...Possibly an additional implant or two in the anterior...That might be done without sinus lift...I would hesitate making a span such as you have described....hope this helps....Dan

 

[rhicks3302]

I still think he's better off with a stud overdenture. The lateral forces will be murder, and the horseshoe won't occupy enough real estate to stop the denture from fishtailing.....

ABSOLUTELY! Instead of extracting these teeth slowly with crowns + hader bars or cantilevered attachments, the dentist needs to amputate, endo, and place resilient attachments. O-rings preferably, if you have the vertical.

We do need an "AGREE" button.

 

[droberts]

ABSOLUTELY! Instead of extracting these teeth slowly with crowns + hader bars or cantilevered attachments, the dentist needs to amputate, endo, and place resilient attachments. O-rings preferably, if you have the vertical.

We do need an "AGREE" button.

I should have known better to even reply. The case designed out correctly could be an attachment type partial. Three saddles, two attachments, and a A-P strap in the post. But you know what? I should not even be saying that now should I? There is way too much information we do not know that non of us should be guessing at this. What is the opposing arch? Are the teeth stable? What is the VDO? Patient a Bruxer?
If the case was going to be a resilient type, an O-ring would be my last choice! Cast to Locator would be the best. So in the future, please post and ask questions with the above mentioned with photos!!!

So if we had an "AGREE" button. What would we be agreeing
to?

 

[TheLabGuy]

I'm curious, what would you do differently if it was a Bruxer Danny?

 

[rhicks3302]

I agree with kcdt, that's all. I would choose an O-ring because it's probably the most resilient attachment out there. This way the abutment teeth are used for retention only, not retention and support. Locator would probably be my second choice because they are low profile and resilient.

Considering the occlusal load and lateral forces only, would anyone put a full mouth roundhouse bridge on 2 abutments? Bruxer or not and IMHO, a rigidly designed RPD with hader bar or attachments fails sooner than later.

You're right, Danny, we need a bunch more info here. But I still wouldn't design this case as the doctor requests.

I guess we need an "agree to disagree" button.

 

[kcdt]

I should have known better to even reply.

Wow. Sorry you feel that way. In my 27 years at the bench, I've seen a good number of these types of cases, and when I was younger and inexperienced, thought they were the cat's meow. But as familiarity with them grew, I discovered that construction of the RPD elements wasn't always such an easy deal- sometimes the bar was done by a C&B lab with NO REGARD fro the removable lab's needs; they often are too tall vertically, and the span over the bar is often an area that comes back after a few years completely separated. It is a weak spot, and trying strategies such as a beaded shell vs an acrylic saddle only delay the delamination issue, but don't seem to stop it. A decade or more down the road these come in as complete dentures, regardless of WHO made them.
So as time and experience taught me, it's a flawed idea that was once considered good, but that time and biomechanics has taken the shine off of.
It's just not a treatment I would endorse knowing what I do now.
I'm sorry if that level of honesty about my evolution in thinking has made you feel somehow criticized, or you thoughts unwelcome. Nothing could be further from the truth.
MY stance is that over the years my dissatisfaction with these has grown to the point that I don't favor them, and I refuse to continue to repeat what I feel were errors on my part.
I didn't intend those statements to turn into a popularity contest, and if you felt slighted by them, then please accept my apology.

 

[droberts]

Gentleman, no apologies needed here. I simply made a mistake on my part by stating a possible solution before knowing all the other info needed. Wont happen again. Like I said, until I see photos and have more information I am not even going to reply to anything here. How can anyone even consider the lateral forces and occlusal load when you dont even know what the opposing arch is? Is the patient a class l, ll, or lll? There is just not enough info to even continue this discussion, or to try an treatment plan this case. Now "qlife", please give more info...

 

[qlife]

The patient basically just has the 2 teeth and that is it. Nothing on opposing, just #6 and #12. The only instructions given were to keep the bar near the gumline, and that he was going to put a denture over it. All he sent was an impression of the upper and nothing else. He just said to make the crowns ideal. We told him we couldn't guarantee the work and just gave him what he ordered.

 

[labmanmike]

Thats about all you can do my friend. All the clinical stuff is not your responsibility. If he just pays the bill now, you are good...