Dental Plate

theocn

Just told I've to get my bottom 4 front teeth out as they're very loose and can't be saved. Dentist said I'll need a plate as the other teeth aren't stable enough to support a bridge. Are plates hard to get used to? My work involves meeting people and talking face to face, don't want to look like a dribbling idiot.

btkm8unsl0w5r4

theocn wrote: »

Just told I've to get my bottom 4 front teeth out as they're very loose and can't be saved. Dentist said I'll need a plate as the other teeth aren't stable enough to support a bridge. Are plates hard to get used to? My work involves meeting people and talking face to face, don't want to look like a dribbling idiot.

Dental implants may also be an options??? A really good chrome plate can be a good solution. those pink plastic ones are not so good. Decided if you are will to wear a denture or not. There is always a way round buy more complex treatment tend to cost more in time and money.

theocn

Apollo Unimportant Vigilante wrote: »

Dental implants may also be an options??? A really good chrome plate can be a good solution. those pink plastic ones are not so good. Decided if you are will to wear a denture or not. There is always a way round buy more complex treatment tend to cost more in time and money.

No, the dentist said my gums aren't healthy enough yet to consider implants, even if I could afford them. He said the plate may be just a temporary measure, he's already done some scaling & deep cleaning, and if my gums recover and the other teeth stabilise, I may be able to get a bridge or implants in the future.

The other thing I'm not looking forward to is having the impressions taken next week. I gag really easy ( I can never have x-rays taken), and I hear that taking impressions is very uncomfortable.

vishal

don't worry, you'll be fine
good luck

charly45

theocn wrote: »

No, the dentist said my gums aren't healthy enough yet to consider implants, even if I could afford them. He said the plate may be just a temporary measure, he's already done some scaling & deep cleaning, and if my gums recover and the other teeth stabilise, I may be able to get a bridge or implants in the future.

The other thing I'm not looking forward to is having the impressions taken next week. I gag really easy ( I can never have x-rays taken), and I hear that taking impressions is very uncomfortable.

Bottom dentures are harder to get used to than top as the bottom jaw is the one that moves when we eat speak etc. Dont worry about the impressions just ask the dentist if you can sit fully upright in the chair while they are being taken and ask if he can use smallest tray possible, lower tray wont make you gag just the upper which is needed to get your bite. I have been a dental nurse for 23 years and most people gag while taking an impression so dont be embarrassed, just arrange to have an empty stomach and you will be fine.

ballsymchugh

as for the drooling, it's a normal response to produce more saliva when something is in your mouth. so the first few days with the denture will be a bit tricky!
i've found that when people need the denture, as in your case where it's replacing the front teeth, they try much harder to get on with it, and they usually do. but as your dentist said, if you get your hygiene under control, you may have other options in the future.
don't worry!!

theocn

Cheers, thanks for all the replies.

wiseold

Hi Theocn,

Hope you're feeling well and getting on with the new fitting.

I may have to have a similar procedure next week and was wondering how you got on and was there much discomfort involved?

Wiseold

georgieporgy

theocn wrote: »

Just told I've to get my bottom 4 front teeth out as they're very loose and can't be saved. Dentist said I'll need a plate as the other teeth aren't stable enough to support a bridge. Are plates hard to get used to? My work involves meeting people and talking face to face, don't want to look like a dribbling idiot.

Loose teeth can be splinted together and then they can last for many more years. It depends on just how loose they are. I have done this in situations where only 1/3 of the supporting bone remains.

The splint can be an ortho wire bonded to the back of the teeth. inexpensive but not good for longterm results. more suited to elderly (80+) patients.
For younger people linked crowns have a better prognosis. ie crown all 6 lower front teeth and join them together. A bit pricey but it saves your teeth and conserves bone. If one or more teeth have to be extracted later the main structure will still hold. This is something that should be done in conjunction with perio treatment.

Wisold--- this applies to you too, but it may not be necessary to have 6 teeth done.

