Re: DTP case discussion

[Guest guest]

Hi Poonam

1st thing is to address pts main complain which is about loose denture.Its not clear why her dentist changed her from metal to acrylic denture(there must be some reason).Anyhow 1st option should be 1- A new proper extended acrylic denture(although flange extension will not make any big difference) or could also try a chairside soft or hard relining of existing denture.2- Try a

Valplast denture(private) which is much better than acrylic especially for lowrr arch.

3- A metal denture(private) if she has no trouble with metal.(as it was changed before).U can make a metal denture with crowns but fabricate occlusal rests on crowns.

4- Bridge looks difficult as 2 pre & 1st molar are missing but u could mention to pt that if she is intertested u could refer her to a specialist for evaluation.

5- An implant supported bridge(private).

6- Now come to her perio problems & tell her everything about hygiene.A diet chart is recommended if there are carious lesions but a su said her fillings are fine & there r not fresh lesions then no need for that.Adevise her regular scaling & polishing.

7- About attrition u could advise her NBG if necessary or try to keep eye on amount of tooth loss.Try to check bridge in upper anteriors,if palatal surfaces of pontic and retainers are in porcelain then that could be cause of tooth loss in lower anteriors.

8- U could also change crowns as their surfaces are rough & new crowns occlusal surfaces could have occlusal rests for metal denture.

9- If pts bridges were removed previously then u also have to address the abutment teeth as those could be without crowns(anteriorly as crowns r present on posteriors).

10- Pts oral hygiene is not taht bad & bridges could have been removed due to problem with abutment teeth.

Please correct me & also add things whichg I have missed.Thanks

Adnan

From: Poonam Kapoor <docpoonam_99@...>Subject: DTP case discussion Date: Friday, 24 June, 2011, 19:43

Dear friends,

I have doubt regarding a previous tt planing case and need your help.

The case is as follows

1. Patient is 44 years old lady, her complaint is she has a lower acrylic partial denture replacing first molars and premolars on both sides. She says her denture comes off when she is eating, it’s loose. She has no other complaints. On taking history she said she had a metallic RPD before but her dentist gave her this acrylic one few months back, when I asked why he replaced it, she wasn’t sure about that. Her gums are fine, BPE scores are 212 and 221, no mobility of any teeth, OPG was given there was slight bone loss corresponding to BPE scores. Intraoral photos were given. Both lower right and left second molars were present, they had crowns on them, they were slightly mesially tilted into the edentulous span. The patient also revealed that she had a bridge for the edentulous spaces before but

later her dentist had taken them off leaving the crowns on lower right and left second molars. She also has asthma takes an inhaler for that. She also grinds her teeth, has slight wear on teeth. She has a bridge replacing upper left central or lateral, I have forgotten. These are the main findings. She also has a few fillings and they are fine. In the information sheet provided it was given that the acrylic denture doesn’t have well extended lingual flanges, there is 1 mm loss of vertical dimension. The crown surfaces (lower second molars) are rough. They also periapical views of lower second molars but I didn’t see any significant finding there. The main thing is she is not happy with her denture, so I tried to address that, explaining why her denture is not retentive (cos of improper design and extension), then talked about the grinding , option of nightguard, told her about her BPE scores and maintenance of hygiene with interdental aids etc, asked her to do a diet chart, the examiner also asked me what kind of denture I would make for her, I said I shall make a metallic one and explained to the patient why I wouldopt for that. She also had recession in a few teeth, not sure which ones . Can someone put forward the treatment plan for this patient .... i want to know can we consider giving metal denture in this case because 2nd molar has crowns so can we give metal dentures? What are the other options we can talk about apart from metal or plastic rpd as this patient does not look after the dentures ,so giving fixed optios is not wise. Why did the previous dentist took out the fixed bridges and metal dentures?i think it because of poor oral hygiene maintenence so basically we should stress on oral hygiene maintenance. Please put forward your views to make a good treatment plan for this case. With Regards Poonam.

