Professional Documents
Culture Documents
MOSTAFA FAYAD
Assistant Lecture of
Removable Prosthodontic
OBJECTIVES AND CLASSIFICATION
TERMINOLOGY
• Prosthesis: Is an artificial replacement of an absent part of the human body.
• Appliance used only for device worn by patient in course of treatment. e.g.
orthodontic appliance and splint
• Partially Edentulous Patient: Patients having one or more but not their entire
natural teeth missing.
• Removable Partial Denture (RPD): An appliance that restores one or more but
not all of the missing natural teeth and associated oral structures for partially
edentulous patients.
The word cast is preferable than word model which used only for
demonstration
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OBJECTIVES AND CLASSIFICATION
Andrews Bridge
The combination of a fixed dental prosthesis incorporating a bar with a
removable dental prosthesis that replaces teeth with the bar area, usually
used for edentulous anterior spaces. The vertical walls of the bar may
provide retention for the removable component. By James Andrews.
Gillett Bridge
Eponym for a partial removable dental prosthesis utilizing a Gillett clasp
system, which was composed of an occlusal rest notched deeply into the
occlusal axial surface with a gingivally placed groove and a circumferential
clasp for retention. The occlusal rest was custom made in a cast restoration.
MORA Device
Acronym for mandibular orthopedic repositioning appliance, a type
of removable dental prosthesis with a modification to the occlusal surfaces
used with the goal of repositioning.
Angle of Gingival Convergence
According to Schneider, the angle of gingival convergence is located
apical to the height of contour on the abutment tooth. It can be identified by
viewing the angle formed by the tooth surfaces gingival to the survey line
and the analyzing rod or undercut gauge in a surveyor as it contacts the
height of contour.
Continuous Gum Denture
An artificial denture consisting of porcelain teeth and tinted porcelain
denture base material fused to a platinum base.
Fulcrum Line
It is an imaginary line, connecting occlusal rests, around which a partial
removable dental prosthesis tend to rotate under masticatory forces. The
determinants for the fulcrum line are usually the cross arch occlusal rests
located adjacent to the tissue borne components.
Semi precision Rest
A rigid metallic extension of a fixed or removable dental prosthesis that
fits into an intracoronal preparation in a cast restoration.
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OBJECTIVES AND CLASSIFICATION
Nesbit Prosthesis
Eponym for a unilateral partial removable dental prosthesis design, that
De. Nesbit introduced in 1918.
Resilient Attachments
An attachment designed to give a tooth borne/soft tissue borne
removable dental prosthesis sufficient mechanical flexion, to withstand the
variations in seating of the prosthesis due to deformation of the mucosa and
underlying tissues without placing excessive stress on the abutments.
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OBJECTIVES AND CLASSIFICATION
Partial Dentures:
Partial dentures are appliances restoring one or more but not the whole
set of natural teeth . These Appliances maybe in form of:
I- Fixed partial prosthesis ( bridge ):
An appliance which restores one or more missing teeth it is permanently
cemented to the neighboring natural teeth and cannot be removed by the
patient.
III- Partial over dentures : Partial over dentures are removable partial
dentures that are constructed to overly and gain additional support
from either :
Natural teeth that are reduced in height and contour or :
Implants inserted in the edentulous areas .
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OBJECTIVES AND CLASSIFICATION
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OBJECTIVES AND CLASSIFICATION
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OBJECTIVES AND CLASSIFICATION
Contraindication
1- Large tongue.
2- Mentally retarded.
3- Poor oral hygiene.
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OBJECTIVES AND CLASSIFICATION
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OBJECTIVES AND CLASSIFICATION
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OBJECTIVES AND CLASSIFICATION
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OBJECTIVES AND CLASSIFICATION
CLASSIFICATION OF PARTIALLY
EDENTULOUS ARCHES
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OBJECTIVES AND CLASSIFICATION
Bilateral RPD: which restore missing teeth and extended on both sides
of the dental arch.
B- Cummer's classification :
This classification mainly based upon various the position of
the direct patner of the finished restoration . The direct retainer
may be diagonally, diametric, unilaterally or multilaterally placed.
This classification describes the restored rather than the unrestored
arch, so it is of line value because it follows denture design .
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OBJECTIVES AND CLASSIFICATION
C - Bailyn classification :
Bailyn,s classification is based on the support afforded to the
denture by the tissues . the restorations may be :
o Tissue born prosthesis : the denture is enterily supported by
the mucosa and the underlying bone .
o Tooth –born prosthesis : the denture is entirely supported by
abutment teeth .
o Tooth –tissue supported prosthesis : the denture is supported
bu both abutment teeth and moucosa.
D- Fridman's classification :
Fridman classified partial dentures in to :
Group A – for anterior restoration
Group B- For bounded posterior restoration
Group C- For posterior free end restoration (c= cantilever) .
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OBJECTIVES AND CLASSIFICATION
Skinner's Classification
He introduced the classification in 1959. He said that about 1,31,072
combinations of partially edentulous arches are possible.
His classification is based on the relation of the edentulous arches to the
abutment teeth.
• Class I: Abutment teeth are present anterior and posterior to the edentulous
space. It may be unilateral or bilateral.
• Class II: All the teeth are present posterior to the denture base which
functions as a partial denture unit. It may be unilateral or bilateral.
• Class III: All abutment teeth are anterior to the denture base which
functions as a partial denture unit. It may be unilateral or bilateral.
• Class IV: Denture bases are located anterior and posterior to the remaining
teeth, and these may be unilateral or bilateral.
• Class V: Abutment teeth are unilateral in relation to the denture base, and
these may be unilateral or bilateral.
H- Kennedy's Classification:
Dr. Edward Kennedy proposed this classification in 1923. This is the
most popular classification. It is based on locations and number of
edentulous areas.
Class III: A unilateral edentulous area with natural teeth remaining both
anterior and posterior to it.8,5%
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OBJECTIVES AND CLASSIFICATION
Class IV: A single, but bilateral (crossing the midline ), edentulous area
located anterior to the remaining natural teeth.3%
FISET'S ADDITIONS
Class VII A partially edentulous situation in which all remaining natural
teeth are located on one side of the arch, or of the median line
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OBJECTIVES AND CLASSIFICATION
Advantages
1- It is the most widely used method of classification of the partially
edentulous arches.
2- It is simple and can be easily applied to nearly all partially
edentulous bases.
3- It permits immediate visualization of the partially edentulous arch
and permits a logical approach to the problems of design.
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OBJECTIVES AND CLASSIFICATION
Rule (6) : Edentulous areas other than those determining the classification
are referred to as modification spaces and are designated by their number.
Rule (7) : The extent of the modification is not considered, only the
number of additional edentulous areas.
Rule (8) : There can be no modification areas in Class IV arches. Any
edentulous area lying posterior to the "single bilateral area crossing the
midline" would instead determine the classification.
Class IV Partial dentures especially those having long edentulous areas
are considered mesial extension bases. They require the same denture design
principles as class I partial dentures.
Class I
This class is characterized by ideal or minimal compromise in the
location and extent of edentulous area (which is confined to a single arch),
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OBJECTIVES AND CLASSIFICATION
Class II
This class is characterized by moderately compromised location and
extent of edentulous areas in both arches, abutment conditions requiring
localized adjunctive therapy, occlusal characteristics requiring localized
adjunctive therapy, and residual ridge conditions.
1. The location and extent of the edentulous area are moderately
compromised:
● Edentulous areas may exist in 1 or both arches The edentulous areas do
not compromise the physiologic support of the abutments.
● Edentulous areas may include any anterior maxillary span that does not
exceed 2 incisors, any anterior mandibular span that does not exceed 4
incisors, any posterior span (maxillary or mandibular) that does not exceed
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OBJECTIVES AND CLASSIFICATION
Class III
This class is characterized by substantially compromised location and
extent of edentulous areas in both arches, abutment condition requiring
substantial localized adjunctive therapy, occlusal characteristics requiring
reestablishment of the entire occlusion without a change in the occlusal
vertical dimension, and residual ridge condition.
1. The location and extent of the edentulous areas are substantially
compromised:
● Edentulous areas may be present in 1 or both arches.
● Edentulous areas compromise the physiologic support of the abutments.
● Edentulous areas may include any posterior maxillary or mandibular
edentulous area greater than 3 teeth or 2 molars, or anterior and posterior
edentulous areas of 3 or more teeth.
2. The condition of the abutments is moderately compromised:
● Abutments in 3 sextants have insufficient tooth structure to retain or
support intracoronal or extracoronal restorations.
● Abutments in 3 sextants require more substantial localized adjunctive
therapy (ie, periodontal, endodontic or orthodontic procedures).
● Abutments have a fair prognosis.
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OBJECTIVES AND CLASSIFICATION
Class IV
This class is characterized by severely compromised location and
extent of edentulous areas with guarded prognosis, abutments requiring
extensive therapy, occlusion characteristics requiring reestablishment of
the occlusion with a change in the occlusal vertical dimension, and residual
ridge conditions.
1. The location and extent of the edentulous areas results in severe occlusal
compromise:
● Edentulous areas may be extensive and may occur in both arches.
● Edentulous areas compromise the physiologic support of the abutment
teeth to create a guarded prognosis.
● Edentulous areas include acquired or congenital maxillofacial defects.
● At least 1 edentulous area has a guarded prognosis.
2. Abutments are severely compromised:
● Abutments in 4 or more sextants have insufficient tooth structure to
retain or support intracoronal or extracoronal restorations.
● Abutments in 4 or more sextants require extensive localized adjunctive
therapy.
● Abutments have a guarded prognosis.
3. Occlusion is severely compromised:
● Reestablishment of the entire occlusal scheme, including changes in the
occlusal vertical dimension, is necessary.
● Maxillomandibular relationship: class II division 2 or Class III molar and
jaw relationships.
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OBJECTIVES AND CLASSIFICATION
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OBJECTIVES AND CLASSIFICATION
(2) To avoid confusion, the maxillary arch is drawn as half circle facing up
and the mandibular arch as half circle facing down. The drawing will appear as
if looking directly at the patient; the right and left quadrants are reversed.
(3) The classification will always begin with the phrase "Implant-Corrected
Kennedy (class)," followed by the description of the classification. It can be
abbreviated as follows:
(i) ICK I, for Kennedy class I situations,
(ii) ICK II, for Kennedy class II situations,
(iii) ICK III, for Kennedy class III situations, and
(iv) ICK IV, for Kennedy class IV situations.
(4) The abbreviation “max” for maxillary and “man” for mandibular can
precede the classification. The word modification can be abbreviated as “mod.”
(5) Roman numerals will be used for the classification, and Arabic numerals
will be used for the number of modification spaces and implants.
(6) The tooth number using the American Dental Association (ADA) system is
used to give the number and exact position of the implant in the arch. (Note:
other tooth numbering systems such as F´ed´eration Dentaire Internationale
[FDI] can be used, as can the tooth name. The ADA system was used by the
authors because of familiarity).
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OBJECTIVES AND CLASSIFICATION
Permanent Teeth
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
(8) The classification can be used either after implant placement to describe
any situation of RPD with implants, or before implant placement to indicate the
number and position of future implants with an RPD.
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OBJECTIVES AND CLASSIFICATION
ICK II (#2).
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OBJECTIVES AND CLASSIFICATION
Denture bases.
Artificial teeth .
Supporting rests.
Connectors: Major connectors
Minor connectors
Retainers : Direct retainers
Indirect retainers
These components may provide one or more of the following functions:
1-Support:
a. The resistance of a denture to tissue ward movement.
b. Adequate and wide distribution of the load to the teeth and mucosa.
2- Retention: The resistance of a denture to vertical displacement force (to
move away from its tissue foundation)).
3- Indirect retention: The resistance of denture rotation away from the
tissues about an axis.
4- Bracing: The resistance of a denture to lateral forces.
5- Reciprocation: The resistance of lateral forces on the abutment during
insertion and removal of the removable partial denture .
Reciprocation is required as the denture is being displaced occlusally
whilst the bracing function, comes into play when the denture is fully
seated.
6- Stability: The resistance of a denture to tipping movement.
Tipping movement: Vertical rotation around a line parallel to ridge crest
(twisting of the denture base)
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Denture Base
4. Major connectors.
3- Indirect retention: The resistance of denture rotation away from the tissues
about an axis.
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Denture Base
Denture Base
The denture base is the part of the denture, which rests on the foundation
tissues and to which artificial teeth are attached. The denture base helps in
transferring occlusal stresses to the supporting oral structures.
The bounded partial denture base covers an edentulous span between two
abutment teeth.
The base bounded by a natural tooth only on one side, while the other side is
free. This type is sometimes called distal extension base.
The snowshoe principle, which suggests that broad coverage furnishes the best
support with the least load per unit area, is the principle of choice for providing
maximum support. Therefore support should be the primary consideration in
selecting, designing, and fabricating a distal extension partial denture base.
4. Provides denture retention for distal-extension dentures by physical means.
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Denture Base
7. The denture base and the artificial teeth serve to prevent migration and over
eruption of the remaining teeth.
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Denture Base
7- Esthetic acceptability.
A. NEED TO RELINE.
1. In tooth borne partial dentures with long span bases, the base
may require periodic relining to compensate for idiopathic or pressure
induced resorptive changes
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Denture Base
Metallic denture bases are generally used in thinner sections than resin bases.
They are made in the form of metal plates having metal posts that allow for
mechanical attachment with the acrylic resin layer holding the artificial teeth.
Metal such as chrome cobalt alloy, gold, or stainless steel is used. Chrome cobalt
alloy is the most commonly used alloy the material is used in cast form only. It
provides the needed rigidity for removable partial dentures even in thin section. It
has low specific gravity which is nearly half that of gold and provides high
resistance to corrosion.
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Denture Base
3- Thermal Conductivity
Metal alloy may be cast much thinner than acrylic resin and
still have adequate strength and rigidity. Cast gold must be given
slightly more bulk to provide the same amount of rigidity but may still
be made with less thickness than acrylic. less weight and bulk are
possible when the denture bases are made of chrome or titanium
alloys.
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Denture Base
3. The color of metal bases does not simulate the natural appearance or
oral tissues.
Indication: 1- short span posterior tooth born 2- when maximum strength is required
(2) The dimensional accuracy with which the alloy can be cast and finished;
(5) The individual clinical observation and experiences with alloys in respect to
quality control and service to the patient.
It is used in cast form only, needs special investments and special casting
and polishing machine and high casting temperature (2400 f).
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Denture Base
Advantages:
B-Gold (type 4)
2- More rigid than acrylic resin but less than chrome cobalt. Modiolus of
rigidity 14×106 P.S.I
3- More expensive.
Some times used for lower partial denture to help in retention due to more
specific gravity (weight).
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Denture Base
2- The bulk of a retentive clasp arm for a removable partial denture is often
reduced for greater flexibility when chromium-cobalt alloys are used as
opposed to gold alloys. This, however, is inadvisable because the grain size
of the chromium-cobalt alloys is usually larger and is associated with a lower
proportional limit, and so a decrease in the bulk of chromium-cobalt cast
clasps increases the likelihood of fracture or permanent deformation.
The retentive clasp arms for both alloys should be approximately the
same size, but the depth of undercut used for retention must be reduced by
one half when chromium-cobalt is the choice of alloys.
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Denture Base
It has been observed that gold frameworks for removable partial dentures are
more prone to produce uncomfortable galvanic shocks to abutment teeth
restored with silver amalgam than frameworks made of chromium-cobalt
alloy.
c- Stainless steel:
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Denture Base
Advantages:
1. Esthetically acrylic resin is satisfactory and looks better in the mouth due to
its pink colour.
4. The fitting surface is porous and not polished which may lead to
retention of soft food particles and plaque causing bad oral hygiene, bad
odour and inflammation of the tissues.
1- When age and time factors may prohibit the construction of the definitive
prosthesis.
2- During the healing process after extraction until the permanent restoration is
made.
3- Cases with extreme bone loss. The presence of acrylic resin is necessary to
restore the original contour of the ridge, giving more satisfactory results than
metal bases.
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Denture Base
6- Immediate denture
Contraindications:
Types of resin.
b.Grafted polymethylmethacrylate.
d. Polyvinyl.
e. Composite resin.
Metal resin interface exhibits a potential space which may enlarge during
thermo cycling and permit the entrance of microorganisms and fluids. This may
lead to discoloration, plaque accumulation and resin deterioration at the interface.
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Denture Base
1. Free-end saddle cases as in Kennedy class I, II and IV and in class III cases
having long edentulous spans to facilitate future relining. Relining is required
to compensate for bone resorption and loss of support, which frequently
occur in these cases.
3. Cases with extreme bone loss. The presence of acrylic resin is necessary to
restore the original contour of the ridge giving more satisfactory results than
metal bases.
b) Mesh construction.
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Denture Base
Retentive mesh and retentive lattice are used when a plastic denture base will
contact the edentulous ridge.
Loops, beads, and posts are used with a metal base to which prosthetic teeth
are attached with processed plastic.
Extension:
In the maxillary arch if the denture base is a distal extension base (no
tooth posterior to the edentulous space), the minor connector must extend
the entire length of the residual ridge to cover the tuberosities.
When a distal extension ridge in the mandibular arch is being treated, the
minor connector should extend two-thirds the length of the edentulous
ridge.
A longitudinal strut should not be positioned along the ridge crest as it may
act as a wedge in the resin and may cause resin fracture.
In the mandibular arch one strut should be positioned buccal to the crest of
the ridge and the other lingual to the ridge crest.
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Denture Base
In the maxillary arch one strut is positioned buccal to the ridge crest, and the
border of the major connector acts as the second strut.
Smaller struts, usually 16 gauge thick, connect the two struts and form the
latticework. These connecting struts run over the crest of the ridge and should be
positioned to interfere as little as possible with arrangement of the artificial teeth.
Generally, one cross strut between each of the teeth to be replaced should be
satisfactory.
The latticework minor connector can be used whenever multiple teeth are to
be replaced. It provides the strongest attachment of the acrylic resin denture base to
the removable partial denture. It is also the easiest of the denture base retainers to
reline if this becomes necessary because of ridge resorption.
It is necessary to provide a relief space over the dentulous ridges for both the
latticework and the mesh minor connector so that there will be a space between
the struts or mesh and the underlying ridge.
It is in this space and around the struts or mesh that the acrylic resin denture
base will be formed. The locking of the acrylic resin around and through the
latticework provides the retention of the denture base.
Relief under the grid-work should not be started immediately adjacent to the
abutment tooth but should begin 1.5 - 2 mm from the abutment tooth.
The junction of grid works to the major connector should be in the form of a
butt joint with a slight undercut in the metal.
The grid work on a mandibular distal extension should extend about 2/3 of the
way from abutment tooth to retromolar pad but not on the ascending portion of
the ridge mesial to the pad. It should has a “tissue stop” at their posterior limit
to provide direct contact with the ridge.
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Denture Base
The mesh pattern is less satisfactory as the space available for incorporating
acrylic resin between metallic strips is narrow so it makes it more difficult to
pack the acrylic resin dough because more pressure is needed against the
resin to force it through the small holes and not allow for enough bulk of
resin which become weak and may detached from the metal base. It also
does not provide as strong an attachment for the denture base.
The major difference between retentive mesh and retentive lattice is the size
of the openings. Retentive mesh has small openings while retentive lattice
has much larger openings.
The mesh type tends to be flatter, with more potential rigidity, but may
provide less retention for the acrylic if the openings are insufficiently large.
The lattice type has superior retentive potential, but can interfere with the
setting of teeth, if the struts are made too thick or poorly positioned.
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Denture Base
Posts, loops, beads , nail head, wire loop retention or metal stop may be used to
for retention of the resin. with metal denture base, which is cast so that it fits
directly against the edentulous ridge; no relief is provided beneath the minor
connector.
beads (made by placing beads of acrylic resin polymer in the waxed denture
base and investing, burning out, and casting these beads);
This form of denture base is hygienic because of better soft tissue response to
metal than acrylic resin. But it can not be relined adequately in the event that ridge
resorption takes place.
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Denture Base
acrylic resin base would be thin and weak. Because relining is not possible metal
bases are generally not indicated for extension RPDs.
Minor connectors forming denture bases should include tissue stops and
finishing line:
They provide stability to the framework during the stages of transfer and
processing. They are particularly useful in preventing distortion of the
framework during acrylic resin processing procedures.
Tissue stops are essential parts in the fitting surface of minor connectors.
They are usually two or three in number that contact the cast.
Tissue stops stabilize the framework on the master cast during processing
as acrylic resin is packed in the retention spaces.
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Denture Base
Tissue stops elevate the minor connectors, forming the denture base, from the
ridge, by a space equal to the thickness of acrylic bases.
They are formed by making holes 2×2 mm in the relief wax placed over the
ridge during preparation of the master cast before duplication.
a b
Tissue stops prevent settling of the framework downwards, and elevate the minor connectors by a
space equal to the thickness of acrylic base.
Finishing Lines:
Finishing lines are butt joints created at the junction of major connectors
with the denture bases.
In distal extension bases, these butt joint finishing lines, are made on both
the external and internal surfaces of the major connector where acrylic resin is
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Denture Base
processed, while in short bounded metallic bases, the butt joint is required only on
the external surface where acrylic resin is packed, for the attachment of teeth.
a. External finish lines are formed during the formation of the wax
pattern by carving a sharp definite angle in the wax pattern at the junction between
the major connector and the minor connectors forming the denture base.
b. This angle should be less than 90 degrees to lock the acrylic resin
securely to the minor connectors and for the acrylic base to blend smoothly and
evenly with the major connector.
c. External finish line is positioned just far enough lingual to the ridge
crest to position the artificial teeth.
e. The external finish line should never be placed directly over the
internal finish line. It should be placed superiorly to the internal finish line so that a
minimum amount of denture base resin is used on the lingual aspect of the teeth.
For maxillary RPDs. the palatal finish line should be located so that it allows
for proper positioning of the artificial teeth while still maintaining normal tissue
contours and a smooth transition from metal to plastic. It should be located 2 mm
medial from an imaginary line that would contacts lingual surfaces of missing
posterior teeth.
For a mandibular distal extension RPD, the external finish line begins at the
distolingual aspect of the terminal tooth and angles posteriorly as it progresses
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Denture Base
toward the floor of the mouth. The lingual finish line for a mandibular tooth-
supported RPD should be located just far enough lingually to allow for setting of
the artificial teeth. If it is placed too far lingually (and thus inferiorly), the major
connector will be weakened.
If the resin ends in a thin edge, saliva and debris will accumulate between
the denture base resin and the metal. The resin will also fracture if left too thin in
this area.
a. Internal finish lines are formed by carving the relief wax used to create
space for packing acrylic resin under mesh minor connector. This relief wax is
applied on the master cast before duplication.
c. The internal finish line is located on the tissue surface side of the
framework. It is formed by the 24- to 26-gauge relief wax placed on the master cast
prior to duplication.
d. The internal finish line is normally placed farther from the abutment
tooth or residual ridge than the external finish line.
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Denture Base
f. Internal finish line should be located 3-4 mm from the natural teeth.
This allows a highly polished metal surface to be placed adjacent to the free
gingival margins.
g. Internal finish line should form a well defined butt joint with the
denture base resin.
h. Internal line angle of the internal and external finish lines should be
less than 90 degrees to provide mechanical retention for the denture base resin.
For tooth borne partial dentures, the internal finish lines should be
placed slightly palatal to the external finish lines. This staggered
relationship contributes to increased framework strength and an
adequate thickness of resin between the finish lines. Placement of
the internal finish line more palatally is usually not indicated,
since only minimal resorptive changes occur.
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Denture Base
1 2 3
1: black arrow indicates the external finishing line(EFL) in tooth-mucosa borne RPD.
2:. a case of maxillary tooth-mucosa borne RPD. arrow (A) indicates The internal finishing
line(IFL), it is placed approximately at the junction of the vertical and horizontal planes of
the palate to permit relining. Arrow (B) indicates the EFL
3: in case of maxillary tooth borne PD, the IFL is slightly palatal to the EFL
a) Antero-posterior extension
- In free-end spaces: The base extends to cover the retromolar pad in the
lower arch and hamular notches and tuberosity in the upper`.
b) Buccally: The flange should extend to the mucosal reflection. The labial
flange is sometimes omitted for esthetic reasons.
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Denture Base
c) Lingually: The flange of the lower denture base should extend to the full
depth of the lingual sulcus as permitted by muscle function.
Lingual surfaces usually are made concave except in the distal palatal area.
Buccal surfaces are made convex at gingival margins, over root prominences, and at
the border to fill the area recorded in the impression. Between the border and the
gingival contours, the base can be made convex to aid in retention and to facilitate
the return of the food bolus to the occlusal table during mastication. Such contours
prevent food from being entrapped in the cheek and from working under the
denture.
Occasionally, the path of insertion can cause the denture flanges to impinge
on the mucosa above undercut portions of the residual ridge, when the partial
denture is being seated. In these instances, it is usually preferable to shorten the
flange, rather than relieving the internal surface. If the internal surface is
relieved significantly, a space will exist between the denture base and the tissues
when the denture is fully seated. Food may become trapped in the space and work
its way under the partial denture.
The ideal relationship between the denture base carrying the artificial teeth and the
adjacent abutment should either be:
1- Close contact between the denture and the proximal surface of the abutment. In
this condition relieving the gingival margin is necessary to avoid its traumatization.
2- Open Contact between artificial teeth carried by the denture base and the
abutment above the contact point allowing enough space between them to create a
cleansable area.
On the other hand improper contact between the denture and the abutment tooth
leaving only a small space between the neck of the abutment tooth and the artificial
tooth is undesirable. This small space is difficult to clean predisposing to caries,
gingivitis and pocket formation.
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Denture Base
1-Close contact between the denture and the proximal surface of the abutment
The natural appearance presented by the labial and buccal flange of a long
saddle is dependent upon:
In shaping the gingival papillae, the space between the teeth should be
filled. The resin representing the papilla may then be lightly polished to give a
surface, which is readily self-cleansing.
The shape of the entire gingival margin is usually more sharply curved if the
neck of the tooth is not prominent, but is higher and straighter if the neck is
prominent. A more vigorous expression may be obtained by emphasizing the
convexity of the gingival margin. The whole area of the gingival margin should be
polished highly to avoid food debris accumulating round the necks of the teeth.
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Denture Base
In ageing, both the interdental papilla and the gingival margin require
modification. The papilla is positioned higher on the neck of the tooth, and the
gingival margin regresses up the root of the tooth and a pointed rather than a curved
form should be used, especially at the neck of a prominent tooth such as the canine.
The thin edge allows the colour of the flange to blend more naturally with
the mucosa. Coloring and shading of labial flanges must be considered to blend
harmoniously with the natural tissues of the patient. Many manufacturers supply
acrylic materials containing colored fibers, to which may be added additional stain
and shaded polymers.
The general principles discussed in relation to long anterior saddles apply equally
to shorter ones:
The artificial papilla must be shaped to match the natural closest papilla.
The shape and contour of the gingival margin must be similar to that of the
natural teeth.
The junction between artificial and natural gum tissue as mixed together as
possible.
The margins of the flanges must be reduced to water thinness, and whenever
possible, extended over the eminences of the abutment teeth. Such thin edges not
only blend inconspicuously with the natural tissues, but also allow their colour to
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Denture Base
show through. It will be necessary to employ a path of insertion that will allow the
thin acrylic to pass over the eminence.
2. A gum-fit can be done by using a longer tooth than is really indicated which is
unsightly when the necks of the teeth are revealed by the patient. Usually it is better
to use a small flange if possible since this can be very thin and discreet and nearly
undetectable at normal distances. The use of a flange also increases the saddle area
which is desirable whenever possible. Fitting to the gum is recommended in some
cases where the first premolar has to be replaced and the canine is still standing.
The ridge just posterior to the canine is often quite prominent and the tooth
angulations will be better if no flange is used. In addition, a flange in this area is
often noticeable when the patient smiles.
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RESTS AND REST SEATS
Definitions
Rests:
Are rigid extensions of a partial denture, fitted into rest seats, which are
prepared on either the occlusal, lingual surfaces or incisal edges of the teeth,
providing support to the partial denture.
Support:
Rest seat:
Types of Rests:
A- EXTRACRONAL (EXTERNAL) REST: which used with an
extracronal clasp assembly-type direct retainer although it is primarily within the
contours of the abutment tooth.
According to their shape and location on the tooth surface they may be
classified as:
1- Occlusal rest.
(2)Interproximal
(4) Extended
2- Incisal rest.
3- Lingual rest.
4- Embrasure Hooks
5- Rest Recess
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RESTS AND REST SEATS
2- Secondary rest: it is an additional rest used on other than abutment teeth for
gaining extra support or act as indirect retainer.
B- According to shape:
1- Posterior rests
2- Anterior rests
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RESTS AND REST SEATS
I- Occlusal Rest:
A rigid extension of a removable partial denture located on the occlusal
surface of a posterior tooth, on a rest seat specially prepared to receive it.
2. The angle formed by the occlusal rest and the vertical minor connector
should be less than 90 o so that the transmitted occlusal forces are
directed toward the long axis of the tooth.
5. In bounded partial denture: occlusal rests are placed in the near zone
of the occlusal surface of the two abutments bounding the edentulous
span.
6. In free end partial dentures: the occlusal rest is placed on the far
zone of the occlusal surface of the abutment, in order to decrease the
torque action on the abutment tooth.
a- Prevent a spreading of the clasp arms, and maintains the components of the
dentures in their planned positions.
2. Assist in distributing the occlusal load among two teeth or more so that each
can bear a proportionate share of the masticatory load in concert with the
residual ridges.
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RESTS AND REST SEATS
3. Help maintain the plane of occlusion in the region of the abutment teeth.The
occlusal rest can be shaped to improve the existing occlusion by building out
the occlusal surface of the tooth to allow contact with the opposing teeth.
4. It may act as indirect retention along with its minor connector if they are
placed beyond the fulcrum.
5. Maintain the clasp in the correct position on the abutment tooth thus helping
to maintain the effectiveness of the retentive and reciprocal components of the
clasp.
4. Serve as a reference point for evaluating the fit of the framework to the teeth.
5. Help prevent extrusion, tipping, or migration of the abutment teeth.
8. In addition to these functions, an internal rest may provide some bracing and
retention for the RPD.
Effect of occlusal rest location on the tooth :
- An extended occlusal rest covering the whole occlusal surface of the
tooth "Onlay rest" allows for the transmission of the vertical load over the whole
occlusal surface and directs the forces along the long axis of the tooth.
- An improperly extended occlusal rest placed on one side of the
occlusal surface causes torque on the tooth when vertical forces are applied. - To
prevent this torque either:
a) Extend the occlusal rest across the mesio-distal center of the tooth,
b) Use two short oppositely placed occlusal rests one on the mesial and the other
on the distal surface of the tooth,
Forms and Requirements of Rest Seat Preparation:
1- Preparations for the occlusal rest must precede making master cast and
follow proximal preparation (guiding planes and elimination of
undesirable undercuts).
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RESTS AND REST SEATS
restoration and refined in the cast metal before the restoration is seated in
the mouth.
4- The out line form of an occlusal rest seat should follow the outline form
of the fossa present on the occlusal surface and should be rounded
triangular in shape, the base of the triangle – located at the marginal
ridge- is about one third to one half the mesiodistal width of the tooth,
it is about 2.5 mm in width, and its rounded apex is directed towards the
center of the tooth .
5- it should be one half the buccolingual width of the tooth from cusp tip to
cusp tip which correspond to one third of the whole buccolingual
diameter of the tooth
7- The rest seats may be prepared in either a box shaped or saucer shaped
form:
Boxed Shaped Occlusal Rest have vertical walls and flat floor,
they are rarely used in bounded cases having strong abutments.
8- The rest seat should have smooth gentle curves with no sharp walls,
angles or ledges.
a- Inclined apically as it approaches the center of the tooth to direct the force
towards the long axis of the tooth.
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RESTS AND REST SEATS
b- The angle formed by the seat & the vertical minor connector should be
also less than 90o for directing the load towards the long axis of the abutment
and prevent slipping of rest creating an orthodontic like force and to direct the
forces along the long axis of the tooth.
d- For bounded cases having strong abutments it may have relatively box-
shape.
Occlusal rest seats in sound enamel may be prepared with burs and
polishing points that leave the enamel surface as smooth as the original enamel.
Occlusal rest seats in crowns and inlays are generally made somewhat
larger and deeper than those in enamel. Those made in abutment crowns for
tooth-supported dentures may be made slightly deeper than those in abutments
that support a distal extension base; thus they approach the effectiveness of
boxlike internal rests.
