Introduction and Classification RPD

Introduction to cast partial denture and classification of partially edentulous arches.

1. Introduction and Classification of RPD Submitted by Raghunandan Singh (Intern )

2. Removable Partial Denture:- A removable denture that replaces some teeth in a partially edentulous arch; the removable partial denture can be readily inserted and removed from the mouth by the patient. (GPT 9th edition) Removable partial dentures can broadly be classified as two types (depending on the manner of support):- Tooth Supported Removable Partial Denture Tooth-Tissue Supported Removable Partial Denture

3. Tooth Supported Removable Partial Denture A partial denture that receives support from natural teeth at each end of the edentulous space or spaces.

4. 2.Tooth-Tissue Supported Removable Partial Denture The denture base that extends anteriorly or posteriorly and is supported by teeth at one end and tissue on the other end. They are also called distal extension partial dentures .

5. Parts of Removable Partial Denture Major Connector Minor Connector Rest Direct Retainer Indirect Retainer Denture Base and Artificial Tooth Replacement

6. Major Connector A part of a removable partial denture which connects the components on one side of the arch to the components on the opposite side of the arch. ( GPT )

7. Minor Connector The connecting link between the major connector or base of a removable partial denture and the other units of the prosthesis, such as the clasp assembly, indirect retainers, occlusal rests, or cingulum rests. ( GPT )

8. Rest A rigid extension of a removable partial denture that contacts the occlusal, incisal, cingulum, or lingual surface of a tooth or restoration, the surface of which is commonly prepared to receive it. ( GPT )

9. Direct Retainer That component of a removable partial denture used to retain and prevent dislodgment, consisting of a clasp assembly or precision attachment. ( GPT )

10. Indirect Retainer The component of a removable partial denture that assists the direct retainer(s) in preventing displacement of the distal-extension denture base by functioning through lever action on the opposite side of the fulcrum line when the denture base attempts to move away from the tissues in pure rotation around the fulcrum line. ( GPT )

11. Denture Base The part of a denture that rests on the foundation tissues and to which teeth are attached. ( GPT )

12. Artificial Tooth Replacement These are the prosthetic teeth that replace the natural teeth .

13. Maxillary framework designed for a partially edentulous arch with a Kennedy Classification I. A , Major connector. B , Rests. C , Direct retainer. D , Minor connector. E , Guide plane. F , Indirect retainer

14.   Mandibular framework designed for a partially edentulous arch with a Kennedy Classification II, modification 1. A , Major connector. B , Rests. C , Direct retainer. D , Minor connector. E , Guide plane. F , Indirect retainer.

15. Indications for Removable Partial Dentures Young Patients Need for Cross Arch Stabilisation Reduced Periodontal Support for Remaining Teeth Excessive Bone Loss within the Residual Ridge Physical and Emotional Problems Aesthetics of Primary Concern Immediate Need to Replace Extracted Teeth Patient Desires Unfavourable Maxillomandibular Relationship

16. Contraindication of Removable Partial Denture :- Macroglossia Patient attitude Poor oral hygiene

17. Classification of Partially Edentulous Arches Need for classification :- To formulate a good treatment plan. To anticipate the difficulties commonly to occur for that particular design. To communicate with a professional about a case. To design the denture according to the occlusal load usually expected for a particular group.

18. Requirements of an ideal classification :- It should permit immediate visualization of the type of partially edentulous arch that is being considered. It should permit immediate differentiation between the tooth-supported and the tooth- and tissue-supported removable partial denture. It should be universally acceptable

19. Over the years many authors have attempted to classify partially edentulous arches, a brief timeline is given below. Year Author 1921 Cummer 1923 Kennedy 1927 Rumpel 1928 Bailyn 1935 Balter 1937 Muller 1937 Hisekorn 1937 Hildebrand 1939 Neurohr 1939 Dubeq si Delmas-Marsalet 1939 Martin 1942 Mauk 1946 L’Hirodelle 1949 Wild 1951 Godfrey

20. Year Author 1953 Friedman 1953,1957 Beckett-Wilson 1954 Craddock 1954 Betelman 1955 Swenson 1955 Eichner 1957 Austin-Lidge 1958 Watt 1958 Applegate 1959 Skinner 1960 Volldrich 1962 Scoala Germana 1966 Avant 1969 Erich Korber 1973 Stefel 1973 Hoffman 1974 Osborn and Lammie

21. Year Author 1975 Costa 1975 Miller 1975 Kerlheinz Korber 1975 Kerschbaum 1978 Dumitrescu 1978 Martin 1979 Kobes 1981 Fabian 2002 McGarry 2007 Arbabi 2008 Al-Johany

22. Kennedy’s Classification :- Most popular classification The Kennedy method of classification was originally proposed by Dr. Edward Kennedy in 1925. It attempts to classify the partially edentulous arch in a manner that suggests certain principles of design for a given situation. Kennedy divided all partially edentulous arches into four basic classes. Edentulous areas other than those that determining the basic classes were designated as modification spaces.

