Suggestions Please

[Al.]

Ive been working on this office for 1 1/2 yrs now and this week they sent me 18 units. Persistance pays off.

I recieved this case yesterday, and Im going to call the Dr on it tommorow.
He wants and 8 unit bridge. 21-28 with 21 and 28 being cantilevers. 21 and 27 abbutments.He is making a new upper denture after he seats the br.
I havnt talked to him about it yet but I assuming he will want it designed for a lower ptr.

Do any of you have recommendations on where I should put the rests?
I dont want anything on the cantilevers do I? I would think that over time that could torque the br and mabey cause it to loosen up and cause microleakage and decay on the abutments.

I sure the Dr is going to tell me his design but I wanted imput from the removable experts.
Thankyou, Al

 

[JohnWilson]

Ive been working on this office for 1 1/2 yrs now and this week they sent me 18 units. Persistance pays off.

I recieved this case yesterday, and Im going to call the Dr on it tommorow.
He wants and 8 unit bridge. 21-28 with 21 and 28 being cantilevers. 21 and 27 abbutments.He is making a new upper denture after he seats the br.
I havnt talked to him about it yet but I assuming he will want it designed for a lower ptr.

Do any of you have recommendations on where I should put the rests?
I dont want anything on the cantilevers do I? I would think that over time that could torque the br and mabey cause it to loosen up and cause microleakage and decay on the abutments.

I sure the Dr is going to tell me his design but I wanted imput from the removable experts.
Thankyou, Al

Hi Al,

Since the Dr is asking for can'ts I imagine he will not be making a RPD. With 2 abutments left, a long span bridge and a removable partial is a recipe for disaster. The only beny is the fact that its opp a denture.

 

[Kreyer]

Al,

Too many forces on two abutments...doomed to fail. What will the crown to root ratio be let alone the lateral forces on these abutments.

Case should be a mandibular root retained overdenture and maxillary complete denture. If the dentist did endo on #21 and #27 remove clinical crown and you make a root cap coping with attachment the overdenture would be very retentive and this design will decrease forces on the two remaining abutments.

Also the maxillary denture should be set up first in wax to determine the smile line and placement of pre-molars. This will dictate placement of mandibular teeth instead of the opposite as you stated.

My recommendation is to set up all maxillary and mandibular teeth for a tryin and this will guide you in making a decision on the treatment plan. This way VDO/CR will be verified as well as aesthetic expectations.

Robert Kreyer CDT

 

[TheLabGuy]

I AGREE WITH KREYER!!!!! This is doomed to fail, doesn't matter if he puts a RPD on the lower (which i doubt) or not, still going to fail. Even if it's a fixed bridge it won't last, way too many forces with no retention. I'd highly suggest doing an overdenture, I know it's the first case, but you're asking for it on this one.

 

[labdude]

I now nothing of this type of work, however, sounds like a sort of "test".
Take what is posted here, as you will, and present it back to the dr, along with your own thoughts. Doesn't seem to be a middle road, if you want a guy later saying how your case didn't work, do exactly what he asks.
For me, glass is half full....guy is waiting to see what you know.
That is the great thing about his site, and, especially the people here.
John Wilson, Robert K., Rob, and all the others that are helping out a fellow worker, thanks to these guys, the over all service recieved by a patient will be greatly improved.

 

[Al.]

Is there any reason I cant do telescopic copings? Build the bridge on top of them. The teeth will be protected. They are both between 9 and 10 mm long.

 

[kcdt]

to Robert Kreyer! This needs to be an overdenture.​

 

[Al.]

Al,

Too many forces on two abutments...doomed to fail. What will the crown to root ratio be let alone the lateral forces on these abutments.

Case should be a mandibular root retained overdenture and maxillary complete denture. If the dentist did endo on #21 and #27 remove clinical crown and you make a root cap coping with attachment the overdenture would be very retentive and this design will decrease forces on the two remaining abutments.

Also the maxillary denture should be set up first in wax to determine the smile line and placement of pre-molars. This will dictate placement of mandibular teeth instead of the opposite as you stated.

My recommendation is to set up all maxillary and mandibular teeth for a tryin and this will guide you in making a decision on the treatment plan. This way VDO/CR will be verified as well as aesthetic expectations.

Robert Kreyer CDT

I dont think these are root canal teeth. There is no reason I cant do 2 pfms splinted with a hader bar is there???

What about two telescopic copings. Then I build the bridge on top of that.
Wont the teeth be protected. He may have to reseat the bridge when it loosens and pay me to repair it if he damages it, but the teeth wont be harmed. Correct?

 

[TheLabGuy]

2 pfms with a hader bar would be like putting buckets on fence posts...................as for telescopic copings, that would just make the bridge rock even more and make the teeth snap off easier, or more likely, bone resorption in the root area because of the forces being presented to it.

I would only handle this case in one way.......Tell the Doc I appreciate this case but am really worried that this bridge won't last and permanent damage will occur to those teeth, maybe the doc will tell you the patient is terminal and wanted a nice smile before he/she dies (had this happen). Then see where the conversation leads. Tell the Doc you'd hate to make the first case you do for him not last. I wouldn't warranty something like this Al. This case may cost me a client, but I'll be able to sleep at night....and a man has to sleep...lol

 

[Kreyer]

I dont think these are root canal teeth. There is no reason I cant do 2 pfms splinted with a hader bar is there???The span between the two abutments is too long plus the curvature of arch from 1st pre-molar to canine adds another variable.

