1 introduction & preview
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The document outlines the course information for a clinical removable partial dentures course, including objectives, contents, references, assessment methods, and weighting. The course is intended for 9th level students and consists of both lecture and clinic components. Key topics covered include diagnosis and treatment planning for partial edentulism, principles of partial denture design, mouth preparation, impressions, framework fitting, occlusion, and delivery. Student assessment includes written exams, oral exams, and a final practical exam.
![1- No abutment tooth posterior to
edentulous space (Free end edentulous area)
unilateral or bilateral. [Free end saddle]
2- Long edentulous bounded span, too
extensive for fixed restoration. FPD
INDICATIONS FOR REMOVABLE
PARTIAL DENTURES
18
FPD
RPD
Free end saddle
Dr. Hamada Mahross](https://image.slidesharecdn.com/1-introductionpreview-220110105645/85/1-introduction-preview-18-320.jpg)
1 introduction & preview
- 1. الرحيم الرحمن هللا بسم Produced by Dr Hamada Mahross Assistant professor of prosthodontics 1 Dr. Hamada Mahross
- 2. Clinical removable partial denture 2 Course Information Course Title Clinical Removable Prosthodontics 1 Course Code 522 PSD Credit Hours 2 Credit hours / one clinic & one lecture Academic Level Level 9. Prerequisites 423 PSD Pre-Clinical Removable Prosthodontics 2 Year / Semester 1st semester 2021/2022 Course Director Dr. Hamada Zaki Mahross Dr. Hamada Mahross
- 3. 3 Course Contents Lecture References Introduction to the course Diagnosis & treatment planning of partially edentulous patient. McCracken’s Removable Partial Prosthodontics 12th edition, Mosby Co. 2011 Chapter 4, 12. Biomechanics of RPDs McCracken’s Removable Partial Prosthodontics 12th edition, Mosby Co. 2011 Chapter 10. Principles of partial denture designing & Writing work authorization McCracken’s Removable Partial Prosthodontics 12th edition, Mosby Co. 2011 Chapter 13, 14. Mouth Preparation for RPD McCracken’s Removable Partial Prosthodontics 12th edition, Mosby Co.2011 chapter 15, 16. Impression materials and procedures for RPD Removable Partial Dentures, A Clinician’s Guide by John D. Jones & Lily T. García, Blackwell Publishing, 2009. Fitting the metal framework McCracken’s Removable Partial Prosthodontics 12 th edition, Mosby Co. 2011 Chapter 17. Dr. Hamada Mahross
- 4. 4 Establishing occlusal relationship for RPD Removable Partial Dentures, A Clinician’s Guide by John D. Jones & Lily T. García, Blackwell Publishing, 2009. Stewart’sClinical Removable Partial Prosthodontics 4th edition, Quintessence Pub Co; 2008 Chapter 14, 15. Try-in completion and delivering the RPD Stewart’s Clinical Removable Partial Prosthodontics 4th edition, Quintessence Pub Co; 2008 Chapter 16. Patient complaints following insertion of the RPD McCracken’s Removable Partial Prosthodontics 12th edition, Mosby Co. 2011 Chapter 18. Laboratory procedures for construction of RPDs McCracken’s Removable Partial Prosthodontics 12th edition, Mosby Co. 2011 Chapter 18, 21, 22. Repair, Relining & Rebasing the Removable Partial Dentures McCracken’s Removable Partial Prosthodontics 12th edition, Mosby Co. 2011 Chapter 12. Revision Final Exam Dr. Hamada Mahross
- 5. Student assessment methods 1. Written exam. (Mid-term & Final-term exam.) 2. Oral exam. (For practical understanding as an item of evaluation criteria.) 3. Final Practical exam. Weighing of assessment components 1. Practical student work. (30%) 2. Practical final exam. (Oral and practical 20 %) 3. Midterm written exam. (20%) 4. Final written exam. (30%) 5 Dr. Hamada Mahross
- 7. INTRODUCTION To REMOVABLE PARTIAL DENTURES (RPD) 7 Dr. Hamada Mahross
- 8. Objectives At the end of this lecture the students must be knowing: 1- Different terminology used during course study. 2- Indication ,advantages and objectives of RPD. 3- Methods of RPD classification. 4- Steps of RPD construction clinically and laboratory. 5- Different casts used during treatment with RPD. 8 Dr. Hamada Mahross
- 9. Dr. Hamada Mahross 9 Contents - Terminology & definitions. - Classifications of partial dentures. - Applegate's rules - Partial denture components. - Steps of RPD constructions - Different casts used during RPD construction.
