Prosthodontics Laboratory 9.

Done by : Osama Yousef.

-no defined subject to talk about, the ideas are random
-well continue speaking of RPD design and well also speak of some points we
talked about them earlier
-Everytime you see a line separating two paragraphs that means its the start of a
new subject
-For demonstration purposes only the images are from a patient mouth but this
process IS NOT ON THE PATIENT its done on the cast.

As you already know , when we talk about RPD design we either classify each
case we have according to :
-1- Kennedy classification.
**Reminder**
The basic configuration for each class of Kennedy classification for e.g. :
A. Class I: default ( or mostly preferred ) is Bilateral design
B.Class ll : tripodal design
C.Class lll : Quadrilateral
D.Class IV : it depends on the length (extenstion) of the edentulous area it can be
bilateral or quadrilateral designs .
**For images of this please look at laboratory 8 pages 6-8.
-2- Tissue support:
class I , ll and long span IV : tooth-tissue supported
class III is: tooth-borne .
But looking at the table below youll discover new concepts for the tissue support
classification.


Class Support Retention
1 Tooth-tissue Tooth ( weak )
ll Tooth-tissue Tooth ( weak )
lll Tooth-borne Tooth
lll ( rare cases ) Tooth-tissue Tooth ( weak )
IV ( long span ) Tooth-tissue Tooth ( weak )
IV ( short span ) Tooth-borne Tooth

As we said earlier , the default design of class III is quadrilateral ( meaning 4
spots or clasps assemblies have to be present )
But what if one of these points is missing or I cant have support on it or I
cant have retention on it ?
-Ill treat it as tooth-tissue supported and weak tooth retained. This is very
important during designing and it might get tricky ( well see an example about
this where we initially start with a class lll and we think that its tooth-borne
supported and tooth retained , but as we go further with the design we discover that
its not ) so keeping an eye in these things is crucial .

-As you already know from other subjects , Amalgam fillings need to be 2 mm
minimum to prevent fractures .
CASE I: If a patient came to me with an amalgam restoration , I dont know how
deep his amalgam is , so when placing a rest the remaining space might be 0.5 mm
and this is very weak and might fracture , because as you already know amalgam
is good in compression but bad in tension .
SO IF I DIDNT PUT THE AMALAGAM I NEED TO BE VERY WORRY AND
CARFAUL WHILE PLACING A REST .

CASE II: lets assume that we have a very deep amalgam restoration ( which is
very rare ) iam allowed to put a rest on it as long s the remeaing amalgam is
ATLEAST 2 mm thick .
** Remember this one is my last choice because we REALELY put a rest on an
existing restoration .
CASE III: Worst case if I had a very bad tooth ( destroyed and very worn out ) I
can put a crown on it and then attach a rest.
While doing so the crown has a metal part that is attached to porcelain and this
metal part will be attached to the rest. (rest = metal , crown = metal ) .


We talked about mobility in the theory but were going to talk about again in the
lab :
Because its going to change a little bit from what we said in the theory.
There are several different classification for mobility in dentistry but the simple
and most used in filed is Grrace and Smoles classification .
They have divided this mobility of the tooth into :
Grade 0 No apparent mobility , very healthy , I dont worry about it.
Grade 1 there is mobility but its less than 1 mm bucco-lingually .
Grade 2 there is a definitive mobility but its 1-2 mm bucco-lingually
Grade 3 severe mobility and its grater than 2 mm bucoo-lingually
AND there will be vertical component to the motion .
-Usually tooth grade 3 is HOPLESS ( ) meaning that there is no
apical bone leading for the tooth to go up and down. And this tooth needs
extraction.
What does this classification means for RPD design? Many of our patients have
partially ednontlues mouths and the remaining teeth are not in excellent health .
Grade 1 as weve said in the theory , I can put a :
Rest on it ( support )
Axaillary retention ( stress-releasing ) combination clasp ( wrought wire
on the buccal and cast reciprocation on the lingual ) .
Or clasp (it helps in retention but doesnt provide the main retention ) .
Reciprocal arm ( reciprocation )
Guide plane .
Lingual plate
For example if I have two teeth with Grade1 , I can put a lingual plate on them
without any rest or arms or anything just a lingual plate .
. , ,
Grade 2 :
A bit more complicated , this is debatable some say you can use it others say no
you cant use it .
-The doctor personal opinion is to stay away from grade 2 teeth .
So many doctors will say Nothing, except we can put on them these things:
Guide plane on ONE surface BRACING OR SPLLINTING
Lingual plate BRACING OR SPLINTING
SOME doctors say it can provide Auxiliary Support (well see in this lab
in some of the examples how we put a rest not to provide support but just to
stop the tooth from moving ) .
NO RETENTION , NO PRIMARY SUPPORT in this grade
Preventing supra-eruption from coming by putting a Rest on it as an
example.




