Review of Cobalt Chrome Denture Design Concepts

L e c tured: Dr. Anas Al-Ibrahim

In the name of Allah

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Sequence of Designing
Saddles (yellow color) Support (red color) Retention (green color) Bracing and reciprocation (blue color) Major and minor connectors (black color) Indirect retention Review of completed design

Kennedy Classification

Class I: Bilateral free-end saddle. Class II: Unilateral free-end saddle. Class III: Unilateral bounded saddle. Class IV: Anterior bounded saddle, across the midline.

>> When you give Kennedy classification determine the most posterior edentulous

space, see if it is (class I,II,III or IV), then consider all other edentulous spaces
anterior to it as modifications >> All Kennedy classifications except for class IV have modifications. Be careful, when u want to determine Kennedy classification remember that it is << different to look directly at the saddles or to look at the prosthesis that is supposed . to replace missing teeth

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In the above pictures you are looking at the prosthesis no directly at the saddles inside the patient's mouth In the left picture, this prosthesis is supposed to replace upper left 2nd premolar posteriorly (e.g. unilateral bounded) and the 6 anterior teeth, so Kennedy classification ( is class III Mod I (not class I Mod I or II In the right picture, this prosthesis is supposed to replace lower right and left 6s and 7s and also the 4 incisors, so Kennedy classification is class I (e.g. bilateral free-end ( saddles) Mod I (not class III Mod I

Did you notice that the patient in the right picture has no 1st premolars, maybe ** they were extracted for ortho purposes in the past :P :P

Saddles **
The design of the occlusal surface
>> Always use narrower and shorter occlusal table in distal extension saddles

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Here in the picture, in the lower left quadrant (e.g. your right side) we have made the occlusal table shorter (excluded the 7 and only replaced 5 and 6) and narrower (buccolingually) compared to that in the right quadrant (e.g. your left side). Doing this will lead to less forces on the

denture, then more retention and better adaptation by the patient

We can exclude the 7 in most cases to make the occlusal table shorter

The base extension

>> Maximum coverage in distal extension saddles

Here in the picture in the lower left quadrant (e.g. your right side) we achieved maximum extension and maximum coverage compared to that in the right quadrant (e.g. your left side)

Doing this will lead to more surface area to aid in

cohesion and adhesion (e.g. better retention by

means of physical forces) and also will enhance

muscular control over the polished surface

leading again to better retention

The design of the polished surface

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Polished surface should be shaped correctly to enhance retention and stability << . by muscular forces

Place teeth in neutral zone (e.g. where there's balance between inward and << ( outward forces from cheek and tongue

Here in the picture, in the lower left quadrant (e.g. your right side) teeth are set in their neutral zone compared to that in the right quadrant (e.g. your left side) where teeth are set out of their neutral zone ( (going lingually

Doing this will lead to NO interferences with the tongue, then better neuromuscular control and

better denture stability and then better retention

The material for the impression surface (e.g. denture fitting surface)
>> Denture base = is that part of removable partial denture that rests on oral mucosa and to which prosthetic teeth are attached

>> Ideal denture base has:

- Accuracy of adaptation to tissues - Non-irritating surface that is capable of receiving and maintaining good finish

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- Biologically compatible with tissues - Thermal conductivity - Light-weighed - Good aesthetics - Dimensional stability - Sufficient strength and resistance to fracture/distortion/deformation - Self cleansing - Low cost

>> Functions of denture base:

- Aesthetics - Support - Retain artificial teeth - Transfer occlusal forces to abutment teeth via rests - Prevent vertical and horizontal migration of remaining natural teeth - Eliminates food traps - Stimulate underlying tissues

>> Denture base materials:

- Metal

>> Indicated in

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- Tooth supported partial dentures (e.g. short span bounded saddles) where relining is rarely needed - Inadequate interarch space

>> Metal bases are thinner than acrylic bases (but still have adequate strength), should be designed with maximum extension and without any sharp margins

>> Metal bases Advantages:

- Maintain their accuracy of form without change inside the patient's mouth compared to acrylic bases - Provide excellent intimate contact with tissues (e.g. accurate fitting) - Have no later internal strains release that lead to deformation as what we have in acrylic resin bases - They are naturally cleaner than acrylic bases and they actually have the

inherent cleanliness property which contributes to healthy oral tissues

- Are thermally conductive unlike acrylic bases which have thermal insulating effect. Thermal conductivity is important for the acceptance of the patient and the health of the tissues (the patient will feel that this drink for example is too hot and so won't burn his mucosa)

>> Metal bases disadvantages:

- Not aesthetically good - Relining difficulty - Restoring normal facial contours can't be achieved when there's extreme residual alveolar bone loss

