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My 86 yr old diabetic Dad is mentally reluctant to extract…

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My 86 yr old diabetic Dad is mentally reluctant to extract his remaining 5 upper front teeth. In his logic, he is determined that he will find someone who can create a partial denture while also keeping these front teeth. 4 dentists said they have to go. One... Read full answer
My 86 yr old diabetic Dad is mentally reluctant to extract his remaining 5 upper front teeth. In his logic, he is determined that he will find someone who can create a partial denture while also keeping these front teeth. 4 dentists said they have to go. One dentist said he has to get bone grafting another said don't bother with bone grafting or implants because his age can make bone healing slow because of diabetes. He is very active but hiding his mouth. He needs something asap so he can eat now and implants will take too long. But my Dad really wants them. Can all these concerns be achieved. 6, 7,8,9,10 3 appear imbedded well but 2 of them are worn down to the gum base. Can one or 2 of his front uppers remain and 2 implants be installed on the upper worn out ridge and just experiment ASAP and if it doesnt work, we can pull the rest of the front teeth later? But at least he can begin to eat sooner than 90 days for extractions to heal?
His upper ridge is very high but the front is lower. The CT scan shows he has enough space for implants to just clear his sinus.
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Answered in 2 hours by:
8/13/2011
Mark Bornfeld, DDS
Category: Dental
Satisfied Customers: 6,091
Experience: Clinical instructor, NYU College of Dentistry; 42 years private practice experience in general dentistry, member Academy of General Dentistry, ADA, Fellow, American Academy of Oral Medicine
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Welcome to JustAnswer, and thank you for putting your trust in me!

Whether or not implants are feasible is not the issue here. If your father is otherwise competent, his preferences must be respected.

Although diabetes does diminish your father's suitability as a dental implant recipient, his ability to choose holds far more weight. There is little question whether an implant-supported prosthesis can be made; the more important question is whether it should be made.

If need be, an acrylic base transitional partial denture can be constructed that will serve well until your father is prepared to embark upon a more ambitious prosthetic treatment plan. In any case, it is likely that even if implants are contemplated, they would be used as supports for a removable prosthesis, and a transitional acrylic partial denture can be retro-fitted with implant attachments later if the additional support and retention is determined to be advantageous. This type of prosthetic device can also have teeth added to it if additional natural teeth are lost, or overlaid over any remaining tooth roots if your father chooses not to extract them and they are not currently infected.

This type of prosthesis will be able to rapidly restore lost chewing function, and is sufficiently versatile that it can be modified to adapt to changing oral conditions, as well as changing preferences.

Hope this helps...
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Customer reply replied 7 years ago
As I mentioned, he has little upper ridge. And no teeth except the front 5.
This should not be a deterrent to making a functional acrylic base partial denture. Although an atrophic alveolar ridge may necessitate some compensatory measures, such as the ongoing use of a denture adhesive, it is a workable alternative that your father will accept.

Keep in mind that many prosthetic dentists are relatively inflexible as regards ***** ***** think is right and what they think is wrong. While their guidance is helpful, many specialists are not sufficiently accommodating, and may take a "my way or the highway" strategy. To my mind, this is the height of arrogance, because it assumes that the patient has nothing useful to contribute to the interchange of prosthetic ideas. If your father is competent, he is in the best position to judge what is and what is not an acceptable plan of treatment.

There is often much latitude in the range of available treatment approaches, and the treatment itself can evolve after an initial conservative approach is offered. This allows your father the dignity of determining his own treatment. Assuming that you find a dentist who is sufficiently respectful of your father's preference, there should be no reason why a favorable treatment outcome cannot be achieved.

Hope this helps. If my answer has been helpful, please remember to click "accept".
Good luck!
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Customer reply replied 7 years ago
My understanding is that the acrylic prosthesis is the denture correct? And that can be made without removing his 5 front teeth even though the dentist claim he needs to remove them? In the meantime the denture can be made even if the teeth are bad correct? Then he will be empowered on his own with dignity. I like that. Can I send you a photo of his front teeth? They are ugly and scary and he thinks they can be crowned. But the dentist feels they are going to compromise his bone because biting down on week teeth will impact his mouth. Also, he always has headaches now. I'm worried if the bad front teeth or a lower one #28 or 21 he made the dentist fix it even though the dentist said to crown or pull it. I will soon accept.
quot;My understanding is that the acrylic prosthesis is the denture correct? And that can be made without removing his 5 front teeth even though the dentist claim he needs to remove them?" Answer: Yes, and yes.

Please feel free to send photos. I will be away from my computer for the next 2-3 hours, but I will respond as soon as I return...
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Customer reply replied 7 years ago

Ok, here are my fathers teeth and a panorex... i have no photos of bottom teeth, but i know that they are ok except for 28 and 18 are teeth that most dentist said he should pull.....one of those, he insisted a dentist simply fix,,, and 2 months later, it is bothering him sooo much,, and i think it is giving him head aches....he can;t eat on it or drink cold liquids....So i know i should encourage him to remove the top teeth too.He saw the photos and he is almost accepting the fact that he has to remove them....So i will try to coax him if in fact if you also think the xray shows that they are going to compromize the rest of his mouth and jaw bone...

