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- 1. Introduction of Removable Prosthodontics Dr Shamsuddin Mahmud Assistant Professor Department of Prosthodontics
- 2. Learning objectives +After the session the student will able to 1. List causes of tooth loss 2. State the consequence of tooth loss 3. Formulate the phases of RPD insertion to the patient 4. Enumate the indication, contraindication of RPD 5. Enumate the advanrages and disadvantages of RPD 6. Classify partially edenyulous arch
- 3. Learning objectives 7. Identify partially edenyulous arch 8. Define and classify different parts of RPD 9. Identify different parts of RPD 10.Define various definition related to RPD
- 4. Causes Of Tooth Loss PERIODONTAL PROBLEMS ( PERIODONTITIS, GINIGIVITIS) PLAQUE PLAQUE RETENTIVE FACTORS
- 6. Systemic Causes Of Tooth Loss +1. Diabetes Mellitus +2. Female Sexual Hormones Condition +3. Hyperpituitarism +4. Hyperthyroidism +5. Primary Hyperparathyroidism +6. Osteoporosis +7. Hypophosphatasia +8. Hypophosphatemia
- 7. Causes Of Tooth Loss CARIES/ TOOTH DECAY
- 8. Causes Of Tooth Loss Syndromic or Genetic
- 9. CAUSES OF TOOTH LOSS AGING
- 13. Consequence of tooth loss +Anatomic oLoss of ridge volume both height and width oBone loss : + mandible > maxilla + Posteriorly > anteriorly
- 14. Anatomic consequences oBroader mandibular arch with constricting maxilary arch oAttached gingiva is replaced with less keratinised oral mucosa which is more readily traumatized.
- 15. Anatomic consequences oTipping of the adjacent teeth oSupraeruption of the teeth oTraumatic occlusion oPremature occlusal contact
- 16. Anatomic Consequences Increased occlusal load on existing teeth Drifting, tooth surface loss
- 19. Physiologic Consequences +Decreased lip support +Decreased lower facial height
- 22. 1. Education of Patient 2. Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation 3. Support for Distal Extension Denture Bases Six Phases
- 23. 4. Establishment and Verification of Occlusal Relations and Tooth Arrangements 5. Initial Placement Procedures 6. Periodic Recall Six Phases
- 24. Education of Patient +Informing a patient about a health matter to secure informed consent. +Patient education should begin at the initial contact with the patient and should continue throughout treatment. +The dentist and the patient share responsibility for the ultimate success of a removable partial denture. +This educational procedure is especially important when the treatment plan and prognosis are discussed with the patient.
- 25. Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation +Begin with thorough medical and dental histories. +The complete oral examination must include both clinical and radiographic interpretation of: o caries othe condition of existing restorations o periodontal conditions o responses of teeth (especially abutment teeth) and residual ridges to previous stress o The vitality of remaining teeth
- 26. Continued….. +Occlusal plan evaluation +Arch form +Evaluation of Occlusal relationship through mounting the diagnostic cast
- 27. +The dental cast surveyor is an absolute necessity in which patients are being treated with removable partial dentures.
- 28. Mouth preparations, in the appropriate sequence, should be oriented toward the goal of +providing adequate support, stability, retention, and +a harmonious occlusion for the partial denture.
- 29. Support for Distal Extension Denture Bases +A base made to fit the anatomic ridge form does not provide adequate support under occlusal loading. +The base may be made to fit the form of the ridge when under function.
- 30. Support for Distal Extension Denture Bases +This provides support and ensures maintenance of that support for the longest possible time. +Distal extension base must be made as equal to and compatible with the tooth support as possible.
- 31. Establishment and Verification of Occlusal Relations and Tooth Arrangements +Are important steps in the construction of a partial denture. +This necessitates the making of a base that will provide the same support as the finished denture.
- 32. Continued… +Then a new corrected base must be used to record jaw relations.
- 33. Initial Placement Procedures +Occlusal harmony be must ensured before the patient is given possession of the dentures. The processed bases must be reasonably perfected to fit the basal seats.
- 34. Initial Placement Procedures +It must be ascertained that the patient understands the suggestions and recommendations given by the dentist.
