FREQUENTLY ASKED QUESTIONS

RESTORATIVE DENTISTRY

I am 63 years old and presently wear an upper denture and only have 6 teeth on the bottom in the front. I have been to a new dentist after not being to the dentist for 20 years. He has told me that I need some gum work on the bottom and a new denture up top. We have not yet discussed any other treatment on the bottom. I am not very happy with the way my teeth look on the top and would like to know what options I have on the bottom. I would rather not have a partial denture on the bottom because in the past one was made and I couldn't wear it. Can you give me some ideas on how to fix me?

It is quite obvious that you need a new denture on the top. In making this denture many things can be done to improve your cosmetics. You simply need to let your dentist know what changes you would like and he or she will let you know if it can be done. As for the bottom, you need to do whatever is necessary to bring those teeth into periodontal (gum) health. I am assuming that you have no decay.

There are a couple of ways to handle the bottom - they are as follows:

  1. Make a conventional partial denture with clasps on your natural teeth.
  2. Crown your front teeth and make a partial that has precision attachments. One half of the attachment is in the denture and the other half is attached to the crowns. They will fit together like a key fits into a lock. When done this way there are no clasps and the forces to the teeth are better distributed.
  3. Crown your front teeth and as part of the crowns hang an extra tooth off the back of each side. By doing it this way you avoid the partial and still get an extra tooth on each side.
  4. Leave your teeth as they are and place implants in the back so that crowns can be placed on them. By doing this you also avoid a denture and replace all of the back teeth with as close to a natural tooth as you can.

Each of these options has its pluses and minuses. It is a matter of which method is best for you, specifically.

About ten years ago I had facings put on my front teeth and never liked the way they looked. They make me look like I have buck teeth. In addition, I am missing all but my back two molars and wear a partial denture with wires hooked on to my eye teeth. Do your have any thoughts on what I can do to make this look better. My granddaughter is getting married in July and I would like to have the smile I've always wanted for it. Please give me your thoughts on this. Thank you.

It sounds as though you have had porcelain veneers placed on your front teeth. The reason they are bulky is probably that when the dentist put them on they didn't shave down a little of the tooth to make up for the thickness of the veneer placed. When veneers are done in this fashion you end up with bulky teeth as you have described.

One of the nicest ways to restore your mouth is as follows. You could put crowns on the front teeth duplicating their original shape and position. On the back of these teeth, you would have an attachment that acts as the female half of a precision attachment. The male portion of the attachment is part of a new partial that would be made. On the back teeth, you could have the partial clasp onto the two remaining teeth that you have in the conventional manner. The advantages of restoring your mouth this way are as follows:

  1. The clasps on the front teeth are eliminated and therefore very esthetic to the point that you would not even look as though you were wearing a partial.
  2. Because you are using precision attachments the torquing forces are greatly reduced on the teeth.
  3. The dentist basically has free reign on the cosmetics of the teeth since they are all being restored at once.

The time it typically takes to restore a mouth in such a way as I described is approximately 3 to 4 months. Based on this, there should be no problem completing your new smile by your granddaughter's wedding. I am excited for you in getting the smile you've always wanted and seeing your granddaughter get married. Congratulations!

I was just to a new dentist and he recommended that I have most of my back teeth root canaled and crowned. I realize that most of these teeth have large old fillings with decay around them, I just don't know if I want to spend all the money needed to fix them. I talked with him about extracting all of my back teeth and making partials. Can you give me any insight?

Both of the treatment plans you have outlined make sense and can work. The real question is one of cost versus comfort. The root canal and crown option will be more costly, though it will also be more comfortable. If the root canals seem as though they will be predictable and long-lasting I would encourage you to move in that direction, assuming you can afford it. If cost is a great concern for you then the option of extraction followed by partials will work very nicely, too. This option should be less costly and quite predictable. Realize that the partials will move to some degree and will not be perceived as your own teeth like the crowns will. What I usually tell my patients in this scenario is that, in either case, you will be getting the same quality of dentistry - the difference is in the procedure along with the inherent advantages and disadvantages associated with it.

I am 87 years old and have just had a filling fall out of one of my remaining 6 lower teeth. I have a denture on the top that will only stay in with Sea Bond adhesive. I also have a denture on the bottom that replaces my back teeth. I had not been to the dentist in 6 years before going to a dentist to have my filling replaced that came out. After going there the dentist said that I have decay in all of my teeth and that they should come out and a denture should be placed as I have on the top, immediately. At my age I really do not want to have the rest of my teeth taken out. I have heard that lower dentures are a problem to keep in and I already have a problem with my uppers. I hate to think of what the bottoms would be like. Do you have any ideas for me to keep my lower teeth?

It sounds as though your dentist has recommended the best thing for you. However, in the event that root canals can be done on your teeth and restored adequately, you may have some options. One option that comes to mind is a scenario that I have written about before. You can have the root canals done, posts placed in the teeth, and crowns (or caps) put on top of them. Attached to the crowns at the ends you would have an attachment that has two halves. One half of the attachment is in the denture and the other half is attached to the crowns. When the restoration is complete the denture fits over the teeth and is well retained. One advantage to this is that there are no clasps and the forces to the teeth from the denture are minimized.

Another idea would be to extract the teeth as recommended, but place implants in the jaw bone that will hold a bar that, in turn, will hold in an implant restoration. This is a very nice way to restore a situation such as yours or someone without any teeth wearing a full denture. It can also work equally as well on the top.

It is impossible for me to give you a firm suggestion without seeing you. I would suggest that you let your dentist know that you really do not want to extract teeth. If there is a way to do it I am sure he or she will talk to you about it. If you are okay with a limited result in trade for keeping your teeth for a while longer you should let your dentist know. As dentists, we usually only want to do things that are predictable and long-lasting, though there are times that, with the patient's approval, we might design a restoration knowing it has a limited life expectancy. I wish you the best in making your decision.

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