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DENT2030 Block Notes:

Removable Partial Denture Design:

Indications for Removable Partial Dentures:


o Long-span edentulous area
o No distal abutment teeth
o reduced periodontal support for remaining teeth
o Excessive bone loss in residual ridge
o Aesthetics of concern (e.g. crowding, diastemas, soft tissue replacement)
o Patient shows emotional or physical problems
o Transitional for future complete denture
o Diagnostic for implant placement or future definitive metal denture
o Immediate need to replace extracted teeth
Patient Preferences:
o Whilst RPDs have unsatisfactory retention, they are preferred by older patients
as RPDs are associated with low cost and less complexity and time of
treatment
o FDPs (fixed dental prosthesis) are associated with high satisfaction rate (by
young and old age group patients) in terms of appearance, mastication and
speech
o Implant-supported restorations are preferred by patients with higher education
levels and significant aspect of patient satisfaction is the aesthetic level \
o Cost, desire for removability, complexity, time of treatment and risk of
problems during surgical procedures are variables that predict the refusal of
implant procedure)\
General Questionnaire:
o Medical history and personality assessment
o Diet history
o Dental history
o Reason for tooth loss (caries, periodontal disease, trauma)
o History of existing and previous RPDs
o Evaluate existing partial denture
o Intra-oral examination
o Evaluation of oral hygiene
o Caries susceptibility
o Patients responsibility in home care
o Obstacles (arthritis, dry mouth, systemic conditions)
o Make alginate impressions for diagnostic casts and to survey
o If suitable, take a bite record
Treatment Planning:
o Periodontal management
o Surgical modifications as needed
o Restorations/endodontics
o Fixed prosthodontic treatment
o Removable prosthodontic treatment

Important Radiographic Findings:


o Caries
o Endodontic lesions
o Assessment of bone loss and periodontal disease
o Retained roots
o Impacted teeth
Aesthetic Limitations:
o Tooth loss generally followed by recession of bone and soft tissues
o Clasp positioning
o Diastemas and recession leading to metal show-through
o Maxillary gingival display on animation
Functional Limitations:
o Large anterior or posterior cantilever length leading to rotation about the
abutment teeth and trauma
o Over-eruption
o Tilting of abutment teeth
o Loss of vertical dimension
o Mobile teeth
Studies Regarding RPDs:
o Studies conducted to determine effect of RPDs on oral structures particularly
the periodontium and remaining teeth. Results not unanimous
o Earlier studies report increased occurrence of caries and periodontal disease
which were extensive
o Others found mild periodontal injuries or practically no caries progression or
periodontal disease progression after RPD insertion
o RPDs promote plaque formation on abutment teeth and teeth in contact with
them
Evidence of Increased Caries:
o Direct relationship between wearing RPDs and prevalence of root caries is
strong
o Wearing of removable partial dentures predisposes to high salivary levels of
streptococcus mutans and yeasts
Impact of RPDs on Periodontal Patient:
o Impact of RPD wearing on periodontal health reported to be unfavourable
o Gingivitis more commonly found in glass I Kennedy than class II cases
o More frequently occurring in mandibular arch than maxillary
o Periodontal health of teeth can be maintained if principles of RPD design are
followed (rigid major connectors, simple design and proper base adaptation)
o Improper RPD design may lead to changes in tooth mobility and increased
probing depth due to increase in plaque bacteria accumulation
o Prior to RPD treatment, periodontal screening in terms of oral hygiene, plaque
and gingival inflammation presence, attachment loss, remaining osseous
support and mobility should be conducted followed by a definitive periodontal
treatment to eliminate periodontal disease, trigger defects that hinder plaque
control and create better cleaning environment
o Strategic extractions of periodontally weakened teeth should be performed

o Potential Further Modifications:


Multiple rests to ensure adequate vertical support remains when
abutment teeth are lost
Open lattice base strategically placed in maxillary major connector (to
facilitate replacement of future loss of teeth)
Location of finish lines modified to provide a smoother resin-to-metal
transition when posterior teeth are lost
Wire direct retainers that provide more physiologically acceptable
clasping of compromised teeth
10 year re-evaluation of 74 patients who had worn RPDs during that
time showed only 36% of dentures were free of hygiene related
problems. 36% had calculus on acrylic surfaces and 14% had calculus
on metal surfaces
However, longitudinal studies indicate that wearing of RPDs is not
associated with any deterioration of the periodontal status provided
good oral hygiene is maintained
High prevalence of plaque, gingivitis and gingival recession, especially
in dento-gingival surfaces in close proximity (within 3mm) to the
dentures
Increased need for regular oral hygiene reinforcement, scaling and
prophylaxis among RPD wearers
Low caries incidence in the study, root caries found to be associated
with contact with the RPDs (P<0.05) but coronal caries were not
Acrylic vs Chrome:
o Based on past prosthesis of patient
o Need for strength or reduced thickness
o Based on future additions required
o Transition to full denture
o Number of remaining teeth
o Patient wants/desires
o Time prosthesis needed
o Cost
o Advantages of Acrylic RPDs:
Less appointments required, reduced treatment time
Additions made easily with chemical bonding
Adjustments on insert relatively easy
Laboratory charge less
o Disadvantages of Acrylic RPDs:
Unknown pressure on abutment teeth since wrought wire clasps are not
precise
Thickness dictates strength of prosthesis
Fractures in areas of weakness and heavy occlusion
Plaque adheres better due to porous nature of acrylic

