Designing for kennedy class i and class ii

PRINCIPLES OF DESIGNING RPD BY MCKRACKEN

1. DESIGNING FOR CLASS I AND CLASS II
DR LEENA TOMER
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2. CONTENTS
INTRODUCTION
HISTORY
PRINCIPLES OF DESIGNING
PHILOSOPHIES OF DESIGNING
BIOMECHANICAL CONSIDERATIONS
ESSENTIALS OF PARTIAL DENTURE
DESIGN
DESIGNING OF CLASS I
DESIGNING OF CLASS II
CONCLUSION
BIBLIOGRAPHY
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3. INTRODUCTION
Thedesignprocessisaseriesofstepsthatleadstowarda
solutionoftheproblemandincludes;identifyinganeed,
definitionoftheproblem,settingdesignobjectives,,
developingadesignrationale,devisingandevaluating
alternativesolutions,andprovidingthesolution.
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4. HISTORY –EVOLUTION OF RPD DESIGN
1711 -First description of RPD was by Heister-he carved a
block of bone to fit the mouth
1728 -Pierre fauchard father of modern dentistry decribed
costruction of lower RPD using two carved blocks of ivory
joined together by metal labial and lingual connectors.
1880 -First maxillary RPD using palatal connector was by
balkwell
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5. 1746 -Retentive clasps were first discussed by Mouton.
1899 -Bonwillintroduced claping abutments with gold
circumferential clasps
1913-Roachintroduced wrought wire clasp
1914-Infra bulge clasp was first mentioned by Henrichsen
1930 -Infra bulge clasp did not gain popularity untill Roach
promoted this concept
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6. Prothero coined the term “fulcrum line”
1950 -1970 Invetigative years
1970 to present –Research
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7. Principles of design by A.H. Schmidt (1953)
1.Thedentistmusthaveathoroughknowledgeofboththe
mechanicalandbiologicfactorsinvolvedinremovable
partialdenturedesign.
2.Thetreatmentplanmustbebasedonacomplete
examinationanddiagnosisoftheindividualpatient.
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8. 3.Thedentistmustcorrelatethepertinentfactorsand
determineaproperplanoftreatment.
4.Aremovablepartialdentureshouldrestoreformand
functionwithoutinjurytotheremainingoralstructure.
5.Aremovablepartialdentureisaformoftreatmentand
notacure.
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9. PHILOSOPHIES OF DESIGNING
1.Stress Equalization
2.Physiologic Basing
3.Broad Stress Distribution
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10. STRESS EQUALIZATION
StressEqualizer-:AccordingtoGPT8
Adevicewhichrelievestheabutmentteethofallor
partofocclusalforces.
Therigidconnectionbetweenthedenturebasesand
thedirectretainerontheabutmentteethisdamagingand
thatsometypeofstressdirectororstressequalizeris
essentialtoprotectthevulnerableabutmentteeth.
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11. Devan determined that the mucoperiosteum of the residual
ridge offers only 0.4 % of the support provided by a periodontal
ligament.
Soft tissues are 250 times more displaceable than are the
adjacent teeth
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12. ADVANTAGES
1.Forcesaredistributedonabutmentandthesofttissue.
2.Minimizethetippingforcesonabutmenttooth.
3.Minimal direct retention is required-as denture base acts
more independently.
4.Has the massaging or stimulating effect on the
underlying bone and soft tissue.
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13. Disadvantages
1.Fragile,complex and costly.
2.Requires constant maintenance.
3.Difficult to repair.
4.Bulky and annoying to patient.
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14. PHYSIOLOGIC BASING
1.Theequalizationofstresscanbebestandmostsimplybe
accomplishedbysomeformofphysiologicbasing,or
lining,ofthedenturebase.
2.Mucosaisrecordedinitsfunctioningform.
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15. ADVANTAGES
1.Physiologically stimulating effect on underlying tissue
2.Simplicity in design and construction
3.Lightweight prostheses requiring minimal maintenance and
repair.
4.Reduced stresses on abutment tooth, hence retained for longer
period.
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16. DISADVANTAGES
1.Premature contacts.
2.Decreased effect of indirect retention.
3.Not well stabilized against lateral forces.
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17. BROAD STRESS DISTRIBUTION
Advocatesbelievethatexcessivetraumatoremainingteethand
theresidualridgecanbepreventedbydistributingocclusalforces
overasmuchtheavailableareaofteethandsofttissueaspossible.
