Other forms of removable partial denture

Other forms of removable partial denture

1. Other Forms of Removable Partial Dentures Prof. Amal F. Kaddah

2. Other Forms of Removable Partial Denture Dr. Amal Fathy Kaddah Professor of Prosthodontic Faculty of Dentistry Cairo University

3. When you realize you've made a mistake, take immediate steps to correct it.

4. Removable Partial Dentures (RPDs) Metallic Removable Partial Denture Acrylic Temporary Removable Partial Denture Other Forms of Removable Partial Denture

5. Unilateral RPD Swing-lock RPD Overlay partial denture (R P overdentures) Implant supported RPDs Attachments for RPDs Fixed-Removable partial dentures. Esthetic design of RPDs Other forms of removable partial denture

6. VII- Esthetic design of RPDs Rotational path of insertion I bar R L S MGR clasp Design Hidden Clasp/ Twin Flex/Saddle Lock EthetiClasp TM Equipoise Virginia RP (Cu- sil Partial Denture. gasket retention systems.)

7. Flexible Removable Partial Dentures Tooth coloured occlusal approaching clasps ( ‘invisible’ clasps ( optiflex ) Other alternatives ABonding composite to clasp arm Anodizing clasp arm 12. Precision & Semi-Precision Attachments for Removable Partial Dentures

8. Tooth and Tissue Supported RPD Tooth Supported RPD Metallic Removable Partial Denture

9. Types of Temporary RPDs Interim Removable Partial Denture (RPD) Transitional RPD Treatment RPD Immediate RPD * Tissue Supported RPD

10. Other Forms of Removable Partial Denture

11. CONTENT S UNILATERAL RPD SWING-LOCK RPD OVERLAY REMOVALE PARTIAL DENTURE IMPLANT SUPPORTED RPDs ATTACHMENTS FOR RPDs FIXED-REMOVABLE PARTIAL DENTURES ESTHETIC CLASPING PARTIAL DENTURES

12. Should be used with caution, as the chance of the denture becoming dislodged and aspirated is too great I- UNILATERAL REMOVABLE PARTIAL DENTURES

13. Bilateral RPD Unilateral RPD (Removable Bridge) Which restore missing teeth and extended on both sides of the dental arch

14. * Long clinical crown of abutment tooth * Buccal and lingual surfaces of the abutment tooth must be parallel to resist tipping forces * Retentive undercuts should be available on both the buccal and lingual surfaces of each abutment UNILATERAL REMOVABLE PARTIAL DENTURES

15. X Unilateral RPD (Removable Bridge)

16. Which has extensions into undercuts on the labial surfaces of the teeth . II- THE SWING-LOCK RPD

17. It consists of a labial/buccal retaining bar, hinged at one end and locked with a latch at the other, together with The swing-lock RPD a reciprocating lingual plate to gain a maximum retention and stability.

18. The bar incorporate rigid struts or an acrylic veneer which make prosthesis immobile. The swing-lock RPD

19. A labial acrylic veneer

20. INDICATIONS  Missing key abutment Reduced bone support

21. Gingival recession

22. The retching ( gagging) Patient Maxillofacial defects

23.   CONTRINDICATIONS Poor oral hygiene High smile line Soft-tissue limitations Certain malocclusion Alveolar limitations

24. The denture can be particularly helpful where the remaining natural teeth offer very little undercut for conventional clasp retention. Advantages

25. The “gate” can carry a labial acrylic veneer . This veneer can be used to improve the appearance when a considerable amount of root surface has been exposed following periodontal surgery. Advantages

26. Disadvantage As this type of denture covers a considerable amount of gingival margin, the standard of plaque control must be high.

27. III- OVERLAY REMOVABLE PARTIAL DENTURE Any removable dental prosthesis constructed over one or more remaining natural teeth, roots of natural teeth, and/or dental implants, providing additional support, stability & retention  = Overlay denture, = Overlay prosthesis, = Superimposed prosthesis

28. The endodontically treated abutment is prepared by removing the clinical crown few millimeters above the free gingival margin to create a dome-shaped preparation with a lightly chamfered margin extending slightly subgingivally .