o Advantages of Chrome:
Can be polished to much thinner proportions without losing strength
Designed to distribute forces to abutment teeth
Rigid and well adapted to teeth and tissues
Rigid and allows soft tissues to take on masticatory force
Can weld on additions
o Disadvantages of Chrome:
Requires accurate master impression
Requires additional appointment for metal try-in
Additions are difficult and cannot be done chair-side
Requires precise planning
Inaccurate impressions may require complete remake
Additional lab cost for framework
o Chrome vs Acrylic Dentist Perceptions:
Dentist experience with chrome and acrylic
Dentists less experienced at providing cobalt-chromium based RPDs
were generally less willing to provide this type of prosthesis
Cobalt-chromium based RPDs seen as harder to get right first time and
more expensive to get wrong
o Chrome vs Acrylic Patient Perceptions:
Patients more motivated to wear their RPD if it filled upper anterior
gap as they felt gap would be obvious to others
RPDs also perceived as helping to support facial shape and for smiling
Aesthetic problems such as pink plastic on acrylic resin based dentures
being wrong colour or metal on cobalt-chromium based denture being
visible when they smiled
Lack of sensation of food in the mouth, inconvenience of having to
apply denture fixative regularly and rinsing dentures after eating and
negative patient based factors
Other negative impacts on physical function were instability of denture
in mouth (flipping), problems with speech and feeling of having
something in the mouth which could include gagging
In conclusion, patient education and continued maintenance essential to success of
RPDs and preservation of remaining structures

Principles of Removable Partial Denture Design Diagnostic Cast:

Objectives:
o Systematic protocol for designing cobalt-chromium partial dentures
o Understand components of CoChr partial dentures
History:
o Physical condition
o Psychological condition
o Frequency of dental examinations
o Previous dental treatment (especially RPDs)
Diagnostic Casts:
o Path of Insertion and Removal Must be different to path of dislodgement by
sticky foods which is perpendicular to the occlusal plane
o Rest Preparation Normally placed adjacent to the edentulous space, ideally
placed on sound tooth structure
o Embrasure Clearance Articulated casts will allow evaluation of clearance of
minor connector of suprabulge clasp over occlusal surface
o Cuspal Interference Articulated casts will allow space evaluation for metal
framework and denture teeth/base
o Excessive Contours Require Reduction Tilted/rotated and natural teeth may
have contours which do not allow for broad guide planes and allow for food
trap. Over contoured teeth may not allow for sufficient undercut for the
retentive clasp and may not promote or enable adequate oral hygiene practice
o Acute Angles Must be Rounded Metal framework cannot pass over acute
angles and this may create space to allow plaque accumulation. Use polishing
discs/burs to round line angles for better adaptation
o Retentive and Non-Retentive Areas of Abutment Teeth Abutment teeth
(adjacent to edentulous space) will often be clasped for direct retention.
Suitable undercuts are evaluated during surveying
o Creation of Undercuts Terminal tip of clasp must end in an undercut to allow
for direct retention. If suitable undercuts are not available these must be
created
o Presentation of Treatment Plan to Patient Patients desires should be
considered. Aesthetics, palatal coverage, previous successful designs and
alternative treatment plans should all be considered
o Fabrication of Individual Trays Remaining dentition checked for clasping
(e.g. periodontal issues, caries and endodontic lesions or heavily restored
teeth)
o Assist in Preliminary Design of RPD Working model is used for surveying
and design of final casting. Should be drawn to accurate dimensions and coded
to allow communication between dentist and dental technician. The borders of
the major connectors should be indicated and are the responsibility of the
clinician

Biomechanical Considerations:
o Tooth more able to tolerate vertical forces than it can oblique or horizontal
forces
o Force Application The lower the better
o The retention arm and clasp arm should contact tooth at the same time
o There are differentials in tissue resiliency
o Movement of the denture base means a torqueing force on the abutment tooth

Occlusal Plane:
o Make occlusal plane of the maxillary arch coincident with that of the
mandibular arch (less overlap)
Tilt:
o Try and minimise undesirable undercuts and maintain desirable undercuts
o Posterior Tilt Generally for replacement of anterior teeth
o Horizontal Tilt Generally best orientation. Equalise undesirable undercuts or
adjust the tooth
Design Sequence:
o After examination of the occlusal plane and establishing the most
advantageous orientation (tilt) of the cast, the RPD design can be formulated
o This is done using a sequence bearing in mind the factors elucidated in the
treatment planning
o Following Sequence is Used:
Rests Controls prosthesis in relation to the teeth
Major Connectors Rigid components that unites various parts of the
denture
Minor Connectors Component that unites other parts with major
connector
Retention Arms Flexible attachment that contacts abutment tooth
below the survey line
Reciprocation Arms Rigid attachment that contacts abutment tooth and opposes the
retention arm

Principles of Removable Partial Denture Design Surveying and Blocking:

Necessity of Surveying:
o To determine path of insertion (maximise desirable undercuts and minimise
undesirable undercuts)
o To determine position of desirable undercuts for retention
o To determine position of undesirable undercuts which need to be blocked out

Undercut Areas:
o Areas below point of contact of analysing rod and tooth or tissue surface

Non-Undercut Areas:
o Areas above point of contact of analysing rod and tooth and tissue surface

Analysing Rod:
o Used in a preliminary study of the model to locate tooth and tissue undercuts
Carbon Marker:
o Replaces analysing rod after desired tilt has been obtained and marks the
survey lines in the abutments
Undercut Gauge:
o Used as a guide in arriving at a correct tilt of the model and in measuring the
exact amount of retention needed for a clasp
o 0.01 Most cast claps
o 0.02 Wrought stainless steel clasps at least 8mm long and longer cast clasps
o 0.03 Wrought gold clasps
o You can be at the mercy of your technician
Support:
o The mechanical function which prevents tissue-ward movement of a partial
denture supplied primarily by well-designed occlusal rests on all abutments

Bracing:
o The mechanical function which prevents lateral shifting of a partial denture
supplied chiefly by rigid portions of the clasps
Retention:
o The mechanical function which prevents dislodgement of a partial denture,
mainly derived from the flexible clasp tips
Reciprocation:
o Counteracts the force of the retentive clasp arm and prevents movement of the
abutment tooth. Should stay above the height of contour for the entire length
of the clasp. The major connector can also serve as a reciprocator
Reinforcing Sheath:
o Used solely to strengthen the carbon marker and reduce the amount of
breakage
Survey Line:
o Mark around the tooth indicating its greatest circumference in any one
position relative to the vertical
Undercut Areas:
o Always below survey line and accommodate the flexible retentive positions of
clasp arms
Non-Undercut Areas:
o Always above the survey line accommodating occlusal rests and ridge portions
of clasps
Direct Retainers:
o Two teeth with survey lines at the same height but the clasp arm will need to
be placed much further below the line on the right in order to engage the same
degree of undercut
o Also known as clasps, can be suprabulge or infrabulge

