Removable Partial Denture therapy in the management of severe interarch size discrepancy- A case report

Rubinya S Iyer BDS; Bryan Dye DDS, MS, FACP; Shelby Alexander DDS, MS, FACP

Graduate Prosthodontics, Department of Restorative Dentistry

 

- A skeletal Class III malocclusion is a craniofacial anomaly characterized by maxillary retrognathia and/ or mandibular prognathism

- Multifactorial etiology; hereditary and/ or environmental

- Generally treated by orthodontics with or without orthognathic surgery

- Oral rehabilitation of such malocclusion can become more challenging when it is accompanied by dentoalveolar anomalies, loss of teeth, and significant psychosocial concerns (due to difficulties with speech, mastication, and impaired esthetics).

Our goal for this patient was to try to achieve an esthetic and functional outcome utilizing a removable partial denture as the sole modality of treatment (due to his age and significant financial limitations). 

 

- A 78-year-old male presented to Graduate Prosthodontics with a chief complaint “I want to be able to eat and look good.” He was referred for maxillary complete denture therapy.

- Extraoral Evaluation: concave facial profile, midfacial deformity with a lack of malar prominence, higher lower lip and decreased upper lip prominence, and obtuse nasolabial angle. Evaluation of temporomandibular joints showed bilateral clicking on closure without any pain or discomfort.

- Intraoral Evaluation: good oral hygiene, partially edentulous maxilla and mandible, a narrow and high vaulted maxillary arch and a wide mandibular arch, with no stable occlusal stops on closure due to the significant arch size discrepancy.

- The patient was counseled on the importance of maintaining as many maxillary natural teeth as possible for use as abutments for a removable partial denture, as opposed to edentulation and replacement with a conventional complete denture

 

➢ Initial Presentation- “how and where do I restore you?”

➢ Preliminary JRR and Wax Try-in- evaluation of tooth positions and VDO, plan extractions, maintain strategic teeth to be used as abutments

➢ Execution- • #8- Endodontic treatment and placement of a root attachment • #2, 6, 12 and 15 prepared for surveyed crowns after surveying the diagnostic model • Cementation of surveyed crowns, framework fabrication, jaw relation record, and wax try-in • Pending insertion of definitive prosthesis