29. Metal coping is made and cemented over the abutments. The removable partial overdenture is then completed in the usual manner.

30. 1- Preservation of the alveolar ridge Advantages of Overdentures Improved occlusal stress distribution. Edentulous mouth Bone loss of 6.6mm in 7 years. Dentate mouth Bone loss of 0.8 mm in 7 years . TallgreenA , Acta Odontol Scand 24: 195-239, 1966.

31. 2- Preservation of the remaining teeth 3- Preservation of proprioceptive response: Enhance neuromuscular control, occlusal awareness and biting force.

32. Improved Crown to Root ratio (C/R) Support and Stability . Controlled Retention through the use of attachments Increase the patient acceptance and Psychological Benefits Convertibility Conventional dental procedures

33. Disadvantages of Overdentures Gingival irritation 1. Covering the gingival margins Periodontal breakdown of the abutment teeth. 2. Caries susceptibility 3. Bony undercuts Limitation of the path of insertion Esthetic, Pain or retention Problems

34. Inadequate reduction of the abutment teeth may cause: Increased vertical dimension. Encroachment of the interocclusal distance. Esthetics

35. Interference with proper setting up of teeth Fracture of artificial teeth Fracture of the denture base

36. Expense and Time consuming Bulkier Removable Prosthesis

37. Types of over-Dentures Tooth supported over-dentures. Implant supported over- denture . Overdentures can be classified into 2 categories, depending on the types of abutment providing support

38. Definitive over-denture Interim and transitional over-dentures Immediate over-denture 4. Attachment retained over-denture Types of tooth supported Over-dentures This type of overdenture overlies natural tooth structures

39. Definitive over-denture Conventional partial over-denture Constructed over 1 or more abutment teeth Could be made entirely of acrylic resin or in conjunction with metal bases

40. Interim and transition overdentures Temporary RPDs Used for patients in transition or preparation phase until permanent overdenture constructed Patient old partial denture can be modified & used by extending the denture & add new artificial teeth using self cure acrylic resin

41. Immediate overdenture Constructed prior to preparation of abutment teeth & ready for insertion after preparation& reduction It enhances patient’s ability & adaptability to wear dentures

42. Attachment retained over-denture Constructed with an incorporated attachment to improve retention More expensive & more time for construction Indicated for patient with good oral hygiene & low caries index The abutment teeth should have good periodontal condition & adequate bone support

43. I V- IMPLANT SUPPORTED RPDs Lack of adequate support (tooth/soft tissue) results in displacement of bilateral and unilateral distal extension removable partial dentures. Placement of implants is one option for managing this problem Distal implants effectively convert a Kennedy Class I or II denture to a Kennedy Class III denture.

44. This type of over denture gains support from both the dental implants and intraoral tissues Implant-supported overdenture provides better stability of prosthesis and reduce bone resorption

45. Completed overlay RPD Implant-assisted overlay partial denture provides favorable biomechanics and also offers optimal esthetics for lip/cheek support and replace hard and soft tissue

46. Why Implants and RPD in this patient? Implants were in grafted bone Implant/restoration ratio unfavorable Facilitate support, stability, retention Implants, teeth, mucosa Esthetic considerations

47. V- Attachments for RPDs Attachment retained Partial denture Attachment retained Partial over-denture Classification of attachments based on their location and Design:

48. 1) Stud Attachments. 2) Magnetic Attachments. 3) Telescopic design 4) Bar attachments. 1- Attachment retained Partial denture 1) Intracoronal stud attachments. 2) Extracoronal stud attachments 2- Attachment retained over-denture

