Are your patients’ teeth breaking faster than you can replace them with implants?
If your answer is yes, you may have to revisit your treatment plan. One of the more common mistakes I see in treatment planning more complex prosthetic cases involving dental implants is that people are so focused on planning the teeth that are missing, they fail to recognize the patients’ remaining teeth are at risk of overloading.
Take the time to evaluate the number and the distribution of the occlusal contacts of the remaining teeth. If there is inadequate posterior support or the occlusal contacts are uneven and localized to one or two teeth, these teeth will be at risk of breaking. Take the time to look at the restorative history of these teeth as well. Chances are they have been heavily restored multiple times.
These teeth may also require further treatment but one of the ways to protect the remaining teeth is to provide an interim acrylic partial denture. The interim partial denture can temporarily restores posterior support, replaces the missing teeth and provide minor splinting effect of the remaining teeth. We sometimes call these treatment removable partial denture, interim acrylic denture, transitional partial denture etc.
Remember, even if the final treatment plan is a fixed implant solution for the edentulous spaces, this interim partial denture can protect the remaining teeth from breaking, until the definitive implant fixed prosthesis can be delivered.
In dental school, we are taught to control the disease process before we should contemplate any major prosthetic work. We are so good at planning for the appointments for SC/RP and restorative treatment for carious control. But we should also look at controlling forces during this phase so to protect the remaining teeth from overloading and temporarily restoring occlusal function. Sometimes that means providing an interim partial denture during this phase of treatment planning.
This case was referred to me by an oral surgeon. The patient’s teeth kept breaking before the dentist can finish restoring the case. When I looked at the maxillary arch, the only tooth that was in contact was the left central incisor. The patient is also a gagger…that may have explained why there was no removable planned. But recognize how this is a very unstable situation. By treating planning only for the edentulous span, this plan will not work because another tooth will break before you can finish restoring the case. And that is exactly what happened here.
I hope you find this information helpful. Thanks for reading.