The Four Survey Lines:

Blocking Out:
o Block out any undercut areas that will be crossed by rigid parts of the denture
(which is every part of the denture framework except the retentive clasp
terminals)
o In addition, block out areas not involved for convenience, ledges on which
clasp patterns are placed, relief beneath connectors to avoid tissue
impingement and relief to provide attachment of the denture base to the
framework (thin layer over the palate for instance)
Process of Fabrication:
o Following surveying and blocking out, the cast should be invested
o A wax pattern of the denture should be fabricated on the invested cast
o The cast should be sprued and is then ready to invest
o Following this it is cast with ingots
o After casting it is polished
Components of a Removable Partial Denture:
o Rests:

o Major Connector:

o Minor Connector:

o Retention Desirable Undercuts:

o Reciprocation:

Principles of Removable Partial Design Major Connectors and Rests:

Kennedy Classification:
o Allows for communication between clinicians and laboratory
o Different design principles based on classification
o Class I Bilateral distal extension:

o Class II Unilateral distal extension:

o Class III Tooth bound saddle area:

o Class IV Anterior saddle that crosses the midline:

Major Connectors:
o Unit of partial denture that connects part of the prosthesis located on one side
of the arch with those on the other side
o Unit of partial denture to which all other parts are directly or indirectly
attached
o Examples:
Anterior/Posterior Straps:

Full Coverage:

o Maxillary Major Connectors:


Single Palatal Strap:
Thin cross-sectional diameter making it versatile and well
accepted by patients
8mm minimum thickness A-P to avoid compromise if rigidity
Offers resistance to bending and twisting as constructed in 2 or
more planes
Increased tissue coverage helps with broad stress distribution
Increased soft tissue coverage may predispose to papillary
hyperplasia with continuous wear

Palatal Bar:
Limited to short class III applications
Should not be placed anterior to 2nd premolar as this may feel
uncomfortable to the patient due to bulk
Should be avoided due to bulk
Narrow A-P width means there is little vertical support from
the palate
A-P Palatal Strap:
Each strap should be 8mm wide
When anterior teeth are not replaced the anterior strap should
be as far posterior as possible for comfort
Open area should be a minimum of 20x15mm
Indicated in cases of palatal tori, loss of anterior or posterior
teeth
Rigid and can be made quite thin
Due to less contact with palate there is less support from the
palate and more from the teeth
Contraindicated with poor periodontal support
A-P Palatal Bar:
Anterior bar resembles palatal strap, posterior bar resembles
palatal bar and is bulky
Increased rigidity due to its shape (encirclement)
Same indications as A-P strap
May be uncomfortable due to tongue and phonetics due to bulk
Horseshoe:
Extends onto soft tissues 6-8mm thick
Borders should be at junction of horizontal and vertical portion
of the plate
Rigidity can be increased by extending borders onto horizontal
portion of the plate
Used primarily when anterior teeth are missing
Due to tendency to flex, not a good choice for distal extension
dentures or when cross-arch stabilisation is required
Due to limited resistance to flexing may have concentration of
forces that result in damage to abutment teeth
Full Palatal Coverage:
Ultimate rigidity/support/greatest amount of tissue coverage
Posterior border should have bead line but cant act as a postdam
Intimate contact with soft tissues increases retention through
adhesion and cohesion
Indicated in periodontally compromised teeth and short
alveolar ridge height
Enhances thermal conductivity
Can observe papillary hyperplasia with continuous wear

o Mandibular Major Connectors:


Lingual Bar:
Most frequently used due to simple design
Indicated for all tooth supported cases unless insufficient space
8-10mm required from gingival margin to floor of the mouth
(minimum 5mm thickness of bar)
pear in cross section
For increased rigidity, increase thickness of bar
Due to decreased tissue coverage there is less plaque
accumulation
Lingual Plate:
Inferior border should be as low as possible without interfering
with function
Should seal interproximally to prevent food pack
Should appear thin and knife edged on cingulum to prevent
tongue irritation
Step backs can be designed to limit metal show
Indicated in periodontally compromised dentitions where
additional splinting is beneficial, in the presence of tori or when
indirect retention through rests on either end is needed
Extensive tissue coverage may lead to soft tissue irritation with
continuous wear

Red is minor connector, blue is major


o Characteristics of Major Connectors Contributing to Oral Health:
Material Needs to be Compatible with Oral Tissues:
Acrylic
Metal (wrought stainless steel, cast cobalt chromium, cast gold
and titanium)
Rigid and uses principles of broad distribution using cross-arch
stability
Should not use flexible materials (e.g. Valplast)
Should not trap or retain food particles
Should not impinge on oral tissues when the denture is placed or
removed or rotates in function
Does not interfere with and should not irritate the tongue

Should not substantially alter the natural contour of the lingual surface
of the mandibular alveolus or the palatal vault
Cover no more tissue than is absolutely necessary
Contributes to support of the prosthesis
Needs support from other elements of the framework to minimise
rotation in function
o Other Major Connectors:
Cingulum bar
Sub-lingual bar
Labial bar
Support:
o Mucosal Support:
Tissue borne denture
Tissue borne denture needs to cover large area of mucosa
o Tooth Support:
Support against occlusal loading obtained almost solely from standing
teeth, usually adjacent to saddle area are tooth borne dentures
Denture gaining a lot of its support from standing teeth will cover less
mucosa than a denture obtaining support only from mucosa
Rests:
o Any unit of a denture that rests on a tooth surface that has been properly
prepared to receive them to provide vertical support
o Prepared surface on abutment tooth is the rest seat
o Purpose of Rests:
Maintain components in their prepared positions
Maintain established occlusal relationships
Prevent impingement of soft tissue
Directs and distributes occlusal loads to abutment teeth
o In Cases with no Rests:
Cannot maintain components in prepared position
Cannot maintain established occlusal relationships
Impinges on soft tissues
Does not direct and distribute occlusal load to abutment teeth
o Form of Occlusal Rest and Rest Seat:
Rounded triangular shape