- 11. •Prosthesis Is an artificial replacement of an absent Part of the human body. •Completely Edentulous Patients Patients having all their teeth missing . •Partially Edentulous Patients Patients having one or more but not their entire natural teeth missing. 11 Dr. Hamada Mahross
- 12. partial dentures • Removable Partial Denture = R.P.D • Fixed bridge= F.P.D • Implant; fixed or removable 12 Dr. Hamada Mahross
- 13. Removable Partial Denture (RPD) • it is an appliance or device replacing one or more natural teeth but not all the teeth and associated oral structures which can be removed with the patient. 13 Dr. Hamada Mahross
- 14. Partial edentulous areas; Posterior Free End Edentulous Area (Distal extension edentulous area): An edentulous area, which has an abutment tooth anterior to it, may be; - Unilateral (class II Kennedy) or - Bilateral (Class I Kennedy). 14 Unilateral Bilateral Dr. Hamada Mahross
- 15. 15 Middle Bounded Edentulous Area: - An unilateral edentulous area, which has an abutment tooth on each end, anterior and posterior to it (Class III Kennedy). Anterior (mesial extension edentulous area) Single, bilateral edentulous area located anterior to the remaining natural teeth. (Class IV Kennedy). Partial edentulous areas; Dr. Hamada Mahross
- 16. Abutment: - A tooth, a portion of a tooth, or that portion of a dental implant that serves to support and/or retain prosthesis. 16 Dr. Hamada Mahross
- 17. INDICATIONS Of REMOVABLE PARTIAL DENTURES 17 Dr. Hamada Mahross
- 18. 1- No abutment tooth posterior to edentulous space (Free end edentulous area) unilateral or bilateral. [Free end saddle] 2- Long edentulous bounded span, too extensive for fixed restoration. FPD INDICATIONS FOR REMOVABLE PARTIAL DENTURES 18 FPD RPD Free end saddle Dr. Hamada Mahross
- 19. 3- Periodontally weak teeth not sufficiently sound to support fixed- partial denture. 4- With excessive loss of residual bone, the use of labial flange or need to restore lost tissues. Why ???? 19 Dr. Hamada Mahross
- 20. • why/ ??? If fixed bridge used With excessive loss of residual bone, space is seen under the pontic can affect; - Esthetic - Impact food (oral health) - Annoying the patient. 20 Dr. Hamada Mahross
- 21. Excessive loss of residual bone use of flanged denture to restore lost tissues (tissue + teeth) INDICATIONS FOR REMOVABLE PARTIAL DENTURES 21 Dr. Hamada Mahross
- 22. 5- After recent extraction or surgery; usually done only to improve esthetics, or for patient satisfaction e.g. immediate denture. 6- Young age (less than 17 years) due to high pulp horn. Young INDICATIONS FOR REMOVABLE PARTIAL DENTURES 22 Dr. Hamada Mahross
- 23. 23 7- Need of bilateral bracing (cross arch stabilization); - In case of fixed restoration the bridge only attached on surrounding abutment and no need for extension to other side of the arch (unilateral bracing and stabilization) - In case of RPD extension to other side is obligatory even replacing short span to engage more abutment (for more bracing and stabilization) and wide distribution of load. (bilateral bracing and stabilization). Dr. Hamada Mahross
- 24. Dr. Hamada Mahross 24 • Cross arch stabilization and bracing must be considered during RPD design, as in case of upper class I if used palatal anterior strap or plate only the most remote posterior part of saddle subjected to flexure ( Tail-fish movement) causing metal fatigue and damage to underling structure so, the posterior two saddle must be connected with posterior palatal bar or strap crossing the arch for more stabilization.