49. a) Rigid attachment Doesn’t allow movement of denture base, provide adequate retention. May induce more torque on abutment. b) Resilient attachment designed to permit some controlled movements of the denture base, during functional loading. Induces less torque on abutments. Resilient attachment Rigid attachment Classification of attachments based on their movement and function:

50. Precision Attachments Ready made attachments ( prefabricated from milled alloys, made of precious metal ) b) Semiprecision Attachments Fabricated in the dental laboratory Classification of attachments based on their method of fabrication and the tolerance of fit between the components

51. Precision Attachments They are Ready made attachments, their components are machined in special alloys under precise tolerance. Box or key way Frictional Retention One path of insertion Allows minimal to no rotation The components are interchangeable and usually easier to repair when necessary

52. A precision attachment is prefabricated from milled alloys, made of precious metal, and fit of two working elements. They are generally intracoronal and non‑resilient.. Precision Attachments Precision attachment can be described as a retainer used in fixed and removable partial denture.

53. Fabricated in the dental laboratory Economic benefits, easily fabrication Less intimate fit Principle to relieve stress Allows movement Resilient or stress releasing Lose stress distributing properties Semiprecision Attachments

54. Intracoronal attachments Precision Non-Resilient B. Extracoronal attachments Precision / Semi-Precision Resilient / Non-Resilient 1- Attachments retained Partial dentures ( Direct retainer Attachments )

55. Uses for Attachments Removable partial dentures Esthetics Retention Function

56. Metal receptacle (female part =matrix ) is incorporated entirely within the contour of the crown . A- Intracoronal attachments : Closely fitting component ( Patrix = male part) which is incorporated within the denture ) mates with the receptacle

57. Excessive tooth reduction and compromised embrasures, which result in oral hygiene and periodontal situation problems. In addition, all intracoronal attachments are non-resilient. A- Intracoronal attachments : Crown

58. Female portion of the attachment is within the crown

59. B- Extracoronal attachments All of their mechanism outside the contour of a tooth. Portion of attachment outside of crown/retainer contours (male or female) Minimal tooth reduction is necessary

60. B- Extracoronal attachments

61. Portion of the crown outside the crown abutment

62. Disadvantages Extra tooth preparation for intracoronal attachment If insufficient reduction, Over-contoured retainer

63. Contraindications Short clinical crowns Large pulps Dexterity problems Bruxers?

64. 2- Over-Denture Attachment 1- Stud Attachments. 2- Magnetic Attachments. 3- Bar attachments. 4- Telescopic retainers. It could be in the form of:

65. Consists of a male (stud), usually attached to metal coping cemented over prepared abutment and female (housing) embedded in the fitting surface of overdenture base. 1- Stud attachments

66. a- Intra-Radicular: The stud is attached to the fitting surface of the denture and the housing is incorporated in the abutment. e.g : Zest Anchor 1- Stud attachment

67. b- Extra-Radicular: The stud is attached to the metal coping cemented over the prepared abutment, while the housing is embedded in the fitting surface of the denture. e.g : Ceka , Rotherman , Gerber 1- Stud attachment

68. Overdentures with stud attachments Female housing is embedded in the fitting surface of the acrylic overdenture. 1- Stud attachment

69. 1- Stud attachment

70. Examples of stud attachments include: Ball and socket attachment O-rings attachment   Extra-radicular attachment (ERA) Locator (self-aligning) attachment 1- Stud attachment

71. Ball attachment: implant abutment while the socket (female unit) is incorporated on the fitting surface of the overdenture 1- Stud attachment This is the simplest system, consisting of a ball and a socket. The ball (male unit) is made on the

72. This system consists of a metal abutment analogue and a metal O-ring fitted with silicone ring. O-rings (ball type)attachment:   Note: Implants must parallel to one another O- ring 1- Stud attachment

73. Favorable stress distribution patterns (ball type only) Minimize the risk of implant loss secondary to implant overload "  Simple to use "  Less initial cost than a tissue bar O-rings (ball type)attachment:   1- Stud attachment

