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In this laboratory there is no defined subject to talk about , well continue speaking of RPD design and well also speak of some points we talked about them earlier . So if you find this a little random pair with it. Everytime you see a line separating two paragraphs that means its the start of a new subject, the doctor was so random at this laboratory. And the usual notes , follow where the images are and note that for demonstration purposes only the images are from a patient mouth but this process IS NOT ON THE PATIENT its done on the cast.
As you already know , when we talk about RPD design we either classify each case we have according to : Kennedy classification or The Tissue Support . And you already know the basic configuration for each class of Kennedy classification for e.g. : class 1 default ( or mostly preferred ) is bilateral design Class ll : tripodal design , class lll : Quadrilateral and finally class IV : we said that Depending on the length (extensive) of the edentulous area it can be bilateral or quadrilateral designs . For images of this please look at laboratory 8 pages 6-8. The other classification is the tissue support: you already know that class 1 , ll and long span IV are tooth-tissue supported and class lll is tooth-borne . But looking at the table below youll discover new concepts for the tissue support classification Class 1 ll lll lll ( rare cases ) IV ( long span ) IV ( short span ) Support Tooth-tissue Tooth-tissue Tooth-borne Tooth-tissue Tooth-tissue Tooth-borne Retention Tooth ( weak ) Tooth ( weak ) Tooth Tooth ( weak ) Tooth ( weak ) Tooth
As we said earlier , the default design of class 3 is quadrilateral ( meaning 4 spots or clasps assemblies have to be present ) but what if one of these points is missing or I cant have support it on it or I cant have retention on it ? Ill treat it as toothtissue supported and weak tooth retained. This is very important during designing and it might get tricky ( well see an example about this where we initially start with a class lll and we think that its tooth-borne supported and tooth retained , but as we go further with the design we discover that its not ) so keeping an eye in these things is crucial .
As you already know from other subjects , Amalgam fillings need to be 2 mm minimal to prevent fractures . If a patient came to me with an amalgam restoration , I dont know how deep his amalgam is , so when placing a rest the remaining space might be 0.5 mm and this is very weak and might fracture , because as you already know amalgam is good in compression but bad in tension . SO IF I DIDNT PUT THE AMALAGAM I NEED TO BE VERY WORRY AND CARFAUL WHILE PLACING A REST . Another case: lets assume that we have a very deep amalgam restoration ( which is very rare ) am I allowed to put a rest on it as long s the remeaing amalgam is ATLEAST 2 mm thick , put remember this is one of my last choice because I REALELY put a rest on an existing restoration . Worst case if I had a very bad tooth ( destroyed and very worn out ) I can put a crown in it and then attach a rest to it . While doing so the crown has a metal part that is attached to porcelain and this metal part will be attached to the rest. (rest = metal , crown = metal ) .
We talked about mobility in the theory but were going to talk about again in the lab : Because its going to change a little bit from what we said in the theory. There are several different classification for mobility in dentistry but the simple and most used in filed is Grrace and Smoles classification . They have divided this mobility of the tooth into : Grade 0 no apparent ( )mobility , very healthy , I dont even worry about it. Grade 1 there is mobility but its less than 1 mm bucco-lingually . Grade 2 there is a definitive mobility but its 1-2 mm bucco-lingually Grade 3 severe mobility and its grater than 2 mm bucoo-lingually AND there will be vertical component to the motion ( ) . usually tooth grade 3 is HOPLESS ( ) meaning that there is no apical bone leading for the tooth to go up and down. And this tooth needs extraction. What does this classification means for RPD design? Many of our patients have partially ednontlues mouths and the remaining teeth are not in excellent health . grade 1 as weve said in the theory , I can put a : Rest on it ( support ) Axaillary retention ( stress-releasing ) combination clasp or ( wrought wire on the buccal and cast reciprocation on the lingual ) . clasp . (it helps in retention but doesnt provide the main retention ) . Reciprocal arm ( reciprocation ) Guide plane . Lingual plate
For example if I have two teeth with class 1 , I can put a lingual plate on them without any rest or arms or anything just a lingual plate . . , , Grade 2 : A bit more complicated , this is debatable some say you can use it others say no you cant use it . The doctor personal opinion is to stay away from grade 2 teeth . ! So many doctors will say Nothing, expect we can put on them these things: Guide plane on ONE surface ------ BRACING OR SPLLINTING Lingual plate -----------BRACING OR SPLINTING SOME doctors say it can provide axiallry support (well see in this lab in some of the examples how we put a rest not to provide support but just to stop the tooth from moving ) . NO RETENTION , NO PRIMARY SUPPORT in this grade Preventing supra-eruption from coming by putting a rest on it as an example.
Theyre as you already know classified according to the location ( suprabulge and infrabulge or occlusally approaching and gingivally approaching ) and according to stress releasing and non-stress releasing : Non-stress release : Cast circfumental : usually first choice if not esthetics of concern ( occlussally approaching Akers . Gingivally approaching : Roach ) . We have modifications to the C-clasp : simple circlet and reverse circlet . The simple circlet it approaches from the edntuoules area . Reverse circlet approaches away from the ednloules area .