23. Class I Bilateral edentulous areas located posterior to the natural teeth

24. Class II A unilateral edentulous area located posterior to the remaining natural teeth

25. Class III A unilateral edentulous area with natural teeth remaining both anterior and posterior to it

26. Class IV A single, but bilateral (crossing the midline), edentulous area located anterior to the remaining natural teeth

27. Kennedy Class I Partial Denture Kennedy Class II Partial Denture

28. Kennedy Class III Partial Denture Kennedy Class IV Partial Denture

29. Merits :- The classification is simple and universally acceptable. It allows to clearly communicate, to write or to diagnose the condition of the oral cavity in which missing teeth are to be replaced. It permits visualization of the type of partially edentulous arches being considered. Classification is based on the relationship of the edentulous spaces to the abutment teeth so type of support can be easily determined. The number and location of edentulous spaces can be identified but does not indicate the number of missing teeth in each edentulous area. This classification provides design for each class. Guidelines and principles for each class have been proposed.

30. Demerits :- Does not assess the choice, number, location and condition of the abutment teeth. Assessment of the hard and soft tissue status not possible. Does not indicate the position of individual tooth. Does not permit assessment of occlusion

31. Applegate-Kennedy Classification:- Dr. O.C Applegate in 1958 modified the original classification proposed by Kennedy, which resulted in addition of 2 more groups. He also gave certain rules governing the application of Kennedy system.

32. Class I an edentulous situation in which all remaining teeth are anterior to bilateral edentulous areas .

33. Class II an edentulous situation in which remaining teeth of either side are anterior to the unilateral edentulous area with all teeth of the opposite side remaining.

34. Class III an edentulous situation in which the edentulous area is bounded by teeth unable to assume total support of the necessary prosthesis. These abutments require the aid of teeth remotely located, so the principles of cross arch splinting (and counter leverage) can be utilised to resist the lateral tilting forces to which these abutments will be subjected.

35. Class IV an edentulous situation in which the remaining teeth bound the edentulous area posteriorly on both right and left sides of the median line.

36. Class V an edentulous situation in which teeth bound the edentulous area anteriorly and posteriorly but where the anterior boundary tooth is not suitable for abutment service (as the lateral incisor)

37. Class VI an edentulous situation in which the boundary teeth are capable of total support of the required prosthesis.

38. Rule 1 Classification should follow rather than precede any extractions of teeth that might alter the original classification. In this instance, the indicated extractions yield a Kennedy Class II, Modification 1 arch.

39. Rule 2 If the third molar is missing and not to be replaced, it is not considered in the classification For purposes of this discussion, each tooth that is missing and to be replaced is shaded. Each tooth that is missing and not to be replaced is identified with an X. Hence, the illustration represents a Kennedy Class III arch.

40. Rule 3 If a third molar is present and is to be used as an abutment, it is considered in the classification Consequently, this illustration represents a Kennedy Class III arch.

41. Rule 4 If a second molar is missing and is not to be replaced (that is, the opposing second molar is also missing and is not to be replaced), it is not considered in the classification

42. Rule 5 The most posterior edentulous area(s) always determines the classification As a result, this pattern of edentulism represents a Kennedy Class II, Modification 1 arch.

43. Rule 6 Edentulous areas other than those determining the classification are referred to as modification spaces and are designated by their number This illustration represents a Kennedy Class II, Modification 2 arch.

44. Rule 7 The extent of the modification is not considered, only the number of additional edentulous areas Consequently, both illustrations represent Kennedy Class II, Modification 1 arches.

45. Rule 8 There can be no modification areas in Class IV arches. Any edentulous area lying posterior to the single bilateral area determines the classification This illustration depicts a Kennedy Class III, Modification 1 arch.

46. Bibliography Glossary of Prosthodontic Terms 9 th Edition McCracken’s Removable Partial Prosthodontics 12 th Edition Oliver. C. Applegate’s Essentials of Removable Partial Denture Prosthesis 3 rd Edition Rangarajan – Padmanabhan Textbook of Prosthodontics 2 nd Edition Stewart’s Clinical Removable Partial Prosthodontics 4 th Edition

47. Thank You