1- The larger round bur is used first to lower the marginal ridge and to
establish the outline form of the rest seat.
2- A slightly smaller round bur is then used to deepen the floor of the
occlusal rest seat.
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RESTS AND REST SEATS
2- Dove tailed occlusal rest: it may prepared in short span bounded saddle
It may extend to the center of the tooth or entirely across the occlusal
surface. The purpose of extending the rest to the center of the tooth or across the
entire occlusal surfaces is to:
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RESTS AND REST SEATS
1) Direct forces more parallel to the long axis of the root than if the rest is
just on the mesial or distal of the tooth,
2. Restores occlusion.
Indication
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RESTS AND REST SEATS
The embrasure type of clasp is, basically, two simple circle clasps jointed
together, and the rest recesses should be fashioned on the two abutment teeth.
This rest can be used to bridge a gap between teeth, thus providing an
effective roof over the vulnerable interdental area. It also prevents food
impaction between the spaced teeth.
The internal rest consists of narrow slot or key way, built into a metal
casting that has been constructed for an abutment tooth, and into which is fitted a
male attachment that has been made an integral part of removable partial denture
framework.
Advantages:
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RESTS AND REST SEATS
7- Onlays:
They are extended occlusal rests covering the whole occlusal surface and
extending buccally and lingually. They are retained by mechanical or adhesive
means. Onlays may be cast in gold or chrome cobalt.
Functions or Onlays:
1- Cover the crown with a restoration that realigns the surfaces of the
tooth with the other teeth in the arch.
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RESTS AND REST SEATS
The rest should be designed to prevent further tipping, it must direct forces
down the long axis of the tooth by either of one of these ways: -
B) A rest preparation that extended from the mesial marginal ridge to the
distal triangular fossa to minimize further tipping.
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RESTS AND REST SEATS
II-Lingual Rests:
A- Cingulum Rest (inverted V Rest).
B. Ball Rest.
C. Canine Ledge.
2 mm
1:1.5 mm 2.5:3
Cingulum Rest
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RESTS AND REST SEATS
B. Ball Rest
Cingulum ball rests with rounded outline are placed on the mesial or
distal halves on the lingual surfaces of all anterior teeth, usually at
the junction of the gingival and middle one thirds. Having 1.5 mm
depth and 2.5 mm width.
C. Canine Ledge
* The ledge rest seat should be perpendicular to the long axis of the tooth.
All undercuts and sharp line angles should be avoided.
They are generally used where the tooth does not have a prominent
cingulum or where a finger-type rest is to be used .
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RESTS AND REST SEATS
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RESTS AND REST SEATS
N.B.: Whereas the most preferred site for a rest, is the occlusal surface of
a molar and premolar. If anterior tooth is the only abutment available, a canine is
preferred over an incisor. In the absence of canine multiple lingual rests are
prepared on anterior teeth.
2.0
1.5
A- Lingual view demonstrates inclination of floor of rest seat, which allows forces to
be directed along the long axis of tooth as nearly as possible.
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RESTS AND REST SEATS
Functions:
1- Bad esthetic.
V- Rest Recess
In mandibular bicuspid with a rudimentary (undeveloped) cusp or in the
abraded tooth
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RESTS AND REST SEATS
VI-Quasicingulum rest
It is prepared for lower first premolar having rudimentary lingual cusp
and consists of accentuated cingulum rest seat prepared in wax up of retainer.
Enamel and cast metal are ideal materials for rest preparations.
Porcelain is less desirable because of its propensity to fracture.
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Major Connectors
CONNECTORS
The various components of removable partial dentures are connected
together by connectors. Connectors are described as being either
Major Connectors
A major connector is the unit of R.P.D., which joins parts of the
prosthesis located on one side of the arch with those on the opposite side.
Functions of connectors:
Classification:
Circular configuration.
Strut configuration.
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Major Connectors
1-Rigid: Rigidity is necessary to transmit and distribute stresses over the entire
supporting area and from one side of the arch to the other.
Other components of the partial denture such as retentive clasps, occlusal rests,
and indirect retainers can be effective only if the major connector is rigid.
The border of the M C should be run parallel to the gingival margin of the teeth.
If the gingival margin must be crossed, the crossing should be at right angles to
the margin to produce the least possible contact with the soft tissues. Relief, or a
space, must be provided between the metal and soft tissue.
6- Not interfere with phonetics by using proper thickness and avoid covering the
rugae area if possible.
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Major Connectors
- Never place the connector on convex tooth surface or incisal third of teeth.
- The border should not end on the crest of prominent rugae but in the valleys
- They should be symmetric on both sides and cross the palate in straight line
The term bar is used whenever the anteroposterior width of the major-
connector is less than 8 mm. If the anteroposterior width of the major connector
is in the 8 to 12 mm. range the term strap is applied. When more than 12 mm is
covered the term palatal plate is used. If the entire palate is covered, the term
complete palatal plate is used.
1-Bars
a. Bars are usually narrow, less than 8 mm in width (6-8 mm) and half oval
in cross section. Their margins are beveled and gently curved.
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Major Connectors
c. However, bars require more bulk of metal in order to gain the required
rigidity; this bulk may interfere with proper speech and may be untolerated
by patients.
2-Straps
a. They are wide and thin palatal bars, more than 8 mm in width to gain the
necessary rigidity.
a. the words palatal plate are used to designate any thin, broad, contoured
palatal coverage used as a maxillary major connector and covering one
half or more of the hard palate.
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Major Connectors
f. The posterior border should not extend onto the movable soft
palate,
g. The borders should be beaded.
h. Both anterior and posterior borders should cross the midline at
right angles, never diagonally.
i. The borders should run parallel rather than diagonal to the
gingival margin and if they cross the gingival margin they should
be crossed abruptly and at right angle to the margin in order to
produce the least possible soft tissue coverage.
2. THE METAL SHOULD NOT BE HIGHLY POLISHED ON THE
TISSUE SURFACE: to preserve intimate tissue contact, except where it
crosses the gingival margin
3. RELIEF OF THE MAJOR CONNECTOR.
Usually no relief is required on the tissue surface of the major
connector. When crossing the gingival margins, the tissue surface should
be lightly relieved and highly polished. Little relief may be required in the
presence of palatal tori or prominent median
4. THICKNESS OF THE METAL should be uniform throughout the palate.
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Major Connectors
Advantages of beading:
1- Prevents food debris from collection under the MC.
2- Provide a thinnest metal on the polished surface while maintain the necessary
strength. This is due to the extra thickness of metal provided by the beading.
3. To ensure intimate tissue contact of the major connector with selected palatal
tissue
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Major Connectors
I- PALATAL BARS
Palatal bars may be in the form of single palatal bars or combined palatal bars.
Design:
Disadvantages
Indication:
Design:
- The bar crosses the middle portion of the palate away from the
rugae area.
Advantages:
b. It provides some support since it lies on the horizontal part of the palate.
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Major Connectors
Disadvantage:
The single posterior palatal bar has limited indications for use. It is used
in tooth supported posterior dentures and in unilateral distal extension partial
denture replacing one or two teeth.
Design:
Advantages
a. The bar exhibits limited palatal coverage and well tolerated by the tongue
if made with proper thickness. It is not likely to affect taste.
b. Bracing is provided by the part of the bar contacting the lateral side of the
palate.
c. The posterior palatal bar provides indirect retention for Kennedy class IV
cases.
Disadvantages:
a. It is rarely used nowadays, because it cannot be made bulk, thus lacks the
required rigidity.
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Major Connectors
Design:
2. It is gently curved and should not form a sharp angle at the junction with the
denture base.
3. It should not be placed further anterior to the second premolar. This position
is favorable for the tongue action.
Disadvantages:
1. For a single bar to maintain any degree of rigidity it should be bulky (less
acceptable by the patient).
2. It drives little support from the bony palate because its narrow anteroposterior
width.
3. Its use is limited to replace one ore two teeth on each side of the arc.
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Major Connectors
Indication
1. It can be used in any class especially when the anterior and posterior
abutments are widely separated.
Design:
Longitudinal bars:
- Two bars, one on each side of the palate, at the junction of its horizontal
and vertical planes. They join the anterior and posterior bars forming the
ring or circle configuration. Thus, the metal forming the connector lies in
two different directions giving the connector strength and rigidity.
Advantages:
a. The A-P bar is the most rigid bar type palatal major connector because it
lies at different planes.
Disadvantages:
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Major Connectors
2. The anterior bar covers the rugae area and may interfere with phonetics
and patient's comfort.
3. Because the bars are narrow, extra bulk is required for rigidity.
4. The multiple borders and edges of the bars may annoy the tongue and are
intolerable by some nervous patients.
Contraindications:
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Major Connectors
(1) Usually none required except slight relief of elevated medial palatal
raphe or any exostosis crossed by the connector.
(2) One thickness of baseplate wax over basal seat areas (to elevate minor
connectors for attaching acrylic resin denture bases).
Beading
Waxing Specifications
Finishing Lines
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Major Connectors
Advantages:
Disadvantages:
Contraindication:
2-Middle Palatal Strap: [some text consider posterior palatal = (midpalatal) strap.]
The middle palatal strap is the most versatile and widely used
maxillary major connector.
Indications:
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Major Connectors
Design:
Its anterior border should be posterior to the rugae area and the posterior
border should terminate short of the junction of the hard and soft
palate
3. It is well tolerated because it can be kept away from the sensitive area
around the rugae and incisive papilla.
4. The anterior border lies just posterior to the commencement of the rugae
area, where the number of tactile receptors is smallest.
6. It can be made relatively narrow, for the small tooth supported prosthesis,
or much wider when the edentulous spaces are longer and the requirement
for support is correspondingly greater.
Disadvantages:
Indication:
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Major Connectors
Advantages:
Disadvantages:
Structural details:
(5) In tooth borne, and mucosa borne partial dentures when replacement of
anterior and posterior teeth is required.
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Major Connectors
(1) Usually none required except slight relief of elevated median palatal
raphe where anterior or posterior straps cross the palate.
(2) One thickness of baseplate wax over basal seat areas (to elevate minor
connectors for attaching acrylic resin denture bases).
Waxing Specifications
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Major Connectors
Finishing Lines
Advantages:
Indications:
3. Class II arch with a large posterior modification space and some missing
anterior teeth.
4. Cases having shallow vault or flat ridge as the complete plate will provide
good stabilization.
6. Class III Kennedy with modifications, when the condition of the abutment
is poor.
The posterior border of the plate at right angle to the median suture line;
extended to pterygomaxillary notches (hamular notch )area(s) on distal
extension side. It extends to the junction of the hard and soft palate. It should
provide a peripheral seal, which adds to the retention of the denture.
The borders are beaded to prevent debris from collecting beneath the
plate.
(1) Usually none required except relief of elevated median palatal raphe
or any small exostoses covered by the connector.
(2) One thickness of baseplate wax over basal seat areas (to elevate minor
connectors for attaching acrylic resin denture bases).
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Major Connectors
Waxing Specifications
Finishing Lines
Advantages:
1. The plate is well tolerated by most of the patients. Its uniform thinness and
the thermal conductivity of the metal are designed to make the palatal
plate more readily acceptable to the tongue and underlying tissue.
Disadvantages:
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Major Connectors
Indications.
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Major Connectors
Design:
Step 1: Outline of primary bearing areas. The primary bearing areas are those
that will be covered by the denture base(s).
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Major Connectors
The need for indirect retention influences the outline of the major
connector. Provision must be made in the major connector so that indirect
retainers may be attached.
Step 5: Unification. After selection of the type of major connector, the denture
base areas and connectors are joined.
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Major Connectors
1- PLACEMENT OF BORDERS.
a. The superior borders are placed a t least 3 mm from the gingival margins
and parallel to the free gingival margin or for the lingual plate it should be
extends to the cingulae of the anterior teeth in which the gingival margin
should be relieved.
b. The inferior border should be gently rounded above the moving tissues of
the floor of the mouth and should not interfere with the soft tissue movement
of the floor of the mouth.
2. Beading is never indicated because of the need for relief under all mandibular
major connectors,
3- The metal should be highly polished on the tissue side to minimize plaque
accumulation.
because the denture does not tend to move, (30 gauge, 0.010 inch)
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Major Connectors
If the lingual slope is near vertical, this needs minimal relief. If the lingual
undercut, sufficient space which may create during blocks out the
relief is usually required (28 gauge, 0.013 inch to 26 gauge, 0.016 inch).
relief is usually required (26 gauge, 0.016 inch to 24 gauge, 0.020 inch).
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Major Connectors
3- Bone index. Where the residual ridge exhibits a poor bone index, more
relief may be required to compcnsate for resorptive changes occurring prior
to anticipated relining.
When the anterior teeth have a pronounced labial inclination, more relief
may be required. It may be impossible to direct the occlusal forces along the
long axes of the teeth. With such an inclination, a continued labial migration of
the teeth may occur. The labial migration may result in the major connector
impinging on the soft tissues.
1. Lingual bar
2. Sublingual bar
5. Linguoplate
6. Labial bar
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Major Connectors
1- Lingual bar
The lingual bar is the simplest of the mandibular connectors, and should
be used in preference to other mandibular major
connectors whenever possible.
Indication:
1. The lingual bar is and located on the lingual side of the alveolar ridge.
5. The inferior border should be gently rounded above the moving tissues of
the floor of the mouth; to avoid irritation or injuring the sub adjacent
tissues when the restoration moves.( vestibule must be 7mm at least)
6. The bar should be relieved sufficiently but not excessively over the
underlying tissues, Lingual tori are generously relieved when surgery is
contraindicated.
2. Patient tolerance.
Disadvantages
Long lingual bars may attain some flexibility, especially if they are
poorly constructed or designed.
Framework goes from thick (at the minor connectors) to thin (at the
bar) to thick again which is metallurgically and structurally
complicated. The result may be weak areas in the casting with the
potential to fracture.
Contraindications:
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Major Connectors
1- Inadequate space between the free gingival margin and the floor
of the mouth. Less than 7 mm exists between the marginal
gingiva and the activated lingual frenum and floor of the mouth.
5- The presence of an undercut on the lingual side of the ridge could cause
gross food entrapment and discomfort in the presence of the lingual bar.
The lingual bar functions only as a major connector. It does not provide
neither support nor indirect retention.
Indications:
4. Distal extension RPD situations with sloped or parallel lingual alveolar
ridges where a lingual bar would rotate into the lingual alveolus as the
base area rotates tissue-ward.
Contraindications
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Major Connectors
(2) An additional thickness of 32-gauge sheet wax when the lingual surface
of the alveolar ridge is either undercut or parallel to the path of placement.
(3) One thickness of baseplate wax over basal seat areas (to elevate minor
connectors for attaching acrylic resin denture bases).
Waxing Specifications
(2) Long bar bulkier than short bar; however, crosssectional shape
unchanged.Finishing Lines Butt-type joint(s) with minor connectors) for
retention of denture base(s).
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Major Connectors
2. It does not cover the teeth or tissues. It permits exposure of the gingival
tissue and the lingual surfaces of anterior teeth allowing for the natural
physiologic stimulation of the gingiva.
4. Some dentists suggested the use of sublingual bar because the under side
of the tongue is relatively sparsely provided with tactile receptors.
Disadvantages:
a) The first method is to measure the height of the floor of the mouth in relation
to the lingual gingival margins of adjacent teeth with a periodontal probe.
During these measurements, the tip of the patient's tongue should be just lightly
touching the vermilion border of the upper lip. Recording of these measurements
permits their transfer to both diagnostic and master casts, thus ensuring a rather
advantageous location of the inferior border of the major connector.
Indication
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Major Connectors
Where there is insufficient room for the lingual bar, between gingival
margin and the floor of the mouth, and unless the periodontal health is well
maintained.
The teeth should have good mesiodistal contact with sufficient crown
length.
Kennedy bar
It is used alone or in conjunction with a lingual bar forming the double lingual
bar, to add to the strength and rigidity of the denture.
Contraindications
(2) When wide diastemata exist between the mandibular anterior teeth and
the cingulum bar would objectionably display metal in a frontal view.
(1) Thin, narrow (3 mm) metal strap located on cingula of anterior teeth,
scalloped to follow interproximal embrasures with inferior and superior
borders tapered to tooth surfaces.
Waxing Specifications
Finishing Lines
Advantages
Permits exposure of the gingival tissue that allows natural stimulation but
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Major Connectors
Disadvantages
The metal bulk of the bar may be disadvantage and esthetic may be
compromised, if spacing is present.
The open space may traps food and may exacerbate gingival trauma and it
may be objectionable to the tongue.
Indication
Contraindications:
3. It is joined to the lingual bar via two rigid minor connectors, which
are located in the interproximal spaces, usually between the canines
and first premolars.
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Major Connectors
It should have the same design as a single lingual bar, half pear-
shaped in cross section with the greatest diameter at the inferior
margin.
(1) Lingual surface of alveolar ridge and basal seat areas same as for
lingual bar.
Waxing Specifications
(1) Lingual bar major connector component waxed and shaped same as
lingual bar.
Finishing Lines
3. The configuration of this bar adds to the strength and rigidity of the
denture.
4. Proper distribution of the stresses acting on the partial denture to all teeth.
6. The double lingual bar acts as an indirect retainer through its terminal
rests.
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Major Connectors
Disadvantages:
2. If the open space is insufficient may collect food and produce tissue
irritation.
Indications:
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Major Connectors
10. Adequate block-out is required for teeth and soft tissue undercuts.
12. The lingual plate must always be supported at each end by rests, to
provide indirect retention.
13. when a single diastema exists a notched lingual plate could be used to
avoid display of metal.
Interrupted linguoplate
When the anterior teeth are quite spaced and the patient
strenuously objects to metal showing through the spaces,the linguoplate
can then be constructed so that the metal will not appreciably show
through the spaced anterior teeth. Rigidity of the major connector is not
greatly altered.
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Major Connectors
(3) Lingual surface of alveolar ridge and basal seat areas the same as for a
lingual bar.
Waxing Specifications
Finishing Lines
Advantages
The lingual palate is the most rigid mandibular connector, and provides
more support and stabilization than do the other connectors.
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Major Connectors
Contraindications:
Diastemas, unless the lingual plate can have slots in it to avoid the
display of metal.
Indications:
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Major Connectors
1. It should be made with greater thickness and bulk than a lingual bar to
counteract the increased flexibility due to increased length.
(2) No relief necessary when the labial surface of the alveolar ridge slopes
inferiorly to the labial or buccal.
(3) Basal seat areas same as for lingual bar major connector.
Waxing Specifications
(2) Long bar necessitates more bulk than short bar; however, cross sectional
shape unchanged.
Finishing Lines
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Major Connectors
Advantages:
Disadvantages:
4. It distorts the lower lip and the presence of the metal between the
gingival tissue and the lip causes patient discomfort.
Contraindications:
Indications
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Major Connectors
Design
Advantages:
2- The labial bar together with the lingual plate provides the required
rigidity, thus the labial bar does not require much bulk.
Contraindications
Indications.
a. May be used where some stress release from the abutment teeth is
desired through the major connector.
Design:
9- Dental bar
On occasions, there is insufficient room between gingival margin and
floor of the mouth for either a sublingual or lingual bar. A lingual plate
should be avoided wherever possible because it might well tip the delicate
balance between health and disease in favour of the latter.
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Major Connectors
Step 4: Connect the basal seat area to the inferior and superior borders of
the major connector, and add minor connectors to retain the acrylic resin denture
base material
1- Function:
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Major Connectors
2- Anatomical consideration :
Mandibular:
Lingual tori
3- Hygiene:
4- Rigidity:
5- Patient acceptability:
Strap or plate type major connectors, because they can be made thinner,
usually have a greater patient acceptance than the bar types. Some patients may
find the increased palatal coverage uncomfortable due to alterations in gustatory,
thermal or tactile perception. Generally, posterior or mid palatal straps are less
objectionable than anterior palatal straps or bars.
The major connector must connect the components of the partial denture.
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Major Connectors
Class I partially edentulous arches with residual ridges that have undergone
little vertical resorption and will lend excellent support: SINGLE BROAD
PALATAL
Class I and II arches in which excellent abutment and residual ridge support
exists, and direct retention can be made adequate without the need for indirect
retention. ANTERIOR-POSTERIOR STRAP-TYPE
Class I arch with one to four premolars and some or all anterior teeth remaining,
and abutment support is poor and cannot otherwise be enhanced; residual ridges
have undergone extreme vertical resorption; direct retention is difficult to
obtain. COMPLETE PALATAL COVERAGE
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Major Connectors
Class II arch with a large posterior modification space and some missing
anterior teeth. COMPLETE PALATAL COVERAGE
----------------------------------------------------------------------------
Inoperable palatal tori that do not extend posteriorly to the junction of the hard
and soft palates. ANTERIOR-POSTERIOR STRAP
inoperable tori extend to the posterior limit of the hard palate. U-SHAPED
PALATAL
3- When the anterior teeth have reduced periodontal support and need
stabilization, the lingual plate or double lingual bar may be used .
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Major Connectors
5- For patient who have large inter-proximal spaces that cause esthetic
problems by the display of the metal of a lingual plate ,a double lingual
bar may be indicated.
Sufficient space exists between the slightly elevated alveolar lingual sulcus and
the lingual gingival tissue. MANDIBULAR LINGUAL BAR
height of the floor of the mouth in relation to the free gingival margins will be
less than 6 mm MANDIBULAR SUBLINGUAL BAR
linguoplate is indicated but the axial alignment of anterior teeth is such that
excessive blockout of interproximal undercuts would be required.
MANDIBULAR LINGUAL BAR WITH CONTINUOUS BAR
wide diastemata exist between mandibular anterior teeth and a Linguoplate
would objectionably display metal in a frontal view. MANDIBULAR LINGUAL
BAR WITH CONTINUOUS BAR
lingual plate or sublingual bar is otherwise indicated but the axial alignment of
the anterior teeth is such that the excessive blockout of interproximal undercuts
would be required. CINGULUM BAR
lingual inclinations of remaining mandibular premolar and incisor teeth cannot
be corrected LABIAL BAR
severe lingual tori cannot be removed LABIAL BAR
severe and abrupt lingual tissue undercuts make it impractical to use a lingual
bar or lingual plate LABIAL BAR
class 1
Class I arch residual ridges have undergone such vertical resorption that they will offer
only minimal resistance to horizontal rotations of the denture through its bases.
MANDIBULAR LINGUOPLATE
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Major Connectors
MINOR CONNECTORS
Design Specifications:
Minor connectors that contacts the axial tooth surfaces or contacts the guiding
plane surfaces of the abutment teeth whether as a connected part to the clasp
assembly or as a separate entity should fulfill the following requirements:
3. Where the minor connector joins a rest, a minimum metal thickness of 1.5
mm at the junction is required for base metal alloys (2 mm for gold
alloys).
6. The surface of metal facing the tongue should be smooth and beveled. The
minor connector should be thickest toward the lingual surface and
tapering toward the contact area, to provide space for the arrangement of
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Major Connectors
teeth. In this case they are triangular in shape, the base of the triangle faces
the tongue and the apex lies toward the lingual contact area of teeth.
3. Transfer the effect of retainers, rests, and stabilizing units to the denture.
It is generally arising from the major connector. They should form a right
angle with the major connector, but the junction should be a gentle curve rather
than a sharp angular connection. The minor connector should be designed to lie
in the embrasure between teeth to disguise its bulk as mush as possible.
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Major Connectors
Design
Proximal plates extend from the proximal facial line angle to, or slightly
past, the proximal lingual line angle of the abutment tooth. They are thin
mesio-distally and taper slightly toward the occlusal (incisal).
They extend from the occlusal/incisal of the tooth to the major connector.
The junction of rests and clasp arms with proximal minor connectors, and
proximal minor connectors to major connectors are rounded right angles.
They extend cervically and contact the mucosa of the ridge crest for 2-3
mm.
The part of the proximal minor connector which contacts the ridge crest is
called the Foot of the proximal plate
Unite the dental arch by substituting for lost proximal tooth contacts
Prevent food impaction between the proximal surface of the tooth and the
RPD,
Provide a definite finish line for the junction of the denture base and
major and minor connectors,
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Major Connectors
Design
They extend from the occlusal, incisal or cingulum surface of the tooth to
the major connector. They join the major connector in a rounded right
angle to avoid sharp corners and they taper slightly toward the occlusal
(incisal).
• Unite the dental arch by substituting for lost proximal tooth contacts
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Major Connectors
Design
Their junction with the major connector is a rounded right angle and they
taper toward the occlusal (incisal).
The lateral borders extend into the proximal embrasures to hide these
edges from the tongue.
The surface minor connector may be penetrated by the tip of the lingual
cingulum rest preparation. This "open" design facilitates fitting the
framework and cleaning the tissue surface of the minor connector.
Another modification of the surface minor connector is a "finger rest" in
which the rest extends from the proximal or embrasure minor connector
into the rest preparation.
Radford modification:
Advantages:
Disadvantages:
encroach on the tongue space and provide more obvious borders and a
greater potential space between the connector and the abutment for food
entrapment.
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Major Connectors
It approaches the tooth from the gingival margin. It should have a smooth,
even taper from its origin to its terminus. It must not cross a soft tissue
undercut.
III-Minor connectors that join the denture base to the major connector:
It may be:
b) Mesh construction.
If the tooth surface is not entirely parallel to the path of placement and
removal of the RPD, a space will be created between the minor connector and
the tooth surface below the height of contour.
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Major Connectors
2- Others suggest that the space should be kept large so that it may be
easily cleaned by the tongue while the RPD is in the mouth ("self-
cleansing design") and thus less likely to cause periodontal damage and
mucosal irritation.
The dentist has little control over the size of this space unless the tooth is going
to be restored with a surveyed crown. And, other factors are much more
important in the success of RPD treatment than the space between the proximal
plate and the tooth.
b) “self-cleansing” design,
State rules of thumb for the form and length of minor connectors connecting acrylic resin
denture bases to major connectors.
Give a rule of thumb for how far the minor connector attaching the resin base to the major
connector should extend posteriorly.
The thickness of impression material when rubber-base material is used should be about 3 mm
(1/8 inch) for accuracy and stability. Does this equally apply to a hydrocolloid impression
material? If not, give a rule of thumb for the desired thickness of the hydrocolloid material in
the impression.
Sufficient relief must be provided beneath a major connector to avoid impingement and/or
displacement of soft tissue resulting in an inflammatory response. What is meant by the word
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Major Connectors
relief? Rationalize planned relief for a lingual bar and give quantitative rules of thumb that
depend on the contour of the anterior, lingual alveolar ridge.
There are definite rules of thumb for the location of the anterior and posterior borders of all
palatal major connectors. Describe the relationship of the borders to rugae, junction of hard
and soft palates, gingival crevices, pterygomaxillary notches, and palatal tori.
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Direct retainers
Retention is the resistance of the partial denture to vertical displacement away from
the tissues.
Retention of an RPD can be achieved by:
- Using the inherent physical forces which arise from coverage of the mucosa by the
denture.
- Physiologic factors: Harnessing the patient’s muscular control acting through the
polished surface of the denture.
- Using mechanical means such as clasps which engage undercuts on
the tooth surface.
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Direct retainers
The effect of physical forces is less applicable to lower dentures than upper denture
because:
a- Lower dentures have less surface area.
b- Lower dentures are bathed in saliva.
c- Lower major connectors are relieved from the underlying tissues
contrary to upper major connectors that are well adapted and their borders
are beaded against the underlying tissues.
d- Strong movements of the tongue tend to break the seal in lower
dentures.
1- The physiologic molding of the tissues around the polished surfaces of the denture
helps to perfect the border seal.
2- Neuromuscular control: The patient ability to control the denture with the lips,
cheeks, and tongue can be a major factor in the retentiveness of the denture.
1. Direct retainers:
The components of partial denture that are used primarily to retain the
denture and resist vertical dislodging forces applied to it.
a- Intracoronal retainer.
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Direct retainers
denture in place.
B- Attachments:
These are ready or tailor made, male and female components.
One component is fixed to the abutment, and the other attached to the
denture. They are either extra coronal or intracoronal attachment.
2. Indirect retainers:
They are components of partial denture that are used to resist vertical
displacement of a distant part of the denture.
3. Frictional fit between the natural and artificial teeth.
4. Parts of the denture engaging tooth undercuts.
5. Parts of the denture engaging tissue undercuts.
Clasp Retainers
Components of a clasp:
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Direct retainers
It is a part of the clasp placed on prepared occlusal, lingual or incisal surfaces of teeth.
Function:! It supports the denture.
3-A retentive clasp arm:
The retentive clasp arm of the occlusally approaching clasp comprises a
rigid part located above the height of tooth contour to provide bracing then
tapers and ends in a flexible terminal, which engages an undercut area below
the height of tooth contour. The terminal end of the clasp arm provides direct
retention.
Function:- Retention, bracing and stabilization.
The retentive arm of the clasp may approaches the undercut area from the gingival
direction and called bar type clasp. It provides retention only for the partial denture
4-A Reciprocal arm (guiding arm) is a rigid, half round, arm located occlusal to the
survey line on a surface of the tooth opposing the retentive arm.
Its main function is to counteracts stresses generated by the retentive arm as it
crosses the height of contour during insertion and removal of the denture,
causing lingual (or buccal) movement of the abutment tooth.
In order to reciprocate forces properly, it should remain in contact
with the tooth during function of the retentive arm. Rigid major connectors,
or minor connectors contacting lingual surfaces of the teeth substitute
reciprocal arm.
- Reciprocal arm also stabilizes the denture against lateral movements.
One arm clasp may be used to encircle the tooth. The rigid part of the arm starts on
one side of the tooth and cross-proximal surface to reach the other side of the tooth as
a tapered (retentive) end.
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Direct retainers
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Direct retainers
2-Angle of approach.
Occlusally approaching clasps are easier in occlusal displacement than
gingivally approaching clasps. Occlusally approaching clasps are pulled up to
move occlusally. Gingivally approaching clasps are pushed up to move
occlusally (Trip action, push or crip action)
Not all gingivally approaching clasps exhibit trip action for example T or
modified T clasp may approach under cut from occlusal direction.
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Direct retainers
The angle formed between the analyzing rod and tooth surface apical to
the height of contour.
A two clasps may engage the same depth of undercut but the distance to
the height of contour varies.
Less gingival convergence (i.e. the retentive tip is at long distance from
height of contour) leading to less resistance to vertical dislodging force .
4- Position of clasps in relation to fulcrum axis
Direct retainer hould be as far away from the fulcrum axis for mechanical
advantages
More increase the flexibility should not be occurring, because this leads to
decrease the clasp ability to provide retention.
D= Ewt3!! 4PL3
The thickness of the tip of the clasp should be half the thickness at
the origin.
c) The tapering:
The clasp arm should be uniformly tapered in such away that the diameter
at its origin is twice that at its tip (Fig. 3-121).
d) The cross sectional form:
A round clasp arm is more resilient than half round or oval cross
section; that are difficult to flex in certain directions.
The round clasp is the only universally flexible clasp. Practically it is
impossible to obtain this universally flexibility by casting & polishing.
Therefore all cast clasps are half rounds in form.
In the half round, the flexibility is limited only one direction. It
flexible only in tooth ward direction, but the flexibility in the edge wise
direction is limited. Also the adjustment of this clasp is in the tooth ward
direction only. The edge wise direction means moving the clasp cervically
or occlusally.
e) The material of alloy:
Gold alloys are more flexible than cobalt chrome alloys.
The chrome alloys have higher modular of elasticity than the gold alloys,
therefore it is less flexible.
The modular of elasticity defined as the constant of proportionality between stress &
strain. It is represents the slope of the elastic portion of stress strain curve.
STRESS
ξ = elastic modulus =
STRAIN
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Direct retainers
Clasps could be located at each end of the denture , this clasping is not
biologically accepted due to more tooth coverage
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Direct retainers
Instead , two clasps can be used in away that a straight line joining them
bisect the denture
If the denture tend to rock about the line joining two clasps , a third
clasp is added as far as possible from others .
The advantages of any particular clasp design should lie in an affirmative answer to
most (or all) of the following questions:
1. Is it flexible enough to satisfy the purpose for which it is being used? (On an
abutment adjacent to a distal extension base, will tipping and torque be avoided?)
2. Will adequate stabilization be provided to resist horizontal and rotational
movements?
