The Component Parts

of Removable Partial Dentures

Five Parts of RPD

1. Rests 2. Minor connectors (including proximal plates) 3. Major connector
Max. Connectors Man. Connectors

4. Denture base and Artificial Teeth 5. Retainers

Direct retainers Indirect Retainers

Metal framework: CrCr-Co alloy is most commonly used Denture teeth: acrylic or porcelain denture teeth Pink acrylic resin

Diagnosis and treatment plan

Draw the Design of the RPD on the diagnostic chart

Survey, determine the path of insertion, and tripod Mouth preparation and impression for the RPD framework Seat and fit the RPD framework Physiologic adjustment and altered cast impression if it is an extension base RPD Maxillomandibular registration (obtain face bow, VDO, and CR records) Tooth selection Wax partial denture try-in if it is esthetic or complex case tryDelivery

Sort out the proper treatment sequence

Draw the Design of the RPD on the diagnostic chart. Identify the axis of . rotation due to the distal extension

Design sequence: Rests Minor connectors Major connector Denture base connectors Retainers

RPD Framework Mouth preparation

Rests Proximal plates/Minor connectors Major connector Denture b D t base connectors t Retainers Requires tooth modification

Draw your RPD design on the study cast

Draw Dra RPD design on the cast follo ing your paper RPD design following our

Surveying Procedure
This may be divided into the following distinct phases:
Preliminary visual assessment of the study cast. Initial survey. Analysis. Final survey.

Preliminary visual assessment of the study cast

This stage has been described as 'eyeballing' the cast and is a useful preliminary to the surveying procedure proper. The cast is held in the hand and inspected from above. The general form and arrangement of the teeth and ridge can be observed, any obvious problems noted and an idea obtained as to whether or not a tilted survey should be employed.

Mounted diagnostic casts with proper VDO and CR record Final RPD design based on surveying analysis and MAP Sort out the proper treatment sequence

View the occlusal relationship from the palatal aspect

Flow Chart of the RPD Clinical Procedures

Diagnosis and treatment plan Pt may requires Treatment of irritated soft tissue Preprosthetic surgery Periodontal treatment Endodontics Orthodontics Restorative Treatment partial

Mouth preparation and impression for the RPD framework

Treatment of Irritated Soft Tissue Causes:

1. Ill-fitted Existing prosthesis, Ill2. lack of positive rests, 3. Hhyperocclusion 3 Hh l i 4. Bacterial and fugal infections

Lack of positive rests results in prosthesis displacement, which can destroy mucosa & periodontal attachment (100% mucosal support) 100% support)

Treatment of Irritated Soft Tissue

Irritated and traumatized soft tissue resulting from a bad partial

Treatment of Irritated Soft Tissue Solution:

Tissue conditioning treatment Fabrication of well design partial

Adding positive rests to control the relationship of prosthesis to mucosa

A treatment liner provides proper mucosa-prosthesis mucosacontact during the tissue treatment period

Conditioning of Abused and irritated tissue by the use of tissue conditioning material

Mouth Preparation
Mouth Preparation , Follow the Preliminary diagnosis , and the development of a tentative treatment plan.

Objectives:Objectives:
To Return the mouth , to the optimum health, and eliminate any condition , that would be determinable to the success of the removable partial denture. Mouth Preparation include Procedures in three categories :1- Oral surgical preparation. 2- periodontal preparation . 3- preparation of abutment teeth .

Oral Surgical Preparation

- As early As Possible . long time interval Between surgery and Removable partial denture construction . 1- Extraction . 2- Removal of residual roots . 33 Impacted teeth . 4- Malposed tooth . 5- Cyst and odontogenic tumors . 6- Exostoses and tori . 7- Hyper plastic tissues. 8- Muscle attachment and frena . 9- Bony spines , and knife edge ridges . 10- Polyps , papilloma , traumatic hemangiomas. 11- Hyper kera tosis, erthyroplakia , and ulcerations. 12-Dento facial deformity . 13- Osseo integrated device . 14- Augmentation & alveolar bone . - conditioning of abused and irritated tissue by the use of tissue conditioning material

Extraction

Removal of Residual Roots

Impacted teeth

Malposed tooth

Preprosthetic Surgery

Enlarged tuberosity g y Gross bone undercut

Large Tori

Exostoses and tori

Polyps, Papilloma, Traumatic Hemangiomas

Osseo-integrated device

Periodontal Preparation
Objectives
1- Removal and control of all the Etiological Factors contributing to periodontal disease . 2- Elimination or reduction of all pockets . 3- Establishment of functional non traumatic occlusion . 4- Development of personalized plaque control.