- 35. Periodic Recall +Is critical for early recognition of changes in oral structures to allow steps to be taken to maintain oral health. +Although a 6-month recall period is adequate for most patients, more frequent evaluation may be required for some.
- 37. Indications +Long edentulous span +No abutment tooth posterior to the edentulous space +Reduced periodontal support of remaining teeth +Need for cross arch stabilization +Excessive bone loss in residual alveolar ridge
- 38. Indications +Primary and emotional problem exhibited by the patients +Aesthetic of primary concerns +Immediate need to replace extracted tooth +Patient desire
- 39. Contraindications +Patients with a large tongue – tends to push the denture away +Patient attitude : mentally retarded patients cannot maintain a prosthesis +Poor oral hygiene : any prosthesis is better avoided
- 40. ADVANTAGES DISADVANTAGES Cheap Relatively easy to construct Easy to modify Pleasing Esthetics Weak material Non – rigid Must be bulky for strength
- 42. Need For Classification +To communicate the condition of the oral cavity +To formulate a good treatment plan +To anticipate the difficulties commonly to occur for that particular design +To design the denture according to the occlusal load usually expected for a particular group
- 43. REQUIREMENTS OF AN ACCEPTABLE METHOD OF CLASSIFICATION +The classification of a partially edentulous arch should satisfy the following requirements: 1. It should permit immediate visualization of the type of partially edentulous arch that is being considered. 2.It should permit immediate differentiation between the tooth- supported and the tooth- and tissue-supported re-movable partial denture. 3.It should be universally acceptable.
- 44. Kennedy classification D y of e e- determinethebasic classesweredesignated asmodif cation spaces(Figure3-2). T efollowingistheKennedy classif cation: Class I Bilateral edentulous areas located posterior to the natural teeth Class II A unilateral edentulous area located posterior to the remaining natural teeth Class III A unilateral edentulous area with natural teeth remaining both anterior and posterior to it Class IV A single, but bilateral (crossing the midline), edentulous area located anterior to the remaining natural teeth
- 49. Merits of Kennedy ‘s classification +Allows visualization of partially edentulous arch +Differentiates b/w tooth and tooth tissue supported +Type of design can be decided +Universally accepted +Aids in discussing, identifying and planning the design +Easy to apply the system to any situation +Widely used system
- 50. Demerits +Does not assess the choice, number, location and condition of the abutment teeth. +Assessment of hard and soft tissue status not possible. +Does not indicate the position of individual tooth. +Does not permit assessment of occlusion.
- 52. +Rule 1: classification should follow rather than precede extractions that might alter the original classification. +Rule 2: if the third molar is missing and not to be replaced, it is not considered in the classification. +Rule 3: if the third molar is present and is to be used as an abutment, it is considered in the classification. +Rule 4: if the second molar is missing and is not to be replaced, it is not considered in the classification.
- 53. +Rule 5: the most posterior edentulous area or areas always determine the classification. +Rule 6: edentulous areas other than those, which determine the classification, are referred to as modification spaces and are designated by their no: +Rule 7: the extend of the modification is not considered, only the no: of edentulous areas, i.e. the no: of teeth missing in the modification spaces is not considered only the no: of additional edentulous spaces are considered.
- 54. +Rule 8: there can be no modification areas in class IV. Because any additional edentulous space will definitely be posterior to it and will determine the classification.
- 55. EXERCISE
- 56. EXERCISE
- 58. Removable Partial Denture +Indirect removable prosthetic restoration for replacing some teeth and patient removes when desire +removable denture that replaces some teeth in a partially edentulous arch; the removable partial denture can be readily inserted and removed from the mouth by the patient. GPT-10
- 59. TERMINOLOGIES Tooth Supported RPD: A partial denture that receives support from natural teeth at each end of the edentulous space or spaces. Eg : Kennedy’s class III Tooth – Tissue Supported RPD: The denture base that extends anteriorly or posteriorly & is supported by teeth at one end & tissue on the other end.
