Interim removable partial dentures

An interim removable partial denture (RPD) addresses patients’ concerns regarding esthetics and function and helps them adjust to the edentulous condition until a more definitive form of treatment can be rendered.

1. NEERAJA M MENON II MDS 1 Interim Removable Partial Denture

2. Contents 2 Introduction Interim partial denture Indications Clinical procedure Transitional partial denture Indications Procedure for fabrication Treatment partial denture Indications

3. 3 Fabrication procedure Immediate partial denture Indications Fabrication procedure Conclusion Related articles References

4. Introduction 4 An interim removable partial denture (RPD) addresses patients’ concerns regarding esthetics and function and helps them adjust to the edentulous condition until a more definitive form of treatment can be rendered. The prosthesis is often fabricated prior to the establishment of a definitive treatment plan to monitor the prognosis of a questionable potential abutment tooth for a definitive prosthesis.

5. 5 Temporary partial dentures- a dental prosthesis to be used for a short interval of time for aesthetics, mastication, occlusal support or convenience or to condition the patient to the acceptance of an artificial substitute for missing natural teeth until more definitive prosthetic therapy can be provided. GPT

6. 6 Interim partial denture- a prosthesis designed to enhance aesthetics, stabilization and/or function for a limited period of time, after which it is to be replaced by a definitive dental prosthesis-GPT7

7. Indications 7 Young patients Elderly patients Lack of available time for definitive care Esthetics Space maintenance Reestablishment of occlusal relationship Conditioning of teeth and residual ridges Conditioning patient for wearing a prosthesis

8. Clinical procedure 8

9. Selection of wrought wire 9 Precious alloys and non Precious alloys Molar and premolar-18 gauge PGP/ 19 gauge cobalt-chromium Active clasp length-<8mm-gauge is reduced ->12mm-guage is increased

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14. Lab procedures 14

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21. Transitional partial denture 21 A removable partial denture serving as a temporary prosthesis to which artificial teeth will be added as natural teeth are lost and which will be replaced after post-extraction tissue changes have occurred.GPT

22. Indications 22 All or some teeth need to be extracted but can’t be done immediately (medically compromised patient) Patient is not psychologically prepared to loose all the teeth at one time.

23. Addition of teeth 23 If existing denture is of acrylic, freshly mixed auto polymerising acrylic is added to the denture. If existing denture is of metal, major connector is modified (by soldering loops, drilling holes) to receive additional tooth which is attached with the help of auto- polymerising resin

24. Design considerations 24 Design should be such that teeth may be added to original framework to prevent remaking the denture after every extraction. As the teeth are extracted, metal retention loops are soldered to the lingual plate and artificial teeth are attached to them or holes are drilled through lingual plate to act as point of retention. Existing RPD can also be used as original framework and teeth added to it.

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29. Modification of interim removable partial denture using thermoplastic vacuum-formed matrix J Prosthet Dent 2008;99:492-493 29 This article describes a method of modifying an existing interim RPD to replace an extracted tooth using auto polymerizing tooth-colored acrylic resin and a thermoplastic vacuumformed matrix.

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31. A technique to fabricate a customized interim removable partial denture (J Prosthet Dent 2009;102:187-190) 31 Patient presented with maxillary right central incisor fractured at gingival level. Use previously made diagnostic cast with tooth intact tooth as reference to fabricate interim removable partial denture. Diagnostic waxing of missing tooth can also serve same purpose.

32. 32 Fabricate facial matrix guide using light-polymerizing acrylic resin on facial surface of diagnostic cast, covering missing/fractured tooth and extending to at least one adjacent tooth on either side . Modify cast: remove fractured tooth or waxing, block out most of undercut, and apply separating agent.

33. 33 Adapt light-polymerizing provisional material against matrix. Apply light-polymerizing denture base material on palatal of maxillary teeth and polymerize.

34. 34 Facial view of completed interim removable partial denture on cast. Evaluate and adjust occlusion at both maximal intercuspal position and protrusion. Insert interim removable partial denture in place to achieve satisfactory esthetic result.