74. This system is deemed most suitable for parallel implant abutments. Extra-radicular attachment (ERA): Male Color Code: Black fabrication male White final male with light retention Orange final male with moderate retention Blue oversize male with heavy retention Grey oversize male with very heavy retention Yellow extra oversized male with more retention than grey Red extra oversized male with more retention than yellow 1- Stud attachment

75. Completed overlay RPD White-colored (the least amount of retention) ERA were used on the implants. Support, stability, and retention are achieved Support provided by the positive occlusal and cingulum rests and the full palatal coverage Extra-radicular attachment (ERA):

76. It is usually indicated when the implant abutments are non-parallel to each other 1- Stud attachment Locator (self-aligning) attachment:

77. * Can be used in cases of limited inter-arch space. *Can accommodate inter implant angulations up to 40°. 1- Stud attachment Locator (self-aligning) attachment:

78. Provides dual retention, one is mechanical and another is frictional. The nylon male head is slightly oversized than its female component which provides frictional fit. 1- Stud attachment Locator (self-aligning) attachment:

79. The outer margin of attachment engages the shallow undercut area on abutment to provide outer mechanical attachment . Locator (self-aligning) attachment: 1- Stud attachment

80. *They cannot be used in cases where rigid restoration is required. *Regular replacement of male nylon part due to constant wear and tear. Disadvantages of using locator attachments: 1- Stud attachment Locator (self-aligning) attachment:

81. 2- Magnetic attachments Small, strong mini magnets One of poles cemented in a prepared cavity in endodontically treated abutment & the other attached to denture base

82. Maxillary and mandibular removable overlay dentures using magnetic attachments

83. Dental magnet placed on abutment keepers ready to be cured to the denture

84. A Kennedy class II defect dentine was restored by a magnetic attachment- supported RPD

85. 3- Bar attachment A bar contoured to connect abutment teeth together, run parallel & overlie residual ridge Provide support & retention for overdenture & splint abutment teeth Bars may be in form of preformed metal or plastic

86. A- Bar units Rigidly fixed to copings, don’t allow any movement between bar & sleeve Transmits occlusal stresses totally to abutments “tooth born”

87. B- Bar joints Resilient attachments allowing movement between bar & sleeve Support provided by both residual ridge & abutment teeth “tooth tissue born”

88. Bar attachment Sleeve Clip, into which the bar will slot Bar

89. The application of computer-aided design and computer-aided manufacturing (CAD/CAM) in the fabrication of the overdenture framework simplifies the laboratory process of the implant prostheses. CADCAM-Bar

90. The CAD/CAM System was utilized to produce a lightweight titanium overdenture bar with locator attachments. CADCAM-Bar

91. The digital workflow of CAD/CAM milled implant overdenture bar allows us to avoid numerous technical steps and possibility of casting errors involved in the conventional casting of such bars . CADCAM-Bar

92. 4- Telescopic Overdenture “Telescopic Overdenture”= Milled primary copings with parallel walls and the denture has secondary copings. Retention is gained from friction due to the parallel walls of the primary copings and the precise fit of the secondary copings, full extension of flanges is not critical.

93. Gold or metallic cast Copings and telescopic crowns are a method of improving overdenture retention. These may be conical crowns (semi-parallel wall) with a friction adaptation at the marginal area of the abutment or Milled crowns for larger areas and parallel surfaces.

94. Friction retention is more commonly used in exclusively tooth-supported overdentures that are not supported by soft tissue.

95. VI- FIXED-REMOVABLE PARTIAL DENTURE The replacement of missing teeth and restoration of alveolar contour. Situations of trauma and cleft lip and palate, and after the surgical excision of pathoses . Reduction of the surrounding volume of hard and soft tissues is even more pronounced

96. The Andrews fixed dental prosthesis was first introduced in 1976 by James Andrews, Consisted of a bar soldered to retainers at each end onto which a denture is clipped.