- 60. Distal Extension Denture Base: The denture base that extends posteriorly without posterior support from natural teeth. They are tooth tissue supported partial dentures
- 61. Difference between tooth supported RPD and tooth tissue supported RPD Points Tooth supported RPD Tooth supported RPD SUPPORT DERIVED From abutment teeth Primarily from tissues Secondarily from abutment teeth IMPRSSION TECHNIQUE S Static (anatomic) impression Functional impression for tissues Anatomic impression for teeth DIRECT RETAINER No stress release design Stress Release design INDIRECT RETENTION Not needed Needed,depending on fulcrum line and axis of rotation BASE MATERIALS Generally metal No need for reline Generally acrylic For ease of reline STRESS BREAKING Not needed Recommended for long span
- 62. Parts of removable partial denture +Components of a typical removable partial denture are 1. Major connectors 2. Minor connectors 3. Rests 4. Direct retainers 5. Stabilizing or reciprocal components (as parts of a clasp assembly) 6. Indirect retainers (if the prosthesis has distal extension bases) 7. One or more bases, each supporting one to several replacement teeth 8. Artificial teeth
- 63. Components of a typical removable partial denture
- 64. Major connector +That component of the partial denture that connects the parts of the prosthesis located on one side of the arch with those on the opposite side. Mc Crakens’ 13th edition +the part of a removable par- tial denture that joins the components on one side of the arch to those on the opposite side. (GPT-10)
- 66. +Strap : having an anterioposterior dimension not less than 8 mm ┼ Bar having an anterioposterior dimension less than 8 mm
- 67. Mandibular Major Connectors +There are six types of mandibular major connectors described historically. +Of these, the lingual bar and the linguoplate are used the majority of the time. 1. Lingual bar 2. Linguoplate 3. Sublingual bar 4. Lingual bar with cingulum bar (continuous bar) 5. Cingulum bar (continuous bar) 6. Labial bar
- 68. Lingual bar
- 69. Linguoplate
- 70. Sublingual bar
- 71. Lingual bar with cingulum bar
- 72. Cingulum bar
- 73. Labial bar
- 74. Maxillary Major Connectors +Six basic types of maxillary major connectors are considered: 1. Single palatal strap 2. Combination anterior and posterior palatal strap–type connector 3. Palatal plate-type connector 4. U-shaped palatal connector 5. Single palatal bar 6. Anterior-posterior palatal bars
- 76. Combination anterior and posterior palatal strap–type connector
- 81. Minor connector +The connecting link between the major connector or base of a removable partial denture and the other units of the prosthesis, such as the clasp assembly, indirect retainers, occlusal rests, or cingulum rests (GPT-10) +Those components that serve as the connecting link between the major connector or the base of removable partial denture and the other components of the prosthesis ( Clasp, indirect retainers, occlusal rests, cingulum rests. etc). (Mc Craken’s 13th edition)
- 82. Types of minor connector 4 types – +Join the clasp assembly to the major connector. +Join direct retainers or auxillary rests to the major connector. +Join the denture base to the major connector. +Serve as an approach arm for a vertical projection or bar type.
- 84. Tissue Stops • Tissue stops are integral parts of minor connectors designed for retention of acrylic resin bases. • They provide stability to the framework during the stages of transfer and processing. • Engage buccal and lingual slopes of the residual ridge for stability.
- 86. Rest +a rigid extension of a removable partial denture that contacts the occlusal, incisal, cingulum, or lingual surface of a tooth or restoration, the surface of which is commonly prepared to receive it (GPT-10) +Any component of a partial denture on a tooth surface that provides vertical support is called a rest (Mc Crakens’ 13th edition)
- 88. Rest Seat +The prepared surface of an abutment to receive the rest is called the rest seat.
- 89. Types of rest +Occlusal rest oOcclusal rest oExtended occlusal rest oInterproximal occlusal rest oInternal occusal rest oOcclusal rest on restoration +Lingual rest +Incisal rest
- 91. Indirect retainer +The component of a removable partial denture that assists the direct retainer(s) in pre- venting displacement of the distal- extension denture base by functioning through lever action on the opposite side of the fulcrum line when the denture base attempts to move away from the tissues in pure rotation around the fulcrum line. (GPT-10)
- 92. Fulcrum line +An imaginary line, connecting occlusal rests, around which a partial removable dental prosthesis tends to rotate under masticatory forces. The determinants for the fulcrum line are usually the cross arch occlusal rests located adjacent to the tissue borne components.