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18. ADVANTAGES
1.Broad stress distribution.
2.Excellent horizontal stabilization.
3.Removable splinting
4.Easier and less expensive to
construct.
5.Less danger of distortion and
breakage of denture
6.Decreased chance of relining
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19. DISADVANTAGES
1.Less comfortable.
2.Requires good maintenance of oral hygiene.
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20. BIOMECHANICAL CONSIDERATIONS.
Abetterunderstandingofthemethodsofcontrolling
forcesonRPDmaybeachievedbyabriefreviewofthe
developmentofforces.Thisconsiderstheapplicationof
mathematicalformulas.
AsTylmanstates,“Greatcautionandreserveare
essentialwheneveranattemptismadetointerpret
biologicalphenomenonentirelybymathematical
computation.”
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21. SIMPLE MACHINE
1.Lever
2.Wedge
3.Inclined plane
4.Screw
5.pulley
6.Wheel and axle
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22. LEVER
Aleverisarigidbarsupportedsomewherealongitslength.
Itmayrestonthesupportormaybesupportedfromabove.
Therearethreetypesoflevers;
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23. CLASS I
Aclass-1leverhasitsfulcrumlocatedsomewhere
betweentheeffortandtheresistance
Ex:Distalextensionremovablepartialdenture
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24. CLASS II
Withaclass-2lever,thefulcrumisatoneend,theeffortisat
theotherendandtheresistanceisinthemiddle
Seenasindirectretentioninremovablepartialdenture
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25. CLASS III
Inaclass-3lever,thefulcrumisatoneendandtheeffort
isappliedbetweenthefulcrumandtheresistance.
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26. INCLINED PLANE
Forcesagainsttheinclined
planemayresultin
deflectionofthatwhichis
applyingtheforceormay
resultinthemovementof
theinclinedplane.
Neitheroftheseresultsare
desirable
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27. WEDGE
A wedge by definition is a solid object with a broad base and
its two sides arising to intersect each other forming an acute
angle opposite the base.
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28. FORCES ACTING ON THE PARTIAL DENTURE
Forces acting on a distal extension partial denture are a
result of a composite of forces arising from the three
principal fulcrums.
A.Fulcrum on the sagittalplane.
B.Fulcrum on the vertical plane.
C.Fulcrum on the horizontal plane.
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29. FULCRUM ON THE HORIZONTAL PLANE
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30. FULCRUM ON THE SAGGITAL PLANE
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31. FULCRUM ON THE FRONTAL PLANE
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32. FACTORS INFLUENCING MAGNITUDE OF STRESSES
TRANSMITTED TO ABUTMENT TEETH
1.Length of span.
2.Quality of support of ridge.
3.Clasp.
1.Quality
2.Design.
3.Length
4.Material.
4.Abutment tooth surface
5.Occlusalharmony.
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33. LENGTH OF SPAN
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34. QUALITY OF SUPPORT OF RIDGE
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35. QUALITIES OF CLASP
Type of clasp:
More flexible the clasp less stress is transmitted to the
abutment tooth.
But at the same time it contributes less resistance to the
lateral and vertical stresses transmitted to the residual
ridges.
Periodontal condition of abutment teeth.
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36. DESIGN OF CLASP
A clasp is designed so that it is passive
the reciprocal arm contacts the tooth before the retentive tip
passes over the greatest bulge of the abutment tooth.
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37. LENGTH OF CLASP
Clasp length may be increased by using a curved
rather than a straight course on an abutment tooth
Doubling the length of clasp will increase its
flexibility 5 fold
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38. MATERIAL USED FOR CLASP FABRICATION
Cromium-cobalt alloy ( higher modulous of elasticity)being
more rigid will exert greater stress on the abutment tooth
than will a gold clasp.
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39. AMOUNT OF CLASP SURFACE IN CONTACT WITH
TOOTH
The greater tooth to metal contact between the clasp
and the tooth, the more will be the stress exerted on to the
tooth
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40. ABUTMENT TOOTH SURFACE
Gold surface crown or restoration offers more frictional
resistance to clasp arm movement than does the enamel
surface of the tooth.
Greater stress is exerted on a tooth restored with gold than
on a tooth with intact enamel.
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41. OCCLUSAL HARMONY.
When deflective occlusal contacts are present
between opposing teeth destructive horizontal forces
which are magnified by leverage are transmitted to the
abutment and ridge.