97. - Extensive alveolar bone loss - Median diastema - Unfavorable skeletal relationships INDICATIONS

98. Precision attachments can be used in conjunction with other conventional means of retention for removable prostheses  Gold crowns have been placed on the  molar teeth   incorporating rest seats, guide planes and undercuts to achieve support, stability and conventional retention. Retention is achieved anteriorly using a precision attachment on the upper left  lateral incisor  root.

99. the female ‘clip’ attachment is embedded into the fit surface of the denture  This tooth has been root treated and prepared for a cast post and diaphragm onto which is soldered the male component of a Rothermann type precision attachment;

100. VII- ESTHETIC DESIGN OF RPDs

101. Alternatives to the circumferential clasp Rotational Path I Bar RLS MGR Saddle-Lock ® EsthetiClasp TM Equipoise® Gaskets VII- ESTHETIC DESIGN OF RPDs

102. Flexible (polystyrene/ valplast ) Tooth coloured occlusal approaching clasps ( ‘invisible’ clasps ( optiflex ) Other alternatives Bonding composite to clasp arm Anodizing clasp arm 12. Precision & Semi-Precision Removable Partial Dentures

103. 1. Rotational Path Partial Dentures Dual Path of Insertion Partial Dentures Conventional All rests seat simultaneously Rotational Path Insertion sequence First segment containing rotational center Second segment rotated into final seat Conventional Vs Rotational Path RPD

104. 1- Elimination of clasps on one side of RPD Rotational Path RPD Objectives 3- Esthetic and Appearance 2- Create Guiding planes and retentive areas

105. Place rigid element into undercut Rotate other end into place (clasps ) Rotational Path RPD 1- Elimination of clasps on one side of RPD

106. Place in Undercut, Rotate Clasp into Place

107. Diagrammatic representation of seating of the RPD framework, eliminating anterior clasps. [From Jacobson: JPD 1994; 71:271-7]. a = long anterior rest acting as the rotational center for insertion of RPD. 

108. RPD rotated in position. No anterior clasp. a = minor connector relieved following the curve of insertion. b = Minor connector providing retention 

109. Large deep rests to provide support, reciprocation Reciprocation from adjacent teeth No rigid elements in undercut Principles

110. Conventional versus Rotational Path

111. Guide planes in addition to Esthetic they provide retention and effective in stabilizing weakened teeth 2- Create Guiding planes and retentive areas

112. A cast in a tilted relationship represents a path of placement toward the side of the cast that is tilted upward

113. Without guiding planes, Clasps designed are ineffective when restoration is subject to dislodging forces in occlusal direction

114. Undercuts may affect appearance when anterior teeth are to be replaced Mesial undercuts on teeth adjacent to saddle ; bony undercut labially Cast tilting may reduce anterior spaces and reduce blocking out of labial undercut 3- Esthetic and Appearance

115. Undercut on the mesial aspects of the abutment teeth >> if the RPD is constructed with this vertical path of insertion >> Unsightly gaps between the saddle and the abutment teeth gingival to the contact point >> Giving the cast a posterior tilt >> avoid these gaps >> better appearance This unsightly gap can be avoided by giving the cast a posterior tilt

116. BY POSTERIOR TILT THIS UNSIGHTLY GAPS CAN BE AVOIDED By rotational path of insertion

117. Path of insertion is marked on the cast using parallel lines Minimal anterior spacing is achieved with an upwards and backwards path of insertion

118. How is problem of interference overcome ? Avoidance - changing path of insertion • Elimination - modify teeth (or bone ?) • Exploitation - sectional dentures - Surgery to remove interfering structures - Contouring the tooth surface

119. For example, if a bony undercut is present labially , insertion of a flanged denture along a path at right angles to the occlusal plane will only be possible if the flange stands away from the mucosa or is finished short of the undercut . This can result in poor retention and appearance

