CC_-PROSTHO-1-RPD-1.pdf

Topic 6: Removable Partial Denture [DCCPRO1C] [DCCPRO1C ] : CLINICAL CONFERENCE PROSTHODONTICS 1 S...

Topic 6: Removable Partial Denture [DCCPRO1C] [DCCPRO1C ] : CLINICAL CONFERENCE PROSTHODONTICS 1 SY 2024-2025 1ST SEMESTER [DR. NICK C. GUZMAN] ○The esthetic impact of tooth loss can be highly significant and may be more of a OUTLINE concern to a patient than loss of function. It is generally perceived that in today’s I Removable Partial Denture society, loss of visible teeth, especially in A Tooth Loss and Age B Consequences of Tooth Loss the anterior region of the mouth, carries C Terminology with it a significant social stigma. II. Consideration for Managing Partial Tooth loss NEED FOR RPD - will increase ○ Patient use of removable partial dentures has been high in the past and is expected CHAPTER1. to continue in the future as an aging REMOVABLE PARTIAL DENTURE (RPD) population who retains more teeth will replaces missing tooth or teeth in a partially present with more partially edentulous edentulous arch conditions. Designed by the dentist to be easily removed and replaced by the patient Terminology Objectives of Prosthodontic Trearment APPLIANCE - device, prosthesis 1 – elimination of oral disease to the greatest extent ○ Splints, orthodontics possible PROSTHESIS - an artificial replacement of part of the 2 – preservation of the health and relationships of the human anatomy restoring form, function, and esthetics teeth and the health of oral and paraoral structures, ○ Denture, FPD, bridges, crowns which will enhance the RPD design PROSTHESIS, RESTORATION, AND DENTURE used The restoration of oral functions that are comfortable, synonimously esthetically pleasing and do not interfere with the ○ Can be used and convey the same patient’s speech. meaning Tooth loss and Age SUPPORT - the foundation area on which a dental Interarch- the interridge distance; the vertical distance prosthesis rests; with respect to dental prostheses, the between the maxillary and mandibular dentate or resistance to forces directed toward the basal tissue or edentulous arches under specified conditions underlying structures ○ Pertains to upper and lower (retain teeth in ○ to hold up, serve as a foundation, or prop lower longer) STABILITY - 1. that quality of maintaining a constant Intraarch - posterior is more or have more roots character or position in the presence of forces that threaten to disturb it; the quality of being stable; to Consequences of Tooth Loss stand or endure; 2. The quality of a complete or Residual ridge removable partial denture to be firm, steady, or ○ With the loss of teeth, the residual ridge constant, to resist displacement by functional no longer benefits from the functional horizontal or rotational stresses; 3. resistance to stimulus it once experienced. Because of horizontal displacement of a prosthesis this, a loss of ridge volume—both height ○ Quality of prosthesis to resist and width—can be expected unless a displacement (horizontal rotation) dental implant is placed. RETENTION -that quality inherent in the dental Bone loss prosthesis acting to resist the forces of dislodgment ○ In general, bone loss is greater in the along the path of placement mandible than in the maxilla and more ○ Resist vertical dimension of displacement pronounced posteriorly than anteriorly, RPD - REMOVABLE PARTIAL DENTURE and it produces a broader mandibular arch ○ Replaces teeth, dentate while constricting the maxillary arch. COMPLETE DENTURE - acronym for COMPLETE Changes can present challenges to RPD design DENTURE ○ These anatomic changes can present ○ All natural teeth challenges to fabrication of prostheses, INTERIM or PROVISIONAL DENTURE - INTERIM including implant-supported prostheses PROSTHES and removable partial dentures. ○ a fixed or removable dental prosthesis, or Attached gingiva maxillofacial prosthesis, designed to ○ The attached gingiva of the alveolar bone enhance esthetics, stabilization, and/or can be replaced with less keratinized oral function for a limited period of time, after mucosa, which is more readily which it is to be replaced by a definitive traumatized. dental or maxillofacial prosthesis; often Esthetic impact such prostheses are used to assist in LIM, V; FABELLON, A; GOZAR, M; TARRAYO, C. | DMD 1  TOPIC 6: RPD determination of the therapeutic for a prosthesis by partially encompassing or effectiveness of a specific treatment plan contacting an abutment tooth; Editorial note for usage: or the form and function of the planned for components of the clasp assembly include the definitive prosthesis RETENTIVE CLASP, RECIPROCAL CLASP, ○ Temporary CINGULUM, INCISAL or OCCLUSAL REST, and ○ Serves for esthetic/function but only for MINOR CONNECTOR short period of time CLASP(direct retainer) - the component of the clasp ABUTMENT - 1. that part of a structure that directly assembly that engages a portion of the tooth surface receives thrust or pressure; an anchorage; 2. a tooth, a and either enters an undercut for retention or remains portion of a tooth, or that portion of a dental implant entirely above the height of contour to act as a that serves to support and/or retain a prosthesis; reciprocating element; generally it is used to stabilize comp, ANGULATED ABUTMENT, HEALING and retain a removable partial