Theyre as you already know classified according to :
1- the location ( suprabulge and infrabulge or occlusally approaching and
gingivally approaching )
2-stress releasing and non-stress releasing :
Non-stress release : (pictures are in lecture 8 )
Cast circfumental : usually first choice if not esthetics of concern ( occlussally
approaching Akers , Gingivally approaching : Roach ) .
-We have modifications to the C-clasp : simple circlet and reverse circlet .
Simple circlet it approaches from the edentulous area .
Reverse circlet approaches away from the edentulous area.
Ring clasp : it might have 2 rests on either side to reduce flexibility as we said .
And it provides its own bracing (because it surrounds the tooth ) . And sometimes
we put a sturt to make it stronger.
Embrasure ( double akres / compound clasps )
Reverse action C-clasp ( hairpin )
and clasp
Extended clasp: very rare , one clasp extending to different teeth.
Multiple clasps: opposite to embrasure, insisted of putting the rest on the middle
between two teeth . We put rest on each tooth and extend from them.
Wrought wire ( combination clasp )
Onlay clasp
Stress-releasing : indicated in class I,II , long span IV and some rae cases of
classIII.
1) RPI 2) RPA 3) Combination clasp










-Now in this design were doing the UPPER ,
-This is Kennedy class III , mod I , And support
classification is tooth-supported (FOR NOW ONLY ) .
-I have Grade 1 mobility on right 7
-Grade 2 right 8 and left 7, 8
-As always we start off by coloring our Abutments
with the color yellow . ( notice we didnt color the 8,7
on the left because in this course we consider grade ll
mobility not good as abutments . But this is only for
th exam purpose ) ( fig.1)
After that I add Rests (purple) as in the picture.(fig. 2)


1
2
after that I need to add my Minor
Connector, -since this is Maxilla ( and the
doctor didnt provide any further information
) Ill go with the Meshwork . ( fig. 3)
-After that I need to add Retention , for the
Right canine what clasps should I put here ?
*We cant place an I-bar ( the depth of
sulcus in that area is 3 mm ) .
I could use :
1-Gingivally approaching cast clasp ,
2- Occlusally approaching cast clasp
3-Occlusally approaching wrought wire (
combination clasp ) .
The doctor went with Occlusally
approaching cast clasp , although its
inferior esthetically than gingival but I
cant put the gingival due to the depth .
-Choosing the wrought wire option is the
same as occlusally approaching c-clasp ,
both are unesthetic so it doesnt make any
difference but the doctor went with the c-
clasp. (fig. 4).
- SO CIRCLET CLASP
OCALLUSALLY APPRAOCHING IN 0.25 MM MESIO-FAICAL
UNDERCUT.
-On the Left canine because I have 6 mm depth , I
can add an I-bar .
Note to remember about the I-bar is that the
retientive tip ( arrow ) of the I-bar must be on the
mesio-facial of the tooth . (fig. 4) .
SO I-BAR IN 0.5mm in MESIO-FAICAL
UNDERCUT
3
4
5
For the 7
th
on the right :
-Can we place a c-clasp on the molar ? No. so were going with the Wrought Wire
-You need to stay 1 mm away from the tooth and you need to fuse it with the
meshwork (fig. 4) .
SO WROUGHT WIRE 0.8 DM , IN 0.5 MM DB UNDERCUT .
Lets see if we need indirect-retention in this design ? anytime you see two or
three points clasp assemblies know that youre going to need to place indirect
retention
We look for the axis of rotation away from the tissue and toward the tissue .
Lets start looking for support :
(fig. 5 ) if the other side ( where there is no pen ) tries
to come out whats going to prevent it ? The direct
retainer on the left canine .
(fig. 6 ) What if the other side ( where there is no pen )
tries to come out ? both the canine and the 7
th
on the right
side will prevent it from doing so .
(fig. 7 ) What if the other side ( where there is no pen )
tries to come up ? the 7
th
on the right will prevent it .
(fig. 8) What if the other side where there is no pen
tries to come up ? I have nothing to prevent it !
because theyre grade ll mobility I cant put direct
retainters on the 8
th
and 7
th
on the left .
HENCE this is one of the special cases where I have a
class 3 but in terms of retention its class ll ( as if the
7
th
and 8
th
dont exist ). So I need indirect retention ,
luckily I have a retainer on the right canine , so Im going
to mark it green to indicate that its an indirect retainer.
( fig. 9 next page ) .


