Section 24 - RPD Design

Handout Abstracts 001. Henderson, D. Major connectors for mandibular removable partial dentures: Design and function. J Prosthet Dent 30:532-548, 1973. 002. Boero, E. and Forbes, W. G. Considerations in design of removable prosthetic devices with no posterior abutments. J Prosthet Dent 28:253-263, 1972. 003. Berg, T. A. and Caputo, A. A. Anterior rests for maxillary removable partial dentures. J Prosthet Dent 39:139-146, 1978. 004. Becker, C. M. and Bolender, C. L. Designing swing-lock partial dentures. J Prosthet Dent 46:126-132, 1981. 005. Kratochvil, F. J. and Caputo, A. A. Photoelastic analysis of pressure on teeth and bone supporting removable partial dentures. J Prosthet Dent 32:52-61, 1974. 006. Jacobson, T. E. and Krol, A. J. Rotational path removable partial denture design. J Prosthet Dent 48:370-376, 1982. 007. Firtell, D. N. and Jacobson, T. E. Removable partial dentures with rotational paths of insertion: Problem analysis. J Prosthet Dent 50:8-15, 1983. 008. Zarb, G. A. and Mackay, H. F. Cosmetics and removable partial dentures. J Prosthet Dent 46:360-368, 1981. 009. Wagner, A. G. and Traweek, F. C. Comparison of major connectors for removable partial dentures. J Prosthet Dent 47:242-245, 1982. 010. Schulte, J. K. and Smith, D. E. Clinical evaluation of swing-lock removable partial dentures. J Prosthet Dent 44:595-603, 1980. 011. Demer, W. J. An analysis of mesial rest-I-bar clasp designs. J Prosthet Dent 36:243-253, 1976. 012. Yalisove, I. L. Crown and sleeve-coping retainers for removable partial prosthesis. J Prosthet Dent 16:1069-1085, 1966. 013. McArthur, D. R. Canines as removable partial denture abutments. Part II. Rest and undercut location for retainers. J Prosthet Dent56:445-450, 1986.

014. Parr, G.R. and Gardner, L.K. The removable partial denture design template. Compend Contin Educ Dent 8:594-602, 1987. Section 24: RPD Design (Handout) Classification Systems ( a historical look) Parr 1. Cummer(1921)- one of 1st classification systems in American literature. Based on teeth remaining or teeth lost. Said 131,072 combinations of RPD when Max and MN arches considered along with all 32 teeth 2. Skinner- based on relationship between abutment teeth and supporting alveolar ridge 3. Bailyn- a two tier system: looks at anterior saddle( anterior to premolars) and posterior saddle (posterior to canine) areas; designated as A or P. Class I, II, III determined by number of teeth missing teeth in the span between the abutments. 4. Kennedy(1925)-Applegate Class I: Bilateral distal extension Class II: A unilateral distal extension Class III: A unilateral tooth supported Class IV: Anterior edentulous span crossing the midline Purpose of Kennedy classification system. - Immediate visualization of tooth lost. - Immediate differentiation between tooth-borne and tissue supported RPDs. - Communication among dentists and lab. - Universally understood. Principles of RPD Design ( Henderson, Boero, Berg, Zarb, Wagner, Kapur) QUESTION: HOW CAN WE DESIGN AN RPD SO THEY ARE SAFE AND AS STRAIGHT FORWARD AS POSSIBLE AND STILL SATISFY THE REQURIMENTS OF SUPPORT, STABILITY, RETENTION, FUNCTION AND ESTHETICS? Support (tooth or tissue) Rests( McArthur, Berg) "Anterior teeth by virtue of their crown and root orientation tend to exert a cantilever effort on supporting bone and periodontal membrane when receiving occlusal loads." Berg. If this is true how can we design anterior rest ? Is one design better(e.g., flat, V, half moon) Surveyed Crowns ( Yalisove) Stability Major Connector Minor Connector