<a href="http://s668.photobucket.com/albums/vv42/stac_it/?action=view&amp;current=f46ca158.jpg" target="_blank"><img src="http://i668.photobucket.com/albums/vv42/stac_it/f46ca158.jpg" border="0" alt="Photobucket"></a>

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you forgot to give me some input on how the bone grafting would go while he has this temporary denture on?

Thank you once again for you sincere advice and help with helping me make a decision.

I agree-- there's no question that keeping the remaining upper teeth will only get in the way of a functional and esthetic denture. It would also be foolhardy for a dentist to encourage therapeutic heroics to salvage these teeth, or #18 or #28, for that matter. However, an acrylic denture could be built around those teeth if your father doesn't come around to seeing things that way, and could be extracted later, and the denture could subsequently have those teeth added to it. Your father needs to be a willing subject, and his dentist should concede to his wishes to the extent possible. As it is now, any improvement in your father's dentition will also provide functional improvement. There is no need to damage his self-esteem in the process by devaluing his preferences.

Bone grafting is a much more involved issue, depending on where it is being done and how much. For example, the placement of a bone graft in the sockets of any teeth being extracted is a simple procedure with a high success rate. On the other hand, a large scale graft intended to restore an extensive area of resorbed ridge is less certain, especially given your father's medical profile. Based on your previous narrative, the sinus would not interfere with implant placement, so there would be no need for grafting for the purpose of a sinus lift. If implants are eventually placed, they would eliminate the need for large scale ridge augmentation, so the rationale for grafting needs to be considered based on long range prosthetic plans, and whether implants are in your father's future.

Hope this helps. If my answer has been helpful, please remember to click "accept".
Good luck!
Mark Bornfeld, DDS
Category: Dental
Satisfied Customers: 6,091
Experience: Clinical instructor, NYU College of Dentistry; 42 years private practice experience in general dentistry, member Academy of General Dentistry, ADA, Fellow, American Academy of Oral Medicine
Verified
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Customer reply replied 7 years ago
Did you see the panorex and the pics of the front teeth? My father did not understand why his own front teeth arent better than implants that would go into the same sockets!
I just wanted to say that you treated my Fathers concerns with utmost respect. Including my own wish to not insult his process of digesting information and not merely following advice like a mindless robot. And trusting the process that is required for making intelligent decisions which also involves an emotional process, not just facts and data.
You are a wise man and i wish you health happiness, honest people around you and longevity.
I did see the panoramic x-ray. In answer to your father's confusion as to why his own teeth aren't better than implants that would go into the same sockets-- he is at least partially justified in his confusion. His teeth are badly worn to the point of being nearly obliterated, so they can no longer be relied upon to either retain a partial denture nor can they function as chewing units on their own merits. However, if he is going to be placing implants, it just makes more sense to place them in positions that will do the most good. Placing implants solely in the front of the mouth in the same location as the remaining teeth would not provide nearly as much retention or stability for a denture as they would if they were distributed more evenly around the circumference of the jaw. I can only speculate that sinus lifts would be necessary to allow implants to be placed in more posterior positions, and your father's dentist(s) have chosen not to perform sinus lift procedures.

I won't dispute that implants limited to the front of the mouth would help to stabilize the denture, but I'm uncertain whether they would provide sufficient benefit to justify the effort and expense. It may be preferable to build a conventional partial denture (or, if you can convince your father that extracting the remaining upper teeth is appropriate, a complete upper denture), and see how he fares with this prosthesis before deciding whether implants are a good idea.

Good luck!
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Customer reply replied 7 years ago

"His teeth are badly worn to the point of being nearly obliterated, so they can no longer be relied upon to either retain a partial denture nor can they function as chewing units on their own merits"

- my Dad thought they can simply clean up the front teetn and restore them with crowns. He tries wiggling them back and forth and he says they are tight and strong.

"It may be preferable to build a conventional partial denture"

- Is this the same one you were referring to in the beginning called an "acrylic base partial denture"? which can be modified when and if he is ready to pull the teeth?

For example, can he go to a dentist and they pull the bottom #18, 28, and 2 of the top ones and bone graft those,,, but restore 3 of the front teeth with crowns. After that, make the mold for the denture and in a few days, the denture will be ready.

In a months time,,, should he decide the denture is annoying,,,, will it be possible to tell why it is not comfortable? And should the front teeth be in the way, you are saying that the denture can always be altered to accomodate any and most dental changes?

And if he pulls teeth a few weeks after wearing the "acrylic base partial denture", that acrylic base partial denture can be redesigned or altered?

but what about a more permanent denture which you also mentioned.?..

does he have to wait till the extraction heels or fills in from the bone graft in order to use the "acrylic base partial dentures?"

if i understood correctly; a bone graft might not be necessary with implants, yet it's a good idea to build a ridge to accomodate a denture correct? The only dentist that mentioned grafting on the written treatment plan happened to be the second dentist that did not recommend implants. The other dentist that gave treatment plans for extractions and dentures did not mention any grafting. Is grafting a routine process after extracting teeth to accomodate a denture and this is why it was not mentioned on the treatment plan?

