Case study: Failing upper partial denture against lower teeth
James G. Jenkins
A gentleman of about 70 years old came in inquiring about a solution to his problem: he had worn an upper partial denture for many years and now the front teeth kept "popping off."
Over the years, he lost a number of upper and lower teeth. He was somewhat apprehensive of dentistry and he wanted a nice smile along with the ability to eat better.
After an exam and some X-rays, the condition of his mouth could be thoroughly evaluated. He had five upper teeth and 10 lower teeth remaining. Every tooth was worn, decayed, broken or had lost bone support.
It became clear that any treatment necessary would require all the remaining natural teeth to be extracted. He was in generally good health physically and definitely young at heart.
A couple of different options were presented to him. One option would be upper and lower full dentures with no implant support. When this treatment is chosen, the dentures are re-lined a couple of months after the teeth are removed to provide a tight fit. This is done to accommodate the tissue shrinkage following extractions.
Another option would be upper and lower full dentures with one or both arches, supported by implants. The lower denture is more likely to move due to the tongue space and is more critical for implant support than the upper. However, with the upper and implant support, the portion of the denture that covers the roof of the mouth can be removed which aides in comfort, taste and speaking.
Another option would be non-removable teeth supported by implants on one or both arches. This is the option you hear about so often as "teeth in a day" or "all on four."
This is the state-of-the-art closest thing to having your own natural teeth back. It has the added advantage of being removable by the dentist for hygiene and repair if necessary.
When considering this type of treatment, be sure to ask the dentist to go over all of the options for your particular condition.
We reviewed all of these procedures with him and he chose an upper full denture with an implant-supported lower denture. The procedure was planned to accommodate his apprehension.
Under sedation, I removed five remaining upper teeth and 10 remaining lower teeth. The original plan was to place two root-form implants at the time of the tooth removal; however, considerable bone re-contouring was necessary to achieve a good base to work with, and the implants were postponed for four months to allow for initial healing.
Using N202 (laughing gas), two root-form implants were placed in the lower arch at that time. Three more months were necessary before attachment of the dentures to the implants could occur.
The entire process took about one year total to go from the upper partial with five natural teeth, and the lower with 10 broken, decayed teeth, to an upper and lower full denture with the lowers implant supported.
Besides not having things move around or pop off with eating, we achieved a particularly attractive result, of which the patient is very proud.
James G. Jenkins, D.M.D. is the owner of Bluffton Dental Care in Bluffton.