Axis of Rotation (All RPDs are like a ship- they pitch, roll and yaw) - Three axes to be concerned with in RPD design. Cant eliminate these but must accommodate them. How? Vertical- "fish-tailing " of a KI RPD sidetoside Horizontal- rotation about a fulcrum line delineated by the distal most rests in a KI RPD Longitudinal rotation about the crest-oftheridge line Force Distribution (Berg, Boero, McArthur) - How are forces acting upon the RPD? - How do you control these forces? How does one avoid a type 1 lever system in an RPD? Esthetics ( Zarb) - Fixed v RPD when to use RPD? a. Edentulous span too long for FPD b. Significant alveolar ridge loss and mid third of face must be supported c. Cleft palate and other maxillofacial defects d. Very young patient Design Principles - Do no harm - No clasps showing - Be retentive. Advantages of RPD - Not irreversible - Limited tooth structure removed - No pulpal necrosis. - Can always go to fixed. Terms 1. Fulcrum Line a. A theoretical line around which an RPD tends to rotate b. The length of the fulcrum (lever arm) determines the amount of force transferred to the abutment tooth.. c. Through the most distal abutment (rest), on either side of the arch, multiple fulcrum lines can exist. 2. Inclined Plane- what an RPD can act as if not properly supported by well-defined rests and good tissue support. Philosophy for Extension Partial Dentures ( Kratochvil, Demer)

Bonus question: What are Roach, Kratochvil, Krol and Demers contributions to the RPI system? Roach-gave the system its name, bar went into a DF undercut; Krat-located I bar to midfacial; Krol- modified the distal proximal plate; Demer reviewed and analyzed the system. RPI( Roach) Demer Indications Contraindications - High survey line - Severe tissue undercut - No midfacial or MF undercut - Insufficient region of attached tissue Advantages Disadvantages Parts of RPI system Rest (support) - Located on mesial. Why? I bar (retention) Must disengage when rotation occurs around an anterior point. Minimal contact on tooth Proximal plate( reciprocation) extends slightly to distal Proper height Krol- 2-3 mm occlusal-gingivally Below HOC. Why Kratovil- " physiological adjustment" What does this mean? Importance? How does Kratochvils proximal plate differ from Krols RPA (Eliason) Unconventional RPD Designs ( Firtell, Jacobsen, Becker,Schulte) Rotational Path (Jacobsen, Firtell) Indications Tilted abutment teeth Esthetics Do no want clasps showing- decrease number of clasps Contraindications Distal extensions Lingualy tilted abutment teeth Advantages Decreased no. of clasps Less components to distort Disadvantages Technique sensitive Classes: Category I: Characteristics of - Seat rest associated with rigid connector 1st and rotate 2nd segment into place

- Can be AP or PA but will replace posterior teeth Category II: - Lateral paths and AP replacing anterior teeth Six Biomechanical Requirements of: - Retention- rigid retentive component (minor connector) - Bracing/Stability- intimate contact of parallel rest seat walls, tissue surface of minor connector, contacting proximal surface abutment - Support-rest ( 1.5-2.0mm deep, > F-L width, dovetail shaped) - Reciprocation- not required since rigid retainer shows passivity in relationship to abutment during and after seating - Encirclement contact of rest and minor connector - Passivity Swing Lock (Becker, Schulte) Indications Compromised periodontal condition of teeth Multiple missing abutment teeth Summary (Kapur) "The periodontium is the testing ground of all restorative procedures." Do you agree with this statement? Why or why not? - Abstracts 24-001. Planning removable partial dentures. J Prosthet Dent 12:524-535, 1962. Purpose: To discuss planning the treatment for a removable partial denture Materials and methods: None Results: None Discussion: A fixed partial denture is the treatment of choice whenever it may be used. If a removable partial denture is to be used it should meet the following requirements. (1) preserve the alveolar ridges and remaining teeth, (2) provide desirable facial expressions, (3) correct occlusion, (4) restore and preserve occlusion and masticating efficiency that had been lost. In planning four items take precedence (1) bilateral distribution of stresses, (2) various types of retainers, (3) cosmetic effect, (4) function. Splinting of abutment teeth may be necessary to add to the stability and life of the RPD abutment. Conclusions: (1) The biologic response of tissue to stress depends upon the tolerance of the tissue. (2) Partial dentures should be designed for bilateral distribution of stresses. (3) The type of retainer which will function best in all respects is the one which should be employed in any specific location. (4) The location of the teeth remaining and available for support and the way they are used are much more important than the number of teeth remaining. (5) Splinting of teeth by clasping in sequence is effective for adding stability to a restoration and avoiding the overworking of abutment teeth.

