Dental patient missing most of her upper teeth

Patient presented with the chief complaint that she wants to do something about her maxilla (upper jaw). She is missing most of her maxillary teeth and some teeth on the mandible. Although her mandible requires a lot of work, her financial situation does not permit her to take care of the full mouth and this is why she wants something done about her maxilla.  According to a PAN, on her maxilla she has present #2, #12 and #13 and root tips of #6, #7 and #11.

According to a PA, #2 is slightly mobile but has no infection around it. Keeping #2, besides its mobility, is a good idea because it is the only posterior tooth on the patient’s upper right quadrant and it provides stability to the occlusion on that side.  Because the patient has healthy #12 and #13 that provide support in the UL quadrant, root tip #11 will be extracted.

Root tips of # 6 and #7 are critical for the anterior occlusion support because there are no other maxillary teeth in the front. #6 and #7 can be used as potential abutments for crowns which would help the patient establish her anterior occlusion. In order to put crowns on #6 and #7 we would need to do crown lengthening, root canal therapy and cast post and core on both teeth.

However, in order to get a better crown-to-root ratio we would need to remove some gum from the front via alveoloplasty.

Generally, her occlusion is mostly ok except for the anterior part where the maxillary gums touch the mandibular front teeth and alveoloplasty would be probably indicated in order to put crowns on teeth #6 and #7. We were going to offer the patient implants on the top along with implant restorations, however her financial situation does not allow that and that is why the patient is probably going to go with zest attachments for the overdenture. Another option would be getting a partial denture for the patient’s upper arch; that is only if we try to keep the top 3 teeth.

In case we do the maxillary partial denture, patient has to be informed that just 3 teeth might not keep the denture stable and these 3 teeth might move or crack under loading.

This is why, in this case, considering the financial situation of the patient, it is better to go with the maxillary implant overdenture which has a better long-term prognosis than the maxillary partial denture because an implant overdenture will draw its retention from the zest attachments which are going to be anchored by the implants set in bone.

R.F., New York University College of Dentistry, Patient 1

Categorised in: Dental Student Experiences

This post was written by Interns