!Introduction!Design Philosophy!Biomechanics!Simplified Component Selection!Design Considerations
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1 Successful Outcomes in Contemporary Removable Prosthodontics: Clinical Removable Partial Dentures Successful Outcomes in Clinical Removable Partial Dentures Mark Dellinges, DDS, FACP, MA 6/19/2015!!Introduction!Design Philosophy!Biomechanics!Simplified Component Selection!Design Considerations Clinical Aspects-! Appointment Sequence! Surveying! Design Sequence! Impressions Trouble Shooting! Altered Cast vs. Reline! Implants & RPD s Best Approach to RPD Design There are over 65,534 partially edentulous situations per arch meaning there are literally tens of thousands of potential RPD designs. Beaumont, A. J. Micro-computer aided removable partial denture design, the next evolution. JPD 62:551-6, 1989 Best Approach to RPD Design!!Identify biomechanical classification of partially edentulous arch!!design should satisfy biomechanical requirements of tooth borne vs. tooth & tissue borne removable partial dentures!!utilize a small number of well designed components whose selection is based on sound biomechanical principles RPD Design Philosophy!!Minimal tooth and minimal gingival coverage!!equitable distribution of functional forces Major Connector Selection!!mandibular arch: lingual vestibular depth!!maxillary arch: requirement for support!!need for contingency planning Tooth Borne RPD Tooth & Tissue Borne RPD Tooth Borne RPD Tooth & Tissue Borne RPD 1
2 Primary Supporting Areas Clasp Selection!!need for stress release anterior to the fulcrum line axis Tooth Borne RPD Tooth & Tissue Borne RPD Tooth Borne RPD s Tooth & Tissue Borne RPD s Tooth & Tissue Borne RPD s Tooth & Tissue Borne RPD s RPI RPC Combo WW 2
3 Selection of Components and Design Considerations for Removable Partial Dentures Tooth & Tissue Borne RPD s No Clasp (rest only) CC (non-retentive) Combo WW 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Selection of Components and Design Considerations for Removable Partial Dentures Tooth Borne RPD s 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Selection of Components and Design Considerations for Removable Partial Dentures Tooth & Tissue Borne RPD s 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar 3
4 Selection of Components and Design Considerations for Removable Partial Dentures Requirements of Major Connectors! Sufficiency Rigid! Properly Located! Must Not Impinge on the Gingiva 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Maxillary Major Connectors 1. Anterior Palatal Selection of Components and Design Considerations for Removable Partial Dentures 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Maxillary Major Connectors Selection of Components and Design Considerations for Removable Partial Dentures 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar 4
5 Maxillary Major Connectors 3. Anteroposterior Palatal Selection of Components and Design Considerations for Removable Partial Dentures 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Maxillary Major Connectors 4. Modified Palatal Plate Selection of Components and Design Considerations for Removable Partial Dentures 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Maxillary Major Connectors Selection of Components and Design Considerations for Removable Partial Dentures 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar 5
6 Mandibular Major Connectors 1. Lingual Bar Selection of Components and Design Considerations for Removable Partial Dentures Mandibular Major Connectors 2. Sublingual Bar 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Selection of Components and Design Considerations for Removable Partial Dentures Mandibular Major Connectors 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar 6
7 Selection of Components and Design Considerations for Removable Partial Dentures 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Requirements of a Clasp Assembly!!Retention!!Stability!!Support!!Reciprocation!!Adequate Encirclement!!Passivity Requirements of a Clasp Assembly!!Retention!!Stability!!Support!!Reciprocation!!Adequate Encirclement!!Passivity Requirements of a Clasp Assembly!!Retention!!Stability!!Support!!Reciprocation!!Adequate Encirclement!!Passivity Requirements of a Clasp Assembly!!Retention!!Stability!!Support!!Reciprocation!!Adequate Encirclement!!Passivity Requirements of a Clasp Assembly!!Retention!!Stability!!Support!!Reciprocation!!Adequate Encirclement!!Passivity 7
8 Selection of Components and Design Considerations for Removable Partial Dentures Requirements of a Clasp Assembly!!Retention!!Stability!!Support!!Reciprocation!!Adequate Encirclement!!Passivity 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Clasp Assemblies - Tooth Borne Clasp Selection of Components and Design Considerations for Removable Partial Dentures 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Clasp Assemblies Tooth Borne Selection of Components and Design Considerations for Removable Partial Dentures 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar 8
