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Question
I just found out that the back 3 lower right side molars will most likely need removed due to fractures going below the gumline.  The dentist stated he could try a crown, then a root canal if necessary, however he stated that was more of a "Hail Mary" move before doing extractions.  Money is tight, so I really need to just have them removed.  However, the molars on the other side are in bad shape as well.  
So my questions are:
1) Should I have all teeth with large fillings extracted even if they aren't bothering me?  2 of the 3 above mentioned ones are really hurting and scheduled to be removed in 6 days.  If I had all large filling teeth removed, it would only leave my front 6 bottom teeth.
2) If I don't have the ones that are okay removed, can I add teeth to the partial if necessary in the future?
3) What kind of removable partial is best?  My insurance will cover either the cast metal or the flexible partial at the same price but I want to make sure the one I pick can have teeth added.
4) If the tooth the partial is clasped on falls out, what happens?  Is the partial remade or is it worthless?

Thank you so much for your time.

Answer
Dear Jody:
Your questions are very important and many people struggle with the same decisions on a daily basis.  I cannot give you specific advise on your situation, since I cannot examine you and your X-rays.  Only your dentist can do that.  However, I can give you "food for thought".
Any decision in life is situation specific.  That includes treatment decisions in dentistry.  It is very important to make a decision that will allow you to absorb the cost, and give you long term prognosis--results.
If money is tight, then "Hail Mary" dentistry is out of the question.  The only time it is appropriate to "gamble" with with someone else resources is if they specifically request, and understand that the treatment outcomes are very compromised.  YOU are NOT in that position.
YOU have to make decisions based YOUR financial and health situation.
If you cannot afford the root canal treatment, you should not proceed, since the final treatment includes fabrication of post/core restorations and crowns, which are even more expensive.  It is generally better to have the teeth carefully extracted and have a removable partial denture fabricated.  If you have compromised teeth on both sides, the extraction of those teeth is recommended, since a symmetrical situation is better for you to handle technically.
However, the decision has to bring into account your age and health.  The best way to avoid the loss of the front six teeth is by NOT hanging the denture on them.  In the past decade, with the use of implants, better prognosis can be achieved by extracting the back teeth, placing an implant on each side to replace the first pre-molar teeth (the ones behind the canines) and using them as the connection for the denture.  In this way, NO clasping is necessary on the anterior teeth and they are left alone.  All the load of denture retention is placed on the attachments on the pre-molar site implants.  This is typically my treatment of choice in your situation.  It allows you the maximum flexibility and delivers a cast metal partial denture, which is far more durable and implant retention, which is better.
You must talk to your dentist about it.  It can, and should, actually be done in stages:
First have the back teeth extracted, and have a transitional plastic denture made.  Following a few months two implants are placed and after their integration (typically 2-6 months), they can be connected to the plastic denture.  Typically in a years' time, when all the tissues have stabilized after the surgical procedures, a final cast metal denture can be fabricated.
If your dentist cannot do it, go to a local dental school and ask to be seen in the Prosthodontic department.  The Prosthodontist is the expert in this are, but since money is tight, you might not be able to afford one in the private sector.  A dental school is a great alternative to receive top-end care for less money (it might take longer, though, since you are treated in a school environment).
Best of luck,
Dr. Zev Kaufman

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Zev Kaufman, D.D.S.

Expertise

I can answer any question from simple routine dentistry to very complex dentistry with emphasis on reconstructive, cosmetic, and implant dentistry. My expertise is in co-ordination of very complex treatment plans with other dental specialists or as a one-man-team, since I have extensive training in Prosthodontics, Surgical Implantology, and orthodontics.

Experience

Over a decade in private practice of Surgical Implantology and Prosthodontics. Founder and owner of Prosthodontics & Implant Surgery of Manhattan, PC. Clinical Assistant Professor at the Post-Graduate Department of Periodontics & Implant Dentistry at New York University College of Dentistry. Lecture weekly since 1999 on advanced Implant Prosthodontics at New York University College of Dentistry Post-Graduate Program in Periodontics & Implant Dentistry. Former clinical assistant professor of Dental Radiology at the NYU College of Dentistry. Former clinical and lecture faculty at Lincoln Hospital, Dental residency program. Former clinical and lecture faculty at St. Barnabas Hospital (Bronx, NY) dental residency program. Lecture nationally on Prosthodontics and Implant Dentistry.

Organizations
Memeber of the American College of Prosthodontics. Memeber of the Acacdemy of Osseointegration. Member or the Omikron Kappa Upsilon (OKU) Honors Dental Society. Member of the American Dental Education Association.

Education/Credentials
Graduated with Honors from New York University College of Dentistry. Post-Graduate training and certificate in the specialty of Prosthodontics. Post-Graduate training and ceritificate in Surgical and Prosthetic Implant Dentistry. Honors-program in Comprehensive and Applied Practice Management. Honors-program in Orthodontics.

Awards and Honors
NYU Cervice award to the community. OKU honor society. National Dean's List. National Who's Who.

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