MOUTH PREPARATION IN

RPD

Presented by:
Parikshit Gupt
PG 2nd year
Dept of Prosthodontics
Himachal dental college, Sundernagar
 CONTENTS
Introduction
Mouth preparation
Oral Surgical Preparation
Conditioning of Abused and Irritated Tissue
Periodontal Preparation
Preparation of abutment teeth
Conclusion
References
 INTRODUCTION

The preparation of mouth is fundamental to a

success of removable partial denture service.

Rationale for Mouth preparation is that the

prescribed prosthesis must not only replace what
is missing but also preserve the remaining tissue
& structures that will enhance the removable
partial denture
 Mouth preparation follows a preliminary diagnosis and the
development of a tentative treatment plan, after
 taking the patient’s medical and dental history,

 digital and visual examinations,

 Radiographs of teeth and edentulous spaces

 surveyed and occluded study casts

(Mouth preparation for removable partial dentures J Prothet Dent 1960;

10:698-706)
 STEPS IN MOUTH PREPARATION

1. Oral surgical procedures

2. Conditioning of abused tissues
3. Periodontal preparations
4. Preparation of abutment teeth
ORAL SURGICAL PREPARATION

All preprosthetic oral surgical treatment should be

completed as early as possible.
They include :
 Extraction of teeth with poor prognosis, impacted or
unerrupted tooth, severely malposed tooth
 Removal of exostosis and tori
 Soft tissues should be examined for hyperplastic
tissue, polyps, papilloma, traumatic hemagiomas,
hyperkeratosis or ulcerations .
 Muscle attachments and freni

 Bony spines and knife-edge ridges

 Osseointegrated devices

 Augmentation of alveolar bone

 CONDITIONING OF ABUSED &
IRRITATED TISSUE
Patients who require conditioning treatment
demonstrate the following symptoms.
1 Inflammation & irritation of mucosa
2 Distortion of normal anatomic structures
3 Burning sensation in residual ridge areas, cheek,
tongue or lips.
These conditions are usually associated with

 Ill-fitting or poorly occluding RPD.

 Nutritional deficiencies, endocrine imbalances &

bruxism must be considered in differential diagnosis

 Treatment
Immediate institution of a good home care program
 Institution of good oral hygiene,

 Rinsing of mouth 3 times a day with saline solution

 Removing the prosthesis at night,

 Massaging the tissues

 Using the prescribed therapeutic multiple vitamin

with high protien dieand low carbohydrate diet.
 Use of tissue conditioners
Maximum benefit from using tissue conditioning
materials may be obtained by
1. Eliminating deflective or interfering occlusal contacts
of old dentures
2. Extending denture bases to proper form to enhance
support, retention, and stability
3. Relieving the tissue side of denture bases sufficiently
(2 mm) to provide space for even thickness and
distribution of conditioning material
4. Applying the material in amounts sufficient to provide
support and a cushioning effect
PERIODONTAL PREPARATION

It usually follows oral surgical procedures & is

performed simultaneously with tissue conditioning

procedures.

It is strongly recommended that gross debridement

should be done before extraction .

Periodontal therapy must be completed before

restorative therapy
 Objective: To return the health of supporting structures

of teeth and creating an environment in which

periodontium may be maintained.

The criteria for satisfying these objectives are as

follows
1. Removal & control of etiologic factors along with

elimination of bleeding on probing.

2. Elimination or reduction of pocket depth

3. Establishment of functional atraumatic occlusal

relationship & tooth stability.

4. Development of personal plaque control program &

definitive maintenance schedule.
 PERIODONTAL THERAPY

1 Initial disease control therapy

2 Periodontal surgical phase

3 Maintenance phase
 Initial Disease Control Therapy
( Phase I)

Oral hygiene instructions

Scaling & root planing

Elimination of local irritating factors other than calculus

Elimination of gross occlusal interferences

 Initial Disease Control Therapy
( Phase I)

Temporary splinting

Use of night guard

Minor tooth movements

 Periodontal surgical phase
(Phase II)

Reevaluate for surgical phase.

If oral hygiene is at an optimum level, yet pockets with
inflammation and osseous defects are still present,
periodontal surgical therapy should be considered to
improve periodontal health.
 Procedures

Periodontal flaps

Guided tissue regeneration

Periodontal plastic surgery

 Maintenance phase
(Phase III)

Reinforcement of plaque control measures

Thorough debridement of all root surfaces of

supragingival and subgingival calculus and plaque by

the dentist or an auxiliary.

The frequency of recall appointments should be

customized for the patient depending on the

susceptibility and severity of periodontal disease.