(By the way....he has no dentist anymore because they pulled the wrong tooth 4 years ago and he got upset.) so i have been taking him to a few dentists for consultations and i feel awful not having an actual dentist, but it has been interesting to see the various pricing and opinions.

quot;my Dad thought they can simply clean up the front teetn and restore them with crowns. He tries wiggling them back and forth and he says they are tight and strong."
A: Although I believe it's appropriate to offer a treatment that a patient desires if it has a chance of providing benefit, those teeth are too far gone to reliably hold crowns. To provide a firm connection between the crown and the tooth, gum tissue would need to be cut away from the roots to expose more of the teeth; in so doing, the teeth would be deprived of sufficient supporting bone to be viable. Sadly, this is one request with which your father's dentist(s) cannot comply-- it would be a waste of effort and money.

"

"It may be preferable to build a conventional partial denture"

- Is this the same one you were referring to in the beginning called an "acrylic base partial denture"? which can be modified when and if he is ready to pull the teeth?"

A: it is the same one. Additional teeth can be subsequently added to the denture when your father is ready to part with his remaining natural upper front teeth.

"For example, can he go to a dentist and they pull the bottom #18, 28, and 2 of the top ones and bone graft those,,, but restore 3 of the front teeth with crowns. After that, make the mold for the denture and in a few days, the denture will be ready."

A: I don't think it would be prudent to restore only 3 front teeth with crowns. Although such a plan could be implemented, 3 teeth clustered together do not provide sufficient benefit in terms of supporting a removable prosthesis to justify the effort or expense. It's one thing to maintain those teeth if your father refuses to extract them, but it's quite another thing for a dentist to exploit your father's understandable but misguided assumption that those teeth are in good condition so that he can charge a crown fee. And as stated previously, I don't necessarily think bone grafts in the extraction sockets are always appropriate, but must be considered in the context of future prosthetic plans. I won't comment on the time factor involved in denture construction, other than to say that the denture can be fabricated prior to the extraction of any front teeth. In some cases, denture fabrication may require a few visits, with time intervals to allow the dental laboratory to provide their service.

"In a months time,,, should he decide the denture is annoying,,,, will it be possible to tell why it is not comfortable? And should the front teeth be in the way, you are saying that the denture can always be altered to accommodate any and most dental changes? "

A: That would depend on why it is uncomfortable, and the diagnostic skills of his dentist. Most common issues would be detected and correctable.

"And if he pulls teeth a few weeks after wearing the "acrylic base partial denture", that acrylic base partial denture can be redesigned or altered?"

A: The design of the denture could not be altered, but the denture can be modified-- for example, to reduce pressure spots that cause soreness, or shortening of the palate to reduce gagging, or addition of those front teeth if the natural teeth are extracted.

"but what about a more permanent denture which you also mentioned.?"

A: I don't recall mentioning a more "permanent" denture. However, the intent of a denture may be "transitional"--i.e., to allow a patient to transition from a partially edentulous condition-- i.e., with some remaining natural teeth-- to a fully edentulous condition (no teeth). That does not mean that the modified denture cannot serve as the definitive prosthesis. Whether some change in treatment strategy would be warranted in the future would be decided by a collaborative decision between your father and his dentist.

"does he have to wait till the extraction heels or fills in from the bone graft in order to use the "acrylic base partial dentures?"

A: No-- it is customary to place dentures immediately over front tooth extraction sites in order to avoid a socially awkward toothless state. The part of the denture base that rests on the fresh extraction site is contoured so that it does not press on the surgical wound, and allows healing to take place.

"if i understood correctly; a bone graft might not be necessary with implants, yet it's a good idea to build a ridge to accommodate a denture correct?"

A: The necessity for bone grafting depends entirely on whether there is sufficient bone in the area under consideration to serve in the capacity in which it will play. To make a determination of whether grafts are appropriate, a proper imaging study-- sometimes using CT scans-- is helpful. Unfortunately, the diagnostic photos and panoramic films you supplied are insufficient for me to weigh in on this issue.

I can understand your reasons for taking your father to several dentists, but you can also see the downside: too many opinions can cause confusion. I'd advise that you choose a dentist and stick with him. If in doubt, a consultation with a prosthodontist, if you have not already had one, would be helpful; members of this dental specialty are best qualified to make difficult prosthetic treatment choices such as your father's. You can find contact information for a prosthodontist near you by referring to the online directory of the American Board of Prosthodontics.

Good luck!

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Customer reply replied 7 years ago
How do i continue and begin this again and of course i will pay...as i don;t have a question but just need to assess what i am learning and deciding with some support. Please refer to what i wrote and alert me to concerns from what i wrote below.
Although an atrophic alveolar ridge may necessitate some compensatory measures, such as the ongoing use of a denture adhesive, it is a workable alternative that your father will accept.