- 93. ROTATION is that movement of an appliance which may occur in a vertical direction while its occlusal rests remain in abutment contact. DISPLACEMENT is that movement of an appliance when the primary occlusal rests also lose tooth contact.
- 94. Types of indirect retainer +Auxillary occlusal rest +Canine extension of occlusal rest +Modification area +Canine rest +Incisor rest +Rugae support +Cingulum bar and linguoplate
- 95. Direct retainer +The component part applied to resist this movement away from the teeth and/or tissue provides retention for the prosthesis and is called the direct retainer. Mc Craken’s 13th edition +that component of a removable partial denture used to retain and prevent dislodgment, consisting of a clasp assembly or precision attachment GPT-10
- 96. BASIC PARTS OF A CLASP ASSEMBLY
- 97. THE BASIC PARTS OF A CLASP ASSEMBLY : REST RETENTIVE ARM RECIPROCAL ARM MINOR CONNECTOR (1)Rest (2)Body of clasp (3)Retentive arm (4)Shoulder (5)Reciprocal element (6)Minor connector (1)Rest (2)Body of clasp (3)Retentive arm (4)Shoulder (5)Reciprocal element (6)Minor connector
- 98. Parts of clasp assembly Circumferential Clasp (Retentive Arm) Reciprocating (Bracing) Arm Distal Occlusal Rest Seat Proximal Plate
- 99. CLASSIFICATION
- 100. Direct Retainers Intracoronal Extracoronal • Internal Attachment • External Attachment • Stud Attachment • Bar Attachment • Special Attachment Manufactured Custom Made Occlusally approaching Gingivally approaching • Bar Clasp • T Clasp • Modified T clasp • Y Clasp • I Clasp • Infrabulge Clasp • I bar Circumferential Embrasure Onlay Half and half Continuous Clasp • Simple Circlet • Reverse Circlet • Multiple Circlet • Ring • Fishhook • Combination
- 101. COMPONENTS OF A REMOVABLE PARTIAL DENTURE (RPD) +EXTRA CORONAL DR + INTRA CORONAL DR
- 104. +SUPPORT : The foundation on which a dental prosthesis rests. +STABILITY : Quality of a prosthesis to be firm, stable or constant and to resist displacement by functional, horizontal or rotational stresses. +RETENTION : Quality inherent in the prosthesis to resist vertical forces acting to displace it away from its foundation.
- 105. +ABUTMENT An abutment is tooth, a portion of a tooth or a portion of an implant that serves to support or retain a prosthesis.
- 106. +HEIGHT OF CONTOUR A lines encircling a tooth, designating its greatest circumference at a selected position determined by a dental surveyor.
- 107. +UNDERCUT : Portion of a tooth that lies between the HOC and the gingiva.
- 108. +Angle of Cervical Convergence Angle viewed between a vertical rod contacting an abutment tooth and the axial surface of the abutment cervical to the height of contour.
- 109. +Guiding Planes Two or more parallel surfaces of abutment teeth shaped to direct a prosthesis during its placement and removal.
- 110. Survey line +A line drawn on a tooth or teeth of a cast by means of a surveyor for the purpose of determining the positions of the various parts of a retainer
- 111. SURVEY LINES : High Medium Low Diagonal Louis Blatterfein’s division of abutment teeth into near zone NZ & far zone FZ
- 112. +HIGH SURVEY LINE: From occlusal 1/3rd in NZ to occlusal 1/3rd in FZ +MEDIUM SURVEY LINE: From occlusal 1/3rd in NZ to middle 1/3rd in FZ.
- 113. +LOW SURVEY LINE: From cervical 1/3rd in NZ to cervical 1/3rd in FZ +DIAGONAL SURVEY LINE: From occlusal 1/3rd in NZ to gingival 1/3rd in FZ
- 114. BLOCK OUT +After the establishment of path of insertion and the location of undercut areas on the master cast, the areas that shall be crossed by the rigid parts of the denture must be blocked out. +Roach carver or No.7 spatula used to adapt the blocking wax.
- 115. BLOCK OUT +Four types: oParallel Blockout oShaped Blockout/Ledge Blockout oArbitrary Blockout oRelief
- 116. DENTAL CAST SURVEYOR: An instrument used to determine the relative parallelism of two or more axial surfaces of teeth or other parts of a cast of a dental arch.
