Introduction to Removable partial dneture.pptx

Causes Of Tooth Loss
PERIODONTAL PROBLEMS ( PERIODONTITIS, GINIGIVITIS)
Systemic Causes Of Tooth Loss
1. Diabetes Mellitus
2. Female Sexual Hormones Condition
3. Hyperpituitarism
4. Hyperthyroidism
5. Primary Hyperparathyroidism
6. Osteoporosis
7. Hypophosphatasia
8. Hypophosphatemia
Causes Of Tooth Loss
CARIES/ TOOTH DECAY
Causes Of Tooth Loss
CAUSES OF TOOTH LOSS
Consequence of tooth loss
Anatomic
Loss of ridge volume both height and width
Bone loss :
mandible > maxilla
Posteriorly > anteriorly

Anatomic consequences
Broader mandibular arch with constricting maxilary arch
Attached gingiva is replaced with less keratinised oral mucosa which is more readily traumatized.

Anatomic consequences
Tipping of the adjacent teeth
Supraeruption of the teeth
Traumatic occlusion
Premature occlusal contact
Anatomic Consequences
Anatomic Consequences





Physiologic consequences
Physiologic Consequences
Decreased lip support
Decreased lower facial height
Physiologic Consequences
Physiologic consequences
Education of Patient

Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation

Support for Distal Extension Denture Bases

Establishment and Verification of Occlusal Relations and Tooth Arrangements

Initial Placement Procedures

Periodic Recall

Education of Patient�
Informing a patient about a health matter to
secure informed consent.

Patient education should begin at the initial
contact with the patient and should continue throughout treatment.

The dentist and the patient share responsibility for the ultimate success of a removable partial denture.

This educational procedure is especially important when the treatment plan and prognosis are discussed with the patient.


Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation�
Begin with thorough medical and dental histories.
The complete oral examination must include both clinical and radiographic interpretation of:
caries
the condition of existing restorations
periodontal conditions
responses of teeth (especially abutment teeth) and residual ridges to previous stress
The vitality of remaining teeth

Continued…..�
Occlusal plan evaluation
Arch form
Evaluation of Occlusal relationship through mounting the diagnostic cast

The dental cast surveyor is an absolute necessity in which patients are being treated with removable partial dentures.


Mouth preparations, in the appropriate sequence, should be oriented toward the goal of
providing adequate support, stability,
retention, and
a harmonious occlusion for the partial denture.




Support for Distal Extension Denture Bases
A base made to fit the anatomic ridge form does not provide adequate support under occlusal loading.

The base may be made to fit the form of the ridge when under function.

Support for Distal Extension Denture Bases
This provides support

1. Introduction of Removable Prosthodontics Dr Shamsuddin Mahmud Assistant Professor Department of Prosthodontics

2. L earning objectives A fter the session the student will able to L ist causes of tooth loss S tate the consequence of tooth loss Formulate the phases of RPD insertion to the patient E numate the indication, contraindication of RPD E numate the advanrages and disadvantages of RPD C lassify partially edenyulous arch

3. L earning objectives I dentify partially edenyulous arch D efine and classify different parts of RPD Identify different parts of RPD D efine various definition related to RPD

4. Causes Of Tooth Loss PERIODONTAL PROBLEMS ( PERIODONTITIS, GINIGIVITIS ) PLAQUE PLAQUE RETENTIVE FACTORS

5. Systemic Causes Of Tooth Loss 1. Diabetes Mellitus 2. Female Sexual Hormones Condition 3. Hyperpituitarism 4. Hyperthyroidism 5. Primary Hyperparathyroidism 6. Osteoporosis 7. Hypophosphatasia 8. Hypophosphatemia

6. Causes Of Tooth Loss CARIES/ TOOTH DECAY

7. Causes Of Tooth Loss Syndromic or Genetic

8. CAUSES OF TOOTH LOSS AGING

9. C onsequence of tooth loss Anatomic L oss of ridge volume both height and width B one loss : mandible > maxilla P osteriorly > anteriorly

10. Anatomic consequences B roader mandibular arch with constricting maxilary arch A ttached gingiva is replaced with less keratinised oral mucosa which is more readily traumatized.