The University doc that saw my Dad said a denture will be very uncomfortable for him and be very dicouraging because he will be using them for the first time at this age in life as opposed to getting use to them when he was younger. They will be uncomfortable and hard to wear comfortably because he has less and less muscle tone in his face and jaw.

While their guidance is helpful, many specialists are not sufficiently accommodating, and may take a "my way or the highway" strategy.


One dentist said; leaving some of the front teeth without extracting them will interfere with a good suction of the denture. he then looked at the CT scan but said to visit the implant specialist that he recommends as opposed to using the direction of the one i allready had my Father see.

- The other thing that i misunderstood is about the bone grafting. First this dentist said; the bone grafting is done to build the ridge up. But now he said, the bone grafting is done when there is an extraction or the bone will decrease.. But if my Dad is getting implants, he needs grafting?. If he gets denture he does not?. but initially he said if my Dad gets no implants and gets dentures then he had to do bone grafting.

so what do you think he actually said because i got mixed up. i saw a surgeon, and a dentist.

- i also need to know what you heard about mini implants and ceramic or zirconiam implants that are less metal ions....

- aLSO,, can you read a CT scan some way? i have my Dads CT scan/

- also, i got an estimate from oral surgousn and implant specialist so i don;t want to try anymore. The latest dentist that i chose for my Dad is up the block and very convenient and is a mercury freee dentist so i assume is more ethical....but he said i must take my Father to this other implant dentist, but i have gotten 3 quotes from implant specialist that i don;t feel i have to go to another one.

Will it make the outcome not good to uses an implant person of my choice?

The University doc that saw my Dad said a denture will be very uncomfortable for him and be very discouraging because he will be using them for the first time at this age in life as opposed to getting use to them when he was younger. They will be uncomfortable and hard to wear comfortably because he has less and less muscle tone in his face and jaw.”

A: This statement is just so unfortunate on so many levels that it cannot stand unchallenged. Although I agree that a doctor must guide his patient in a direction he feels is best, ***** ***** always remember that the therapeutic encounter is a dialog; the days of doctor as God are long over. First, the statement is patently false; the majority of denture prosthesis patients are already elderly, and if what he said were true, there would be no such thing as a successful denture. Second, the success or failure of treatment is heavily influenced by a patient’s psychological preparation and expectations. This doctor’s statement is not intended to help your father; its intent is quite the opposite—to sabotage the outcome of a legitimate treatment whose only intrinsic failing is that it does not agree with what the doctor wants to do. Having heard these negative suggestions, your father would interpret any challenges he may encounter in adjusting to his new denture as validation that it is a doomed effort, instead of the normal learning process it is.

One dentist said; leaving some of the front teeth without extracting them will interfere with a good suction of the denture.”

A: True, but this would not be an insurmountable obstacle. Although a partial denture does not have as much intrinsic “suction”, that partial dentures often succeed is indisputable.

“…he then looked at the CT scan but said to visit the implant specialist that he recommends as opposed to using the direction of the one i allready had my Father see”

A: If a restorative dentist is going to be working in collaboration with a surgeon, it would be entirely appropriate for that restorative dentist to choose a surgeon with whom he is familiar. However, there should also be room for flexibility.

The other thing that i misunderstood is about the bone grafting. First this dentist said; the bone grafting is done to build the ridge up. But now he said, the bone grafting is done when there is an extraction or the bone will decrease.. But if my Dad is getting implants, he needs grafting?. If he gets denture he does not?. but initially he said if my Dad gets no implants and gets dentures then he had to do bone grafting…so what do you think he actually said because i got mixed up. i saw a surgeon, and a dentist

A: As stated previously, the necessity for bone grafting depends entirely on whether there is sufficient bone in the area under consideration to serve in the capacity in which it will play. This can only be determined on a case by case basis by assessing the diagnostic record. I cannot guess what your father’s dentist actually said—you will need to ask him.

i also need to know what you heard about mini implants and ceramic or zirconiam implants

A: Standard diameter titanium or titanium alloy implants are the current standard for definitive prosthetic treatment. Mini implants are primarily intended for temporary stabilization, and not for permanent use.

aLSO,, can you read a CT scan some way? i have my Dads CT scan

A: I would be unable to provide specific guidance, as a meaningful analysis requires access to the original digital data so it can be run through implant planning software.

also, i got an estimate from oral surgousn and implant specialist so i don;t want to try anymore. The latest dentist that i chose for my Dad is up the block and very convenient and is a mercury freee dentist so i assume is more ethical....but he said i must take my Father to this other implant dentist, but i have gotten 3 quotes from implant specialist that i don;t feel i have to go to another one. Will it make the outcome not good to uses an implant person of my choice?

A: Unknown. However, as stated above, when the surgical and prosthetic phases of implant service are divided between two different practitioners, it is vital that treatment be properly coordinated. The prosthetic dentist must be familiar with the hardware supplied by the surgeon and vice versa for the treatment to succeed. Therefore, the dentist who provides the prosthetic part of the service would have primary responsibility for choosing the surgeon; after all, he will need to use the foundation provided by the surgeon, so he must be comfortable with the surgeon’s work.