3. Will rigidity be provided where it is needed?
4. Is the clasp design applicable to malposed or rotated abutment teeth?
5. Can it be used despite the presence of tissue undercuts?
6. Can the clasp terminal be adjusted to increase or decrease retention?
7. Does the clasp arm cover a minimum of tooth surface?
8. Will the clasp arm be as inconspicuous as possible?
9. Will the width of the occlusal table remain the same or be decreased?
10. Is the clasp arm likely to become distorted or broken? If so, can it be replaced?
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Direct retainers
Cone theory
In 1916 protherio present a cone theory to explain clasp retention , he described
the crown form as two cones sharing common base.
De van ‘s concept
De van divided the abutment into suprabulge and infrabulge portions
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Direct retainers
Definition: it is a retainer that encircles a tooth by more than 180 degrees, including
opposite angle, and which generally contacts the tooth throughout the extent of the
clasp, with at least one terminal located in an undercut area.
Component parts of the clasp assembly:-
1- Rest: location: - it is lie on the occlusal or lingual surface or
on the incisal edge.
Function: provide support for RPD.
2- Body Location: - above the height of contour.
Function: - connect the rest and clasp arms to the minor
connector.
3- Reciprocal arm Location: - above the height of contour on the side
of the tooth opposing the retentive clasp arm.
Function: - 1- Resist the tipping force generated by
retentive terminal.
2- Help in stabilization of RPD against
lateral movements.
3- Support the prosthesis due to it lie on
the supra bulge.
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Direct retainers
The reciprocal clasp arm must be contact to the tooth before retentive clasp arm pass
over high of contour, and remain in contact while the retentive terminal passes the
height of contour, to resist the tipping force.
4- Retentive arm: - it includes two parts:-
A) Shoulder Location:- above the height of contour (NOT
FLEXABLE)
Function:- connect the body of the clasp terminal.
B) Retentive terminal Location: - below the height of
contour (FLEXABLE).
Function:- provide direct retention.
5- Minor connector:- It is the part of clasp that joints the body of the clasp to the
remainder of the framework ( IT MUST BE REGIDE).
denture & the proximal surface of the tooth. Therefore advisable to place an
additional occlusal rest next to the edentulous space to eliminated this problem.
But this additional rest will decrease or eliminate the releasing action of the
clasp tip as the denture base is depressed on the distal extension side.
3- Poor esthetic result with excessive display of metal.
Indications:
a. Acker clasp is considered best suited for strong abutments teeth because it
transmits the force directly to the tooth and reduce stress on the residual
ridge.
b. It is, therefore more often used in unilateral and bilateral tooth borne
partial denture.
Advantages of Aker clasp
1-This clasp fulfills the requirements of support, stability, encirclement,
reciprocation, and passivity better than any other types of clasp.
2- It is easy to construct and simple in repair.
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Direct retainers
surface but does not change the retentive qualities arising due to
engagement of an undercut.
d. The clasp cannot be used in free-end saddle cases due to its rigidity,
except with a stress equalizing design.
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Direct retainers
The multiple Aker clasp consists of two opposing Aker’s clasps, Two
Lingual rigid reciprocal arms are connected together at the terminal ends to
augment their rigidity.
Indications:
The multiple Aker clasp is used
It is a circlet clasp with its retentive arm turned back (curved ) to engage
an undercut near the edentulous area (below the point of origin).
Indication
1- when the retentive clasp must engage an undercut adjacent to the occlusal rest
or edentulous space and a soft tissue undercut precludes the use of a bar
clasp.
2- When the reverse circlet clasp cannot be used because of lack of occlusal space.
3- when a proximal undercut must be used on a posterior abutment and when
tissue undercuts or high tissue attachments prevent the use of bar type clasp.
Its disadvantages are:
1. greater coverage of tooth surface, that increase the functional load on the
abutment.
2. food trapping at the loop of the arm, and
3. inferior esthetics.
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Direct retainers
The extended arm clasp has the same form as an Aker clasp but its arms
are extended to cover the abutment tooth and the tooth adjacent to it. The
bracing arm lies above the survey line of both teeth. The retentive arm also lies
above the survey line of both teeth and then tapers to engage the undercut of
the second tooth. It is more liable to distortion if its thickness is incorrect.
If this clasp is made in gold alloy the uses is restricted to the premolars,
but with chrome cobalt alloy along arm can be used and two molars can be
clasped.
Indication:
The clasp is used when the undercut on the tooth near the edentulous area
is poor, while that on the adjacent tooth is suitable.
The double Acker clasp is also called embrasure clasp, Compound clasp,
Butterfly , modified crib clasp, Bonwill clasp or Interdental clasp.
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Direct retainers
It consists of two Acker clasps arising from a common body and from the same
minor connector, which is located in the embrasure between the two clasped teeth.
Indication
1- on the dentulous side of unilateral edentulous cases (Kennedy class II or
III having no modifications).
2- Kennedy class IV (on the posterior teeth).
It is used primarily to provide bilateral stabilization, and bracing, in addition to
retention. It also splints the two teeth
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Direct retainers
An Aker circumferential retentive arm arising from the superior portion of the
proximal plate. and extends around the tooth; tapered to engage the mesio-
buccal undercut.
The rigid bracing portion of the arm should contact tooth only along
superior border of the survey line. When an occlusal load is applied to the
denture base, the retentive arm can move into the undercut because of the
relief under its rigid section and release from the abutment tooth.
If a conventional Akers clasp is used, with the retentive arm coming off
the proximal plate above the survey line and crossing the survey line in the
middle of the tooth to engage the undercut then the vital releasing capability will
be lost.
Indication:
It is indicated in distal extension RPDs presented with shallow
vestibule or severe tissue undercut that contraindicate the use of the gingivally
approaching clasps.
Advantages:
1. The RPA assembly is designed with the rest on the mesio-occlusal surface of
the tooth, permitting the other components to release from the tooth and drop into
undercuts when occlusal loads are placed on the denture base. This in turn prevents
tipping of the abutment.
2. Absence of a lingual rigid reciprocal arm minimizes rotational forces falling
on the abutment.
3- RLS Clasp
(Mesial Rest, L-bar direct retainer and Stabilizer)
It is a lingually retained clasp assembly for distal extension removable
partial dentures. This clasp assembly fulfills the biomechanical principles and
the esthetic requirements of patients.
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Direct retainers
1) A mesioocclusal rest.
2) A distolingual L-bar direct retainer,
located on the distal surface of
the abutment tooth. Engages the
distolingual undercut adjacent to
the edentulous ridge.
Advantages:
1. The mesio-occlusal rest reduces the anterior component of movement of the
denture and reduces torque on the abutment tooth.
2. A retentive clasp tip placed on the most distal part of the tooth will undergo a
downward vertical movement and disengage as the distal extension base
moves tissue-ward in function.
The back action clasp is a single arm clasp, provide single bracing only .
The minor connector originates from the major connector. It starts at the of
mesiolingual line angle.
The bracing arm extends above the survey line on the palatal surface till the
proximal surface, then starts its taper to engage a mesiobuccal undercut of
0.01 of an inch.
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Direct retainers
The occlusal rest is located distally,and some times an additional rest could be
employed on the mesial side to improve support.
Indications:
The Reverse back action is similar in structure to the back action but it is
located in the reverse direction.
The minor connectors originates buccally from the saddle starts at the
mesiobuccal line angle and ends to engage a mesiolingual undercut of 0.01 or
0.02 of an inch.
The clasp is Frequently used on lingually tipped bicuspids. It also provides
single bracing only. It has an additional esthetic disadvantage.
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Direct retainers
6- Ring Clasp
The ring clasp is a single-arm clasp, indicated on tilted, isolated molars.
It originates mesially and the single arm encircles nearly all the tooth surface
resembling a ring.
It is generally exhibiting a mesiobuccal undercut in case of upper molars and a
mesiolingual undercut on lingually tilted lower molars. The clasp engages a
0.02 or 0.03 of an inch undercut.
The occlusal rest is located on the mesial marginal ridge.
An auxiliary distal rest is preferably added to prevent further mesial tilting of the
tooth.
A reinforcing supporting strut arm located on the non-retentive side is usually
considered to limit the flexibility of the clasp.
7- Onlay Clasp
It is an extended occlusal rest with buccal and lingual clasp arms. The clasp may
originate from any point on the onlay that will not create occlusal interferences.
Indications:
1- when the occlusal surface of the abutment tooth is below the occlusal plane.
If the onlay clasp is constructed of chrome alloy and is opposed by a natural tooth,
the occlusal surface should be constructed of acrylic resin or gold.
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Direct retainers
These clasps are also called Infra-bulge, I-Bar, Vertical Projection or Roach
clasps.
The bar clasps approach the undercut or retentive area on the tooth from a
gingival-direction, resulting in a "push" type of retention. This push retention of bar
clasps is more effective than the "pull" retention characteristic of circum.
Disadvantages of bar clasps:-
1- Greater tendency to collect and hold food debris.
2- The increased flexibility of the retentive arm, it does not contribute as much
to bracing and stabilization. Additional stabilizing units.
The flexibility of the bar clasp can be controlled by the taper and length of the
approach arm.
Contraindication:
It is contraindicated if the undercut is more than 1mm or the depth of the buccal sulcus
is less than 4mm.
Indications:
-It is used mainly in unilateral and bilateral free end cases to minimize the
torque on the abutments.
-It provides better retention and better esthetic but less bracing than Aker's
-It can utilize different amount of undercut.
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Direct retainers
Contra-indications:
- Deep cervical undercut on abutment or excessive tissues undercut. To avoid
food impaction.
- Shallow sulcus.
1- The approach arm of the bar clasp must not impinge on the soft tissues it is
crosses. It is not desirable to provide an area of relief under the arm, but the
tissue side of the approach arm should be smooth& polished.
2- The approach arm should cross the gingival margin at a 90-degree angle.
3- The approach arm must extend on the abutment tooth to the height of contour.
The retentive terminal leaves the approach arm at that point and extends into
the undercut area. The tip of the retentive terminal must be end toward the
occlusal surface. (The approach arm contacts the tooth only at the height of
contour).
4- The bar clasp should also be placed as low on the tooth as possible while
honoring the height of contour to reduce the leverage-induced stress to the
abutment tooth.
7- The approach arm must be tapered uniformly from it is attachment to the clasp
terminal. It must never be designed to bridge soft tissue a undercut, to avoid the
tapering of food & to avoid the irritation of cheeks or lips.
8- The approach arm should taper gradually and uniformly from its origin to the
retentive end.
9- It must not bridge a soft tissue undercut to avoid food trapping and irritation .
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Direct retainers
10- The tip of the retentive arm may be in the form of I.T.U.C or Y . One end of
the T or Y engage undercut while the other end placed above the survey line
the only function of this additional end is to encircle more than 180º of the
tooth, if the retentive undercut is near to minor connector and occlusal rest.
11- The bar--type clasp is said to have a "push" type of retention (Trip action of
the clasp). As this arm is relatively longer than occlusally approaching arm, it
is considered as a more flexible arm. However, curvature of the arm in more
than one plane minimizes this expected high flexibility.
12- Tripping action is attributed to clasp arms that engage the undercut directly
from a gingival direction. Not all bar clasp arms have tripping action, since
the retentive terminal may actually engage the undercut from an occlusal
direction as is true with the "T" bar or modified "T" bar
A retentive clasp arm originating from the denture base• approaching the buccal
A rigid reciprocal clasp arm on the opposite side of the tooth. This arm is
usually in the form of a circumferential clasp arm and rarely in the form of a
bar arm. This arm is located above the survey line. It provides bracing and
reciprocation.
An occlusal rest and a minor connector joining the rest with the framework.
a- T Clasp
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Direct retainers
b- Modified T Clasp
The modified T clasp is essentially a T clasp with the nonretentive finger (usually
mesial).
This clasp is most often used on canines or premolars for esthetic reasons.
The potential danger in its use is that encirclement, or 180-degree coverage, of the
abutment tooth may be sacrificed to esthetics.
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Direct retainers
Esthetics should always be considered when the partial denture is being designed,
but its consideration must not supersede the necessity of making the prosthesis
mechanically acceptable. An esthetically superior denture that leads to ultimate
destruction of the remaining oral tissues is not in the best interests of the patient.
c- Y Clasp
The Y clasp is basically a T clasp; it's used when the height of contour on the facial
surface of the abutment tooth is high on the mesial and distal line angles but low on
the center of the facial surface.
The RPI clasp is a current concept for bar clasp design, as the full “T” bar should
not be used since it covers an unnecessary amount of tooth structures compared with
the RPI clasp.
1- A mesio-occlusal rest:
A mesio-occlusal rest with the minor connector placed into the
mesiolingual embrasure.
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2- A proximal plate:
a- It is placed on a distal guiding plane, extending from the marginal ridge to
the junction of the middle and gingival third of the abutment tooth.
b- The proximal plate minor connector should contact approximately 1 mm of
the gingival portion of the guiding plane in distal extension cases.
c- The bucco-lingual width of the proximal plate is determined by the proximal
contour of the tooth.
- The proximal plate together with the mesiolingually placed minor
connector provides stabilization and reciprocation of the assembly.
3- The I bar arm:
a- It should be located in the gingival third of the buccal or labial surfaces
of the abutment in 0.01 of an inch undercut.
b- The I-bar approaches the undercut in a vertical direction at the center
of the abutment tooth.
c- It may be placed towards the mesial but not towards the distal to avoid
torquing of the abutment tooth when a vertical load is applied on the distal
extension base (.
d- The whole arm of the I-bar should be tapered to its terminus, with no
more than 2 mm of its tip contacting the abutment.
e- The base of the I-bar must be located at least 4 mm from the gingival
margin.
f- Slight relief is required where the arms crosses the gingival margin.
Indications:
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Contraindications:
The RPI clasp is contraindicated with:
a- Shallow vestibule (the base of the I-bar should be at least 3mm from
the gingival margin).
b- High floor of the mouth which necessitates the use of lingual plate.
c- When buccal undercut is absent or only distobuccal undercut exists.
d- In cases with severe tissue undercut to avoid food or tissue trap.
e- If the facial surfaces of teeth are facial to the tissue surface, the RPA
clasp may be used.
This clasp is basically indicated for posterior teeth or a single isolated last
molar. The RII clasp is composed of:
a- Occlusal Rest (R) located on the side of the tooth near the edentulous area.
b- Two I bar arms (II): one arm Located on the lingual or palatal surface of the
abutment above the survey line, this arm is usually rigid for bracing.
The other arm is a flexible retentive arm located on the buccal surface of
the abutment tooth. The retentive terminal uniformly tapered engages an
undercut of 0.01 of an inch below the survey line (Fig.3-150).
Support is provided by occlusal rest,
Bracing is provided by mesial minor connector and rigid lingual I bar.
Retention is provided by buccal I bar, and
Reciprocation is provided by mesial minor connector and rigid lingual I bar.
It is a bar type clasp, used when the tooth surface having no undercut.
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The retentive arm is a round platinized gold wire, with a ball at one end.
This end engages a dimple on the buccal surface of the tooth prepared in a
gold inlay..
The DeVan clasp is highly retentive and esthetically agreeable due to its
proximal location. But food debris may be entrapped between the arm and the
denture base.
Advantages of De Van clasp:-
1- It can used when a buccal or lingual survey line are unfavorable.
2- Good esthetics even when used on premolars& canine. Because, it is can be hidden
behined the buccal convexity of the tooth.
3- Good retention/ due to the angle of approach of the clasp to the undercut which gives
a marked trip action.
4- It is compact design in relation to the saddle periphery helps to prevent it is
accidental displacement.
b- Mesio-distal clasp
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It may be used when clasping canines. specially when little undercut on the buccal
surface of canine, or to avoid the clasping of the buccal surface which is esthetically
displacing. This clasp is always cast in gold & embraces the canine on the mesial,
palatal & distal sides.
The mesial surface of the canine should be cut or reduced to create a necessary
space. If a diastema is exists between the canine and lateral incisor this space
provides an accommodation for the mesial part of the clasp without reduction of the
mesial surface of canine.
In free end saddle cases, it must be employed without using a stress breaker.
1 It is accepted esthetically.
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Since the occlusally approaching clasp arm generally has a rigid portion
lying in contact with the non-undercut zone of the tooth, its bracing effect is
greater than the gingivally approaching clasp.
3. Caries Susceptibility:
The incidence or caries under clasp arms may said to be inversely
proportional to the efficiency of the patient's oral hygiene. If cementum is ex-
posed, there is some risk of cemental caries with gingivally approaching arms.
While the occlusally approaching clasp covers more of the tooth surface,
this increases the susceptibility of enamel caries.
4. Gingival Health:
When properly designed, clasps are used in combination with adequate
tooth support of the denture. Gingival health is rarely affected.
Traumatic gingivitis, however, more often seen with gingivally
approaching clasps, either as a result of inadequate relief of the clasp arm, or
through its accidental displacement.
5. Esthetics:
The gingivally approaching clasp has sometimes to be preferred
than the other, due its proximity to gingival margin, hence are less visible.
However, in cases, where the gum is shown as in the gumy smile
patients, the gingivally approaching clasp is even more noticeable than
occlusally approaching clasp.
7-Tolerance:
The gingivally approaching is less tolerated specially if excessive
block-out is done leading to food and tissue trap.
8- indication:
The occlusally approaching clasp is indicated in case of Tooth
Supported RPD, when esthetic s not important because of its stabilizing
ability.
The gingivally approaching is indicated incase of Tooth- Tissue
Supported RPD, because of its stress releasing action. And in case of Tooth
Supported RPD when esthetic is the prime concern.
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c. The clasp is highly flexible, hence can be used in distal extension bases
requiring stress breaking action.
d. Easily constructed.
Wrought-wire retainer arm has been contoured to follow the design and is
incorporated into the wax pattern
3-Combination clasp
It is essentially a cast clasp in which wrought wire has substituted the
buccal cast retentive arm. If this term is used the term wrought wire clasp is limited
to wrought wire retention arms reciprocated by acrylic or metal lingual or palatal
plates
If the partial denture framework is to be constructed of gold or low-heat
chrome alloy, the wrought wire clasp can be incorporated into the framework
during the waxing step and the alloy can be cast directly to the wrought wire clasp.
If a high-heat chrome alloy is used, the wrought wire must be soldered to the
completed framework.
Indication:
- on an abutment tooth adjacent to a distal extension space when the usable
undercut on the tooth is on the mesiobuccal surface.
Advantages of the combination clasp
1- Combines both the resiliency and flexibility of the wrought retentive arm
and stabilizing effect of the cast clasp.
The clasp has a stress breaking action. The wrought wire acts as a
stress equalizer preventing the undesirable forces created by the lever action
of the retentive clasp tip from lifting or torquing the abutment tooth as
downward forces occur on the denture base.
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It is emphasized that the internal rest is not used as a retainer but that its near-
vertical walls provide for reciprocation against a lingually placed retentive clasp
arm. For this reason, visible clasp arms may be eliminated, thus avoiding one of
the principal objections to the extracoronal retainer.
Such a retentive clasp arm, terminating in an existing or prepared infrabulge area
on the abutment tooth, may be of any acceptable design. It is usually a
circumferential
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arm arising from the body of the denture framework at the rest area. It should be
wrought, because the advantages of adjustability and flexibility make the wrought
clasp arm
preferable. It may be cast with gold or low-fusing chromium-cobalt alloy, or it may
be assembled by being soldered to one of the higher-fusing chromium-cobalt
alloys. In
any event, future adjustment or repair is facilitated.
The use of lingual extracoronal retention avoids much of the cost of the internal
attachment yet disposes of a visible clasp arm when
esthetics must be considered. Often it is employed with a tooth-supported partial
denture only on the anterior abutments and, when esthetics is not a consideration,
the posterior abutments are clasped in the conventional manner
One of the dentist's prime considerations in clasp selection is the control of stress
transferred to the abutment teeth when the patient exerts an occluding force on
the artificial teeth. The location and design of rests, the clasp arms, and the
position of minor connectors as they relate to guiding planes are key factors in
controlling transfer of stress to abutments.
Errors in the design of a clasp assembly can result in uncOntrolled stress to
abutment teeth and their supporting tissues. The choice of clasp designs should be
based on biologic as well as mechanical principles. The dentist responsible for
the treatment being rendered must be able to justify the clasp design used for
each abutment tooth in keeping with these principles.
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•Extracoronal retainers:
Esthetic clasps:
5. Esthetic solutions:
hidden clasps
Covered by porcelain.
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8- Saddle lock:
The saddle-lock system eliminates facial clasp display while achieving natural
esthetics with superior stability and retention. Saddle lock eliminates facial clasps by
using the available mesial! distal concave surfaces of the abutment teeth for retention
instead of the buccal undercuts.
The benefits of saddle lock
Superior esthetics, without visible clasps,
improved retention with little or no adjustment,
easy vertical insertion that protects abutments,
applicable in most partial denture cases,
simple preparation procedures for less chair time.
Limitations
There is no metal horizontal shoe extension,
the retentive arm is short.
9- Spring clasp ( Twin-Flex technique)
This consists of a wire clasp soldered into a channel that is cast in the
major connector. Because this clasp is flexible instead of rigid, it does not generate as
much torque when the distal extension is depressed. The ability to adjust this clasp and
its conventional path of insertion provides an excellent design option for retention
adjacent to an anterior edentulous segment.
Disadvantages of this technique include extra thickness of the major connector
over the wire clasp tang, the extra laboratory steps with increased cost, and difficulty
in repairing the clasp if breakage occurs. (J Prosthet Dent 1997;77:450-2.)
10 - Internally braced clasp
This design is especially suited for cases, in which anterior abutment tooth is a
crowned mandibular canine and is excellent for Kennedy Class III cases.
In this crown, a deep cingulum wedge-shaped rest is prepared with occlusally
diverging walls and a rounded floor. An undercut is prepared in the gingivolingual
third of the crown to accept the retentive arm of the RPD. The rest and the clasp arm
emerge from the saddle to occupy their respective areas of the crown. The retentive
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arm engages the lingual undercut and the rest seats accurately in the wedge shaped
preparation.
Esthetics is improved by the absence of a buccally placed retentive area.
Support is provided by the rounded floor and wedge-shaped walls in the prepared
crown. Retention is provided by the undercut. Bracing and reciprocation are provided
by the internal walls of the preparation.
Disadvantages
This design can be used only in teeth with adequate crown height.
It is generally not applicable in maxillary teeth.
The abutment tooth must be crowned
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Disadvantages
During processing, excess acrylic may be allowed to surround the clasp. When
this happens the clasp is not able to flex into the retentive undercuts. Therefore, the
clasp may not seat completely in the mouth or may place unfavourable forces on
the abutment tooth. 'Freeing up' the clasp after processing is difficult and time
consuming. To counter this, stalite spacer is placed around the clasp during
processing. This spacer can be easily removed during finishing and polishing
procedures.
Equipoise Clasp(E-clasp)
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Rest Preparation
Rests on incisors are prepared over the cingulum or on the incisal edge of the
tooth. The cingulum rest should be at least 1 millimeter deep and one-half the
width of the tooth mesiodistally away from the edentulous area. The incisal
rest should be at least 1.5 mm deep and 1.5 mm wide.
Interproximal Preparation
The C&E Milled Design features the application of a milled abutment crown (
1/2 degree milled undercut) with a precision c-rest ( for stabilization and
reciprocation) and conventional E-clasp ( for retension). This semi-precision
design shows no metal while maintaining proper contact with the adjacent
tooth.
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Impression Procedure
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However, the technique has not been refined primarily because the composite
resins are designed for restorative purposes. Therefore, they are strong but rigid.
The difficulty of using acrylic/composite resin to veneer RPD metals lies
in the difference between their abilities to flex and their coefficient of thermal ex-
pansion. Non noble metals possess strength and resist flexure. However, acrylic
and composites are subject to greater deformation from physical and thermal
conditions. The composite is brittle past its elastic limit. As a result the abilities of
metals and composites to plastically deform are incompatible. Therefore, the less
flexible the clasp, the more likelihood there is that the bond will endure.
The various methods used to mask the metallic direct retainer are as
follows:
Macromechanical retention:
Retentive beads and meshwork have been used to retain facing of either acrylic or
composite resin.
Disadvantages
Bulk that is created by adding the veneer will enlarge the total size of the clasp
thus defeating the purpose of disguising the clasp,
bonding is unreliable.
GAP formation and micro leakage when used in combination with composites
Micromechanical retention:
It involves air borne particle abrasion. This helps to improve retention between the
alloy and the resin.
Disadvantages
Bond strengths obtained after the use of micro mechanical systems are insufficient
especially after thermal conditioning.
2- Silica coating:
This technique is based on adhesion of resin to silane bonding agents.
These silanes, however, failed to bond directly to metals. The reason for such a
failure is the lack of preferred substrate and groups required for a good chemical
bond of silane to metal. Such end groups maybe Si-OH and AI-OH, which are not
readily supplied by the alloys used.
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This new technique involves coating the metal with silica intermediate
layer (SiOx-C) that bonds to metal and also supplies the -OH group for silane
bonding. The tribochemical effect of air borne particle coated with silicic acid on
the alloy surface renders it amiable to silane bonding agents. This coating allows
the development of superior bond strengths to electro etching or chemical etching.
Hence, even in the presence of the flexing retentive clasps the bond strengths are
significant to prevent debonding.
Disadvantages
Lack of long-term controlled studies limits the use of this technique.
C- METAL-FREE CLASPS
1- Dental D clasps
They are the perfect solution to unsightly metal clasps either on chrome or acrylic
dentures and can be prescribed for new or existing dentures. Dental D comes in a
choice of shades to match the patients own teeth or pink shades to match the patients
gum. The Dental D clasps are very tough, flexible and does not distort.
With the Opti= Flex acetyl resin clasps, metal-free, lightweight partial dentures that
provide natural esthetics and a comfortable fit can be designed. Using the Opti= Flex
Coating applied to metal clasps, it is possible to give new or existing metal partial
dentures a new esthetic appeal. It is available in 16 tooth-colored shades (matched to
the base Vita Shades) and hence Opti- Plex can meet every patient's esthetic
requirements.
Flexite Plus 'Flexible' partial dentures eliminate the use of metal, providing
patients with a metal partial denture alternative. Flexite Plus is fabricated from a
flexible thermoplastic material that is available in three tissue shades. The material is
monomer-free, virtually unbreakable, lightweight, and impervious to oral fluids.
Flexite Plus may also be combined with a metal framework to eliminate the display of
metal labial clasps.
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Available in 20 shades with three pink hues. The tooth or tissue coloured resin clasps
though as slim as those made of metal provide superior strength. They are flexible and
light weight. They are also up to 20 times harder than restorations fabricated from
standard acrylic materials.
Clear wire is an excellent new way to fabricate clear, strong, flexible clasps in
minutes. This new material and technique can be used to make T-bars, l-bars, Roaches,
Acers, and most other types of clasps. It can also be used to add or repair clasps in an
existing partial denture. It should be noted that the technician must have a good
working knowledge of partial design before trying to incorpo rate a Pro flex Clear
Wire technique into their work.
6- Smile-Rite partials:
Smile Rite is a high strength acetyl resin-polymer used for making tooth coloured
clasps on cobalt-chrome alloy partial frameworks.
The combination of Smile Rite with a metal frame gives patients the proven long-term
reliability of a cobalt-chrome alloy framework with the durability and esthetics of
Smile-Rite tooth coloured clasps. Existing metal frameworks can be retrofitted with
SmileRite clasps for esthetically conscious patients. Smile Rite is colour stable and is
resistant to staining and plaque buildup.
The high strength of Smile Rite makes it possible to fabricate the entire framework
metal free. The framework can be made from either tissue colour or tooth colour
monomer-free Smile-Rite acrylic.
7- DUET CLASPS
Estheti-fl ex 'Duet': Developed with the esthetically driven patient in mind, the Estheti-
Flex 'Duet' combines the support of a Vitallium or Titanium cast framework with the
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comfort of Estheti-Flex tooth coloured clasp system for the ultimate in function and
esthetics. The Estheti-Flex 'Duet' appliance is recommended for patients requiring cast
rests for support combined with Vita shaded or clear resin clasps for improved
appearance in the esthetic zone)
Thermoflex is an improved acetal resin system that brings the many benefits of
metal-free restorations without the pitfalls associated with acrylic)15]
Thermoflex is so flexible that it can flex around the largest tooth, and then use its
superior elastic memory to cling deeper into the undercut for a rigid functional hold.
Thermoflex has unsurpassed durability and it bonds well with conventional acrylics, as
well as, to itself, which means it can be repaired, relined or rebased. It is available in
19 shades, 16 tooth coloured and 3- tissue coloured. The Thermoflex partials are
injection molded using heat and pressure which makes the final product dense
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Pain -less d enture sy stem by Dr.S akurai. Certain adjus tment with a
pilot d enture.
We can realize denture to be able to fit clos ely w ith high technique of
plas tic molding.
FIN Denture
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The basis for all clasps is a standard wax shape. It has a uniform taper and its
cross-section forms half of an elipse with a width-to-height ratio of 10:8.
The length of the clasp is measured with a device built similar to those used for
measuring the mileage on maps. In order to form a clasp arm with the desired
retentiveness after the depth of the undercut and the length ofthe clasp have been
determined, it is only necessary to read from the table how many millimeters to
cut from the tip of the standard wax shape.
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The Bios standard clasp arm shape serves as a basic element for all types of clasps.
The flexibility 01 a clasp arm is determined by how much length is removed from
the small end of the pattern.
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Unilateral prosthesis
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INDIRECT RETAINERS
INDIRECT RETAINERS
Definitions:
Indirect Retention: The resistance to rotational movement of a tooth-tissue
supported denture base and palatal major connector away from the denture
foundation area when occlusal forces (sticky foods) are applied to the denture
base.
Indirect Retainers are “components of removable partial denture that are used to
reduces the tendency of the denture to rotate in an occlusal direction about the
fulcrum axis”.
The fulcrum line (prothero 1916) is an imaginary line, connecting occlusal rests,
around which a partial removable dental prosthesis tends to rotate under
masticatory forces. The determinants for the fulcrum line are usually the cross
arch occlusal rests located adjacent to the tissue borne components.
It is a theoretical line passing through the point around which a lever functions
and at right angles to its path of movement
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INDIRECT RETAINERS
Direct retainers are retaining elements (clasps) used to retain near ends of partial
dentures. However, Indirect retainers are supportive elements (rests) used to
retain far ends of partial dentures
This movement of the saddle may be caused by the action of sticky food or by
gravity in the upper jaw. Indirect retainers do not prevent displacement towards
the ridge. This movement is resisted by the occlusal rest on the abutment tooth and
by full extension of the saddle to gain maximum support from the residual ridge.
The concept of indirect retainer is advanced by Dr W.E.Cummer as means of
resisting rotational movement
Movement of a distal extension base RPD in function can be summarized as
rotation around:
The degree and direction of the denture base movement are greatly influenced by
the quality of the supporting residual ridge, the design of the RPD and the extent of the
forces exerted on the denture during function
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INDIRECT RETAINERS
The main function is to resist occlusally displacing forces acting on the free end
saddle by creating a resistance on the opposite side of the fulcrum axis.
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INDIRECT RETAINERS
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INDIRECT RETAINERS
1- Auxiliary occlusal rests: This is the most common form of indirect retainers. It is
placed on an occlusal of the tooth as far away from the fulcrum axis as possible on
mesial marginal ridges of first premolars..
2- Canine extension from occlusal rests: A finger like extension arising from the
principal premolar rest and placed on the prepared cingulum of the adjacent canine
tooth. It indicated in long distal extension cases, as it is used instead of locating of
the indirect retainers on an incisor tooth which may not be strong enough to support
the denture
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INDIRECT RETAINERS
3- Canine rests (cingulum rest): The canine rest is used as an indirect retainer in
cases where the mesial marginal ridge of the first premolar is too close to the
fulcrum axis.
4- Principal occlusal rest of modification area:
The occlusal rest on the anterior abutment of modification space provides indirect
retention.
Auxiliary occlusal rests, canine extension from an occlusal rest, terminal rests of
the continuous bar and cingulum rests on maxillary canines are used as maxillary
indirect retainers. In addition, there are other forms of indirect retainers that are
supported by the palate, these are:
1) Cummer arm:
It is a maxillary indirect retainer that extends either from the denture base or
from a palatal major connector and rests on a canine tooth. This type exerts excessive
load on the supporting tooth causing movement of the tooth labially. It is also liable to
distortion.
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INDIRECT RETAINERS
2) Palatal arm
It is an extension of the palatal major connector on the opposite sides of the
fulcrum line. The projections may initiate bad tongue habits, interfere with speech,
and are liable to cause irritation of the palatal mucosa underneath the end of the arm..
