missing teeth and partial dentures

[ScorpiORTHO]

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What are the options for someone missing all teeth in a right quadrant from the canine back? Also the second premolar is broken off but the root is still in there.

Is a partial denture possible?

 

[DcS]

What are the options for someone missing all teeth in a right quadrant from the canine back? Also the second premolar is broken off but the root is still in there.

Is a partial denture possible?

1. Nothing
2. Partial...yes it's possible
3. Implants
4. One or two implants and then a FPD from that implant to the canine

 

[aphistis]

1. Nothing
2. Partial...yes it's possible
3. Implants
4. One or two implants and then a FPD from that implant to the canine

What he said.

 

[DDSSlave]

1. Nothing
2. Partial...yes it's possible
3. Implants
4. One or two implants and then a FPD from that implant to the canine

#4 is absolutely wrong. You cannot use an implant and a tooth as abutments for the same bridge. Strong contraindication.

As for a partial, it's not ideal, but it could work. Are we talking max or mand? The 2nd premolar is on the partially edentulous right side as well, right? Can you crown the premolar/root with a post and core while retaining good solid root structure? My guess is probably not from the way you describe. Plus how's the perio around the premolar/root? Any mobility or pockets? Unless it's pretty rock solid you can't use that as an abutment for an RPD. And then you're left with trying to clasp the canine assuming it isn't perio involved as well. You can do it, but keep in mind there will be quite a bit of torque on whatever you have on the right side, and any abutment would have to be pretty solid. Also consider the perio involvement of the remaining teeth. Is it maintainable? Cause you're about 1 tooth away from a complete denture.

Certainly if they have the funds and anatomy to support implants you could place 3-4 single tooth implants. Even if you did a bridge with implants you'd still need 3 for an adequate tripod.

 

[DDSSlave]

Actually I reread your post, and if the pt is also missing the right canine, then you're out of luck as far as RPDs.

 

[DcS]

#4 is absolutely wrong. You cannot use an implant and a tooth as abutments for the same bridge. Strong contraindication.
.

Not from anything that we were taught at UNC...I seem to remember it being mentioned but not as an absolute contraindication.

 

[tx oms]

Teeth flex, implants do not. A bridge using a tooth and an implant as pontics is bound to fail.

 

[12YearOldKid]

Teeth flex, implants do not. A bridge using a tooth and an implant as pontics is bound to fail.

You mean abutments --- not that it matters. 😀

 

[DcS]

Teeth flex, implants do not. A bridge using a tooth and an implant as pontics is bound to fail.

I know the reasoning, I'm curious if it's an absolute or relative contraindication... I will ask the head of the implant course at our school and report back. Like I said, I remember it being mentioned...and it may as well been a contraindication, i simply can't remember.

 

[ItsGavinC]

As I understand it, it is a relative contraindication. I was taught it was absolute, but during our patient screenings the past couple of weeks, multiple attendings have mentioned it as an option for treatment plans.

 

[DDSSlave]

As I understand it, it is a relative contraindication. I was taught it was absolute, but during our patient screenings the past couple of weeks, multiple attendings have mentioned it as an option for treatment plans.

Fixing a crown to tooth with a viable pdl and micromovement is asking for failure. Years ago, dentists figured if it was osseointegrated then you could load it however you want. Obviously that's now known to be wrong. Fixing an implant to a tooth is as contraindicated as having lateral forces on a single tooth implant. There's just no good excuse to do it. If a patient can only afford 1 implant to replace an edentulous span, then they can't afford to lose that implant or redo it because the dentist figured it would be cheaper in the short term. It's just irresponsible dentistry IMO.