- 25. 8- Enhancing esthetics in anterior region, by the use of translucent artificial teeth instead of dull fixed partial denture pontic. Or replace gingival tissue with red acrylic. 9- Economic considerations, attitude and desire of the patient. 10- suitable for medically compromised patient, or patients with deficient supporting structure for implant or fixed restoration. 25 Dr. Hamada Mahross
- 26. – Muller M. De Van’s dictum, (1952) “It is more important to preserve what already exists than to replace what is missing” OBJECTIVES OF REMOVABLE PARTIAL DENTURES The main objective of any prosthetic procedures is the preservation; 26 Dr. Hamada Mahross
- 27. OBJECTIVES OF REMOVABLE PARTIAL DENTURES 1- Preservation of the Remaining Tissues; A- Preservation of the health of the remaining teeth. B- Prevention of muscles and TMJ Dysfunction C-Preservation of the residual ridge. D- Preservation of the tongue contour and space. 27 Dr. Hamada Mahross
- 28. - Replacement of lost teeth prevents the migration of teeth into the edentulous area following the loss of the natural dentition. - Change the pattern of mandibular closure and Normal masticatory cycle as a result of loss of some teeth. 28 OBJECTIVES OF REMOVABLE PARTIAL DENTURES Dr. Hamada Mahross
- 29. 2- Restore the Continuity of the Dental Arch to Improve Masticatory Function. 3- Improvement of Esthetics, speech and Providing Support to the Para-oral Muscles, Lips and Cheeks and vertical dimension of face. 4- Enhance psychological comfort OBJECTIVES OF REMOVABLE PARTIAL DENTURES 29 Dr. Hamada Mahross
- 30. ADVANTAGES OF REMOVABLE PARTIAL DENTURE OVER FIXED PARTIAL DENTURE 1- RPD constructed for any case whilst FPD are confined to short spans bounded by healthy teeth and with a normal occlusion. 2- Cheaper than fixed partial denture 3- They are more easily cleaned 4- They are more easily repaired 5- No tooth reduction is required 30 Dr. Hamada Mahross
- 31. CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES 31 Dr. Hamada Mahross
- 32. CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES WHY?????? Classifications are important to facilitate communication between the dentist and the laboratory technician. Requirements of an Acceptable Classification: 1- Permit immediate visualization of the type of partially edentulous arch 2- Permit immediate differentiation between bounded and free extension RPD. 3- It should be universally accepted 32 Dr. Hamada Mahross
- 33. CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES I- Classification According to the Extent of the Removable Partial Denture: 1- Unilateral RPD (Removable Bridge) 2- Bilateral RPD 33 Dr. Hamada Mahross
- 34. CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES So, the following considerations must be observed: 1- long clinical crown of abutment tooth to increase lateral bracing. 2- Buccal and lingual surfaces of the abutment tooth must be parallel to resist tipping forces. 3- Retentive undercuts should be available on both the buccal and lingual surfaces of each abutment. X √ Unilateral RPD (Removable Bridge) The problem with unilateral appliance is less stability as no cross arch stabilization. 34 Dr. Hamada Mahross
- 35. N.B Unilateral RPD (Removable Bridge) should be used with caution, as the chance of the denture becoming dislodged and aspirated is too great Caution thermo flex 35 Dr. Hamada Mahross
- 36. Bilateral RPD: which restore missing teeth and extended on both sides of the dental arch. - Extend to other edentulous side to restore missed teeth or other sound side to add more retentive and stabilizing component. CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES 36 Dr. Hamada Mahross
- 37. CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES II- Classification According to the type of support of the R.P.D.: 1- Tooth Supported RPD (Tooth-borne) removable partial denture 2- Tissue Supported RPD (Tissue-borne) removable partial denture 3-Tooth and Tissue Supported RPD (Tooth and tissue borne) Tooth Supported RPD Tissue Supported RPD Tooth and Tissue Supported RPD 37 Dr. Hamada Mahross