11. Anatomic c onsequences T ipping of the adjacent teeth S upraeruption of the teeth T raumatic occlusion P remature occlusal contact

12. Anatomic Consequences Increased occlusal load on existing teeth Drifting, tooth surface loss

13. Anatomic Consequences Tooth surface loss

14. P hysiologic consequences

15. Physiologic C onsequences D ecreased lip support D ecreased lower facial height

16. Physiologic C onsequences Compromised aesthetics

17. Physiologic consequences COMPROMISED SPPECH

18. Education of Patient Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation Support for Distal Extension Denture Bases Six Phases

19. Establishment and Verification of Occlusal Relations and Tooth Arrangements Initial Placement Procedures Periodic Recall Six Phases

20. Education of Patient Informing a patient about a health matter to secure informed consent. Patient education should begin at the initial contact with the patient and should continue throughout treatment. The dentist and the patient share responsibility for the ultimate success of a removable partial denture. This educational procedure is especially important when the treatment plan and prognosis are discussed with the patient.

21. Diagnosis, Treatment Planning, Design, Treatment , Sequencing, and Mouth Preparation Begin with thorough medical and dental histories . The complete oral examination must include both clinical and radiographic interpretation of: caries the condition of existing restorations periodontal conditions responses of teeth (especially abutment teeth) and residual ridges to previous stress The vitality of remaining teeth

22. Continued….. Occlusal plan evaluation Arch form Evaluation of Occlusal relationship through mounting the diagnostic cast

23. The dental cast surveyor is an absolute necessity in which patients are being treated with removable partial dentures.

24. Mouth preparations , in the appropriate sequence, should be oriented toward the goal of providing adequate support, stability, retention, and a harmonious occlusion for the partial denture.

25. Support for Distal Extension Denture Bases A base made to fit the anatomic ridge form does not provide adequate support under occlusal loading. The base may be made to fit the form of the ridge when under function.

26. Support for Distal Extension Denture Bases This provides support and ensures maintenance of that support for the longest possible time. Distal extension base must be made as equal to and compatible with the tooth support as possible.

27. Establishment and Verification of Occlusal Relations and Tooth Arrangements Are important steps in the construction of a partial denture. This necessitates the making of a base that will provide the same support as the finished denture.

28. Continued… Then a new corrected base must be used to record jaw relations.

29. Initial Placement Procedures Occlusal harmony be must ensured before the patient is given possession of the dentures. The processed bases must be reasonably perfected to fit the basal seats.

30. Initial Placement Procedures It must be ascertained that the patient understands the suggestions and recommendations given by the dentist.

31. Periodic Recall Is critical for early recognition of changes in oral structures to allow steps to be taken to maintain oral health. Although a 6-month recall period is adequate for most patients, more frequent evaluation may be required for some.

32. I ndication contraindication merits and demerits

33. I ndications L ong edentulous span No abutment tooth posterior to the edentulous space Reduced periodontal support of remaining teeth Need for cross arch stabilization Excessive bone loss in residual alveolar ridge

34. I ndications Primary and emotiona l problem exhibited by the patients Aesthetic of primary concerns Immediate need t o replace extracted tooth Patient desire

35. C ontraindications Patients with a large tongue – tends to push the denture away Patient attitude : mentally retarded patients cannot maintain a prosthesis Poor oral hygiene : any prosthesis is better avoided

36. ADVANTAGES DISADVANTAGES Cheap Relatively easy to construct Easy to modify Pleasing Esthetics Weak material Non – rigid Must be bulky for strength

37. Classification of partially edentulous jaw

38. Need For Classification To communicate the condition of the oral cavity To formulate a good treatment plan To anticipate the difficulties commonly to occur for that particular design To design the denture according to the occlusal load usually expected for a particular group

39. REQUIREMENTS OF AN ACCEPTABLE METHOD OF CLASSIFICATION The classification of a partially edentulous arch should satisfy the following requirements: 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 re-movable partial denture. It should be universally acceptable.