6
7
8
Now what about support ?
(fig .5 ) What if the patient bites down on the
canine area ? Ill have support provided from
the canine there .
(fig. 6 ) What if the patient bites down on the
right canine and 7
th
area ? Ill have lots of
support there from the canine and the 7
th
.
(fig. 7) What if the patient bites down on the
7
th
area ? Ill have support from the 7
th
in that
area .
(fig. 8) What if the patient bites down on the
left 7
th
? There is nothing there ; No support ,
so itll go down and on the other side ( the right
canine ) itll try to come up .
Now I need to reconsider my design ,
** On the right canine we put a occluasally
approaching cast clasp , but with the pulling
action of it ( it tends to go up ) itll eventually
harm the tooth , so Ill replace it with a wrought
wire because its much more flexible and gentle
on the tooth .
SO ON THE RIGHT CANINE ITS 0.8 DM
WROUGHT WIRE IN 0.5 UNDERCUT.

After that I need to connect everything
together, so its time for Major connector.
But notice I didnt draw the reciprocation arm
for the clasp assemblies , and this is to show
you that sometimes the major connector can
do the job of reciprocation if its extended to
the tooth , AN ARM , A PLATE OR A REST
can do the job or reciprocation .
9
10
11
For the major connector were going with
the mid-platatal strap.
** On the right canine and the left canine I
already have repcorcaiton provided by the
rest , we could draw the major connector as
fig. 10 .
OR I could draw it like fig. 11 in which the
strap extends to the rest , as long as the
distance in square 1 is grater than 6 mm and
I dont have a minor connector blocking the way as in square 2 figure 11 , same
thing applies for the right canine . (fig 12 shows both of the ways ).
(fig.13 ) Now continuing putting the Mid-platal strap posteriorley , you can
notice in square 1 Ive added a reciprocating arm to make the design as simple as
possible and not to extend the palatal strap into the whole tooth. As in fig.14








The 7
th
and 8
th
on the left are grade 2
mobility , and in the upcoming years they
might need to be extracted , so i make the
strap to cover them so that in the future I can
just remove them and add acrylic teeth ( like
pieces of lego ) (fig. 15)
12
13 14
15
**Well do also the Lower design .
- In the lower as youll see the 8
th
on the right is grade lll and there is BOP , so it
need to be extracted , but Im afraid if I did this the upper 8
th
might supra-erupt ,
whats the solution ?
- Ill add a Rest ( preventing supra-eruption) and extend the Strap just in case the
right 8
th
needs to be extracted .(figure 16 and 15).
SO AT THE END OF THE DEISGN WE DISCOVERED THAT THIS
DEISGN IS TOOTH-TISSUE SUPPORTED.
Now well discuss the lower for this case.










-We start as always , coloring our
Abutments with the color yellow (fig.
17).
After that I add Support (fig. 18).
After that Ill add Minor connector , for
the left side Ill put a Lattice , but the
lattiace Im going to add is called
17
Modified lattice in which each tooth has its
preserved location so that when the
technician add the acrylic he knows where
to add them exactly .(fig. 19).
For the right side Ive added a metal base
since I only have one tooth missing
( fig. 19).