Hope this helps…

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Customer reply replied 7 years ago
the particular dentist i chose for my father said he is an oral surgeon, but he doesn't do as much as a oral surgeon. Will my Father be at risk? And he stated that he has gone to the same school and training as the oral surgeon my Father saw initially. This dentist assured my Father can get implants at a future date with the surgeon of his choice if he insists, and that he doesn;t need bone grafting in the front upper 5 teeth and in fact there is too much bone up there.
But my confusion is that the the implant dentst from the Dental Colege says there should be bone grafting now in case my Father does not succeed with the denture only method and needs implants in the future and so the bone doesn;t shrink.

(also, have you been paid yet including my bonus? )
what times are you available to answer so that i plan ahead to ask you any questions in the future, or is it random?
Bone grafting may reduce the amount and speed of bone resorption in the vicinity of the tooth extractions. Grafting is something that might help in this regard, but it is no guarantee that there will not be need for additional grafting in the future if implant placement is delayed. Therefore, grafting at the time of extraction is discretionary.

I have been paid. My availability at JustAnswer is intermittent-- I am a full-time practicing dentist, and catch up with questions over lunchtime, mornings and evenings, and when there are gaps in my schedule. I usually get several opportunities during the day to respond to questions.
Mark Bornfeld, DDS
Category: Dental
Satisfied Customers: 6,091
Experience: Clinical instructor, NYU College of Dentistry; 42 years private practice experience in general dentistry, member Academy of General Dentistry, ADA, Fellow, American Academy of Oral Medicine
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Customer reply replied 7 years ago
Follow up; The dentist we settled for, Dr. Z who now states in his revised treatment plan; "Your Father may not be comfortable with partial lower. An alternative would be, 3 lower implants and a 6 unit bridge. The fee wold be higher." "This estmt does not include any future crowns on the lower if necessary or any refitting of the Denture to Implants."
Complete upper is $2,200 - LowerPartial-resin base is $1,850,(this is a metro area). What i find odd is Dr Z's 1st treatment outline last winter lists bone grafting on each extraction. But now he states insistingly and impatiently that my Dad won;t need the grafting now or even in the future should he be uncomfortable with the denture and wants implants on the top to hold the snap on denture. He saw the CT scan. He also stated that should Dad want implants , a new denture has to be made. He insisted that this is the denture he needs and if he requires to retrofit it in the future that a whole new denture needs to be made,,,And the bad thing is that my Father allready gave him $1000 to begin and the treatment plan was faxed to me after the doctor allready got the $1000 downpayment. The treatment was to extract all the uppers and 2 on the bottom. My Father does not want to get the one on the bottom extracted which was recently filled but he feels pain upon drinking cold liquids and this current dentist insists my Father will be complaning after he gets the partial on the bottom if he does not extract that tooth,,#18, and 28..(one of them my Father wants to still keep it becuse he says he can tolerate the pain if he does not let cold water on that side. (i know my Dad is old school and been through bombs and famine and all that,, so he endures everything.
Do you have a specific question?
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Customer reply replied 7 years ago
What could be the reason why the dentist initially recommended bone grafts, but now he doesn't? Yet the other dentist recommends it's better to do bone grafting now so it's allready done. Also, Dr Z says a bridge on the bottom is his recommendation. Does that mean there would be no need for a bottom partial?
I agree that the inconsistency in your doctor's treatment recommendation needs to be explained, but I cannot answer for him. Likewise, I cannot comment on whether Dr. Z intends to use a fixed bridge as a sole prosthesis, or whether he intends to use it in conjunction with a partial denture. These questions would be best directed to the doctors making the treatment recommendations, because only they would know their intent in providing their guidance.

Hope this helps...
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Customer reply replied 7 years ago
I will ask for an explanation to Dr Z of why his initial treatment plan 8 months ago required grafting and not the second opinion last week?. I think its because my Dad definately wanted implants when he got the first treatment plan. But abandoned the idea of doing anything when he learned he had to remove all his upper teeth.

Perhaps he changed his recommendation because my dads bone shrunk in 8 months, or he changed his recommendation of not grafting now because i told him we wanted to start with dentures and worry about implants later and then retrofit them. But he said NO to retrofitting a denture. Why would that be?

Dr Z insists my Dad won;t need implants later and even if he did, he wont need bone grafting. Re-read my previous text i begun earlier this eve. His fee for the bone grafting for all the 5 upper front sockets was an extra $200 per socket. But now he says there is in fact too much bone where those front 5 teeth are located since the back has no ridge. They do kind of protrude like an appendage low down because the ridge has retracted high up into the upper palate so its almost flat on top.
Statistically;Do most people fare ok with dentures with this type of situation at this age? Or are they miserable with requiring too much glue to hold the upper denture? He would want the most functional and comfortable system.

You mentioned acrylic transitional partial in the very beginniing. WHen i mentioned this to Dr Z,, he said that will be more costly to retro fit it,, and the way to go is the complete denture now and another one has to be made later if he wants implants.
. BUt is an acrylic transitonal partiall much cheeper than a $2,200 denture?
quot;But he said NO to retrofitting a denture. Why would that be?"
A: Whether or not a denture could be retrofitted with implant attachments would depend on the design of the denture. For example, if the dentist chooses to make an all-metal denture base, it would complicate future efforts of adding attachments. Of course, this is by choice; he could theoretically use a denture design that could be revised-- for example, by using an acrylic base in the proposed future site for implants.