Length/width is 2.5mm (if they are smaller they are too weak)
Marginal ridge needs to be lowered by up to 1.5mm
Floor should be concave and apical to marginal ridge
Rest:Minor connector angle should be less than 90o
Preparation of occlusal rest seats should always follow proximal
preparation (guide planes), never precede it

o Interproximal Occlusal Rest Seats:


Adjacent rests used to avoid interproximal wedging
Preparation may extend further to lingual and buccal

o Cingulum Rests on Anterior Teeth:


Canines preferred over incisors
Rarely satisfactory on lower incisors due to insufficient enamel
Preparation of Cingulum Rests:
Slightly rounded V
Floor needs to be perpendicular to long axis of the tooth
Place in a cast restoration

Cingulum rests function as indirect retention


o Incisal Rest:
Used mainly as auxiliary rests or as indirect retainers

Direct and Indirect Retention for Denture Bases:


Clasp Design and Indirect Retainers:
o Design clasps and indirect retainers to minimise tooth coverage
o Excessive coverage will increase plaque retention
o Gap between partial denture clasp and posterior tooth is a minimum of 6mm

Support:
o Resists tissue ward movement of prosthesis
o Distributes masticatory load
o Prevents damage to periodontal structures
Bracing:
o Resistance to horizontal movement of prosthesis
o Horizontal forces are generated during function by occlusal contacts and by
the oral mucosa surrounding the denture. These forces tend to displace the
denture in both antero-posterior and lateral directions
o Bracing occurs only when the denture is fully seated
o Posterior movement of the distal extension saddle is prevented by the
coverage of the retro-molar pad and the minor connector
o The distal end saddle can undergo rotation in the horizontal plane. If a single
abutment tooth is rigidly clasped, it can undergo considerable forces
Retention:
o Resistance to dislodgement in an occlusal direction
o Flexibility of metal determines amount of undercut
Shape, bulk and stiffness of metal determine flexibility
o Retentive areas similar on opposite sides of the arch
o Retention should be the minimum necessary to resist reasonable dislodging
forces
Reciprocation:
o Opposes the force exerted by the clasp arm terminal during seating and
unseating of the prosthesis
o Prevents tooth movement from over adjustment of clasps
o The reciprocal arm does not engage an undercut
Encirclement >180o:
o The clasp assembly must engage more than 180 degrees to prevent tooth
movement
o Prevents clasp from slipping off the tooth
o Minimum three-point contact is necessary
Passivity:
o When a clasp is in place it should not grip the tooth
Factors Affecting Resiliency of a Clasp:
o Cross-sectional size
o Length
o Taper
o Kind of metals (cast metal not as resilient as a wrought metal)
o Proper heat treatment will increase resiliency

Additional Factors in Proper Clasp Design:


o Position of survey line and undercut depth
o Occlusal rest must be thick enough
o Rests should never be placed on inclined surfaces
o When anterior teeth are replaced, lingual or Incisal rests should be placed in
prepared rest seats
o Clasp arms that cross a groove on a tooth should follow the groove contour to
maintain a uniform thickness
Types of Clasp:
o Suprabulge Pull type:
Approaches from occlusal aspect of the survey line
o Infrabulge Push (trip) type:
Approaches from the gingival aspect of the survey line
o Suprabulge Circumferential (Akers):
Clasp with arms that originate at the minor connector, usually near the
occlusal rest and approach the undercut from an occlusal direction

o Suprabulge Reverse C:
Modification of circumferential
Useful if undercut near embrasure where clasp arm originates

o Suprabulge Dev Van:


Clasp arm originates in the saddle and follows the line of the acrylic
saddle above the undercut and then turns

o Suprabulge Back action:


Engages 0.010 inches in the undercut on the distal if the buccal
undercut is small (0.010 inches or less)

o Suprabulge Ring:
Encircles nearly all the tooth
Engages 0.020 inches in the undercut in bilateral tooth borne partial
dentures
Frequently used with tilted molars
o Infrabulge Bar or roach:
The approach arm of a bar clasp must never impinge on soft tissue
The approach arm must never designed over a deep soft tissue
undercut

o Infrabulge RPI Clasp:


Important with a distal extension base
R Mesial rest
P Proximal plate
I I bar clasp arm

Indirect Retainers:
o A part of a removable partial denture which assists the direct retainers in
preventing displacement of an extension base by functioning through lever
action on the opposite side of fulcrum line
o In extension base partial dentures, dislodging forces occur which tend to lift
the bases and cause a displacement
o Imaginary lines drawn between distal rests will indicate fulcrum lines
o Indirect retainers are effective in proportion to their support and distance from
the fulcrum line, the further the better
o Types of Indirect Retainers:
Occlusal rest
Incisal rest
Cingulum rest
Others (lingual plate is poor and should not be considered as an
indirect retainer)
o Also important for reline procedures of extension base partial dentures
Denture Bases:
o Part of the RPD that rests on the oral mucosa to which the artificial teeth are
attached
o Consideration for Denture Bases:
Support is the primary concern
Cover the greatest area possible within the confines of the musculature
The base should be able to be modified or relined easily and
economically
o Types:
Plastic Resin Base:
Extension base RPDs
Long edentulous span
Relining anticipated
Strong junction between base and major connector
Tissue stops
Tight mesh not desirable
Metal Base:
Tooth supported RPDs with short spans
Inadequate occlusal space for a resin base
Dont over extend
Base can be thinner than framework for resin denture base
Avoid sharp margins in finishing

Fundamentals of Occlusion:

