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RPDs are components of prosthodontics ( branch of Dentistry) pertaining to the restorations and maintenance of oral function, comfort, appearance, and health of the( pt) by replacement the missing teeth and craniofacial tissues with artificial substitute.
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P.D may: Give support to periodontally diseased teeth. Restore vertical facial dimension. Prevent T.M.J problems. Prevent tooth drifting or over eruption. Stimulate non-used tissues. Support collapsed structure (muscles of lips and cheeks). Prevent attrition of remaining teeth. Improve oral hygiene by preventing stagnation of food in disused areas.
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Designing Support
a. Tooth support: When abutment teeth available at both ends of the denture base( bounded saddle). It most commonly obtained by occlusal rests. b. Mucosa support: (mucoperiosteum covering residual alveolar bone). It allows varying degree of displacement. The amount of displacement( tissue ward movt) will depend on: 1. The amount of pressure applied. 2. The nature of the mucosa (thickness).
3. Area covered by the denture( the wider the area the less the displacement). 4. Fit of the denture base. 5. Type of impression( anatomical, functional, or selective pressure). c. Tooth-mucosa support: ( Bilateral free end saddle). Posterior tissue support, and anterior tooth support.
Designing Retention
Retention should be designed to counter act dislodging forces( sticky food, muscle at periphery of the denture, intercuspation, gravity). Retention is gained by mechanical means 1. direct retainers: a. Intercoronal( clasps). b. intracronal(percision attachment). 2. Indirect retainers. Physical factors( cohesion, adhesion, atmospheric pressure, surface tension). it play a minor role RBD.
Components Of RPDs
1. 2. 3. 4. 5. Major connectors. Minor connectors. Rests. Direct retainers. Stabilizing or reciprocal components (part of clasp assembly). 6. Indirect retainers( if prosthesis has distal extension).
Major Connecters
Major connector is component of the PD which connect all parts of the prosthesis directly or indirectly. It provides the cross-arch stability to help resist displacement by functional stresses.
6. Cover no more tissue than is absolutely necessary. 7. Doesn't contribute to the trapping of food particles. 8. Has support from other elements of the frame work to minimize rotation in function. 9. Contribute to the support of the prosthesis.
Contraindication: Remaining natural anterior teeth severely tilted toward the lingual. Characteristics and location: 1. Half-pear shaped same like the lingual bar except that the bulkiest portion is located to the lingual and the tapered portion is toward the labial.
2. The superior border of the bar should be at least 3mm from the free gingival margin of the teeth. 3. The inferior border is located at height of the alveolar lingual sulcus when the pts tongue is elevated. 4. Functional impression is most. Finishing line: Butt-type joints with minor connectors for retention of denture base.
3. Mandibular Linguoplate
Indication for use: 1. No sufficient space for lingual bar. 2. The residual ridge undergone a vertical resoption which offer minimal resistance to horizontal rotation. 3. Periodontally weakened teeth. 4. When future replacement of one or more incisor teeth will be facilitated.
Characteristics and location: 1. Half-pear shaped with bulkiest portion located. 2. Thin metal apron extending superiorly to contact cingulum of ant. Teeth. 3. Apron extended interproximally to the height of contact points. 4. Inferior border at ascertained height of the alveolar lingual sulcus where the pts tongue is slightly elevated.
Characteristics and location: 1. Shaped and located same as lingual bar. 2. Thin, narrow(3mm) metal strap located on a cingula of anterior teeth. Scalloped to follow interproximal embrasures. 3. Originated bilaterally from incisal, lingual, or occlusal rests of adjacent principal abutment.
Characteristics and location: 1. Half pear shaped with bulkiest portion inferiorly located on the labial and buccal aspect of the mandible. 2. Superior border tapered to soft tissue. 3. Superior border located at least 4mm inferior to labial and buccal gingival margins and more if possible. 4. Inferior border located in the labial buccal vestibule.
B. Single Broad Palatal Major Connector Indication: 1. Class I. 2. V or U shaped palate. 3. Strong abutments. 4. 6 remaining ant teeth. 5. No interfering tori.
Characteristics and location: 1. Anatomic replica form. 2. Anterior border following valleys of rugae and at right angle to median suture line and extending anterior to occlusal rests or in direct retainer. 3. Posterior border located at junction of hard and soft palate. And extended to pterygomaxillary notches.
C. Anterior-posterior Strap Indication: 1. Class I and II. 2. Long edentulous span class II MOD 1 arches. 3. Class IV. 4. Palatal tori.
Characteristics and location: 1. Parallelogram shaped and open in center portion. 2. Relatively broad(8-10mm) ant. And post. Palatal strap. 3. Lateral palatal strap (7-9mm) parallel to curve of arch. 6mm from gingiva of remaining teeth. 4. Anterior palatal strap; ant border not placed further interiorly than ant rests and never closer than 6mm to lingual gingival cervices.