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INDIRECT RETAINERS
Some times the reciprocal arm of direct retainer located anerior to the fulcurum
line and act as indirect retainer
3- Modification areas
If occlusal rest on the secondry abutment is far from the fulcurum line it can act as an
indirect retainer
II- Indirect retainer placed on the palate (for maxillary denture only)
1- Palatal arm:
2- Anterior palatal bar:
3- Posterior palatal bar:
4- Rugae support:
5- Palatal strap:
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Attachments in RPD
• Many names have been given to describe these attachments as male and female, patrix
and matrix, key and keyway, parallel, frictional, internal and slot attachment.
- A good level of knowledge of attachment & team work between the clinician & technician
- The patient must be aware of the cost and time required for this type of treatment
Contra indication
a - Abutment not suitable for attachment retainer
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Attachments in RPD
2- Vertical and horizontal lodes are applied more directly to the abutment teeth than by
clasps or rests. This advantageous only if the supporting structures of this tooth are perfect.
3- The efficiency of retention is not affected by the contour of the abutment tooth.
4- The number of the component of the denture is reduced and hence tolerance should be
better.
5- When used with lower free end saddles, posterior movement of the denture is
prevented.
6- Their use may be indicated when retentive clasp arm reciprocation can not be achieved.
2- When the crowns of the abutment teeth are small or short, this attachment can not be
used.
4- It can not be used for free end saddle due to rigidity of the union between the tooth and
saddle.
5- Owing chair and laboratory time involved and the high coast of the attachments.
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Attachments in RPD
1- Since the principle of the internal attachment does not permit horizontal movement,
all horizontal, tipping, and rotational movements of prosthesis are transmitted directly to the
abutment tooth. The internal attachment therefore should not be used in conjunction with
tissue support distal extension denture base unless some form of stress breaker is used
between the base and the rigid attachment.
2- The Intracoronal attachment engages the vertical walls built into the crown of the
abutment teeth to created frictional resistance to removal.
Classification of attachments
1 – according to manner of fabrication :-
2 – according to location
-e.g. : - -Dalbo bar unit , -non resilient dalbo stud attachment ,- non resilient Ceka
B ) class II :- - Allow for vertical resiliency -used with short free end saddle
CEKA extra coronal attachment , dalbo stud attachment , CEKA stud attachment
C ) classIII :- - allow for hinge movement - used with long span free end saddle
D )class IV :- - allow for hinge & vertical movement - used with long span free end saddle
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Attachments in RPD
A) Frictional :-
. Is resistance to relative motion oe two or more surface s in intimate contact with each other
B) Mechanical :-
. Is resistance to the relative motion of two or more surfaces due to a physical under cut
.Caution :- if the plunger of the a achment doesn̕t engage the female undercut there will be no
Mechanical retention
d)Magnetic :-
. is the resistance to movement caused by a magnetic body that attracts certain materials by
virtue of a surrounding field of force produced by the motion of its atomic electrons and
alignments of its atoms
Caution :- it does not provide lateral stability and contra indicated for flat ridges
e) Suction : -
Caution :- Most removable restoration require a periodic check of tissue condition and if
deficiency occur reline it
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Attachments in RPD
- they are considered " semi – precision" since in their fabrication they are
subject to inconsistent water/powder ratio , burn out temperature , and other
variables so resultant component varies to a small degree
Advantages: -
2 – Easy fabrication
Disadvantages: -
2 – difficult to repair
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Attachments in RPD
B) Precision attachment
- They are ready made & their component are maintained in special meta alloys
under precise tolerance & these tolerances are within 0,01mm
(a) The active friction grip attachments: These include an adjustable spring. This is
usually accomplished by designing a split patrix so that part of it forms a leaf
spring, which can be opened to compensate wear to give retention
(b) The active snap grip attachments: In this group, the active element consists of
a spring -loaded plunger, a split ring or U-spring, which engages in a prepared pit
or groove.
Advantages: -
2 – The load fall down with the long axis of the abutment
Disadvantages: -
4 – Very expensive
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Attachments in RPD
2 – According to location :
Made of
*usually contained within the normal or expanded contour of the crown of abutment
- Their function is to provide positive direct retention for a partial denture. They may prove
more retention than the clasp, but the clinical situation in which they are used required careful
assessment and the standard of the patient oral hygiene must be good. OSBORNE
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Attachments in RPD
Advantages:-
Disadvantages:-
Types
B ) McCollum attachment
C) Crisman's attachment
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Attachments in RPD
D ) schatzman's attachment
B ) Extra coronal
- The fewer abutments remaining, and the weaker the abutments are, the greater the
need for resiliency or free movement to direct the forces away from the abutments to
the supportive bone and tissue via the base of the prosthesis.
Indication
- used for patients with limited manual dexterity, or the prosthesis has a difficult path
of insertion and removal.
Design:-
Advantages:-
2 – Minimal tooth reduction & the possibility of devitalizing the tooth is reduced
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Attachments in RPD
4- Intracoronal females in retaining abutments will collect food and present problems
when the patient attempts to seat the intracoronal retained prosthesis.
Disadvantages:-
- It is ,however , more difficult to maintain hygiene with extra coronal attachment and
patients should be instructed on the use of dental floss and hygiene accessories.
Types
B ) Ceka attachment
- The matrix is attached to the abutment , -the patrix has a split in it's center to
enhance friction , - a spacer ring can be placed between matrix & patrix to increase
vertical resilience
The metal surface is coated with silicate and silane to bond the resin adhesive to the adhesive
anchor. The enamel should be conditioned using conventional techniques.
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Attachments in RPD
- Stud precision attachments are primarily used on roots and implants for retaining
removable partial dentures or over dentures. All stud attachments MUST be
parallel to each other to provide ease of insertion and removal and reduce wear
potential.
- Do not engage labial soft tissue undercuts with the denture base flange, as this
will alter the path of insertion and cause excessive wear and servicing
requirements.
- Stud attachments are low in profile to reduce leverage upon the retaining
abutments, are easy for patient hygiene maintenance, allow physiologic
independent movement of abutments, and are easy to service
advantages :-
-the crown root ratio is also enhanced with the low profile of the stud type
attachment
indication :-
Types
1 ) Dalbo a achment-:
-the matrix got fingers that are protected using a Teflon ring
- A new over denture attachment system that allows the user to replace
both the male (threaded sphere) and female. The females engage the
undercuts of the sphere to allow for superior retention and less wear on
the height of contour.
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Attachments in RPD
The tradi onal Ceka Axial has been in use for over 30 years. As a result, it is
one of the most widely used attachments in the world. It is much like the
Ceka Revax Axial, but for one major difference--the Ceka requires 0.45 mm
more ver cal clearance. When space is available, select the tradi onal M3
Ceka as it is stronger and easier to service.
1 ) Zest anchor
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Attachments in RPD
- the wide band on the male allows for increased retention and reduced
wear (less bending and breakage), the female has a titanium coating for
hardness and a smoother internal surface
The males may be placed "chairside." The female may be used with a cast
coping or directly placed into a root. -There are two sizes--regular (4.0 mm
height, 3.8 mm width) and mini (2.3 mm height, 3.3 mm width)
D )Bar type
indication:-
3 - implant prosthesis
the round plasti-wax bar, more easily bent to follow the alveolar crest. Do not
engage labial soft tissue undercuts with the denture base flange, as this will alter
the path of insertion and cause excessive wear and servicing requirements.
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Attachments in RPD
Rigid resilient
Regular Mini
Ackermann Hader
used in curved arch as can follow the ridge curvature & be used in anterior
maxilla the matrix is the bar & the patrix is the sleeve
* Hader attachment:- the most popular of all bar systems due to its
economy and simplicity.
*advantage :-
1 - superior stability,
2 –retention
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Attachments in RPD
A round bar is useful in situations where the bar must be bent to accommodate the ridge
anatomy, or in close-bit situations.
Round Bar
E) Magnet
F) Locator Root
o Extra-Radicular Design
G ) Auxillary attachment
- they include component such as plunger , hingers & screws these types of
attachment must be incorporated into the design of the prosthesis
*types:-
1) plungers
2 ) screw units
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Attachments in RPD
-labial flange is connected from one side by a joint & a lock on other side
-so in much R.p.d , labial undercut & teeth interdental area are used to
increase retention
Contraindication:-
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Attachments in RPD
A ) R.P.D : -
3 ) screw on
Treatment planning
A) Intra oral assessment
intra oral examination should include assessment of the soft & hard tissues.
periodontal examination :-
a full periodontal assessment should be carried out this should include full
arch pocket charting , an assessment of oral hygiene status & a full
radiographic assessment of bone support as fixed or removable prosthesis
may influence the pattern of health & disease of periodontium .
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Attachments in RPD
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Stress breaker
Stress breaker
It is a device, which allows movement between the denture base and the retainer
to reduce lateral and tipping forces on abutment teeth. It is also called "Stress
director" or "Stress equalizer".
Indications:
1- When internal attachments are used.
2- In distal extension removable partial dentures to distribute the load between the
abutment teeth and the ridge.
3- In cases exhibiting weak abutment teeth and well formed ridges.
Advantages:
1- Decrease horizontal forces acting on the abutment teeth thus it preserve alveolar
support of these teeth
2- Distribute the stress between the abutment teeth and the residual ridge.
3- Prevent the quick damage of abutment teeth if relining is needed but not done.
4- Providing physiological stimulation of bone which prevent bone resorption.
Disadvantages:
1- Difficult to construct and expensive.
2- Concentration of vertical and horizontal forces on the ridge may increase ridge
resorption.
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Stress breaker
3- If relining is not done when needed it will leads to the increase of ridge
resorption.
4- Less tolerated by the patient.
5- Flexible connectors may be bent and distorted.
6- Some split connectors pinch the underlying soft tissue or tongue as they open
and close under function.
7- The effectiveness of indirect retainers is reduced or eliminated.
8- Repair and maintenance of any stress breaker is difficult.
9- All mechanical devices that are free to move in the mouth may collect debris
and become unclean.
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Stress breaker
Torsion bars
These may be used in the design of a lower partial denture
carrying bi-lateral free-end saddles. Bars extend anteriorly
from the clasp units on each side to join a lingual bar near
the mid line. Flexibility can be controlled by varying the
cross-section of the torsion bars, the method of construction (cast or wrought) and the
material of construction (normally gold alloys or cobaltchromium alloys).
Disadvantages are associated with the use of the torsion bar structure in that the
double bar system is liable to trap food and cause irritation to the tongue.
- Split casting modifying the lingual plate: a split of appropriate length is made at
the inferior border of the plate. The saddle is joined to the more flexible part of
the plate. The lower part must be flexible in the vertical direction, than
horizontal direction, so that the appliance will have lateral rigidity to distribute
horizontal force widely. This design applied in long class II cases.
Disadvantages: The slit opens slightly in function and theoretically is liable to trap
either the tongue or food particles. With a long saddle, however, the slit is anteriorly
placed and in this position may be intolerable to some patients. The patient using
dental floss can clean the slit easily.
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Stress breaker
The lingual bar connector used to join two saddle is distally extended on each side
and then recurved along the residual ridge to allow attachment into the matrix resin
of the saddle. The support is design on mesial aspect of the abutment to increase
the length of the bar and better distribute the load.
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Stress breaker
2. Occlusally approaching clasp having resilient retentive wrought gold wire arm
(Combination clasp).
3. Back-action clasp.
5. Extended-arm clasp.
6. Ring clasp.
8. RPI clasp.
9. RPA clasp.
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ARTIFICIAL TEETH
Selection of artificial teeth for form• colour and material is made easy by the
FUNCTIONS:
2. Restoration of esthetics.
DESIRABLE CHARACTERISTICS
b- Acrylic resin teeth are retained by chemical union with the acrylic
resin covering metallic denture bases during laboratory processing
procedures.
A c
INDICATIONS:
1. When a processed plastic base will be used to attach the prosthetic teeth to the
framework.
CONTRAINDICATIONS:
1. Where there is insufficient space occlusal/incisalgingival or mesiodistally for a
denture tooth-plastic base combination.
a) Less than 5 mm between the occlusal plane and the edentulous ridge.
b) Single tooth edentulous space.
2. Where protrusive or lateral occlusal guidance will be on the prosthetic teeth.
3. When available denture teeth do not satisfy esthetic or occlusal requirements. In
these situations a custom made prosthetic tooth is necessary.
ADVANTAGES:
1. Denture teeth are prefabricated by several manufactures.
2. There is a large selection of shades, sizes, and shapes. An acceptable denture
tooth can
usually be found.
3. Available in plastic and porcelain.
4. Can be easily adjusted (particularly plastic) to fit the framework, available
space, existing occlusion, and desired size and shape of the tooth.
5. There is great flexibility of arrangement of denture teeth.
6. The denture tooth arrangement can be tried in the patient's mouth to preview the
esthetics of the completed denture.
7. Replacement of denture teeth on a processed plastic base is fairly easy and rather
inexpensive.
DISADVANTAGES:
1. Plastic and porcelain denture teeth may fracture where as metal prosthetic teeth
will not.
2. Plastic denture teeth are not as abrasion resistant as metal prosthetic teeth.
3. Cannot be used in small spaces, or where occlusal guidance will be on
2) PROCESSED PLASTIC TEETH
Processed plastic teeth are custom made prosthetic teeth processed from tooth
colored heat polymerized acrylic resin. They are attached to the framework by
retentive mesh, loops, beads, or posts. They may be used with or without a
processed plastic base.
INDICATIONS:
1. A posterior edentulous space which is too small occlusal/incisal- cervically or
mesiodistally for a denture tooth.
2. Where available denture teeth do not satisfy the esthetic or size requirements.
CONTRAINDICATIONS:
1. Where a simpler prosthetic tooth-denture base combination may be used.
2. As anterior prosthetic teeth (custom facings are used because of superior
esthetics).
ADVANTAGES:
1. Can be utilized in very small spaces.
DISADVANTAGES:
1. Difficult to obtain esthetic shade match with processed plastic teeth.
2. Processed plastic teeth abrade more than commercial available denture teeth.
3. A wax try-in is not possible.
3) ACRYLIC RESIN OR PORCELAIN FACINGS (STEEL’S
BACKING):
a- Readymade facings
Facings used on RPDs are
manufactured prosthetic teeth consisting of
two parts: a veneer of tooth colored porcelain
or plastic (the FACING) and a BACKING
made of a plastic material.
The backing is incorporated into the
wax-up of the framework. The facing and
backing are related by a slot and groove. The
facing is cemented onto the framework with a
dental adhesive.
Because of their many disadvantages and the advent of custom made
facings using light-cured composite resin materials, the use of commercially
purchased facings is being phased out of RPD prosthodontics.
DISADVANTAGES:
1. Not as esthetic as denture teeth because the backing shows through the veneer.
2. A wax try-in is difficult.
3. If occlusion is placed on the backing the refractory cast must be mounted on an
articulator so the occlusion can be developed in the wax pattern for the framework.
4. Limited selection of sizes, shapes, and shades.
5. Selection more difficult than for denture teeth because there is no mold guide.
Selection is made from mold chart with sizes indicated.
6. More difficult to obtain than denture teeth.
7. Subject to fracture (particularly porcelain).
Steel’s Backing
4) Tube teeth
INDICATIONS:
1. Single tooth edentulous spaces which preclude the use of a processed plastic
base.
2. Short (occlusal/incisal cervical) edentulous spaces in conjunction with a metal
base. The tube tooth will be cemented to the post, not attached by a processed
plastic base.
Anterior tube teeth are usually butted to the edentulous ridge; posterior tube teeth
usually have metal facial and lingual finish lines
CONTRAINDICATIONS:
1. Where a denture tooth processed plastic base may be used.
2. Where the occlusion must be on metal.
3. Where the space is too narrow or too short for a denture tooth. A metal pontic,
custom made facing, or processed plastic tooth is used in these situations.
DISADVANTAGES:
1. Subject to fracture.
2. No wax try-in possible to preview the esthetics of the completed denture.
3. No chemical bond between the tube tooth and the framework. The 4-Meta luting
cements show promise when bonding denture teeth to the metal framework.
A tube tooth. A metal post casted with the partial denture framework specially designed for
the attachment of the tube teeth.
5) Braided post
It is similar to tube teeth , both forms depend on a centrally located reinforcement strut , however
the method used for strut configuration re significantly different .
A braided post is created by twished two small diameter wax ropes around one another in a helical
fashion the frame work then casted . the acrylic resin tooth is attacted to the frame work using heat or self
cure acrylic resin
6) Metal teeth
3- Denture base acrylic resins formulated with 4-Meta are also available
and provide a mechanism of bonding acrylic resin to metal.
INDICATIONS:
1. A posterior edentulous space which is extremely small mesiodistally or
occlusocervically.
CONTRAINDICATIONS:
1. Anterior edentulous spaces.
2. Where a simpler or more esthetic type prosthetic tooth may be used.
ADVANTAGES:
1. Can be used where other prosthetic teeth can not.
2. Have all the advantages of cast metal such as permanence of form, wear
resistance, dense surface, etc.
DISADVANTAGES:
1. Not as esthetics as other types of prosthetic teeth even when veneered with tooth
colored plastic.
2. All the disadvantages of metal such as hardness, wear of opposing teeth and
tooth materials, etc.
3. May require that the refractory cast be mounted in an articulator to develop the
occlusion of the pontic.
- Have strong chemical bond with -Less efficient mechanical bonding with
denture bases. denture bases.
- Rebasing dentures is not easily done , - Teeth can be easily separated facilitating
as it is difficult to remove teeth. rebasing procedures.
- Can be used opposing gold
restorations as they cause minimum - Cause wear in opposing gold restorations.
amount of wear.
- Clicking sounds
2- MOULD SELECTION
- The artificial teeth should be in harmony with the facial feature and natural
teeth.
4- Tube teeth
5- Pressed on / post
2- Shade
The shade of the posterior teeth should be in harmony with the shade of
the natural teeth. The maxillary bicuspids may be slightly lighter than the other
posterior teeth but not lighter than the anteriors.
3- Occlusal form
The ridge form can be used as an index for the amount of cusps angulation. The
ridge form can be used as an index for the amount of cusp modification.
1- They are more adaptable to universal jaw relations and class II and class III
jaw relationships.
4- They give the patient a sense of freedom as they do not lock the mandible in
one position only.
5- They eliminate horizontal forces that may be more damaging than vertical
forces (less bone resorption).
The non-anatomic teeth offer less masticatory efficiency. However, they may be
used in the following cases:
- Cross-bite relationship.
- Flat ridge.
- Knife-edge ridges.
- IPN resin.
3- Tube teeth
4- Metal tooth
5- Pressed on acrylic
6- Braided post
1) The size and form of the remaining natural teeth which acts as a guide for
tooth selection.
2) The cusp height of the remaining natural teeth which determines whether to
use cusped or non cusped teeth.
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DENTAL SURVEYOR
newly developed surveyors which have been already introduced to the dental
market be feb.2008 and of these trends:
Stress –o- graph : it is type of surveyor with two vertical tool holder.
2. Base equipped with a lock screw, on which the table swivels by ball and
socket joint, permits movements of the table in all directions.
5. Horizontal arm with spindle housing and a tightening screw, from which
the surveying tool suspends.
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DENTAL SURVEYOR
A- Analyzing rod: is a rigid metal rod used for diagnostic purposes in the
selection of the path of placement.
B-Carbon marker: is used for the actual marking of the survey lines on the cast.
A metal shield is used to protect it from breakage.
C- Undercut gauges: are used to measure the extent of the horizontal undercuts
that are being used for clasp retention. Usually there are three sizes: 0.01، 0.02
and 0.03 of an inch.
D- Wax trimmer is used to trim excess wax that may be inserted into those
undercut areas, which are to be obliterated.
Parts of the dental surveyor: 1.Horizontal Platform، 2.Vertical arm، 3. Horizontal arm، 4. Table
with clamp، 5. Base، 6. Mandrel (spindle)، 7. Storage compartment for storing the tools، 8.
Tightening screw، 9. Screw to lock spindle, 10. locking screw for tilt top, 11,Rack for
accessories.
The most widely used dental surveyors are the Ney and the Jelenko , they
differ principally in
1- In Jelenko surveyor: by loosening the nut at the top of the vertical arm, the
horizontal arm may be made to swivel. The objective of this feature, originally
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DENTAL SURVEYOR
2- The vertical arm of the Jelenko surveyor is spring mounted and returns to the
top position when it is released. It must be held down against spring tension
while it is in use. The vertical arm on the Ney surveyor is retained by friction
within a fixed bearing. The shaft may be moved up or down within this bearing
but remains in any vertical position until again moved. The shaft may be fixed in
any vertical position desired by tightening a set screw.
4- Jelenko surveyor has one undercut gauge with different ends but the Ney
surveyor has three different undercut gauge with different sizes.
4-Williams surveyor has Gimbal stage table that is adjustable to any desired
anterior, posterior, or lateral tilt. Degree of inclination can be recorded for
repositioning of cast at any time. Distinct advantage of this table over universal
tilt table is that center of rotation always remains constant. Superstructure of this
surveyor consists of jointed arm and spring-supported survey rod, all
components of which can be locked in fixed position if desired. This surveyor is
perhaps best suited for placement of internal attachments rather than for cast
analyzing and other purposes.
Because the shaft on the Ney surveyor is stable in any vertical position it may be
used as a drill press when a handpiece holder is added. The handpiece may thus
be used to cut recesses in cast restorations with precision by using burs or
carborundum points of various sizes in a dental handpiece.
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DENTAL SURVEYOR
Objectives of surveying
Surveying of both the study and the master casts is essential for proper
diagnosis، designing and treatment planning. Surveying of the master cast
follows mouth preparations. The objectives of surveying are:
5. Identify and measure tooth undercuts that may be used for retention and
locate the flexible components in their position below the survey line of the
tooth.
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DENTAL SURVEYOR
PURPOSES OF SURVEYOR
The surveyor may be used for surveying the diagnostic cast, recontouring
abutment teeth on the diagnostic cast, contouring wax patterns, measuring a
specific depth of undercut, surveying ceramic veneer crowns, placing
intracoronal retainers, placing internal rests, machining cast restorations, and
surveying and blocking out the master cast.
2. To identify proximal tooth surfaces that are or need to be made parallel so that
they act as guiding planes during placement and removal.
3. To locate and measure areas of the teeth that may be used for retention.
5. To determine the most suitable path of placement that will permit locating
retainers and artificial teeth to the best esthetic advantage.
8. To record the cast position in relation to the selected path of placement for
future reference.
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DENTAL SURVEYOR
Those surfaces of restorations that are to provide retention for clasp arms
should be contoured so that retentive clasps may be placed in the cervical third
of the crown and to the best esthetic advantage.
2. To cut recesses in the stone teeth on the diagnostic cast for estimating
the proximity of the recess to the pulp (used in conjunction with roentgenograph
to estimate pulp size) and to facilitate the fabrication of metal or resin jigs to
guide the preparations of the recesses in the mouth.
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DENTAL SURVEYOR
Internal rest seats may be made in the form of a non retentive box, a
retentive box fashioned after the internal attachment, or a semi retentive box. [In
the latter the walls are usually parallel and non retentive, but a recess in the floor
of the box prevents proximal movement of the male portion. Small round burs
are used to cut recesses in the floor of the rest seat . Tapered or cylindrical
fissure burs are used to form the vertical walls].
Retention depend on (a) the flexibility of the clasp arm, (b) the magnitude of the
tooth undercut (the magnitude of the angle of cervical convergence below the
point of convexity), and (c) the depth the clasp terminal is placed into this
undercut
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DENTAL SURVEYOR
2. All casts are originally surveyed with the occlusal-plane parallel to the base of
the surveyor (zero tilt).
3. When the surveyor blade contacts a tooth on the cast at its greatest convexity، a
triangle is formed, the apex of the triangle is at the point of contact of the surveyor
blade with the tooth, and the base is the area of the cast representing the gingival
tissues. The apical angle is called the angle of cervical convergence. This will
indicate the areas available for retention and the existence of tooth and other tissue
interference to the path of placement.
5. Any areas cervical to the height of contour may be used for the placement of
retentive clasp components, whereas areas occlusal to the height of contour may
be used for the placement of non-retentive, stabilizing or reciprocating
components.
7. The location of the undercut area can be changed by tilting the cast anteriorly or
laterally.
8. Deciding the tilt of the cast depends on path of placement and removal.
10. An anterior tilt is sometimes preferred in distal extension bases this increases
resistance to vertical displacement by the denture base by engaging undercuts
distal to abutment teeth.
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DENTAL SURVEYOR
11. The retentive tips of clasps must engage undercuts, which are present, when the
cast is surveyed with the occlusal plane parallel to the base of the surveyor، i.e.
undercut areas should be present at both zero tilt and the new tilt
12. The retention on all principal abutments should be as nearly equal as possible.
13. Without guiding planes, clasp retention will either be detrimental or practically
nonexistent.
Uniform clasp retention depends on depth (amount) of tooth undercut rather than on
distance below the height of contour at which clasp terminus is placed.
The fallacy of attempting to create retentive undercuts by tilting the cast on the
surveyor
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DENTAL SURVEYOR
Clasps designed at tilt are ineffective without development of corresponding guide planes to
resist displacement when restoration is subject to dislodging forces in occlusal direction.
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DENTAL SURVEYOR
should be located on all four. But if three abutment teeth are involved (as
they are in a Kennedy Class I I , modification 1 arch), the posterior
abutment on the tooth-supported side and the abutment on the distal
extension side are considered to be the principal abutments, and retention
needs to be equalized accordingly. The third abutment may be considered
to be secondary, and less retention is expected from it than from the other
two.
If there is bilateral soft، bony or tooth interferences that may prevent the
insertion and removal of rigid connector, surgery and/or recontouring of
lingual tooth surfaces may be unavoidable. If interference is only
unilateral, change the path of insertion at the expense of guiding planes and
retention.
The analyzing rod is replaced with a carbon marker and the survey line is drawn
on abutment teeth.
The carbon marker is removed from the tool holder and the suitable
undercut gauge is fixed in the holder. The undercut gauge is placed in contact
with the tooth to be clasped with its shaft touching the tooth surface at the survey
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DENTAL SURVEYOR
line. The head will indicate the undercut area where the clasp will terminate. A
sharp pencil is used to mark this point.
It is preferable that undercuts be present on both zero tilt and lateral tilt to
avoid creation of apparent undercuts. Retentive terminals located in apparent
undercuts will be displaced by occlusally displacing forces.
All these steps are performed while the master cast is still mounted on the
survey table without changing the tilt.
Tripoding:
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DENTAL SURVEYOR
cast is modified until the rod touches the three cross marks. Then locking the
surveyor table.
Two sides and the dorsal aspect of the base of the cast are scored with a sharp
instrument held against the surveyor blade. By tilting the cast until all three lines
are parallel to the surveyor blade, the original tilt can be re-established.
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DENTAL SURVEYOR
1. Single path
Two or more parallel axial surfaces on abutment teeth which can be used
to limit the path of insertion and improve the stability of a removable prosthesis.
Guide surfaces may occur naturally on teeth but more commonly need to be
prepared.
2. Double path
3. Multiple path:
Multiple paths will also exist where point contacts between the saddle of
the denture and the abutment teeth are employed in the ‘open’ design of saddle.
4. Rotational path
Multiple paths of insertion will be exist where guide surfaces are not
utilized where the abutment teeth are divergent or where point contact between
the saddle and the abutment teeth is employed.
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DENTAL SURVEYOR
d) Extraction.
2- Retentive undercuts
Those undercuts should be equal in depth and should also permit the
location of clasp tips in the gingival third of the tooth. The tilt is normally
changed to lower the height of contour on an abutment tooth so that the clasp
arms, retentive or reciprocal, can be positioned no more occlusal than the
junction of the gingival and middle third of the tooth. This position is more
esthetic and lowering the torque forces transmitted to the tooth by the clasp
- Retentive clasp arms must be located so that they lie in the same
approximate degree of undercut on each abutment tooth. Clasp retention is no
more than the resistance of metal to deformation.
- The size of the angle of convergence will determine how far into that
angle a given clasp arm should be placed. Retention will depend on the location
of the retentive part of the clasp arm, not in relation to the height of contour, but
in relation to the angle of cervical convergence.
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DENTAL SURVEYOR
2- Alter the flexibility of the clasp arm by changing its design, its size, and
length or the material of which it is made.
4- Esthetics:
The retentive area should be selected with the most esthetic clasp
location. The most esthetic placement of artificial teeth is made possible with
less clasp metal and less base material displayed.
5- Guiding planes:
When anterior teeth must be replaced with partial denture vertical path of placement
may be necessary to avoid excessively altering abutment teeth and supplied teeth.
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DENTAL SURVEYOR
Thus, if undercuts are present but not efficient at the zero tilt and if
displacement of the prosthesis is anticipated with the least displacing forces,
another path of insertion should be decided. This is achieved either by:
The path of placement may also be slightly off of the zero tilt to allow for
reduction in the amount of undercut when rigid minor connectors contacting
guiding planes are planned to help in providing retention.
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DENTAL SURVEYOR
In the broader sense of the term, blockout includes not only the areas
crossed by the denture framework during seating and removal but also (1) those
areas not involved that are blocked out for convenience; (2) ledges on which
clasp patterns are to be placed; (3) relief beneath connectors to avoid tissue
impingement; and (4) relief to provide for attachment of the denture base to the
framework.
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DENTAL SURVEYOR
Paralleled blockout
Shaped blockout
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DENTAL SURVEYOR
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DENTAL SURVEYOR
SURVEY LINES
A SURVEY LINE is a line produced on a cast by a surveyor or scribe
marking the greatest prominence of contour in relation to the planned path of
placement of a restoration.1
Survey lines are marked on a cast by first orienting the cast in the cast
holder at the tilt indicating the path of placement for the denture and then sliding
the cast holder along the surveyor table so that the cast surface is lightly rubbed
against a carbon marker held in the chuck in the spindle of the surveyor .
Survey lines are marked on wax patterns for crowns by dusting the
surface with zinc stearate or powdered white wax, then sliding the cast holder on
the surveyor table so that the surface of the wax pattern is lightly rubbed against
an analyzing rod held in the chuck in the spindle of the surveyor.
Survey lines are marked on polished metal and glazed porcelain crown
surfaces in a similar manner substituting a layer of disclosing medium
(i.e.Occlude, Die Mark, etc.) on the surface of the crown.
The survey line on the facial and lingual of abutment teeth is important in
selecting clasps and planning the modifications of the teeth necessary for the
selected clasps.
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DENTAL SURVEYOR
Survey lines are marked on all bony and soft tissue prominences located
in the area of the denture. These lines are important in the selection, location,
and design of major and minor connectors, and bar clasp approach arms,
Blatterfein divided the buccal and lingual surface of the tooth adjacent to
the edentulous area into two halves by a line passing through the center of this
surfaces along the vertical axis of the tooth .
The area closer to edematous area called near zone and the area away
from the edematous area called far zone.
High survey line passes from the occlusal third in the near zone to the
occlusal third in the far zone. When a high survey line is present, the undercut
will be deep and hence a wrought wire clasp which is more flexible should be
used.
It passes from the occlusal third in the near zone to the middle third in
the far zone – Either Aker's or Roach clasp is used for teeth with a medium
survey line. Aker's clasp is preferable. During survey, the cast should be tilted
such that maximum number of teeth have a medium survey line.
This survey line is closer to the cervical third of the tooth in both near and
far zone. A modified T-clasp is used for teeth with low survey lines.
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DENTAL SURVEYOR
A bracing or reciprocal arm is placed along the low survey line and
a retentive wrought wire clasp is placed to engage the undercut on
the opposite side.
This survey line runs from the occlusal third of the near zone to the
cervical third of the far zone. Here, a reverse circlet clasp is used. It is more
common on the buccal surfaces of canines and premolars. It can be managed by
using reverse action (hair pin) or ring type Aker's clasp (occlusally approaching)
, or L or T type roach clasp (gingivally approaching).
Undercuts
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DENTAL SURVEYOR
Retention depend on
(b) The magnitude of the tooth undercut (the magnitude of the angle of
cervical convergence below the point of convexity), and
(c) The depth the clasp terminal is placed into this undercut
Partially edentulous mouth has many undercut areas that result due to:
c- The inclination of soft tissues or bone to a vertical line drawn from the
occlusal surface resulting in soft tissue or bony undercuts.