Many dentists will not recommend this because they think you should not use loose teeth as bridge retainers. They confuse splinting with bridgework. A periodontist encouraged me to do it agressively about 20 years ago and I have seen excellent long term results.

vishal

That's an interesting philosophy georgieporgy and am not doubting your experience but I don't know about that medico-legally.

btkm8unsl0w5r4

Splinted Crowns :eek:...that's Bulgaria style. Unless you use a post ceramic solder (and even at that controlling the shrinkage of 5 soldier joints!!!), splinting 6 crowns will inevitably lead to marginal discrepancies, technically very difficult to do. Also crowning lower incisors is risky at the best of times, on young teeth with big pulps! Why no just use a bonded non precious rochette retainer on the lingual.

georgieporgy

Apollo Unimportant Vigilante wrote: »

Splinted Crowns :eek:...that's Bulgaria style. Unless you use a post ceramic solder (and even at that controlling the shrinkage of 5 soldier joints!!!), splinting 6 crowns will inevitably lead to marginal discrepancies, technically very difficult to do. Also crowning lower incisors is risky at the best of times, on young teeth with big pulps! Why no just use a bonded non precious rochette retainer on the lingual.

The casting is done as one unit. like a 6 unit bridge, no soldered joints. no big deal. We are talking about adult teeth here that are periodontally compromised. No big pulps to worry about.The advice proffered by the present dentist is to extract the teeth!
I am merely suggesting something more conservative.
I suppose the problem with being a specialist is one suffers a teensy bit of tunnel vision :rolleyes:. Look at the big picture. Save the natural teeth. I am willing to drill off half the tooth in an attempt to save the other half. That is less destructive than pulling it out and tossing it in the bin.
My patients prefer to save their natural teeth as long as possible. Implants are a nice option if you have no teeth. Dentures are borderline malpractice!

My associate (a semi retired prostodontist) favours the rochette retainer you describe with mixed results. It's like a maryland bridge insofar that it debonds from some of the loose teeth which defeats the purpose.

I am aware the Bulgarians and their neighbours place joined crowns on young teeth. That is an entirely different situation and should be highly condemned.

georgieporgy

vishal wrote: »

That's an interesting philosophy georgieporgy and am not doubting your experience but I don't know about that medico-legally.

remember ,Vishal, the only other option is to extract the teeth!
I offer a full refund if it fails within 5 years, to be credited to the new rehab (bridge or implants).
If it fails within 10 years I offer a generous discount to future work.
I have very few failures, 5-10% within 10 years.( i graduated in 1974)

I repeat.....a periodontist in North America recommended this course of treatment as 'best practise' for saving loose teeth many years ago.

georgieporgy

Please remember guys that this type of treatment is aimed at people aged 50 and over, very often much older.

vishal

I understand your reasoning and don't doubt your success rates but if one did get sued one would have to defend the tx to a prosthodontist who may have tunnel vision. I suppose if you if credit towards failure then it matters less.

georgieporgy

The patients are so happy to be able to bite into solid food again ! And it's instant! I get a better 'wow' response from them than I do from other ordinary crown and bridge work cases.
Such splinting must be done in conjunction with perio treatment. It's important to get rid of any perio disease in the mouth so we are dealing with healthy (loose) teeth,
When you consider that many elderly people are on bisphosphonate med for osteoporosis and are at risk of bony necrosis if surgery is attempted one shouldn't be too fast in reaching for the forceps.

btkm8unsl0w5r4

georgieporgy wrote: »

.
For younger people linked crowns have a better prognosis. ie crown all 6 lower front teeth and join them together.

georgieporgy wrote: »

Please remember guys that this type of treatment is aimed at people aged 50 and over, very often much older.

I am confused is this for young or old people

georgieporgy wrote: »

The casting is done as one unit. like a 6 unit bridge, no soldered joints. no big deal.

The point of using solders is to avoid the pitfalls of casting as one unit, 6 castings or 4 castings with only a millimeter between the thin margins is impossible to cast accurately in one piece ( even in high gold) due to the differential cooling of the metal in the investment. Even if you manage to cast it as one piece well, the ceramic furnace causes slumping of the thin marginal areas (Cad-cam could do it maybe). You cast each unit individually to ensure marginal accuracy, try them in ceramic and all (sprues left on) and pick them up in another impression. From this impression a solder index is made and the individual crown joined with a low fusing post ceramic solder. Its the proximity of the thin margins that are the problem, especially true of lower incisors. And marginal accuracy, and emmergence profile in periodontally involved teeth is a priority.

Do a lot of resin bonded, and debonding is not a big issue with thick retainers. Also a debond is no big deal, take if off, sand blast and rebond. Most these days for perio splinting I use fiber reinforced composite splints. I am all for keeping teeth, and would crown a dogs tooth if it stood still for long enough, however not a big fan of adjacent spinted crowns unless absolutely necessary. However if it works in your hands keep doing it. I usually cant justify spending 600-1300 a unit on loose lower incisors. Great fan of the canine to canine 6 unit bridge though.

