Missing Teeth
Thursday September 6, 2007 

Dear Dr. Mady: I am missing all of my back teeth on the top and have had a consultation with my dentist about my options for replacement. The implants sounded great but probably unaffordable for me. The removable partial denture seems to be the best option, but I can not stand the thought of the wires showing when I smile. My dentist said these are usually required to help hold the plate in. Is there any other option that may work for me and not completely drain my bank account? Janice in Tecumseh


Dear Janice: Missing teeth can be a real problem for anyone. Not only does it look unappealing, but it can affect nutrition and digestion for your entire body. A mouth with missing teeth is like a sports team that is missing some of its valuable players, and your chewing function will be decreased, just as the team’s capability of competing with their best ability.

The fact that you have taken the first step is great news. Implants are still a great option if they are affordable, but if not, the removable partial is another treatment option. If you would have had any of the back teeth remaining between your present teeth and the endentulous (empty) areas, you may have been a candidate for fixed bridgework, depending on the condition of the abutment teeth and their supporting structures.

A removable partial will fill in the spaces created by your missing teeth and help you chew properly. In addition, it will improve the esthetics of your smile and fill in spaces that may have sunken in your face from the missing teeth and subsequent natural bone shrinkage. In many cases, the face will sag after years of edentulism and some of the support for cheeks and lips can be lost. By replacing these teeth it can be like knocking years off your age instantly and your speech may even be improved.

Regular removable partials are retained by attaching them to natural teeth with some sort of attachment. This must be flexible enough to allow the partial to be removed and rigid enough so that it won’t fall out when you are eating or speaking. Metal clasps, although sometimes undesirable, are the most common type of attachment, but they can be esthetically unattractive, and can sometimes loosen the teeth they attach to and even cause cavities where they attach if oral hygiene is not impeccable. Sometimes claps don’t even work well if the natural tooth does not have proper undercuts and contours.

Taking all of this into consideration along with the fact that a removable partial denture is more affordable for you than implants and because you don’t want any retentive clasps to show when you speak or smile, I have a solution for you. If you think it sounds good, discuss it with your dentist and see if it will work for you. What I am thinking and speaking of is known as a semi-precision or precision partial denture.

This type of prosthesis is basically removable and it relies on something other than cast or wrought-iron claps for its retention. Precision partials are always more esthetic. They are as close to a natural look and feel as can be accomplished with a removable prosthesis and may provide better distribution of force to the remaining natural teeth than would be possible with a conventional clasped partial.

There are some disadvantages associated with the semi-precision and precision partials and the main one is cost due to technically demanding procedures. This is because they almost always require the placement of lab-fabricated crowns on the abutment teeth where the partial attaches and these crowns have the special features that coincide with the design of the attachment on the partial. These are more difficult to fabricate and adjust and occasionally some of the attachment components have to be replaced, but ultimately are a far more superior choice than a regular clasped partial. The cost is more than a regular partial, but still considerably less than that of dental implants.

Janice, you have your own unique oral conditions and oral health requirements, just like every patient. Your dentist will determine if this design is appropriate for your specific situation or not. Taking into account your function desires, esthetic concerns, financial capability and your present oral conditions, I am sure your dentist will lead you down the proper path to replacing these missing teeth in a way that is satisfying to you. Good Luck!

E-mail questions to drmady@drmady.com and visit my website www.askthedentist.ca under the “articles” section for an abundance of dental related content.

This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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