DENTAL CARE

Q: What Can I Do To Stop My Partial From Moving? A: When we move away from the realm of permanent replacement teeth to the world of teeth that come in and out this question is very common. Permanent teeth can take various forms. They can be crowns … they can be bridges that are locked into place… they can be implants. All of these forms of tooth replacement have the same common feature. They are cemented or otherwise permanently attached to their support. This support can be another tooth or it can be an implant. When we start to replace teeth with something that comes in and out on a daily basis, we see a new problem. The replacement teeth must be loose enough to come in and out. To put it another way, they have to have enough play in them so the patient can take them out of the mouth, at will, for cleaning. The cleaning routine has to include the natural teeth that are still in the mouth as well as the removable teeth. Food debris and plaque has to come off both areas to maintain proper hygiene. The problem now becomes obvious. If the partial denture is loose enough to come in and out, what is to stop if from moving around when we eat. Movement during chewing is annoying for the patient. Not only does the food in the mouth need manipulation to chew it efficiently, but the removable teeth have to be managed so they work as intended. We have discussed this latter concept before, especially in regards to full dentures. Partial dentures may not be as movable as a full denture, yet they are not entirely fixed in place like permanent bridges or implants.

The answers lies in the design of the partial denture. If the teeth that the partial denture attaches to go every which way then the partial has to be have enough leeway to engage these teeth. As an aside this is more common than one would think. Direction of teeth is typically irrelevant if nothing would be coming in and out. Let me explain this a little better. If one tooth is pointed left and another tooth is pointed to the right, then the space needed to place the partial has to be large enough to accommodate both teeth. This is all well and good. However, once the partial is in its final place in the mouth, that extra space that was needed to allow the partial to be seated now contributes to the looseness of the partial during talking and especially chewing. What needs to be done is to minimize the divergence of the natural teeth upon which the removable teeth attach. The direction or path of placement of the partial denture has to be as parallel as possible to create a stable base for chewing. This all comes down to the design of the partial. Sometimes, I can gently reshape a tooth in the mouth to create this parallel path. More often than not, I instruct and guide my lab with the design of crowns to create this perfect path. One hundred percent parallel is really not workable as the fit will be too much to allow insertion. We strive to create a path that is just a few degrees off of parallel. The result of a design like this is taking a sloppy partial denture into one that really stays in place. Of course, the more teeth that we can anchor to, the more stable will be the final result. We strive to use at least two teeth for anchorage. In a real ideal world, four teeth make a dramatic difference. Just yesterday, I delivered a partial denture to a patient, that is almost as stable as a full denture. Reshaping of anchor teeth together with crowns made this possible. If it wasn’t for the need to take it in and out for hygiene, these removable teeth are just as stable as a permanent bridge. Proper planning and preparation are crucial to a successful partial. I can teach someone to take an impression in a few lessons, but taking the concept to successful reality requires years of training and practice If you are struggling with a sloppy teeth and would like to explore the options, please give Megan a call. She will be happy to set up a visit for us to talk about your concerns and desires. I can be reached at 440.951.7856. I look forward to hearing from you. Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine. The Healthy Smile 34586 Lakeshore Boulevard (¼ mile west of Route 91 on Lakeshore Blvd) Eastlake, Ohio 44095 440-951-7856 Severance Medical Arts, Suite 603 5 Severance Center Cleveland Heights, Ohio 44118 216-371-2333 www.jeffreygrossdds.com