40. Kennedy classification

41. Merits of Kennedy ‘s classification Allows visualization of partially edentulous arch Differentiates b/w tooth and tooth tissue supported Type of design can be decided Universally accepted Aids in discussing, identifying and planning the design Easy to apply the system to any situation Widely used system

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

43. Applegate’s rules

44. Rule 1: classification should follow rather than precede extractions that might alter the original classification. Rule 2: if the third molar is missing and not to be replaced, it is not considered in the classification. Rule 3: if the third molar is present and is to be used as an abutment, it is considered in the classification. Rule 4: if the second molar is missing and is not to be replaced, it is not considered in the classification.

45. Rule 5: the most posterior edentulous area or areas always determine the classification. Rule 6: edentulous areas other than those, which determine the classification, are referred to as modification spaces and are designated by their no: Rule 7: the extend of the modification is not considered, only the no: of edentulous areas, i.e. the no: of teeth missing in the modification spaces is not considered only the no: of additional edentulous spaces are considered.

46. Rule 8: there can be no modification areas in class IV. Because any additional edentulous space will definitely be posterior to it and will determine the classification.

47. EXERCISE

48. EXERCISE

49. Terminology and parts

50. Removable Partial Denture I ndirect removable prosthetic restoration for replacing some teeth and patient removes when desire 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-10

51. TERMINOLOGIES Tooth Supported RPD: A partial denture that receives support from natural teeth at each end of the edentulous space or spaces. Eg : Kennedy’s class III Tooth – Tissue Supported RPD: The denture base that extends anteriorly or posteriorly & is supported by teeth at one end & tissue on the other end.

52. Distal Extension Denture Base: The denture base that extends posteriorly without posterior support from natural teeth. They are tooth tissue supported partial dentures

53. Difference between tooth supported RPD and tooth tissue supported RPD P oints Tooth supported RPD Tooth supported RPD SUPPORT DERIVED F r om abut m ent teeth P rimari l y f r om tissues Se c onda r i l y f r om abutment teeth IMPRSSION TECHNIQ U ES Static ( anatom ic) impression Functiona l i mp r es s io n f or tissues Anatom i c i mp r es s io n f or teeth DIRECT RETAINER No stress release design Stress Release design INDIRECT RE T ENT I O N Not needed Neede d , d epending on ful c rum lin e and axis of r otati o n BASE MATERIALS Gene r al l y metal No need f or r eline Gene r al l y ac r ylic F or ease of r eline STRESS BREAKING Not needed R e com m ended f or lon g span

54. Parts of removable partial denture Components of a typical removable partial denture are Major connectors Minor connectors Rests Direct retainers Stabilizing or reciprocal components (as parts of a clasp assembly) Indirect retainers (if the prosthesis has distal extension bases) One or more bases, each supporting one to several replacement teeth Artificial teeth

55. Components of a typical removable partial denture

56. Major connector That component of the partial denture that connects the parts of the prosthesis located on one side of the arch with those on the opposite side. Mc Crakens’ 13th edition the part of a removable par- tial denture that joins the components on one side of the arch to those on the opposite side. ( GPT-10)

57. Strap : having an anterioposterior dimension not less than 8 mm Bar having an anterioposterior dimension less than 8 mm

58. Mandibular Major Connectors There are six types of mandibular major connectors described historically. Of these, the lingual bar and the linguoplate are used the majority of the time. Lingual bar Linguoplate Sublingual bar Lingual bar with cingulum bar (continuous bar) Cingulum bar (continuous bar) Labial bar

59. Lingual bar

60. Linguoplate

61. Sublingual bar

62. L ingual bar with cingulum bar

63. C ingulum bar

64. L abial bar

65. Maxillary Major Connectors Six basic types of maxillary major connectors are considered: Single palatal strap Combination anterior and posterior palatal strap–type connector Palatal plate-type connector U-shaped palatal connector Single palatal bar Anterior-posterior palatal bars

66. Single palatal strap

67. Combination anterior and posterior palatal strap–type connector

68. Palatal plate-type connector

69. U-shaped palatal connector

70. Single palatal bar

71. Anterior-posterior palatal bars

72. 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-10) Those components that serve as the connecting link between the major connector or the base of removable partial denture and the other components of the prosthesis ( Clasp, indirect retainers, occlusal rests, cingulum rests. etc ). (Mc Craken’s 13th edition)

73. Types of minor connector 4 types – Join the clasp assembly to the major connector. Join direct retainers or auxillary rests to the major connector. Join the denture base to the major connector. Serve as an approach arm for a vertical projection or bar type.