1) Desirable undercuts:
Desirable undercuts are used for retaining the partial denture against
dislodging forces. Discerning the angle of cervical convergence is important in
developing uniform retention through clasps.
2) Undesirable undercuts:
Undercuts other then those used for retention are considered undesirable
and should be eliminated. This done by
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DENTAL SURVEYOR
False undercut: Tilting the cast away from the path of placement of the
RPD may create undercuts, but these are FALSE UNDERCUTS because they do
not provide retention (resistance to movement of the prosthesis away from the
tissues along the path of placement and removal of the denture) since they are
not present along the path of placement and removal of the denture.
Guiding planes
Guiding planes are flat axial surfaces in an occluso-gingival direction on
the proximal or lingual surfaces of teeth. They are made parallel to the path of
placement, help in guiding the prosthesis during placement and removal.
They are prepared on the enamel surface after the path of Insertion is
selected according to the other three factors.
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DENTAL SURVEYOR
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DENTAL SURVEYOR
c. Minor connectors that join the auxiliary rests to the major connector.
3- The frictional contact of the prosthesis against these parallel surfaces can
contribute significantly to the overall retention of the prosthesis، and
assisting the reciprocal clasp arm to perform its intended function.(Fig.6-11)
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DENTAL SURVEYOR
The interface between the tooth surface and the clasp should be such that
a slight degree of movement of the base and the clasp is permitted without
transmitting torsional stress to the tooth.
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DENTAL SURVEYOR
parallel
Include more than one common axial surface (e.g. proximal and
lingual surfaces)
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
Paralleled blockout
The blockout wax is trimmed parallel to the path of insertion and
removal by using the wax trimmer surveyor tool while the cast is positioned
in the predetermined tilt. It is done in the following areas:
- Proximal tooth surfaces to be used as guiding planes
- Beneath all minor connectors
- Tissue undercuts to be crossed by rigid connectors
- Tissue undercuts to be crossed by origin of bar clasps
- Deep interproximal spaces to be covered by minor connectors or
linguoplates beneath bar clasp arms to gingival crevice
Shaped blackout
It is done in the form of ledges on the buccal and lingual surfaces of
abutment teeth. It will help in proper positioning and carving of the clasp
arms.
- On buccal and lingual surfaces to locate plastic or wax patterns for clasp
arms.
- Ledges for location of reciprocal clasp arms to follow height of convexity
so that they may be placed as cervical as possible without becoming retentive
- Ledges for location of retentive clasp arms to be placed as cervical as
tooth contour permits; point of origin of clasp to be occlusal or incisal to
height of convexity, crossing survey line at terminal fourth, and to include
undercut area previously selected in keeping with flexibility of clasp type
being used.
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LABORATORY PROCEDURES
2-Relief
It is done for creating a space between the metal framework and the cast
as in the following areas:
- Beneath lingual bar connectors or the bar portion of linguoplates
when indicated
- Areas in which major connectors will contact• thin tissue such as hard
areas so frequently found on lingual side of mandibular ridges and elevated
median palatal raphea.
- Beneath framework extension onto ridge areas for attachment of resin
bases
3-Tissue Stops:
Tissue stops is done by removal of two small squares of 2 mm,
usually an anterior and posterior, of relief wax at the distal end the
edentulous ridge. It provides stability of the framework during clinical
work and during acrylic resin processing.
They will result in metal projections resting on ridge areas. Hence,
the framework maintains its position while being subjected to the pressure
of packing later on.
Arrows indicate three small “nail head” minor connectors in which individualized impression
trays may be attached when secondary impression is used.
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LABORATORY PROCEDURES
8- Duplication
Duplication is the procedure of accurately reproducing a cast.The
modified master cast is duplicated to form a refractory cast made of investment
material.
A duplicating flask is used for this procedure. The most commonly used
material for duplication is the reversible hydrocolloid agar agar. The solid
agar material is heated to melt and then cooled to 55 degree C to be poured
gently into the duplicating flask that contains the modified cast. The flask is put
in a shallow container filled with one inch water to allow the agar to cool from
the bottom upwards (compensation for gelation shrinkage).
This duplication is essential to:
A) The stone of the master cast can not withstand the high temperature
during casting.
B) The stone cast will not allow thermal or hygroscopic expansion to
compensate for casting shrinkage.
C) The stone material is not porous and will not allow for gas to escape
during burnout of the wax pattern.
Duplicating flask is metal case that consists of:
a)Bottom.
b)Ring.
c)Feeding top.
Ticoniurn duplicating flask is used because of its simple design and
reliability in controlling shrinkage.
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LABORATORY PROCEDURES
6- Break the hydrocolloid away from the 7- Drying the refractory cast.
cast.
8- Immersing the refractory cast into 9- Cooling the dipped wax on absorbent
molten bees wax, to provide sealing. paper.
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LABORATORY PROCEDURES
Duplicating colloids are capable of being re-used many times. They must
be cleaned and melted after each use. They may be prepared and
stored in automatic duplicating machine. If this machine is not
available, a double boiler can be used to prepare the colloid for
duplication.
The clean colloid can be cut into small pieces and re-heated
in this double boiler to a fluid consistency. When cooled to working
temperature, it will be cool enough to flow easily without melting
the blockout wax. A 630C is a suitable working temperature.
Investment material is used for making the refractory cast. The type of
investment depends on the type of the alloy used.
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
1) Top Sprueing
It consists of the sprue originating from the top of the wax
pattern.The sprue has a diameter of a pencil, it consists of a main
wide central sprue from which narrower auxiliary sprues run to each
corner of the wax pattern. Done for majority of maxillary cases.
2) Inverted Sprueing:
In which the base of the refractory cast should have a hole in
its center. A cone-shaped metal sprue of suitable size is placed into
the hole. Auxiliary sprues are then placed between the main sprue
and the thick sections of the wax pattern.
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
b) The outer cast investment surrounding the cast and pattern. This portion is
confined by a ring (cylinder), winch is made of metal. The ring will not be
removed till the end of casting procedure. It should be lined with a wet layer
of cellulose to allow for both setting and thermal expansion of the investment.
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LABORATORY PROCEDURES
REMENBER
- The investment ring is lined with one layer of asbestos casting ring
liner. The liner should be 6:7 mm shorter than the ring at the crucible end to
act as a lock against investment rotation inside the ring. The asbestos
permits for the escape of hot gases and allows space for investment
expansion.
- The refractory cast is dipped in slurry water to moisten its surface
and to prevent it from absorbing water from the investment material.
- The pattern is painted with a wetting agent to allow the outer
investment to adhere to the pattern.
Top Ring
Asbestos Substitute
¼ inch clearance of
Asbestos Substitute
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LABORATORY PROCEDURES
The investment is placed in the burn out furnace with the sprue
hole downwards. The investment should be moist before starting the
burn out cycle to allow the investment to heat uniformly.
The burnout should start in a cold oven, and then the temperature
should be slowly increased to 12500F over a period of two hours. This
temperature is maintained for half an hour (heat soaking).
The time and temperature required to eliminate the wax should
be according to the Manufacturer’s instructions.
- Burnout furnaces are either electric or gas and must be vented to allow
the noxious fumes that result from the burnout, to escape the work area.
Modem furnaces are controlled electronically to permit time/temperature
relationship to be set exactly to the alloy manufacturers specifications. With
these modern furnaces, over and under-heating are avoided.
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
4-Making the final impression either with d-Pouring the final impression in stone plaster to
A-Alginate impression material in case of tooth construct a master cast.
supported partial dentures. e- Surveying the master cast to draw the survey
B-Functional impression in case of tooth and tissue line on abutment teeth and to determine the
supported partial dentures. path of placement of the partial denture.
f- Drawing the design of the partial denture.
g- Preparation of the master cast for duplication
1.Blocking the undesirable tooth undercuts in
wax.
2.Establishing the relief areas in wax.
3.C-Making the ledges in wax.
4.Blocking the tissue undercuts.
h-Duplication of the master cast into a refractory
cast (investment cast). This is done by the use
of agar-agar material in a duplicating flask.
i- Construction of the wax pattern on dried
refractory cast.
j-Spruing, investing, wax elimination (burn out)
and casting in metal (gold or Chrome cobalt
alloy)
K-Pickling, finishing and polishing the metal
5-Testing the framework on the master cast and then framework.
try in of the metal in the patient’s mouth.
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Diagnosis of partially edentulous patients
EXAMINATION, DIAGNOSIS
(3) The selected replacement of lost teeth for the purpose of restoration of
function in a manner that ensures optimum stability and comfort in an
esthetically pleasing manner.
G. Anterior esthetics.
J. Ease of plaque removal from the natural teeth and partial de ture.
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Diagnosis of partially edentulous patients
G. Periodontal health.
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Diagnosis of partially edentulous patients
(2) Ascertaining the patient's dental needs through a diagnostic clinical exam.
(3) Developing a treatment plan that reflects the best management of the
desires and needs (unique to their medical condition or oral environment).
a prophylaxis,
full-mouth radiographs,
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Diagnosis of partially edentulous patients
A. Patient interview:
C. Oral prophylaxis
B-Radiographic survey
D. Consultation requests:
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Diagnosis of partially edentulous patients
A ] PATIENT INTERVIEW
1- Structure of interview:
HISTORY TAKING
2- Objectives:
a. Establishing of a rapport:
We should meet the mind of the patient before we meet his mouth.
De Van stated, "Meet the mind of the patient before meeting the mouth
of the patient". Hence, we understand that the patient's attitudes and
opinions can influence the outcome of the treatment.
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Diagnosis of partially edentulous patients
Arthritis Epilepsy
Acromegaly Cancer
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Diagnosis of partially edentulous patients
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Diagnosis of partially edentulous patients
*Anticoagulants
*Saliva-inhibiting drugs
e. Dental history:
The cause of teeth loss: If the teeth were lost because of caries,
special emphasis will have to be placed on oral hygiene
procedures. If the teeth were lost because of periodontal disease,
every effort must be made to discover and eliminate its cause.
Chewing habits: The patient is asked about the preferred and non
preferred side for chewing. This will determine the amount of
support, retention and bracing of the denture on each side.
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Diagnosis of partially edentulous patients
3- Obstacles:
INFECTION CONTROL
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Diagnosis of partially edentulous patients
B] Clinical examination
PATIENT EVALUATION
• Age : patients belonging to the fourth decade of life will have good
healing abilities and patients above the sixth decade will have
compro¬mised healing.
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Diagnosis of partially edentulous patients
Extraoral examination
a-Facial Features :If the face appears collapsed, it indicates the loss of
vertical dimension (VD). Decreased VD produces wrinkles around the
mouth. Excessive VD will cause the facial tissues to appear stretched.
b. Complexion :The colour of the eye, hair and the skin guide the selection
of artificial teeth.
Oral Examination
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Diagnosis of partially edentulous patients
visual examination,
oral prophylaxis,
radiographs,
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Diagnosis of partially edentulous patients
arches can be obtained only if the teeth are clean; otherwise the teeth reproduced
on the diagnostic casts are not a true representation of tooth and gingival contours.
Objective:
1. Opposing occlusion.
3. Parafunctional habits.
a. Clenching. b. Bruxism
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Diagnosis of partially edentulous patients
1. Caries and existing restorations: All carious teeth must be restored prior to
starting definitive prosthodontic treatment,
3. Sensitivity to percussion
4. Mobility and C/R ratio: The degree of mobility of all teeth should be
recorded using a scale commonly used for classifying mobility:
Causes:
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Diagnosis of partially edentulous patients
Treatment:
Scaling
Splinting when:
• The first premolar and all molars have been lost and the
second premolar is to serve as the abutment
5. Periodontium:
2. Furcation involvement
4. Marginal exudate
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Diagnosis of partially edentulous patients
B] . Oral mucosa:
Pathologic changes
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Diagnosis of partially edentulous patients
o Relieving the denture base or reducing the length of the denture border
o Surgical correction of undercuts.
o Flexible denture base or flexible border
o Reduce length of denture border
The mylohyoid ridge: Some of these ridges are felt to be
pronounced and the soft tissue covering is thin and is easily
traumatized by insertion and removal of prosthesis.
D]. Soft tissue abnormalities:
E] Occlusal relationships:
It is the relation between the opposing teeth and between the teeth and
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Diagnosis of partially edentulous patients
Thick ropy saliva alters the seat of the denture because of its tendency
to accumulate between the tissue and the denture. Thin serous saliva
does not produce such effects.
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Diagnosis of partially edentulous patients
Anterior abutments that are considered poor risks may not be so freely
used because of the problems involved in adding a new abutment retainer when
the original one is lost. It is rational that such questionable teeth be condemned
in favor of more suitable abutments, even though the original treatment plan
must be modified accordingly.
Kennedy Class II, mod I in which molar abutment has a guarded prognosis. Premolar clasp assembly is a
mesial rest, distal guide plane, and wrought wire retainer design that will accommodate future distal extension
movement.
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Diagnosis of partially edentulous patients
a- the design and quality of construction should be noted and any associated
problems in relation to gingival and mucosal inflammation or to decalcification
of contacting tooth surfaces.
C -Radiographic survey:
All radiolucent and radiopaque areas that vary from normal ranges
to determine whether a pathologic condition is present.
Root fragments and other foreign bodies to determine whether
their removal is indicated.
Un erupted third molars to determine whether they should be
retained or removed.
Evaluate quantity of bone.
oAlveolar.
oResidual ridge.
oBasal.
a. Bone Index (bone factor):
The bone factor provides an assessment of the relative response
of bone to stimulation or irritation. This assessment is made by
analyzing bone index areas.
Bone index areas are those areas of bony support which disclose
the reaction of bone to increased force, e.g. areas of bone around
abutment teeth or any other teeth subjected to increased loading.
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Diagnosis of partially edentulous patients
b. Bone Density
In the mandibular arch the external oblique ridge, the mylohyoid ridge
and the genial tubercles, which are areas of muscle attachments, continue
to resist resorption even when the residual ridge is greatly resorbed.
The presence of dense cortical bone is often the result of applied forces
arising from ligamentous or muscle attachments which provide tension to
the underlying bone.
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Diagnosis of partially edentulous patients
Genetic. Pathologic.
Hormonal. Biochemical.
Nutritional. Other.
The presence and extent of caries and the relation of the carious lesion
to the dental pulp
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Diagnosis of partially edentulous patients
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Diagnosis of partially edentulous patients
D] DIAGNOSTIC CASTS
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Diagnosis of partially edentulous patients
(b) Retentive and non retentive areas of the abutment teeth; (c)
areas of interference to placement and removal; and
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Diagnosis of partially edentulous patients
Occlusion,
The mounted diagnostic casts provide visual access from all directions and
enable the dentist to make a detailed analysis of the patient’s occlusion.
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Diagnosis of partially edentulous patients
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Diagnosis of partially edentulous patients
3. Inspection of:
Interarch distance
Caused by
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Diagnosis of partially edentulous patients
A segment of teeth that has been unopposed for a prolonged period will
frequently overerupt, carrying the alveolar process with it. Subsequent
removal of the teeth will produce a situation in which it is impossible to
establish a functionally and aesthetically acceptable plane of occlusion.
Management
The surgical reduction of the vertical height of the tuberosity and at times
the adjacent residual ridge is necessary if satisfactory replacement of the
missing teeth is to be accomplished. The area and amount of tissue that should
be removed can be indicated on the diagnostic east. This provides an excellent
guide for the oral surgeon or dentist who performs the surgical correction. The
radiographs are a valuable aid in planning the surgical of fibrous tissue.
Healing is usually complete in 7 to 10 days. The healing period is extended to 2
to 5 weeks when bone removal is necessary.
Management
The undercut must be evaluated with the aid of the dental surveyor.
With the cast on the surveying table at the predetermined path of insertion, a
determination is made as to the amount of relief that will be required in the
denture if the undercut is not reduced. Moderate to severe tuberosity undercuts
usually require surgical correction with bone removal.
bulbous tuberosities
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Diagnosis of partially edentulous patients
Management
Occlusal plane
Management
Available treatments depend on the degree of extrusion and the condition of the
tooth:
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Diagnosis of partially edentulous patients
• Severely extruded teeth such as those contacting the opposing ridge present
greater problems. If the alveolar bone has followed the eruption of the
offending tooth, it may be necessary to extract the tooth and remove the
surrounding bone.
• At times endodontic treatment and & drastic reduction of the tooth will enable
it to be used as an overdenture abutment. This treatment can provide valuable
support for a distal extension base. Extruded teeth must always be evaluated
with the occlusal plane in mind.
Management
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Diagnosis of partially edentulous patients
Malrelation of jaws:
Severe malrelation of the jaws can prevent the restoration of adequate function
and esthetics.
Management:
Management:
Classification:
Akerly (1977) has classified traumatic vertical overlap into the following
four basic types:
Type I -The mandibular incisors extrude and impinge into the palate.
Type II-The mandibular incisors impinge into the gingival sulci of the
maxillary incisors.
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Diagnosis of partially edentulous patients
Clinical symptoms:
Abrasion,
Mobility,
Management:
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Diagnosis of partially edentulous patients
If all the maxillary teeth are present and have healthy support, it may
be possible to build up the cingula of the anterior teeth with cast
restorations >>>>> not feasible if the horizontal overlap is too great.
Occlusion
The mounted diagnostic casts are also used for an evaluation of the patient’s
occlusion. The information obtained from the analysis of the occlusion should
be correlated with other clinical findings.
Occlusal interferences:
Bruxism:
Severe bruxism can injure the teeth, the periodontium, and the
Temporomandibular joint and may initiate muscle spasm, pain, or discomfort.
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Diagnosis of partially edentulous patients
• Root resorption.
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Diagnosis of partially edentulous patients
E. Consultation requests:
3. The physical aspects of the prosthesis with regard to bulk and tissue
coverage.
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Diagnosis of partially edentulous patients
Elimination of Infection
Elimination of Pathology
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Diagnosis of partially edentulous patients
Preprosthetic Surgery
Alveolectomy Implants
Tissue Conditioning
The patient should be requested to stop wearing the previous denture for
at least 72 hours before commencing treatment. He/she should be taught to
massage the oral mucosa regularly.
Nutritional Counseling
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Diagnosis of partially edentulous patients
PROSTHODONTIC CARE
For a patient with few teeth, which are likely to be extracted an immediate
or conventional, definitive or interim, implant or soft tissue supported
dentures can be given.
1-fixed bridge
Indication:
A-GENERAL INDICATIONS:
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Diagnosis of partially edentulous patients
B-LOCAL INDICATIONS:.
3- short span.
Contraindication:
A-GENERAL CONTRAINDICATIONS:
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Diagnosis of partially edentulous patients
• poor cooperation
3- contraindication to L.A
1- long span
2- when the bridge will occlude with opposing teeth on its end or 1/2 or less of
its length
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Diagnosis of partially edentulous patients
2-Complete denture
Indication:
1-poor abutment
6- poor alignment
7- radiation therapy
Indicaton
4- weak abutment
8- immediate replacement
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Diagnosis of partially edentulous patients
10- need for complete denture in future( due to increase possibility of further
tooth loss)
12- patient desire (economic and time and preserve of sound teeth )
20- diabetic pt
Containdications:
A-Intraoral contraindication
B-Patient contraindication
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Diagnosis of partially edentulous patients
1- un cooperative pt.
1-AGE:
• Avoid extraction
Physiologic
psychologic
b- old patient :
2-GENERAL HEALTH:
3- SEX:
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Diagnosis of partially edentulous patients
Female:
4- ECONOMIC CONSIDERATION
R P D may need root canal treatment and crown inlays thus more cost.
5- SOCIOECONOMIC BACKGROUND
7- OCCUPATIONAL FACTORS
8- TIME FACTORS
Removable partial denture . may be used for long term prognosis, the best
R.P.D, service for many years.
Or for short term prognosis and in future the patient need complete denture,
must be simple in design and permit the addition of future teeth (additive
partial denture)
This temporizing treatment gives the patient experience in denture wearing and
in adaptation to artificial dentition.
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Diagnosis of partially edentulous patients
Clinical factors related to metal alloys used for removable partial denture
frameworks: see denture base
Various alloys can be considered for use, Practically all cast frameworks
for removable partial dentures are made from a chromium-cobalt alloy.
Questions
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BIOMICHANICS OF REMOVABLE PARTIAL DENTURE
Definition: The relationship between the biologic behavior of oral structures and
the physical influence of an R P D.
Mechanics may be classified into two general categories: Simple & complex.
1 - lever 4-screw
A removable partial denture in the mouth can perform the action of two simple
machines, LEVER & INCLINED PLANE,
LEVER : The lever is a rigid bar supported at some point along it is length.
The first type: the fulcrum (F) is in center of the bar, resistance (R) is at one and the
force (E) is at opposite end (called cantilever).
A cantilever: It is a beam supported only at one end, when force is directed against
unsupported end of beam cantilever can act as first class lever.
The second-class lever: the fulcrum at one end, the force at opposite end & the
resistance in center. This type is seen as indirect retention in R P D.
The third class lever: the fulcrum t one end & the resistance at opposite end & the
force in the center. This type is not encountered in R P D. (e.g. tweezers)
The length of fulcrum to resistance is called Resistance arm, while the length of
lever from fulcrum to the point of application of force is called Effort arm.
Every effort should be done to avoid class I lever (cantilever). To avoid this
cantilever (lever class I) we can made either lever class II or using stress release
direct retainer.
a) Lever class II
A. MAXILLARY.
1. Horizontal hard palate.
a. Keratinized mucosa.
b. Presence of fatty (anterior) and glandular (posterior) submucosa
(excluding midline suture).
c. Cortical bone.
2. Posterior ridge crest.
a. Keratinized mucosa.
a. Presence of dense firmly bound submucosal connective tissue
which may contribute to clinically observed resistance to pressure
induced resorption.
Maxillary primary (10) supporting areas are the horizontal hard palate
and the anterior ridge crest serves as a secondary (2°) supporting area.
B. MANDIBULAR.
1. Buccal shelf. A primary force bearing area which is comprised of
cortical bone. It extends from the base of residual ridge in the poste-
rior part of the mandible to the external oblique ridge.
a. Presence of submucosa.
b. Cortical bone.
a. Buccinator muscle attachment. The longitudinally directed fibers
apply tension to the underlying bone but do not dislodge the
denture base during contraction.
2. Pear-shaped pad. The most distal extension of keratinized tissue
covering the ridge crest. It is formed by the scarring pattern
following the extraction of the most distal mandibular molar. It
should be differentiated from the m~e posterior retromolar pad
during clinical examination.
a. Keratinized mucosa.
a. Presence of dense firmly bound submucosa.
a. Medial tendon of the temporalis muscle inserts lingually in the
area of the apices of the mandibular third molars and applies
tension to the underlying bone.
Mandibular primary (10) supporting areas are
the buccal shelf and pear-shaped pad.
The anterior facial incline of the ridge is non-contributory (N/C).
The lingual ridge inclines may require relief (R)
and the genial tubercle area
and ridge crest serve as secondary (2") supporting areas.
Stresses acting on a partial denture are transmitted to the teeth, and
tissues of the residual ridges. The stresses, which tend to move the denture in
different directions, may be summarized as follows:
1- Masticatory stresses.
2- Gravity tends to displace a maxillary denture downwards.
3- Sticky food tends to pull the denture occlusally away from the tissues.
4- Muscle pull and tongue action tend to displace a denture from its
position.
5- Intercuspation of teeth may tend to produce horizontal and rotational
stresses unless the occlusion is balanced.
Natural teeth are better able to tolerate vertical directing forces acting
on them. This is because more periodontal fibers are activated to resist the
application of vertical forces. On the other hand, lateral forces are potentially
destructive to both teeth and bone. Lateral forces should be minimized in order
to be within the physiologic tolerance of the supporting structures.
TYPE OF FORCES ACTING ON RPD
I- Vertical forces
A) Tissue-ward movements B) Tissue-away movements
II- Horizontal forces:
A) Lateral movements B) Antero-posterior movements.
III- Rotational forces:
They are due to the variation in compressibility of supporting structures,
absence of distal abutment at one end or more ends of denture bases, and /or
absence of occlusal rests or clasps at any end of the bases.
1-Rotation of the anterior and posterior extension denture base around
coronal (transverse) fulcrum axis:
A) Rotation of the denture base towards the ridge around the fulcrum axis
joining the two main occlusal rests:
B) Rotation of the denture base away from the ridge around the fulcrum axis
joining the retentive tips of the clasps.
2-Rotation of all bases around a longitudinal axis parallel to the crest of the
residual ridge (Buccolingual or labiolingual).
3-Rotation about an imaginary perpendicular axis, this axis either near the
center of the dental arch in class I, or is the long axis of abutment tooth in class
II partial denture.
I- Tissue-ward movements
a) Tissue-ward forces are, “Vertical forces acting in gingival direction
tending to move the denture towards the tissues”.
c) Rigid major connectors that are neither relieved from the tissues nor
placed on inclined planes also provide support.
Tissue-away forces occur due to: The action of muscles acting along
the periphery of the denture, gravity acting on upper dentures or by sticky food
adhering to the artificial teeth or to the denture base.
Retention in partial dentures is mainly provided by: {see direct retainer for
detail}
a- physical forces which arise from coverage of the mucosa by the denture.
1. Bracing clasp arms placed at or above the survey line of the tooth.
3. Proximal plates.
The removable partial denture being anchored to both sides of one arch and
joined by a rigid major connector can provide cross arch stabilization to forces
acting in bucco-lingual direction.
B) Antero-posterior movements
There is natural tendency for the upper denture to move forward and for
the lower to move backward.
2. Palatal slope.
3. Maxillary tuberosity.
3. Proximal plates.
II- Rotation about a longitudinal axis formed by the crest of the residual ridge
(Tipping movement).
III- Rotation about an imaginary perpendicular axis near the center of the
dental arch (Fish tail movement).
I-Rotation of the denture base around fulcrum axis joining the principal
abutments:
More than one fulcrum lines may identified for the same removable partial
denture depending on the direction and location for force application.
Flexible clasps are preferred over rigid clasping to reduce stresses and
torque applied on abutments. If the clasps are rigid, the abutments tend to rotate
distally during tissue ward movement of the denture base resulting in
periodontal breakdown and looseness of teeth.
1- Cross arch stabilization (The action of clasps on the opposite side of the
arch).
3- Quality of clasp: - the more flexible clasp arm, the less force transmitted
to the abutment.
4- Clasp design: - a passive clasp when it is completely seated on the
abutment teeth will exert less stress on the tooth than the non passive.
A clasp should be designed so that the reciprocal arm contacts the
tooth before the retentive tip passes over the greatest bulge of the tooth
during insertion and it should be the last component to lose tooth
contact during removal of the prosthesis.
5- Length of the clasp.
Doubling the length increases the flexibility by five times. This
decreases the stress on the abutment tooth. Using a curved rather than a
straight clasp on an abutment tooth will aid to increase the clasp length
6- Material used in clasp construction
A clasp constructed of chrome alloy will exert more stress on
the abutment tooth than a gold clasp because of its greater rigidity. To
decrease the stress, the chrome alloy clasps are constructed with a
smaller diameter.
7- Abutment tooth surface: - the surface of a gold crown or restoration
offers more functional resistance to clasp arm movement than does of
enamel surface of a tooth therefore greater stress is exerted on the
abutment.
Bone is the tissue which ultimately absorbs the greatest amount of the
force applied to both the muco-osseous and dento-alveolar segments.
A.DENTO-ALVEOLAR SEGMENT.
1.Tooth.
Tooth movement.
2.Periodontium
b. Excessive forces may increase the width of the periodontal ligament and
result in increased tooth mobility.
c. Plaque induced inflammation may compromise the periodontium. It can lead
to apical migration of the crevicular epithelial attachment (functional
epithelium) and destruction of the fibroblasts and connective tissue of the
connective tissue attachment. In the presence of inflammation normal
functional forces may accelerate the rate of periodontal attachment loss.
3.Alveolar bone.
b.Bone index or Bone factor. The response of bone to pressure varies in terms
of the rate of resorption depending on genetic, nutritional, hormonal and
biochemical and other intrinsic factors. The bone index is determined by
analyzing the previous response of bone to force.
c. Cortical vs. cancellous bone. Cortical bone is more dense, more highly
mineralized, less cellular, and less metabolically active. It tends to be more
resistant to pressure induced resorption than cancellous bone. Lamina dura is
cortical bone.
1.Mucosa.
2.Submucosa
3.Bone
b. Bone index. The bone index of the alveolar bone surrounding natural teeth
may differ from that of the bone comprising the residual ridges. (Fig. 3-6)
c. Cortical vs. cancellous bone. The residual ridge crest is comprised mainly of
cancellous bone and is less resistant to resorption. The facial and lingual
inclines of the residual ridges are comprised of cortical bone and are more
resistant to remodelling. The rate of cancellous bone resorption has been
described as being approximately three times that of cortical bone.
The first two causes of untoward tissue reaction can be accentuated the
longer a prosthesis is worn. It is apparent that mucous membranes cannot
tolerate this constant contact with a prosthesis without resulting in
inflammation and breakdown of the epithelial barrier. Some patients become so
accustomed to wearing a removable restoration that they neglect to remove it
often enough to give the tissue any respite from constant contact. This is
frequently true when anterior teeth are replaced by the partial denture and the
individual does not allow the prosthesis to be out of the mouth at any time
except in the privacy of the bathroom during tooth brushing. Living tissue
should not be covered all the time or changes in those tissue will occur. Partial
dentures should be removed for several hours each day so that the effects of
tissue contact can subside and the tissue can return to a normal state.
1. Clasp
The retentive clasp arm is the element of RPD that is responsible for
transmitting most of destructive forces to the abutment teeth. A RPD should
always be designed to keep clasp retention to a minimum yet provide
adequate retention to prevent dislodgment of the denture by unseating
forces. It should also be remembered that the retentive clasp should be
designed such that it is active only during insertion and removal.
3. Frictional control
The RPD should be designed so that guide planes are created on as many
teeth as possible. Guide planes are areas on teeth that are parallel to the path
of insertion and removal of the denture. The plane may be created on the
enamel surfaces of the teeth or restorations placed on teeth. The friction of
RPD against parallel surfaces can contribute significantly to retention of the
denture.
4. Neuro-muscular control
The design and contour of the denture base can greatly affect the ability of
lips, checks and tongue to retain the prosthesis. Any over-extension of the
denture base either facially, lingually in the mandible or posteriorly onto the
soft palate will contribute to the loss of retention and the abutment teeth
bearing the direct retainers will be over stressed.
5. Clasp Position
a- Quadrilateral configuration
b- Tripod Configuration
Tripod clasping is used primarily for class II arches. If there is a modification
space on the edentulous side the teeth anterior and posterior to the space are
clasped. If a modification space is not present. One clasp on the edentulous
side of the arch should be positioned as far posterior as possible and the
other, as far anterior as factors such as interocclusal space, retentive
undercut, and esthetic considerations will permit. By separating the two
abutments on the tooth-supported sides as far as possible, the largest possible
area of the denture will be enclosed in the triangles formed by the clasps.
c- Bilateral configuration
Most RPD with bilateral distal extension group in class I fall into bilateral
configuration. In the bilateral configuration the clasp exert little neutralizing
effect on the leverage induced stresses generated by the denture base. These
stresses must be controlled by other means.
6. Clasp design :
a- Circumferential clasp :
The conventional circumferential cast clasp originating from a distal occlusal
rest on the terminal abutment tooth and engaging a mesio-buccal retentive
undercut should not be used on a distal extension RPD. The terminal of this
clasp reacts to movement of the denture base toward the tissue by placing a
distal tipping, or torquing, force on the abutment teeth. This particular force is
the most destructive force a retentive clasp can exert. This clasping concept
must be avoided.
On the other hand if the circumferential clasp with mesial occlusal rest
approaches a disto-buccal undercut form the mesial surface of the abutment,
is acceptable. The effect on the abutment is reversed from that of the
conventional clasp. As the occlusal load is applied to the denture base, the
retentive terminal moves further gingivally into the undercut area and loses
contact with the abutment teeth. In this manner torque is not transmitted to
the abutment tooth.
The vertical projection clasp, or bar clasp is used on the terminal abutment
tooth on a distal extension RPD when the retentive undercut is located on the
disto-buccal surface. As the denture base is loaded toward the tissue, the
retentive tip of the clasp rotates gingivally to release the stress being
transmitted to the abutment tooth.
c- Combination clasp :
Flexible clasps produce the least stress and rigid cast circumferential clasps
produce the maximum stress in an abutment.
