Maxillary Full Denture with Impacted 3rds

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This topic contains 2 replies, has 2 voices, and was last updated by  Richard Frost Fri May 24, 2019 05:39 am.

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  • #3900

    Richard Frost
    Participant

    Hi Dr. Resnick,
    I apologize for the poor image. This patient, Bob is 74 years old has a complicated medical history. I have an anesthesiologist (MD) available to do sedation per patient’s request. We plan to remove his remaining maxillary teeth in preparation for a full denture. He’s a bruxer and I expect these to be difficult extractions. We had some discussion about leaving the thirds. Bob doesn’t want to have deal with a possible second surgery to remediate a problem, should it occur with the thirds. My first question is how to handle #16. With no adjacent tooth to elevate from, I’m concerned that relying on forceps too much will risk removing more than the tooth (i.e. sinus floor or tuberocity). Any suggestions? If you think the risk is too high to remove the thirds, could you suggest an alternative?

    Second question is if I don’t get any movement with initial elevation, should I just do a full thickness flap accross the anteriors to remove buccal bone and do surgical extractions on all of them just to reduce the time of surgery? Or would you just go tooth by tooth to decide if it’s surgical or regular extraction? Should I section the Molars? I’ll be charging the same fee regardless. I so appreciate your input!

    RB Frost

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  • #3905

    Dr. Jay Reznick
    Keymaster

    Hi Dr. Frost- I definitely agree that it is best to deal with those upper thirds when you remove the other teeth. If you put a full denture over them, you are just asking for trouble. Both #s 1 and 16 look like they could have roots projecting in to the sinus. I would anticipate this. Since these have been protected from occlusion all these years, the bone around them may not be very dense, which will facilitate removal. For #16, you can make a trough with a 702 bur to get a purchase point if you cannot get a forceps on it.

    Since you will need to do some alveoloplasty to smooth the ridge after the teeth are removed, I would recommend laying a flap from the outset. This will make it easier to use forceps and elevators, and will save time if you have to retrieve broken roots. As far as sectioning the molars, if the tooth does not move with elevator/forceps, then get out the surgical hand piece.

    #3909

    Richard Frost
    Participant

    Thanks Dr. Reznick!

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