Removable Partial Dentures Quiz

Clinical Partial Denture Prosthodontics

• Presented in lectures and clinical phases
• Student training in prosthodontic therapeutic techniques will focus on procedures that are part of comprehensive patient care from a general dentistry standpoint.
• Emphasis on proficiency in basic removable partial denture prosthodontics techniques.

Professional Performance Standards

• Students will be able to identify, manipulate, and understand the properties of all materials used in clinical and laboratory procedures.
• Students will follow a complete diagnostic procedure and treatment plan, including any pre-prosthetic management.
• Students will be able to perform basic clinical steps like impression making, mouth preparation, jaw relation recording, try-ins, insertion procedures, and post-insertion problem management.
• Students will be able to perform related laboratory procedures.
• Students will evaluate treatment results.
• Students will evaluate patient care for proper prosthesis and oral tissue maintenance.

Course Topics

• Examination of partially edentulous patients
• Primary impressions and diagnostic casts
• Indications and contraindications of removable partial dentures
• Surveying procedures
• Designing work authorizations for laboratory technicians
• Principles of partial denture design, including clasp, major connector, minor connector, and rest design.
• Management of distal-extension base partial dentures (Kennedy Class I and II)
• Management of class III and IV (Kennedy modifications)
• Mouth preparation for removable partial dentures (R.P.Ds)
• Modification of abutment tooth contours
• Definitive impressions for R.P.Ds
• Try-in of metal frameworks and inter-maxillary relations for R.P.Ds
• Selection and arrangement of artificial teeth, try-in of waxed-up partial dentures
• Insertion of partial dentures, advice to R.P.D patients, adjustment, and follow-up procedures
• Repair of R.P.Ds and addition of clasps
• Harmful effects of R.P.Ds
• Special, unconventional R.P.Ds
• Prosthetic aspects of dental implants
• Implant-retained removable partial dentures
• Implant-retained complete overdentures
• Implant-retained fixed detachable complete dentures
• Maxillofacial prosthodontics

Effect of Tooth Loss

• Images illustrating the effects of tooth loss.

Partial Denture Prosthodontics

• Replacement of missing teeth for partially edentulous patients
• Design and construction emphasizing the preservation of remaining oral structures.

Removable Partial Denture Treatment Objectives

• Preserve remaining oral structures
• Provide adequate masticatory function
• Restore natural appearance
• Restore normal speech
• Enhance the patient's quality of life

Limitations of Removable Partial Dentures

• Natural teeth are firmly rooted in the jaw bone, while artificial dentures rely on abutment teeth for retention.
• Removable partial dentures maintain strategically important teeth if implant options aren't available.
• Prosthetic flanges can maintain facial fullness.
• Abutment teeth for removable dentures are at high risk for caries and periodontal disease.
• RPDs are complex devices; technical errors can lead to complications.
• Biological, mechanical, aesthetic, and psychological patient factors impact prosthesis acceptance and treatment success.
• Patient age, experience, and tooth replacement position influence self-reported satisfaction.

R.P.Ds Complications

• Plaque accumulation causing decalcification and caries in teeth and inflammation of gingival tissues, progressing to underlying structures.
• Direct trauma to teeth, abrasions, and fractures of restorations.
• Transmission of excessive functional forces.
• Occlusal errors causing tooth mobility, and aggravation of existing periodontal disease.
• Inflammation of mucous membranes, localized inflammation, and denture-induced hyperplasia
• Muscle dysfunction.

Alternative Treatment Options

• Illustrations of different treatment options.

Shortened Dental Arch Concept

• Anterior and premolar dental arches are sufficient for functional dentition.
• Functional needs and number of teeth vary per individual, requiring tailored treatment.
• Shortened dental arch (SDA) treatment offers oral functionality, improved oral hygiene, comfort, and cost reduction without compromising patient care.

Diagnosis and Treatment Planning

• Diagnosis involves examining the physical and psychological state of the patient to ensure a predictable outcome.
• Treatment planning for partially edentulous mouths must address caries and periodontal disease control.
• Restorations of individual teeth, harmonious occlusal relationships, and replacement of missing teeth using fixed or removable prostheses are crucial elements of comprehensive care.
• The selection and sequencing of treatment should precede irreversible procedures.