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- Acrylic resin

>> Indicated in - Distal extension saddles and long span bounded saddles where we expect

bone resorption and might need relining

- When there's extreme loss of residual alveolar bone and we want to

restore normal facial contours

- Adequate interarch space

>> Acrylic resin bases should be of adequate strength and bulk

>> Acrylic resin bases are attached to the major connector via minor connectors (e.g. open lattice or mesh) so that when we have acrylic resin bases we actually have acrylic and metal together (thus requiring more interarch space) but when we have metal bases we actually have metal only (thus requiring less interarch space)

Here in the picture, the black arrow points to the

tissue/cast stop in distal extension bases

metal framework, this stop: - Enables me to check fitting of the metal framework without any rocking - Support the framework (e.g. prevent downward movement) - Support the framework during packing and processing of acrylic resin. So tissue/cast stop in distal extension bases is extremely important

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Here in this photo prosthetic teeth are about to be attached to metal base in the bounded saddle area via mechanical interaction (e.g. beads, tags ...) without any acrylic

The junction between saddle and abutment tooth.

>> The junction between the saddle and the abutment teeth is either open design (as in the left picture) or closed design (as in the right picture)

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>> The advantage of the open design over the closed one is the fact that it is more

hygienic and doesn't aid dental plaque accumulation

>> The advantages of the closed design over the open one is the fact that is more

aesthetic and also associated with guiding plane preparation which will enhance
retention by means of friction and creates path of insertion. It is somehow cleansable

>> The only case in which we can prepare guiding planes on abutment teeth and use the open design is when the clinical crown height of abutment teeth is too long, but in general guiding planes preparation is done when the closed design is used

** Support
Support = the resistance to vertical force directed towards the mucosa (e.g. to << ( prevent the sinking of the denture into the mucosa : Support in RPDs can be <<

Mucosa-borne >> only found in acrylic transitional RPDs (coz there's no rest seat preparation on teeth to deliver occlusal forces to abutment teeth, look at (a) ( below

Tooth borne >> found in Cr-Co RPDs restoring short span bounded saddles (look at (B) below). Support comes from mesial and distal abutment teeth

Tooth-mucosa borne >> found in Cr-Co RPDs restoring free end saddles and long span bounded saddles (look at (C) below). Support comes from abutment
tooth/teeth and mucosa

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Planning support
This actually depends on 3 important factors that should be interrelated together << to understand how much support we need for the prosthesis and how much support we : can get from the remaining natural teeth. Those 3 factors are

Root surface area of abutment teeth >> Support gained from each tooth is dependent on the type of the tooth and its

periodontal health
>> The picture on the right above represents the root surface area of all teeth, you can see that the largest root surface area is for molar teeth (2.7) and the smallest root surface area is for lower incisors (1.0), so molars give the maximum support while incisors give the least support compared to other teeth. Molars won't give the same amount of support if their periodontal health is compromised (as here in the picture on the right) because when periodontal health is compromised, and there's reduced periodontal support and attachment loss, root surface area is reduced and so the support

The extent of the saddles

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>> In the left picture above, we have bounded saddles, thus we don't need that much support from teeth. While in the right picture above, we have extensive saddles (e.g. free-end

saddle), thus we need to maximize support by adding more support components, having maximum extension and coverage of the denture base
(especially in maxillary RPDs) and also using double rest (as in the picture below) instead of one rest (especially in mandibular RPDs)

The expected

force on the saddles

>> This actually depends on:

- The length of the edentulous space >> we need less support for edentulous span restoring 2 missing teeth than we need for edentulous space restoring 3 or 4 missing teeth. As the length of edentulous span increases we expect the vertical forces to increase as well thus we have to compensate for this by maximizing the support

- The nature of the opposing occlusion >> we need less support if the opposing occlusion is a prosthesis (e.g. complete denture) than if it is natural dentition because we expect less vertical forces in case of opposing complete denture than if we have opposing natural teeth

** Tooth support for distal extension saddles

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>> The major component for support is the rest

>> Where to place the rest in distal extension saddles, away from the saddle area (e.g. mesially) or toward the saddle area (e.g. distally)?