denture; syn, AKERS ABUTMENT, DENTAL IMPLANT ABUTMENT, CLASP, BAR CLASP, CIRCUMFERENTIAL CLASP, INTERMEDIATE ABUTMENT, one-piece abutment, COMBINATION CLASP, CONTINUOUS CLASP, STANDARD ABUTMENT, two-piece abutment INFRABULGE CLASP, SUPRABULGE CLASP, ○ Tooth used so that it can be used as an WROUGHT WIRE CLASP abutment Bar clasp - a clasp retainer whose body extends from Height of Contour - a line encircling a tooth and a major connector or denture base, passing adjacent designating its greatest circumference at a selected to the soft tissues and approaching the tooth from a axial position determined by a dental surveyor; a line gingivo-occlusal direction encircling a body designating its greatest ○ RPI - Rest (mesial), Proximal Plate (distal), circumference in a specified plane; syn, SURVEY LINE I bar (buccal) ○ Convexity on the middle (highest area) ○ RPA - rest, proximal plate, Aker’s clasp Undercut - 1. the portion of the surface of an object ○ RPY - rest, proximal plate, Y clasp that is below the height of contour in relationship to ○ RPT - rest, proximal plate, T clasp the path of placement; 2. the contour of a Circumferential clasp - a retainer that encircles a tooth cross-sectional portion of a residual ridge or dental by more than 180 degrees, including opposite angles, arch that prevents the insertion of a dental prosthesis; and which generally contacts the tooth throughout the 3. any irregularity in the wall of a prepared tooth that extent of the clasp, with at least one terminal located prevents the withdrawal or seating of a wax pattern or in an undercut area indirect restoration Precision attachment - 1. a retainer consisting of a ○ to create areas that provide mechanical metal receptacle (matrix) and a closely fitting part retention for dental materials placement (patrix); the matrix is usually contained within the ○ Anything under height of countout normal or expanded contours of the crown on the ANGLE OF CERVICAL CONVERGENCE - the angle of abutment tooth/dental implant and the patrix is gingival convergence is located apical to the height of attached to a pontic or a removable partial denture; 2. contour on the abutment tooth; it can be identified by an interlocking device, one component of which is viewing the angle formed by the tooth surface gingival fixed to an abutment or abutments, and the other is to the survey line and the analyzing rod or undercut integrated into a removable partial denture to stabilize gauge of a surveyor as it contacts the height of and/or retain it; syn, ATTACHMENT contour ○ Interlocking device ○ Space that constricts` the ○ The function becomes too heavy, it breaks neck Semiprecision - a laboratory fabricated rigid metallic GUIDING PLANES - two or more vertically parallel patrix of a fixed or removable partial denture that fits surfaces on abutment teeth and/or fixed dental into a matrix in a cast restoration, allowing some prostheses oriented so as to contribute to the direction movement between the components; attachments of the path of placement and removal of a removable with plastic components are often called semiprecision partial denture, maxillofacial prosthesis, and attachments even if prefabricated (not laboratory overdenture fabricated); comp, PRECISION ATTACHMENT ○ Used to have placement of removable of ○ Metallic extension prosthesis Indirect retainer - the component of a removable RETAINER - any type of device used for the partial denture that assists the direct retainer(s) in stabilization or retention of a prosthesis; comp, preventing displacement of the distal-extension DIRECT RETAINER, FIXED PARTIAL DENTURE denture base by functioning through lever action on RETAINER, INDIRECT RETAINER the opposite side of the fulcrum line when the denture ○ Attachment device used to fixation and base attempts to move away from the tissues in pure stabilization of prosthesis rotation around the fulcrum line DIRECT RETAINER - that component of a removable Major connector - : the part of a removable partial partial denture used to retain and prevent dislodgment, denture that joins the components on one side of the consisting of a clasp assembly or precision attachment arch to those on the opposite side ○ Clasp assembly Lingual bar major connector - a mandibular major ○ To prevent dislodgement connector of a removable partial denture located CLASP ASSEMBLY - : the part of a removable partial lingual to the dental arch denture that acts as a direct retainer and/or stabilizer LIM, V; FABELLON, A; GOZAR, M; TARRAYO, C. | DMD 2  TOPIC 6: RPD Linguoplate major connector - : the portion of the Centric Jaw relation/Centric occlusion - the occlusion major connector of a removable partial denture of opposing teeth when the mandible is in centric contacting the lingual surfaces of the natural teeth relation; this may or may not coincide with the maximal Palatal plate major connector - a major connector of a intercuspal position removable partial denture that covers a significant Balanced occlusion - the bilateral, simultaneous portion of the palatal surface occlusal contact of the anterior and posterior teeth in Palatal strap - a major connector of a maxillary excursive movements removable partial denture having an anterioposterior Functional occlusal registration - the contacts of the dimension not