Acrylic Removable Partial Denture

Lecture 3, part 2: This lecture is VERY important and simple (2nno mosh kol marra btemshy 3aleena hal jomle ya Dr.Sale7 :S ) , and it is a review of what I gave you last year, in addition to that, you started selecting partial denture cases so its gonna be clinically useful for you. What is the treatment option of partial edentulous patients? 1234NO treatment. RPD (Removable Partial Denture) FDD (Fixed Partial Denture) Implant supported prosthesis.

Note! These points are not in sequence, so dont start with No treatment and then you move to RPD! No, they are options and you choose one of them!!! (-.-)

- First option: No Treatment. When is no treatment a choice!?

Examples: missing eight; there is no clinical importance to replace a missing eight!

missing seven, what is the advantage of replacing lower right seven for
example? Is it aesthetically important? Most of patient NO, except for patient who, during smiling, have a big mouth opening, so it might show, but usually over 90 % of the patient it doesnt show, so there is no aesthetic problem. Is there a functional problem? Does a patient with missing seven lose one kilo gram every year? No, bel 3aks, partially edentulous patient are usually over weight!
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So there is no functional problem to replace the tooth. We may replace it for one reason which is the stability of the dental arch, because in a missing teeth, what happen to the adjacent teeth? Drifting, what happen to the opposing tooth? supraeruption, but even this is not a main reason to replace a missing seven, because these changes dont happen in all patients! It happens just in 20 % of patients, and if they happen they usually happen shortly after extraction, and usually the patient who complains of missing tooth already extracted long time ago.

So there is no real scientific reason to replace the missing seven.

It is very good to examine the risk versus benefit, for each and every procedure there is morbidity or risk, and you have benefit in the other side, so you have to balance between them.
Example: if am gonna replace missing lower seven with a bridge, fixed partial denture, what is the risk or morbidity? First of all you will do preparation for two sound vital teeth, and there may become pulpitis, in addition to the costs! What are the benefits for that procedure? Nothing! So risk versus benefit says no treatment.

- Second option: RPD. - Third option FPD or what is called bridge. - Fourth option: implant supported prosthesis. Either fixed or removable; an important point is that some students think that implants are always fixed! Thats wrong; implants can be removable and can be fixed.

Definition of RPD: it is a prosthesis that replaces some teeth in a partial edentulous arch. It can be removed from the mouth and can be replaced as well.

Types of RPD: 1- Mucosally supported: like the acrylic RPD, but that doesnt mean that the acrylic RPDs are complete mucosal supported! usually it covers the lingual surface of teeth, in addition to the clasps, so it is mainly and not completely supported by the tissue. 2- Tooth supported or tooth mucosal supported, which is the metal framework RPD.

The students always cant differ between indications and advantages, when I ask; what are the indications of a RPD he says cheap! Indications means; when do we prescribe removable partial denture for a patient, so you say, for example, free end saddle and the patient cant afford implants, this is an indication, but cheap is an advantage. Now some indications are advantages, for example one of the indications for an RPD is a multiple edentulous area, so to simplify the treatment you make him a RPD prosthesis, so it is an indication, and at the same time it is an advantage, when you have multiple edentulous areas it is easy to use a removable partial denture.

So an indication is not always an advantage, and a contraindication is not a disadvantage, but sometimes an indication might be an advantage.

Indications for an RPD: 1. 2. 3. 4. 5. 6. 7. 8. 9. Long span edentulous area. No abutment tooth posterior to the edentulous area. Reduced periodontal support for remaining teeth. Excessive bone loss within the residual ridge. Physical or emotional problems exhibited by patients. Esthetics. Immediate replacement of teeth that need extraction. Patient's desire. Unfavorable maxillomandibular relationships.