"Statistically;Do most people fare ok with dentures with this type of situation at this age? Or are they miserable with requiring too much glue to hold the upper denture?"
A: I'm not sure that statistics are meaningful, because success or failure depends on so many variables-- gum ridge morphology, saliva quantity and quality, neuromuscular adaptability, and patient expectations. Patient satisfaction runs the gamut of completely happy to using the denture as a paper weight. The majority of patients do well.

"BUt is an acrylic transitonal partiall much cheeper than a $2,200 denture?"
A: I don't know what Dr. Z would charge for an acrylic transitional partial denture, so this is perhaps a better question for him to answer. I can only say that my fee for an acrylic transitional partial denture is significantly below $2200.

Hope this helps...
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Customer reply replied 7 years ago
Would the labor cost to retrofit an acrylic transitional partial denture onto implants in the future and to reline and adjust the denture for for retracting bone and ridge be so costly that making a new one makes more sense?.

if the dentist chooses to make an all-metal denture base, it would complicate future efforts
So if Dr Z is in fact making a metal base denture, it would be in my Dads interest for me to advocate for an acrylic transitional partial denture because the likeli hood of it sliding and moving out of place are very high once the front 5 teeth are pulled and the bone shrinks without bonegrafting in the sockets. The ridge is practically flat with the upper pallet. That means there is nothing for the denture to lean against and stay stable. I would think we should keep those ugly front teeth even though they are not infected maybe they should be kept after all.

How would it play out if he began to get frustrated while eating and would begin to run out of the house and be too lazy to put his dentures in? he hated using his bottom partial.

Please answer this previous concern; Perhaps Dr Z changed his treatment of grafting to not grafting 8 months later because my dads bone shrunk, and because i entertained the idea that i wanted to begin with a denture as a start to see if simply using dentures alone would suffice? Where as before, it was initially a desire to begin with implants from the start so his treatment listed grafting in the pricing.

What would happen if my Dad felt discomfort and the denture moved or loses its suction and is cumbersome and implants and bone grafting was needed after all ? Would the outcome be better bone integrity doing the graft 6 months to a year after he's been wearing the denture or having bone grafted inside the sockets immediately after the exractions. And why did Dr Z say bone grafting the upper front sockets is not needed because there is actually too much bone in the upper front? and can that work against the denture fitting properly? Ive read its actually better to have some original teeth on the top even if its just one because it keeps the denture in its place better if there were no teeth at all. see where it says
Cu-Sil
http://www.doctorspiller.com/Denture_types.htm

You wrote; "Therefore, grafting at the time of extraction is discretionary."
can it hurt to graft in my Dads case if he does not get implants ever?....i got 2 opinions from both dentists that saw the CT scan....

Dentist Z felt assured that my Dad will be satisfied and he will not desire implants. Dentist A felt it was his best to do bone grafting in any case because his guess is my Dads muscles were weak and he would be overwhelmed with the fussines of glue and adjusting the denture that he would be dissapointed eventually and want the help that implants would provide.

Lastly...the bottom he has 2 teeth needing to be extracted...# 18 and 28...Amd a handful of teeth will remain.
the Dr Z recommends 3 implants and a 6 unit bridge on the bottom on his treatment advice. .... he feels my Dad will not be comfortable with the partial lower.

How valid is this issue with bottom dentures and partials being less stable than the upper?
perhaps the Cu-sil would work best here?

How do i keep replying and simply adding tips to keep the thread going without posting a new question?
quot;Would the labor cost to retrofit an acrylic transitional partial denture onto implants in the future and to reline and adjust the denture for for retracting bone and ridge be so costly that making a new one makes more sense?."
A: That would depend on whether any information gained during the wearing of the transitional denture supported some type of design modification. It is almost always less costly to modify a pre-existing denture than it is to start from scratch.

"So if Dr Z is in fact making a metal base denture, it would be in my Dads interest for me to advocate for an acrylic transitional partial denture"
A:I think it's in your Dad's interest for him to seek treatment from a dentist whose expertise he trusts, and for both of them to collaboratively arrive at a therapeutic course that they both can live with. Not knowing your Dad and not being familiar with his diagnostic record, I would not presume to know what is best for him.

"Please answer this previous concern; Perhaps Dr Z changed his treatment of grafting to not grafting 8 months later because my dads bone shrunk, and because i entertained the idea that i wanted to begin with a denture as a start to see if simply using dentures alone would suffice? Where as before, it was initially a desire to begin with implants from the start so his treatment listed grafting in the pricing."
A: A reasonable assertion, but speculative. Again, I cannot know the motivations or rationale of another person, and it would be better to ask him.

"
What would happen if my Dad felt discomfort and the denture moved or loses its suction and is cumbersome and implants and bone grafting was needed after all ?"
A: Then his dentist would take whatever action he deemed appropriate at the time.

