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Julian Chen
Julian Chen, Dentist
Category: Dental
Satisfied Customers: 559
Experience:  Practicing General Dentist since 2002
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As an alternitive to a partial denture to replace two missing

Customer Question

As an alternitive to a partial denture to replace two missing front teeth and a few missing back teeth, my dentist suggested using a monodent bridge. My dentist had tried to make a partial denture made of a new flex material. The first partial was a disater. The fit was bad and only got worse. the second partial, the fit was good but the front teeth popped out by the second day. Now, the dentist and the lab tell me that the teeth popped out of the second partial due to the new position of the front teeth. I don't buy that because the front teeth on the first partial stay in place very well and seem very strong, why the front teeth on the second partial I popped out with not too much problem. I don't know what to believe. They are refunding all my money and are still making a new partial, so it's not really a money issue. Now, they suggest the monodent bridge to replace the front teeth and a metal based partial to replace the back teeth. Is the monodent strong enough for front teeth?
Submitted: 5 years ago.
Category: Dental
Expert:  Julian Chen replied 5 years ago.
HiCustomer

I'm sorry to hear about the frustraction you're going through trying to get a working partial denture.

Personally, I would not recommend going with the Monodont bridge system. It's basically a modified form of a Maryland bridge. Instead of bonding to the back of the adjacent teeth, we'd have to drill into the adjacent teeth and then seal it with bonding material. In my opinion, the design is rather weak and would not provide enough support to allow you to bite with the Monodont tooth.

I also do not like the idea of drilling into adjacent teeth. If we're going to go as far as drilling into an adjacent tooth, we might as well proceed with a traditional bridge (fixed partial denture). At least a FPD is a time-tested, tried & true restorative method. I am addressing the issue of longevity of the restoration. Even though we'd have to remove a lot more healthy tooth structure going with the traditional bridge, but at least we know it will last. If you do decide to go with the Monodont bridge, I would recommend that you avoid chewing/biting with that tooth as much as you can.

Here is a website and photos showing a typical Monodont bridge.

http://www.dentalartslab.com/dal-monodont-bridge

As you can see of yourself, I don't believe this design is strong enough to withstand biting/chewing forces for a long time.

Regards,

JulXXXXX XXXXX, DDS
Customer: replied 5 years ago.
Could you tell me if the problems that I had with the teeth poipping out of the partial are common. I liked the partial made of the flex material, but since the teeth came loose on the second partial, the dentist said maybe I wasn't such a good candidate for the flex partial. I don't necessarily agree with their opinion because the front teeth on the first partial remained strongly in place.
Expert:  Julian Chen replied 5 years ago.
The following is my personal opinion. I do not like flex partials at all. If a partial is going to be made, I feel very strongly that there needs to be a metal framework and direct tooth support with the properly designed rest seats to help disperse the forces.

Flex partials are very comfortable, very cosmetic, and usually fit very well at the time of delivery. However, they are also known as "gum strippers" in our profession. Because if there is no metal framework and properly designed rests to distribute the chewing forces, all the pressure applied will be directed onto the underlying gum tissue. Bone is dynamic, and if you apply pressure on it, it will receed/retreat. So what will result is accelerated bone loss and the partial will start to feel loose very quickly because you've lost the ridge of the bone.

I would not say that it is a "common problem" for denture teeth to pop out. However, this would depend on the available occlusal space between the arches. If there is enough room for a metal framework, then there should be enough room to have a good denture tooth placed. You would still need to be careful and not apply too much lateral forces on the denture tooth itself (because it is plastic).

Without the opportunity to examine your current bite, I am unable to give you my opinion as to why the denture tooth popped off the partial.

Regards,

JulXXXXX XXXXX, DDS
Customer: replied 5 years ago.
So, you would possibly recomend a partial with a metal base over the plastic partial or the monodont bridge? I have never worn a partial with a metal brace and am conserned with the comfort and also with the metal clasps being visable on my front teeth.
Expert:  Julian Chen replied 5 years ago.
A metal framework denture does not mean the clasps need to be in metal. Valplast (a name brand known very well for its flex denture) also can provide metal framework in conjuction with a flex resin clasp and retaining features. The metal framework will be still covered by plastic resin material so can still remain rather cosmetic.

It's also a question of how old you currently are, and how many years will we expect you to wear partial dentures vs. possibly moving into an implant system. The thing is, if we end up losing too much bone along the way, we would also eliminate your implant options.

I know you may be content with the look and feel of a flex denture now. Most patients are. However, in 2-5 years, when you feel the unfortunate side-effects of these flex partials, you may end up changing your mind. With accelerated ridge loss, your flex partial will be unstable and move around easily. Even if you decide to get a new one made that's made to "fit" better, however, due to the loss of the ridge, the denture will never feel as comfort and stable as before and the problem will just get worse over time.