Advantages for an RPD: 1- It restores function and esthetics. 2- It improves speech and occlusal stability. 3- Replaces one or more missing teeth in one side or both sides of the upper or lower jaw. 4- More affordable than fixed. Because it is very cheap. 5- Replaces missing soft tissue and bone as well. 6- Less accurate techniques than fixed prosthesis and easy occlusal adjustments. 7- Easy to clean because it's removable. 8- May provide as an interim prosthesis. During extensive treatment. 9- Quite easy to adjust, and add more teeth easily if later loss of a tooth occurs. And this is a special advantage for acrylic partial dentures Disadvantages for an RPD: 1- Can cause caries for adjacent teeth depending on the design of the RPD, and the age of the patient; young patient usually dont like RPDs but even though there is a big percentage of young patients, even in the complete denture, and the oral hygiene efficiency, even it is removable, but most denture are not cleaned well, this usually cause infections.
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2- Can damage the supporting tissues if poorly designed and cause tooth loosening and mucosal ulceration, because they are removable. 3- Unsuitable for many patients who don't like removable prosthesis 4- The RPD rotates during function especially the mucosally or duallysupported one (because of the compressability of the oft tissue) which reduces efficiency and increases trauma. 5- Its construction involves some preparation and adjustment of the remaining dentition. We need to do adjustment on teeth, especially in metal framework in which we have rests and so on 6- The acrylic teeth wear and require later replacement, Especially if the opposing teeth are porcelain or natural teeth. If the opposing are acrylic teeth it will not be a big problem. 7- The clasps may be unaesthetic if placed anteriorly. 8- May stimulate candidal infection of the mucosa underneath, especially if it is not cleaned frequently and after meals. And also if the RPD is not stable. 9- The acrylic has low impact strength and may fracture. A lot of patient comes to the clinic duo to broken dentures. 10Bone resorption if mucosally or dually-supported and frequent relining may be required. 11Bulky if compared with fixed prosthesis, and so uncomfortable for new wearers. 12Some patients complain of reduced thermal sensation, specially with upper RPD covering the palate. 13Better to be removed at night for tissue re-adaptation, a lot of wives dont remove the prosthesis during night, and some husbands even dont know that their wives are wearing prosthesis!!!

The difference between acrylic RPD and Metal RPD is the material of the base, Acrylic RPD has acrylic base, and metal RPD has metal base, but both of them has acrylic components, like the flanges and teeth.
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Types of Provisional/ Temporary Acrylic RPD: 1- Interim RPD: Which is not the final or definitive treatment, usually we prescribe it for patients if age or health is of some issue, like young patient, 12 years old, implant and bridge is not an option, so in this case we use a RPD, or a patient is medically compromised, like uncontrolled Diabetes, we construct an RPD temporary until it is controlled. 2- Transitional: Usually for periodontally compromised teeth, since it is a big psychological trauma to directly transverse the person from dentate to edentulous, so I construct a partial denture for the missing teeth, and from time to time we continuo extracting the other hopeless teeth, and adding acrylic teeth to the denture, therefore we call it transitional. 3- Treatment: When we have fungal infection, so that the denture is a carrier for medicaments for the infection. Now Dr Sale7 started talking about the advantage again!! But focused that these are the MAIN one: MAIN advantages: 1- Cheap 2- Easy to construct 3- Easy to adjust

MAIN disadvantages: 1- Bulky 2- Weak

3- Damage the soft tissue, thats why it is called sometimes gum stripper or sometimes flipper. So if you remove the partial denture, especially if they cover the gingival margin, you will see that the gingival margin is pushed down, causing recession, and the gum is inflamed, so the gum is stripped. 4- Plaque accumulation and periodontal breakdown, because acrylic itself harbors bacteria and plaque, so if you examine any denture you will found it smelly with plaque on the fitting surface, specially for patients with poor oral hygiene.

5- Lateral forces and wedging on the teeth, The denture is a removable prosthesis, so as there is movement there will be lateral forces and wedging on the teeth, so there is always damaging forces and wedging on teeth.

The End
It is very useful to go back to the last year lecture (lecture 2, introduction to the RPD) it contains further more information, and Dr Sale7 emphasized to read it again.

This lecture is dedicated to My Group B2 And special regards to Dafers Daughters the two Wonderful flowers LEENAH & TALAH

Done by: Ammar Anagreh

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