- When placed mesially, we will have more favorable vertical delivery of occlusal forces to abutment teeth (as seen in the picture above)

- When placed distally, we will have distal tipping of the abutment tooth (as seen in the picture below)

>> You should know that the issue of where to place the rest in distal extension saddles is still controversial, because there will be rotation of the denture base toward the abutment

tooth and other remaining teeth due to the slope and curvature of the residual ridge, this is why there's nothing causing distal tipping, however in
general we like to place rests mesially (away from the saddle area) in distal extension saddles

** Partial denture support

>> Support components include:

- Rests (occlusal, incisal and cingulum) - Maxillary major connector (provides maximum extension) - Saddles - Rigid part of the clasp arm, why?
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>> Because the rigid part of the clasp arm lies over the survey line, and it will act as a rest without embracing any undercut

** Retention

>> Retention = the resistance to removal away from the supporting tissues

>> Retention is either:

- Direct

- Indirect (this is mainly useful in distal extension RPDs)

>> Retention of RPDs:

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- Inherent physical forces

>> Adhesion and cohesion

>> Here we need maximum coverage and large surface area to be covered to be effective

- When we have few missing teeth (as seen in the picture above) we won't need maximum coverage to enhance retention by means of physical forces because the retention gained by the clasps is enough

- When we have so many teeth missing (as seen in the picture below) and extensive free-end saddles then we will need to maximize the coverage to enhance retention by means of physical forces beside the retention gained by the clasps

>> Usually more effective in acrylic partial dentures than with Cr-Co RPDs

- Neuromuscular control

>> By the act of the surrounding musculature on the polished surface of the denture

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>> Neuromuscular control is extremely important when it comes to mandibular

bilateral distal extension saddles denture, because we have forces coming

from the tongue and the cheek, so we need to shape the polished surface correctly to enhance retention my means of neuromuscular control on the polished surface

- Mechanical

>> By the use of:

A- Guide planes

Here in the picture, the dotted line represents the path of insertion; the other line represents the path of displacement. Path of insertion is what we have at the new tilt while path of

displacement is what we have at zero tilt. If

we have such path of insertion as in here then the only way to dislodge the denture is by applying forces along its path of insertion. When vertical forces try to dislodge the denture at this path of insertion, then the denture base will engage the undercuts directly and thus enhancing its retention. Always remember that guide planes are direct not indirect retainers because the principle idea of guide planes functioning is the same as that of the clasps which engage undercuts under vertical forces. When path of insertion = path of displacement (e.g. didn't gain new tilt) then there's no need for guide planes and direct retention will only be gained by the clasps

B- Attachments
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C- Clasps
>> The most important components for mechanical retention

>> Clasps are mainly classified into:

- Occlusally approaching clasps

>> E.g. the ring clasp (in the lower picture to the left)

- Gingivally approaching clasps

>> E.g. I-bar which is the most commonly used one. We have also T-bar

>> Comparison between occlusally and gingivally approaching clasps: - Retention >> Premolar tooth for the clasp to be of good retention we need
enough length (e.g. enough flexibility). Occlusally approaching clasps are okay for molars, because molars have

enough Mesiodistal width (about 15 mm) and this will cause the clasp
to have enough length then good flexibility and retention.

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Premolars have less Mesiodistal width than molars (about 7 mm), so

clasps on premolars won't be so long as they are on molars teeth. Cr-Co alloy is very rigid especially if it is very short. So occlusally approaching clasps made of Cr-Co alloy won't be of enough

length neither flexibility nor retention when placed on premolars.

For molars we can go for occlusally approaching clasps, for premolars we can go for either gingivally approaching clasps or wrought wire

clasps.

>> Periodontally involved tooth ideally only the terminal third of the occlusally
approaching clasp should be below the survey

line.
Unfortunately, in most of the cases we can't achieve this, so that more than the terminal third of the clasp will be below the survey line, and this will lead to displacing forces and

harmful effect on abutment tooth.

This is why we prefer Gingivally approaching

clasps over occlusally approaching ones when we have Periodontally involved teeth, because
in Gingivally approaching clasps only the tip contacts the tooth and this lead to less displacing forces on the abutment tooth.

- Appearance

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>> Gingivally approaching clasps are better aesthetically

Here in the picture the clasp is engaging a distobuccal undercut, which is aesthetic.

>> Tooth-coloured clasps

- Polyoxymethylene clasps - Coloured clasps >> aesthetic - Very thick clasps >> so that they need

more Mesiodistal width of the tooth

(so that they can be longer and more flexible) and deeper undercut - Very expensive - Aid plaque accumulation (less hygienic) - Its disadvantages are more than the advantages

- Hygiene
>> Gingivally approaching clasps might increase plaque accumulation

>> Gingivally approaching clasps might increase the risk of root caries in the presence of gingival recession and xerostomia

>> Occlusally approaching clasps are more hygienic than gingivally approaching ones

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- Occlusion
>> Occlusally approaching clasps might require in most of the cases tooth reduction in order to provide adequate space for the rigid part of the clasp that is supposed to be over the survey line, this reduction might be done for the clasped tooth or the opposing tooth. - Gingivally approaching clasps have nothing to do with occlusion