less than 8 mm that directly or obliquely maxillary and mandibular teeth during mastication and traverses the palate; it is generally located in the area deglutition of the second premolar and first molar; comp, Cast - to produce a desired form by pouring or PALATAL BAR CONNECTOR, PALATAL PLATE injecting a molten liquid or plastic material into a mold ○ 8 mm ○ a life-size likeness of some desired form; it Palatal bar - a major connector of a maxillary is formed from a material poured into a removable partial denture that crosses the palate and matrix or impression or from a CAM has a characteristic shape that is half-oval printed replica anteroposteriorly with its thickest portion at the center Investment cast (refractory cast) - a cast made of a of the bar connector material that will withstand high temperature without ○ Less than 8 mm disintegration; syn, REFRACTORY CAST Rest(s): ○ Metal casting 3 types of Rests - named by its location Refractory investment - a cast made of a material that ○ Occlusal - a rigid extension of a removable will withstand high temperatures without disintegrating; partial denture that contacts the occlusal syn, INVESTMENT CAST surface of a tooth or restoration, the Wax pattern - a wax form that is the positive likeness occlusal surface of which is commonly of an object to be fabricated prepared to receive this rest; comp, REST Casting - : something that has been cast in a mold; an SEAT object formed by the solidification of a fluid that has ○ Lingual/Cingulum rest - a metallic been cast into a refractory mold extension of a removable partial denture ○ the action of pouring or injecting a framework that fits into a prepared flowable material into a refractory mold depression within an abutment tooth’s Dental stones - he alpha-form of calcium sulfate lingual surface hemihydrate with physical properties superior to the ○ Incisal rest - a rigid extension of a beta-form (dental plaster); the alpha-form, a-calcium removable partial denture that contacts a sulfate hemihydrate, is created when the dihydrate of tooth at the incisal edge gypsum is heated under steam pressure resulting in Residual/edentulous ridge - the portion of the residual the formation of dense rods or prisms, and is, bone and its soft tissue covering that remains after the therefore, more dense than the b-calcium sulfate removal of teeth hemihydrate (dental plaster); syn, GYPSUM Basal seat or denture foundation area - the oral Dental cast surveyor(SURVEYOR) - a paralleling anatomy available to support a denture instrument used in making a dental prosthesis to Denture base - the part of a denture that rests on the locate and delineate the contours and relative foundation tissues and to which teeth are attached. positions of abutment teeth and associated structures; ○ Part of the denture where there is the syn, PARALLELOMETER residual ridge and pontics are embedded Plastic - any of numerous organic synthetic or Rebasing - the laboratory process of replacing the processed materials that generally are thermoplastic or entire denture base material on an existing prosthesis thermosetting polymers, usually of high molecular ○ Taking out all the stuff and leave the parts weight; they can be cast, extruded, molded, drawn, or but replaces the whole base laminated into films, filaments, and objects Relining - scraping off a portion of a denture tooth and ○ Hardens and retains its shape add more acrylic Resin - 1. any of various solid or semisolid amorphous Functional ridge form - eponym for the classification of natural organic substances that usually are transparent residual alveolar ridge form into three categories or translucent and brown to yellow; usually formed in identified as class I, II, and III. Class I plant secretions; are soluble in organic solvents but defectsdfaciolingual loss of tissue width with normal not water; are used chiefly in varnishes, inks, plastics, ridge height; Class II defectsdloss of ridge height with and medicine; and are found in many dental normal ridge width; Class III defectsda combination of impression materials; 2. a broad term used to describe loss in both dimensions natural or synthetic substances that form plastic ○ Form of residual ridge when its under materials after polymerization; they are named function according to their chemical composition, physical Static form - : related to bodies at rest or forces in structure, and means for activation of polymerization; equilibrium comp, AUTOPOLYMERIZING RESIN, COPOLYMER ○ The impression during (anatomic form) RESIN ○ Stays the same ○ Substance according to composition and means of activation by light or heat LIM, V; FABELLON, A; GOZAR, M; TARRAYO, C. | DMD 3  TOPIC 6: RPD CHAPTER 2. Maxillary and mandibular clasp-retained removable CONSIDERATION FOR MANAGING PARTIAL partial dentures. All clasps are extracoronal retainers TOOTH LOSS (clasps) on abutments. POINTS OF VIEW? TOOTH REPLACEMENTS FROM THE PATIENT ’ S PERSPECTIVE: ○ Tooth loss is a permanent condition in that the natural order has been disrupted, and in this sense it is much like a chronic medical condition. Like hypertension and diabetes, two medical conditions that are not reversible and that require medical management to monitor care to ensure appropriate response over time, tooth replacement prostheses must