Prosthodontics & Occlusion · patient case question
Given her stated chief complaint and the clinical findings, what is the best treatment?
Patient case: “I Want Teeth That Don't Come Out”
Patient: 64-year-old female
Chief Complaint: “I'm done with these plates. I want teeth that don't come out.”
Background: Wearing maxillary and mandibular removable partial dentures for eight years. Good general health, non-smoker, financially able to proceed.
Medications: Atorvastatin
Vital Signs: BP 126/78 mmHg · HR 72 bpm · RR 16 · T 98.4°F
Findings: Maxilla: first molars and canines present in both quadrants. Mandible: second molars and some premolars present. Remaining teeth are periodontally sound with good bone support. Adequate ridge volume in the edentulous spans on CBCT. No parafunction.
Show answer and explanation
Correct answer: B. An implant-supported FIXED prosthesis
- A. An implant-RETAINED removable prosthesis still comes out, which is precisely what she has rejected. It is the compromise for a patient with inadequate bone, limited finances or poor dexterity — none of which apply.
- B. CORRECT. The chief complaint is explicit and it is the governing constraint: she wants a FIXED result. She has adequate bone, sound remaining teeth, good general health and the means to proceed — every prerequisite is satisfied. An implant-supported fixed prosthesis meets the stated goal, preserves the remaining teeth by avoiding their preparation, and maintains alveolar bone through functional loading.
- C. A better-made removable denture is still removable. Making a superior version of the appliance the patient has explicitly rejected does not address the complaint.
- D. The edentulous spans are extensive and multiple. Conventional bridgework across them would violate Ante's law, require preparation of sound teeth, and produce excessive leverage on the abutments.
Note: The teaching point of this item is that the CHIEF COMPLAINT frames the treatment plan. Where a patient states a clear goal and the clinical situation permits it, the plan that ignores the goal is wrong however technically sound it may be.
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