Patient with periodontitis should be placed on a 3-4
month recall system to maintain results achieved by
nonsurgical and surgical therapy
PREPARATION OF ABUTMENT
TEETH
To accomplish abutment tooth preparation according
to the proposed tentative RPD design, we should have
information about :
 The proposed path of placement

 The areas of teeth to be altered and tooth contours

to be changed
 The location of rest seats and guiding planes
 Steps in tooth preparation

Six steps in chronological order:

Establish occlusal plane
Recontour proximal surfaces of posterior teeth
Recontour proximal surfaces of anterior teeth
Recontour facial and lingual surfaces of teeth
Fabricate rest preparations
Smooth and polish all altered surfaces

(Preparing teeth to receive a removable partial denture (J

Prosthet Dent 1999;82:536-49)
 Establishment of occlusal plane

Treatment options:
Consider correction by shaping of enamel not exposing
dentine, while maintaining anatomy
More than 2 mm of enamel reduction should be restored
Extrude tooth may be shortened with endodontic therapy
Crown lengthening may ne required for sufficient height
of clinical crown to make to adequate retention
Infra occluded tooth should be restored to occlusion
Malaligned teeth should be corrected by orthodontics,
recontouring or placement of restoration.
Hopelessly extruded or mobile teeth may be reduced
to 2-3 mm above gingival level after endodontic
therapy to be used as overdenture abutments.
A weak 3rd molar make shaped and covered with
denture base fro vertical support
Removal of teeth should be last resort
 Recontour proximal surfaces of
posterior teeth
Reduces undesirable undercut
Reduces proximal undercuts permitting closer
placement of minor connector
Reduces gingival embrasure space hence less food
enlodgement
Prepares vertically parallel guiding planes for a
direction of placement and removal of RPD
proximal guiding planes aid in stabilizing abutments
against lateral forces and RPD against horizontal
forces
Treatment :
Place the surveyed and designed diagnostic cast on the
surveying table at the correct tilt. Use it as a reference
for Correct orientation of the handpiece in the mouth.
 Recontour proximal surfaces of
anterior teeth

Treatment option:
 With a cylindrical smooth cut carbide bur recontour
proximal surface maintaining facial and lingual
surface
 combination of tooth reduction and tilting the cast
in surveyor to change path of insertion establishes
Recontour facial and lingual
surfaces
Fabricate rest preparations
 Fabricate rest preparations

The primary purpose of the rest is to provide vertical

support for the partial denture:
Maintains components in their planned positions
Prevents impingement of soft tissue
Directs and distributes occlusal loads to abutment
teeth

 Rest for posterior teeth

Occlusal rest

Extended occlusal rest

Interproximal occlusal rest

Occlusal rest seat

Rounded triangular shape

 Apex near center of tooth
Base of triangle should be one third the bucco-lingual
width of the tooth
Marginal ridge must be lowered by 1-1.5mm and rounded
Bulk of metal to prevent fracture
Floor should incline towards the center
Angle formed by rest and minor connector should
be less than 900
Deepest portion should be centre
Floor should be concave or spoon shaped ball-&-socket
joint
“Positive” Rest Seats

An explorer tip will not slide off the rest

seat
Conventional Form
Adjacent Tooth
 Rest not flared to facial line angle
 Lingual flared more - space for minor connector
 Extended occlusal rest

• Should extend more than one half the mesiodistal

width of the tooth
• Should be one third the bucco-lingual width of the
tooth
• Minimum of 1-mm thickness of the metal
Interproximal occlusal rest
 Rest for anterior teeth

Cingulum rest

Round lingual rest

Composite bonded rest

Incisal rest
Cingulum rest seat
Composite Bonded Cingulum
Rests

Correct Overcontoured Overcontoured

Open margin
Round Lingual Rest Seat Form
Incisal rest
In the absence of other suitable placements for Incisal
rests and rest seats, incisal rests on multiple Mandibular
incisors may be considered
Smooth and polish all altered
surfaces
Scratches are removed by lightly preparing surface

with fine diamond or white stone bur before polishing

Polish using rubber abrasives with intermittent pressure

For posteriors us e dull carbon steel bur in reverse

direction

Apply fluoride gel to surface after polishing

 CONCLUSION

The success or failure of a removable partial denture

depends on how well the mouth preparations are
accomplished.
It is only through intelligent planning and competent
execution of mouth preparations that the denture can
satisfactorily restore lost dental functions and
contribute to the health of the remaining oral tissue.
 REFERNCES

McCracken’s Removable Partial Prosthodontics -11 edition

Removable Partial Denture Manual Robert W. Loney, DMD, MS
Preparing teeth to receive a removable partial denture (J
Prosthet Dent 1999;82:536-49)
Removable partial dentures with rotational paths of insertion:
Problem analysis (J Prosthet Dent 1983;50:8-15)
The Effects of Buccolingual Width and Position of Occlusal
Rest Seats on Load Transmission to the Abutments for Tooth-
supported Removable Partial Dentures (Int J Prosthodont
2001;14:340–343.)
THANK YOU