Ring clasp , it might have 2 rests on either side to reduce flexibility as we said . And it provides its own bracing (because it surrounds the tooth ) . And sometimes we put a sturt to make it stronger. Embrasure ( double akres / compound clasps ) : put picture from slides here Reverse action C-clasp ( hairpin ) and clasp Extended clasp: very rear , one clasp extending to different teeth. Multiple clasps: opposite to embrasure, insisted of putting the rest on the middle between two teeth . We put rest on each tooth and extend from them. Wrought wire ( combination clasp ) Onlay clasp Stress-releasing : indicated in class 1,2 , long span 4 and some raer cases of class 3. 1) RPI 2) RPA 3) Combination clasp
This is keneedy class lll , mod 1 . And support classification is tooth-supported (FOR NOW ONLY ) . As always we start off by coloring our abutments with the color yellow . ( notice we didnt color the 8,7 on the left because in this course we consider grade ll mobility not good as abutments . But this is only for the exam purpose ) ( figure 1) After that I add rests as in the picture.(figure 2)
3 after that I need to add my minor connector, since this is maxilla ( and the doctor didnt provide any further information ) Ill go with the meshwork . ( figure 3) after that I need to add retention , for the right canine what clasps should I put here ? we cant place an I-bar ( the depth of sulcus in that area is 3 mm ) . I could use gingivally approaching cast clasp , occlusally approaching cast clasp and 4 occlusally approaching wrought wire ( combination clasp ) . The doctor went with occlusally approaching cast clasp , although its inferior esthetically than gingival but I can put the gingival due to the depth . Choosing the wrought wire option is the same as occlusally approaching c-clasp , both are ugly so it doesnt make any difference but the doctor went with the cclasp. (figure 4). SO CIRCLET CLASP OCALLUSALLY APPRAOCHING IN 0.25 MM MESIO-FAICAL UNDERCUT. On the left canine because I have 6 mm depth , I can add an I-bar . A side-note to remember about the I-bar is that the retientive tip ( arrow ) of the I-bar must be on the mesio-facial of the tooth . (figure 4) . SO I-BAR IN 0.5mm in MESIOFAICAL UNDERCUT For the 7th on the right , can we place a c-clasp on the molar ? No , so were going with the wrought wire . You need to stay 1 mm away from the tooth and you need to fuse it with the meshwork (figure 4) . SO WROUGHT WIRE 0.8 DM , IN 0.5 MM DB UNDERCUT .
Lets see if we need indirect-retention in this design ? anytime you see two or three points class assemblies know that youre going to need to place indirect retention We look for the axis of rotation away from the tissue and toward the tissue . Lets start looking for support : (fig 5 ) if the other side ( where there is no pen ) tries to come out whats going to prevent it ? The direct retainer on the left canine . (fig 6 ) what if the other side ( where there is no pen ) tries to come out ? both the canine and the 7th on the right side will prevent it from doing so . (fig 7 ) what if the other side ( where there is no pen ) tries to come up ? the 7th on the right will prevent it . (fig 8 next page ) what if the other side where there is no pen tries to come up ? I have nothing to prevent it ! because theyre grade ll mobility I cant put direct retainters on the 8th and 7th on the left . HENCE this is one of the special cases where I have a class 3 but in terms of retention its class ll ( as if the 7th and 8th dont exist ). So I need indirect retention , luckily I have a retainer on the right canine , so Im going to mark it green to indicate that its an indirect retainer.( figure 9 next page ) .
Now what about support ? (figure 5 ) what if the patient bites down on the canine area ? Ill have support provided from the canine there . (figure 6 ) what if the patient bites down on the right canine and 7th area ? Ill have lots of support there from the canine and the 7th . (figure 7) what if the patient bites down on the 7th area ? Ill have support from the 7th in that area . (figure 8) what if the patient bites down on the left 7th ? there is nothing there ; no support , so itll go down and on the other side ( the right canine ) itll try to come up . Now I need to reconsider my design , on the right canine we put a occluasally approaching cast clasp , but with the pulling action of it ( it tends to go up ) itll eventually harm the tooth , so Ill replace it with a wrought wire because its much more flexible and gentle on the tooth . SO ON THE RIGHT CANINE ITS 0.8 DM WROUGHT WIRE IN 0.5 UNDERCUT.
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After that I need to connect everything together, so its time for major connector. But notice I didnt draw the reciprocation arm for the clasp assemblies , and this is to show you that sometimes the major connector can do the job of reciprocation if its extended to the tooth , AN ARM , A PLATE OR A REST can do the job or reciprocation . For the major connector were going with the mid platatal strap.