Periodontal Treatment
For I-bar consideration: 1. Tissue quality: 2-3mm attached gingiva 2. Tissue contour: in relation to the abutment

Free gingiva graft can provide attached mucosa in an area critically associated with the prosthesis

Periodontal Preparation

Periodontal diagnosis and ttt planning Initial disease control therapy (phase 1) Definitive Periodontal surgery (phase 2) Recall maintenance (phase 3) Advantages of periodontal therapy

Periodontal diagnosis and TTT planning

Initial disease control therapy (phase 1) Oral hygiene instructions . scaling and root planning . elimination of local irritating factors , other than calculus. Elimination of gross occlusal interferences. Guide to occlusal adjustment. Temporary splinting Use of night guard. Minor tooth Movement.

Periodontal diagnosis and TTT planning

Definitive Periodontal surgery (phase 2)
Gingivectomy. Periodontal Flap. Mucogingival surgical procedures

Recall maintenance (phase 3)

Advantages of Periodontal Therapy

1- Elimination of periodontal disease --- primary Etiologic Factor of tooth loss. 2- peridontium free of disease much better enviornment For successfull Restorations. 3- Response of strategic but questionable teeth, to periodontal therapy, help to make final decision to Exclude or include them in RPD Design.

Restorative and Fixed

Complete crowns to restore remaining teeth are often necessary and are contoured to coordinate and integrate with RPD treatment. Note positive rests.

Treatment Partial Denture: #23 & 26: hopeless teeth An acrylic resin partial denture Extraction is recommended that is placed on interim or transitional bases

Indications:
1. Cases require restoration of vertical dimension 2. Immediate esthetic & functional needs 3. Evaluation of hygiene & abutments 4. As immediate extraction site Immediate treatment partial in place bandage right after extraction

Abutment Preparation
Correction of occlusal plane Correction of mal-alignment . Provision for support for periodontal weakened teeth. Reestablishment of arch continuity. Examination of each abutment tooth individually as to what type of restoration is indicated. Reshaping teeth. - Enameloplasty. - Developing guiding planes. - Interproximal Preparation for Minor connectors. - Changing height of contour. - Enhancing Retentive undercuts - Rest seat preparation.

Correction of occlusal plane

1- Unopposed teeth for a long period of time over Eruption. If over Eruption is Minor Recontouring the surface of the tooth. If moderate cast restoration, e.g. onlays or crowns. If Extreme Extraction.

Maxillary supraeruption accompanied by down ward migration of tuberosity 2- Tipped molar

Correction of mal-alignment
- Tipping of teeth , facially , lingually they complicate
clasping procedure, and alter the design of RPD.

Provision of support for periodontally weakened teeth

Teeth showing decreased periodontal support would require splinting.

Reasons f splinting. for

To provide adequate support, and stabilization for a RPD.

Types of splinting .
Fixed splinting . Designing of the RPD to join the teeth as a functional unit.

Provision of support for periodontally weakened teeth

Fixed Splinting .
By joining teeth , with complete or partial coverage restoration . Fixed splinting of the posterior teeth will provide resistance to Antero posterior Forces But Not Medio lateral forces. To Resist Medio lateral forces, splinting Should include one or more anterior teeth

Advantages Disadvantages

Resistance to applied forces. Closure of inter proximal Contacts complicates Oral hygiene measures

Provision of support for periodontally weakened teeth

Splinting by using properly designed RPD Swing lock Removable partial denture leads to an even distribution of applied force. Extended arm Clasp. Kennedy bar. Lingual Plate. Fixed or Removable splinting?

Reestablishment of arch continuity

Lone standing tooth adjacent to an extension base area is termed a pier abutment. Placing a clasp on such a tooth leads to periodontal destruction and abutment loss. An appropriately constructed fixed partial denture is used to reestablish arch continuity.

Examination of each Abutment tooth individually

Aim
Protection of abutment to be used in RPD construction. Restoring canine or premolars using veneer type crowns. Molars being restored full cast crown. Proximal caries, on abutment with buccal and lingual surfaces sound gold inlay may be indicated , best possible support for occ. Rests. Most vulnerable area, is the proximal gingival area, lies beneath the minor connector, due to accumulation of debris, and food susceptibility to caries. This area, must be fully protected, by inlay restoration, extending to beneath gingival margin.

Examination of each Abutment tooth individually

Reshaping the tooth

Enameloplasty Recountouring, But not over cutting. Must be confined to Enamel surface , other wise consider the properly contoured crowns.

