L18 - Introduction to RPD and Classification ST_40c9bfed9ce261c40a548a7c6a14ff7e.pptx

Introduction to the partially edentulous state and Classification McCracken’s Removable Partial Prosthodontics 12th Edition Ch 1 Pages 2 – 7, Ch 3 Pages 16 – 20 L18 INTRODUCTION TO THE PARTIALLY EDENTULOUS STATE Dr. Alaa Refai 3 Definition of Removable Partial denture • A removable denture th...

Introduction to the partially edentulous state and Classification McCracken’s Removable Partial Prosthodontics 12th Edition Ch 1 Pages 2 – 7, Ch 3 Pages 16 – 20 L18 INTRODUCTION TO THE PARTIALLY EDENTULOUS STATE Dr. Alaa Refai 3 Definition of 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 ~ Glossary of Prosthodontic Terms, 9th Edition • A component of prosthodontics, which denotes the branch of dentistry pertaining to the restoration and maintenance of oral function, comfort, appearance, and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and craniofacial tissues with artificial substitutes. ~ Removable Partial Prosthodontics, 12th Edition 4 The basic objectives of prosthodontic treatment (1)The elimination of oral disease to the greatest extent possible (2)The preservation of the health and relationships of the teeth and the health of oral and para-oral structures, which will enhance the removable partial denture design (3)The restoration of oral functions that are comfortable, are esthetically pleasing, and do not interfere with the patient’s speech. 5 Consequences of Tooth Loss ANATOMIC 1. Loss of Ridge Volume (Residual Ridge Resorption) - both height and width not predictable Mandible Maxilla Posteriorly Anteriorly } Broader Mandibular arch Constricted Maxillary arch 2. Mucosal Changes - Associated with loss of bone - Attached gingiva replaced by less keratinized oral mucosa - Readily traumatized 6 Consequences of Tooth Loss PHYSIOLOGIC 1. Chewing (Mastication) - Usually controlled by input from Periodontal mechanoreceptors (PMRs), gingiva, mucosa, periosteum/bone and TMJ - Loss of teeth results in less precise muscular guidance from peripheral receptors 2. Esthetics - Loss of visible teeth is associated with social stigma - Change in facial features owing to altered lip support and/or reduced facial height 7 Need for Removable Partial Dentures • Partial edentulism is more common than complete edentulism • Not all patients can afford Implant treatment • Dentists need to understand how this treatment modality works to help maximize its benefits for the patients 8 What’s a Fixed Dental Prosthesis The general term for any prosthesis that is securely fixed to a natural tooth or teeth, or to one or more dental implants/implant abutments; it cannot be removed by the patient; - GPT9 Indications for RPD When FDPs are not a good choice due to: 1.Long edentulous spans 2.Lack of a posterior abutment (distal extension) 3.Abutments with short clinical crowns and unsuitable for fixed restorations 4.Structurally and anatomically compromised abutments • Absence of adequate periodontal support • Poor axial length/retention potential of abutments • Periodontally weakened teeth are present near the edentulous spaces 5.Expected Survival/ Value-Cost 6.Need to restore soft and hard tissue contour/Anterior esthetics 7.Severe loss of tissue on the edentulous spaces /Excessive loss of residual ridge 10 Indications for RPD When FDPs are not a good choice due to: 8. Insufficient numbers of abutments 9. Immediate replacement 10.Transitional treatment 11.After recent extractions 12.Cross arch stabilization 13.Ease of plaque removal 11 Indications for RPD When FDPs are not a good choice due to: 14.Age and health (young age, less than 17 years) 15.Attitude and desires of patient 16.Economic