35. Treatment partial denture 35 A dental prosthesis used for the purpose of treating or conditioning the tissue which are called upon to support and retain a denture base-GPT

36. Indications 36 As a vehicle to carry tissue treatment material To increase or restore vertical dimension on a temporary basis As a splint following oral surgical procedures As a night guard to protect teeth from trauma due to oral habits

37. Tissue conditioner 37 It’s a soft material which is applied temporarily to tissue surface of a partial denture. Non irritating non toxic soft elastic A new denture can be constructed or pt’s existing partial denture can be used Supplied as powder & liquid Powder- acrylic polymer of ethylmethacrylate Liquid – ethanol+aromatic ester Setting –polymerization reaction

38. Mode of action 38 Dissipates forces occurring against denture –permitting soft tissue to return to its normal form and function Produce intimate tissue contact –messaging the tissue Reduces inflammation –increasing blood flow to the abused tissue Replaced every 4-5 days

39. Procedure 39 Preparing treatment partial denture-2mm

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44. To establish a new vertical dimension 44

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46. Overlay Removable Partial Denture - Case Report Journal of Dental Specialities , Vol. 2, Issue 2, September 2014 46

47. 47 Primary impressions were made in alginate Diagnostic casts were mounted using a centric relation record at an increased vertical dimension. An interim acrylic occlusal splint was given to assess her adaptability to an increase in the VDO, which she was advised to wear for three weeks prior to commencement of the mouth preparation for final impressions. Mouth preparation consisted of minimal occlusal reduction and beveling of functional cusps of all posterior teeth.

48. 48 Maxillary and mandibular elastomeric impressions were made after mouth preparation A bite registration record was made in bite registration elastomer at the required vertical dimension.

49. Design of the Partial Overlay Dentures 49 Maxillary Arch : Kennedy Class II -open horse shoe major connector, with the major connector plate overlying the occlusal surfaces of maxillary posteriors and the lingual surfaces of maxillary anteriors . Mandibular arch Kennedy Class III – The chrome –cobalt framework was designed to cover the occlusal aspect of mandibular premolars and molars A lingual bar major connector was planned. Metal pontics were designed as part of the overlay denture to replace the missing premolars.

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51. Surgical splints 51 Protect and to improve healing of post-operative surgical sites

52. Immediate partial denture 52 A complete removable partial denture constructed for insertion immediately following the removal of natural teeth Advantages Anterior replacement-immediate aesthetics & improves patient psychology Posterior replacement-prevents migration of teeth into edentulous spaces Acts as splint and controls haemorrhage & swelling Classification Temporary Immediate partial denture Permanent Immediate partial denture

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54. Trimming Procedure For Anterior Teeth J.Prosthet.Dent 16(6): 1048 – 1051, 1999 54 According to Frank.C JERBI, and that of Kelly’s“Rule of Thirds” technique where labial aspect of tooth was divided into three equal bands of space between gingival line and depth of vestibular space, i.e., the gingival, middle and vestibular bands

55. 55 First step is to cut away those parts of the crowns of the teeth that are visible i.e., at free marginal gingiva Step two is to trim the cast so that the sites of previously removed crowns are recessed approximately 1mm.

56. 56 Third step is to make a flat cut across the facial surface of the ridge, that extends from the labial depth of length of the crown to the junction of the gingival and middle third of facial surface of the ridge . Step four is another flat cut across facial portion of the ridge. This cut begins at crest of ridge and extends to the mid width point of cut made in step three.

57. 57 The fifth step is to trim that part of the cast which is lingual to the teeth. The last step is to shape and smooth the surface of the cast that have been trimmed in the previous steps.