Occlusion:
o Static relationship between incising and masticating surfaces of the maxillary
and mandibular teeth or tooth analogues
Facial Types:
o Mesofacial:
Most symmetrical, balanced pattern
o Dolicofacial:
Increased lower face height
Increased mandibular angle
o Brachyfacial:
Reduced lower face height
Reduced mandibular plane angle
Angles Classification:
o Measuring parameter
o Based on first molars
o Class I, II and III
o Fails to address horizontal (over jet) and vertical (overbite) dimensions of
malocclusion
o Fails to address underlying skeletal discrepancy
Ideal Occlusion:
o A standard against which patient occlusion can be compared and evaluated
o Treatment plans can then aim to improve the occlusal scheme
Natural (Organic) Occlusion:
o Bilateral posterior centric contact
o Anterior guidance
o Mutually protective scheme of occlusion
o Ideally occlusion may be studied in be unrestored complete dentition
o Canine Guidance:
Form of mutually protected articulation in which vertical and
horizontal overlap of the canine teeth disengage the posterior teeth in
the excursive movements of the mandible
o Posterior occlude in centric relation only
o Incisors are only teeth contacting in protrusion
o Canines are only teeth contacting in lateral excursion
Lateral Movements Types:
o Group function
o Partial group function
o Canine guidance (posterior disclusion)
Group Function:
o Multiple contact relations between maxillary and mandibular teeth in lateral
movements on the working side whereby simultaneous contact of several teeth
acts as a group to distribute occlusal forces
o Whenever the arch relationship does not allow anterior guidance to do its job
of discluding the non-working side. Case by case choice

o Indications:
Class III with all mandibular anterior teeth outside of maxillary
anterior teeth
Some end to end bites
Anterior open bite
Periodontally/traumatically compromised canines
Partial Group Function:
o Allows some of the posterior teeth to share the load in excursions while others
contact only in MIP
Occlusion Disorders:
o Parafunction results in bruxism/clenching
o Missing teeth result in over eruption and tipping
o Loss of anterior guidance
o Malocclusions
o Organic occlusion is highest mechanical arrangement given to teeth
Signs of Instability:
o Hypermobility of one or more of the teeth
o Excessive wear (interferences)
o Migration of one or more teeth
Horizontal shifting
Intrusion
Supraeruption
Types of Contacts:
o Tripodization:
Tripod contacts difficult to accomplish but can be done as long as the
anterior teeth are capable of discluding the posterior teeth in all
excursions
Should not be used when posterior teeth are involved in group function
Errors in centric relation result in a loss of tripodization

o Cusp-tip-to-Fossa:
Easiest occlusion to equilibrate, offers stability and flexibility to
choose any distribution of lateral forces

Guidelines:
o When occlusal reconstruction is considered, the prosthetic replacement of the
articulating surfaces is the last phase of treatment
o Prior to prosthodontic therapy all active disease should be controlled, hygiene
should be optimized and periodontic, endodontic and orthodontic treatment
should be completed
o A comfortable, functional and physiologically appropriate position of the
condyles in the glenoid fossa must be achieved
o Braced, centric condylar position with an interposed disk in centric closure
o Occlusal forces directed along long axis of the teeth
o Working side dental contacts disarticulating teeth on the balancing side during
lateral excursion
o Anterior teeth disarticulating the posterior teeth during protrusive excursions
o Posterior teeth contact heavier than anterior teeth in centric or habitual
closure
Occlusal Vertical Dimension:
o Recording of the OVD should always precede the bite record
o Bite record in MIP or CR should be taken at the correct vertical dimension.
Failure to do so results in occlusal interferences and excursive interferences
o Consideration of facial shape and extent of vertical dimension increase should
be matched
o Measuring OVD:
Physiological rest position Freeway space (FWS)
To achieve rest position, ask patient to swallow then relax lips, ask
patient to pronounce M
Should be examined with patient sitting upright and reference points
marked on the nose and chin in the midline of the face. Repeat
measurements till consistency is achieved
Can differ with muscle tonicity, time of day (e.g. fatigue) and tongue
posture
Underlying disease (TMJ, skeletal, neuromuscular, mental can alter
OVD)
Variations in Freeway Space:
o Class I Skeletal Cases 3mm (normal)
o Class II Cases Can be up to 4-5mm
o Class III Cases Down to 1-2mm
o Look for:
Face fallen in (excessive FWS)
Small barely perceptible movement of mandible when swallowing
(correct)
If no movement or stained lips there is insufficient FWS
Periodontal Ligament:
o Responds to occlusal overload by allowing drifting of teeth, bone apposition
or loss. Highly sensitised shock absorber
o In bruxers 500-600N of force can be generated during night time parafunction
o In dentate patient the PDL will compress 125m during mastication

Differences Between Natural and Denture Occlusion:


o Natural Dentition:
Retained in PDL
Units move independently
Malocclusion effects not immediate
Non-vertical forces affect only teeth involved and usually well
tolerated
Incising doesnt affect posteriors
Bilateral balance is rare
Tactile sensitivity
o Denture Dentition:
Mobile bases on mucosa
Teeth move as a unit
Malocclusion affects entire base immediately
Non-vertical forces affect all teeth and are traumatic
Incising affects all teeth attached to base
Bilateral balance is often desired for base stability
Decreased tactile sense
Bilateral Balanced Occlusion:
o Stable, simultaneous contact of opposing upper and lower teeth in centric
relation position with a smooth bilateral gliding contact to any eccentric
position within the normal range of mandibular function, developed to lessen
or limit tipping or rotation of the denture bases in relation to supporting
structures
Partial Dentate Patient:
o In the partially dentate patient one must decide whether to use CR or MIP
when restoring the mouth if the two dont coincide
Centric Relation or MIP:
o Decision based on multiple factors
o Number of teeth occluding
o Position of teeth
o Presence or absence of joint dysfunction symptoms
o Extent of tooth alteration requirements to achieve centric relation should
occlusal interferences be present
o Sufficient restorative space for denture components or whether the OVD needs
re-evaluation and increasing at which point CR is the only restorative position
Occlusal Contact Relationships for RPDs:
o Occlusion of tooth support partial dentures may be arranged similar to
occlusion in normal dentition as long as there is anterior guidance
o Balanced occlusion in eccentric positions should be formulated when the
partial denture is opposed by a maxillary complete denture
o This promotes the stability of the complete denture
o Simultaneous working side and balancing side contact should be obtained for
the distal extension denture
o Only working side contacts need to be formulated for either the maxillary or
mandibular unilateral distal extension partial denture

