Need help with prostho patient case.

[sam12]

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Hello,

I have a patient with lower cast partial and currently has an existing bridge from #6 through 13, with abutments on #6, 11, 12 and 13. He is missing his remaining maxillary teeth. Patient had requested a "clear" partial which we made using duraflex but it did not fit well at all. Everytime he bit down, the partial would move up and down as its obviously not tooth borne and he has severe bone loss in posterior aspects of maxilla where there are no teeth.
I am confused as to how to proceed with this case. Patient has severe bone loss in posterior maxilla, where he is missing his teeth, thus ruling out implants. Plus its questionable to try another flexible partial. What options are there for this case? Can we do a cast maxillary partial, but if we do, then doesn't that lead to risk of fracture of the abutment crowns part of his bridge.
Please help.

 

[niles19]

Block bone graft & sinus lift?? Are those out of the question cuz I hate those types of partials.

 

[sam12]

Block bone graft & sinus lift?? Are those out of the question cuz I hate those types of partials.

He does not want to go the route of implants either, plus finances are a concern to him.

 

[niles19]

Well if he is unwilling to do proper tx, not willing to do a metal partial & you've already tried your best with "clear" partial....I'd reevaluate his wants & expectations cuz they seem unrealistic & may not match what you are willing to do "ethically".....personally I'd tell the pt that this may not get the practice for him (legally, ethically & morally he sounds like a issues & a headache you DONT want). If he doesn't wish to do sound TX I'd tell him to stick with what he has, go to a full denture or look deeper into implants. Remember...it's your license, you have to sleep at night & if you wouldn't do it on your self DONT do it on others🙂). Gooooood luck!!!

 

[sam12]

Well if he is unwilling to do proper tx, not willing to do a metal partial & you've already tried your best with "clear" partial....I'd reevaluate his wants & expectations cuz they seem unrealistic & may not match what you are willing to do "ethically".....personally I'd tell the pt that this may not get the practice for him (legally, ethically & morally he sounds like a issues & a headache you DONT want). If he doesn't wish to do sound TX I'd tell him to stick with what he has, go to a full denture or look deeper into implants. Remember...it's your license, you have to sleep at night & if you wouldn't do it on your self DONT do it on others🙂). Gooooood luck!!!

He is open to the metal partial, but I am asking if I do that, doesn't that run the risk of fracturing his bridge in the future? Especially with the rest placement.

 

[niles19]

There is always a risk....just use TONS of water...educate him of the risks etc. it's still pushing the envelope on the basis of any partial but as long as he knows the risks & you can sleep well at night then do it. If there is any doubts then don't do it & stick to something that has better & more increased predictability (ie doing nothing or implants)

 

[sam12]

There is always a risk....just use TONS of water...educate him of the risks etc. it's still pushing the envelope on the basis of any partial but as long as he knows the risks & you can sleep well at night then do it. If there is any doubts then don't do it & stick to something that has better & more increased predictability (ie doing nothing or implants)

Thank you!