58. Cast modification for immediate complete dentures: Traditional and contemporary considerations with an introduction of spatial modeling Rodney D. Phoenix and Jeffrey D. Fleigel J Prosthet Dent 2008;100:399-405 58 Cast modification technique proposed by Standard. A, Cross-sectional view of cast in posterior region. B, Coronal segment is removed using saw or laboratory engine. C, Subsequent cut joins lingual gingival margin to intermediate line on facial surface of cast. Intermediate line is parallel and 2 mm apical to facial gingival margin. D, Stone contours are gently rounded at facial and lingual surfaces. On facial surface, rounding extends to soft tissue height of contour. E, Resultant reduction is shown. Dotted line indicates premodification contours. F, Cross-sectional view of tooth placement and denture base contours proposed by Standard. A B C D E F

59. 59 Cast modification technique proposed by Jerbi . A, Cross-sectional view of cast in posterior region. B, Coronal segment is removed using saw or laboratory engine. C, One-mm-deep recess is created in area occupied by root A B C

60. 60 D, Vertical cut extending from facial extent of prepared socket to line denoting junction of cervical and middle thirds of facial surface. E, Cut extending from faciolingual center of socket to midway point of cut. F, Floor of prepared socket is extended lingually . G, Stone contours are gently rounded at facial and lingual surfaces. H, Resultant reduction is shown. I, Cross-sectional view of tooth placement and denture base contours proposed by Jerbi . D E F G H I

61. 5 Cast modification based upon spatial modeling. 61 A, Bone levels superimposed upon cross-section of a representative posterior segment. B, Coronal segment is removed using saw or laboratory engine. C, Two lines are placed on surface of cast. One line arcs from mesiofacial line angle to distofacial line angle, and is located 2 mm lingual to midfacial surface. Second line is parallel to and 4 mm from gingival margin. D, Sharp blade or laboratory engine is used to connect lines drawn in Figure 5, C.

62. 62 E, Two lines also guide lingual reduction. One line arcs from mesiolingual line angle to distolingual line angle, and is located 2 mm facial to midlingual surface. Second line is parallel to and 2 mm from gingival margin. F, Sharp blade is used to connect lines , E. G, Sharp angles and lines are eliminated, thereby creating gently rounded faciolingual contour. H, Foregoing cast modifications permit natural collapse of soft tissues into extraction site to minimize likelihood of binding or tissue compression during placement of prosthesis.

63. 63 I,Resultant reduction shown. Broken line indicates premodification contours. J, Cross-sectional view of tooth placement and denture base contours as determined by spatial modeling. K, Mesiodistal cross-section of cast with osseous contours superimposed. Papillae are shortened and rounded to simulate collapse that occurs following extraction of adjacent teeth. Broken line indicates premodification contours. L, Papillae may collapse due to their relationships with underlying interradicular bone. Papillae also may “roll” as depicted in Figure 5, H.

64. Interim Prosthodontic Management of Surgery-Induced Dental Agenesis: A Clinical Report of 8 Years of Treatment Journal of Prosthodontics . 2013 Jul;22(5):408-12. 64 The prosthodontic management of a child with missing teeth needs to follow a systematic protocol involving a multidisciplinary dental team and a close follow-up.

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67. CONCLUSION 67 Simple and easily modified removable appliances serve as a vehicle for the delivery of orthodontic services and direct the eruption and arrangement of the permanent teeth. In the present report, the first interim RPD was modified to guide the settlement of the permanent dentition. While the patient was going through her mixed dentition stage, the permanent teeth were directed to occlude in the desirable OVD, assessed by both orthodontic and prosthodontic criteria.

68. 68 The subsequent interim RPDs prevented the natural teeth from attaining unfavorable positions and preserved the edentulous space. They also provided the young patient with much-needed functional and esthetic improvement. The restoration of function and, most importantly, esthetics is beneficial to the social and psychological maturation of a child with a handicap from the early school years through adolescence .

69. Restoration of the Occlusal Vertical Dimension with an Overlay Removable Partial Denture: A Clinical Report Journal of Prosthodontics . 2016 Oct;25(7):585-8 69 This clinical report reviews restoration of a severely resorbed dentition with overlay removable partial denture.