>> Factors on which effectiveness of clasps depends:

A- Tooth shape >> Depth of undercut the deeper the undercut the more retentive
the clasp

>> Steepness of undercut

Here in the picture, both tooth #1 and #2 have the same depth of undercut so that

the overall retention would be the same,

but the undercut in tooth #1 is steeper than that on tooth #2, which means the initial resistance for vertical displacing forces in tooth #1 would more than that in tooth #2 but the overall retention would be the same (only the initial resistance to displacing forces will be different)

B-

Clasp design (flexibility)

(The more the flexibility the more the retention)

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>> Section - Round >> in here the flexibility if the clasp is the same in all directions (vertical and horizontal) - Half-Round >> in here the flexibility of the clasp is more in the horizontal direction than in the vertical. We need the clasp
to be more flexible in the horizontal direction because most of displacing forces are vertical

>> Length the longer the clasp the more flexible it is

>> Thickness reducing the thickness by 1/2 will increase the

flexibility by 8 times

>> Alloy
- The most commonly used alloys to fabricate clasps include: S.S, Cr-Co and gold - Gold is more flexible than S.S, and S.S is more flexible than Cr-Co (Gold>S.S>Cr-Co) - Here the picture represents comparison between S.S (blue), Cr-Co (black) and gold (pink). The black circle represents the proportional limit (the limit after which the alloy undergoes permanent deformation). - Cr-Co alloy has a value of stiffness that is twice that of the gold alloys. Which means, we need double the force needed to bend
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gold alloy for a distance to bend the Cr-Co alloy for the same distance. (Gold alloy has twice the flexibility of Cr-Co) - Hardened S.S has the highest proportional limit. Proportional limit of gold and Cr-Co are comparable.

>> The choice of the retentive clasp:

There are a number of factors that are important to consider when choosing the appropriate retentive clasp. When to use gingivally approaching clasps, when to use occlusally approaching clasps, and when using occlusally approaching clasps when to use ring clasp. Those factors are:

- Appearance
>> Gingivally approaching clasps are better aesthetically than occlusally approaching ones, so in aesthetic zone use Gingivally not occlusally approaching clasps

- Length if the clasp

>> The only Mesiodistal width that is suitable for good length occlusally approaching clasp and good flexibility and retention is the Mesiodistal width of molars. So for molars occlusally approaching clasps but for premolar Gingivally approaching clasps. If for a reason or another we need to use occlusally approaching clasp on a premolar tooth then it should be wrought wire rather than a rigid cast Cr-Co wire.

- Occlusion
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>> Gingivally approaching clasps don't compromise the occlusion and need no occlusal reduction as occlusally approaching clasps do, so if we have problem in the occlusion we better choose Gingivally not occlusally approaching clasps

- Position of the undercut

>> In most of the cases when we survey the cast we will find that

suitable undercuts are further away from the edentulous space

and this is ideal actually. Here in the picture we have a missing tooth between the 1st molar and 1st premolar teeth, the suitable undercut on both teeth is below the

survey line and farther away from the edentulous space. On the molar we have
occlusally approaching clasp and on the premolar we have Gingivally approaching clasp. Sometimes we will survey the cast and we will find the suitable undercut

closer to the edentulous space, then if I extend my clasp the usual way
it will be shorter, to overcome this we might use the ring clasp. Here in the picture, the suitable

undercut is located buccally and closer to the edentulous space, so we

used a ring clasp, which encircles the tooth from the lingual side to the buccal side to engage the undercut. Another indication for ring clasp is when

the suitable undercut is located lingually not buccally because the tooth is tilted, so this time the clasp will encircle the tooth from the
buccal side to the lingual side to engage the undercut.
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In the RPI system the I-bar should engage a suitable undercut on the

midpoint of the tooth or slightly anterior (mesial) to it. Other

Gingivally approaching clasps can be placed where the suitable undercut is, it doesn't matter as it matters with the I-bar specifically.