[Guest guest]

Hi AdnanThank you for giving your treatment planning.I also feel that we have to give to the Pt all options incl.implants but provided that he maintains excellent oral hygiene.Sincerely

Lyudmyla

From: Poonam Kapoor <docpoonam_99@...>Subject: DTP case discussion Date: Friday, 24 June, 2011, 19:43

Dear friends,

I have doubt regarding a previous tt planing case and need your help.

The case is as follows

1. Patient is 44 years old lady, her complaint is she has a lower acrylic partial denture replacing first molars and premolars on both sides. She says her denture comes off when she is eating, it’s loose. She has no other complaints. On taking history she said she had a metallic RPD before but her dentist gave her this acrylic one few months back, when I asked why he replaced it, she wasn’t sure about that. Her gums are fine, BPE scores are 212 and 221, no mobility of any teeth, OPG was given there was slight bone loss corresponding to BPE scores. Intraoral photos were given. Both lower right and left second molars were present, they had crowns on them, they were slightly mesially tilted into the edentulous span. The patient also revealed that she had a bridge

for the edentulous spaces before but

later her dentist had taken them off leaving the crowns on lower right and left second molars. She also has asthma takes an inhaler for that. She also grinds her teeth, has slight wear on teeth. She has a bridge replacing upper left central or lateral, I have forgotten. These are the main findings. She also has a few fillings and they are fine. In the information sheet provided it was given that the acrylic denture doesn’t have well extended lingual flanges, there is 1 mm loss of vertical dimension. The crown surfaces (lower second molars) are rough. They also periapical views of lower second molars but I didn’t see any significant finding there. The main thing is she is not happy with her denture, so I tried to address that, explaining why her denture is not retentive (cos of improper design and extension), then talked about the grinding , option of nightguard, told her about her BPE scores and maintenance of hygiene with interdental aids etc, asked her to do a diet chart, the examiner also asked me what kind of denture I would make for her, I said I shall make a metallic one and explained to the patient why I wouldopt for that. She also had recession in a few teeth, not sure which ones . Can someone put forward the treatment plan for this patient .... i want to know can we consider giving metal denture in this case because 2nd molar has crowns so can we give metal dentures? What are the other options we can talk about apart from metal or plastic rpd as this patient does not look after the dentures ,so giving fixed optios is not wise. Why did the previous dentist took out the fixed bridges and metal dentures?i think it because of poor oral hygiene maintenence so basically we should stress on oral hygiene maintenance. Please put forward your views to make a good treatment plan for this case. With Regards Poonam.

[Guest guest]

hi Adnan that was a good explanation......i have one doubt what if the patient has an abutment teeth that was crowned and if she choose an option for metallic denture in that case how would u go ahead..... it might be a bit silly question but i would appreciate ur help.thanks veenaFrom: Adnan Ashraf <adnanashraf2401@...> Sent: Sat, 25 June, 2011 4:00:11 AMSubject: Re: DTP case discussion

Hi Poonam

1st thing is to address pts main complain which is about loose denture.Its not clear why her dentist changed her from metal to acrylic denture(there must be some reason).Anyhow 1st option should be 1- A new proper extended acrylic denture(although flange extension will not make any big difference) or could also try a chairside soft or hard relining of existing denture.2- Try a

Valplast denture(private) which is much better than acrylic especially for lowrr arch.

3- A metal denture(private) if she has no trouble with metal.(as it was changed before).U can make a metal denture with crowns but fabricate occlusal rests on crowns.

4- Bridge looks difficult as 2 pre & 1st molar are missing but u could mention to pt that if she is intertested u could refer her to a specialist for evaluation.

5- An implant supported bridge(private).

6- Now come to her perio problems & tell her everything about hygiene.A diet chart is recommended if there are carious lesions but a su said her fillings are fine & there r not fresh lesions then no need for that.Adevise her regular scaling & polishing.

7- About attrition u could advise her NBG if necessary or try to keep eye on amount of tooth loss.Try to check bridge in upper anteriors,if palatal surfaces of pontic and retainers are in porcelain then that could be cause of tooth loss in lower anteriors.

8- U could also change crowns as their surfaces are rough & new crowns occlusal surfaces could have occlusal rests for metal denture.

