An Interesting Case: I Want to Keep My Teeth AND Don’t Want a Denture

 

I have a new patient who has come in with a loose upper central incisor, a definite cosmetic problem. She has 1 upper molar left on each side, and she is missing a premolar on each side as well. The loose front tooth needed to be extracted and her other central incisor is guarded but still usuable for some period of time.

The question is: should be just extract all of her teeth and give her a complete denture? Is it worth trying to save her teeth?

During the evaluation I noticed that on the palate there is a bony torus. This is a mushroom shape of bone that sits in the palate (called a palatal torus). It is not a pathological feature and is usually left alone. But having a complete denture could be a problem for her. Many times a surgeon will go in and remove this bony mass prior to fabricating a denture. This is yet another reason for her to keep her teeth.

So this patient’s treatment is to take that incisor out, fabricate a treatment partial for her to wear during the healing phase, and include all of the missing teeth. After 6 months I will evaluate how she is doing. She has also had a deep cleaning to help her with her periodontal condition.

At the 6 month reevaluation I will see how she is doing with the partial. If all seems to be fine, I will recommend a traditional upper partial denture that will be more stable. This will have a thin piece of metal on the roof of her mouth (away from her torus), metal clasps on her molars, and tooth colored clasps to secure the partial on the upper. She is also in need of lower partials, missing all of her molars and one lower premolar.

One other consideration came up: the patient wanted an implant on the front tooth. I usually think this is a great idea, but with the remainder of her teeth being in a guarded condition periodontally, I don’t think this is a great idea. Money is a consideration for this patient, and having a dental implant placed that may need to be converted to a denture in 5 years, well, this is not the patient to try this on.