- 38. CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES II- Classification According to the most posterior edentulous span or space location ( Kennedy’s classification) Class I: Bilateral edentulous areas located posterior to the remaining natural teeth. Class II: Unilateral edentulous area located posterior to the remaining natural teeth. Class III: Unilateral edentulous area with natural teeth, both anterior and posterior to it Class IV: Single, bilateral edentulous area located anterior to the remaining natural teeth. 38 Dr. Hamada Mahross
- 39. • The numeric sequence of the classification system is based on the frequency of occurrence of each class. • Class I being the most common while class IV is the least common. • Kennedy's classification was then modified by Applegate • Additional edentulous areas are referred to as modification spaces and are designated by their number. CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES 39 Class Class modification Dr. Hamada Mahross
- 40. Applegate's rules for applying Kennedy classification 40 Dr. Hamada Mahross
- 41. Applegate's rules for applying Kennedy classification Rule1 Classification should follow mouth preparations, since further extractions may alter the class. Ex. If the left molar is extracted class III becomes class II X 41 Dr. Hamada Mahross
- 42. Applegate's rules for applying Kennedy classification Rule2 If the third molar is missing and not to be replaced, it is not considered in the classification. Rule3 If the third molar is present and to be used as an abutment, it is considered in the classification. 42 Dr. Hamada Mahross
- 43. Rule4 If the second molar is missing and not to be replaced, because the opposing second molar is also missing, it is not considered in the classification. Rule5 The most posterior edentulous area (or areas) always determines the classification. 43 Dr. Hamada Mahross
- 44. Applegate's rules for applying Kennedy classification Rule 6 Additional edentulous areas other than those determining the class are referred to as modification spaces and are designated by their number. Rule7 The extent of the modification is not considered, only the number of additional edentulous areas . 44 Dr. Hamada Mahross
- 45. 45 Rule 8 There is no modification areas in class IV arches, because if there is a posterior edentulous area beside the anterior one, the former will determine the class and the anterior edentulous area will be a modification to the class. Applegate's rules for applying Kennedy classification Dr. Hamada Mahross
- 46. Practice for classifications X 46 X Dr. Hamada Mahross
- 47. The Component Parts of Removable Partial Dentures • RPD component parts: 1- Denture base carry the teeth 2- Connectors – major connector – minor connector 3- Retainers – direct retainer (clasp or attachment) – indirect retainer 47 Dr. Hamada Mahross
- 48. Steps of Removable Partial Dentures construction I- Clinical steps II- Laboratory steps 48 Dr. Hamada Mahross
- 49. 1- History taking , examination & diagnosis. 2- primary impression in suitable stock tray. Clinical step Steps of Removable Partial Dentures construction 49 Dr. Hamada Mahross
- 50. 3- Pouring the impression in dental stone, to construct the diagnostic cast; a. Surveying the study cast & designing of the RPD b. Initial Design is drawn on the study cast c. Construction of the special tray Laboratory steps 50 Dr. Hamada Mahross
- 51. 4- Mouth preparation 5- Final impression Clinical steps 51 Dr. Hamada Mahross
- 52. 6- Pouring the impression for making master cast. a- Surveying the master cast. b- transferring the design from the study cast & drowning it on the master cast. c- Block- out & relief of the master cast (modified master cast). Laboratory step 52 Dr. Hamada Mahross
- 53. 7- Duplication of the master cast by extra hard stone to withstand melting point to make investment or refractory cast or modified cast (modified by relief and blackout). - Drying the investment cast & beeswax dip Laboratory step 53 Dr. Hamada Mahross
- 54. 8- Waxing up the framework - Spruing the waxed framework - Investing refractory cast - Burnout of wax pattern Laboratory step 54 Dr. Hamada Mahross
