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Root Canal molar extraction and open sinus cavity
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Bellsafire posted:
To make long story short: Upper root canal molar #3 was done 1960's. Recently, I tried to save it but after thousands of dollars, and the sinus cavity opened into my mouth (bone loss), I had to have the root canal extracted. I have six front, upper teeth that I want to keep. Now, I do not have the root canal molar to hook my partial plate onto. Oral-Maxillofacial surgery was completed to close the sinus cavity that emptied into my mouth. Fat (from somewhere in my mouth) was used in the open area and gum tissue wrapped around it and sutured. Question: I will need a new partial plate made and I'm wondering how that can be accomplished with only two eye teeth to connect? What can I expect? Thank you.
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Zev Kaufman, DDS responded:
Dear Bellsafire:

I can understand your concern. It is justified. In order to retain a partial upper denture, the canine teeth will have to take a large burden. The dentist will have to design a system of clasps (metal or plastic arms) which will "grab" the teeth and hold the denture in place. Many dentists crown the six front teeth and connect them for strength and this way re-distribute the stress to all remaining front teeth. Attachments are placed the the back of the canine crowns and help hold the denture.

However, all these permutations are short lived. The crown and bridge work, after several years (usually 3-7), typically fails and the patient ends up in a complete denture.

Many times, if the front remaining teeth are somewhat compromised and finances are a problem, many would recommend removal of all remaining teeth and making a complete denture.

However, today, there are other options.

You should speak to your dentist and oral surgeon about placing four implants, strategically in the maxilla (top jaw). Two in the first premolar areas (being the canine teeth) and two in the second molar areas which are typically "behind" the sinuses, or might have some minimal bone for short implants. The most important factor is for all four implants to be as parallel as possible to each other. This can be accomplished with proper training of the dentists and also using current CT 3D technology.

A removable denture can then be fabricated, which IS NOT attached to the front teeth at all! It is a much better option than taxing the remaining front teeth, and also a much longer lasting. The partial denture is connected with attachments and the patient can remove the denture and easily clean it and maintain the connectors to the implants inside the mouth.

This is a treatment modality which has gotten more fans in the Prosthodontic community, since several studies have shown the success of this work.

In addition, if your current denture is somewhat useable, it can be used and connected to the implant attachments.
If your dentists are not comfortable with this, go to www.gotoapro.org and talk to a Prosthodontist in your are who will tell you more about this option. In addition, if this turns out to be out of financial reach, a Prosthodontic training program in a university dental school will be a great option.

Best of luck,
Dr. Zev Kaufman


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