Partial Dentures

I have been a dentist for more than 30 years and have been fortunate enough to have several long- term patients throughout my tenure.  As these patients have continued to see me throughout the years, their dental conditions have changed, as well as dental technology available to help in treatment.  But through all the changes and variables, there has always been the constant goal of saving as many teeth as possible or to come up with the best solution when replacement is necessary.   Case in point: I  have a patient who first came in almost 20 years ago for a comprehensive treatment. He was missing multiple posterior teeth, and the teeth he had required much dental work. He had his upper anterior teeth crowned as well as some of the posterior teeth. The smaller cavities were treated with fillings. His lower anterior teeth are severely crowded, and he had some bone loss there. The goal is to try to maintain these as long as possible.

Since over time, there are frequently changes in someone’s dental condition, sometimes there are modifications that will affect the partial denture. I want to address some of these.

A couple years ago, this patient needed a crown replaced. He had experienced some gum recession around the tooth, and there was decay in some places. This had been going on for a few years and I could doing fillings to treat the decay, but the decay had become extensive and a new crown was needed. Keep in mind that this patient has some medical history, namely hepatitis C.

Another tooth suffered the same situation. However, this tooth is key in supporting the upper partial denture in terms of a place for the partial to seat and for a clasp that helps keep the partial in place. When an impression is taken for the new crown, the partial denture must be placed and picked up in the impression, and must go to the laboratory when

the model is poured up. The lab can then correctly make the crown so that the partial can rest on the tooth, and the clasp can help hold the partial against the crown for stability. This aspect went very well, but I did have to adjust the clasps to help keep the partial from falling out. This adjustment was done with a set of special pliers that can gently twist the clasps, applying more pressure to the tooth.

Last year, the patient had a lower front tooth that was in trouble. Not only was there a lot of bone loss, but there was a radiolucency at the apex (end) of the root on the x-ray. This indicates that the tooth would need endodontics (a root canal) to save. My decision was to extract the tooth and to have a denture tooth added to the partial.  This all went rather well, the area healing very well, and the partial doing fine. If enough teeth are added to the partial denture, it is common to have a new one made.

My goal with partial denture patients is to save the existing teeth and service the partial denture as long as possible. If there are too few teeth to have the appliance be stable, then a complete denture is called for. Although this feels like a failure at the end, there does come a point where that may be the solution. Keeping the existing partial and the supporting teeth as long as possible is always the most important aspect of planning this kind of treatment.