70. 70 Classical situations involving tooth wear: ( A) initial conditions of tooth wear and OVD loss; (B) restorative solution for case A; (C) initial condition of tooth wear without OVD loss; and (D) periodontal surgical procedures and restorative treatment for correction.

71. 71 Intraoral view of the patient’s initial condition .

72. 72 Virtual planning performed to assist in the predictability of the restorative procedure Incisal restoration of the anterior teeth and the occlusal rest seat.

73. 73 Framework wax-up with a simple occlusal retention for the acrylic resin. ORPD final aspect.

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75. Concluion 75 The overlay RPD treatment seems to be satisfactory, restoring the OVD and esthetics and providing greater muscle comfort for the patient with low cost and shorter working time. Further randomized clinical trials are suggested to compare the longterm effectiveness of different treatment options for the worn teeth associated with OVD loss.

76. Adaptation of an interim partial removable dental prosthesis as a radiographic template for implant placement. Journal of Prosthetic Dentistry. 2016 Jul 1;116(1):147-8 . 76 The use of radiographic guides allows the transfer of the prosthodontic plan to a CBCT scan, which combined with the enhanced assessment of the alveolar ridge, allows the clinician to determine the best position for implant placement.

77. 77 Interim partial removable dental prosthesis (top). Intaglio and occlusal indices placed (bottom).

78. 78 Occlusal (left) and intaglio (right) surface detail. Cone-beam computed tomography view.

79. 79 The technique converts an existing laboratory processed IPRDP into a radiographic template for implant placement. The advantages include: Minimal chairside and laboratory time Cost savings because prosthesis duplication and additional adjustment appointments are not needed Fidelity of the radiographic guide versus duplication distortion of the surgical guide Ability to create a modifiable surgical guide after duplicating the IPRDP/radiographic template

80. Removable Partial Denture in Combination with a Milled Fixed Partial Prosthesis as Interim Restorations in Long-Term Treatment. Journal of Prosthodontics : Implant, Esthetic and Reconstructive Dentistry. 2010 Jan;19(1):77-80 . 80 Many complex situations require fixed and removable prostheses in the same arch, significantly increasing chair time and the length of treatment. Consequently, interim restorations must be adequate for long-term use. This report describes a protocol for rehabilitation of the maxillary or mandibular arch with an interim acrylic resin-milled fixed prosthesis and RPD with metallic framework in the first phase of rehabilitation treatment.

81. Technique 81 1. Make a full-arch impression with irreversible hydrocolloid. Record a facebow transfer and centric relation, obtaining the diagnostic casts eto be mounted in a semiadjustable articulator. 2. Formulate an interdisciplinary treatment plan with the aid of clinical and radiographic examination and diagnostic casts. 3. On the diagnostic cast, cut the teeth scheduled for extraction, contour the cast in this area, and prepare the remaining teeth to serve as abutments. 4. Construct the interim fixed prosthesis with milled surfaces, using the dental surveyor to assist in determining the path of insertion for the RPD. This restoration should demonstrate a straight emergence profile with optimal termination. 5. After the construction of interim fixed restorations, cast the framework of the removable partial prosthesis using a base metal (Cr–Co) alloy. 6. Verify the adaptation of the metallic framework on the interim acrylic crowns. The superstructure should maintain a relief space for the soft tissues in extraction areas and provide for future implant placement.

82. 82 Interim removable partial prosthesis in combination with milled fixed prosthesis. The arrows indicate the lingual rests.

83. 83 7. Surgical procedures should be performed after prosthetic procedures to avoid contamination of the surgical site. 8. Seat the interim-milled-fixed restorations and removable partial prosthesis. Reline margins of interim-fixed restorations with autopolymerizing resin to readapt them to the preparations. Next, seat the fixed and removable restorations together to maintain the path of insertion and reduce torque on the terminal abutment. 9. Remove excess material before complete setting of the provisional material to prevent potential undercuts from locking the crown into place; allow curing, then refine margins and repolish restorations. 10. The denture base over the area of the extractions can be lined with a soft material to aid healing of the planned extractions. 11. Verify occlusal adjustment and marginal fit before cementation. 12. Cement the interim restoration with a temporary luting agent and fit it precisely together with the RPD to determine the accurate path of insertion.

