Some advice on this case.

[aidihra]

The five anterior teeth on the maxillary will probably be prepared for a 5 unit splinted pfm. The doctor wants to attach a denture to the 5 unit splinted pfm (with a lingual ledge on the teeth) . He wants attachments that can easily be replaced if needed. I was thinking ERA attachments for this case. There is plenty of room for attachments so space is not a problem. There will be a partial denture on the mandibular.

Any ideas or suggestions for this case is appreciated. It's been a while since I used attachments on a case.

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[Jo Chen]

Well, lots of people looked at your case but nobody is suggesting anything. I’ll take a stab at it. ERA’s are too cumbersome and create a cantilever. My suggestion would be Bredent SG (2.2mm) attachments or Preci Sagix (2.2mm) from Preat .

http://www.dent-line.com/2011 attachment web.pdf

preci_sagix

Both attachments have interchangeable females (can’t wait to see the comments to this one). Mill two palatal ledges on each side. The palatal milled ledges should be milled in a curve, not in a straight line. The “wings” can be waxed and cast in gold and then lasered or soldered to the partial frame. If cost is an issue, cast the wings as part of the partial.

 

[stevo]

I'm not sure what ever you use to retain this denture will be successful as it will still drop in the posterior region or it will place to much force on the remaining teeth that it will create trauma to the bone which will eventually lead to the loss of these teeth. If it was a case that presented to me I would be suggesting a Full clearance and a immediate denture. The anterior teeth looked liked they have been bonded together which suggest that they are not stable

 

[aidihra]

Thanks for the suggestions Jo.

Stevo I agree, the teeth seem like they may not be that stable. The teeth have shifted far out buccally. I haven't really discussed this case with the doctor in too much detail, but I was already thinking to suggest to him that maybe a full upper denture would be best. I'll talk with him later this week. Until then, I'm looking for any ideas.

 

[Jo Chen]

The wings counter the dropping since the attachments act as the fulcrum, preventing any rotation.
Don't extract the teeth if the teeth are periodontically sound. This will preserve the bone for potential future implants. Maybe cut the coronal portion, do RCT, post and attachment if the coronal part of te tooth is not worth saving.
popcorn

 

[paulg100]

just finished a combi case like this wich crowns and chrome. I used the Bredent variosoft attchments, worked out ok.

The only thing with those is its not a pick-up type so you better hope the imps accurate.

 

[nvarras]

I'm with Jo. If the teeth are unstable do not extract. Have the doctor cut off the coronal portion and use overdenture attachments to stabilize the denture. There are plenty out there that work just make sure you use a castable one. Castable attachments will allow you to cover the root form with a coping rather than leaving it exposed with something like a direct placement attachment.

 

[Al.]

Well, lots of people looked at your case but nobody is suggesting anything.

Probably because it should be posted in the removable section or over on the dark side of dentistry.

 

[aidihra]

If anyone wants to move this topic to another section, I'd be ok with that.

The 5 teeth will not be removed, so there will be a pfm bridge there.

 

[thetoothfarie]

is that a retained root tip in #2 area? If so, I suggest a locator attatchment.

Without x-rays it is impossible to determine the stability of the anteriors. If the postier teeth have been missing for a while, the anteriors may have flaired due to the extra force placed on them.

 

[Jo Chen]

Probably because it should be posted in the removable section or over on the dark side of dentistry.

LOL, it is a combo case after all. You Al could do a great job with the porcelain for the bridge. Making it look like teeth that have been in the mouth for three decades, none of this LVI (Las Vegas Veterinary Institute?) stuff.

 

[Bobby Orr ceramics]

I would have no problem doing this case with ERA's on a spinted bridge. However, the most important challenge here is getting this maxillary mounted to the proper X,Y,Z plane. Design it to as close to horizontal table as possible yet still contact with lower teeth. The other critical component that will make or break this case is the bite registration of the new mandible position....... This patient should be in a temporary partial on the maxillary to create the new mandibular position with posterior support. Very important prior to prepping and then mounting the lower in space.

Good Luck !! PM me if ya need some help, James

 

[aidihra]

The patient is wearing temporary upper and lower dentures. She looks like a monster with those upper anterior teeth protruding so much. Thanks for the help offer.