9- If pts bridges were removed previously then u also have to address the abutment teeth as those could be without crowns(anteriorly as crowns r present on posteriors).

10- Pts oral hygiene is not taht bad & bridges could have been removed due to problem with abutment teeth.

Please correct me & also add things whichg I have missed.Thanks

Adnan

From: Poonam Kapoor <docpoonam_99@...>Subject: DTP case discussion Date: Friday, 24 June, 2011, 19:43

Dear friends,

I have doubt regarding a previous tt planing case and need your help.

The case is as follows

1. Patient is 44 years old lady, her complaint is she has a lower acrylic partial denture replacing first molars and premolars on both sides. She says her denture comes off when she is eating, it’s loose. She has no other complaints. On taking history she said she had a metallic RPD before but her dentist gave her this acrylic one few months back, when I asked why he replaced it, she wasn’t sure about that. Her gums are fine, BPE scores are 212 and 221, no mobility of any teeth, OPG was given there was slight bone loss corresponding to BPE scores. Intraoral photos were given. Both lower right and left second molars were present, they had crowns on them, they were slightly mesially tilted into the edentulous span. The patient also revealed that she had a bridge for the edentulous spaces

before but

later her dentist had taken them off leaving the crowns on lower right and left second molars. She also has asthma takes an inhaler for that. She also grinds her teeth, has slight wear on teeth. She has a bridge replacing upper left central or lateral, I have forgotten. These are the main findings. She also has a few fillings and they are fine. In the information sheet provided it was given that the acrylic denture doesn’t have well extended lingual flanges, there is 1 mm loss of vertical dimension. The crown surfaces (lower second molars) are rough. They also periapical views of lower second molars but I didn’t see any significant finding there. The main thing is she is not happy with her denture, so I tried to address that, explaining why her denture is not retentive (cos of improper design and extension), then talked about the grinding , option of nightguard, told her about her BPE scores and maintenance of hygiene with interdental aids etc, asked her to do a diet chart, the examiner also asked me what kind of denture I would make for her, I said I shall make a metallic one and explained to the patient why I wouldopt for that. She also had recession in a few teeth, not sure which ones . Can someone put forward the treatment plan for this patient .... i want to know can we consider giving metal denture in this case because 2nd molar has crowns so can we give metal dentures? What are the other options we can talk about apart from metal or plastic rpd as this patient does not look after the dentures ,so giving fixed optios is not wise. Why did the previous dentist took out the fixed bridges and metal dentures?i think it because of poor oral hygiene maintenence so basically we should stress on oral hygiene maintenance. Please put forward your views to make a good treatment plan for this case. With Regards Poonam.

[Guest guest]

Hi Venna

Ideally u should plan a new crown alongwith a metal denture and lab will design an occulas rest on new crown for denture.I think Valplast denture is best for such situation as they dont use any clasp in it so it does not interfare with crowns.

From: Poonam Kapoor <docpoonam_99@...>Subject: DTP case discussion Date: Friday, 24 June, 2011, 19:43

Dear friends,

I have doubt regarding a previous tt planing case and need your help.

The case is as follows

1. Patient is 44 years old lady, her complaint is she has a lower acrylic partial denture replacing first molars and premolars on both sides. She says her denture comes off when she is eating, it’s loose. She has no other complaints. On taking history she said she had a metallic RPD before but her dentist gave her this acrylic one few months back, when I asked why he replaced it, she wasn’t sure about that. Her gums are fine, BPE scores are 212 and 221, no mobility of any teeth, OPG was given there was slight bone loss corresponding to BPE scores. Intraoral photos were given. Both lower right and left second molars were present, they had crowns on them, they were slightly mesially tilted into the edentulous span. The patient also revealed that she had a bridge for the edentulous spaces before but

later her dentist had taken them off leaving the crowns on lower right and left second molars. She also has asthma takes an inhaler for that. She also grinds her teeth, has slight wear on teeth. She has a bridge replacing upper left central or lateral, I have forgotten. These are the main findings. She also has a few fillings and they are fine. In the information sheet provided it was given that the acrylic denture doesn’t have well extended lingual flanges, there is 1 mm loss of vertical dimension. The crown surfaces (lower second molars) are rough. They also periapical views of lower second molars but I didn’t see any significant finding there. The main thing is she is not happy with her denture, so I tried to address that, explaining why her denture is not retentive (cos of improper design and extension), then talked about the grinding , option of nightguard, told her about her BPE scores and maintenance of hygiene with interdental aids etc, asked her to do a diet chart, the examiner also asked me what kind of denture I would make for her, I said I shall make a metallic one and explained to the patient why I wouldopt for that. She also had recession in a few teeth, not sure which ones .

