Removeable partial denture troubles

[twaite]

I just had a consult with an rpd patient. It was pretty interesting. He had had his prd adjusted 21 times by his former dentist, always on the left side under the saddle. It rubbed there because when he bites down it rocks.
I adjusted his bite on the right side and reduced it by about 3mm, then reduced the bite on the left about 2mm, It still rocked. So I tightened the clasp, it still rocked. Finally, I added some coe soft on the left side to build up where it had been previously adjusted. It still rocked.

From what I can tell the frame work looks good, the rest are seated, the bar is on the tissue, the design seems good. The clasp seem good, It's replacing teeth 18,19,20 and 29,30,31.

Can anyone help me figure this out?

Teresa

 

[XxJamesAxX]

Did you make the partial or just jumping in?

Either way its probably going to be cheaper and a whole lot less time consuming to just start over. IMO... If it was me I would recommend stripping the frame to see how it fit. If all is good just start over from there, if not make a new frame. I'm sure if it was made somewhere else the Pt doesn't want to pay for a new one but you and the new Dr. going to be out more time then its worth. 21 adjustments thats crazy...

 

[twaite]

yah, I'm jumping in, and yes he doesn't want to invest any more money, He was just hoping we could do something for him. It would be so great to figure it out though. I was thinking of stripping it, taking a new bite, and setting new teeth and even offered that to him but of corse that requires fees. My last thought is perhaps the clasp on 27 isn't under the under cut enough and it's not holding it down.

 

[wilkscm]

If it is a free end saddle then it will allows move under compression no way round that also what type of clasps does it have how much bone loss is in the saddle area

 

[XxJamesAxX]

yah, I'm jumping in, and yes he doesn't want to invest any more money, He was just hoping we could do something for him. It would be so great to figure it out though. I was thinking of stripping it, taking a new bite, and setting new teeth and even offered that to him but of corse that requires fees. My last thought is perhaps the clasp on 27 isn't under the under cut enough and it's not holding it down.

Really difficult to say without seeing it or actually being there, seems you have all the basics covered is the reason I suggested stripping or starting over. We have those cases from time to time that just seem unexplainable. I hate spending much time trying to fix something because if you aint careful it soon would of been cheaper and faster to just remake it. (Especially something someone else made) If you & the dr. are feeling generous maybe offer the pt a discount. After 21 adjustments he should of had the last dr. remake it. My 2 cents is something is tweaked in a way your not going to be able to fix it with simple adjustments...

 

[jobu]

Does it rock all the time or only after the patient bites down? I have found that if the flange is long or thick in the area under the molars it will pop up or rock. There are three muscles and a tendon that join in this area. These muscles work to push food over the teeth. Being long or thick here will cause the muscles to dislodge the partial. This may be the source of the problem. Or not.

 

[twaite]

I think you are spot on. I'm going to suggest that to the Doc. It's quicker, cheaper, easier to just start over from the framework. I could recapture the bite, set teeth, wax try in process and call it a day.

 

[Flipperlady]

I think you are spot on. I'm going to suggest that to the Doc. It's quicker, cheaper, easier to just start over from the framework. I could recapture the bite, set teeth, wax try in process and call it a day.

And maybe he could get around to pouring up that alginate impression a little sooner

 

[AJEL]

Originally Posted by twaite
I think you are spot on. I'm going to suggest that to the Doc. It's quicker, cheaper, easier to just start over from the framework. I could recapture the bite, set teeth, wax try in process and call it a day.
And maybe he could get around to pouring up that alginate impression a little sooner

I think Teresa takes her own impressions & pours them up, They allow that in Portland (denturism),& this is a case that came in from another facility that she has the opportunity to learn more about fixing stuff.
I only hope she doesn't get to learn about marring a case.

 

[lcmlabforum]

I think you are spot on. I'm going to suggest that to the Doc. It's quicker, cheaper, easier to just start over from the framework. I could recapture the bite, set teeth, wax try in process and call it a day.

I would take a good look at how rigid that framework is before doing that.
I have seen cast lingual bars that are so thin it would flex like a Valplast. You would be wasting your time
if the major connector design is lacking. Remember that the mandible flexes.
Just my 2 cents worth.
LCM

 

[AlbertLam]

I think the doctor should check if the remaining teeth has periodontal problem.
If the abutment teeth are rocking, the RPD will not be stable, no matter how well it fits the model.

 

[Smilestyler]

A partial that has been adjusted 21 times is not your problem until you start messing with it. I would try and back away from this RPD. Tell the patient it is not fixable and put together a treatment plan to correct his problem (new one). Don't get in the habit of fixing another practitioners screw ups unless he pays you well for it.

 

[prodigy1]

Could you reline it?

 

[TomZ]

Altered cast technique, see if it still rocks. View attachment altered cast tech PP [Compatibility Mode].pdf

 

[twaite]

Hi TomZ, I have seen several of your videos. Thank you for posting them. I can't seem to get this link to open. I will check website? I have another rpd that is rocking. This time it's one I impressed for.
When the pt bites on the left it pops off on the right. I tightened the clasp really tight but it still pops, he also states that it doesn't feel like it goes up all the way. This is the second rpd with this palate problem from the lab I use.
I'm not sure what caused this problem or what I can do to prevent it. The lab says to take a new impression and they will remake the framework but even after that it still doesn't fit.
The problem is the patients are loosing confidence and I don't know if its lab side or chairside.
I have the framework cast at an outside lab but I set and process at my lab.
During framework try in I do have to make a lot of adjustments and grinding to get the frame to fit but I get it fitting so I move forward to set and process.
For processing I flask in a hanau flask and pack the acrylic. press and cook.

 

[twaite]

I got the link to Altered cast techniquie.