o Balancing side contacts would not enhance stability


o In the anterior saddle denture, ensure balanced occlusion during protrusive
movement
Occlusal Contact Relationships for Other Cases:
o Simultaneous bilateral contacts of opposing posterior teeth must occur in
centric relation
Methods for Establishing Occlusal Records:
o Direct apposition of casts where there are enough occluding teeth to allow
stability through hand articulation
o Use partial occlusal wax rim when the edentulous space is large. There are
some opposing teeth
o Use occlusal rims when no occlusal contact exists between the remaining
natural teeth (e.g. a lower partial denture opposing a complete upper denture)

Distal Extension Removable Partial Dentures:

Distal Extension Problem:


o The two tissues (tooth and mucosa) that support a distal extension removable
partial denture differ markedly in their visco-elastic response to loading
o Mucosa displaces far more readily than tooth due to the resilience of tooth
permitted by the PDL compared to the mucosa.
Necessity of Removable Partial Denture:
o Resultant forces from muscles of mastication pass through the distal of the 35
and 45, may not be necessary to replace teeth distal to these to maintain
equilibrium
o If the maxillary posterior teeth are present it is necessary to replace
mandibular posteriors to prevent over eruption
Aims of RPD Fabrication:
o Evenly distribute the loading forces (mastication and parafunction) between
the teeth and soft tissues covering the edentulous span
o Minimise torqueing forces to the teeth
o Various Design Factors can be Employed to Minimise Torqueing Forces:
Indirect Retention Minimize the rotation of the denture base around
the posterior abutments on application of a lifting force
Indirect Retainers Effective in proportion to their support and
distance from fulcrum line
Cover the Greatest Possible Denture Bearing Area Decreasing
denture bearing area by half increases displacement of denture 4 times
Cover no more tissue than is absolutely necessary
Major connectors contribute to prosthesis support
Reduce Load Applied To distal extension by decreasing size of
occlusal table (use fewer and narrower teeth)
Rests If placed on mesial of posterior abutment, more mucosal
support will be utilised and in a better direction. Forces will tend to tilt
the abutment towards the mesial
Consider Mandibular Ridge Shape:
round
Undercut
Flat
Sharp
Fibrous
Consider Surrounding Muscles:
Buccinator
Mylohyoid
Hyoglossus
Styloglossus
Palatoglossus

Proximal Plates:
o Kratchovil Mesial Rest, Long Proximal Plate:
Fulcrum occurs at base of guide plane under load
Causes rest to be lifted out of seat
No torque applied to tooth
o Krol Mesial Rest, Short Proximal Plate:
Fulcrum point at mesial rest
Torqueing forces are minimised
May still result in fulcrum at guide plane
o McGivney Mesial Rest, 1mm Proximal Plate:
Similar principles to Krol
Direct Retention:
o Use I-bar on maximum point of curvature on abutment to allow clasp to
disengage the undercut and minimise torqueing of the tooth
o Several have stated that good adaptation of the base to the tissues outweighs
importance of clasp design
Anterior Abutment of Kennedy Class II RPD:
o As distal extension moves down under loading, the anterior abutment, if
clasped, will tend to be extruded
o Keep retentive element to the distal as much as possible
Impression Technique:
o No single material that can record both anatomic form of teeth and tissues in
the dental arch at the same time
o Dental soft tissues do not compress evenly
o Selective Tissue Placement Impression Method:
Soft tissues that cover basal seat areas may be placed, displaced or
recorded in their resting or anatomic form
e.g. Palatal tissues in vicinity of vibrating line can be slightly displaced
to develop posterior palatal seal for maxillary complete denture and
remain in a healthy state but will become inflamed if they are overly
displaced
Oral tissues that are overly displaced or distorted attempt to regain
their anatomic form
Maximise soft tissue support while utilizing the teeth to their
supporting advantage
o Altered Cast Technique Allows for different compressibility of different
parts of the mucosa and ensures that an even pressure is applied everywhere
when force is applied
Metal casting is made in usual manner
Acrylic base then added to saddle area of metal casting
Impression of saddle area taken under light pressure
Model that casting was made on is cut so that DE saddle area is
removed, casting with impression is then repositioned
New distal extension saddle poured in stone
This process accommodates for disparity between resilience of tooth
permitted by PDL and that of the mucosa

Altered Cast Technique:

Supporting structures of edentulous ridge and remaining teeth are utilized to best
advantage by altering the edentulous part of the cast upon which a distal extension
RPD is fabricated
Employs principles of impressions for complete dentures to fabrication of tissue
surfaces of extension RPDs, refined edentulous tissue impression made after metal
casting is used to alter edentulous areas of master cast
The resultant cast reproduces supporting tissues in a form that provides the correct
denture base extension and favourable physiologic support when denture is in its
fully seated position
Rationale:
o Tissues of edentulous ridge are displaced and distorted when impression made
with stock tray, therefor extension RPD can move excessively if it has been
fabricated on a cast made from such an impression, even if it was done with a
specially made tray
o Alginate material in a stock tray is satisfactory for making impression for cast
on which metal framework is fabricated (PVS more likely used now)
Procedure:
o Metal framework is fabricated on a cast made from an impression obtained in
a dimensionally accurate and stable material (formerly irreversible
hydrocolloid)
o Solution of rouge and chloroform is painted on surfaces that contact teeth and
framework is placed in mouth where it is moved as it would in function
(disclosing) indicating metal contacts which may interfere with placement of
framework and should be relieved
o After cast has been fitted in mouth, a layer of base plate wax is placed over
edentulous regions to the master cast. The denture base retention meshworks
of the casting are warmed over a flame and the framework is seated on the
master cast
o Wax that flows over the denture base retentive part of the casting is removed
and autopolymerising acrylic resin is adapted over the edentulous ridge to
form a tray attached to the frame work
o Metal framework with the resin tray attached is tried in mouth and tray is
shortened to eliminate interference with tongue and cheek movements
o Low fusing model plastic placed on borders of resin tray and softened in
controlled water bath. Modelling borders are moulded as dictated by
movement of tongue and cheek. Modelling plastic (impression compound) that
flows inside tray is trimmed away without reducing border side and escape
holes for material are drilled in acrylic resin as well
o ZOE paste placed on tissue side of resin tray and carried to patients mouth
o Metal casting is seated on teeth and firm pressure applied to parts of the metal
that contact the teeth to be certain there is no framework movement
o Pressure is maintained on metal until impression material is set, no finger
pressure on resin covering edentulous ridge