- Health of the periodontal ligament

>> For Periodontally involved teeth we prefer using Gingivally approaching clasps over occlusally approaching ones

- Shape of the sulcus

>> Here in the picture, we have a premolar tooth, suitable to be clasped by Gingivally approaching clasp, but we have a ridge

undercut, this interferes and contraindicates the

placement of Gingivally approaching clasps for the fact it will irritate the buccal mucosa and the cheek. We call the gingivally approaching clasp that irritates the buccal mucosa and the cheek and aid in plaque accumulation and is preferably not placed because there's a ridge undercut the "cabbage catcher" clasp

>> The RPI system: - Definition = this is a design that permits the denture to rotate on the
distal abutment teeth without causing any damage to remaining oral tissues

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- Main components include: > R - Rest, placed mesially on the most

distal abutment tooth. More vertical loading, transmits less torque

> P - Proximal plate. Designed so as not

to transmit torque to abutment when saddle is loaded

> I - I-bar. Disengages tooth when saddle is loaded

- Here in the picture, we have occlusally

approaching clasp and a rest on the most distal tooth directed distally
(toward the edentulous space). Under vertical loading on the saddle, there will be rotation, the distal rest is the point of rotation, the clasp will engage the

undercut and there will be distal tipping

of the abutment tooth (e.g. the clasping system will act as an extraction forceps)

- Here in the picture, we have Gingivally approaching clasp and a rest on the most distal tooth directed mesially
(away from the edentulous space). Under vertical loading on the saddle, there will be rotation, the mesial rest is the point of rotation, the I-bar will disengage the

abutment tooth and the guiding plane

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will move downward and mesially thus preventing distal tipping

(e.g. the clasping system won't act as an extraction forceps)

- Here in the picture, we have the RPI system, mesial rest, I-bar and proximal plate, the blue colour represents the saddle before loading and the purple colour represents the saddle after loading, under vertical loading the there will be rotation, the mesial rest is the point of rotation, the proximal plate will move downward and mesially to prevent distal tipping of the abutment tooth and the I-bar will disengage the undercut and the abutment tooth

- For the proximal plate to be effective (e.g. to be able to move downward and mesially when the saddle is loaded), guiding plane should be prepared on the gingival part of the distal surface of the most

distal tooth

** Reciprocation

- Reciprocation = the resistance to horizontal forces exerted on a tooth by a clasp during either insertion or removal of a denture - Components of reciprocation >> reciprocal arm or reciprocal plate

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- For the reciprocal component to be effective, guiding

plane preparation should be done.

- Here in the picture, the top one, no guiding plane

preparation was done, A and B before loading, A' and

B' after loading. After loading, the clasp will engage the undercut and the reciprocal component will disengage

the tooth, thus no effective reciprocation. The

bottom one, we have prepared guiding planes on lingual surface of abutment tooth, A and B before loading, A' and B' after loading. After loading, the clasp will engage the undercut and the reciprocal component will move up with the

retentive component while still engaging the tooth thus effective reciprocation.

** Bracing

- Bracing = the resistance to displacement of the denture in both anteroposterior and lateral directions (horizontal plane)

- In reciprocation we specifically talk about the clasp and the tooth, in

bracing we talk about the whole denture

- Bracing occurs when the denture is fully seated but reciprocation occurs during removal and insertion of the denture (e.g. when the clasp is effective)

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- Bracing component >> any component that covers the vertical part of the ridge or the teeth is a bracing component (e.g. the major connector, the saddle
)

- Here in the left picture, the rigid component of the Cr-Co RPD that covers the vertical part of the ridge resisted horizontal forces and thus dislodgement. In the right picture, the rigid component of the Cr-Co RPD that covers the vertical part of the anterior teeth resisted antero-posterior forces thus dislodgement

** Major connectors

- Major connector = joins the components on one

side of the arch with those on the opposite side (blue circle in the right picture)

- Minor connector = joins the other components,

such as rests and clasp to the major connector (red circles in the right picture)

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- Anything in the denture rather than the rests, clasps and major connector is actually a minor connector

- Requirements for major connector: >> Be rigid

- Rigidity permits broads distribution of applied forces

- Rigidity enhances effectiveness of other components of the RPD.

>> Protect the soft tissues

- Borders of a maxillary major connector should be located 6 mm away from the free gingival margins (as in the right picture)

- Borders of a mandibular major connector should be located 3 mm away from the free gingival margins

- 3 mm in the mandible while 6 mm in the maxilla because in the mandible

the sulcus tends to be shallower

- Borders should run parallel to the gingival

margins of the remaining teeth. Because we

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want to reduce plaque accumulation and to reduce crossing with the gingival margin

- Gingival margins must be crossed at right

angle. In order to reduce the contact between the

delicate gingival margin and the minor connector

>> Provide a means for placement of one or more dentures bases

- Different major connectors can be used according to the number and location of edentulous

spaces

>> Promote patient comfort - Anterior border of a maxillary major connector should not end on the anterior slope of a prominent rugea.
Here in the top picture the anterior border of the maxillary major connector ended on the anterior slope of the prominent rugea area which isn't favourable because it will interfere with the tongue, then speech and also might traumatize the rugea area.
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Here in the bottom picture the anterior border of the maxillary major connector ended on the posterior slope not the anterior one (so that it is in harmony with the rugea area and not very thick or prominent). This is favourable because it won't interfere with tongue neither the speech nor traumatizing the area.

