Response 1

1. New RPD with more esthetic clasping.
2. Crown posterior abutments with ball attachment to fit into new RPD.
3. As above, but keep existing RPD and modify.
4. Two implants on the lower right and 2 on the left and restore as implant-supported crowns.
5. As in 4, but restore with RPD that would snap onto implant attachments.
6. Leave RPD as is, i.e. no change.

Response 2

1. Leave maxilla as is.
2. Leave teeth in mandibular anterior region, and place implant fixtures at 44 and 46 positions with a 3 unit fixed bridge. Place individual fixtures at 34, 36 areas with individual crowns.
3. Clear remaining teeth in mandibular anterior region. Place 2-3 implant fixtures and make implant supported over-denture. Or, place more fixtures (6) and make implant supported fixed bridge from 46 to 36.

Response 3

1. A new partial denture with cast clasps on the cuspids. 
2. Same, with semi-precision attachments on the cuspids for a new partial denture,
3.  Two or 3 implants for each of Q3 and Q4 supporting fixed bridgework.

Response 4

1. Restore posterior function to first molar occlusion on the left with two implant-supported crowns and to the mesial of second molar occlusion on the right with a 3-unit bridge supported by 2 implants. If the current large restorations on teeth # 34 and 43 are in good condition at this time, I would not restore them. 
2. PFM crowns for teeth #43 and #34 with occlusal rests and guiding planes integrated in the design and a new RPD with full lingual apron based on a functional impression.

Response 5

1. One or two implants on each side, assuming width, height bone are good and tissue is healthy.
2. Possibly perform a vestibuloplasty if implants are not feasible.

Response 6

1. Depending on the degree and number of complaints I may just suggest a hard reline of the RPD and an occlusal adjustment and see how the patient fares.
2. Recommend at least two implants in each posterior quadrant and restore with a fixed prosthesis.

Response 7

1. Re-equilibrate occlusion on existing RPD –> may help with retention and stability of current denture.
2. Reline denture –> may help increase retention and stability if tissue has changed over the years through pressure exerted by full natural upper dentition
3. Fabrication of implant retained RPD –> if there exists enough bone in some areas behind last remaining teeth. Can consider locator abutments to help increase retention; may not be fully fixed option but will definitely help with retention + stability.
4. Implant-supported FPD 44-46, Implant 35, 36 –> if there exists enough bone.

Response 8

Specific to the chief complaint of an ‘unsatisfactory mandibular RPD’

1. Posterior dental implant-supported screw-retained fixed ceramo-metal prostheses, 46i-45p-44i, 34i-35p-36i
2. Appropriately designed and executed RPD Kennedy Class I.
3. RPD Kennedy Class I dental implant over-denture with dental implants at 34 and 44 positions, Locator type over-denture abutment/retainers, alternatively dental implants at 46 (or 47) and 36 (or 37) locations, passive abutment or active Locator type over-denture abutment/retainers.

Response 9

1. Mandibular clearance with 4 implants anterior to mental foramen and a fixed lower prosthesis.
2. Four to 5 implants with crowns (2 on left side, 2 or 3 on right side) distal to his present teeth.
3. Removable partial lower denture retained by mini implants.

Response 10

If contra-indications to implants then: crowning 43 and 34 with precision attachments and a precision partial.

If no contra-indications to implants and distance from ridge height to the IA nerve is fine, then options could be:

1. Two implants in each mandibular segment with screw-retained fixed bridges. 
2. Individual implants in mandibular segments with individual crowns, e.g. 44, 45, 46, 35, 36 and if patient wants more then 37 and 47 also.  
3. If ridge height is unfavourable then advise ridge augumentation before options 1 & 2.

Response 11

1. No treatment
2. Accept status quo
3. Possible grafting of alveolus, nerve transposition surgery
4. Placement of multiple dental implants

Response 12

1. Precision attachment supported RPD.
2. Two implants either side to replace premolar,
3. Four implants (2 each side) to provide bridge right and left.
4. Ridge augmentation may be needed.

Response 13

1. If partial denture mobility and retention are the problems, perhaps a new partial that is more retentive and less mobile.
2. If patient’s desire is for a fixed prosthesis, perhaps he would be satisfied with a shortened dental arch with two implant-supported crowns on each side.
3. Implant-assisted RPD with implants and locators in 35, 44.
4. If there is adequate bone volume, dental implants supporting crowns 35, 44, 45.
5.  Fixed bridges on maxilla would prevent supra-eruption.
6.  Studies on shortened dental arch indicate most would be satisfied with 20 occluding teeth
7. If adequate bone, implant-supported crowns to replace 36, 47.

Response 14

1. Replace existing PLD with a new appliance,
2. Replace existing PLD with a bilateral implant-supported PLD with locator attachments for retention minus clasps on teeth,
3. Replace PLD with bilateral implant supported bridges. Bone acceptability for implants and cost to patient brought into consideration. 
4. Depending on available bone and nerve proximity, I would treat this case without input from specialist.