(6) Modern periodontal procedures which are saving teeth are making partial denture service increasingly necessary. (7) Removable partial dentures can effectively stabilize loose teeth so that they will grow firm again. (8) Elastic clasp are more efficient for retention and less traumatizing to abutment teeth than clasp which lack resiliency. (9) Removable partial dentures move slightly under functional loads. (10) Teeth splinted together by fixed restoration provide strong abutments. (11) It is the responsibility of the dentist to plan and design removable partial dentures. 24-002. Boero, E. and Forbes, W. G. Considerations in design of removable prosthetic devices with no posterior abutments. J Prosthet Dent 28:253-263, 1972. Abstract not available at this time ........... 24-003. Berg, T. A. and Caputo, A. A. Anterior rests for maxillary removable partial dentures. J Prosthet Dent 39:139-146, 1978. Abstract not available at this time ........... 24-004. Becker, C. M. and Bolender, C. L. Designing swing-lock partial dentures. J Prosthet Dent 46:126-132, 1981. Abstract not available at this time ........... 24-005. Thompson W.D. Kratochvil, F.J. and Caputo, A.A. Valuation of Photoelastic stress Patterns Produced by Various Designs of Bilateral Distal Extension Removable Partial Dentures. J Prosthet Dent 38:261-273,1977. Purpose: To compare the forces exerted on the supporting structures of abutment teeth by seven RPD designs using a photelastic model. Methods & Materials: A model was fabricated with plastic teeth extending to the first premolars. Another plastic was used for PDL and another for bone. Seven RPD frameworks of various design were fabricated. Each design was loaded in a photoelastic testing apparatus. Results: Anterior positioning of rests provides better vertical load transfer. The least favorable designs all had mesial undercuts and distal rests. The most favorable designs were mesial rest with an I bar or wrought wire combination clasp. Conclusion: A retainer with a mesial rest and a buccal I bar or a wrought wire and cast lingual arm exhibited the most favorable distribution of vertically applied forces. Distal rests tend to move the clinical crown distally and the root mesially at the apex, resulting in horizontal forces in bone. Placing rests more anteriorly provides an axis of rotation that directs applied forces in a more vertical direction. The distal rest with circumferential retainers developed greater horizontal forces within the supporting structures. 24-006. Jacobson, T. E. and Krol, A. J. Rotational path removable partial denture design. J Prosthet Dent 48:370-376, 1982.

Abstract not available at this time ........... 24-007. Firtell, D. N. and Jacobson, T. E. Removable partial dentures with rotational paths of insertion: Problem analysis. J Prosthet Dent 50:8-15, 1983. Abstract not available at this time ........... 008. Zarb, G. A. and Mackay, H. F. Cosmetics and removable partial dentures. J Prosthet Dent 46:360-368, 1981. Abstract not available at this time ........... 24-009. Wagner, A. G. and Traweek, F. C. Comparison of major connectors for removable partial dentures. J Prosthet Dent 47:242-245, 1982. Abstract not available at this time ........... 24-010. Schulte, J. K. and Smith, D. E. Clinical evaluation of swing-lock removable partial dentures. J Prosthet Dent 44:595-603, 1980. Abstract not available at this time ........... 24-011. Demer, W. J. An analysis of mesial rest-I-bar clasp designs. J Prosthet Dent 36:243253, 1976. Abstract not available at this time ........... 24-012. Yalisove, I. L. Crown and sleeve-coping retainers for removable partial prosthesis. J Prosthet Dent 16:1069-1085, 1966. Abstract not available at this time ........... 24-013. McArthur, D. R. Canines as removable partial denture abutments. Part II. Rest and undercut location for retainers. J Prosthet Dent 56:445-450, 1986. Abstract not available at this time ........... 24-014. Parr, G.R. and Gardner, L.K. The Removable partial denture design template. Compend Contin Educ Dent 8:594-602, 1987. Abstract not available at this time ...........