We care about this in Cr-Co but not in acrylic because acrylic has better adaptation to tissue (e.g. better cohesion and adhesion) but Cr-Co is still a metal and thus it has poorer adaptation to tissues, so we should keep this in mind always and end the anterior border of the maxillary major connector on the posterior slope not the anterior one.

- Borders of a maxillary major connector should cross palatal midline at right angle. Because I need the maxillary major connector to be the thinnest in the midpalatine suture area. - Tori should be avoided as much as possible.
Because the mucosa overlying them is very thin and irritable easily traumatized

- Major connector should exhibit smooth and rounded contours and angles. This will give the
patient more comfortable sensation and less plaque accumulation

- Maxillary major connectors: Palatal bar

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- Rarely indicated, honestly it is rubbish, shouldn't be used - We won't be able to use it, because in order to be rigid enough it should be very very thick and it won't be comfortable to the tongue

- Narrow half oval with its thickest point at the centre

2-

Palatal strap

- One of the most commonly used maxillary major connectors - It consists of a wide band of metal with a

thin cross-sectional dimension

- Comfortable and might be used for most of the cases especially long span bounded saddles cases. They can be also used for class I and II Kennedy but not that much

3-

Anteroposterior palatal strap

- Consists of two palatal straps, each should be at least 8 mm in width to be of good rigidity - Can't be used if we have a massive tori
(because each strap is 8 mm in width), in this case

anterioposterior palatal bar is used instead

4-

Anteroposterior palatal bar

- Narrow Anteroposterior variation of anterioposterior palatal strap - Anterior bar is flat and similar to palatal strap in cross section.
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- Posterior bar is half oval and similar to palatal bar in cross section - The two bars are joined by flat longitudinal elements on each side of the palate - Indicated in: torus palatines cases - In both anterioposterior palatal bar and anterioposterior palatal strap, we have the anterior part covering the vertical part of the palate, while the posterior part covers the horizontal part of the palate, so that the major connector will be in 2 planes at the same time, leading to the "L beam

effect" which enhances the rigidity of the major connector. So, all major
connector designs with anterior and posterior components exhibit the "L beam effect" and have very good rigidity.

5-

Horseshoe

- Indicated in: torus palatines cases, Periodontally involved teeth (so that we extend
the major connector to cover teeth to splint them),

prominent midpalatine suture (because the

horseshow is the only major connector that doesn't cover any part of the midpalatine suture, unlike anterioposterior palatal strap and anterioposterior palatal bar which has its posterior part covering part of the midpalatine suture) Consists of a thin band of metal running along the lingual surface of the remaining teeth and extending 6 to 8 mm onto the palatal tissues The main disadvantage of horseshoe major connector = its tendency to -

flex, because it isn't rigid enough and this is why it is contraindicated in

( free end saddles (class I and II Kennedy It is preferable for free end saddles (class I and II Kennedy) to use either wide palatal strap or complete palatal coverage (we need them to ( be rigid enough, not to flex under loading

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6-

Complete palate

- Anterior border should be kept 6 mm from gingival margin or cover the cingula of anterior teeth (if teeth are mobile and periodontally involved
and need splinting)

- Posterior border should extend to the junction between the hard and soft palate. Acrylic post dam area at the distal end of the major connector in the opinion
of the doctor is better (e.g. enhances retention more) than metal beading which he thinks isn't effective at all

- It is very very good, because it provides ultimate rigidity and support,

it also maximizes distribution of forces, and it enhances thermal

conductivity (even better than acrylic resin) and it is also less porous than acrylic resin so more hygienic - It isn't comfortable for the patient

- Conclusions about the maxillary major connectors:

- If the remaining teeth are periodontally involved, a wide palatal strap or a complete palate is indicated.

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- If a torus is present and is not to be removed, anterioposterior palatal

bar, anterioposterior palatal strap (if not massive), or horseshoe major

connector may be used

- Horseshoe major connector shouldn't be used routinely because of the

possibility of flexure
- A palatal bar is very rarely indicated

- Mandibular major connectors: 1Lingual bar

- Half pear shaped in cross section - The broadest portion of the bar is located at its inferior border - Maximum cross-sectional dimension is Oriented vertically (so it gains its rigidity from its height not width) - At least 8 mm of sulcus depth must be present - Rigidity isn't always good because many errors might occur during the processing of the lingual bar that will compromise its thickness thus the ultimate rigidity - Hygienic and tolerable by the patient