2- Indirect Retention
In class I prosthesis, the fulcrum line would be moved from the tips of
the retentive clasp to the most anteriorly located component, the indirect
retainer. Because the indirect retainer resists lifting forces at the end of a long
lever arm, it must positioned in a definite rest seat so that the transmitted
forces are diverted apically through the long axis of abutment tooth. The
indirect retainer also contributes to a lesser degree, to the support and
stability of the denture.
3- Occlusion
4- Denture Base
The distal extension denture base must always extend onto the
retromolar pad area in the mandible and cover the entire tuberosity of the
maxilla. Both structures are capable of absorbing more stress than alveolar
ridge anterior to them.
The type of impression used to record the residual ridge will influence
the amount of stress the residual ridge can effectively absorb. Several
techniques are used to make functional impression of the residual ridge. Each
technique is based on the theory that if the ridge were recorded in its
functional state rather than its resting form, when the denture base is actually
subjected to occlusal loading, the tissue would not displaced to any great
stint. The magnitude of stress transmitted to the abutment teeth, therefore,
would be minimal.
5- Major Connector
In the maxillary arch the use of a broad palatal major connector that
connects several of the remaining natural teeth through lingual plating can
distribute stress over a large area. The major connector must be rigid and
must receive vertical support through rests from several teeth.
It should distribute the occlusal load over a wide area and at the same
time produce the least amount of stress. There are three important principles
for design exclusively used for a major connector. They are:
Circularconfiguration.
Strut configuration.
The L-beam or L-bar or Linear beam theory states that the flexibility of
a bar is directly proportional to the length of the bar and inversely
proportional to its thickness.
Now apply this concept in the design of a major connector. The palate
has a flat vault and two lateral slopes.
If the slopes are shallow, the quartic part of the major connector also
decreases leading to increased flexibility of the prosthesis under occlusal load.
The major connector should be located and designed such that it lies over the
steeper slopes in the palate.
Circular configuration
6- Minor Connector
One of the most critical points of the rest seat is that the floor of the
preparation must form an angle of less than 90 degrees with the long axis of
the tooth. This permits the rest, whether occlusal, incisal or lingual, to grasp
the tooth securely and prevent its migra on. If more than 90 degrees, an
inclined plane action is set up and stress against the abutment tooth is
magnified.
Splinting could be achieved by clasping more than one tooth on each side of
the arch using a number of rests for additional support and stabilization and
preparing guiding planes on as many teeth as possible to contribute to
horizontal stabilization of the teeth and the prosthesis. The multiple clasps
should not all be retentive.
Designing of partial denture necessitates a proper planning for the form and
extent of a dental prosthesis and studying of all the factors involved.
The prosthesis must be designed following the most favorable biomechanical
principles, as the proper design helps in reducing the harmful effects on the
supporting structures.
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Here a movable joint is placed between the direct retainer and denture base.
This joint may either be a hinge or a ball and socket or a sleeve and cylinder. Adding
these stress breakers to the junction of the direct retainer and the denture base, allows
the denture base to move independently.
This decreases the amount of force acting on the abutment. The combined
resiliency of the periodontal ligament and the stress director will be equal to the
resiliency of the oral mucosa overlying the ridge.
Examples for hinges include DALBO, CRISMANI, ASC 52 attachments.
Type I I
It has a flexible connection between the direct retainer and the denture base. It
can be a wrought wire connector, divided or split major connector or a movable joint
between two major connectors.
In a split major connector, the major connector is split by an incomplete cut
parallel to the occlusal surface of the teeth into two units namely the upper unit (more
near to the tooth) and the lower unit. The denture base is connected to the lower unit
and the rests and direct retainers are connected to the upper unit.
Advantages
The alveolar support of the abutment teeth is preserved as the stresses acting on
the abutment teeth are reduced.
The stress on the residual ridge and the abutment teeth are balanced.
Weak abutment teeth are well splinted even during the movement of the denture
base. Abutment teeth are not damaged even if relining is not done appropriately
(after the denture wears out).
Minimal requirement of direct retention.
Movement of the denture base produces a massaging effect on the soft tissues..
This avoids the frequent need for relining and rebasing.
Disadvantages
Design is complicated and expensive.
The assembly is very weak and tends to fracture easily. Distorts to rough
handling.
It is difficult to repair.
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It can be used only to counter the vertical forces on the denture. Inability to
counteract lateral stress acting on the ridge leads to ridge resorption.
Reduced stability against horizontal forces.
Both vertical and horizontalforces are concentrated on the ridge leading to
resorption.
Inappropriate relining leads to excessive ridge resorption.
Reduced indirect retention.
The split major connector tends to collect food debris at the area of split.
Physiologic Basing
This technique distributes the occlusal load between the abutment teeth and the
soft tissues by fabricating a denture based on a functional record. Functional record is
obtained by recording the tissues under occlusal load or by relining the denture under
functional stress. This technique involves making an impression of the soft tissues in a
compressed state.
The denture fabricated using a functional impression has one major
disadvantage. That is the denture tends to compress the soft tissues even at rest. This
can lead to excess ridge resorption. Since the denture is fabricated using a functional
record (compressed tissues), the soft tissues offer more resistance to further
compression. This increased resistance to compression provided by the oral mucosa
equates to that of the periodontal ligament of the abutment tooth. In this manner the
abutment tooth is protected from excessive forces and the denture can distribute
occlusal load evenly to the teeth and tissues.
Requirements for Physiological Basing
rigid metal framework
Functional occlusal rests
Indirect retainers to provide additional stability.
Well-adapted, broad coverage denture bases.
Advantages
Good adaptation of the denture base.
Simple design and economical.
Minimal direct retention decreases the
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They are a very small dentures which replacing one or two teeth on one side only and
often they are called (removable bridges).
(3) Tooth-and tissue born dentures:
They are supported by the soft tissue and the natural teeth.
The best example of this type is the RPD with distal extension bases. The tooth
structure provides the support interiorly, where soft tissue supports the denture base
posteriorly.
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Atmospheric Pressure
Effect of Gravity
Plastic molding between tissues / denture polished surfaces aid to little extent in
retention of partial denture
b] Mechanical means
(1) Direct retainers:
A- Intracoronal (precision attachments).
B- Extracoronal (clasps)
(2) Frictional fit between the denture and the abutment teeth.
(3) Parts of the denture base engaging in undercuts on the teeth.
(4) Parts of the denture base engaging in undercuts on the soft tissues.
(5) Indirect retainers. {Prevent rocking movements of the denture}.
C] Physiological means of retention:
1- The physiologic molding of the tissues around the polished surfaces of the
denture helps to perfect the border seal.
2- Neuromuscular control
Direct retainers:
A- precision attachments:
• They are fitted more to the small unilateral RPDs (side-plates).
• They are bought ready-made (usually the mail portion is attached to the
denture, while the other is soldered into a crown or large inlay in an abutment
tooth.)
B- Clasps:
1- To resist displacement of the denture by vertically applied forces .
2- To resist displacement of the denture by horizontal applied forces.
Selection of clasp:
Selection of the clasp depends mainly on (type of support, presence of
undercut area, and esthetics).
1- For bounded saddles: the retentive undercut present is used with any acceptable
clasp type.
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2- for distal extension base: Retainers for distal extension partial dentures, although
retaining the prosthesis, must also be able to flex or disengage when the denture
base moves tissueward under functional. stress releasing clasp is desired, which
equitably distribute the force between the abutment and the ridge;
a) If a mesiobuccal undercut is available on the terminal abutment, a combination
clasp with the wrought wire, back action, RPI, RPA clasps are used.
b) If the retentive undercut is located on the distobuccal surface, a bar clasp, and
the C clasp are used.
c) If mesiolingual undercut is present a reverse back action clasp is used.
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Reciprocation:
It is the resistance to horizontal forces exerted on a tooth by the retentive clasp
arm during insertion and removal of the RPD.
This can be obtained by bracing clasp arm or plate contacting the tooth surface
while the movement of the retentive tips over the height of contour of the abutment.
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Stabilizing Components
- Stabilization is the resistance of partial denture to tipping forces.
Causes of tipping, rocking and rotation of RPD:
1- Different quality in the nature of the supporting structures
In tooth supported RPDs, the abutment teeth on both sides of the edentulous
area provide adequate support and resistance to rotational forces through
supporting rests and clasps placed on them.
In Tooth-tissue supported distal extension partial dentures derive support from
two different tissues. This results in vertical movement of the denture base either
in tissue-ward or tissue-away direction when occlusal forces act on artificial
teeth.
2- Sticky foods and muscle pull, acting on the periphery of the denture.
3- Intercuspation and occlusion of teeth
Resistance to vertical and lateral tipping forces (rocking) is gained by:
1. Adequate base coverage.
2. The use of three, and if possible four, widely separated areas of tooth support
3. Rigid bracing clasp arms
4. Balanced occlusal contact and reduction of cusp slope.
5. The use of additional rests serves as, indirect retainers.
6. Coverage of the rugea area acts as an indirect retainer.
Stabilizing components of the removable partial denture framework are those rigid
components that assist in stabilizing the denture against horizontal movement.
o minor connectors that contact vertical tooth surfaces
o reciprocal clasp arms
Minor connectors
• should have sufficient bulk to be rigid
• Little bulk to the tongue as possible.
• Should be confined to interdental embrasures whenever possible.
• When minor connectors are located on vertical tooth surfaces, it is best that these
surfaces be parallel to the path of placement.
A modification of minor connector design has been proposed that places the minor
connector in the center of the lingual surface of the abutment tooth. Proponents of this design
claim that it reduces the amount of gingival tissue coverage and provides enhanced bracing
and guidance during placement. Disadvantages may include increased encroachment on the
tongue space, more obvious borders, and potentially greater space between the connector and
the abutment.
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PARTIAL DENTURE DESIGN
Guiding Plane
It is defined as two or more parallel, vertical surfaces of abutment teeth, so
shaped to direct a prosthesis during placement and removal.
Guiding planes may be contacted by various components of the partial denture:
the body of an extracoronal direct retainer, the stabilizing arm of a direct retainer, the
minor connector portion of an indirect retainer, or by a minor connector specifically
designed to contact the guiding plane surface.
The functions of guiding plane surfaces are as follows:
(1) To provide for one path of placement and removal of the restoration (to eliminate
detrimental strain to abutment and framework during placement and removal).
(2) To ensure the intended actions of reciprocal, stabilizing, and retentive components
(to provide retention against dislodgment of the restoration when the dislodging force
is directed other than parallel to the path of removal and also to provide stabilization
against horizontal rotation of the denture).
(3) To eliminate gross food traps between abutment teeth and the denture.
Dimensions of guiding plane surfaces:
As a rule, proximal guiding plane surfaces should be about one half the width of the
distance between the tips of adjacent buccal and lingual cusps or about one third of the
buccal lingual width of the tooth. They should extend vertically about two thirds of the
length of the enamel crown portion of the tooth from the marginal ridge cervically.
Guiding planes squarely facing each other should not be
prepared on lone standing abutment. Minor connectors of
framework (gray areas) would place undue strain on abutment when
denture rotated vertically either superiorly or inferiorly.
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VII-Minor connectors:
Design considerations:
-it should be ensuring that there is 5 mm of space between adjacent vertical minor
connectors to prevent food impaction.
- must contact the guiding plane surfaces of the teeth to facilitate path of insertion
and provide bracing.
-should cross the gingival tissue abruptly and join the major connector at rounded
right angles. These allow them to cover as little as possible of the gingival tissues.
VIII- Esthetic:
The function and esthetics of removable partial denture are dependent on
the correct orientation of the occlusal plane. The main esthetic problem is the
presence of visible retainers in the buccal vestibule. Rotational path partial
denture may be used to improve esthetic
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PARTIAL DENTURE DESIGN
a removable partial denture should replace only the missing posterior teeth after the
remainder of the arch has been made intact by fixed restorations.
Occasionally, it is necessary that several missing anterior teeth be replaced with the
RPD rather than by fixed restorations. This may be because of
• Accident or surgery,
• If esthetic requirements can better be met through using of teeth added to the
denture framework.
It is necessary to provide the best possible support for the replaced anterior
teeth. Ordinarily, this is done through the placement of occlusal or lingual rests, or
both, on the adjacent natural teeth, but when the edentulous span is too large to
ensure adequate support from the adjacent teeth, other methods must be used.
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PARTIAL DENTURE DESIGN
The internal clip attachment differs from the splint bar in that the internal clip
attachment provides both support and retention from the connecting bar.
The cast bar should rest lightly or be located slightly above the tissue. Retention
is provided by one of the commercial preformed metal or nylon clips, which is
contoured to fit the bar and is retained in a preformed metal housing or partially
embedded by means of retention spurs or loops into the overlying resin denture
base. The internal clip attachment thus provides support, stability, and retention for
the anterior modification area and may serve to eliminate both occlusal rests and
retentive clasps on the adjacent abutment teeth.
Indications:
1- When salvage the roots and a portion of the crown of a badly broken-down
molar through endodontic treatment.
3- An unopposed molar may have extruded to such an extent that restoring the
tooth with a crown is inadequate to develop a harmonious occlusion.
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The vertical load applied on the saddle during mastication should be reduced in
order to minimize vertical displacement of the denture base. The vertical load may be
reduced by decreasing the size of the occlusal table and by maximum extension of
the denture base within the functional limits of muscular movements.
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PARTIAL DENTURE DESIGN
Stress breakers:
Thus, when a vertical load is applied, the stress breaker will allow movement of
the saddle towards the ridge to a greater extent than if the retainer unit is directly
connected to the saddle, although the ridge bone will be subjected to an increased
load. However, this load is widely distributed antero-posteriorly over the ridge and
not on the distal part only. Also flexibility of the stress breaker can be changed to
govern the distribution of load between the ridge aril abutments.
• Movable joints as hinges between the saddle unit and the retaining unit. e.g.
attachments like Dalbo or Crisimany attachments,
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PARTIAL DENTURE DESIGN
• Designs applying the stress breaking principle used in combination with the
main rigid connector (using flexible connection between the direct retainer and
the denture base ).{for detail see stress breaker}
- Lingual bar connector with flexible distal extension (having thinner section
than lingual bar (use of semi-flexible bar).
- Disjunct RPD.
Thus, bar clasps apply the stress-breaking principle. I-bar, RPI clasps are
examples of gingivally approaching clasps that provide a stress breaking effect
when a rigid connector is used in distal extension bases.
The resilient wrought wire arm allows some movement of the clasp over the
tooth, thus following the stress breaking principle. Back-action clasps are also
used in distal extension bases due to their stress breaking effect. It should be noted
that excessive resiliency is not favorable because it results in an unretained
denture.
It can be rarely used in young age, will developed ridge, and very short saddle.
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PARTIAL DENTURE DESIGN
2. Occlusally approaching clasp having resilient retentive wrought gold wire arm
(Combination clasp).
3. Back-action clasp.
5. Extended-arm clasp.
6. Ring clasp.
8. RPI clasp.
9. RPA clasp.
• The farther the anterior placement of the rest, the more vertical will be the
forces, the less is the horizontal component of force falling on the ridge,
The rest proximal plate, I bar clasp (RPI) and the reverse circlet clasps have
mesially located rests which can fulfill this requirement,
Advantages:
• Greater part of the occlusal load will be borne by the ridge and hence less
stresses and less torque on the abutment.
• Even distribution of the load 'in an antero-posterior direction. The bone near the
abutment will thus share the distal part of the ridge in bearing the occlusal load,
• Changing the direction of torque on the abutment from the distal to the mesial
side of the tooth where resistance to torque action will be supplied from the
neighbouring teeth.
Disadvantages:
• Wedging effect
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PARTIAL DENTURE DESIGN
Distribution of the occlusal load widely is effective in reducing the force per
unit area on the residual ridge.
The denture base should cover the largest possible area and should be adequately
extended to the functional limit of the surrounding musculature. The broader the
coverage, the greater the distribution of load, the more the ability of the denture to
withstand vertical and horizontal stresses.
V- Functional impression
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PARTIAL DENTURE DESIGN
The normal mucosa covering the ridge can be recorded in its displaced
functional form rather than the anatomic form. This reduces movement of the denture
base towards the tissues during function, which in turn helps in reducing leverage and
torque on the abutment teeth.
The presence of a well formed residual ridge covered by healthy firm mucosa,
provides favorable partial denture support. However, the presence of tori or
hyperplasic tissues necessitates correction to improve the supportive ability of the
ridge.
Numerous esthetic clasp systems are available for distal extension RPD.These clasps
can either utilize the proximal, lingual, labial or buccal retentive undercut.
Examples: Mesiodistal clasp, the De-Van clasp, the Equipoise clasp and twin Flex
clasp
Class I partially edentulous cases when the remaining teeth are weak,
periodontally affected, and require splinting and stabilization are
sometimes treated using swing-lock partial dentures.
1) Under vertical load the posterior sink of the saddle is less marked due to:
- The submucosa covering the tuberosity has dense fibres than retromolar area.
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The main problem: is the same as with the bilateral free-end saddle denture including:
a) Torque of abutment.
b) Ridge resorption.
Management: as Class I-Kennedy RPD.
c) The problem of retention (similar saddle is not present on the other side)
Management: Additional retention must be provided on the intact side by:
- Clasping more than one tooth on this side
- More rigid types of clasp.
b) The problem of bracing (due to absence of rigid major connector)
Management:
- Cross-arch bracing (Through a rigid major connector).
- Bracing components.
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PARTIAL DENTURE DESIGN
- The use of semi-flexible bar: This is more applicable with shot saddles, it
involves anterior placement of an occlusal rest.
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PARTIAL DENTURE DESIGN
1- The occlusal rest is placed on the far zone of the abutment tooth.
2- The abutment is rigidly clasped, and joined to the clasp onto the
opposite dentulous side by a rigid connector (lingual bar).
- Split casting modifying the lingual plate: a split of appropriate length is made at
the inferior border of the plate.
1- The saddle is joined to the more flexible part of the plate. The
lower part must be flexible in the vertical direction, than
horizontal direction, so that the appliance will have lateral rigidity
to distribute horizontal force widely.
2- This design applied in long class II cases. (used with long saddle)
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PARTIAL DENTURE DESIGN
Retention on the side of the bounded saddle is dependent upon the ability of the
single molar tooth to withstand the loads applied; therefore:
i. If the periodontal condition of such a single standing tooth is good, rigid
construction is employed and frequent inspection of the appliance is essential so that
rebasing may compensate resorption under the free-end saddle. If this is not done, a
damaging torque will be applied to the single standing molar leading at least to
increased tilting and at worst to loosening and eventual loss.
ii. If the periodontal condition of such a single standing tooth is doubtful, it
may be possible to design the denture incorporating a flexible connector to the distal
extension saddle as already described. In addition less stress will be applied to the
tooth if wrought wire instead of cast metal is used for clasp construction.
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PARTIAL DENTURE DESIGN
Retention should not be considered the prime objective of design. The main objectives
should be the restoration of function and appearance and the maintenance of comfort, with
great emphasis on preservation of the health and integrity of all the oral structures that
remain.
Close adaptation and proper contour of an adequately extended denture base and
accurate fit of the framework aga- inst multiple, properly prepared gulde planes should be
used to help the retentive clasp arms retain the pros- thesis.
2- Clasps
a- The simplest type of clasp that will accomplish the design objectives should be employed.
b- The clasp should have good stabilizing qualities, remain passive until activated by
functional stress, and accommodate a minor amount of movement of the base without
transmitting a torque to the abutment tooth.
Wrought wire clasps. RPI, I-bar, combination clasps, back action, reverse back action
or reverse circlet clasps can be used.
d- Clasps should be strategically positioned in the arch to achieve the greatest possible control of
stress.
Class I prosthesis usually requires only two retentive clasp arms: one on each terminal tooth.
Thereciprocal or bracing arm must be rigid. This component of the clasp system can be
replaced by lingual plating.
The distal extension side should be designed with the same considerations as for a
class I prosthesis.
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PARTIAL DENTURE DESIGN
The tooth supported, or modification, side should usually have two retentive clasp
arms : one as far posterior and one as far anterior as tooth contours and esthetics permit.
If a modification space is present, it is usually most convenient to clasp a tooth anterior
and a tooth posterior to the edentulous space.
- The type of clasp and position of the retentive undercut can be selected for
convenience.
- Rigidity is required for all bracing arms. Lingual plating may be substituted.
- RPI - RPA
- Combination clasps
3- Rests
Rest seats should be prepared so that stress will be directed along the long axis of the
teeth.
Rest seats should be carefully located and prepared to avoid torque and allow
transmission of stresses along the long axes of abutment teeth.
The floor of the rest seat should inclined apically as it approaches the center of the
tooth. The angle between the minor connector and the rest should be less than 90˚ to
prevent slippage of the prosthesis creating an orthodontic like force and to direct the
forces along the long axis of the tooth.
Mesially placed rests are preferably used on abutment teeth. However, absence of a
rest adjacent to the edentulous area may permit packing of food. This could be avoided
by using .
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PARTIAL DENTURE DESIGN
Saucer-shaped rest seats are preferred over box shaped seats to avoid locking of the
rest and transmission of torque on abutments.
The occlusal rest must fit the tooth to minimize the food collection beneath it and
preserve their location in relation to the tooth.
4- Indirect Retention
The indirect retainer should be located as far anterior to the fulcrum line as possible.
Two indirect retainers should generally be used in a class I design, whereas one placed on
the side opposite the distal extension base may be adequate in a class II- design.
The indirect retainers should be positioned in teeth prepared with positive rest seats that
will direct forces along the long axis of the tooth.
2. Lingual plating can be used to extend the effectiveness of indirect retention to several
teeth. It must always be supported by positive rest seats.
5- Major connector
a- The simplest connector that will accomplish the objective should be selected.
2- Promotes cross-arch force transmission (contributes to cross arch stability and support)
b- Support from the hard palate should be used in the design of the maxillary major
connector when it would be beneficial.
c- Extension of the major connector onto the lingual surfaces of the teeth may be employed
to increase rigidity, distribute or eliminate potential food impaction areas. Lingual plating
should always be supported by adequate rest seats.
d- Antero posterior palatal bars and palatal plates are preferred for maxillary class I cases to
provide maximum support, direct and indirect retention.
e- For mandibular class I cases, lingual bars with terminal rests are preferred due to their
simplicity, limited coverage and patient's tolerance. However, mechanically, lingual plates
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PARTIAL DENTURE DESIGN
with terminal rests are biologically preferred due to their rigidity, distribution of lateral
forces and due to improved indirect retention.
6- Minor connectors
-Guiding planes are flat axial parallel surfaces in an occluso-gingival direction on the
proximal or lingual surfaces of teeth. They are 2-4 mm in height، extending from
the marginal ridge to the junction of the middle and gingival third of the
abutment tooth. The bucco-lingual width of the proximal plate is determined by
the proximal contour of the tooth.
-For bounded base a well-engineered guiding planes are contacted by the truss arms
of the framework as the prosthesis is inserted and removed, thus horizontal
wedging is virtually eliminated.
-The proximal plate together with the mesiolingually placed minor connector
provides stabilization and reciprocation of the assembly.
Guiding plane surface should be like area of cylindrical object It should be continuous surface
unbounded by even rounded line angle. B, Minor connector contacting guiding plane surface has
same curvature as does that surface. From occlusal view it tapers buccally from thicker lingual
portion, thus permitting closer contact of abutment tooth and prosthetically supplied tooth. Viewed
from buccal aspect, minor connector contacts enamel of tooth on its proximal surfaces about two-
thirds its length.
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PARTIAL DENTURE DESIGN
Diagrammatic illustration showing comparative width of the proximal plates for differently
contoured teeth. (A). Proximal plate (p) relatively wide due to the square contour of the 2nd
bicuspid. (B). Proximal palate (p) relatively narrow due to the tapering contour of the 1st
bicuspid. The proximal plate should be designed as narrow as possible but should prevent lingual
migration of the tooth. A narrow proximal plane permits greater exposure of the gingival tissue
(g).
8- Occlusion
2.A harmonious occlusion should be established with no interceptive contacts and with all
eccentric movements dictated by, or in harmony with, the remaining natural teeth.
3.Artificial
teeth should be selected and positioned to minimize stresses produced by the
prosthesis.
Smaller and/or fewer teeth, and teeth that are narrower bucco-lingually may be selected.
For mechanical advantage teeth should be positioned over the crest of the mandibular
ridge when possible.
Teeth should be modified if necessary to produces sharp cutting edges and ample
escape-ways.
9- Denture base
1.The base should be designed with broad coverage so that the occlusal stresses can be
distributed over as wide an area of support as possible. The extension of the borders must
not interfere with functional movements of the surrounding tissues.
2.Aselective pressure impression should record the residual ridge in a functional form. Or it
may be constructed in the static form if the stress breaking principle is applied.
3.The polished surfaces should be contoured to enable the patient to exercise maximum
neuromuscular control.
4. A combined metal-acrylic base is used to allow for future relining as bone resorption is
usually anticipated.
Recontouring
The contours of the natural teeth most often require adjustments for the proper placement
and functioning of the RPD.
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PARTIAL DENTURE DESIGN
3.Improve the occlusal plane by grinding of the cusp tips and incisal edges of
anterior teeth.
Excessive tooth contours are reduced by lowering the height of contour so that;
2. The retentive terminal is placed in the gingival third of the crown for
better esthetics and better mechanical advantage.
3. The reciprocal clasp is placed above the height of contour, but not higher
than the cervical portion of the middle third of the crown.
1- Restoring a single tooth or a short span unilateral area is not practical especially in
cases having bad oral hygiene and caries susceptibility.
2- Restoration of any missing tooth is necessary in order to: -Restore the integrity of
the dental arch, prevent tilting, drifting, rotation or overeruption of the remaining
natural teeth.
- Restore aesthetics.
II - Fixed bridges:
Fixed bridges are usually the treatment of choice for short span bounded
edentulous areas when:
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PARTIAL DENTURE DESIGN
a- Provision of lingual and buccal cusp contacts on the working side in lateral
movement.
b- Maximum extension of the rest seat preparation and the occlusal rest especially
to the buccal side. This keeps the axis of rotation as far buccally as possible and
ensures transmission of vertical component of force lingual to this axis.
- Extending the denture base on the vertical slope of the hard palate.
- Bracing arms located on the abutment tooth and the tooth adjacent to it.
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PARTIAL DENTURE DESIGN
- Conical shaped abutment teeth, weak teeth, or teeth having short crowns that
cannot provide adequate retention and bracing.
- In old patients.
1-Denture base:
The denture base is designed to fit the static rather than the functional form of
the ridge because the denture base is adequately supported on both sides by abutment
teeth, i.e. tooth supported.
- Weak posterior abutments that may be possibly removed and change the case into a
Kennedy class II
- Anterior edentulous spans requiring aesthetic that is provided by the colour of acrylic
resin.
- Patients susceptible to bone resorption that may require future relining e.g. diabetic
patient and after recent extractions.
2- Rests:
Rests are usually placed on the near zone of the abutment teeth to provide
adequate support (fig. 6-4). Rest seats can be prepared in either a box-shaped or saucer
-shaped configuration depending on the condition of the abutment teeth.
3- Clasps:
Rigid clasps are usually used on abutments bounding the edentulous area. An
embrasure clasp is used on the intact (dentulous) side.
4- Major connectors:
A lingual bar is used for mandibular denture and a palatal bar or palatal strap is
used for maxillary denture.
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PARTIAL DENTURE DESIGN
Modification of class III involving short saddle are common in upper jaw.
When the saddles are short and the abutment teeth are supported with sound healthy
bone, a number of small fixed bridges may be the treatment of choice. Also a
removable partial denture can be constructed.
When Class III having long edentulous spans and modification spaces, they are
usually considered tooth tissue supported dentures. Maximum coverage of the residual
ridge and palatal tissues is required to provide adequate denture support retention of
the denture abutment from physical forces as adhesion in addition to wrought wire
clasps.
When the condition of upper teeth is not good, the best result can be obtained
by using Every denture.
Every denture
Indication of Every denture:
Indicated in class III with many modifications and when the condition of the
abutment is not good.
By making. contact point, not contact area, the lateral forces are distributed
mesiodistally along many teeth in the arch. Porcelain teeth is preferable to reduce wear
in this cases. The lateral forces in Every denture are resisted by the palate, the buccal
mucosa and anterior abutment teeth if present.
3- Uncovered gingival
To prevent pockets between the denture and the tooth substance and allow natural
stimulation of the gingiva .
4- Contact of the denture with a stabilizer (round Wire) distal surface of the last
standing tooth:
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PARTIAL DENTURE DESIGN
This stabilizer (round Wire) is used to prevent distal drifting of this tooth.
- Free occlusion: Is a type of occlusion which permits the mandible to slide from one
position to another, with the upper and lower teeth in contact and without
intercuspation.
N.B. The base material will be acrylic resin with straight round wire used to form the
stabilizer positioned posterior to the last standing tooth on each side of the arch.
1.Retention can be achieved with much less potential harmful effect on the abutment teeth than
with the class I or II arch.
2- Clasps :
Tooth and tissue contours and esthetics should be considered, and the simplest clasp
possible selected.
If restorations are required to correct tooth contours, the wax patterns must be shaped
with the surveyor.
3- Rests
1.Rest seats should be prepared next to the edentulous space when possible.
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PARTIAL DENTURE DESIGN
2.Rests should be used to support the major connector and lingual plating.
4- Indirect retention
2.If one or both of the posterior abutment teeth are used for vertical support alone without retentive
clasp arms, the entire design must follow the requirements of a class I or II design.
- They must be rigid and meet the same requirements as for a class ! or II design.
6- Occlusion
7- Denture base
2.The extent of coverage of the residual ridge areas should be determined by appearance, comfort,
and the avoidance of food impaction areas.
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PARTIAL DENTURE DESIGN
Kennedy Class IV
!!
Kennedy class IV partial dentures are constructed to restore anterior edentulous
spans that cross the midline. Long class IV cases are designed following the principles
of free end saddle cases because the edentulous area exhibits abutments that lie
posterior to the edentulous area and lacks anterior abutments.
- Form of the dental arch; In V-shaped arches the artificial anterior teeth will be
more distant from the fulcrum axis, thus, the magnitude of displacing forces will
be more leading to excessive torque on abutment teeth.
2- Class IV cases occur at any age but are usually predominant in children and
adolescents because anterior teeth especially upper teeth are subjected to trauma.
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PARTIAL DENTURE DESIGN
3- The need for an esthetic restoration is a pre-requisite due to the anterior location
of the edentulous area.
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PARTIAL DENTURE DESIGN
The most commonly used temporary appliance for restoring anterior teeth is the
Spoon denture. It can be constructed for both children and adults.
Spoon Dentures
- The spoon denture usually covers a large area of the palate to attain
adequate support and to overcome the problem of retention usually
associated with temporary appliances.
- The lateral borders of the denture are usually placed 3-4mm away from the
gingival margin to avoid caries and gingivitis especially in children where
adequate oral hygiene measures cannot be fulfilled.
- It is usually extended to the junction of hard and soft palate in order to:
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PARTIAL DENTURE DESIGN
- Extending the posterior part of the palatal plate laterally above the survey line of
the first permanent molars. The first molar is then clasped by a 7mm stainless steel
wire in the form of an Adam's crib. This design may be used where it is possible
to adapte thin wire between opposing arches without interfering with occlusion.
- production of a cast cobalt chromium base with clasps engaging the buccal
undercuts of the molar teeth (T-shaped cobalt chromium denture).
o The nature of the mucosa: best retention is obtained from firm mucosa of
adequate thickness rather than thin mucosa.
o Form of the hard palate: Large palate having moderate slopes provides better
retention by adhesion and cohesion and good stability. Flat palate provides
better retention and less stability compared to palates exhibiting steep slopes
where better stability and less retention are anticipated.
o The degree of overlap of anterior teeth; the presence of deep overlap usually
associated with partial loss of teeth especially in adults induces excessive
stresses on the partial denture.
Advantages:
Cases having long, markedly curved edentulous spans as this may add
excessive stresses to abutments.
Retainers in the form of attachments or bar clasps are placed on the canines or
the first premolars. However, this places excessive stresses on the canines. For this
reason," the canines should be diagnosed with long well formed roots to resist torque.
In this case, the denture is designed with a combined denture base, rests on the
neighboring natural teeth for support, bar clasps as retainers, preferably on first
premolars, and an anterior palatal strap as the major connector.
It is indicated only when 1\ 1 are only missed and perfect bone support for
canines. Contra-indicated in cases where torque is marked as in excessive bone
resorption or more than 2 teeth are missing.