Can someone put forward the treatment plan for this patient ....

i want to know can we consider giving metal denture in this case because 2nd molar has crowns so can we give metal dentures?

What are the other options we can talk about apart from metal or plastic rpd as this patient does not look after the dentures ,so giving fixed optios is not wise.

Why did the previous dentist took out the fixed bridges and metal dentures?i think it because of poor oral hygiene maintenence so basically we should stress on oral hygiene maintenance.

Please put forward your views to make a good treatment plan for this case.

With Regards Poonam.

[Guest guest]

Hello Adnan,

Thanks a lot for your help.

Regards

Poonam

From: Poonam Kapoor <docpoonam_99@...>Subject: DTP case discussion Date: Friday, 24 June, 2011, 19:43

Dear friends,

I have doubt regarding a previous tt planing case and need your help.

The case is as follows

1. Patient is 44 years old lady, her complaint is she has a lower acrylic partial denture replacing first molars and premolars on both sides. She says her denture comes off when she is eating, it’s loose. She has no other complaints. On taking history she said she had a metallic RPD before but her dentist gave her this acrylic one few months back, when I asked why he replaced it, she wasn’t sure about that. Her gums are fine, BPE scores are 212 and 221, no mobility of any teeth, OPG was given there was slight bone loss corresponding to BPE scores. Intraoral photos were given. Both lower right and left second molars were present, they had crowns on them, they were slightly mesially tilted into the edentulous span. The patient also revealed that she had a bridge for the edentulous spaces before but

later her dentist had taken them off leaving the crowns on lower right and left second molars. She also has asthma takes an inhaler for that. She also grinds her teeth, has slight wear on teeth. She has a bridge replacing upper left central or lateral, I have forgotten. These are the main findings. She also has a few fillings and they are fine. In the information sheet provided it was given that the acrylic denture doesn’t have well extended lingual flanges, there is 1 mm loss of vertical dimension. The crown surfaces (lower second molars) are rough. They also periapical views of lower second molars but I didn’t see any significant finding there. The main thing is she is not happy with her denture, so I tried to address that, explaining why her denture is not retentive (cos of improper design and extension), then talked about the grinding , option of nightguard, told her about her BPE scores and maintenance of hygiene with interdental aids etc, asked her to do a diet chart, the examiner also asked me what kind of denture I would make for her, I said I shall make a metallic one and explained to the patient why I wouldopt for that. She also had recession in a few teeth, not sure which ones .

Can someone put forward the treatment plan for this patient ....

i want to know can we consider giving metal denture in this case because 2nd molar has crowns so can we give metal dentures?

What are the other options we can talk about apart from metal or plastic rpd as this patient does not look after the dentures ,so giving fixed optios is not wise.

Why did the previous dentist took out the fixed bridges and metal dentures?i think it because of poor oral hygiene maintenence so basically we should stress on oral hygiene maintenance.

Please put forward your views to make a good treatment plan for this case.

With Regards Poonam.

[Guest guest]