120. Posterior tilt f the cast, thus the path of insertion is parallel to the labial surface of the ridge. Thus, it is possible to insert a flange that fits the ridge accurately

121. Undercut Alveolar Ridges The labial undercut here is a source of ‘interference’

122. 2. I bar Mesial occlusal rest Distal guide plane with proximal plate Buccal bar clasp Less visible than a circumferential clasp

123. 3. RLS Clasp Mesio -occlusal Rest , A distolingual L-bar direct retainer Distobucca Stabilizer Advantages: Reduces torque on the abutment tooth. Clasp disengagement as the distal extension base moves tissue-ward in function Hiding Denture Clasp

124. The design of clasp for a distal extension RPD that helps preserve both 3. RLS Clasp the abutment teeth and the tissues of the edentulous ridge is described.

125. 4. MGR Clasp Design M esial G roove R eciprocation Retention: 19 gage round W.W. I bar Retentive dimple at distal buccal Reciprocation Mesial groove/rest Distal proximal plate

126. distal facial I-bar (wrought wire 19 ga.) M esial G roove R eciprocation shallow rest Lingual view

127. NO!

128. 5. Saddle-Lock ® - hidden clasp r = retainer that emerges from denture base to engage the undercut on the proximal tooth surfaces. b = bracing arm p = proximal minor connector with relief space to allow flexure of the retainer. 

129. Saddle-Lock ® - hidden clasp Advantages Esthetics Limitations No metal horizontal shoe extension Short retentive arm Adjustment access

130. Utilizes proximal undercuts Encircles tooth 181° L clasp C clasp 6. EsthetiClasp TM

131. L-Clasp Clasp arm extending from lingual minor connector Independent reciprocal rest L > rigidity than C EsthetiClasp TM

132. C-Clasp Modified back-action clasp Rest incorporated in clasp C > flex than L EsthetiClasp TM

133. 7. Equipoise RPD System Esthetic retentive concept for distal extension situations Rests placed away from edentulous span 1mm vertical inter-proximal reduction between abutment and adjacent tooth Proposed by J.J. Goodman

134. Equipoise Lingual back-action clasp reciprocated Minimal facial clasp display.1mm

135. Labial view of a different RPD with an equipoise clasp on tooth 22, satisfying the aesthetics as the clasp assembly is inconspicuous

136. Optional Bu-Li retentive groove at mid and gingival third junction on distal surface of abutment tooth Equipoise RPD System

137. Occlusal view of the clasps placed on the 13 and the 24 as part of a Kennedy class IV RPD.  Equipoise Clasp:

138. Equipoise ® - Critique Caries susceptible preparation Mesial proximal plate torque Minimal Stress release Potential loss of proximal space ( Greater preparation) Requires greater surveillance Kennedy Class III situations Visible metal mesial embrasure display

139. Cu-Sil is a tissue-bearing appliance featuring a soft elastomeric gasket 8- Cu-Sil® PARTIAL OVERDENTURES Gasket Retention Systems

140. It clasps the neck of each natural tooth, sealing out food and fluids, cushioning and splinting each natural tooth from the hard denture base. 8- Cu-Sil® PARTIAL OVERDENTURES Gasket Retention Systems

141. 8- Cu-Sil® PARTIAL OVERDENTURES Gasket Retention Systems It helps prevent tooth loss and improves the prognosis of loose, mobile, isolated, elongated or periodontally involved abutments by eliminating wear, stress and torque .