History Taking

• Essential details, including chief complaint, expectations, and health information are obtained.
• Data gathered should include: Patient data (name, address, phone number, age, sex, and occupation), Chief Complaint, Medical History, Dental History, and Prosthesis History (satisfactory or unsatisfactory).

Medical History

• A thorough medical history is crucial and must be updated as needed.
• Reviewing allergies, medication (including blood thinners), current medical conditions such as poorly controlled diabetes, cardiovascular diseases, bleeding disorders, osteoporosis, chronic obstructive pulmonary diseases, psychological conditions, and drug interactions are essential.
• Potential systemic and local conditions affecting tooth replacement success can be categorized for diagnosis and treatment.

Dental & Prosthesis History

• Patient's dental history, including the starting and severity of dental disease, and reaction to previous treatment.
• Inquiries about past extractions and any difficulties associated with them.
• Radiographic investigations are necessary to rule out potential over-retained roots or pathologies following tooth extractions.
• Allowing sufficient time for healing and ridge stability after tooth extractions is crucial.
• Consideration for the use of temporary appliances, previous prosthetic experiences, and duration of denture wear are important factors for prognosis.

Observation of the Patient

• General appearance, complexion, and details about facial features.
• Classifications of mental attitudes: philosophical, exacting, indifferent, and hysterical patients to inform optimal treatment approaches.

Cross-Infection Control

• Procedures to prevent cross-infection and ensure operator safety, using appropriate barriers, sterilization, and immunization protocols.
• Clean-up of instruments and surfaces in the operatory.
• Use of iodine or chlorine (diluted household bleach solutions) to clean surfaces.
• Handling contaminated disposable materials carefully and discarding them in plastic bags.
• Punctures and scalpel blades must be contained in puncture-resistant containers before disposal.

Clinical and Laboratory Disinfection

• Immunization protocols
• Barrier system implementation
• Hand washing with antimicrobial soap
• Personal protective equipment (PPE): gloves, mask, eyewear, face shield, and protective clothing
• Instrument sterilization and/or disinfection

Recommended Infection Control Practices

• Use gloves
• Use masks to protect oral and nasal mucosa
• Protect eyes with appropriate covering
• Properly sterilize dental instruments
• Use appropriate sterilizing equipment: steam autoclave, dry heat oven, chemical vapor sterilizers, chemical disinfectants

Denture Stomatitis

• Image examples provided.

Prosthetic Appliances

• Illustrations and instructions for cleaning/disinfecting prosthetic appliances.

Facial Examination

• Frontal view: forehead, zygomatic arch, and mandibular angle
• Profile view: Convex, straight, and concave lip lines
• Detailed examination for identification and diagnosis.

Clinical Examination

• A complete clinical examination providing information to arrive at a specific diagnosis.
• The examination should include evaluation of the maxillofacial extra-oral and intra-oral tissues, taking impressions, and obtaining records and radiographs for articulation, and photographs.
• Careful collection of essential information

Extra-Oral Examination

• Assessing facial form and symmetry.
• Evaluating jaw movements and palpation of the temporomandibular joints (TMJs) and jaw muscles.
• Evaluating muscle tone (good, fair, or poor)
• Evaluation of the temporomandibular joint including; deviation, tenderness, clicking, and dislocation
• Checking lymph nodes.
• Conducting esthetic risk assessments (ERA)
• Illustrations of extra-oral examinations.

Intra-Oral Examination

• Assessment of denture bearing areas (incisive papillae, rugae, residual ridges, palatine raphe, maxillary and mandibular tuberosities, hamular notches, vibrating line, and palatine fovea).
• Evaluation of buccal frenum, buccal sulcus, zygomatic buttress, and other intra-oral areas.
• Preliminary visual inspection of oral hygiene, level of caries susceptibility, quality of restorations. Addressing of specific complaints, and initiating emergency interventions.
• Examination of soft tissues and possible pathologies (denture stomatitis).
• Evaluation of dental arches and edentulous spaces, with alignment, and relationship to existing teeth. - Assessment of the form of the residual ridge and the compressibility of soft tissues.
• Evaluation of the integrity of existing restorations and charting of carious cavities.
• Determining the health of periodontium and assessing plaque control, recording pocket depths. Observing any mobility of remaining teeth, especially abutment teeth.
• Determining the floor of the mouth position and border tissue attachments.
• Evaluation of dental arches and edentulous spaces, with alignment, and relationship to existing teeth.