Hi Adnan, thanks for your help! On my point of view the valplast dentures are quite new on the market and it is easier to fit and looks good but from my experience stains too quickly and does not look very good after short time. The clasps and the rests are from the same material and are not stable. A good choice maybe would be valplast combined with crome-cobalt frame . We could have the stability of the chrome plus the aesthetics of the composite clasps . Well, this is based only on my experience and please let me know your opinion! I was also wondering if we should mention such new techniques on the exam or just stick with the more traditional choices(such as acrylic and chrome/acrylic). Pls correct me if wrong. Thanks, Vera.Sent using BlackBerry® from OrangeFrom: Adnan Ashraf <adnanashraf2401@...>Sender: Date: Sat, 25 Jun 2011 11:45:57 +0100 (BST)< >Reply Subject: Re: DTP case discussionHi Venna Ideally u should plan a new crown alongwith a metal denture and lab will design an occulas rest on new crown for denture.I think Valplast denture is best for such situation as they dont use any clasp in it so it does not interfare with crowns.From: Poonam Kapoor <docpoonam_99@...>Subject: DTP case discussion Date: Friday, 24 June, 2011, 19:43 Dear friends, I have doubt regarding a previous tt planing case and need your help.The case is as follows 1. Patient is 44 years old lady, her complaint is she has a lower acrylic partial denture replacing first molars and premolars on both sides. She says her denture comes off when she is eating, it’s loose. She has no other complaints. On taking history she said she had a metallic RPD before but her dentist gave her this acrylic one few months back, when I asked why he replaced it, she wasn’t sure about that. Her gums are fine, BPE scores are 212 and 221, no mobility of any teeth, OPG was given there was slight bone loss corresponding to BPE scores. Intraoral photos were given. Both lower right and left second molars were present, they had crowns on them, they were slightly mesially tilted into the edentulous span. The patient also revealed that she had a bridge for the edentulous spaces before butlater her dentist had taken them off leaving the crowns on lower right and left second molars. She also has asthma takes an inhaler for that. She also grinds her teeth, has slight wear on teeth. She has a bridge replacing upper left central or lateral, I have forgotten. These are the main findings. She also has a few fillings and they are fine. In the information sheet provided it was given that the acrylic denture doesn’t have well extended lingual flanges, there is 1 mm loss of vertical dimension. The crown surfaces (lower second molars) are rough. They also periapical views of lower second molars but I didn’t see any significant finding there. The main thing is she is not happy with her denture, so I tried to address that, explaining why her denture is not retentive (cos of improper design and extension), then talked about the grinding , option of nightguard, told her about her BPE scores and maintenance of hygiene with interdental aids etc, asked her to do a diet chart, the examiner also asked me what kind of denture I would make for her, I said I shall make a metallic one and explained to the patient why I wouldopt for that. She also had recession in a few teeth, not sure which ones . Can someone put forward the treatment plan for this patient .... i want to know can we consider giving metal denture in this case because 2nd molar has crowns so can we give metal dentures? What are the other options we can talk about apart from metal or plastic rpd as this patient does not look after the dentures ,so giving fixed optios is not wise. Why did the previous dentist took out the fixed bridges and metal dentures?i think it because of poor oral hygiene maintenence so basically we should stress on oral hygiene maintenance. Please put forward your views to make a good treatment plan for this case. With Regards Poonam.

[Guest guest]

Hi Vera

Thanks for ur comments.I dont have any practical experience of Valplast especially its combination with metal and I totally believe what you have said about it.I think we can mention these new things in exam alongwith traditional or conventional appliances to prove our knowledge about fresh techniques.But ofcourse its everyones own choice and 1st preference should be about commonly used appliances.

Adnan

From: Poonam Kapoor <docpoonam_99@...>Subject: DTP case discussion Date: Friday, 24 June, 2011, 19:43

Dear friends,

I have doubt regarding a previous tt planing case and need your help.

The case is as follows

1. Patient is 44 years old lady, her complaint is she has a lower acrylic partial denture replacing first molars and premolars on both sides. She says her denture comes off when she is eating, it’s loose. She has no other complaints. On taking history she said she had a metallic RPD before but her dentist gave her this acrylic one few months back, when I asked why he replaced it, she wasn’t sure about that. Her gums are fine, BPE scores are 212 and 221, no mobility of any teeth, OPG was given there was slight bone loss corresponding to BPE scores. Intraoral photos were given. Both lower right and left second molars were present, they had crowns on them, they were slightly mesially tilted into the edentulous span. The patient also revealed that she had a bridge for the edentulous spaces before but