Recontouring
The contours of the natural teeth most often require adjustments for the proper q j p p placement and functioning of the RPD.

Recontouring may be required to

1. Improve survey lines (improve clasp location) 2. Improve clasp retention (dimpling) 3. Improve the occlusal plane by grinding of the cusp tips and incisal edges of anterior teeth.

Excessive tooth contours are reduced by lowering the height of contour so that;
1. The origin of the circumferential clasp is placed preferably at the junction of the middle and gingival third of the crown 2. The retentive terminal is placed in the gingival third of the crown for better esthetics and better mechanical advantage. 3. The reciprocal clasp is placed above the height of contour, but not higher than the cervical portion of the middle third of the crown.

Examination of each Abutment tooth individually

Developing guiding planes.
Guiding planes : they are surfaces on proximal or lingual surface of teeth, that are parallel to each other, more important parallel to the path of insertion and removal. Guiding plane adjacent to a tooth supported segment should be 2 to 4 mm in height

 Guiding plane of tooth adjacent to distal Extension Edentulous space i slightly shorter it 1 5 2 mm is li htl h t its 1.5 in height
- Decreased height results in decreased contact with the minor connector, and so permits greater movement of RPD damaging torque forces on Abutment so

Guiding Plane on lingual surface of Abutment

1- Properly

Prepared guiding Plane Permits contact between the reciprocal element and Abutment so Prevent lateral forces.

2- Minimize the number of Pathways by which the Prosthesis May enter and exist 3- Reciprocal clasp arm With lingual guiding plane Effective Reciprocation

Advantages of Guiding Planes

Guiding the prosthesis during insertion and removal. Enhance Stabilization Undesirable space Between Prosthesis and Abutment Retention -- Frictional Resistance

Changing the height of contour

Enhancing Retentive undercuts

Rest seat Preparation

Any unit of the partial denture that rests on a tooth surface, to provide vertical support is called a rest. ll d t The prepared surface of the abutment to receive the rest called rest seat. Primary purpose of a rest to provide vertical support they would transmit vertical forces to the abutment, and direct forces along long axis of the roots.

Rest seat Preparation

Form of occlusal Rest and Rest seats 1- Outline
Triangular with deepest Part of occlusal Rest Preparation should be inside lowered marginal ridge ( reduction app. 1.5mm )

Rest seat Preparation

2) Floor: Should be concave
or spoon shape. To prevent transferring of horizontal stresses to the Abutment 3) Angle Formed by occlusal rest and minor connector Should be less than 90 to direct the force along axis of Abutment.

If the angle Formed by occlusal rest and minor connector is greater than 90, this will lead to: :

a- slippage of the prosthesis away from the abutment orthodontic like force leading to Movement of tooth b- Torque on the abutment.

Support for Rests

Rests can be placed on :a) S ) Sound Enamel dE l b) Any restoration, that proven to resist fracture or distortion, when subjected to forces.

Severely Tilted Abutment

- Secondary occlusal Rest - Extended occlusal Rest - Onlay to Restore occlusal plane
To Minimize Further tipping of the abutment and Direct Forces towards the long axis of tooth

Interproximal occlusal Rest seat

as Individual occ. Rests, occ Rests Except that it must be extended further lingually used to avoid interproximal wedging by framework.

- Prepared

Internal occlusal Rests

RPD totally tooth supported by means of cast retainers on all abutments, use internal occlusal rest seat for :1- Occlusal support-------- derived from the floor of the rest seat 2- Horizontal stabilization -------near vertical walls of this type of rest seat - Should be parallel to path of insertion - Tapered occlusally, and dove tailed to prevent dislodgment proximally

Advantages of internal rest seats:1- elimination of visible clasp 2- location of the rest seat in a more Favorable position in relation to the tipping axis Indicated only for tooth supported RPD

Lingual Rests on canines and Incisor teeth

Canine rest more preferable to an incisal rest

Cingulum rest
- Confined to maxillary canines - Rounded inverted v- shaped.

Lingual Rests on canines and Incisor teeth

At junction of gingival margin and middle 1/3 Floor, should be toward the Fl h ld b t d th cingulum rather than the axial wall For mandibular canines -----contraindicated due to lack of thickness of enamel to prepare a retentive rest seat Most satisfactory cingulum rest from the support point of view -- that prepared on cast restorations

Incisal rests and rest seats

On incisal Angles of Anterior teeth Outline: Rounded notch at incisal angle, deepest portion of preparation, apical to incisal edge Notch: Should be beveled lingually and labially

- They are used predominantly as Auxiliary rests for indirect retainers

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