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42. AREA OF BASE TO WHICH LOAD IS APPLIED
Ideally,the occlusal load should be applied in the center of
the denture –bearing area, both antero-posteriorly and
bucco-lingually
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43. DESIGN CONSIDERATIONS IN THE CONTROL OF
STRESS
1.Direct retention
•Adhesion ,cohesion
•Frictional
•neuromuscular
2.Clasp position
•Quadrilateral
•Tripod
•bilateral
3.Clasp design
•Circumferential clasp
•Bar clasp.
•Combination clasp
4.Splinting of abutments
5.Indirect retention
6.Occlusion
7.Denture base
8.Major connector
9.minor connector
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44. Design considerations for stress control
At present there is no way that all forces can be totally
negated or countered.
Long term clinical observations have proved that a design
philosophy that strives to control these forces within the
physiologic tolerance of the teeth and supporting structures
can be successful.
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45. Direct retention
The retentive clasp arm is responsible for transmitting most
of the destructive forces to the abutment teeth.
Clasp retention should be kept at the minimum yet provide
adequate retention to prevent dislodgement of the denture.
Other components should be used to contribute for the
retention so that amount of retention provided by clasp can
be reduced
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46. ADHESION AND COHESION
For adhesion and cohesion to work
I.Maximum area of available support should be used.
II.Denture base should be accurately adapted to the
underlying mucosa.
Though peripheral seal cannot be developed due to
presence of teeth .Atmospheric pressure helps in retention
of the maxillary partial denture when accurately adapted to
the underlying mucosa.
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47. FRICTIONAL CONTROL
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48. NEUROMUSCULAR CONTROL
The innate ability of the patient to control the action of the
lips, cheeks, tongue can be a major factor in the retention of
a denture.
A properly contoured denture base, however, can aid the
patient’s neuromuscular control of the prosthesis.
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49. CLASP POSITION
The position of retentive clasp is more important than the
number of retentive clasp used in any design.
The number of clasps used is determined by classification.
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50. QUADRILATERAL CONFIGURATION
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51. TRIPOD CONFIGURATION
Used primarily for class 2 arches.
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52. BILATERAL CONFIGURATION
Used in class 1 cases.
In this configuration the clasps exert little neutralizing
effect on the leverage induced stresses generated on to
the denture base. These stresses must be controlled by
other means.
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53. SPLINTING OF ABUTMENTS
It increases the periodontal ligament attachment area
and distributes the stress over a larger area of support.
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54. OCCLUSION AS A METHOD OF STRESS CONTROL
1.Harmonious intercuspation
2.Size of food table
3.Occlusalpattern of posterior teeth
I. sharp cutting surfaces
II.steep cuspalinclines
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55. DENTURE BASE AS A METHOD OF STRESS CONTROL
1.size and configuration of the base
2.accuracy of adaptation of the base of tissue
3.form of polished surface
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56. ESSENTIALS OF PARTIAL DENTURE DESIGN.
It should be systemically developed and outlined on an
accurate diagnostic casts.
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57. FIRST STEP
Decide how the partial denture has to be supported.
If Tooth supported.
Evaluate :
1.Periodontal health
2.Crown and root morphologies
3.Crown to root ratio.
4.Location of tooth in arch.
5.Length of edentulous span.
6.Opposing dentition.
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58. IF TOOTH AND TISSUE SUPPORTED.
1.Quality and contour of supporting bone and mucosa
2.Extent to planned coverage of ridge.
3.Type and accuracy of impression registration.
4.Accuracy of denture base.
5.Design characteristics of the component parts of
framework.
6.Anticipated occlusalload.
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59. SECOND STEP
Connect the tooth and tissue support units.
These connection is facilitated by designing and locating
major and minor connectors in compliance with the basic
principles and concepts.
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60. THIRD STEP.
Determine how the partial denture is to be retained.
Select clasp design that will
1.Avoid direct transmission of tipping or torquingforces
to the abutment
2.Accommodate the basic principles of clasp design by
definitive location of components parts correctly
positioned on abutment tooth surfaces.
3.Provide retention against reasonable dislodging
forces.
4.Be compatible with undercut locations,tissue
contour,andesthetic desires of the patient.
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61. FOURTH STEP
Connect the retention units to the support units
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62. FIFTH STEP.
Outline and join the edentulous area to the already
established design components.
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63. 1. Direct retention :
The main objective should be restoration of the
function and appearance and the maintenance of
comfort, with great emphasis on preservation of the
health and integrity of the remaining oral structures.