Loving a bit of proper debate rather than the usual ortho threads. thanks guys:)

georgieporgy

Apollo Unimportant Vigilante wrote: »

I am confused is this for young or old people

Younger than 80+.

Older than 50. The people I am talking about are usually missing some teeth in their mouths already and come in saying they don't want to lose any more. The loose teeth are generally not packed closely together so hygiene maintenance not too difficult. Case sellection is important. I don't recommend forcing this on people. I merely offer it as one of many options. But I do find that many people prefer to keep their natural teeth a bit longer and find a prognostic life span of 7-15 years good value. Personally I think if such a splint lasted only 10 years I would be dissappointed.

I've done my share of fibre reinforced comp splints too. Never really liked the end result. (my fault - poor plastering skills). I now tend to refer candidates who want something like this to a local ortho who manages to do a neat job with ortho wire. It occurred to me that orthodontists are so well practised placing fixed retainers that they are most suited to it. These wire splints are weaker and may fail within a couple years. But they are really cheap and can be redone.

vishal

you can do them yourself. send to ortho lab for fixed retainer, ask to use a heavy wire. when comes back, loop some floss around the wire around the contacts, pull tight but not too tight as to activate wire. have nurse hold floss. etch, bond, flowable composite.

he is using elastic thread in the photo but you can use floss

ballsymchugh

georgie, i might have missed this somewhere, but how do you take an accurate impression of prepared perio involved teeth for a fixed prosthesis?

georgieporgy

preps are supragingival. perio disease has been cleaned up. no bleeding gums, just loose teeth wich are being further traumatised by occlusal forces.

ballsymchugh

don't the teeth move slightly while you're seating the impression tray?

georgieporgy

That's where your chairside assistant plays her role. she carefully places her thumbs against the labial mucosa thereby preventing movement of the teeth.

ballsymchugh

ah right. i couldn't possibly imagine my dsa to do anything in the lines of work...:mad:

georgieporgy

Mine used to work for a specialist before coming to me

Seriously though, you have to be careful making your impression. Lots of light body material and work fast. If in doubt make 2 impressions.

btkm8unsl0w5r4

Really must get a dentist only forum going for these things.

Placing thumbs is a bit odd / cumbersome during an impression, sure isnt there just as much chance of displacing the teeth this way.
I do it the classic way, metal try in. Get everything in metal only single units, try these units in, duralay them together in the mouth, pickup impression (they wont move relative to eachother cause of the duralay), pour a resin die model, solder or laser wield if you want to splint, ceramic (margins on individual dies) and finish.

I still don't understand the treatment rational for rigidly splinting with full crowns perfectly good teeth with only mobility, yeah of course it will last for years sure half the abutment teeth could have no bone / gross caries and it will still hold (I call this the Budapest effect), I just think the same results could be had at a fraction of the price, treatment time and less risk to the vitality of the teeth.

Perio treatment + Occlusal equlibration + regain posterior support with implants, bridges or RPD's + get some canine guidance or group function and keep the protrusive guidance off the centrals + rigid or non rigid splinting with bonded resin or metal.

Here is a few picture of the problem with one piece cast splinted units, the margins are all over the shop, they don't debond when there is a problem allowing everything to rot out underneath, they are difficult to clean especially for the older less dexterous patient with a history of poor hygiene (the very ones these are aimed at).

vishal

i like that, "the Budapest effect"

georgieporgy

The reference to thumbs was meant to be a joke.......

Fitz, the case you have posted looks like something different to splinting loose teeth. It looks as if someone overloaded multiple abutments to support a removable appliance.

Big_G

For me, the simplest way forward in these cases is a fibre reinforced direct resin splint. Ribbond or something of the like. If the patient can display meticulous OH around the teeth, then move towards a lingual cast metal maryland style bonded splint. I try and avoid these cases unless the patient can demonstrate a willingness to change a lifetime of poor habits. I have had one case that was successful. In the other four the patient continued to deteriorate, necessitating extraction of the perio involved teeth.

I bow to your superior experience georgie, but imo the splinting of anterior teeth using multiple crowns is another layer of supervised neglect in the majority of cases, and in the minority where it would work is likely overcomplication of treatment. That's just my tuppence ha'penny. Although in my limited dental experience, no two dentists will do things the same...

BTW dentist only forum is a great idea. We nearly have a critical mass of contributors here.

btkm8unsl0w5r4

Big_G wrote: »

BTW dentist only forum is a great idea. We nearly have a critical mass of contributors here.

+1 on that, wonder iif Tbh could help us?????