considerations 17.Multiple edentulous spaces 18.Abutment teeth are tipped and contraindicated for FDP 19.Insufficient bone for osseointegrated implants and/or lack of patient desire for an FDP 12 Contraindications for RPD 1 W he ne ve r F D P ca n be su cc es sf ull y us ed W he n or al hy gie ne is po or an d car ies su sc ep tibi lity is hig h La ck of pa tie nt co op er ati on or ap pr ec iat io n Whe n the prog nosi s for the rem aini ng natu ral teet h is dou btfu l and the resi dual ridg es afte r extr acti ons wou ld be goo d. 13 CLASSIFICATIO N 14 Requirements of an acceptable method of classification 1. It should permit immediate visualization of the type of partially edentulous arch that is being considered. 2. It should permit immediate differentiation between the tooth-supported and the tooth- and tissue-supported removable partial denture. 3. It should be universally acceptable. 15 Interesting facts • There are more than 12 different classifications • Most widely used and universally accepted is the Kennedy’s Classification with Applegate’s rules • Dr. Edward Kennedy proposed his classification in 1925 • Applegate modified the Kennedy classification in 1960 16 and added 8 rules CLASSIFICATION KENNEDY’S CLASSIFICATION CLASS I BILATERAL EDENTULOUS AREAS LOCATED POSTERIOR TO THE REMAINING NATURAL TEETH 17 CLASSIFICATION KENNEDY’S CLASSIFICATION CLASS II UNIILATERAL EDENTULOUS AREA LOCATED POSTERIOR TO THE REMAINING NATURAL TEETH 18 CLASSIFICATION KENNEDY’S CLASSIFICATION CLASS III UNIILATERAL EDENTULOUS AREA WITH NATURAL TEETH REMAINING BOTH ANTERIOR AND POSTERIOR TO IT 19 CLASSIFICATION KENNEDY’S CLASSIFICATION CLASS IV A SINGLE, BUT BILATERAL (CROSSING THE MIDLINE) EDENTULOUS AREA LOCATED ANTERIOR TO THE REMAINING NATURAL TEETH 20 Why did Kennedy classify Bilateral distal edentulous areas as Class I and a Unilateral distal edentulous area as Class II??? 1.A patient would go edentulous first on one side before going edentulous bilaterally. Although this is the case, Kennedy classified them on basis of which type of edentulous patients presented more to the clinics. Patients who lost teeth unilaterally could still chew on the other side, however, if they lost teeth on both sides it would hamper the function of mastication. 2.It is also for the purpose of designing. A Class II component design is a combination of the design for a Class I and Class III. It comprises of both a tooth-supported and a tooth-and-tissue-supported design. 21 APPLEGATE’S RULES 22 APPLEGATE’S RULES RULE 1 CLASSIFICATION SHOULD FOLLOW RATHER THAN PRECEDE ANY EXTRACTIONS OF TEETH THAT MIGHT ALTER THE ORIGINAL CLASSIFICATION 23 APPLEGATE’S RULES RULE 2 IF A THIRD MOLAR IS MISSING AND NOT TO BE REPLACED, IT IS NOT CONSIDERED IN THE CLASSIFICATION 24 APPLEGATE’S RULES RULE 3 IF A THIRD MOLAR IS PRESENT AND IS TO BE USED AS AN ABUTMENT, IT IS CONSIDERED IN THE CLASSIFICATION 25 APPLEGATE’S RULES RULE 4 IF A SECOND MOLAR IS MISSING AND NOT TO BE REPLACED, IT IS NOT CONSIDERED IN THE CLASSIFICATION 26 APPLEGATE’S RULES RULE 5 THE MOST POSTERIOR EDENTULOUS AREA (OR AREAS) ALWAYS DETERMINES THE CLASSIFICATION 27 APPLEGATE’S RULES RULE 6 EDENTULOUS AREAS OTHER THAN THOSE DETERMINING THE CLASSIFICATION ARE REFERRED TO AS MODIFICATIONS AND ARE DESIGNATED BY THEIR NUMBER RULE 7 THE EXTENT OF THE MODIFICATION IS NOT CONSIDERED, ONLY THE NUMBER OF ADDITIONAL EDENTULOUS AREAS 28 29 APPLEGATE’S RULES RULE 8 THERE CAN BE NO MODIFICATION AREAS IN CLASS IV ARCHES 30 CLASS EXERCISE Classify the following 31 32 33 34 35 36 Next Lecture Brief description of Dental Surveyors and Tooth Contours McCracken’s Removable Partial Prosthodontics 12th Edition Ch 7 Pages 86 – 87, Ch 11 Pages 130 -134 37