CLASS I AND CLASS II DESIGN
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64. 2. CLASPS
1.simplest type of clasp should be used
2.clasp should have a good stabilizing quality, remain passive
until activated by functional stress.
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65. CLASPS IN CLASS I PROSTHESIS
Requires only two retentive
clasps, one on each side.
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66. CIRCUMFERENTIAL CLASP
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67. If a distobuccalundercut is present, the vertical
projection retentive clasp is preferred.
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68. REVERSE CIRCLET CLAP
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69. Ifmesiobuccalundercut
ispresent,wroughtwire
claspisindicated.
The reciprocal or bracing
arm must be rigid.
COMBINATION CLASP
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70. One school of thought advocated
omitting of the distal rest in favour
of a mesial rest is that the forces are
directed to the ridge in more vertical
direction which are better tolerated
by the ridge.
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71. CLASPS IN CLASS II PROSTHESIS
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72. If a modification space
is present, clasp the
teeth adjacent to the
edentulous space.
Tripod configuration.
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73. 3. RESTS
rests seats should be
prepared so that stress will
be directed along the long
axis of the teeth
In most instances rests
should be placed next to
the edentulous space.
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74. 4. INDIRECT RETENTION
should be located as far
anterior to the fulcrum
line as possible
two indirect retainers
should be used for class I
prosthesis.
indirect retainers should
not be placed more
anterior than canines
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75. one indirect retainer can be
used on the side opposite
the edentulous space in a
class II design
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76.  should be placed in
properly prepared rest
seats so that forces will be
directed along the long
axis of the teeth
Lingual plating can also
be used as an effect
indirect retainer.
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77. MAJOR CONNECTOR
Should be rigid
Not impinge on the gingival
tissues
Support from the hard
palate .
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78. Can be extended onto the
lingual surfaces of the
tooth to increase rigidity,
distribute lateral forces,
improve indirect retention,
and eliminate food
impaction
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79. MINOR CONNECTORS
Rigid
It’s position should enhance comfort, cleanliness and to
place teeth.
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80. OCCLUSION
1.centric relation should coincide with centric occlusion
2.harmonious occlusion
prosthetic teeth should minimize the stresses;
1.fewer teeth, narrow buccolingually.
2.placed over the crest of the ridge.
3.should display sharp cutting edges and ample escapeways.
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81. DENTURE BASES
1.broader coverage to distribute forces without interfering
with functional movement of tissues.
2.selective pressure impressions for distal extension.
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82. REVIEW OF LITERATURE
William E. Avant, Indirect retention in partial denture
design.
Indirect retention is required on all extension-base
partial dentures retained by clasps
It is required also when the tooth at one end of a partial
denture is clasped for retention but the tooth at the
other end is not suitable for retention
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83. SUMMARY: the principle of indirect retention is shown to
be an application of a class 2 lever.
The so-called indirect retainer is a major connector
stabilizer
A secondary fulcrum line is usually established when
partial denture design includes indirect retention
Indirect retention prevents the retentive clasp tips from
becoming a fulcrum about which the prosthesis could
rotate when the forces move the denture base away
from the tissues
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84. Curtis M. Becker et al Evolution of removable
partial denture design
This is a review of the evolution of RPD design concepts,
beginning with the first recorded mention of an RPD in
1711 and continuing with the most significant theories
through 1990.
The long term success of an RPD prosthesis can be
favorable, provided proper attention is given to oral
hygiene, periodontal considerations, basic RPD design
concepts, and judicious execution of partial denture
construction
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85. CONCLUSION:
Adequatetimemustbespentinproperlydiagnosingthe
particularcaseanddevisingaworkabletreatmentplan.Once
thisisdonethemechanicaltaskoflayingoutthe“nutsand
bolts”ofremovablepartialdenturedesigncanbecarriedout
toensurethatourpatientsreceivefullbenefitsofour
knowledgeandskills.
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86. REFERENCES
1.Removable partial prosthodontics-Mc Crackens 11
th
ed
2.Clinical removable partial prosthodontics-Stewart 2
nd
3.Removable denture prosthodontics-A.A.Grant
4.Partial dentures-John Osborne 4
th
ed
5.Textbook of removable partial dentures-Kratochvil
6.Removable partial prosthodontics-Grosso-Miller 3
rd
edition.
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87. 7. Indirect retention in partial denture design.
J Prosthet Dent 2003, 90, 1-5.
8. Evolution of removable partial denture design
Journal Of Prosthodontics 1994, 3,158.
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88. Thank you
Thank you
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