Fixed Partial Denture: How to Ensure Support for the Lips and Facial Muscles?

Anon. asks:
I am relatively new to the implant field. I do not place my own dental implants, but I restore them. I am a bit concerned about a case I treatment planned last year.

The patient had an edentulous maxilla and was wearing a complete denture. The alveolar ridge is moderate in dimensions and there is adequate bone height and volume. She wants a fixed appliance. I treatment planned for her to receive 6-implants in the maxilla in #4, 6, 8, 9, 11, 13 areas. This was done and all have osseointegrated.

My only concern is that when I make the fixed partial denture will it support the lips and facial muscles as well as the complete denture? I have relieved the pre-existing complete denture so it fits comfortably over the transmucosal healing abutment. There continues to be excellent support for the upper lip and facial muscles. But what happens when I insert the fixed partial denture? How do I test this out to determine if there will be adequate support? If I do not have adequate support from the fixed partial denture, how do I fix the problem? The patient is female and very demanding.

6 Comments on Fixed Partial Denture: How to Ensure Support for the Lips and Facial Muscles?

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satish joshi

2/23/2009

Don't you think this question should have been raised at the time of treatment planning,not in the middle of treatment? Best way to find out presence or lack of labial support is to remove labial flange of existing denture or make provisional fixed partial and let patient try out. If labial support is a real problem, then go for hybrid or bar over denture. You should decide your final destination before you embark on journey.Good luck.

Ryan Dunlop DMD

2/25/2009

I agree with the previous post: in the future, decide on what type of full arch prosthesis before you place implants. When someone needs a full flange for adequate facial profile support, I restore with an overdenture. When someone needs lip support but only a partial flange, a fixed hybrid is the solution. I find that FPD is the rarest because in full arch cases, is is rare to find someone with minimal enough resorption that all they need is teeth that are normal length to solve their problem. If this patient is demanding then for SURE create a duplicate denture, trim down the flange completely and try in the teeth. If she thinks her lip sinks in, then consider a fixed hybrid. If she hates long looking teeth, then be wary of fixed porcelain bridgework. The fixed hybrid with denture teeth and pink acrylic is quickly coming into fashion again because of high esthetics and easy of repair. Full arch porcelain cases inevitably chip porcelain over time and are a nightmare to repair. A screw retained hybrid is so easy to repair and they look phenomenal. Good luck!

JACK FOUNTAIN CDT

2/25/2009

WE MAKE SEVERAL FIXED HYBRIDS A WEEK AND BOTH THE DOCTORS AND PATIENTS LOVE THEM WE ALLWAYS RECOMEND A WAX TRY IN TO CHECK SMILE LINE ,PHONICS.AND LIP SUPPORT I WILL BE HAPPY TO ANSEWER ANY QUESTIONS YOU HAVE IF YOU CALL ME STAR DENTAL LAB 512-267-6776

Dr.Amit Narang

2/26/2009

thats why its always said that gone are the days when implants were surgically driven, nowadays they should be prosthetically driven . . . meaning that prosthetics should be planned before the surgery. neways now you can make a provisional with and without lip support and check that intra-orally, whichever suits fine you'll have to continue in the same direction. GOOD LUCK and its never late to learn, do a better job next time.

sanjay

3/4/2009

To solve your problem look up the Marius Bridge It's fixed in the patients mouth with a labial flange but patient can remove it to clean. Good Luck

Nicole pesce

5/30/2016

I am not a Doctor, I am a patient researching my options as well as building knowledge. So, I have learned that certain prosthetics with the right techniques can help with adequate lip support as well as enhancing facial attractiveness, but I have still to find information on bone grafting for this specific topic. I know bone grafting is performed if there is not enough bone both in width and in height for an implant to be placed, but can bone grafting be done in the maxillar to its original height, in both severe or moderate resorption cases to help add to the maxillary arch, reducing the risk of poor lip support? Wouldn't this be an option if not wanting a flange? Thank you in advance for your advice, I have been looking for this answer for a while now.