Three Things To Evaluate when Your Patient Needs a New Crown and a Denture
I get a lot of questions from my students about what they have to do for a patient who will need a crown and a new partial denture. The common answer is you need to fabricate the fixed treatment (the crown) first before the removable. At minimum, you need to know the design of the partial denture so you know where the rest and the retentive element are.
But the more I do these cases, there are many logistical issues that need to be addressed at the time of treatment planning. And they are rarely covered well in standard prosthodontic textbooks. So if you are ever treatment planning a fixed removable case, whether it be one crown or multiple crowns along with a partial denture, ask yourself these questions. I hope by answering these questions, they will help you better plan your cases so there are no surprises for you and the patient.
1/Does you patient currently wear a partial denture that replaces several teeth? If you make a new crown first and have it cemented before your new partial denture is fabricated, the old existing partial denture is not going to fit very well, possibly compromising comfort and aesthetic. You can adjust the denture to make it fit but I usually like to postpone cementing the new crown until the new denture is ready. It makes it a bit more tricky to fabricate the denture but it ensures the patient can continue to wear the same denture while everything is being made.
2/Does your patient have enough occlusal stops to allow hand articulation?
If the patient is wearing a partial denture, there is a high chance that there are enough missing teeth that you may not be able to articulate the case properly. Traditional method of jaw relation will call for a recording base and occlusion rim. This will usually mean a separate appointment following final impression so the lab can fabricate the occlusion rim for the jaw relation record. The usual two appointments requirement for a crown may not apply here. Review your appointments carefully so you plan for this step properly.
3/Does your case require a diagnostic set up?
The patient may or may not have an existing denture already. But there are enough teeth missing that the case may benefit from having a diagnostic teeth set up. This step will allow you to evaluate the space more carefully and to improve from what the patient has already prior to starting the tooth preparation.
Doing a diagnostic teeth set up may call for additional appointments. When I plan for a case like this, I ensure that the fees reflect the additional time and responsibility.
At the end of the day, I hope these questions can help you plan your cases more effectively and allow you to be proactive at addressing these potential issues.
Thank you for reading!
Simple Case Documentation
Complex Case Documentation
Check out the other more complicated fixed removable cases I have documented here on my blog