2-

Sublingual bar

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- Maximum cross-sectional dimension is oriented horizontally (so it gains its rigidity from its width not height)

- Needs special impression technique

To record functional depth and width of the sulcus accurately

- Needs less sulcus depth than lingual bar

(coz its widest cross-sectional diameter is horizontally oriented not vertically) - The most rigid type of mandibular major connectors - Sublingual bar is thicker in width, while lingual bar is thicker in length, but finally the thickness of the sublingual bar (where we use speacial impression technique to record the full width and depth of the sulcus) is more than that of the lingual bar thus more rigidity - Hyginic and tolerable by the patient

3-

Dental bar

- Covers part of the lingual surfaces of the anterior teeth - Clinical crowns should be long enough - Very thick (in height) and not always

tolerable by the patient

- It is hygienic - It's rigidity isn't always good because many errors might occur during the processing - When using lingual or sublingual bar is contraindicated (e.g. shallow sulcus depth, high muscle attachment, high frenal attachment ...) , then using the dental bar is indicated instead
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- Can be used to splint periodontally involved teeth when their clinical crowns are long
4-

Kennedy bar

- Consists of dental bar and lingual bar

- The upper bar (dental bar) should Present a scalloped appearance (in order Not to interfere with the tongue) - Rarely indicated because it is technically

Difficult to fabricate
- Indicated when the dental bar is indicated (e.g. when lingual and sublingual bars are contraindicated) - Can be used to splint periodontally involved teeth - Kennedy bar is better than dental bar major connector because the upper part of it (e.g. the dental bar it has) is thinner and more tolerable and less irritating to the patient than the dental bar major connector itself - We will compensate for the thinner dental bar (the upper component) by adding lingual bar (the lower component) to enhance rigidity of the major connector - Lingual bar used in here doesn't require great sulcus depth and it is also narrower than lingual bar major connector
5-

Lingual plate

- Covers most of the lingual surfaces of the teeth, the gingival margin and the lingual aspect of the ridge - Rigidity is achieved by thickening the Lower border to a bar like section
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- Indicated when lingual and sublingual bars are contraindicated and also when we have periodontally involved teeth (its main indication actually is to have periodontally involved teeth, and it is the most important type of mandibular major connector to splint periodontally involved teeth) - Main disadvantage >> it aids plaque accumulation (not hygienic) - Its rigidity is good, also tolerable by the patient

6-

Labial/buccal bar

- Runs across the mucosa on the facial surface of the mandibular arch - Limited space and increased length makes it difficult to achieve rigidity - More effective when used for short spans - Indicated when we have lingually tilted premolars, and mandibular tori - Poor tolerance by the patient, because we have limited space between teeth and cheek thus it will be very irritating - It isn't always rigid because we have minimal space and thus minimal thickness and rigidity - It is hygienic

Mandibular Major Connectors Comparison ( present, ? Uncertain, x ( absent

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: Conclusions about the mandibular major connectors Lingual bar and sublingual bar are routinely used Lingual plate can be used when there is insufficient depth of sulcus, inoperable mandibular tori, and for patient with high muscle or high lingual frenum attachment

Lingual plate is also indicated when anterior teeth have poor periodontal support and need stabilisation
A labial/buccal bar is rarely indicated -

** Minor connectors

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Minor connectors that join clasp assemblies to major connector (green colour in the ( picture Minor connectors that join indirect retainers to major connectors (orange colour ( in the picture Minor connectors that join denture bases to major connectors (purple colour in the ( picture Minor connectors that serve as approach arms for vertical bar type clasps (blue : colour in the picture), these include

Open construction <<

Need more interocclusal space than mesh because the metal is thicker Setting of teeth is easier (that's why it isn't always true to say that open lattice needs more interocclusal space since teeth in here get in ( between the transverse slots

Mesh construction <<

Need less interocclusal space because the metal is thinner Setting of teeth is very difficult (we might trim the entire tooth to be able to set it ( properly If used it allows us to do relining later on -

** Indirect retention
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Is useful in a tooth-mucosa borne denture to help prevent lifting of the saddle away from the mucosa Is provided by either a rest (top picture) or a maxillary -

major connector (bottom picture) placed on the opposite

side of the axis of rotation

** References
A Clinical Guide To Removable Partial Dentures : Davenport et al A Clinical Guide To Removable Partial Dentures Design : Davenport et al -

: Done by
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Tahany Mazen Abu Al-Teen

Who appreciates ART is no less than who creates it... What if we are in a position to create it guys ;) .. Shine on

I insisted to have my last lecture summarized in the field of Prosthodontics (; because the first lecture I summarized was in Prosthodontics