- 55. 9- Casting the framework 10- Removing the casting framework from model for Finishing & polishing and cut sprues. Laboratory step 55 Dr. Hamada Mahross
- 56. 11- Fitting & try-in the framework in the Pt’s mouth. 12- Special impression procedures for tooth-tissue support RPD. Clinical steps 56 Dr. Hamada Mahross
- 57. 13- Pouring functional impression or altering the master cast. 14- Construction of record block Laboratory step 57 Dr. Hamada Mahross
- 58. 15- Recording jaw relationships - Orientation of planes (occlusal plane , midline, canine line, high and low lip line). - Vertical dimension relation (OVD and RVD) - Centric relation record - Face bow record. - selection of artificial teeth Clinical steps 58 Dr. Hamada Mahross
- 59. 16- Mounting the master casts on an articulator 17- Setting up of artificial teeth Laboratory step 59 Dr. Hamada Mahross
- 60. 18- Esthetic try- in & waxed denture try- in. Clinical steps 60 Dr. Hamada Mahross
- 61. 19- processing of acrylic - Flasking - Wax elimination. - Packing of acrylic resin - Curing of acrylic resin - Deflasking, finishing & polishing Laboratory step 61 Dr. Hamada Mahross
- 62. 20- Insertion & delivery of the finished denture Clinical steps 62 Dr. Hamada Mahross
- 63. Different Types of Casts and impressions used in RPDs Construction 1- Diagnostic Cast, Primary cast, study cast 2- Secondary cast, master cast, working cast 3- Refractory Cast, investment cast, modified cast 4- Altered cast 63 Dr. Hamada Mahross
- 64. Diagnostic Cast& primary cast • Used as a diagnostic aid. May be considered as primary cast and used for special tray construction. • Made from diagnostic impression or primary impression. • Made before mouth preparation, 64 Dr. Hamada Mahross
- 65. Master Cast • More definite cast, made after mouth preparation . • Used for surveying, final design drawing, duplicated to refractory cast, final construction of the denture. • Knowing by all mouth preparations appear on it (rest seat, guide planes, …etc. • Made from secondary impression. 65 Dr. Hamada Mahross
- 66. Refractory Cast • It is a cast made after modification and duplication of master cast. • Made of material that withstand high melting point temperatures of metal without disintegrating (called also investment cast, modified cast). • Used for waxing up framework, construction of cast metal framework. • Knowing by blocking out, relief and other feature on master cast. • Made from duplicated master cast. 66 Dr. Hamada Mahross
- 67. Altered Cast • Made for teeth-mucosa borne type partial denture, • Made after framework construction and functional impression make. • Constructed from master cast and new pouring free end area recorded by functional impression. • Used for final denture construction. 67 Dr. Hamada Mahross
- 68. Summary • RPD is an appliance for replacing one or more natural teeth with their associated oral structures and can be removed with the patient. • RPD is an appliance used for all cases not accepted the fixed bridge. • using of RPD can preserving the remaining tissue, teeth, TMJ, masticatory efficiency, speech and esthetic. • there are many method for RPD classification according to location of edentulous area, type of support or denture extent. • clinical and laboratory steps must be followed regularly for good end come results. 68 Dr. Hamada Mahross
- 69. Quizzes • A tooth, a portion of a tooth, or an implant that serves to support and/or retain prosthesis termed: a- Framework. b- Occlusal rest. c- Abutment. d- Proximal plate. • A unilateral edentulous area, which has an abutment tooth on each end, anterior and posterior to it, this edentulous area can be classified as: a) Class I Kennedy b) Class II Kennedy c) Class III Kennedy d) Class IV Kennedy • It is a cast made after modification and duplication used for waxing up framework, construction of cast metal framework: a) Master cast b) Refractory cast c) Altered cast d) Diagnostic cast 69 Dr. Hamada Mahross
- 70. 70 References 1- Stewart’s Clinical Removable Partial Prosthodontics 4th edition, Quintessence Pub Co; 2008 chapter 1, pg: 14-46. 2- McCracken’s Removable Partial Prosthodontics 12th edition, Mosby Co. 2011 chapter 3 pg: 17-20 Dr. Hamada Mahross
- 72. Thank You 72 Dr. Hamada Mahross