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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.