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Partial Dentures - Case Study

Failed aesthetics: failing partial dentures, crowns and bridgework affecting patients comfort, function and aesthetics. This is further compounded by the presence of high smile line.

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Treatment: reconstruction of maxilla (upper arch) and mandible (lower arch) using partial dentures with supporting crowns. Where teeth have failed that require removal. This study will show:

  • Complexity of treatment
  • Treatment outcome
  • Patient’s assessment

Note patient unable to put the teeth together. Teeth do not meet.

Poor unnatural aesthetic appearance of denture. Poor worn partial dentures that have been repaired.

Chief concerns: improving the aesthetic apperance of her smile. The concern is to improve aesthetics and provide normative function. This lovely patient wants to smile and chew her food confidently.

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Initial presentation

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Patient was referred by her dentist, seeking specialist’s opinion and treatment in relation to options for optimal outcome. Patient had minimal finances and treatment plan was tailored to her comfort function and aesthetics using combination of crowns and partial dentures.

The loss of teeth from failing bridgework has left considerable soft and hard tissue defect. We have unacceptable aesthetics and function. It’s surprising to see how much patients can tolerate with broken down dentition. I guess we all are busy in our lives, looking after the family and finally when everyone is ok, it time for us. In general, whenever possible we construct new dentures would like to replace, or at least get close to the original teeth and gum colour and optimal tooth position in the arch to create natural aesthetics.

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Note Upper and lower arches: broken-down dentition, discoloured crown margins, worn teeth, poorly constructed partial dentures with unnatural teeth: colour, form, progression and gum line.

Lower arch: Missing molars and premolars on LRS.

Diagnosis

Unacceptable dental aesthetics and fucntion due dissatisfaction with failing restorations and dentures creating an aesthetic and fucntional disturbance.

Our Aim: to improve the aesthetics of upper arch: tooth shape, display, tooth colour, length, symmetry and smile line in general, as well replacing missing teeth using cspecially constructed chrome-cobalt based partial Dentures that will be comfortable to enable chewing and confidence in smiling.

This was accomplished with minimal discomfort to the patient and Mrs. O. Never left the practice without missing teeth. The provisional crowns and partial dentures were both aesthetic and comfortable.

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Treatment

Following with discussion of all risks and treatment modalities with our patient that included:

  1. No treatment: this is not an option as the restorations are failing and affecting longevity of supporting teeth.
  2. Repair existing restorations and make removable partial denture: this is a temporary measure and not accepted by the patient.

Provision of new crowns and partial dentures: accepted by the patient. Laboratory: Reconstruction of upper arch: implant supported bridgework and tooth supported crowns. Clinical: Reconstruction of upper arch: implant supported bridgework and tooth supported crowns.

Procedure & Results

Improve lower smile line with restoration of worn lower six front teeth. Level the bite level-occlusal plane. Treatment – provisional aesthetic partial dentures. The work was completed in six months. Final treatment outcome: we have restored esthetics comfort and function and we have a happy patient.

Can you tell where the missing teeth are? As a specialist we need to add that artistic touch in creating not just functional restorations and partial dentures, but imitating nature. This is aesthetics. During normal speech and smiling the clasps are not showing. The clasps can be redesign not to show as well. If you want complete or partial dentures, you need to see a specialist prosthodontist. After all we are the specialists in these areas.

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Unfortunately, this work was initially completed by a dentist with minimal qualifications and experience. Hence the reason for patient seeking specialist prosthodontist for correct diagnosis and treatment planning; providing an optimal outcome for this lovely patient.

Thank you for taking the time to explore this patient’s story. I hope this gives you an idea of what I can do for you if you are having difficulty and need help, because there is always hope.

Dr. Sarkis Nalbandian
Visiting Professor YSMU
Specialist Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London
D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth) FIADE, FPFA