84. 84 Occlusal view of interim prostheses. Note the precise fit of the clasps and rests on the teeth.

85. 85 (A) Initial view of the case. (B) Frontal view of interim prosthesis placement.

86. Concluion 86 The procedure described is indicated for lengthy restorations, when the dental treatment involves complex and extensive procedures such as surgical, periodontal, or endodontic treatments and when fixed prostheses and removable partial prostheses are needed in the same arch.

87. 87 The advantage of such interim restorations is that they are stronger and more resistant than conventional interim restorations. Thus, less time is spent repairing interim prostheses as a result of fractures. Interim restorations also provide arch stabilization, preserve the path of insertion, maintain vertical dimension and denture-supporting structures, enhance the esthetic appearance and comfort of the patient, and may be used as a template for the definitive restorations.

88. 88 One disadvantage of this procedure is that it can be more expensive and require a more experienced professional. Over the long term, however, the procedure is advantageous because fewer visits for repair are needed, and the interim restorations fracture less often. The clasps of the RPD may cause wear on the surface of an acrylic resin-fixed prosthesis, but this occurs rarely.

89. Immediate Vacuum Formed Overdenture for a Pediatric Patient with Ectodermal Dysplasia . Journal of Dentistry for Children. 2018 Sep 15;85(3):139-42 89 The purpose of this clinical report was to present a simple, fast, and cost-effective technique to re-establish a pleasant smile of an eight-year-old male patient with hypohydroticED . A vacuum-formed overdenture prosthesis is described, which is recommended as an immediate interim restorative treatment in the maxillary arch with excellent stability and retention.

90. 90 Initial presentation smile . Panoramic X-ray showing oligodontia and eruption of the permanent central incisors in the maxillary arch, and anodontia in the mandibular arch.

91. 91 The treatment plan goal was oriented to immediately restore the esthetics of the anterior segment using a different appliance design to improve the retention and function. Abnormal morphology of the maxillary permanent central incisors.

92. 92 Working model with pontics and facial acrylic veneers to restore the smile arc. Vacuum formed overdenture before insertion.

93. 93 Occlusal view of the vacuum form overdenture in place. Close up smile with the interim prosthesis .

94. Concluion 94 Different techniques have been proposed for the oral rehabilitation of patients with ED, including fixed prostheses, removable partial or complete dentures, and dental implants. The use of an immediate vacuum-formed overdenture was an effective way to restore the esthetics of the anterior segment in one visit, with minimum adjustments and excellent retention. The patient will be seen every three months to monitor the eruption of the permanent incisors and to allow the timely remaking of the interim overdenture as needed.

95. Site development interim removable dental prosthesis. The Journal of prosthetic dentistry. 2016 Nov 1;116(5):663-740 . 95 Transitioning a patient with partial edentulism through hard and soft tissue grafting to an implant restoration with an interim removable dental prosthesis (IRDP) presents a challenge to the restorative dentist. The management of grafted sites requires care, and without the appropriate design, an IRDP may impede surgical outcomes and place the graft at risk for displacement or necrosis. A site development IRDP (SDIRDP) for a grafted site must fulfill restorative goals and promote the surgical objectives for site development.

96. Technique 96 1. With a diagnostic cast, consult with the surgeon to quantify the extent of site augmentation and review the planned design for the SDIRDP. 2. Prepare the SDIRDP abutment teeth as needed, such as the addition of composite resin rest seats for support or the enhancement of undercuts to aid in retention.

97. 97 3. Make an impression with an elastomeric impression material, select a suitable tooth shade, and make the appropriate interocclusal records necessary to mount the casts. 4. Pour the impression in dental stone and remove the teeth planned for extraction from the cast. 5. Add block-out wax to the cast in the area of the planned graft. The first wax application should reflect the desired definitive contour of the ridge augmentation.