be managed to ensure appropriate response Prostheses from previous slide shown intraorally in over time. occlusion Tooth loss = is a permanent chronic medical condition (HYPERTENSION/DIABETES). Management ○ suggests a focus on meeting needs that may change over time. These needs may be expected or unexpected. Expected outcomes ○ are those that accompany the common clinical course for a type of prosthesis that is related to the tooth-tissue response. This biological toll response is heavily Maxillary prosthesis using intracoronal retainers and full influenced by the type of prosthesis palatal coverage. The male portions of the attachments chosen. are shown at the mesial position of the artificial teeth Unexpected needs and will fit into intracoronal rests ○ are those that might involve factors related to our control of manipulations (such as tissue damage or abuse, material design flaws, or prosthesis design) or to those out of our control (such as parafunction or accidental trauma). SHARED DECISION MAKING: ○ To achieve a state of oral health, they need to recognize behavioral issues related to plaque control so that once active disease is controlled, they have an understanding that best ensures future health Internal attachment prosthesis in the patient’s mouth. TOOTH SUPPORTED PROSTHESES Note the precise fit of male and female portions of the attachments. The major categories of partial tooth loss are: 1) with teeth both anterior and posterior to the edentulous space (tooth supported space) 2) with teeth anterior only to the edentulous space (DFE) (tooth and tissue supported space) RPD can be designed in various ways to allow use of abutment teeth and supporting tissue for stability, support, and retention of the prosthesis. RPDs that do not have the benefit of natural tooth support at each end of the replacement teeth (extension base RPD). Clasp retained RPD possible disadvantages: 1) Strain on the abutment teeth often is caused by improper tooth prep or clasp design, and/or loss of tissue support under distal extension bases LIM, V; FABELLON, A; GOZAR, M; TARRAYO, C. | DMD 4  TOPIC 6: RPD 2) Clasps can be unesthetic, particularly when they Buccal view of anatomic ridge form are placed on visible tooth surfaces without consideration of esthetic impact. 3) Caries may develop beneath clasp components, especially if the patient fails to keep the prosthesis and abutments clean Six phases of Partial Denture Service: 1) EDUCATION OF PATIENT- process of informing a patient about a health matter to secure informed Buccal view of functional or supportive ridge form. Note consent, patient cooperation, and a high level of that the supportive form of the ridge clearly delineates patient compliance. the extent of coverage available for a denture base and 2) DIAGNOSIS, TREATMENT PLANNING, DESIGN, is most different from the anatomic form when the TREATMENT SEQUENCING, AND MOUTH mucosa is easily displaced. PREPARATION – treatment planning and design begin with thorough medical and dental histories Complete oral examination must include both clinical and radiographic interpretation of: ○ 1)caries; ○ 2)condition of existing restorations; ○ 3)periodontal conditions; ○ 4)responses of teeth (especially abutment) and residual ridges to previous; 4) ESTABLISHMENT AND VERIFICATION OF ○ 5)vitality of the remaining teeth OCCLUSAL RELATIONS AND TOOTH 3) SUPPORT FOR DISTAL EXTENSION DENTURE ARRANGEMENTS – important step in the BASES – 3rd of the 6 phases, it does not apply to construction of RPD. For the distal extension base, jaw tooth supported RPD; relation records should be made only after the best ○ A base made to fit the anatomic ridge possible support is obtained for the denture base. form does not provide adequate support 5) INITIAL PLACEMENT PROCEDURES – occurs under occlusal loading. It does not provide when the patient is given possession of the RPD. max border extension nor accurate border Occlusal harmony must be ensured before the patient detail. is given possession of the dentures, but the processed bases must be reasonably perfected to fit the basal Occlusal view of a cast from a preliminary impression, seats. patient must understand the suggestions and which produced an anatomic ridge form (left), and an recommendation given by the dentist for care of the altered cast of the same ridge showing a functional or dentures and oral structures - Patient must understand supportive form (right). The altered cast impression the suggestions and recommendation given by the selectively placed pressure on the buccal shelf region, dentist for care of the dentures and oral structures. which is the primary stress-bearing area of the mandibular posterior residual ridge. 6) PERIODIC RECALL – initial placement of adjustment of the prosthesis certainly is not the end of treatment. Periodic re-evaluation is critical for early recognition of changes in oral structures to allow steps to be taken to maintain oral health.- These examinations must monitor the condition of the oral tissue, the response to tooth restorations, the prosthesis, the pt’s acceptance, and the pt’s commitment to maintain oral hygiene. Although a 6-month recall period is adequate for most patients, more frequent evaluation may be required for some. LIM, V; FABELLON, A; GOZAR, M; TARRAYO, C. | DMD 5