74. Tissue Stops Tissue stops are integral parts of minor connectors designed for retention of acrylic resin bases. They provide stability to the framework during the stages of transfer and processing. Engage buccal and lingual slopes of the residual ridge for stability.

75. 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-10) Any component of a partial denture on a tooth surface that provides vertical support is called a rest (Mc Crakens’ 13th edition)

76. Rest Seat The prepared surface of an abutment to receive the rest is called the rest seat .

77. T ypes of rest O cclusal rest O cclusal rest E xtended occlusal rest I nterproximal occlusal rest I nternal occusal rest O cclusal rest on restoration L ingual rest I ncisal rest

78. Indirect retainer T he component of a removable partial denture that assists the direct retainer(s) in pre- venting 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-10)

79. Fulcrum line An imaginary line, connecting occlusal rests, around which a partial removable dental prosthesis tends to rotate under masticatory forces. The determinants for the fulcrum line are usually the cross arch occlusal rests located adjacent to the tissue borne components.

80. ROTATION is that movement of an appliance which may occur in a vertical direction while its occlusal rests remain in abutment contact. DISPLACEMENT is that movement of an appliance when the primary occlusal rests also lose tooth contact.

81. T ypes of indirect retainer Auxillary occlusal rest Canine extension of occlusal rest Modification area C anine rest I ncisor rest R ugae support C ingulum bar and linguoplate

82. D irect retainer The component part applied to resist this movement away from the teeth and/or tissue provides retention for the prosthesis and is called the direct retainer. Mc Craken’s 13th edition that component of a removable partial denture used to retain and prevent dislodgment, consisting of a clasp assembly or precision attachment GPT-10

83. BASIC PARTS OF A CLASP ASSEMBLY

84. (1)Rest (2)Body of clasp (3)Retentive arm (4)Shoulder (5)Reciprocal element (6)Minor connector

85. Parts of clasp assembly Circumferential Clasp (Retentive Arm) Reciprocating (Bracing) Arm Distal Occlusal Rest Seat Proximal Plate

86. CLASSIFICATION

87. Direct Retainers Intracoronal Extracoronal Internal Attachment External Attachment Stud Attachment Bar Attachment Special Attachment Manufactured Custom Made Occlusally approaching Gingivally approaching Bar Clasp T Clasp Modified T clasp Y Clasp I Clasp Infrabulge Clasp I bar Circumferential Embrasure Onlay Half and half Continuous Clasp Simple Circlet Reverse Circlet Multiple Circlet Ring Fishhook Combination

88. COMPONENTS OF A REMOVABLE PARTIAL DENTURE (RPD) EXTRA CORONAL DR INTRA CORONAL DR

89. SUPPORT : The foundation on which a dental prosthesis rests. STABILITY : Quality of a prosthesis to be firm, stable or constant and to resist displacement by functional, horizontal or rotational stresses. RETENTION : Quality inherent in the prosthesis to resist vertical forces acting to displace it away from its foundation.

90. ABUTMENT An abutment is tooth, a portion of a tooth or a portion of an implant that serves to support or retain a prosthesis.

91. HEIGHT OF CONTOUR A lines encircling a tooth, designating its greatest circumference at a selected position determined by a dental surveyor.

92. UNDERCUT : Portion of a tooth that lies between the HOC and the gingiva .

93. Angle of Cervical Convergence Angle viewed between a vertical rod contacting an abutment tooth and the axial surface of the abutment cervical to the height of contour.

94. Guiding Planes Two or more parallel surfaces of abutment teeth shaped to direct a prosthesis during its placement and removal.