11 On the right canine and the left canine I already have repcorcaiton provided by the rest , we could draw the major connector as figure 10 . OR I could draw it like figure 11 in which the strap extends to the rest , as long as the distance in square 1 is grater than 6 mm and I dont have a minor connector blocking the way as in square 2 figure 11 , same thing applies for the right canine . (figure 12 shows both of the ways ). (figure 13 ) now continuing putting the midplatal strap posteriorley , you can notice in square 1 Ive added a reciprocating arm to make the design as simple as possible and not to extend the palatal strap into the whole tooth. As in figure 14 12
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15 The 7th and 8th on the left are grade 2 mobility , and in the upcoming years they might need to be extracted , so why dont I make the strap to cover them so that in the future I can just remove them and add acrylic teeth ( like pieces of lego ) (figure 15) Now in this design were doing the upper , well do also the lower for this design . In the lower as youll see the 8th on the right is grade lll and its BOP . So it need to be extracted , but Im afraid if I did this the upper 8th might supra-erupt , whats the solution ? Ill add a rest ( preventing supraeruption) and extend the strap just in case the right 8th needs to be extracted .(figure 16 and 15). SO AT THE END OF THE DEISGN WE DISCOVERED THAT THIS DEISGN IS TOOTH-TISSUE SUPPORTED. Now well discuss the lower for this case.
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17 We start as always , coloring our abutments with the color yellow (figure 17). After that I add support (figure 18). After that Ill add minor connector , for the left side Ill put a lattice , but the lattiace Im going to add is called modified lattice in which each tooth has its preserved location so that when the technician add the acrylic he knows where to add them exactly .(figure 19). For the right side Ive added a metal base since I only have one tooth missing ( figure 19).
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21 Looking at figure 20 ( previous page ) , we need to add retention now . For the left molar we added a normal occlusally approaching simple circlet C-clasp . For the canine one the left weve added an I-bar/RPI system ( because the depth allows us to do so ) . On the right side weve added a simple cast clasp on the premolar ( we cant add an I-bar here due to the depth which is 3 mm ) . on the molar in the right side weve added a ring clasp with a distal rest to enhance retention . notice in figure 20 also that the reciprocation arms are drawn fro the clasps ( for the left canine we didnt provide a reciprocation arm because the function of reciprocation can be done through the rest on the cingulum or through the major connector like plate ) . on the right the molar had a ring and the ring provide its own reciprocation as you already know . Figure 21 , its time to make a lingual bar , notice how we draw it in figure 21 . and then notice how it couldve been drawn in figure 22 if we didnt have a distal rest. Now for the anteireor teeth theyre grade 1 , ll mobility so its best to plate them with the major connector , but what about the left premolar ? should I plate it or leave it ? looking at figure 23 its not a good idea to not plate it and leave this space below the premolar , its not good for hygienic and health ; its not selfcleansing. , alright what about the right side ? from 3,4 and 5 ? should I plate them or not ? you have the freedom to either do figure 24 or plate it as figure 25 ; next page. 22
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25 figure 26 shows the final design for both the upper and lower for case 1.
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29 we start always as usual by coloring the abutments with the color yellow . (figure 28). To be honest with you if we have this patient in real life well do him either bride or implants when we have UNILATERAL WITH ONE OR TWO TEETH MISSING WE TEND TO MAKE FIXED TREATMETNS . Ideally class 3 design is quadrilateral so I need to mark 2 more abutments ALTHOUGH there is no edntoulues area on the other side where am marking the 2 extra abutments . I like the design to be symmetrical so Ill mark the same teeth on the right side. As in figure 29. Next were going to draw a meshwork as in figutr 30 . but just a side-note : IF YOU HAVE A ROOM LATTICE IF YOU HAVE LIMTED ROOM MESHWORK . After that were going to add rests as in figure 31. After that were going to add retention as in figure 32 ( next page ) .
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32 notice in figure 32 all of them are occllusally approaching C-clasps. Finally for the major connector were going to use mid-palatal strap as in figure 33. Now looking at the design and all these clasps , I ask myself can I make the design more simpler ? well I can as in figure 34 and figure 35. In figure 34 , I could place a clasp on the 6th . In figure 35 I could make a double embrasure with the 6th and 5th . But the most correct design is figure 32 the first one . 33
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36 now lets solve the lower for case 2. What class is this ? 1 or 2 ? well to determine so you have to look for the opposing arch , looking at figure 33 you can see that 8th and 7th on the right side are there . if Im not replacing the 7th and 8th and If I had a rest on the 8th to prevent it from supra-eruption than this is class 2 ! But since I have teeth and the 8th might supra-erupt its class 1. So its good idea to replace the lower right 7th and 8th . So we start as always by coloring the abutments yellow. as in figure 37. after that Im going to add the minor connector as in figure 38 , notice that the minor connector on the right side behind that 6th is a modified lattice work.
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39 after that lets add retention , we need a stress-releasing design ( RPI, RPA , CC ) .figure 39 after that Im going to add the major connector as in figure 40. Remember when we did wax pattern in the lab ? those of you who worked with lower models had to make triangles in the 6th and 6th these triangles are to help connect the plate ( major connector ) with the lattice ( figure 40). The End of laboratory 9. Done by : Osama Yousef.
The number of deaths in Syria since the first Prosthodontics script was
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