Partial Dentures P4

Feb
2014
14

posted by on Gum Disease Prevention

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They’ve looked at that for the last 40 or 50 years. Here’s that case basically in the mouth. You look at the one side, you look at the other. They’ve got this one pictured…cause this is the other side of the mouth. And what they’re using here is the proximal [inaudible]. There’s the try-in and if you go ahead and get teeth processed [inaudible]. Another lateral that has a longer span. Same thing. You got a long span here. You can look at this and you can block across to the other side of the arch. The idea is when you’re looking at into a case where you might think about using [inaudible] Definitely what you want to do is talk to your faculty, take a look at the case and decide whether rotational path is the way… Now swinglock removable partial. Basically this is what the framework would look like. This fits around labial of the teeth  with these little eyebars that come out vertically.  These little eyebars will engage into labial surface of the lower teeth. I don’t use these all that much anymore. Pretty much now with high speed instrumentation you can reshape the contour of the teeth fairly easily [inaudible] restoration without crowding teeth you can also build up undercuts where you need them. The other thing you want to know is that these frameworks will cost at least $200-$250 more than your conventional framework. So from [inaudible] and those folks it’s not uncommon for the framework to cost alone between $650 and $800. If the framework cost alone, you haven’t added teeth on, you haven’t processed anything plastic on it, if your framework cost alone is pushing six to eight hundred dollars you want to make sure you are being remunerated enough for the partial that you are not losing money on it. Several years ago one of our grad students did for a nice patient Mr Traylor and so we got the whole thing done anatomically. It was a very complex framework that overlaid the occlusal surface and everything else. We did the case and we were charging Mr Traylor basically the graduate fee for the partial denture which is around $1250 and that framework cost us $1800.

That’s a great business plan, isn’t it? If you’re losing money on each one of these you’ll make it up on the volume. Here’s accentuation also or some of these as I say [inaudible] the number of teeth missing or number of defects you’re trying to fill up is very extensive, it may be that the extra grip with the swinglock may be worthwhile. Now this is basically just a set of duplicate cast that goes through the sequence of how long these frameworks would be made, the standard blocking out they are going to go ahead and duplicate it. Here’s our study model and we go ahead and say how we’re going to watch the framework up. Here’s the wax up of the framework. Frameworks are waxed up as there are these  stainless steel spindles that are incorporated into the wax up and the reason this stick up into the air as far as it does is just so that it can fit into a dental surveyor, like a surveying tool, but what’s going to happen is after casting all of this stuff that sticks out into the air will get cut off. So all this is for is extra things to use it in the tool that seats these down so that the bottom part of these spindles will be incorporated into framework but the top 80% of these things will be just cut off [inaudible] and made smooth finishing of the partial denture framework. Here’s another view of the framework. Here’s your labial plate, here’s your maxillary labial view, here’s your two spindles. One side is going to be the gate side. That’s going to be the hinge. The only difference on these things is which side is the gate and which side is the hinge. After way up stage if you look at the cast metal this vertical part right here is the bottom part of the spindle right here. This part of the spindle right here is what you see here. The top part of where the spindle was here has been cut off and polished so this has been cut off and polished it’s what stands up in the air. Now on one side when they do the wax up of this they carry the waxing all the way around that vertical spindle. On the other side there’s going to be the snap in gate.

The wax up on that side is only going to surround about little more than 180 degrees. It’s not going to surround all the way around that spindle. So one side is waxed up all the way around it and that becomes the gate side. On the other side the waxing over here wraps around part of this spindle but doesn’t go around the 180 degrees. Then when it’s cast there is just enough surface contamination on these they will allow these things to open up and swing. Here is your hinge side so you can see when the waxing was done here unlike on the hinge side on the other side this waxing didn’t warp all the way around this spindle. Again this spindle used to go up into the air or up in the surveyor but the top part of it was cut off. So the only difference is instead of being waxed all the way around the spindle, it was only waxed partly around the spindle [inaudible] The other things is because these are totally interchangeable which side do you want to wax all the way around and which side you want to wax partly around, you should make these things open either way. Just depends how they’re waxing up [inaudible] If you’re thinking of doing one of these you want to ask if the patient is right or left handed. Which side will be easier for him to get a hold of this gate and snap them open, if they had a preferred side.  Here’s the situation clinically in which you look at the teeth from the anterior. We go ahead and basically have our partial denture here. Here’s examples of them. Here’s a swinglock .Again, we don’t need to do these so much anymore because nowadays there’s a high speed instrumentation [inaudible] materials that can alter the contour of these teeth to make them more favorable fairly easily. So if you see these used at all they will tend to be used in maxillofacial situations for the most part. These are ugly. Doesn’t this bite into patient’s lip? And isn’t that the food trap? We find with most patients that these have been done on [inaudible] Isn’t that the food trap?

Yes. But because partial can be taken out and cleaned and that’s your hope that the patient will continue to clean these things. Surprisingly a lots of patients when they smile these eyebars are located fairly close to the pregingival margin, they are not esthetically unsightly. So typically… here’s a nice lady, there is her upper denture but you don’t see lower swinglock partial at all. If you’ve got the same thing but with modifications face, the modification faces can be fitted on the partial and the gates just spin around the modifications face. Again with the materials we have available to us today I can’t justify anymore spending many hundreds more dollars for a framework like that when I can recontour the teeth to get a conventional partial pretty much the way I want it. These situations might be a little more challenging when you’ve got all the teeth on the one side. Again this shows a situation where you’re trying to clasp those teeth a little more firmly. You got these teeth clasped pretty firmly and this is our replacement teeth. Again the thing that is not available during your practicing lifetime. But I’ve been thinking about rather than taking a real expensive framework would be in a situation like this…over in this area is considering putting one or two dental implants over there strategically located. And then you can have partial denture in this area here it’s just under the partial denture in this area you’d have couple of [inaudible] attachments that were just snapped on. Again when these frameworks were involved we did not have that as one other option. Here’s another one that clasps teeth in two different ways. Again these are very expensive frameworks. They worked out okay but like I said I want to show you the swinglock partials as much as anything. If you heard of them you sort of know what some indications might be. Mostly maxillofacial. And nowadays when we have dental implants available to us and the possibility of recontouring teeth much more easily either by [inaudible].

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