1st lecture summarized >> was the 7th lecture in the course of Introduction to dentistry, 24/7/2007, was lectured by Doctor Bilal Mas'oud Last lecture summarized >> is a review lecture in the topic of Cr-Co RPD design concepts, 1/5/2011, was lectured by Doctor Anas AlIbrahim
And there are so many lectures in between; each one of them is a whole experience for me and a pleasant journey where I sailed in the mind of each lecturer, trying to figure out the unique way he thinks and exploring his perception of the topic he lectured in my own way , I actually found myself in . summarizing, as I found unlimited ultimate passion that can't be described I do love you Dentistry. This is my true feeling as I know I might be living similar experiences while attending any other school because it is me maybe who determined the way it should go and end, however I can't deny how much being a dentist polished and finished every single detail of my personality and also .. designed the geographical map of my life As I'm going back to the old times when I was a first year dental student and exploring all those friends who showed up, remained, gone, the old ones who are still here and the new ones who were never there and now they are here, I just feel a sparkle shining everywhere in the air, charging my soul with unexplained amount of positive energy and warmth .. And yeah I now realize that it doesn't matter the way we begin it as it matters the way we end it .. We can begin it
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anyway but we should always end it the proper way .. I know that sometimes it is a must that we begin doing things the proper way to continue doing them the proper way and end them properly too but how many of us can guarantee this??!! There's still hope that we can end in the right trail whatever path we were following all these old times .. We just need a little faith and believe a little push.. And too much patience And how much having the right people around is essential, as I know that we are also lucky enough to have the "not right" people around sometimes because you can learn from those people what you can't learn from any others .. you can know more about yourself, the way you deal with certain situations, the way you might force certain people to look at you, and what they might be expecting from you, and lot of other things .. so never consider yourself unlucky to suffer from anyone just because you didn't pick him carefully .. What is now a wound, is a healed scar later, and how many scars we need to have to learn??!! The more we .. have the more we learn .. and the more we learn the luckier we are And as a second space maintainer has longer median survival time than the first one not because it is technically better but because our perception for the case is now better, Re-Friending (let's call it) who was supposed to be "not right" in the past might be a rewarding friendship and experience in the future .. friendships can happen anytime, and relationships can never be deadly ended .. we are supposed to get maturer .. and so our perception .. what was supposed to be .. vague in the past, is supposed to be clearer (not totally clear) now At the end, who we are now is what matters .. And what those experiences .. carved in our image about life is what matters as well As I'm looking back to the old Tahany and exploring the updated version of me ;P I just laugh hhhhh .. though I used to love the old me since PARTs of her are still somewhere here, but I'm so satisfied about whom I get .. we might lose ourselves at certain tracks .. it doesn't matter, having a new adventure and adding a new experience to our life, what matters is to understand the gift everyone of us is blessed to have (the true You ) and try to get ourselves to the right track again .. nothing is more relaxing, honest, rewarding than being .. You and only You whatever you are trying to prove

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I would like to thank the 8 lettered word "Thank You" since it helped me a lot to express my pleasure to deal with lot of people and lot of experiences in the past and still do.. and now I can feel this word is weak and disabled to help me as it used to in the past .. you Mom and Dad, Amani (my soul twin), Wa'el, Na'el and also 3addoool .. who believed in me from the beginning and never stopped doing so .. you are my gift .. I would never be me without you standing beside me all the way through .. you are my treasure .. and as I'm trying to get better and better, only you I want to make proud of me .. thanks for all the love, the care .. thanks for being my HOME .. thanks for being so GREAT and so PERFECT .. Thanks ^ the last number in the world .. for everything u did and u still do and .. u will do in the future enshalla .. your ability to give is unlimited And you my friends .. all of you .. what would I say? .. with you I traveled through so many cultures .. knew loads of stuff .. and shared so many wonderful amazing indescribable moments .. Thank you for letting me part of your life .. thank you for considering me a sister of yours .. thank you for all those laughs, stand ups, happiness tears, successes, craziness, and so many other things that I feel grateful to live and experience while you are around .. I do love you all .. and I wish we can keep on touch as much as we can in the future .. I'm not creating any drama scene in here .. LoL .. I just wish we can and I hope we will I hope I could leave a good reason for anyone of you to remember me .. I hope I could leave a good impression .. precise secondary impression with a good impression material .. so that when I meet you in the future you would be .. remembering me Shine on guys .. keep on believing .. get more passionate .. love what you do before you have the chance to do what you love .. appreciate people more .. Aspire before you inspire .. appreciate beauty before you would be able to create any .. be ALIVE guys .. be ALIVE Thank You

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