The clasps are placed as far posteriorly as possible. This system is more
favorable because it provides better retention and indirect retention. It is also
esthetically more satisfactory. Canines are also protected from torque that may be
implied by clasping.
In this case, the denture is designed with a combined denture base, rests on the
neighboring natural teeth usually canines for support and an Aker clasp (embrasure
clasp) or multiple Aker clasp placed on the two last standing molars on each side of
the dental arch.
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PARTIAL DENTURE DESIGN
Major connector: two palatal bar connectors arising from the saddle and placed
on the lateral walls of the palate equi-distance between the gingival margins and the
midline. The distal ends of the bars are attached to the posteriorly placed double Aker
clasps on both sides.
One section is cast in metal and is inserted from the palatal aspect of the ridge,
which enables the proximal undercuts of the abutment teeth to be engaged. The labial
section which carries the teeth and the labial flange is inserted from below in an
upwards and backwards path. It is frictionally retained to the first section by means of
split post matrices attached to the cast portion, which will engage a stainless steel tube
matrix in the labial section.
A design can also be used which incorporates a hinge between the two parts,
with the anterior flange and teeth being rotated into place and held in position by a
locking bolt. Retention may be improved by use of intracoronal attachments for the
first section.
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PARTIAL DENTURE DESIGN
electrolytic etching process. This improved the resin bond by establishing mechanical
retention between the micropores of the etched alloy surface and the composite resin
in a manner similar to its attachment to an etched enamel surface.
Teeth with inadequate support, large carious lesions, extensive restorations, and
evidence of severe attrition are not suitable for use as abutments.
The advantages of this technique are that a saddle of limited span can be
restored economically without loss of healthy tooth substance or the wearing of a large
partial denture. For aesthetic reasons it is not suitable where there is obvious soft tissue
loss.
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PARTIAL DENTURE DESIGN
Long anterior edentulous areas which may extend to include premolars usually
occur in adults. Hence, a permanent restoration in the form of metal partial dentures is
the treatment of choice.
- Multiple clasping is required to help in splinting of the remaining teeth and in order
to widely distribute the stresses and torque action. Since the remaining naturally teeth
are usually posterior teeth. Therefore the clasping system is usually better than in long
class I cases having anterior teeth as abutments.
- Stress breakers may not be necessarily used in upper class IV cases due to the
good support obtained from palatal coverage. However, a stress broken design may be
required if a long edentulous area covered by compressible tissues is to be restored.
- As with free end saddles frequent inspection and rebasing are necessary since only a
slight degree of rotation about the occlusal rests will open up a space between the
posterior periphery of the denture base and the hard palate, into which food will find
its way.
Usually required in adults who have lost the four lower anterior teeth through
periodontal disease or rarely caries. In this situation a cast metal denture is the
treatment of choice.
The design consists of bilateral lingual bars extending posteriorly from the
saddle, terminating in clasps; continuous clasping may or may not be present. The
saddle must be adequately tooth supported anteriorly, and this can be accomplished by
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PARTIAL DENTURE DESIGN
using rests on the mesial aspect of the occlusal surfaces of the premolars. The use
of the canines for support has the advantage of bringing the axis of rotation forward so
that the posterior clasping is consequently more effectively but will necessitate
extensive preparation of the teeth to provide effective seats for the rests on the cingula
or else the use of incisal edge rests with their obvious aesthetic disadvantages.
2.The esthetic arrangement of the anterior replacement teeth may necessitate their
placement anterior to the crest of the residual ridge, resulting in potential tilting
leverage.
Every effort should be made to minimize these stresses. Some possibilities follow:
3.A critical evaluation of each remaining tooth in the arch should be made with the
intent of retaining as many teeth as possible.
The shorter the edentulous area, the less will be the harmful tilting
leverage.
The major connector should be rigid, and broad palatal coverage should be
used in the maxillary arch.
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Mouth preparation
A] RESTORATIVE PREPARATION
A. Removal of caries.
D. Occlusal modification.
E. Correction of malocclusion.
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Mouth preparation
1. Sensitivity.
2. Caries susceptibility.
B] ENDODONTIC
C] ORTHODONTIC
A. Abutment teeth.
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Mouth preparation
Extractions:
Impacted Teeth
All impacted teeth, including those in edentulous areas and those adjacent
to abutment teeth, should be considered for removal. If an impacted tooth is
left, it should be recorded in the patient's record and the patient should be
informed of its presence. Roentgenograms should be taken at reasonable
intervals to be sure that no adverse changes occur.
Any impacted teeth that can be reached with a periodontal probe must be
removed to treat the periodontal pocket and prevent more extensive damage
Malposed Teeth
Individual teeth or groups of teeth and their supporting alveolar bone can be
surgically repositioned. Orthodontics may be useful in correcting many
occlusal discrepancies, but for some patients, such treatment may not be
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Mouth preparation
The patient should be informed of the diagnosis and provided with various
options for resolution of the abnormality as confirmed by the pathologist's
report.
The removal of exostoses and tori is not a complex procedure, and the
advantages from removal are great in contrast to the deleterious effects their
continued presence can create.
Hyperplastic Tissue
All these forms of excess tissue should be removed to provide a firm base
for the denture. This removal will produce a more stable denture, reduce stress
and strain on the supporting teeth and tissue, and in many instances will
provide a more favorable orientation of the occlusal plane and arch form for the
arrangement of the artificial teeth.
The maxillary labial and mandibular lingual frena are the most common
sources of frenum interference with denture design. These can be modified
easily with any of several surgical procedures. Under no circumstances should
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Mouth preparation
Sharp bony spicules should be removed and knifelike crests gently rounded.
If, the correction of (a knife-edge) residual crest results in insufficient ridge
support for the denture base, the dentist should resort to vestibular deepening
for correction of the deficiency or insertion of the various bone grafting
materials that have demonstrated successful clinical trials.
All abnormal soft tissue lesions should be excised and submitted for
pathological examination before the fabrication of a removable partial denture.
Dentofacial Deformity
Patients with a dentofacial deformity often have multiple missing teeth as part
of their problem. Correction of the jaw deformity can simplify the dental
rehabilitation.
Osseointegrated Devices
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Mouth preparation
Considerable attention has been devoted to ridge augmentation with the use
of autogenous and alloplastic materials, especially in preparation for implant
placement.
1. Inflammation and irritation of the mucosa covering the denture bearing areas
3. A burning sensation in residual ridge areas, the tongue, and the cheeks and
lips.
A suggested home care program includes rinsing the mouth three times
a day with a prescribed saline solution;
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Mouth preparation
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Mouth preparation
F] PERIODONTAL PREPARATION
evaluation procedure :
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Mouth preparation
(9) Caries;
Treatment Planning
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Mouth preparation
Tooth mobility
Management
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Mouth preparation
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Mouth preparation
In anterior teeth:
A- Anterior teeth:
B- Posterior teeth:
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Mouth preparation
- Subluxation,
- Pain,
Balancing side:
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Mouth preparation
Working side:
Grind on 'bull' rule, to avoid the supporting cusps (the upper palatal
and the lower buccal cusps) which preserve the vertical dimension of
occlusion
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Mouth preparation
BULL Rule: Grind only cuspal slopes, which are not providing centric
contact. Grind distal inclines of maxillary buccal cusps and mesial
inclines of mandibular lingual cusps.
(1) those abutment teeth that require only minor modifications to their
coronal portions, include : teeth with sound enamel, those with small
restorations not involved in the removable partialdenture design, those
with acceptable restorations that will be involved in the removable partial
denture design, and those that have existing crownrestorations requiring
minor modification that will not jeopardize the integrity of the crown.
(2) those that are to have restorations other than complete coverage crowns,
(3) those that are to have crowns (complete coverage). they provide the best
possible support for occlusal rests.
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Mouth preparation
(a) the origin of the circumferential clasp arms may be placed well below
the occlusal surface, preferably at the junction of the middle and gingival
thirds;
(b) retentive clasp terminals may be placed in the gingival third of the
crown for better esthetics and better mechanical advantage; and
(c) reciprocal clasp arms may be placed on and above a height of contour
that is no higher than the cervical portion of the middle third of the crown
of the abutment tooth.
3. After alterations of axial contours are accomplished and before rest seat
preparations are instituted, an impression of the arch should be made in
irreversible hydrocolloid and a cast formed in a fast-setting stone. This cast
can be returned to the surveyor to determine the adequacy of axial alterations
before proceeding with rest seat preparations. If axial surfaces require
additional axial recontouring, it can be performed during the same appointment
and without compromise.
4. Occlusal rest areas should be prepared that will direct occlusal forces along
the long axis of the abutment tooth.
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Mouth preparation
B. Crowns.
1- Enameloplasty:
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Mouth preparation
But when, the height of contour lies near the occlusal surface in the
tipped tooth this can be lowered by grinding
(enameloplasty).
When there is insufficient under cut and when the patient has good
oral hygiene and low caries index, these teeth can be modified by
increasing amount of the undercut by contouring the
enamel surface; By creation of gentle depression
(concavity) about 4mm in mesiodistal length and
0.01inch deep (not a pit or hole).
B- crowns:
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Mouth preparation
When the remaining teeth do not posses natural contours and the
enamel surfaces cannot be modified to create undercut, cast restoration
should be planed. Cast crown also may be planned in case of extensive
caries, defective restoration, tooth fracture, and endodontically treated
teeth.
To shape the wax pattern of the crown, the wax knife is used to
carve the guiding plane on the surveyor.
The pattern must be hand carved tom place the height of contour
in the middle third of lingual surface if the tooth is to receive a
reciprocal clasp arm and at the junction of the gingival and middle third
of the buccal surface to receive a retentive clasp arm.
The position and depth of the retentive undercut can be verified by use
of an undercut gauge.
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Mouth preparation
Each seat must be positioned in a properly prepared rest seat. These rest
seats must be prepared before final impression and master cast are made.
The basically outline form of an occlusal rest seat is triangular, with its
base directed at the marginal ridge and the apex toward the tooth center,
occupying about one half of the buccolingual width of the occlusal
surface, and the apex should be rounded as all margins of the
preparation.
Extension of the rest seat mesiodistally about one third to one half of the
mesiodistal diameter.
The floor of the occlusal rest seat must be inclined toward the center of
the tooth to place the deepest part of the rest nearly at the center of the
preparation.
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Mouth preparation
When using round diamond bur care must be taken to avoid creation of
mechanical undercut at the peripheries of the preparation.
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Mouth preparation
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Mouth preparation
- Contact between the teeth should not be broken since this may result in
tooth migration or food impaction.
- The form and depth of the rest seat: at the facial and lingual
embrasures, the embrasure rest seat should be 3.0 to 3.5 mm wide and
1.5 to 2.0 mm deep.
Indications:
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Mouth preparation
Design:
2- The rest seat should be V-shaped when viewed from the proximal;
with rounded line angles. (This permits direction of the force along the
long axis of the tooth).
Preparation:
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Mouth preparation
Incisal rest seats are the least desirable rest seats for anterior
teeth. Because of its bad esthetic, interference with occlusion, and its
damaging effect on the abutment.
Indications:
Disadvantages:
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Mouth preparation
Design:
2- When viewed from the facial surface, its floor is concave in shape
and inclined toward the center of the tooth to direct the force along to
the long axis of the tooth.
3- When viewed from the proximal, the outline form is convex (saddle
shape) with buccal and lingual bevels.
Preparation:
Special consideration
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Mouth preparation
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Mouth preparation
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Mouth preparation
A reciprocal clasp arm built on a crown ledge is actually inlayed into the
crown and reproduces more normal crown contours. The patient's tongue then
contacts a continuously convex surface rather than the projection of a clasp
arm.
a; Open circle at top and bottom illustrates that retentive clasp is only passive at its first
contact with tooth during placement and when in its terminal position with denture fully
seated. During placement and removal, reciprocal rigid clasp arm placed on opposite side of
tooth cannot provide resistance against these horizontal forces.
b. True reciprocation throughout full path of placement and removal is possible when
reciprocal clasp arm is inlaid onto ledge on abutment crown.
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Mouth preparation
Spark Erosion
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Mouth preparation
premolars generally have round and tapered roots, which are easily loosened by
rotational and tipping forces. They are the weakest of the posterior abutments.
Mostafa Fayad 32
Mouth preparation
(2) The isolated tooth is splinted to the other abutment of the fixed
partial denture, thereby providing multiple abutment support.
2- Esthetic consideration
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Mouth preparation
6- The patient is dismissed after the excess cement has been removed.
8- The wax pattern buildup on the resin coping is usually not begun until
the patient returns.
Mostafa Fayad 34
Mouth preparation
dull areas. The process is repeated until a smooth occlusal registration has been
obtained.
11- wax is added to buccal and lingual surfaces where the clasp arms
will contact the crown, and the wax pattern is again reseated in the mouth.
12- The clasp arms,minor connectors, and occlusal rests involved on the
removable partial denture are carefully warmed with a needlepoint flame,
carefully avoiding any adjacent resin, and the removable partial denture is
positioned in the mouth and onto the wax pattern.
14- the temporary crown may be replaced and the patient dismissed.The
crown pattern is completed on the die by narrowing the occlusal surface
buccolingually, adding grooves and spillways, and refining the margins.
15-Any wax ledge remaining below the reciprocal clasp arm may be left
to provide some of the advantages of a crown ledge. Excess wax remaining
below the retentive clasp arm, however, must be removed to permit the
addition of a retentive undercut later.
16- The wax pattern must be sprued with care so that essential areas on
the pattern are not destroyed. After casting, the crown should be subjected to a
minimum of polishing, because the exact form of the axial and occlusal
surfaces must be maintained.
17- After the crown has been tried in the mouth with the denture in
place, the location of the retentive clasp terminal is identified by scoring the
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Mouth preparation
crown with a sharp instrument. Then the crown may be ground and polished
slightly in this area to create a retentive undercut.
Mostafa Fayad 36
IMPRESSIONS FOR RPD
A- PRIMARY IMPRESSIONS
Primary impressions are used in the preparation of study casts which playa vital
role in the planning and construction of a removable partial denture.
Stock tray
If the maxillary arch has a high vault, build up the tray with impression
compound to prevent the hydrocolloid from sagging away from the palatal
surface. The margins of the stock tray may need to be lengthened with
impression compound or it may need to be trimmed.
a- Air bubbles.
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IMPRESSIONS FOR RPD
e- trapping of air.
This may be improved by lifting the impression in the patient mouth one or
two minutes more after setting.
Advantages of alginate:
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IMPRESSIONS FOR RPD
toward the teeth and will result in an undersized rather than oversized cast);
and (e) by attempting to pour the cast with stone that has already begun to set.
2. A ratio of water to powder that is too high. Although this may not cause
volumetric changes in the size of the cast, it will result in a weak cast.
3. Improper mixing. This also results in a weak cast or one with a chalky
surface.
5. Soft or chalky cast surface that results from the retarding action of the
hydrocolloid or the absorption of necessary water for crystallization by the
dehydrating hydrocolloid.
7. Failure to separate the cast from the impression for an extended period.
B- FINAL IMPRESSION
ANATOMICAL FORM FINAL IMPRESSION
FOR TOOTH SUPPORTED R P D
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IMPRESSIONS FOR RPD
Advantages:
Types:
A- Mercaptan(Thiokol or polysulphide):-
Indication:
Advantages:
1- longer setting time than alginate , which gives a chance for a better border
molding.
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IMPRESSIONS FOR RPD
Disadvantages:
1- the medium and heavy body materials do not recover well from deformation
and so should not be used when large undercuts are present.
2- the long term of dimensional stability of these materials is poor due to water
loss after setting.
B- Silicone:
Indications:
Advantages:
3- pleasant odor.
6- the addition reaction silicones can be poured up to one week. While the
condensation reaction silicones should be poured within one hour.
Disadvantages:
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IMPRESSIONS FOR RPD
C- polyether:
Indications:
Advantages:
Disadvantages:
2- The flow and flexibility are the lowest, which may cause cast breakage
during removal from the impression.
Master cast:
- The impression is poured in two stages; in the first stage the stone is vibrated
into the impression until it is filled.
After initial setting of this layer, the second stage is start for making a base for
the cast.
- Stone should be allowed to set for 45 minutes before separating the cast from
the impression.
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IMPRESSIONS FOR RPD
- The cast is rejected if voids or nodules of stones are found in a critical areas
e.g. rest seat area.
Objective:
Since the denture base does not contribute to the support of the partial
denture and the underlying mucosa and bone are not subjected to functional
forces, a tooth-supported RPD can be
constructed on a master cast made from a single
impression that record the teeth and soft tissues
in their anatomic form.
The impression of teeth is made with a material that records the teeth in
their anatomic positions, while the impression of the residual ridge must record
the soft tissues in their functional form.
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IMPRESSIONS FOR RPD
1. The anatomic form and the relationship of the remaining teeth in the dental
arch and the surrounding soft tissue must be recorded accurately so that the
denture will not exert pressure on those structures beyond their physiological
limits.
2. The supporting form of the soft tissue underlying the distal extension base of
the partial denture should be recorded so that firm areas are used as primary
stress-bearing areas and readily displaceable tissues are not overloaded. Only in
this way can maximum support be obtained for the partial denture base. An
impression material capable of displacing tissue sufficiently to register the
supporting form of the ridge will fulfill this second requirement. A fluid
mouth-temperature wax or any of the readily flowing impression materials
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IMPRESSIONS FOR RPD
Recording the anatomic form of both teeth and supporting tissue will
result in inadequate support for the distal extension base. This is because the
cast will not represent the optimum coordinating forms, which necessitates that
the ridge be related to the teeth in a supportive form. This coordination of
support maximizes the support capacity for the arch and minimizes movement
of the partial denture under function.
1- The material should record the tissue covering the primary stress
bearing areas in their function form.
2- Tissues within the basal set area other than the primary stress bearing
areas must be recorded in their anatomic form.
a)- there is only a limited ridge area can be used as a primary stress
bearing area.
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IMPRESSIONS FOR RPD
In the maxillary arch the dual impression does not often improve the
stress distribution. Because, the maxillary distal extension ridge is usually
covered by a firm, dense will attached mucosal the stress bearing area must be
the crest & buccal slope of the ridge.
2- Long span anterior edentulous ridge where the ridge must supply some
support for the partial denture.
Impression methods
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IMPRESSIONS FOR RPD
In this technique the impression of the edentulous areas was made with
impression past loaded in an acrylic tray which was providing with occlusion
rim under biting force.
Disadvantages: - The tray used for over all impression was in contact with
the occlusion rims of the original impression & held in his position with finger
pressure. This pressure does not simulate the occlusal loading. This lead to the
advantage of the technique was lost with this variation.
in Hindel's technique the imp of the edentulous ridge was not made under
pressure but it is an anatomic imp made with a free-flowing zinc oxide-eugenol
paste. After setting of the impression, a tray with ¾ inch holes in the regions
of the first molar for the second impression is made. So that finger pressure
could be applied through this holes of the tray as the hydrocolloid impression
was made. The pressure had to be maintained until the alginate was completely
set. The finished impression was a reproduction of the anatomic surface ridge
and the surface of the teeth.
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IMPRESSIONS FOR RPD
Disadvantages:
It can also be used for relining an old partial denture to compensate for
bone resorption.
In making the reline impression, the patient must maintain the mouth in
a partially opened position while the border molding and impression are being
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IMPRESSIONS FOR RPD
b) Impression making:
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IMPRESSIONS FOR RPD
The selected pressure impression technique and the fluid wax functional
impression are made after the framework construction for the purpose of
correcting the master cast before processing the denture base ( Altered cast
technique ) . The framework is constructed on a master cast made from a
single impression .
The term fluid wax is used to denote waxes that are firm at room
temperature & have the ability to flow at mouth temperature.
The most frequently used fluid waxes are (Lowa wax & korrecta wax No.4.)
The korrecta wax is lightly more fluid than Lowa wax.
Mostafa Fayad 14
IMPRESSIONS FOR RPD
Impression technique
2- Green stick compound is used for border molding the impression tray .
3- Relieving the tray and impression making , relief between the tray
and the ridge of 1-2 mm is provided .
5-The tray is seated in the mouth for about 5 minutes, while the patient’s
mouth is kept opened. The patient is instructed to do functional
movements and border trimming is made .
7-Any dull spots or imperfections are coated with wax and the procedure
is repeated. The entire surface of completed impression should have a
glossy appearance and all peripheral margins are definitely turned over.
Mostafa Fayad 15
IMPRESSIONS FOR RPD
Method:
2- The mandibular tray is relieved at specific area of the ridge as the crest
of the ridge down to the metal . Only slight relief is provided in the
buccal shelf and lingual slope areas . The tray may be vented over the
ridge crest to allow escape of the impression material and decrease
tissue displacement. Impression is made with zinc oxide paste if the
ridge is free from gross undercuts . Both polysulphide and silicon
impression materials are indicated for those ridges with bony undercuts.
Framework try in
Before the trays are attached, the framework must be fitted in the mouth.
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IMPRESSIONS FOR RPD
N.B: One reason for modifying the impression tray with molding plastic is to
prevent the trapping of the floor of the mouth or the sublingual gland within the
impression.
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IMPRESSIONS FOR RPD
The buccal extension of the tray should be observed as the cheek is moved
down word, outward and upward, the edge of the tray should be just shy (1 or
2mm) of the movable tissue.
4- The patient moves the tongue into each cheek with the operator
fingers resting lightly on the tray to check the lingual flange
extension. If the tray moves during this movement, the lingual
flange opposite the cheek toward which the tongue moves, should
be shortened.
1- From the anterior extent of the buccal flange to the most posterior
extent of the tray.
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IMPRESSIONS FOR RPD
A low – fusing modeling plastic, green or gray stick, is used for this
procedure. This step will be as in correcting the peripheral extension. This
processes basically the same as that for complete denture.
D – Relieving trays:
Now the relief under the tray is done at specific area needed .
1- The ridge area(s) of the cast , which will be replaced by corrected cast
impression , is outlined with a pencil and removed with a handsaw .
Retentive grooves on the cut surface of the cast are made. These grooves
will help in retention of the poured new stone to the old cast .
2- The framework with the impression is seated and sealed to the sectioned
cast .
3- The sectioned cast with the impression is inverted , beaded , boxed and
poured into dental stone .
The resultant cast is used to complete the partial denture . The tissue
displacement during impression requires that the metal stop should be adapted
to the cast by self – curing resin before making the record base .
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IMPRESSIONS FOR RPD
Areas to be removed from the cast are outlined , removed & retentive grooves are made to
help in retention of the poured new stone to the old cast .
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IMPRESSIONS FOR RPD
Beading & boxing of the impression . The corrected cast after hardening of
dental stone.
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IMPRESSIONS FOR RPD
Procedure:
1- A custom tray with 2 mm. Short borders is constructed over the study cast
after adaptation of two layer wax on teeth and residual ridge. Aluminium foil is
burnished over the wax.
2- Occlusal stops are placed over the remaining teeth by cutting boxes through
the aluminium foil and wax to ensure proper seating of the tray.
4- Reheat compound and place intraorally. Remove, check and then apply
modelling compound to the border
5- Relief the tissue surface of compound 1mm except for primary stress bearing
area.
6- Make complete impression using rubber base material with applying finger
pressure.
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IMPRESSIONS FOR RPD
Control of gagging
a) Ask the patient to use astringent mouth rinse and cold-water rinses
c) Ask the patient to take a deep breath and hold the breath while the
dentist quickly checks the size and fit of the tray.
b) Fast-setting alginate.
b) Seat the posterior part of the tray first and then rotate the tray into
position.
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IMPRESSIONS FOR RPD
d) Ask the patient to: • Keep the eyes opened and focused on some
small object. • Breathe through the nose.
5. The “leg lift” procedure is used before and during the making of the
impression.
Control of saliva
If the teeth are too dry, alginate has a tendency to stick to them. Therefore the
teeth should not be air dried before making an impression.
The excessive saliva can be controlled for most patients by having the
patient rinse the mouth with an astringent mouthwash followed by a rinse
of cold water and then packing the mouth with unfolded 2 x 2 inch gauze:
• In the maxillary arch one gauze strip is placed in the right buccal vestibule
and another in the left vestibule. The dentist must wipe the palatal area just
before making the impression.
• In the mandibular arch one gauze strip is placed in each of the buccal
vestibules and another is placed in the linguoalveolar sulcus by having the
patient raise the tongue, placing the gauze in the sulcus, and then having the
patient relax the tongue to hold the gauze in position. The gauze is removed
immediately before the impression is made.
• With excessive amount of thick mucinous saliva from the palatal salivary
glands, the patients should be instructed to rinse with an astringent mouth rinse.
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IMPRESSIONS FOR RPD
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Establishing occlusal relationship
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Establishing occlusal relationship
9. Artificial posterior teeth should not be arranged further distally than the
beginning of a sharp upward incline of the mandibular residual ridge or over the
retromolar pad.
Mostafa Fayad 2
Establishing occlusal relationship
Vertical diminution (V D) :-
Mostafa Fayad 3
Establishing occlusal relationship
2- Extrem anterior vertical overlap in which the mandibular teeth actually strike
the soft tissue of the palate and migration of the condyles (this seen in
radiographically).
-If the teeth not in contact by the appliance; will tend to erupted to reestablished
the functional contact. - If sufficient number of remaining teeth is not used to
support the appliance, the supporting teeth will be submerged or depressed to an
infraocclusal position.
Establishing V D O:-
Mostafa Fayad 4
Establishing occlusal relationship
2- C R & the C O position do not coincide but the planned C O position is clearly
denned and the decision has been made to fabricate the restoration in the planned
intercuspal position;
3- C R & the planned C O position do not coincide and the intercuspal position is
not clearly denned, therefore the decision should be made to fabricate the
restoration in centric relation;
4- Posterior teeth are not present in one or both arches and the denture will be
fabricated in centric relation.
Mostafa Fayad 5
Establishing occlusal relationship
Several factors influence the final occlusal schem for the partial denture patient.
(Hanau Quint)
In a patient who has partial dentures, however, the factors governing the
occlusal patterns are already determined.
The presence of some natural teeth means that the prominence of the
compensating curve has been determined& the plane of orientation is present.
The presence of anterior teeth means that the incisal guidance is determined
and the height of the cusps is known.
This means that in partial denture construction the remaining natural teeth will
dictate the form and position of the artificial teeth. The only exceptions are:
2. When only anterior teeth remain in both arches and the incisal relationship is
noninterfering.
There are basically two methods of establishing the occlusion for a removable
partial denture:
Mostafa Fayad 6
Establishing occlusal relationship
I- Articulator Technique
The occluded casts are secured together with wooden sticks and sticky
wax and mounted arbitrarily on an articulator. A face-bow mounting is generally
not indicated.
Mostafa Fayad 7
Establishing occlusal relationship
- All excess wax should now be removed with a sharp knife. All wax that
contacts mucosal surfaces be trimmed free of contact. The chilled wax record
again should be replaced to make sure that no contact with soft tissue exists.
1- Uniformity of consistency.
4- Dimensional stability.
Mostafa Fayad 8
Establishing occlusal relationship
2- Be sure that the casts are accurate reproductions of the teeth being
recorded.
A ready made bite tray may be used to record the jaw relation. The final
recording medium is placed on both sides of the tray and the patient is guided to
close in centric occlusion.
In the first jaw relation record made to complete the diagnostic mounting
procedure, baseplates were used to transport occlusion rims and recording media.
The baseplates were constructed of autopolymerizing acrylic resin.
For the final jaw relation record the framework should be used to support the
occlusion rim and recording medium.
1- The framework should be fit & any occlusal interference have been corrected
or eliminated at the framework try-in appointment. This means that the
framework will be a stable and accurate base on which to record the jaw
relationship.
Mostafa Fayad 9
Establishing occlusal relationship
Lab procedures:-
If the edentulous space is not too long, hard baseplate wax may be formed over
the acrylic resin retention metal in contact with the edentulous ridge. The normal
precautions must be taking during handling the framework, and using a pressure-
free interocclusal media, to decrease the pressure on the record base.
The baseplate wax record base & the casts must be mounting on an
articulator immediately to avoid the distortion of the wax.
Regardless of the material used to construct the record base, soft tissue undercuts
on the edentulous ridge must be blocked.
Separating medium should be painted over the edentulous ridge before the
framework is seated.
b- Occlusion Rim
An occlusion rim of medium baseplate wax is added to the record base. The
occlusion rim should be centered over the crest of the edentulous ridge. The
mandibular distal extension occlusion rim may be constructed so that the height
will be even with the cusps of the adjacent abutment tooth anteriorly and
posteriorly to two-thirds the height of the retro-molar or pear-shaped pad.
Mostafa Fayad 10
Establishing occlusal relationship
c- Recording Media
d- Clinical Procedures
The framework with the record base and occlusion rim attached is tried in the
patient's mouth. The height of the occlusion rims must be adjusted so that no
contact takes place between the opposing teeth and the rim. A space of
approximately 1 mm is desired.
When the opposing occlusion rims are to be used. The mandibular rim is
usual used to establish the ideal occlusal plane because the landmarks that are
normally present. The posterior height of the rim is established at 2\3 the height
of the retromolar pad and anterior to the height of the remaining teeth.
Mostafa Fayad 11
Establishing occlusal relationship
The surface of the occlusion rim that is to support the recording medium
should be roughened. To ensure that the record will remain attached to it.
The greatest cause of incorrect jaw relation records is pressure. If any force
occurs on the occlusion rims, the distal extension record base will depress the
soft tissue beneath the base. This is enough to cause an incorrect jaw relation
record.
If the jaw relation record is accurate, the casts may be mounted on the articulator
and the artificial teeth selected and set.
It is used when
- The recording proceedes much the same as in the previous method, except that
occlusion rims are substituted for remaining teeth.
Jaw relation record bases are useless unless they are made on the same cast
or a duplicate cast on which the denture will be processed, or are themselves the
final denture bases. The latter may be either of cast alloy or a processed acrylic
resin base.
Mostafa Fayad 12
Establishing occlusal relationship
There are many ways by which centric relation may be recorded when
record bases are used. The least accurate is the use of softened wax occlusion
rims.
Modeling plastic occlusion rims, on the other hand, may be uniformly softened
by flaming and tempering, resulting in a generally acceptable occlusal record.
This method is time proved, and when competently done, it is equal in accuracy
to any other method.
- When wax occlusion rims are used, they should be reduced in height until just
out of occlusal contact at the desired vertical dimension of occlusion. A single
stop is then added to maintain their terminal position while a jaw relation record
is made in some uniformly soft material, which sets to a hard state. Quick-setting
impression plaster, bite registration paste, or autopolymerizing resin may be
used.
- With any of these materials, opposing teeth must be lubricated to facilitate easy
separation.
- When two blocks are being used, one of the bite blocks is inserted first and the
occlusal plane is trimmed to the correct level. Which block is selected depends
upon which arch will be the greater help in aligining the occlusal plane. If a
posterior molar is standing the plane is adjusted to a level indicated by this tooth.
If no posterior teeth are present (Kennedy class I & II ), the lower occlusal plane
should be trimmed first to a level indicated anteriorly by the abutment teeth, and
posteriorly by the center of the retromolar pad.
- The upper block is then inserted and the occlusal plane is trimmed to provide
even contact with the lower at the predetermined occlusal vertical dimension.
Mostafa Fayad 13
Establishing occlusal relationship
It is used when
In any of these situations, jaw relation records are made entirely on occlusion
rims. The occlusion rims must be supported by accurate jaw relation record
bases. Here the choice of method for recording jaw relations is much the same as
that for complete dentures. Either some direct interocclusal method or a stylus
tracing may be used.
In this case recording jaw relations is such the same as that for complete
dentures. This includes:
Mostafa Fayad 14
Establishing occlusal relationship
5- Locking the maxillary and mandibular occlusion blocks and mounting the
lower cast on articulator.
The patient take the framework with the denture base and occlusion rim
attached home and to wear it continuously for 24 hour except when eating and
when drinking hot or chilled drinks.
The value of the patient's wearing the denture while sleeping is that
involuntary or bruxing contacts will be recorded. The resulting pathway will be a
record of all possible jaw movements and tooth contacts even though some of the
contacts may be undesirable.
Mostafa Fayad 15
Establishing occlusal relationship
This wax pattern is boxed and poured in improved dental stone to provide a
permanent record of the generated pathways. The stone record is mounted on an
articulator.
The patient is creating the pathway in the dental office directly under the
supervision of the dentist.
Advantage of this method: - the dentist's being able to observe and correct the
movement the patient is making.