o Close mandible just short of tooth contacts before final seating of impression
to allow tissue to assume its normal, unstretched position. Jaws gently closed
short of occlusal contact once framework is in position
o Casting and impression of edentulous ridge are removed from mouth. Excess
impression material then removed to expose finished lines of casting
o Edentulous parts of the master cast are removed and grooves for retention are
drilled into cast
o Framework with attached impression is placed in its correct position on master
cast and secured with sticky wax
o New impression is boxed prior to pouring up altered edentulous sections of the
cast
o Ensure all surfaces of the boxing and impression are sealed so stone does not
flow out onto occlusal surface
o Remove framework and impression and altered cast is then used as master cast
for remainder of the design of the RPD
Overall Method Provides:
o Improved stability in denture base region of distal extension RPDs
o Positive occlusion which will be maintained for long periods
o Reduced stress on abutment teeth from unfavourable forces
o Reduced number of post insertion adjustments

Material Properties:

Consider:
o How strong it is
o What force will deform/break it
o Thermal expansion/contraction
o Reproduction detail of teeth and soft tissues
o Setting shrinkage/expansion
o Degree of wear/pattern of wear
o Biocompatibility
Stress:
o When a force acts on a body to produce a deformation a resistance is
developed equal in intensity and opposite in direction
o Stress = Force/Area
o Calculated in MPa
o e.g. Stress on an RPD clasp
o Types of Stress:
Tension Force away (pulling force)
Compression Force directed towards a body
Shear Stress Resistance of one body sliding against another,
substance must be immediately adjacent to the interface
Strain:
o Change in length per unit length of a body subjected to stress
o Described as a percentage change or absolute value
Stress/Strain Graph:
o Proportional Limit:
Linear part of the graph
Area below designated the elastic portion of material
If force is removed the material returns to its original state (no
permanent deformation)
Slope of the line gives modulus of elasticity (relative stiffness/rigidity
of the material)
o Ultimate Compressive/Tensile Strength - Point at which material will fail
o Plastic Region - Area below the graph at which material will start to
permanently deform
o Yield Strength - Point at which material begins to exhibit plastic behaviour
Wear and Hardness:
o Ability of material to resist abrasion or wear
o Hardness is ability to resist indentation
o Tests Barcol, Brinell, Rockwell, Shore, Vickers, Knoop
o Wear tests use determined force to penetrate surface of material and measure
resultant depth and width
o 4 Types of Wear Adhesive, corrosive (chemically initiated), surface fatigue
(loose particles leading to subsurface cracks) and abrasive wear (soft surface
in contact with harder surface)

Malleability and Ductility:


o Pertains to metallic properties
o Malleability Ability to be hammered or rolled into a sheet
o Ductility Ability to be drawn into a wire
o Brittleness Opposite of ductility. Amalgam, ceramics and composites are
brittle at oral temperatures (5-55oC) and sustain little or no plastic strain before
fracture (fracture close to proportional limit)
Other Properties:
o Viscosity
o Tear strength
o Biocompatibility
o Co-efficient of thermal expansion
Gypsum:
o Naturally obtained from gypsum rock
o Mainly calcium sulphate dihydrate
o Dihydrate is material with two parts water to one part compound
o One part calcium to two parts water
o Plaster of Paris can become gypsum and vice versa
o CaSO4 + 0.5 H2O CaSO4 + 2H2O
o During manufacturing process gypsum is converted to Plaster of Paris and
artificial stone via a process called calcining
o Gypsum is first ground to fine powder of particle size (Plaster of Paris derived
when gypsum subjected to heat in open vat, artificial stone produced when
gypsum processed by steam heat under pressure)
o In both products, the reaction converts calcium sulphate hemihydrate by the
removal of 75% of the water molecules
o Type 1:
Impression plaster
4-8 MPa compressive strength
0-0.15% expansion
Impressions only
o Type 2:
Model plaster
9MPa compressive strength
0-0.3% expansion
Articulation
o Type 3:
Dental stone
20MPa compressive strength
0-0.2% expansion
Edentulous casts, denture investment
o Type 4:
Dental Stone
35MPa compressive strength
0-0.15% expansion (low)
Crown and bridge dyes

o Type 5:
Dental stone
35MPa compressive strength
0.16-0.3% expansion (high)
Accounts for casting shrinkage in base metals vs noble metal alloys
Plaster vs Stone:
o Chemically plaster and artificial stone are identical, however plaster particles
are rough, irregular and porous while stone particles are prismatic, more
regular in size and dense
o When plaster or stone is mixed with water, a hard substance is formed and the
process described above is reversed so that the hemihydrate converts to
dihydrate
o In the setting reaction, crystals of gypsum intermesh and become entangled
with one another giving the set material its strength and rigidity
o Reaction also released heat at a rate of 3900 cal/gm mole
Storage of Plaster and Stone:
o Keep containers tightly closed otherwise humidity above 70% causes partial
conversion of hemihydrate to dihydrate which greatly increases speed of
setting reaction CaSO4.0.5H2O CaSO4.2H2O
Setting Expansion:
o Setting reaction of calcined calcium sulphate hemihydrate reaction with water
to form a hard mass of calcium sulphate dihydrate is associated with an
expansion of 0.3-0.6%
o When this occurs within the confines of an impression tray it will lead to a
significant reduction in accuracy
o Mixing the plaster with anti-expansion solution (containing 4% potassium
sulphate and 0.4% borax) will reduce this
o The potassium sulphate reduces expansion to 0.05% but this also accelerates
setting reaction and borax is added as a retarded which gives more time to
pour up the impression