"Would the outcome be better bone integrity doing the graft 6 months to a year after he's been wearing the denture or having bone grafted inside the sockets immediately after the exractions."
A: The difference in the outcome would be unknown. However, it would be preferable to do any necessary surgical preparatory work prior to denture fabrication in order to avert the need for future modification of the denture. Obviously, if various aspects of treatment can be anticipated in advance, it will make for a more rational course of treatment with less need for extra work.

"And why did Dr Z say bone grafting the upper front sockets is not needed because there is actually too much bone in the upper front?"
A: The logical answer is that because grafting is intended to treat an insufficiency of bone rather than a surplus of bone, a graft is inappropriate to the situation. Again-- is that why Dr. Z said what he did? You'll need to ask him. As for keeping natural teeth-- there are always advantages and disadvantages. Just where the ba***** *****es needs to be determined based on individual circumstance.

"can it hurt to graft in my Dads case if he does not get implants ever?"
A: Almost any surgical intervention carries with it some risk. However, the primary risk of performing unnecessary treatment is to the wallet.

"How valid is this issue with bottom dentures and partials being less stable than the upper?
perhaps the Cu-sil would work best here?"
A: Although it can be said that complete lower dentures are uniformly less stable than complete upper dentures, the same cannot be said about partial dentures. Stability, retention, and functionality are entirely dependent on design and the distribution of remaining teeth, which varies.

"How do i keep replying and simply adding tips to keep the thread going without posting a new question?"
A: You've already been doing that. However, in fairness, if you have new questions (and it appears you have many), you should open new questions. Otherwise, neither I nor JustAnswer get paid for our work here.

Hope this helps...
Mark Bornfeld, DDS
Category: Dental
Satisfied Customers: 6,091
Experience: Clinical instructor, NYU College of Dentistry; 42 years private practice experience in general dentistry, member Academy of General Dentistry, ADA, Fellow, American Academy of Oral Medicine
Verified
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Customer reply replied 7 years ago
you should open new questions
I did, and my question got answered by someone else, so i think i did that incorrectly.
And if i ask a new question, how will you know it pertains to this same subject? On my end, it will go onto a new box and i wont see all these details which i need to refer to.
I want to keep adding bonuses all along. but i can't pay $23 for each question, i ll go broke. I asked the customer service about this and they have not answered this particular point...

I think it's in your Dad's interest for him to seek treatment from a dentist whose expertise he trusts,

Dads European and doesn't understand what the dentist is saying,,,He says what, what? he wants me to choose., and when he says no,, i have to do my best to educate him with drawings and photos and dental info and picture on the i nternet to explain pros and cons..and then he can agree, but only when he gets all the facts does he agree. I think that's a smart thing but very exhausting but worth it.
I did, and my question got answered by someone else, so i think i did that incorrectly.
And if i ask a new question, how will you know it pertains to this same subject? On my end, it will go onto a new box and i wont see all these details which i need to refer to.
"
A: If you want to direct a question to me, simply put my name in the subject line. Of course, if you need a clarification of a particular answer of mine, you may feel free to reply to my response under the same question. To ask a new question on a different topic, please start a new question. It is cumbersome for me to read a long series of interchanges in order to determine what is relevant to your current question--- remember, I am reading through a lengthy list of questions from other customers as well, and I have a limited amount of time available here at JustAnswer. As for access to our previous exchanges, you should be able to find them under a link "my questions" or by clicking a "search" button on your profile page.

"Dads European and doesn't understand what the dentist is saying,,,He says what, what? he wants me to choose., and when he says no,, i have to do my best to educate him with drawings and photos and dental info and picture on the i nternet to explain pros and cons..and then he can agree, but only when he gets all the facts does he agree. I think that's a smart thing but very exhausting but worth it."
A: I am not unfamiliar with the problem, as my wife is not a native English speaker and I need to accompany her on her various doctors' appointments. I appreciate the burden and responsibility. However, one must never underestimate the importance of rapport and trust between doctor and patient, and you as an intermediary can only do so much. You might want to see if you can find a dentist who is culturally or linguistically more compatible with your father, if only so he can establish the professional contacts and coordinate the specialist referrals. It will relieve more of your burden, and it will allow your father to take a more active and independent role in his own care.
Ask Your Own Dental Question
For some reason, your new reply is not showing in the message thread, so I've reproduced it here (perhaps you've inadvertently edited it away?)

"How crucial is sending my Father to an oral surgeon to do his extractions as opposed to the general dentist he is seeing for the dentures who's treatment includes extraction. But the oral surgeon emphasized, "if it were my Father needing a few extraction i would think carefully before letting him not use a surgeon, especially that he has some medical conditions." (the medical condition is diabetes).He has the small front 5 teeth. 2 of which have root canals, 2 of which are flush with the gum level so i am not sure how the dentist is going to get them out....But the regular dentist said he went to the same school as the surgeon my Father likse and he is also an oral surgeon....so i am confused. I prefer to give you bonuses because it's related to the same dental issue and person. I know the controversy on extraction debri and roots left behind causing cavitations.....Should i be concerned? My dentists through the years,,( i have moved) have extracted my teeth wihtout my having to go to an oral surgeon. They were all alternative holistic dentists and made sure to get the root i assume. Is there any thing i can ask of the regular dentist to ensure my father will be safe since the teeth are all in the front? I can send you a photo again of his front teeth needing to be extracted. I don;t see the button to keep adding bonuses..."