The record should be removed and examined every few minutes. The wax will
exhibit a glossy surface where tooth-wax contact is occurring. Those areas not in
contact will appear dull. Wax may be melted and added to those areas to ensure
complete and even contact. The record is boxed and poured the same as for the
overnight record.
1- The incisal guide pin is opened 1 mm before the artificial teeth are
positioned. This increase in vertical dimension will be returned to normal
by selectively grinding the denture teeth. The selective grinding also
develops the occlusal anatomy of the denture tooth to conform to the
functionally generated stone path.
2- The denture teeth are positioned over the framework in the correct
anteroposterior and buccolingual position. Then the incisal guide pin is
returned to correct vertical dimension of occlusion.
Mostafa Fayad 16
Establishing occlusal relationship
4- The spots of dye transferred from the stone pathway to the denture teeth
indicate the areas of contact and are reduced by grinding.
5- Selective grinding is continued until the incisal pin again contacts the
incisal table.
At this time, intimate contact should be present between the artificial teeth
and the stone pathway. The articulator is not moved into protrusive and lateral
excursions because these positions are incorporated in the pathway.
Advantages:-
2- Eliminates the need to make a face-bow transfer, because all the in-
formation derived from a face-bow transfer is contained in the pathway.
Numerous studies have also shown that the masticatory cycle differs depending
on the type and texture of food being chewed. This may mean that the pattern
developed in the wax is accurate for the wax only and that food-stuffs may fall
inside or outside the particular chewing cycle.
Mostafa Fayad 17
Establishing occlusal relationship
- A face bow transfer is made of that arch and cast is articulated on the
articulator.
- than face bow and complete denture is remover and irreversible hydrocolloid
impression of the denture is made.
(2) When the removable partial denture replaces all posterior teeth and the
anterior teeth are no interfering.
A central bearing point tracer is used may be mounted im the plate on maxillary
denture. A centric relation are recorded by means of introral stylus tracing
against the stable mandibular base.
In other instance the mandibular arch is restored first and jaw relation are
established if they would be a full complement of opposing teeth. Thus the
maxillary complete denture is occluded with an intact arch.
Mostafa Fayad 18
Establishing occlusal relationship
In designing occlusion for partial dentures, the location of the edentulous area
and the condition of the opposing arch will significantly influence the desirable
occlusal contacts during functional movement of the mandible.
Mostafa Fayad 19
Establishing occlusal relationship
6- For Kennedy class III partial denture, opposing natural dentition contact
of the posterior teeth during functional movement is not desirable, since
stability of the denture is maintained by direct retainers on both sides.
Fully dentate
Fully dentate Working and balancing side
contact
Mostafa Fayad 20
Try-in of RPD
TRY IN OF RPD
Even the best partial denture frameworks do not fit perfectly in the mouth.
Stewart Rudd and Kuebker have stated that up to 75% of all frameworks may not
fit the mouth on the day of insertion. Since clasp tips are designed to fit passively
into a specified undercut, any discrepancy in seating of the partial denture
framework will cause the direct retainers to become active, thereby causing
orthodontic movement of the teeth. For this reason, frameworks must be adjusted
intraorally.
1. Trial of a cast metal framework, where one is included in the design of a partial
denture.
2. Trial of the partial denture, with the replacement teeth arranged on a temporary
or 'permanent' (metal) baseplate.
Mostafa fayad 1
Try-in of RPD
Framework Evaluation
A] Extraoral evaluation of the Framework
Examine the relationship between the framework and the soft tissue areas.
Presence of defects
Finish lines
c. Radiographic evaluation
Mostafa fayad 2
Try-in of RPD
iii. Check for close adaptation of rests, clasp arms, and lingual plates:
(b) Fitting the framework to the soft tissue (Check soft tissue contact or relief):
4- Checking stability
6- Checking aesthetics
7- Checking occlusion:
Mostafa fayad 3
Try-in of RPD
1-If the design drawn on the diagnostic cast was followed. The dental laboratory
should never change the framework design without consulting the dentist.
Conversely, errors in framework design caused by inaccurate drawing on casts or
omissions in laboratory prescriptions are the fault of the dentist.
The fit of the framework to the master cast. The framework should fit the master
cast. If it does not, it will probably not fit intraorally. Replace the framework on
master cast as little as possible to prevent abrasion (in case a remake is necessary).
Mostafa fayad 4
Try-in of RPD
Check to see whether the rests are fully seated: The margins of the rests
should be flush with the margins of the rest seats. If they are not, the source
of interference should be determined and corrected.
Evaluate the contours of the rests: overcontoured rests will interfere with
occlusion, and undercontoured rests may be too thin and weak and subject to
fracture.
6. Examine the relationship between the framework and the soft tissue areas.
Inspect areas where the major connector is in contact with soft tissue,and
make sure there is intimate contact to prevent food from getting beneath the
framework.
Check relief under bar clasps and acrylic resin retentive mesh, and make
sure the tissue stop rests on the crest of the edentulous ridge.
Clasp arms should have the proper shape, diameter, and taper. Wrought
wire clasps should be long enough and the solder joint placed far enough away
from the tip to allow adequate flexibility.
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When properly designed and constructed, the lingual plate will be scallop
shaped to close off the interproximal embrasures and cover the cingulum areas.
Open spaces between the lingual plate and the teeth can result in food impaction
and gingival inflammation, which may lead to bone loss in the area. A space may
also encourage the patient's tongue to play with the edge of the framework.
In fact retention may be greater on the cast because of friction and the rough
surface of the cast.
The abraded areas on the cast correspond to areas of interference in the mouth.
Areas that necessitate close inspection include rest seats, guide planes, the lingual
surfaces of mandibular bicuspids and molars, retentive areas, and the junction
between minor connectors and clasp arms.
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Note especially that cingulum rests should not be carried into embrasures and
that embrasure minor connectors for distal extensions should not be in contact
with the more anterior tooth (unless it has a rest seat preparation). Adjust, if
possible, or have lab adjust or remake framework.
Butt joints should be adequate for acrylic resin (slightly undercut). Adjust,
if possible, or have lab adjust or remake framework
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a- Inner surfaces of the framework should be free from pits , scratches and
bubbles .
c - Both internal and external finish lines should be sharp , definite and
slightly undercut .
d- The taper of the clasp should be uniform and free from nicks and
notches.
4- Presence of defects. The framework should be evaluated for defects that might
compromise its adaptation or strength.
5- Finish lines.
b. The internal line angles of external and internal finish lines should
be less than 90 degrees to provide mechanical retention for the denture
base resin.
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C - Radiographic evaluation; it shows the invisible porosity and the size of the
partially visible one.
3. Technique.
Excessive force should not be applied as this may cause discomfort or make
it difficult to remove the framework subsequently without overstressing the
periodontal attachment of the tooth.
A near fit of the framework is not sufficient; an accurate fit is essential for
success. The framework may fit the cast but does not fit in the mouth, due to:
A distorted impression,
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Shifting teeth.
In the latter two instances, if the interferences are minor and can be located,
one may be able to, with care, adjust the framework into place.
One should avoid over reducing contacts on guide planes, rests, and
retentive tips. Contacts between the framework and the teeth gingival to the survey
line should not be arbitrarily removed, because these contacts can help guide the
framework into place and provide some degree of retention and stability.
1. under rests
To locate small areas of the framework that are interfering with the fit,
b) A probe may also be used to check the closeness of fit of any elements
contacting the teeth. Clasp arms should be checked for non traumatic placement
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relative to the gingival margins of the teeth. The various component elements
should also be checked for correct positioning relative to the soft tissues. For
example, gingivally approaching clasp arms should not enter soft tissue
undercuts. Palatal connectors on an upper framework should be in contact with the
underlying tissues. Where a lingual bar has been used in the design of a lower
framework, it should be correctly positioned relative to the gingival margins of the
standing teeth and the functional level of the lingual sulcus.
The fitting of the framework to the mouth should be done in three phases:
Use gentle pressure over the rests as the framework is seated along the path of
insertion. Areas of interference must be relieved.
The most common areas that will interfere are: the junction between rests and
minor connectors, periphery of rests, guide planes, undercut areas, and clasp arms.
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Failure to relieve even the smallest amount of interference can cause slight but
continuous pressure on abutment teeth, which may cause pain and discomfort.
Repeat the adjustment steps until the framework is seated in place uniformly and
completely.
Place fingers on the rests and rock the framework. The rests should stay in place
and not lift out of the rest seats as pressure is applied to one side and then the
other.
iii. Check for close adaptation of rests, clasp arms, and lingual plates:
After the framework has been seated, it is evaluated for fit . All rests should
seat completely in their prepared seats. Clasps, indirect retainers and minor
connectors should be in intimate contact with the abutment teeth. The adaptation
of the framework to the teeth may be confirmed by rouge and chloroform or
disclosing wax.
Excess saliva and bubbles should be blown of the teeth. All metal structures
designed to contact tooth structure should be adapted closely to the teeth, which
will ensure a precise fit.
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Disengagement of the retentive tips and guide planes as the framework rotates
around the rest seats.
Proximal contact areas between abutments and adjacent teeth to ensure that the
abutments are not being torqued during rotation of the framework. Make sure
there is enough clearance between the proximal plate and gingiva to allow some
movement of the framework without tissue impingement.
Care should be taken when the framework is adjusted along the occlusal edge of
guide planes, rests, and major connectors. Do not accidentally open the
tooth/metal contact and create an area for food impaction.
b. Fitting the framework to the soft tissue (Check soft tissue contact or relief):
Make sure there is adequate space between the meshwork and the soft
tissue to allow a sufficient amount of acrylic resin material under the retentive
meshwork.
The tissue stop must be in contact with the edentulous ridge. The retentive
arm of a bar-type clasp should not impinge on soft tissue. There should not be an
excessive amount of relief that could result in a food trap.
The same can be said for minor connectors that cross soft tissue. Lingual
plates or bars should not impinge on soft tissue in the lingual vestibule area.
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B- Tilting during seating from the intended path of insertion , results when clasp
arm in one side is more rigid or extended into a deeper undercut than the other side
. To equalize force during seating and prevent tilting , the resisting clasp is
reduced in diameter , or its taper is increased .
After the framework is properly seated, remove and replace the framework several
times to evaluate retention. If there is too little or too much retention, the clasps
can be carefully adjusted.
The instruments of choice are orthodontic contouring pliers, which have smooth
beaks.
After adjustment, the clasp should have the desired retention and still be intimately
adapted to the tooth surface.
Avoid over bending the clasps, which may change the characteristics of the metal
through work hardening.
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As long as the forces are limited and do not exceed the elasticity of the periodontal
fibers, there should not be any damage to the teeth.
Each reciprocal arm should contact the abutment just prior, or at the same
time as the retentive arm. This will brace the abutment against the force applied by
the flexible retentive arm.
4- Checking stability
Where the design of the partial denture includes the use of a stress-
breaker, especially where this is of Type 1, an appreciable degree of rotational
displacement should be observable when pressure is applied to the metalwork of
the free-end saddle. Where no stress breaker has been used, and yet an appreciable
degree of rotational displacement of the free-end saddle occurs when this check is
applied, there is a need for subsequent action to be taken to overcome this
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instability. This will usually involve relining of the free-end saddle at the insertion
stage of treatment.
A clasp may have been deformed during finishing and polishing . A clasp
under tension may force the frame to assume wrong or tilted position . This
condition is mostly seen with wrought wire clasps . Deformed clasp should be
corrected and should be passive when fully seated .
6- Checking aesthetics
The framework should be inserted and its appearance noted when the
patients lips are at rest and when the patient is smiling. If any elements of the
metalwork are visible when the patient smiles, it is advisable to point this out to
the patient and show them what is involved with the aid of a hand mirror.
If proper care has been applied in the stages of treatment planning and
denture design, objections to the aesthetics of a metal framework should be rarely
encountered. Where objections do arise, they usually relate to an unaesthetic
display of clasp arms or incisal rests. Where this is due to an unnecessary
thickening having occured in the construction of the framework, it may be
possible to overcome the objections by reducing the thickness of the element
concerned by grinding.
7- Checking occlusion:
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together. Any interference noted now will be between the metal of the opposing
frameworks.
The highly polished metal surfaces do not mark well with articulating
paper so that the opposing occlusion should be checked for heavy contacts.
Diamond burs, heatless stones, Shofucoral stones or cross cut Brasseler lab burs
will most readily remove interferences. DO NOT FORGET TO LOCATE AND
ADJUST EXCURSNE INTERFERENCES.
Heatless stones or diamond instruments in the high speed hand piece are
used to reduce the interference, first in centric occlusion, then eccentric positions.
The framework must not keep the natural teeth from making normal
occlusal contact in either centric or eccentric closures. Since most frameworks are
be fabricated on unmounted casts there are usually occlusal interferences present
on rests and indirect retainers. These should be adjusted at this time.
If occlusal interferences exist that will excessively thin the rests, the rest
seat preparation may have to be deepened and a new impression taken, or an
opposing cusp or framework
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Where the natural dentition does not contact at the required occlusal
vertical dimension and the design of the framework includes onlays, a check
should be made that with the framework inserted the opposing natural teeth and
the metalwork contact evenly at a vertical dimension providing an acceptable
freeway space.
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The framework should not prevent the natural dentition from contacting in
the CO/MIP or during normal functional movements.
Adjust the framework without over thinning and weakening the metal
components. Rests and clasp arms are usually at risk of being excessively adjusted
and subsequently weakened. However, sometimes tooth migration can reduce the
desired occlusal clearance.
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After the framework has been fit and occlusal adjustments have been made,
the surfaces of the ground metal must be finished and polished. Carborundum
points and wheels are used to restore smooth finish to all ground surfaces.
Dedco green knife edge wheels for chrome cobalt alloys will remove
scratches and bring the adjusted surface to a high shine quickly. Additionally,
Dedco blue clasp polishers or any other carborundum impregnated points can be
used to finish the chrome cobalt alloy. A final polish can be placed using a tripoli
on a bristle brush and rouge on a small diameter cloth wheel. Use care not to snag
the cloth wheel on sharp edges of the framework (to prevent injury to yourself).
Remove traces of the polishing compounds with soap and water and a toothbrush.
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When relieving or polishing, avoid staying in one spot for extended periods
of time to prevent the generation of localized areas of high temperature, which can
run the risk of changing the temper of the framework metal.
In most cases distal extension cases will be designed with relatively short
occluso-gingival guiding planes to allow for release of the abutments during
tissueward movement of the denture base. However, there are some cases where
teeth are tipped and a long guiding plane is the only type of guiding plane that can
be placed. In these instances, "physiologic relief' of the framework should be used
to provide release. With this technique the distal guiding planes, minor connectors
and linguoplates are coated with alcohol and rouge (not wax or silicone). The
framework is placed intraorally and placed under hyperfunction by pressing over
the distal extension gridwork. The framework is removed and the guideplanes and
other rigid metal contacts, which could torque the tooth, are relieved in areas of
burn-through. Relief should be provided so that marks remain in only the occlusal
one third of the guiding planes.
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Indications:
B. Evaluation of the accuracy of the jaw relationship when all posterior teeth
in one or both arches are being replaced.
EXTRAORAL EXAMINATION:
INTRAORAL EXAMINATION
B.Esthetic try-in:
• It is better if the dentist examines the teeth in the mouth before the patient
has an opportunity to observe them. Corrections can be made without
upsetting the mental attitude of the patient.
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Procedures
5) The dentist should evaluate the position of anterior teeth and assess
lip support.
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11) Checking of the teeth shade specially if there are natural teeth is
present, which makes shade selection and patient acceptance a
critical point.
Once the technical and mechanical requirements are satisfied, the patient should
be allowed to view his new RPD and comment on the results. The patient's
remarks should be noted, and required changes should be made.
1- Abnormal fullness
If anterior teeth have been missing for 6 months or more, the patient may
report a sensation of abnormal fullness at the upper lip.
2-Teeth length
If all anterior teeth are being replaced and the upper lip is of normal length,
the edges of the central incisors should be visible when the lip is relaxed.
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When the lip is drawn upward, the gingival contours of the denture base
should be minimally evident.
3- Short space
4-Large space
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This midline must be examined for its vertical alignment and for its
midface position.
7- Tooth shade.
The patient should stand several feet from a wall mirror to examine the
teeth critically.
Treatment should not proceed until patient approval has been gained.
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In many cases, visual evaluation may be sufficient for checking of the contact of
the opposing natural teeth, and for checking the occlusion in centric and eccentric
positions.
D. Checking phonetics
Maxillary incisors should make fricative “f” and “v” sounds at the wet/dry line of
the lower lip . “s” sound is most important
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E. Verification of waxing up
F. patient approval
PRESCRIPTION WRITING
When a trial denture is returned to the laboratory for finishing, the following
information should be provided:
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2. Details of position and depth of anyperipheral seal lines required at the borders
of palatal connectors in an upper denture.
3. Details of any areas which require relief. Information on the site and depth of
relief areas should be given in the written prescription, supplemented by the
mapping out of the required extent of relief areas on the casts. Sites which
frequently require relief include a torus palatinus which is to be covered by an
upper denture base and the gingival areas of standing teeth, where these are to be
covered by connectors.
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Disclosing media
Ideal requirements of disclosing media
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Advantages :
Disadvantages:
Advantages
i. They are easy to read, ii. Easy to remove from the framework,
Disadvantages
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Advantages
Disadvantages
i. It is expensive,
ii. There is potential for applying too thick a layer of material, and
Advantages
Disadvantages
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Advantages
Disadvantages
ii. Extended use of air abrasion may affect adaptation of the framework by
abrading the intaglio surface of the framework.
Clinical Adjustment
Binding against one or more of the abutment teeth can cause inadequate seating of
a framework. The area(s) of binding cannot be located without the use of an
indicating medium.
b- The framework should be aligned over the abutment teeth and finger
pressure applied in the direction of the planned path of insertion .
c- The framework should be carefully removed from the mouth and then
examined under magnification . The most common points of metal show
through or high spots that interfere with seating occur above the survey line
on the teeth . These usually occur under rests , shoulder of circumferential
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Use of Indicating Media (technique described for wax but applicable for
all media)
2. Remove the framework and coat it with indicating medium. Align the
framework over the abutment teeth and use finger pressure over rest seats along
the path of insertion. DO NOT PLACE PRESSURE OVER GRIDWORK OF
DISTAL EXTENSIONS as this will fulcrum the framework. If gross resistance to
seating is encountered, remove and inspect for areas of burn-through. Have an
instructor inspect the framework. Relieve areas of binding as indicated. Repeat
until seating is achieved. The master cast can be inspected for areas of abrasion
that may indicate areas of gross binding as well.
3. Once the denture can be seated, coat with wax and seat along the path of
insertion again. Use firm even pressure over the rest seats and or indirect retainers.
A mirror handle can be used for seating purposes. Use care in removing the
framework, as removal along the wrong path of insertion will change the markings
in the wax.
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5. Completely remove the wax contaminated with metal grindings and place
fresh wax. Repeat this procedure until full seating is achieved. At this point a thin,
even film of wax should be observed under rests and indirect retainers. The wax
will have a greyish hue from the underlying metal. The feel of the denture upon
seating will change from a grating or snapping sensation to one of a gliding
sensation. Normal adjustment of a framework should take no longer than 20
minutes.
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leave accordingly. Maxillary palatal connectors should exhibit broad even contact
with the palate.
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Delivery of RPD
A. Objectives:
B. Checking of:
IV - Maintenance
-----------------
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To ensure that:
e. Elimination of acrylic resin entered the gingival sulcus adjacent to the natural
teeth.
f. The duplicate casts (If present) should be examined for signs of abrasion
produced by forcing rigid portions of the denture into place. Such abraded areas
indicate parts of the denture, which may require adjustment.
A. Objectives:
Objective:
1. Identify and elimination "show through" that would prevent the denture from
seating properly.
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Once the denture is seated and is comfortable the fit of all its
components is checked.
The cheek is held between the thumb and index fingers, and moved
downward, outward and upward (for lower denture) or moved
upward, outward and downward (for upper denture).
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4. Adjustments.
a. Tooth borne partial dentures. The occlusion and articulation can usually
be evaluated and adjusted intra orally.
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b. The use of occlusal indicator wax. It may be obtained as a special item that is
supplied with one surface of the wax treated with an adhesive so that it adapts
firmly to the teeth being studied.
Intraoral method:
Technique:
Insert one partial denture into the mouth and get the patient
closing in centric occlusion, and note the selected index teeth,
if they are not contacting, articulating paper is used to locate
interference, which must be relieved until the index teeth
getting in contact.
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1. When all or nearly all the posterior occlusion is being restored and
locating discrepancies intraorally would be difficult if not impossible
(stability of the prosthesis is questionable).
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Painting the tissue surface of the base evenly with a thin coating of
pressure indicating paste.
The paste over the areas which preventing the partial denture from
seating correctly will be displaced.
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i. Denture base.
c. Place the partial denture in the mouth and verify its complete seating.
Remove the partial denture and inspect the tissue surface for regions
of paste displacement.
d. Relieve the pressure areas where the paste has been displaced, using
an appropriate bur. Repeat the process until the areas of unfavorable
pressure have been removed.
a. Denture base.
b. Major connectors.
c. Bar clasps.
b. Manually activate or instruct the patient to move the lips, tongue, cheeks
and jaw through simulated functional movement.
1. The rests should demonstrate a complete and stable seating in their rest seats.
2. The clasps, minor connectors, and proximal plates should demonstrate the
required contact with the abutment teeth.
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1. Brushing technique.
b. Brush over a sink with water or a towel in it. This minimizes the
potential for damage if the RPD is dropped.
2. Cleaning agents.
a. Hand soap.
d. Ultrasonic baths may be useful for patients who have difficulty brushing or
as an adjunct cleaning procedure.
3. Adjustments. The patient should be advised not to adjust their RPD. If any
difficulties with the fit or retention develop, they should contact their dentist.
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a. Floss holders.
b. Tooth picks.
c. Interproximal brushes
6. Fluoride may be useful for patients who demonstrate an increased risk for
caries.
a. Rinses.
b. Gels.
7. The use of disclosing tablets is excellent way to disclose areas that are
susceptible to plaque accumulation.
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10. The patient should be instructed to remove the prosthesis all over the night.
(Only in rare instances RPD should be worn at night).
The proper placement and removal of the RPD should be demonstrated. The
patient should be able to accomplish these procedures before leaving the office.
2. The patient should be cautioned not to seat the RPD with occlusal force (not
"bite" into place).
3. Devices or modifications in the RPD may be required for patients who have
difficulty removing the RPD with their fingers.
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5. Weak components must be pointed out; thus clasps should not be used as
fingernail holds during removal.
a. Bulk. It may take several days to several weeks before the patient
accepts the presence of the partial denture, especially for the inexperienced
patient.
2. Prosthesis should be removed from the mouth several hours daily to facilitate
tissue health. Several exceptions may be noted:
b. RPD that maintains the occlusal vertical dimension. When RPD prevents
trauma to remaining natural teeth or mucosa, a splint may be used at night as a
substitute for the RPD.
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c. When the RPD is worn at night, the patient should clean the oral tissues
and prosthesis before retiring and again in the morning.
Written instructions:
It is impractical to expect that all patients will remember all of the instructions
provided in the insertion visit, so providing the patient with written instructions will
permit him to review the instructions at home.
Post insertion difficulties should be expected by both the dentist and the patient;
however attention to details during the fitting and insertion visit will minimize, but not
eliminate all possible complications. Therefore the patient should return to his dentist
within 24 hours of partial denture insertion. This period is sufficient to allow detection
of initial signs of post insertion complications.
Methods of managing the complications depend upon the type of that complication.
IV - MAINTENANCE
A. PERIODONTAL.
1. Recall intervals.
B. RESTORATIVE.
1. Tooth examination.
a. Caries.
b. Defective restorations.
2. Soft tissue examination. Examine all oral soft tissues, especially those adjacent
to or supporting the R
3. RPD Examination.
a. Extraoral.
b. Intraoral."
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• The need for regular review of the mouth and denture should be emphasized.
Not only may the natural teeth and periodontal tissues require treatment, but
also it is necessary to prevent damage from the denture, which, in the initial
stages, may be painless. For instance, free-end saddles may need to be relined in
order to eliminate the rocking movement that could loosen abutment teeth and
hasten loss of alveolar bone in the edentulous area. It must also be made clear
that dentures have a limited life and therefore replacements will need to be
constructed as appropriate.
3. Adjustment.
b. Place the partial denture into the mouth and verify complete seating of
the partial denture.
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c. An indelible pencil may be used to mark the mucosa in the pressure area.
The mark transferred to the prosthesis may be used to confirm the area to be
adjusted.
B. OCCLUSION.
2. Clinical examination.
a. Visual.
b. Articulating paper.
c. Wax.
d. Shim stock.
3. Adjustment.
C. FRAMEWORK.
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!!REPAIRS AND ADDITIONS
Relining
Definition:
Relining is the resurfacing of the tissue surface of a denture base
with new material to make it fit the underlying tissues more accurately,
Indications:
1. Loss of tissue support that cause rotation of the distal extension
base.
NB; in the bounded saddles loss of tissue contact leads to unpleasant
appearance, food traps, and/or patient’s discomfort.
2. Loss of occlusal contact.
Diagnosis:
In order to diagnose if the distal extension partial denture is n need
of relining,
1- A pressure or force is applied on the extreme distal end of the
denture base and watching, if the anterior indirect retainer (rest seat) lift
off its rest preparation as the denture rotates around the fulcrum line; this
indicates that there is a tissue loss occurred, and a relining is required.
2- Another method for diagnosis by using alginate impression as
indicating paste for the area needed for relining, Areas loaded with
alginate.
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!!REPAIRS AND ADDITIONS
B- PROCSDURES OF RELINING
Before relining or rebasing is undertaken, the oral tissues must be
returned to an acceptable state of health by conditioning abused and
irritated tissues.
a- Resin base
Methods of relining:
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!!REPAIRS AND ADDITIONS
Procedure:
Materials:
1. Special auto polymerizing resins that are intended to be cured in
the mouth.
2. Visible light cured resin as a hard chair side relining.
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!!REPAIRS AND ADDITIONS
Metal base
A metal base is not used in a tooth supported area in which early
tissue changes are anticipated. A metal base should not be used after
recent extractions or other surgery or for a long span when relining to
provide secondary tissue support is anticipated.
Commonly, tooth supported partial denture bases are made of
metal as part of the cast framework. These generally cannot be
satisfactorily relined, although they may sometimes be altered by
1- Drastic grinding to provide mechanical retention for the attach-
ment of an entirely new acrylic resin base.
2- Using some of the new acrylic resin bonding agents, such as
Four-meta, Silicoating, or Rocatec.
B) Laboratory relining:
Procedure:
• Removing a uniform amount of denture base resin from the tissue
side of the base as well as all undercuts.
• Sufficient space is allowed beneath the denture base to permit the
excess material to flow to the borders, where it is either turned by
the bordering tissues or, as in the palate, allowed to escape through
venting holes without unduly displacing the underlying tissues.
• Impression material which used that will record the anatomic form
of the oral tissues.
• A closed mouth impression technique is performed (because the
tooth-supported denture base cannot be depressed beyond its
terminal position with the occlusal rests seated and the teeth in
occlusion, and because it cannot rotate about fulcrum) by asking
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!!REPAIRS AND ADDITIONS
B- PROCSDURES OF RELINING
Laboratory relining
• As in bounded saddle relining except some differences
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!!REPAIRS AND ADDITIONS
Rebasing
Definition:
Rebasing is the replacement of the entire denture base with new
material while preserving the occlusal relationship. The artificial teeth
may need to be replaced in a rebase procedure.
Indications:
• When the denture borders do not extend to cover all the supporting
tissue.
• When the denture is fractured in the denture base.
• When the denture is stained or discolored.
Technique:
First Technique
The tissue side denture base is relieved as in relining.
Modeling plastic is then added in small increments for border
molding.
Covering of the base with the suitable impression material for
making the final impression.
The rebase impression is flasked directly without pouring a cast.
After opening the flask the traces of the impression material and
wax are removed and the old resin is removed.
Packing of acrylic resin, curing, deflasking, finishing and polishing
is carried out.
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!!REPAIRS AND ADDITIONS
Second Technique
1- The tissue surface of the denture base is relieved and trimmed to provide
space for re adaptation of borders with modelling plastic.
2- Border moulding is done.
3- After border moulding, a final impression is made using the framework.
4- A cast is poured against the rebase impression.
5- The modelling plastic and the final impression material is scrapped away
from the denture base.
6- The denture base extending over the area to be rebased should be trimmed
leaving just about 2-3 mm adjacent to the base of the teeth.
7- When the anterior teeth are involved, the junction of the new resin and the
existing denture base should be kept in an area that is not visible. A faint line
will always exist at this junction and it may be visible when the patient smiles.
8- This observable line is reduced when the borders of the resin are at 90º to the
external surface. If aesthetics is not important, the junction should be rounded
to reduce the stress concentration and to increase the strength. 9- Now the
framework with the trimmed denture base will not contact the edentulous ridge.
10 - The contour of the denture base is re-established by adding small amounts
of base plate wax. This gives a finished contour to the processed rebase and
reduces the finishing time.
11- Flasking is done.
12- A boil-out procedure is done to soften the wax and modelling plastic.
13- The tissue surface of the denture resin is trimmed to provide space for the
new resin. This trimmirtg should stop short of the denture teeth.
14- Acrylization and processing is done as usual.
15- The denture is de-flasked using a lab knife or pneumatic blade and a shell
blaster.
16- Finishing and polishing is done.
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- A hole is then drilled just below the adjacent denture tooth. From
this hole a groove is cut in the resin base long enough to
accommodate sufficient length of the wrought wire.
- A piece of 18-gauge wrought wire is shaped and adapted to fit the
groove.
- A right angle bend is made at the end of the wire.
- A straight portion is left emerging from the resin base at the point of
origin of the new clasp arm.
- The projecting wire is then cut off to the required length and
adapted to the abutment tooth on the master cast to serve as a new
retentive clasp arm. The wire is fixed to the base with chemically
activated resin.
Because of the flexibility of the wrought wire, it cannot be used to
replace a rigid stabilizing clasp arm. In such case, it is better to entirely
cast a new clasp assembly and attach it to the framework by soldering. The
resin base must to be protected with wet asbestos during soldering. Gold
solder is used for soldering both gold and chrome-cobalt alloys. A colour-
matching white gold solder is preferred for the chromium-cobalt alloys.
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RECONSTRUCTION OF RPD
The partial denture is reconstructed by removing the resin and denture
teeth from the framework The existing framework can be re-used if it has a
clinically acceptable fit.
Indications
When the denture base is damaged beyond repair.
When the fit of the denture is not satisfactory .
Loss of aesthetics, function, etc.
Procedure
• The resin is removed from the tissue side while holding the framework in a cotton
forceps or haemostat (artery forceps).
• The framework is sandblasted to remove the residue and re-polished.
• The framework is seated in the mouth and an alginate impression is made over it.
• The framework should come out along with the impression. If it remains in the
mouth (separated from alginate), the retentive clasp arms should be adjusted to
reduce retention and the impression is remade.
• In order to accurately record the tissues in the retentive meshwork area, the
impression material must be forced into the mesh by applying finger pressure.
• Cast is poured with dental stone.
• The framework is carefully separated from the stone cast by lifting it along the
inferior border of the major connector.
• Force should not be applied as it can distort the retentive clasp arm.
• dual impression can be made (if needed)
• Then the RPD is articulated and fabricated as usual.
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impression with the clinician holding the partial in position while the assistant
seats the sectional tray.
The partial denture is seated in the mouth, and additional material is
syringed onto the prepared tooth and into the space between the tooth and the
partial. Once the space is filled with the low-viscosity material, the sectional
tray can be seated. This tray must extend on either side of the repair area so that
there will be sufficient impression material to lock the partial into the
impression.
The master cast is then poured. It is critical that the stone is poured
directly against all parts of the partial denture with the exception of clasp arms,
precision attachments, and undercut s in the resin areas.
The technician marginates the die and wax the crown to fit the
framework. This is usually done by first waxing a thin coping to the margins.
The casting is then seated on the cast. and molten wax is flowed in the space
between the coping and the casting using a glass eye dropper that have been
warmed in the flame to prevent the wax from cooling too quickly.
The most difficult part of the repair is waxing the area where the clasp,
should there be one, will lie. not only will the wax need to flow against the
internal area of the clasp arm , but a retentive contour will have to be built into
the wax-up.
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