142. It is a  denture  with holes, lined by a gasket of silicone rubber , the holes thus providing space for remaining natural teeth to emerge into the oral cavity through the  denture 8- Cu-Sil® PARTIAL OVERDENTURES Gasket Retention Systems

143. It is an acrylic tissue-bearing appliance featuring a soft elastomeric gasket which clasps the neck of each natural tooth, Sealing out food and fluids, and cushioning and splinting each natural tooth from the hard denture base. 8. Gasket Retention Systems(Cu- sil )

144. Cu-Sil – Elastomeric No clasps Silicone gasket around teeth Retaining their very few remaining teeth. 8. Gasket Retention Systems(Cu- sil )

145. Flexite / Valplast –Thermoplastic Compensates for lost bone/gingival height 8. Gasket Retention Systems(Cu- sil )

146. It is an innovative approach to preserve the few remaining natural teeth Cu - sil denture  is the simplest RPD, No special impression techniques or materials are required. 8. Gasket Retention Systems(Cu- sil )

147. It is a practical alternative to overdentures It can be used for roofless uppers and free end partials where tooth contour is insufficient to cast clasps. It improves the prognosis of loose, mobile isolated elongated or periodontally involved abutments 8. Gasket Retention Systems(Cu- sil )

148. Mechanical undercut of the remaining natural teeth was examined with the help of a surveyor and blocked out using dental plaster. 8. Gasket Retention Systems(Cu- sil )

149. It is an excellent option for the patients who want to replace their missing teeth while retaining their very few remaining teeth. 8. Gasket Retention Systems(Cu- sil )

150. Preserving the remaining natural teeth and have a positive effect on retention and stability of dentures. 8. Gasket Retention Systems(Cu- sil ) It gives the patient psychological satisfaction of retaining the natural teeth.

151. Future add-ons and relines are possible. The Cu- sil like denture can serve as conventional full denture if the patient later loses all the natural teeth. Cu- sil dentures serve as a solution for lone standing or very few remaining teeth present in the dental arch. No need of endodontic procedures 8. Gasket Retention Systems(Cu- sil )

152. Cu-Sil Bitem 8. Gasket Retention Systems(Cu- sil ) Limitations Hygiene Caries potential and Perio risk Liner lifespan Deterioration Bond Elasticity Yeast

153. Difficult to adjust, polish Tend to tear, rough surface 8. Gasket Retention Systems(Cu- sil )

154. 9- FLEXIBLE (POLYSTYRENE/ VALPLAST) Biocompatible nylon and thermoplastic resin-flexibility and stability. Color, shape and design of valplast partials blend with natural appearance of gingiva making prostheses nearly invisible.

155. FLEXIBLE (POLYSTYRENE/VALPLAST ) Strength of valplast resin doesn’t require a metal framework-eliminates metallic taste. Enables partial to be fabricated thin enough with non metallic clasps.

156. Polymethylene clasps are alternative to metal clasps 10. Tooth coloured occlusal approaching clasps ‘Invisible’ Clasps ( Optiflex ) Non-metal, White Opti•Flex Coating applied to metal clasps Thick, white, ugly clasp? Porous (plaque) Fatigue Bulky (comfort)

157. Bonding composite to clasp arm Anodizing clasp arm 11 - Other alternatives

158. 12. Precision & Semi-Precision RPDs Partial overdenture Extracoronal attachments

159. Summary - Esthetic Clasps Retention location Components Preparation Lab support Colour

160. The choice of the RPD design should be based on biologic as well as mechanical principles. The dentist responsible for the treatment rendered must be able to justify the design used for each case in keeping with these principles. Conclusion

