Re: Are Upper Dentures As Comfortable As Lower?

jdm003 wrote:

Thanks for the new information, Steve. Maybe we will try the partial as
you recommended. The #11 tooth, by the way, had a root canal, and I
believe the dentists wanted to do a root canal on #13, although there
were no problems reported by my mother on this tooth. This brings up
another question: Are root canals done when there is no apparent need
for them? Is there a preventitive reason for doing one before a crown?
The dentist did not explain the reason for wanting to do a root canal;
I would sure like to know why!

John

You deserve to know the reason, and there had better be one.

Steve


Steven Bornfeld wrote:

jdm003 wrote:

Thanks for the reply, Steve. The cost is the main reason I am debating
between the bridge(s) and the partial. All the options that I mentioned
are viable according to the dentist. It's about what to expect in
comfort and stability from an upper partial that I am trying to
determine. I don't understand why an upper partial would be as or more
comfortable - or "accepted," as you said - as a lower partial, if the
upper partial might have a pallete. And also if gravity is not working
with it to stay in the right position as it does with a lower partial.
Maybe you could explain this further if you want to.

Gravity as a factor is grossly overrated (;-)) in stability and
retention of dentures. Lower dentures generally suffer from a much
smaller bearing area. If you've ever seen a full upper and full lower
denture, you see that the lower is horseshoe-shaped, balanced generally
on a thin bony ridge. The tongue, surrounded by other muscles fits in
between. Not only does a lower denture (full or partial) present more
of an adjustment problem for the tongue which must fit between the left
and right flanges, but the muscles of the floor of the mouth tend to
dislodge the lower during function. There is generally an adjustment
necessary for speech even if there are no front teeth on the partial
lower because of the major connector (lingual bar) of the left and right
sides. Finally, that full upper denture is like a big suction cup.
Actually getting real suction in a full lower denture is rare.
The same applies (though not as extremely) with partial dentures.
Uppers are more stable because they generally can rest on a broader
surface--specifically the palate. If the frame is cast, the connector
on the roof of the mouth does cover part of the palate, but it is very
thin and rarely much of an adjustment problem.



The spaces involved are #2 (tooth), #3-#5 (missing), #11 (tooth), #12
(missing), #13 (tooth) and #14 (tooth). Let me know what you think
about the pallete, what would be the likely design. Of course, I will
also talk to the dentist about this if I choose a partial. It is hard
to gather all the information from the dentist, and frankly they do not
like to spend too much time explaining things, so I'm trying to get
some information on my own.

Well, I'm not thrilled about the difficulty getting information out of
them, This is only taking a couple of minutes for me to explain, and
would take less if I could speak instead of type and actually show you
examples of different types of partials that I keep around the office
for demonstration purposes.
The biggest concern in your particular scenario is the missing 3, 4,
and 5. Replacing this with a fixed bridge is a long span, and while I
have seen bridges stretching from 2 to 6 succeed, you can imagine that
this forces the 2 teeth at either end to do the work of 6--generally not
a good thing. I see no advantage to doing the three-unit bridge 11-X-13
and wearing a removable bridge for the missing teeth on the right side.
It is possible that if #11 and 13 are heavily filled they might be
better off with crowns to allow them to hold the partial more securely,
but this is a separate issue. To me the viable options appear to be
either replacement of all missing teeth with implants, or implants on
the right side and fixed bridge on the left--or a partial upper to
replace all the teeth. Obviously the quickest, simplest and far the
cheapest is the removable appliance, and it is probably sensible to try
this first, since the probability of acceptance is very high.

Steve


Steven Bornfeld wrote:

jdm003 wrote:

My mom has been wearing lower partial dentures for many years, so she
is familiar with how those feel. She leaves the partial in all day, so
she would do the same with an upper partial. Now she needs to decide
between a right-side upper partial covering three molars in combination
with a left-side bridge; an upper partial that covers the three
right-side molars and also covers one tooth on the left side; or
bridges on both sides.

I would like to hear from people that have upper partials (and dentists
can also reply with their expertise) how they feel, especially how they
might differ from a lower partial. Do they stay on as well? Are they
comfortable? Does anyone know if the partial would need a pallet (flat
piece under the roof of the mouth) in either of the options mentioned
above? I would like to get different opinions on this, so please
don't hesitate to reply even if there are already some replies.
Thanks a lot.


Generally speaking, upper partial dentures are accepted as well or
better than lower partials. The only caveat is for patients with a very
strong gag reflex, and for partials this means relatively very few patients.
How much of a palatal base would be required depends upon which teeth
are being replaced, and the location of the teeth to be clasped.
Generally removable partials are more stable when there are teeth being
replaced on both sides of the mouth. The selection process between
removable partials and fixed bridges depends upon the condition and
location of the remaining teeth (including periodontal condition),
esthetic concerns and cost. Most of the time the choice is between
fixed bridges on both sides and a removable appliance. If fixed bridges
aren't a good bet because of the condition of the teeth, a patient is
generally better off with a removable appliance replacing teeth on both
sides rather than a fixed bridge on one side.

Hope that's clear,
Steve




--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
.

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