98. 98 A second wax addition should be 2 mm thicker than the planned definitive contour of the ridge. The additional room will allow the surgeon to overbuild the site to compensate for shrinkage of the graft and to accommodate postoperative edema during the healing process. The block-out should extend approximately 8 to 10 mm lingual from the free gingival margins of the teeth planned for extraction and continue laterally to the 2 adjacent teeth. The block-out should end in a 35-degree bevel, tapered to the lingual surface.

99. 99 6. After the block-out is complete, duplicate the cast with an elastomeric impression material and pour the impression in dental stone. 7. If clasps and/or rests are planned, bend orthodontic wires to the desired size and shape. Care should be taken to avoid placing the proximal ends of the wires in areas over the sites planned for augmentation, because the acrylic resin in these areas will likely require adjustment. 8. Adjust the selected denture teeth to be used in the prosthesis and set them in the desired position with baseplate wax.

100. 100 10. Complete the waxing by adding a 2- to 3-mm thickness of baseplate wax in all areas of the planned denture base. 11. Invest the completed waxing in a denture flask and process with the preferred processing method. 12. Complete a laboratory remount. 13. Section the cast, finish, and polish the prosthesis 14. Deliver the SDIRDP at the time of surgery. Relieve the prosthesis as needed in the area of the grafted site. 15. Monitor healing of the grafted site and adjust the SDIRDP as needed.

101. 101 Intaglio surface of site development interim removable dental prosthesis showing relief to specification in area of ridge augmentation.

102. 102 Site development interim removable dental prosthesis in situ. A, Frontal view. B, Occlusal view.

103. 103 Augmented ridge. A, Frontal view. B, Occlusal view.

104. Concluion 104 A technique has been described for the design and fabrication of an IRDP that facilitates surgical procedures for site development while maintaining prosthetic goals. Although the technique offers many advantages, in certain situations, the opposing occlusion may preclude the use of an SDIRDP. Although a fixed interim restoration using adjacent abutment teeth, transitional implants, or definitive implants is often preferred, it is not always available or possible as a treatment option, and the clinician may be forced to use an interim removable dental prosthesis (IRDP).

105. References 105 McCracken’s removable partial prosthodontics Stewart’s clinical removable partial prosthodontics Dental laboratory procedures removable partial dentures-Rudd and Morrow Clinical dental prosthodontics – H.R.B Fenn Cast modification for immediate complete dentures: Traditional and contemporary considerations with an introduction of spatial modeling Rodney D. Phoenix and Jeffrey D. Fleigel J Prosthet Dent 2008;100:399-405 Trimming Procedure For Anterior Teeth J.Prosthet.Dent 16(6): 1048 – 1051, 1966 Overlay Removable Partial Denture - Case Report Journal of Dental Specialities , Vol. 2, Issue 2, September 2014

106. 106 Restoration of the Occlusal Vertical Dimension with an Overlay Removable Partial Denture: A Clinical Report Journal of Prosthodontics . 2016 Oct;25(7):585-8 Adaptation of an interim partial removable dental prosthesis as a radiographic template for implant placement. Journal of Prosthetic Dentistry. 2016 Jul 1;116(1):147-8. Removable Partial Denture in Combination with a Milled Fixed Partial Prosthesis as Interim Restorations in Long-Term Treatment. Journal of Prosthodontics : Implant, Esthetic and Reconstructive Dentistry. 2010 Jan;19(1):77-80. Immediate Vacuum Formed Overdenture for a Pediatric Patient with Ectodermal Dysplasia. Journal of Dentistry for Children. 2018 Sep 15;85(3):139-42 Site development interim removable dental prosthesis. The Journal of prosthetic dentistry. 2016 Nov 1;116(5):663-740.

107. 107 A technique to fabricate a customized interim removable partial denture (J Prosthet Dent 2009;102:187-190) Interim Prosthodontic Management of Surgery-Induced Dental Agenesis: A Clinical Report of 8 Years of Treatment Journal of Prosthodontics . 2013 Jul;22(5):408-12.

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