161.   Applegate O.C.: Essentials of removable partial denture prosthesis. 1st ed. Philadelphia (PA): W. B. Saunders Co. 2000. Aviv I, Ben-Ur Z, Cardash HS . An analysis of rotational movement of asymmetrical distal-extension removable partial dentures. J Prosthet Dent; 61:211-214. 1989. Davenport, J.C. and Pollard, A.: Aspects of partial denture design; University of Birmingham .U.K. 2005. Davenport, J.C., Basker , R.M., Heath, J.R. and Ralph, J.P.: A colour Atlas of Removable Partial Dentures. Wolfe Medical Publications Ltd. 2005. Applegate O.C.: Essentials of removable partial denture prosthesis. 1st ed. Philadelphia (PA): W. B. Saunders Co. 2000. Bas Garcia LT. The use of a rotational-path design for a mandibular removable partial denture. Compend Contin Educ Dent;25:552-567. 2004. El Gamrawy , E. A.: Basic principles of Removable Partial Denture. Clinical course. Fifth ed. 1990. Firtell DN, Jacobson TE. Removable partial dentures with rotational paths of insertion: Problem analysis. J Prosthet Dent;50:8-15. 1983. Garver DG. A new clasping system for unilateral distal extension removable partial dentures. J Prosthet Dent;39: 268-273. 1987. Halberstam SC, Renner RP. The rotational path removable partial denture: The over-looked alternative. Compendium;14: 544-552. 1993. J. C. Davenport, R. M. Basker , J. R. Heath, J. P. Ralph, P-O. Glantz and P. Hammond: Clasp design, BDJ. JANUARY 27, VOLUME 190, NO. 2, PAGES 71-81. 2001 J. C. Davenport, R. M. Basker , J. R. Heath, J. P. Ralph, P-O. Glantz 5 and P. Hammond: Indirect retention, EBRUARY 10, VOLUME 190, NO. 3, PAGES 128-132. 2001 Davenport, J. C., R. M. Basker , J. R. Heath, J. P. Ralph, P-O. Glantz 5 and P. Hammond: Surveying NOVEMBER 25, VOLUME 189, NO. 10, PAGES 532-542. 2000 Davenport, J. C.,. Basker R. M,. Heath, J. R. Ralph J. P,. Glantz P-O and Hammond P.: Tooth preparation, MARCH 24, VOLUME 190, NO. 6, PAGES 288-294. 2001 .   Davenport J. C., R. M. Basker , J. R. Heath, J. P. Ralph, P-O. Glantz 5 and P. Hammond: Bracing and reciprocation, JJANUARY 13, VOLUME 190, NO. 1, PAGES 10-14,2001. Davies, R. M. J. Gray and J. F. McCord: Good occlusal practice in removable prosthodontics NOVEMBER 10, VOLUME 191, NO. 9, PAGES 491-502. 2001 Jacobson TE, Krol AJ. Rotational path removable partial denture design. J Prosthet Dent;48:370-376. 1982 Jacobson TE. Rotational path partial denture design: A 10-year clinical follow-up—Part I. J Prosthet Dent;71:271-277. 1994 Kaddah, A. F.: OCCLUSION IN PROSTHODONTICS , Varieties, Aberrations & Management. Dar Eletehad . First Co. First ed. Cairo Egypt. 98/7071, 1998. Kratochvil : Removable Partial Prosthodontics, 5 th ed. St. Louis (MO): C.V. Mosby Co. 1990. Krol AJ, Finzen FC. Rotational path removable partial dentures: Part 1. Replacement of posterior teeth. Int J Prosthodont;1: 17-27. 1988 McCracken W. L.: Partial denture construction. Eleventh ed. St. Louis (MO): C.V. Mosby Co.; 2005 Raymond J. Byron Jr.,. Robert Q. Frazer, , Michael C. Herren, : Rotational path removable partial denture: An esthetic alternative . Featured in General Dentistry , May/June. Pg. 245-250. 2007. Reagan SE, Dao TM. Oral rehabilitation of a patient with congenital partial anodontia using a rotational path removable partial denture: Report of a case. Quintessence Int;26:181-185. 1995. Schwartz RS, Murchison DG. Design variations of the rotational path removable partial denture. J Prosthet Dent 1987;58:336-338. ic principles of Removable Partial Denture. Clinical course. Fifth ed. 1990. Swenson M, Terklo L.: Partial denture. 1st ed. St. Louis (MO): C.V. Mosby Co.1975. Ting-Ling Chang: Removable Partial Dentures; Division of Advanced Prosthodontics – lecture, UCLA School of Dentistry. Bibliography

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