Removable partial denture is no longer retentive: best options?
I have a patient who had a maxillary removable partial denture Kennedy Class III Modification 1 [bilateral posterior edentulous spaces bounded by terminal abutment teeth] that was retentive. After extracting #2 [maxillary right second molar; 17] the removable partial denture was no longer retentive. The patient does not want to have more teeth extracted and cannot afford sinus grafting + multiple implants bridges. I would like to install an implant in #2 site and use a Locator to supplement the retention of the removable partial denture on the right side with a conventional clasp on #6 [maxillary right canine; 13] as well as conventional clasping on the left side. Can I combine the implant-Locator on the right side with the conventional clasp assemblies on the left side into one removable partial denture? Is this an acceptable removable partial denture design? Or what other alternative options should be considered?
12 Comments on Removable partial denture is no longer retentive: best options?
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Alex Zavyalov
1/23/2014
The upper frontal teeth might be covered by the cosmetic telescopic crowns embedded into removable prosthesis to avoid any implant insertion procedure.
CRS
1/23/2014
The locator should work fine. If it were me I. Would let this patient know that it is a matter of time before the maxillary teeth will be lost due to the partial and the mandibular natural teeth. To be proactive I would be selecting my other locator sites for the future denture. I think we do our patients a disservice not telling them the prognosis so that they can figure out a way to afford treatment. I would give her a ballpark estimate so a plan can be developed. Another idea would be a single molar implant with a screw retained crown to maintain the vertical on that side. It can be switched out later for a locator if it is screw retained. This patient will probably start chewing on one side now with the loose partial. I would retrofit the partial and spend the money toward the final prosthesis and plan. The patient seeing the difference with a stable implant will help sell the plan.
Dr J
1/27/2014
If the patient refuses an implant in the #2 site which I think would work well with a conventional crown or locator, I would consider a PFM on #6 with a larger ERA and a new distal extension partial. The implant would give back the same feel she was used to....but to save a buck there is an option.
Dr Bill
1/28/2014
Telescoping off the anterior teeth will only hasten their loss due to the compressive forces in the posterior. Without some kind of vertical stop something will give -your cement or your tooth structure. I also think you can get by with a locator for retention because you have some natural teeth to reduce the lateral forces. An implant crown is also a possibility but it will not compress like the teeth so Im not sure of the dynamics with a partial when it supports a rest seat along with the natural teeth I think you run some risk in any case if the arch isn't looked at as a whole If you decide to do a crown on 6 with an ERA you need to stay on top of the posterior soft tissue support or you will be repairing that partial or crown
Manosteel
1/28/2014
If you have the available bone volume put in the largest implant you can parallel with the path of insertion on the partial. After integration you can place a locator over the # 2 area. Make sure the partial fits well and is stable otherwise reline it.. On installing the locator make sure it has a passive fit ie provides retention mostly. If you have enough room and acrylic you can retrofit an existing partial, but it does work out best if you can make a new framework and partial around the locator cap.
Vipul G Shukla
1/28/2014
Yes, your Tx plan is reasonable, and it will give decent retention. You can even reline the existing cast partial such that the LOCATOR attachment can be added in to it after implant integration. I have made this in the recent past and it gives patients a lot of satisfaction at a low price.
Having said that, LOCATOR system works best when paired.
Good Luck!
A.P.Ingel,DMD,FAGD
1/28/2014
I agree that Locator attachments are the best choice. You must measure the prosthetic space in the posterior area. I would consider the Zest LODI implant in the 2, 5 and 11 areas.This will eliminate clasp and functional stresses on #6 and #10. I would retain a clasp on #15. Of course, you will verify bone height and width with CBCT. The LODI system will help with cost to allow three implants. Finally, a new partil would be indicated as well.
Jochen
1/29/2014
The partial you are envisioning would essentially create three pontics between #2 the implant and #6 as the anchor for the clasp on that side of the patients mouth. Considering the expected poor bone quality often found in the area of #2 and the increased bite force the further posterior the teeth are situated you may explore other attachment options than Locators that would not transfer bite forces directly to the implant. Maybe a custom abutment that is hour glass shaped and a soft tissue material gasket in the partial denture that engages the hour glass shape would provide retention but not transfer bite force to the implant. The gasket would need to be designed so the hour glass shaped abutment could not "bottom out" against the hard acrylic of the partial denture.
Dr. Samir Nayyar
1/29/2014
Hello Buddy
You can give 1-1 implant on both sides anterior to the maxillary sinus and use ball attachments for the retention of the RPD. This is most economic as well as will provide good retention. These implants could be used later on if the patient would prefer more implants.
Have a nice day.
Richard Hughes, DDS, FAAI
1/29/2014
I prefer O rings over locators. I would like to see implants placed at the # 2. 6 and 11 sites, if possable and used for retaining the RPD.
luiz jesus
2/1/2014
I would make a crown on the implant to dente16 if you can take the current removable prosthesis. If not, other removable if the problem is financial
robert l. selders,dds
2/3/2014
have you considered placing mini implants...i think they will work well for retention
