Partial Denture Designing

Tony Johnson and Duncan Wood University of Sheffield School of Clinical Dentistry Academic Unit of Restorative Dentistry October 2011

What you need to design partial dentures:

Study models Model surveyor Patients previous partial denture history Details regarding the patients oral and general health

The model surveyor

Uses: To locate accurately the height of survey lines on teeth for a given path of appliance insertion To determine the best path of appliance insertion To measure the actual depth of undercut present and to precisely position clasp arms and determine the design which ensures that the metal has the necessary resilience to prevent trauma to the teeth or clasp fracture To establish soft tissue and tooth undercuts which must be blocked out prior to model duplication or denture construction

The model surveyor

Uses continued: To establish soft tissue undercuts which may require surgical removal or be used for added retention when compatible with the path of insertion. To provide information for the design of the entire partial denture, including clasp design and position, location of rests, location of bars, plates and retention elements. To aid in the restorative procedures necessary on abutment teeth. To trim wax patterns of crowned teeth to coincide with the path of insertion and improve the fit of the appliance and aid reciprocal action.

A system of design
Denture support
o Tooth or tissue borne

Saddles Surveying the model Direct retention

o Design criteria and options for direct retainers

Reciprocation Support Connectors

o Design criteria and options for connectors

Indirect retention

The shortened dental arch principle

A reduced dentition may actually be adequate for many patients and it is more important in these cases to maintain the teeth that remain than replacing the missing ones The World Health Organization have set a standard for good oral health as having 20 natural teeth throughout adulthood. However, in the context of having a functional occlusion it may be less important than the number of teeth that occlude with each other to permit acceptable oral function

The shortened dental arch principle

Some reasons for not providing an RPD for patients who have 20 occluding teeth are: RPDs that replace molar teeth may not provide the patient with any immediate masticatory benefit and may require the patient to learn new skills to effectively use the appliance A high standard of oral hygiene is required by the patient if further tooth loss is to be avoided. Older patients may find this harder to achieve At least 50% of all free-end saddle RPDs are not worn!

The shortened dental arch principle

Some potential disadvantages of not providing an RPD for patients who have 20 occluding teeth are: Could be an increased risk of anterior tooth wear Subsequent provision of an RPD, due to further tooth loss, may be harder for the patient to habituate to due to potential enlargement of the tongue due to it having a larger masticatory role and its inability to accommodate the new prosthesis placed into a space it had previously occupied Could be an increased risk of TMJ dysfunction. However, there is no evidence to confirm this and free-end saddle RPDs would not necessarily prevent TMJ dysfunction anyway.

Tissue Borne RPDs

Factors to think about: Teeth to be replaced
o What teeth should be chosen? The narrower the teeth the less pressure they exert on the denture and underlying tissues use premolars not molars!

Saddle extensions
o Always extend the base to the maximum denture bearing area even if only a few teeth are being replaced the snow shoe effect!

Path of insertion
o Can the path of insertion be altered from the path of displacement? This improves retention and aesthetics

Chromium/cobalt RPDs
Factors to think about: All the factors mentioned for tissue borne dentures are applicable here as well How sound are the teeth needed for clasping or resting? Is there enough undercut for clasps to usefully engage? What depth of undercut should the clasps engage?
o Based on the tooth to be clasped and the type of clasp and material being used

Major connectors and there extension Which type and how far do they need to extend? Always check the patients old denture if they have one to ascertain what problems, if any, they had with it no point creating the same problems.

Transferring your design to the technician

Clear easy to understand instructions are essential if you and the patient are to get the RPD you both want. The best method of transferring your design to the technician is to draw it precisely onto the surveyed study models. Detailed drawings and written instructions detailing every aspect of your design are required to enable the technician to produce the RPD you requested. The factors you should detail are: direct retainer types on which teeth and engaging what undercut depth; the type of connector and its exact extension; the position of occlusal or incisal rests; saddles, extension and the number and type of teeth they hold; reciprocal elements, types and extension; indirect elements; general instructions including the surface finish of metal denture bases, mirror or stippled. The colour of the acrylic resin denture base can have an important effect on aesthetics, particularly when involving anterior teeth; you may need to use an acrylic resin shade guide to achieve a good match between the natural tissue and the denture base.

A final word on design!

All partial dentures exact a biological price from the patient. The dentists role is to minimize the price. The design should be as simple as possible, so long as it is compatible with the requirements for support, retention and strength. Inappropriate design causes more damage than the wrong choice of materials. When replacing upper teeth the case for an acrylic base denture is strengthened by the presence of the hard palate and the support it provides.

A final word on design (contd)

Permanent mandibular partial dentures should make use of soft tissue support as much as possible to prevent trauma to the soft tissues. This will usually dictate the use of a cast metal major connector since although it is possible to construct metal rests which can be incorporated into an acrylic resin denture it is not cost-effective. Provision of a denture saddle posterior to a natural molar abutment cannot be justified. An unopposed tooth in the opposite jaw does not alter the importance of this statement. Special impression techniques (such as the altered cast technique) for mandibular free-end saddle partial dentures are highly recommended in order to provide a more stable result for this often poorly tolerated prosthesis.