- 117. COMPONENTS OF A REMOVABLE PARTIAL DENTURE (RPD) +STABILIZING/RECIPROCAL COMPONENTS: +Imparts stability to denture against functional, horizontal and rotational stresses. +Provided by: oReciprocal/ stabilizing arm of clasp assembly. oMajor connector (CAS) oVertical supporting minor connector (together with Maj. Connector.)
- 118. COMPONENTS OF A REMOVABLE PARTIAL DENTURE (RPD)
- 119. COMPONENTS OF A REMOVABLE PARTIAL DENTURE (RPD) +DENTURE BASE : Rests on the foundation tissues and to which teeth are attached.
- 120. Impression +A negative likeness or copy in reverse of the surface of an object ; imprint of teeth and adjacent structures for use in dentistry.
- 121. ACCORDING TO THE METHOD OF IMPRESSION MAKING RESIDUAL RIDGE Anatomic form Functional form
- 122. ANATOMIC FORM +The surface of the residual ridge at rest. +It is the shape of the ridge before functional load is applied.
- 123. FUNCTIONAL FORM +It means the shape of the residual ridge tissue when it is functioning to support the denture base. +It is the shape of the ridge after functional load is applied.
- 124. 1 2 4 Anatomic or Resting form Supporting or Functional form
- 125. CONCEPT OF FUNCTIONAL IMPRESSION +The term functional impression means recording the functional form of the residual ridge tissue & to obtain uniformity of support when the functional load is applied.
- 126. NEED OF FUNCTIONAL IMPRESSION +The displaceability of the mucosa of residual ridge is not uniform. +The need of functional impression arises in cases of distal extension based partial denture. +Some mouth does not exhibit significant difference in anatomical and functional form of ridge. +Short span distal extension bases.
- 127. INDICATIONS FOR FUNCTIONAL IMPRESSION +Mandibular distal extension partial dentures – Only a limited ridge area can be used as a stress bearing site. +Mainly Kennedy’s class I & II edentulous arches.
- 128. OBJECTIVES OF FUNCTIONAL IMPRESSION (O.C. Applegate) To obtain the maximum area of coverage Traumatic impact on any area must be avoided At rest there must be no islands of ischemia Under work loads all areas must receive massage stimuli.
- 129. IMPRESSION MATERIALS +Anatomic impression oIrreversible Hydrocolloid oReversible Hydrocolloid oElastomeric Impression materials +Functional impression oMetalic pastes oElastomeric impression materials oFluid waxes oSoft liners
- 130. Cast +An accurate and positive reproduction of a maxillary or mandibular dental arch made from an impression of that arch; further designated according to the purpose for which it is made, such as diagnostic cast, master cast, or investment cast; also may be used as an infinitive (to cast) or as an adjective (cast framework, or cast metal base).
- 131. Diagnostic cast
- 132. Master cast
- 133. Refractory cast
- 134. Refractory cast
- 135. Altered cast technique Altered cast: a final cast that is revised in part before processing a denture base—called also corrected cast, modified cast Altered cast partial denture impression: a negative likeness of a portion or portions of the edentulous denture bearing area(s) made independent of and after the initial impression of the natural teeth. This technique employs an impression tray(s) attached to the removable dental prosthesis framework or its likeness
- 136. Alter cast
- 137. Duplication
Editor's Notes
- ECTODERMAL DYSPLASIA, PAPILLON LEFEVERE SYNDROME
- The loss of a large number of teeth puts an increasing functional burden on the remaining teeth. In this example there is existing periodontal disease. The increased functional load has hastened the destruction of the periodontal attachments of the maxillary anterior teeth, which have become increasingly mobile and have drifted labially.
- The loss of maxillary anterior teeth may prevent the clear reproduction of certain sounds, particularly the ‘F’ and ‘V’ which are made by the lower lip contacting the edges of the maxillary incisors. The replacement of missing maxillary anterior teeth will make a significant contribution to the quality of speech.
- Body which connects the rests and shoulders to the minor connector. Shoulder connects body to the the clasp terminals. Portion of the clasp arm that arises from the minor connector is cald the shoulder.