Process of Removable Partial Denture Construction Start to Finish:

Clinical Steps:
o 1 Consultation/impression
o 2 Survey and formulate treatment plan
o 3 Pre-prosthetic treatment (extractions, caries control, survey crowns and
oral hygiene)
o 4 Mouth preps, secondary impressions and border moulding if distal end
saddle
o 5 Metal framework try-in
o 6 Bite registration (MIP, CR) and determine tooth shade and mould
o 7 Wax try-in
o 8 Insertion, home care instructions
o 9 Review
Clinical Consultation/Examination:
o General Questionnaire:
Medical history and personality assessment
Diet history
Dental history
Reason for tooth loss
History of existing and previous RPDs
Evaluate existing partial denture
Intra-oral examination (oral hygiene, caries susceptibility, patients
responsibility in home care and obstacles such as arthritis, dry mouth
and systemic conditions)
o Treatment Planning:
Periodontal management
Surgical modifications as needed
Restorations/endodontics
Fixed prosthodontic treatment
Removable prosthodontic treatment
o Important Radiographic Findings:
Caries
Endodontic lesions
Assessment of bone loss and periodontal disease
Retained roots
Impacted teeth
o Components:
Major Connector:
Functions:
o Be Rigid Flexible major connectors may cause
damage to soft and hard tissue as well as allowing for
forces to be contained on individual teeth instead of
distributed
o Protect Associated Soft Tissue 6mm away from
gingival margin in maxilla and 3mm away from margin
in mandible

o Provide Means of Placement of One or More Denture


Bases
o Promote Patient Comfort Major connector must not
end on the anterior border of the rugae in the palate. It
should end at the posterior slow so the thickness is not
discernable by the tongue
Maxillary Major Connectors:
o Palatal bar
o Palatal strap
o A-P Palatal bar
o Horseshoe
o A-P Palatal strap
o Full palate
Mandibular Major Connectors:
o Lingual plate
o Lingual bar
o Double lingual (Kennedy) bar
o Labial bar
o Swing-lock
Minor Connector
Rests
Dire Retainers/Clasps
Indirect Retainers
Denture Bases Associated with Denture Teeth
Survey and Treatment Plan:
o Step 1 Study Casts:
Good preliminary casts
No bubbles/drags
Clear gingival margins
Extending to hamular notch and retromolar pad region
Floor of mouth captured and tongue space cleared
o Step 2 Check Occlusion:
Hand articulate casts
Use pencil to mark occlusal overlap which is the incisal limit of
framework extension
o Step 3 Check Tilt and Tripod
o Step 4 Survey Undercuts (Tooth and Soft Tissue)
o Design:
Colours:
Red Rest seats/modifications
Blue Saddle areas
Brown Metal framework
Black Wiring instructions on the cast

o Components:
Major connector
Minor connector
Rests
Direct retainers/clasps
Indirect retainers
Denture bases associated with denture teeth
o For Maxilla:
Draw framework design in brown
All lines should be rounded
Plating crosses midline perpendicularly
Proximal plate should extend to contact point
If large diastemas use Cummer fingers
Avoid horse-shoe major connectors where possible
Design to accommodate for future tooth loss
Check proximal planes are as parallel as possible or mark for
modification
o For Mandible:
Measure gingival margin to floor of mouth
Remove all calculus prior to secondary impression
Check all proximal planes are as parallel as possible
Distal End Saddle Rules:
If both premolars remain then 35 distal rest and 34 mesial rest
If only one premolar remains then 34 mesial rest and circular
cast clasp or wrought wire combination clasp
Consider RPI and RPA where appropriate
Occlusal forces on the distal extension base cause rotation
about the mesial rest. The retentive terminus disengages into
the mesial undercut minimising torque at the abutment
Mouth Preps/Impression and Shade Guides:
o Purpose of Mouth Prep:
To parallel guide planes
To provide rest seats for which rest components of framework will seat
To create favourable undercuts for direct retainers
To recontour tipped or over-erupted teeth which interfere with occlusal
plane
o Border Moulding:
Tooth borne partial dentures do not require border moulding
Distal end partial dentures should be fabricated with broad base
extension principles and thus should extend as far as possible to the
functional depth of the sulcus
o Lab Prescription:
Master model in high strength stone
Construct CoChr partial framework as per design indicated on study
model, mandibular cast enclosed for occlusal examination
Return framework for metal try-in, no wax bases

o Choose shade/mould
o Lab Prescription Continued:
Articulate maxillary and mandibular casts with bite record provided do
not reduce vertical dimension following articulation
e.g. Set denture teeth, Mould T360, Shade 1A for $11-14, 21-24 and
33-37 as well as 43-47
Return for wax tooth try-in
Do not move teeth
e.g. Finesse wax-up in #13-23 region
Process in 60:40 original and light pink acrylic
o Tooth Try in on Framework:
Obtain approval from patient regarding shade and mould
Reverify bite position
Retake jaw record as needed
Send to lab for processing
o Preparation of the Mould and Packing:
Prepare for flasking
Master cast in stone with occlusal surfaces exposed for recovery
Fully flask
Separate flask after wax elimination
Properly mix resin and place it into mould cavity
Apply pressure to flask assembly
Remove excess material from flask
o Insertion and Review:
Similar to complete denture check denture base areas and peripheral
borders
Check for any acrylic in the guide planes that may hinder seating
Check occlusion with articulating paper
Give home care instructions