The necessity of specialty referral is always a matter of whether the general dentist knows the limitations of his own skills, and whether those limits would be exceeded by the task at hand. There is a bit of vagueness in your dentist's description of himself as "also an oral surgeon", because either he is an oral surgeon, in which case he limits his practice to oral surgery, or he is not. If he is making dentures or doing other prosthetic work, he is not an oral surgeon. Simply going to the same school as an oral surgeon does not make him one.

The advantage of having the extractions performed by a general dentist is that it is easier to coordinate the extractions with the other dental service, and the fees will almost certainly be significantly less, because a specialist commands higher fees.

However, teeth that have had root canal therapy and teeth that are broken do pose additional challenges to successful extraction, and your father's general dentist must be honest with himself and with you. If he truly believes he can successfully extract those teeth and manage any potential postoperative complications, there is no reason not to let him provide the service. (The diabetes is a non-issue, because the possible dental complications from diabetes are not usually managed surgically, and the endocrine complications wouldn't be handled by a dentist in any case.)

It is true that some general dentists either have inflated views of their own skills, or simply take on challenges they shouldn't because they can't bear the thought of letting a good fee walk out the door after a specialist referral. So, you must decide for yourself whether the general dentist's self-knowledge is accurate. If you don't want to leave it up to chance, then by all means take the uncertainty out of it and go to an oral surgeon anyway.

Hope this helps...
Mark Bornfeld, DDS
Category: Dental
Satisfied Customers: 6,091
Experience: Clinical instructor, NYU College of Dentistry; 42 years private practice experience in general dentistry, member Academy of General Dentistry, ADA, Fellow, American Academy of Oral Medicine
Verified
Mark Bornfeld, DDS and 87 other Dental Specialists are ready to help you
Ask your own question now
Customer reply replied 7 years ago
The Dentist that initialy wrote my Dads treatment plan, included extractions, bone grafting and dentures. Now after doing 3 seperate impressions week after week,,,he tells my Father that he should go to an oral surgeon to get his upper 5 front teeth pulled.
Why did he begin doing the denture first and not pulling the teeth? I asked him and he said he does the denture first. Why is he taking so many impressions week after week?
Is this normal?
I also told him that we will only do one upper denture first, and not do anything on the bottom yet. So the whole denture has been paid in full $2,200.

My Father is still hanging onto his keeping his front teeth even though we said he should pull them in order for the denture to keep a better suction.

At this point,,, can we get cheap crowns put over those front teeth somewhere, and have the denture provide spaces for those teeth to stick out so my Dad can keep them?
His assistance/secretary assured me he is doing the acrylic transitional denture which can be modified later should implants be neeeded.

Does this mean my Father might still be able to wear this denture without pulling any of his front teeth?
My Dad eventually agrees that he has to remove those front teeth,, but my animal intuition feels a tugging that says my Father is hanging onto his youth with those 5 front teeth in some way...does that make sense? i feel that if he gets them pulled,, he loses a piece of himself and that he will really feel old....
Unfortunately, I cannot answer this question, because I cannot presume to know your father's dentist's rationale for the guidance he has provided.

On a separate note, I have been informed by JustAnswer management that the inclusion of separate questions under the heading of a single question is against this site's terms of service. Additional questions must be entered individually in the future.

Thank you for compliance with this rule.
Ask Your Own Dental Question
Customer reply replied 7 years ago
It's still the same concern of the question. They will probably design something to manage this in the future I hope.
Customer reply replied 7 years ago
ok,, sorry, i had a family emergency for a week...but i am back.
I understand your answer and i will post my questions as you requested from now on except for those that are related.
This is related
Mark Bornfeld
How does an acrylic transitional partial denture work? Initially my 86 yr old Father had agreed to pull his upper 5 front teeth so that a denture can be made. BUT
now after 3 weeks of fittings, he changed his mind and does not want to pull them anymore. I don't want to ask my Fathers dentist anything because he gets irritated. But can he stop and make this denture into an "overdenture".

I faxed him this question but i think he is really annoyed so i want to get answers first.

also, this is what you originally answered me in your first answer.;
This type of prosthetic device can also have teeth added to it if additional natural teeth are lost, or overlaid over any remaining tooth roots if your father chooses not to extract them and they are not currently infected.

I canc't picture this denture? Can you describe how it fits over the teeth?
.
In my dads case, there are 5 remaining uppers all in the front, i think 2 are worn down to the gum, another 2 are still strong although ugly and 2 are root canaled. My Father is having fittings for dentures every week,

. Can the dentist simply make an overdenture from this mold and it will fit right over my fathers teeth?
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Dr. Bornfeld, DDS

Dr. Bornfeld, DDS

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