95. S urvey line A line drawn on a tooth or teeth of a cast by means of a surveyor for the purpose of determining the positions of the various parts of a retainer

96. SURVEY LINES :

97. HIGH SURVEY LINE: From occlusal 1/3 rd in NZ to occlusal 1/3 rd in FZ MEDIUM SURVEY LINE: From occlusal 1/3 rd in NZ to middle 1/3 rd in FZ.

98. LOW SURVEY LINE: From cervical 1/3 rd in NZ to cervical 1/3 rd in FZ DIAGONAL SURVEY LINE: From occlusal 1/3 rd in NZ to gingival 1/3 rd in FZ

99. BLOCK OUT After the establishment of path of insertion and the location of undercut areas on the master cast, the areas that shall be crossed by the rigid parts of the denture must be blocked out. Roach carver or No.7 spatula used to adapt the blocking wax.

100. BLOCK OUT Four types: Parallel Blockout Shaped Blockout /Ledge Blockout Arbitrary Blockout Relief

101. DENTAL CAST SURVEYOR: An instrument used to determine the relative parallelism of two or more axial surfaces of teeth or other parts of a cast of a dental arch.

102. COMPONENTS OF A REMOVABLE PARTIAL DENTURE (RPD) STABILIZING/RECIPROCAL COMPONENTS: Imparts stability to denture against functional, horizontal and rotational stresses. Provided by: Reciprocal/ stabilizing arm of clasp assembly. Major connector (CAS) Vertical supporting minor connector (together with Maj. Connector.)

103. COMPONENTS OF A REMOVABLE PARTIAL DENTURE (RPD)

104. COMPONENTS OF A REMOVABLE PARTIAL DENTURE (RPD) DENTURE BASE : Rests on the foundation tissues and to which teeth are attached.

105. Impression A negative likeness or copy in reverse of the surface of an object ; imprint of teeth and adjacent structures for use in dentistry.

106. ACCORDING TO THE METHOD OF IMPRESSION MAKING

107. ANATOMIC FORM The surface of the residual ridge at rest. It is the shape of the ridge before functional load is applied.

108. FUNCTIONAL FORM It means the shape of the residual ridge tissue when it is functioning to support the denture base. It is the shape of the ridge after functional load is applied.

109. 124 Anatomic or Resting form Supporting or Functional form

110. CONCEPT OF FUNCTIONAL IMPRESSION The term functional impression means recording the functional form of the residual ridge tissue & to obtain uniformity of support when the functional load is applied.

111. NEED OF FUNCTIONAL IMPRESSION The displaceability of the mucosa of residual ridge is not uniform. The need of functional impression arises in cases of distal extension based partial denture. Some mouth does not exhibit significant difference in anatomical and functional form of ridge. Short span distal extension bases.

112. INDICATIONS FOR FUNCTIONAL IMPRESSION Mandibular distal extension partial dentures – Only a limited ridge area can be used as a stress bearing site. Mainly Kennedy’s class I & II edentulous arches.

113. OBJECTIVES OF FUNCTIONAL IMPRESSION (O.C. Applegate)

114. IMPRESSION MATERIALS Anatomic impression Irreversible Hydrocolloid Reversible Hydrocolloid Elastomeric Impression materials Functional impression Metalic pastes Elastomeric impression materials F luid waxes S oft liners

115. Cast An accurate and positive reproduction of a maxillary or mandibular dental arch made from an impression of that arch; further designated according to the purpose for which it is made, such as diagnostic cast, master cast, or investment cast; also may be used as an infinitive (to cast) or as an adjective (cast framework, or cast metal base).

116. Diagnostic cast

117. M aster cast

118. Refractory cast

119. Refractory cast

120. Altered cast technique Altered cast: a final cast that is revised in part before processing a denture base—called also corrected cast, modified cast Altered cast partial denture impression: a negative likeness of a portion or portions of the edentulous denture bearing area(s) made independent of and after the initial impression of the natural teeth. This technique employs an impression tray(s) attached to the removable dental prosthesis framework or its likeness

121. Alter cast

122. Duplication