What about two telescopic copings. Then I build the bridge on top of that.
Wont the teeth be protected. He may have to reseat the bridge when it loosens and pay me to repair it if he damages it, but the teeth wont be harmed. Correct?

The roots will come out with the bridge

Al,

Give the dentist two technical treatment options each with their advantages and disadvantages. One option with the dentist original plan and state possible longevity problems and having to possibly convert the lower to a full mucosal supported denture. The second is the mandibular overdenture and state how long this will last the patient providing they have good hygiene around the abutments. Most denture wearers have very poor hygiene habits.
You and the dentist will be providing the patient with a very good prosthodontic service with the overdenture. The dentist and you might not make as much money but you will have a case that has taken into consideration the biomechanic variables and a very happy patient.

Believe me the dentist will respect you much more for recommending another option. If they want to go ahead with original plan just state that you will not be responsible if the abutments are extracted by the bridge. When the abutments do come out and they will (it is just basic engineering principles of a lever) then the patient will be into complete mucosal supported dentures unless implants are an option.

Rob

 

[Al.]

The roots will come out with the bridge

Al,

Give the dentist two technical treatment options each with their advantages and disadvantages. One option with the dentist original plan and state possible longevity problems and having to possibly convert the lower to a full mucosal supported denture. The second is the mandibular overdenture and state how long this will last the patient providing they have good hygiene around the abutments. Most denture wearers have very poor hygiene habits.
You and the dentist will be providing the patient with a very good prosthodontic service with the overdenture. The dentist and you might not make as much money but you will have a case that has taken into consideration the biomechanic variables and a very happy patient.

Believe me the dentist will respect you much more for recommending another option. If they want to go ahead with original plan just state that you will not be responsible if the abutments are extracted by the bridge. When the abutments do come out and they will (it is just basic engineering principles of a lever) then the patient will be into complete mucosal supported dentures unless implants are an option.

Rob

Thankyou Rob, for an OD how much tooth do I want remaining supragingival and what attachments would you recommend.

How long would you give the bridge? Only God knows? 6months-6yrs?

 

[Al.]

I would only handle this case in one way.......Tell the Doc I appreciate this case but am really worried that this bridge won't last and permanent damage will occur to those teeth, maybe the doc will tell you the patient is terminal and wanted a nice smile before he/she dies (had this happen). Then see where the conversation leads. Tell the Doc you'd hate to make the first case you do for him not last. I wouldn't warranty something like this Al. This case may cost me a client, but I'll be able to sleep at night....and a man has to sleep...lol

Ive probably done 40 units for this office over the last 1 1/2 yrs. His other lab he has used for 10 yrs. He just recently decided to send me everything.
Its him and his son and they have two offices. They both make very nice preps, take perfect impressions.

Ive done cr & br on terminal patients also. Ive also done compromised bridges on patients in their mid 70's also at the Drs request.

 

[Kreyer]

Al,

If you do a gold root cap coping and remove the clincal crown the surface is usually milled at zero degrees about 1mm above gingival margins. The post should be as long as possible preferably 2:1 2 being root post and 1 the attachment height. I prefer a gold post and root cap coping over a prefab attachment post.

Just propose this option to him and if he decides to go for it call me and I will be glad to help you get through the case via email and phone conversations.

Rob

 

[Al.]

Al,

If you do a gold root cap coping and remove the clincal crown the surface is usually milled at zero degrees about 1mm above gingival margins. The post should be as long as possible preferably 2:1 2 being root post and 1 the attachment height. I prefer a gold post and root cap coping over a prefab attachment post.

Just propose this option to him and if he decides to go for it call me and I will be glad to help you get through the case via email and phone conversations.

Rob

Thank you very much. You give clinics on removables? Im going to have to attend some. Over the years Ive gone to tons of courses on ceramics but none on removables and case planing.
You said your doing hands on courses, that is probably over my head now. Do you have any recommendations ?
I can start by reading the threads in this section. Ive never even looked at them.

 

[CloudPeakDL]

Al,
I just have to add my two cents. Having done fixed and removable in my career I don't see how this could be anything but an over denture. Both Robs are correct about the forces applied eventually causing this to fail.

 

[TheLabGuy]

Al,
Both Robs are correct

LOL............this is a great case Al, thanks for presenting it to the forums. Much knowledge shared on this case.

 

[Kreyer]

Thank you very much. You give clinics on removables? Im going to have to attend some. Over the years Ive gone to tons of courses on ceramics but none on removables and case planing.
You said your doing hands on courses, that is probably over my head now. Do you have any recommendations ?
I can start by reading the threads in this section. Ive never even looked at them.

Al,

Yes, I do give courses on removables. Although I really enjoy sharing information on websites like this one.

Here is a link to some upcoming courses. I will be in Memphis, Tenn. giving a presentation on April 4th. The brochure is not posted yet.

http://www.personalizeddenture.com/coursesconsulting/courseinformation.html

Robert

 

[zena]

Thank you very much. You give clinics on removables? Im going to have to attend some. Over the years Ive gone to tons of courses on ceramics but none on removables and case planing.
You said your doing hands on courses, that is probably over my head now. Do you have any recommendations ?
I can start by reading the threads in this section. Ive never even looked at them.

just wondering what ever happen with this case?