I hope I'm not coming off as confrontational as that is not my intent. I've seen too many patients come across my office wondering why their flex partials of less than 2 years now doesn't fit, and then to be informed that they've lost 2-3 mm of ridge height over that short amount of time.

Ultimately, you'll have to make a decision and can still go with the flex denture. I just want to make sure that you know all the pros and especially the cons before venturing down that road.

Regards,

JulXXXXX XXXXX, DDS
Customer: replied 5 years ago.
I thank you very much for your replies and your candor. That is what I need. I am not sure that the dentist and lab representative have my best interests at heart, and I have to make a decision over the next couple of days as to which dental appliance will best meet my needs. I am forty-six years old and am hoping to have this dental appliance for three to four years and then move to implants to replace the missing teeth. My dentist originally suggested the flex partial. And now that we have had so many problems with that device, the lab representative has suggested the monodent bridge and the metal based partial to replace the back teeth. But, like you, I don't feel that the monodent partial bridge will have the strength to hold up over time, which makes me question the advice of my dentist and the lab rep. Which dental appliance would you recomend for me, to replace the two missing front teeth and the four missing back teeth, two on each side. The lab rep also recomended the metal based partial, with front and back teeth.
Expert:  Julian Chen replied 5 years ago.
To help me with my recommendation, can you tell me if this is a lower or upper partial denture?
Customer: replied 5 years ago.
I'm sorry. This is an "upper" partial, and it is replacing my two front teeth and two rear mollers on each side of the mouth.
Expert:  Julian Chen replied 5 years ago.
Well, if the 2 front teeth needs to be replaced, I definitely would advise against going with the Monodont bridge system. There is no way the Monodont design can hold up for #8 & 9 for an extended period of time, especially if we're going to rely on #7 & 10 for support, which are the 2 smallest teeth in the upper arch.

And if the lab rep is recommending a metal-based partial, then that would mean there's should be no space issue between the two arches. Given that you're 46, we want to make sure this partial is completely tooth-supported and apply very minimal pressure on the underyling gum tissue. We want to retain as much bone as possible so that when you're able to go forward with implant restorations, that we'll have sufficient bone for the implant fixtures. You might still need sinus lift for your posterior molars (depending on the location and size of your maxillary sinugs), but at least we don't want to jeorpardize bone loss for your 2 front teeth.

The good thing about a metal framework partial on the upper arch is that the palate is rather strong and can help in the distribution of the chewing forces. And using the metal framework, we can use the palate as an additional "rest" for support.

I am going to assume that you're missing teeth #2, 3, 8, 9, 14, & 15. (2-3 are the upper right side back 2 molars, 8-9 are your front teeth, and 14-15 are the upper left side molars). There should be 4 "rest seats" designed for this partial. Mesial rest seat designed on teeth #4 & 13, and cingulum rests on teeth #6 & 11. This would mean that there will be minimal drilling on teeth #4 & 13 (your 2nd pre-molars), as well as minor grooves drilled into the tongue-side of #6 & 11 (your upper canines). So when you chew with the partial, the biting forces will be redirected and distributed mainly to these 4 teeth and not directly on the soft tissue. This will help reduce the amount of bone loss. Then I-bars or flex resin clasps can be specifically designed to help retain the partial and keep it from coming off too easily.

Of course this is just a preliminary design for the metal framework and how viable it is would depend on the health and conditions of #4, 6, 11, & 13. As long as these teeth aren't periodontally involved, then they should be great candidates for placement of rest seats.

However, ultimately, it will be up to your restoring dentist to try and provide you with the best design that will help you retain the most bone and ridge height as to optimize your eligibility for implant placement down the road. It is also possible that since you've had 2 failed partials, to ask your general dentist if it's possible to refer you to a "prosthodontist". A prosthodontist is a specialist in more complex restorative cases. They go through additional years of training specifically in the areas of implant restoration, as well as removable complete and partial dentures. Although you may have to pay a slightly higher fee for a partial they will provide for you, in my opinion, it's worth the additional cost because I'd pay for having the additional bone support down the road. Once the bone is gone, it's nearly impossible to grow back.

I'll leave that at your discretion, whether you feel it's time to ask for a prosthodontic referral. As long as the partial is primarily tooth-supported, then the prospect of minimizing bone-loss would be really good. It's the completely soft-tissue supported dentures that we need to stay away from, even though they are extremely comfortable and look great.

Regards,

JulXXXXX XXXXX, DDS
Julian Chen, Dentist
Category: Dental
Satisfied Customers: 559
Experience: Practicing General Dentist since 2002
Julian Chen and 3 other Dental Specialists are ready to help you
Customer: replied 5 years ago.
Julien, thank you for your answers. Your advice has been very helpful and much appreciated.

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