Radiographic Evaluation

• Radiographs are an important part in determining if adjacent teeth and bone are free of pathology.
• The minimum includes panoramic, bite-wing, and periapical radiographs.
• Radiographs are used to check for new or recurrent carious lesions, assessing extent of bone loss, and identifying any pathological changes.

Preliminary Impressions

• Obtaining accurate impressions of a patient's mouth using stock trays.
• Creating study casts needed for treatment planning, denture design, and definitive impression trays.
• Selection of suitable tray size, adequate space between the tray and teeth, use of utility wax to expand tray coverage, and applying impression material in areas of inadequate tray coverage.
• Application of adhesive to the tray, loading with alginate, seating the tray in the mouth, and taking and disinfecting the impression.

Disinfecting Impressions

• Rinsing and disinfecting impressions to remove saliva, blood, and debris.
• Immersion disinfection preferred to spraying, as it ensures all surfaces are exposed to disinfectants.
• Using appropriate solutions such as iodophors, chlorine solutions, glutaraldehydes, or phenols.
• Labeling all disinfected items, and indicating decontamination.

Disinfecting Impression Trays

• Cleaning and disinfecting plastic disposable trays.
• Using sodium hypochlorite as a disinfectant but monitoring for corrosion.
• Heat sterilizing impression trays as an alternative.

Diagnostic Casts

• Accurate reproduction of all potential features aiding diagnosis. Include, tooth locations, contours, occlusal plane, residual ridge contour, size, mucosal consistency, and oral anatomy.
• Information from appropriate cast mounting: occlusal plane orientation, impact on opposing arch, tooth/palatal soft tissue relationship, and tooth/ridge relationship (vertical/horizontal).

Mounting

• Related casts to anatomical articulators for understanding occlusion's role in removable partial denture design and stability.

Occlusal Records

• Recording occlusal relationships using inter-cuspal position or wax templates.
• Constructing wax blocks when insufficient teeth are remaining for a thorough record.

Diagnosis

• Using the patient's chief complaint, and gathered history, examination, and testing and investigation results, a definitive diagnosis is derived.

Treatment Plan

• Implementing any necessary emergency treatment.
• Taking impressions, creating casts, and mounting them on articulators as needed.
• Developing and discussing treatment options with the patient including alternatives.
• Explaining the possible pre-prosthetic procedures required if removable partial dentures (RPDs) are considered.
• Treatment options may include no treatment, extraction, or full dentures.

Advantages and Disadvantages of Treatment Options (Removable Prostheses)

• Summarizing advantages and disadvantages of using removable prostheses, including replacing multiple teeth in different sites, being used in growing patients, potentially accommodating further loss of teeth, accommodating missing soft tissue, good lip support, good aesthetics, and low cost.
• Summarizing disadvantages including possible patient dislike, covering soft tissue and compromising periodontal health, spoiling aesthetics, and having moderate maintenance needs.

Advantages and Disadvantages of Treatment Options (Fixed Prostheses, including Resin Bonded Bridgework and Conventional Partial/Full Coverage Bridgework)

• Summarizing advantages and disadvantages of using fixed prostheses, especially advantages and disadvantages of resin bonded bridgework and conventional partial or full coverage bridgework.

Advantages and Disadvantages of Treatment Options (Implant-retained prostheses)

• Fixed or removable. Dependent upon bone quantity and quality, involving surgery. High initial expense and lengthy time. Moderate maintenance.
• Immune to dental caries, high predictability, good maintenance of supporting bone.

Treatment Choice

• The choice of treatment may rest with the patient, dependent on their wishes and financial capacity and willingness to undergo treatment.
• Patient expectations should be realistic.

Summary

• Presentation of treatment alternatives to the patient, highlighting advantages and disadvantages relevant to their situation.
• Outlining treatment plans, estimated costs, detailed descriptions, and projected timelines.
• Ensuring the patient's understanding of proposed treatments.
• Obtaining written consent regarding the treatment plan.

R.P.D Design

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Test your knowledge on removable partial dentures (RPDs) and their advantages, design considerations, and patient acceptance factors. This quiz covers crucial aspects regarding oral rehabilitation and the Shortened Dental Arch concept. Assess your understanding of the management strategies and risks associated with RPDs.