sassmonkey

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Aug 8, 2013
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    Hi,

    I have a patient who needs a maxillary removable partial denture to replace teeth #5, 9, 13, and 14. The problem is that they have severely reduced interarch space between the edentulous ridge where 13 and 14 would normally be and the opposing arch. The teeth have been missing for so long that #19 has supraerupted to the point where it is almost in contact with the opposing ridge (less than 1 mm of space).

    I have been told that an option would be to fabricate a resin base maxillary partial denture with an acrylic block in place of #14 instead of a denture tooth. This could work because #19 needs a RCT, post, core, and crown, so I could contour the crown to regain some interocclusal space.

    However, I came across an article describing a "novel" approach to dealing with a similar situation in which the authors fabricated a cast metal removable partial denture with inbuilt metal pontics. The pontics were then veneered with porcelain for esthetics.

    I know cast metal frameworks are stronger than resin acrylic, and I'm worried that the lack of interarch distance won't allow the resin to be thick enough to be resistant to fracture, so I'm wondering if this cast metal RPD with inbuilt pontics is another viable option?? I have tried to find more information on the internet but I don't see any similar studies. The article is below.

    https://www.researchgate.net/public..._WITH_BUILT-IN_PONTICS_A_CLINICAL_CASE_REPORT

    I am a third year dental student who is brand new to the clinic, so any help would be appreciated! I would really like some input before I talk to my faculty about this alternate treatment option.

    Thank you!!
     

    doc toothache

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      In school, you are surrounded by dentists who are unlikely to be too impressed with students going off the reservation to seek advise on treatment planning. Should you offer the article to your mentor, please do tell us how impressed the faculty is with the alternative treatment offering from the Middle East.
       

      Bernie Sanders

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        In school, you are surrounded by dentists who are unlikely to be too impressed with students going off the reservation to seek advise on treatment planning. Should you offer the article to your mentor, please do tell us how impressed the faculty is with the alternative treatment offering from the Middle East.
        rofl
         
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        syap

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          In school, you are surrounded by dentists who are unlikely to be too impressed with students going off the reservation to seek advise on treatment planning. Should you offer the article to your mentor, please do tell us how impressed the faculty is with the alternative treatment offering from the Middle East.
          So Pubmed, evidence based dentistry, etc aren't relevant, just do it the way your professor says? Sounds great.
           

          doc toothache

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            So Pubmed, evidence based dentistry, etc aren't relevant, just do it the way your professor says? Sounds great.
            By now, you should know that ds is more like a prison system and you "do it the way your professor says". In any case, you may be confusing a published "Case Report" with a research based study on the merits. You will likely have a hard time finding a dentist/prosthodontist who will be impressed with the design of the rpd found in this article.

            I've heard there is yet to be a documented case of a dental school professor being wrong in the US.
            That's because the rank of ds "professor" comes with a Lifetime Member of Demigods certificate and anyone rubbing elbows with Zeus is never wrong.
             
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            ktran17

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              One indication for including a tooth in the original cast metal frame work is due to loss of VDO. I wouldnt recommend re-contouring #19 as its RCT treated with a post. As you should have learned from your classes, remaining tooth structure is the single most important factor in whether or not a tooth that has been RCT with post and crown will survive long term. (ferrari et. al)
               
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              Bis-GMA111

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                this would be a clear cut referral at my school.
                it seems that with #19 the crown: root ratio might be less than ideal, if it's really that super erupted... so it would be pushing it. did your faculty deem it as an acceptable abutment?

                if you were to say, do the RCT, post, core, survey crown on it... i don't see how putting a resin block would work to oppose it, as the resin isn't stable enough with a collapsed bite

                the issue is, you need to open up space. as others have suggested go with what your faculty says, and get a prosthodontist to work with you if that's an option.
                 
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