later her dentist had taken them off leaving the crowns on lower right and left second molars. She also has asthma takes an inhaler for that. She also grinds her teeth, has slight wear on teeth. She has a bridge replacing upper left central or lateral, I have forgotten. These are the main findings. She also has a few fillings and they are fine. In the information sheet provided it was given that the acrylic denture doesn’t have well extended lingual flanges, there is 1 mm loss of vertical dimension. The crown surfaces (lower second molars) are rough. They also periapical views of lower second molars but I didn’t see any significant finding there. The main thing is she is not happy with her denture, so I tried to address that, explaining why her denture is not retentive (cos of improper design and extension), then talked about the grinding , option of nightguard, told her about her BPE scores and maintenance of hygiene with interdental aids etc, asked her to do a diet chart, the examiner also asked me what kind of denture I would make for her, I said I shall make a metallic one and explained to the patient why I wouldopt for that. She also had recession in a few teeth, not sure which ones .

Can someone put forward the treatment plan for this patient ....

i want to know can we consider giving metal denture in this case because 2nd molar has crowns so can we give metal dentures?

What are the other options we can talk about apart from metal or plastic rpd as this patient does not look after the dentures ,so giving fixed optios is not wise.

Why did the previous dentist took out the fixed bridges and metal dentures?i think it because of poor oral hygiene maintenence so basically we should stress on oral hygiene maintenance.

Please put forward your views to make a good treatment plan for this case.

With Regards Poonam.

Hi

[Guest guest]

hi adnan thanks a lot.. regards veenaFrom: Adnan Ashraf <adnanashraf2401@...> Sent: Sat, 25 June, 2011 4:15:57 PMSubject: Re: DTP case discussion

Hi Venna

Ideally u should plan a new crown alongwith a metal denture and lab will design an occulas rest on new crown for denture.I think Valplast denture is best for such situation as they dont use any clasp in it so it does not interfare with crowns.

From: Poonam Kapoor <docpoonam_99@...>Subject: DTP case discussion Date: Friday, 24 June, 2011, 19:43

Dear friends,

I have doubt regarding a previous tt planing case and need your help.

The case is as follows

1. Patient is 44 years old lady, her complaint is she has a lower acrylic partial denture replacing first molars and premolars on both sides. She says her denture comes off when she is eating, it’s loose. She has no other complaints. On taking history she said she had a metallic RPD before but her dentist gave her this acrylic one few months back, when I asked why he replaced it, she wasn’t sure about that. Her gums are fine, BPE scores are 212 and 221, no mobility of any teeth, OPG was given there was slight bone loss corresponding to BPE scores. Intraoral photos were given. Both lower right and left second molars were present, they had crowns on them, they were slightly mesially tilted into the edentulous span. The patient also revealed that she had a bridge for the edentulous spaces

before but

later her dentist had taken them off leaving the crowns on lower right and left second molars. She also has asthma takes an inhaler for that. She also grinds her teeth, has slight wear on teeth. She has a bridge replacing upper left central or lateral, I have forgotten. These are the main findings. She also has a few fillings and they are fine. In the information sheet provided it was given that the acrylic denture doesn’t have well extended lingual flanges, there is 1 mm loss of vertical dimension. The crown surfaces (lower second molars) are rough. They also periapical views of lower second molars but I didn’t see any significant finding there. The main thing is she is not happy with her denture, so I tried to address that, explaining why her denture is not retentive (cos of improper design and extension), then talked about the grinding , option of nightguard, told her about her BPE scores and maintenance of hygiene with interdental aids etc, asked her to do a diet chart, the examiner also asked me what kind of denture I would make for her, I said I shall make a metallic one and explained to the patient why I wouldopt for that. She also had recession in a few teeth, not sure which ones . Can someone put forward the treatment plan for this patient .... i want to know can we consider giving metal denture in this case because 2nd molar has crowns so can we give metal dentures? What are the other options we can talk about apart from metal or plastic rpd as this patient does not look after the dentures ,so giving fixed optios is not wise. Why did the previous dentist took out the fixed bridges and metal dentures?i think it because of poor oral hygiene maintenence so basically we should stress on oral hygiene maintenance. Please put forward your views to make a good treatment plan for this case. With Regards Poonam.