18
19 20
Looking at figure 20 ( previous page ) , we need
to add retention now:
**Left side:
-For the molar we added a normal occlusally
approaching simple circlet C-clasp .
- For the left canine weve added an I-bar/RPI
system ( because the depth allows us to do so )
and on the
**Right side:
-For the Premolar weve added a simple cast clasp
( We cant add an I-bar here due to the depth which is
3 mm ) .
-For the Molar weve added a ring clasp with a distal
Rest to enhance retention .

-Notice in fig. 20 also that the reciprocation arms are
drawn for the clasps ( for the left canine we didnt
provide a reciprocation arm because the function of
reciprocation can be done through the rest on the
cingulum or through the major connector like plate ) .
on the right molar there is a Ring and the ring provide its own
reciprocation as you already know .
-Fig. 21 , its time to make a Lingual bar .
If we dont have distal rest we can draw it like this (figure 22).
-Now for the Anterior teeth theyre grade 1 , ll mobility so
its best to plate them with the major connector , but what
about the left premolar ? should I plate it or leave it ?
Looking at figure 23 its not a good idea to not plate it and
leave this space below the premolar , its not good for
hygienic and health ; its not self-cleansing.

21
22
23
24
Now what about the right side ? from 3,4 and 5 ? should I plate them or not ? you
have the freedom to either do figure 24 or plate it as figure 25 ; next page.

figure 26 shows the final design for both the
upper and lower for case 1.


















25
26 A.
26 B.

-THIS FOR THE UPPER CAST
Figure 27 Kennedy class lll . its Tooth-supported ( FOR NOW ).








We start always as usual by coloring the
abutments with the color yellow . (figure 28).

To be honest with you if we have this patient in
real life well do him either bride or implants when
we have UNILATERAL WITH ONE OR TWO
TEETH MISSING WE TEND TO MAKE
FIXED TREATMETNS .
-Ideally class III design is quadrilateral so I
need to mark 2 more abutments ALTHOUGH
there is no edntoulues area on the other side where
am marking the 2 extra abutments .
-I like the design to be symmetrical so Ill mark
the same teeth on the right side. As in figure 29.

27
28
29
Next were going to draw a Meshwork as in fig.30 .
But just a side-note :
**IF YOU HAVE A ROOM LATTICE
**IF YOU HAVE LIMTED ROOM MESHWORK
.
-After that were going to add Rests as in fig.31.
-After that were going to add Retention as in fig. 32.
-Notice in fig. 32 all of them are Occllusally
Approaching C-clasps.
-Finally for the Major Connector were going to use
Mid-palatal strap as in fig. 33.
-Now looking at the design and all these clasps , I ask
myself can I make the design more simpler ? well I can
as in fig. 34 and fig.35.
-In fig. 34 , I could place a Clasp on the 6 .
- In fig. 35 I could make a Double Embrasure with
the 6 and 5 .
-But the most correct design is figure 32 the first
one .

30
33 34 35
31
32

-Now lets solve the Lower for case 2.
-What class is this ? 1 or 2 ? well to
determine so you have to look for the
opposing arch ,
looking at figure 33 you can see that 8
th

and 7
th
on the right side are there .
A.If Im not replacing the 7
th
and 8
th
and If I
had a rest on the 8
th
to prevent it from supra-
eruption than this is class 2 ! But:
B. Since I have teeth and the 8
th
might supra-
erupt its class 1. So its good idea to replace
the lower right 7
th
and 8
th
.
-So we start as always by coloring the
Abutments yellow. as in fig. 37.
-After that Im going to add the Minor
Connector as in fig. 38 , notice that the
minor connector on the right side behind that
6
th
is a Modified Lattice Work.

36
37
38
-After that lets add Retention , we need a
Stress-Releasing design ( RPI, RPA ,
CC ) .fig39
-After that Im going to add the Major
Connector as in fig. 40.
-Remember when we did wax pattern in
the lab ?
**Those of you who worked with lower
models had to make triangles in the 5th
and 6
th
these triangles are to help connect
the plate ( major connector ) with the
lattice ( figure 40).
.
Done by : Osama Yousef.
CORRECTED BY:Gewanna Ghazal

39