D. Complete Palatal Coverage Indication for use: 1. Situation in which only some or ant teeth remains. 2. Class II arch with large posterior modification space and some missing anterior teeth. 3. Class I arch with 1-4 PM and some or all ant teeth remaining, abutment support is poor, residual ridge extremely resorbed, direct retention is difficult to obtained 4. No tori.
Characteristics and location: 1. Anatomic replica form supported anteriority by rests seats. 2. Palatal Linguoplate supported anteriorly and designed for the attachment of acrylic resin extension posteriorly. 3. Contact all of the teeth remaining in the arch. 4. Posterior border, terminates at the junction of the hard and soft palate, extended to hasmular notch areas.
D. U-shaped Palatal Major Connector Is used only in which inoperable tori extended to the posterior limit of the hard palate. It is the least favorable design of all palatal major connector( lack rigidity).
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The primary purpose of the rest is to provide vertical support for PD. It also does the following: Maintain components in planned position. Maintained established occlusal relationship. Prevent impingement of soft tissue. Direct and distribute occlusal loads to abutment teeth.
Interproximal Occlusal rests. Intra-coronal Rest: It is used for both occlusal support and horizontal stabilization. Horizontal stabilization is derived from the near vertical walls of this type of rest seat. The form of the rest should be parallel to path of placement, slightly tapered occlusaly, and slightly dove-tailed to preve3nt dislodgement proximally. The main advantages of the internal rest are that it facilitates the elimination of the visible clasp arm.
Direct Retainer
It is a clasp or attachments applied to an abutment tooth for the purpose of holding RPD in position. Classification: 1. Extracronal direct retainer ) casted clasp, wrought wire clasp). a/ Occlusaly approaching clasp (circumferential) . b/ Gingivally approaching clasps (Bar clasps)
2. Intracronal direct retainer( attachments): a/ Internal attachment. b/ External attachment. c/ Special attachment. Component parts of the clasp: 1. Retentive terminal 2. Retentive arm 3. Reciprocal arm 4. Occlusal rest 5. Shoulder 6. Body 7. Minor connector
Height of contour: is greatest convexity of tooth. The basic principle of clasp design is encirclement to obtain more than 180* of continuous contact. Types of cast Circumferential clasps: 1. Simple circlet clasp: widely used, tooth supported PD, approach the undercut from edentulous space. Not used for distal extension.
2. Reverse clasp. 3. Multiple circlet clasp( combination of two circlet clasps). 4. Embrasure clasp 5. Ring clasp; no buccal undercut. Isolated abutment, lingually tipped molar, from disto- buccal to distolingual undercut. 6. Hairpin clasp. when undercut is near to edentulous space. 7. Combination clasp.
Bar clasp: Composed of two parts ( Gingivally approaching and retentive tip) 1. Approach arm: It is a minor connector. Semi circular in cross section, cross the gingival margin at right angle. 2. Retentive terminal : it should end below undercut.
Advantages:
1. 2. 1. 2. 3. Easy to insert and difficult to remove. More aesthetic, cover less tooth structure. Types of Bar clasps: T-Bar clasp. Y- Bar clasp. I- Bar clasp.
Indirect Retainer
Apart of RPD which assists the direct retainers in preventing displacement of distal extension denture base by functioning through lever action on the opposite side of the fulcrum line.
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Types of indirect retainer: Auxiliary occlusal rest, most frequently used, located far as possible from distal extension base, placed perpendicular to the mid point of the fulcrum line. If this perpendicular line ends on the incisal area it is a voided, instead it transfers to PM in both sides. Canine extension from occlusal rest, finger like extention(lug seat) from the PM rest is placed on the lingual slope of adjacent canine. Canine rest. Continuous bar retainers and Linguoplate.
Denture Base
Denture base defined as that part of a denture which rests on the oral mucosa and to which teeth are attached. Ideal requirements: 1. Accurate tissue adaptation with minimal change in volume. 2. Thermal conductivity. 3. Sufficient strength to resist fracture or distortion under function.
4. Cleansability. 5. Ability to be relined if necessary. 6 Cost effective. 7. Low specific gravity. 8. Ability to achieve a good finish.
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Types of denture base: Acrylic Metal. Combination. Acrylic Resin denture base; mainly used for distal extension PD- attached to the frame work by minor connector-with 1.5mm thick to have a adequate strength.
Advantages: 1. Anterior teeth can be replaced at their original position (aesthetic level). 2. Restore the contour of the edentulous ridge. 3. Brings out the normal contour of the lip and cheeks. 4. Can be relined.
Disadvantages: 1. May break on usage. 2. Tend to accumulate mucous deposits and food debris. 3. Soft tissue irritation. 4. Allergy.
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Metal denture base: mainly used for tooth supported PD. Advantages: Accurate tissue adaptaion( better retention). Easy to clean. Strong even in thin section. Heat conductivity( physiologic tissue stimulation).
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Disadvantage: Difficult to trim and adjust. Over extension can injure the soft tissue. Poor aesthetic. Difficult to reline and rebase.