9 Clasp Assemblies Tooth Borne Selection of Components and Design Considerations for Removable Partial Dentures 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Clasp Assemblies Tooth & Tissue Borne Clasp RPI Clasp Functional Movement of the RPI Clasp Selection of Components and Design Considerations for Removable Partial Dentures 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar 9
10 Clasp Assemblies Tooth & Tissue Borne Clasp RPC Clasp Selection of Components and Design Considerations for Removable Partial Dentures Clasp Assemblies Tooth & Tissue Borne 3. Combination Wrought Wire Clasp 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar Selection of Components and Design Considerations for Removable Partial Dentures Combination WW Clasp 1. Anterior Palatal (Same as Mandibular ) 4. Modified Palatal Plate 2. Sublingual Bar 10
11 Review of Clinical Removable Partial Denture Prosthodontics Clinical and Laboratory Procedures for RPD Fabrication Introduction!! Intake Interview & Clinical Assessment!! PARP Form!! Treatment Planning & Clinic Forms!! Treatment Sequence for RPD s - tooth borne RPD s - tooth mucosa borne RPD s - combination C/D & RPD Introduction!! Intake Interview & Clinical Assessment!! PARP Form!! Treatment Planning & Clinic Forms!! Treatment Sequence for RPD s - tooth borne RPD s - tooth mucosa borne RPD s - combination C/D & RPD Introduction!! Intake Interview & Clinical Assessment!! PARP Form!! Treatment Planning & Clinic Forms!! Treatment Sequence for RPD s - tooth borne RPD s - tooth mucosa borne RPD s - combination C/D & RPD 11
12 Introduction!! Intake Interview & Clinical Assessment!! PARP Form!! Treatment Planning & Clinic Forms!! Treatment Sequence for RPD s - tooth borne RPD s - tooth mucosa borne RPD s - combination C/D & RPD Introduction!! Intake Interview & Clinical Assessment!! PARP Form!! Treatment Planning & Clinic Forms!! Treatment Sequence for RPD s - tooth borne RPD s - tooth mucosa borne RPD s - combination C/D & RPD Introduction!! Intake Interview & Clinical Assessment!! PARP Form!! Treatment Planning & Clinic Forms!! Treatment Sequence for RPD s - tooth borne RPD s - tooth mucosa borne RPD s - combination C/D & RPD 12
13 Introduction!! Intake Interview & Clinical Assessment!! PARP Form!! Treatment Planning & Clinic Forms!! Treatment Sequence for RPD s - tooth borne RPD s - tooth mucosa borne RPD s - combination C/D & RPD Introduction!! Intake Interview & Clinical Assessment!! PARP Form!! Treatment Planning & Clinic Forms!! Treatment Sequence for RPD s - tooth borne RPD s - tooth mucosa borne RPD s - combination C/D & RPD 1 st Clinical Appointment -Evaluation for RPD s!!clinical Assessment!!Making Diagnostic Cast Impressions 1 st Clinical Appointment -Evaluation for RPD s!!clinical Assessment!!Making Diagnostic Cast Impressions 13
14 -Getting Casts Ready for Mounting!!Making Record Bases!!Placing Wax Rims -Getting Casts Ready for Mounting!!Making Record Bases!!Placing Wax Rims 2 nd Clinical Appointment -Recording Maxillomandibular Relations!!Interocclusal Record!!Facebow Transfer 14
15 2 nd Clinical Appointment -Recording Maxillomandibular Relations!!Interocclusal Record!!Facebow Transfer -Cast Mounting & Framework Design!!Mount Maxillary Cast!!Mount Mandibular Cast!!Design RPD s!!record Design -Cast Mounting & Framework Design!!Mount Maxillary Cast!!Mount Mandibular Cast!!Design RPD s!!record Design -Cast Mounting & Framework Design!!Mount Maxillary Cast!!Mount Mandibular Cast!!Design RPD s!!record Design The Survey & Design Sequence for RPD s!!survey Cast!!Rests & Minor Con.!!Major Connector!!Clasp Arms!!Retentive Network!!Ext. Finish Lines!!Int. Finish Lines!!Fill Out Forms 15
16 Definitions: The Survey Process: Dental Surveyor A Paralleling instrument used in the fabrication of a Removable Partial Denture. Surveying The procedure of analyzing and delineating the contours of the abutment teeth and associated structures before designing a Removable Partial Denture.!! Secure cast to neutral tilt!! Identify guiding planes!! Adjust anteroposterior tilt!! Identify potential undercuts!! Adjust mediolateral tilt!! Index the cast!! Draw survey lines!! Mark depth of undercuts!! Indicate modification areas!! Draw design The Survey & Design Sequence for RPD s!!survey Cast!!Rests & Minor Con.!!Major Connector!!Clasp Arms!!Retentive Network!!Ext. Finish Lines!!Int. Finish Lines!!Fill Out Forms -Cast Mounting & Framework Design!!Mount Maxillary Cast!!Mount Mandibular Cast!!Design RPD s!!record Design 3 rd Clinical Appointment -Rest Seat Prep. & Master Impressions!!Rest Seat Preparation!!Master Impressions 16
17 Mouth Preparation for RPD s Modifications of Tooth Contour Sequence of Treatment!!Diamonds!!Burs!!Polishing Instruments!!Guiding Planes!!Height of Contour!!Retentive Grooves!!Rest Seats Review of Mouth Preparation with Patient Problem:!!Patient s Study Cast with Design!!Models!!Lack of Proper Mouth Preparation Solutions: 1.! Mouth preparation check list 2.! Verify tooth modifications before final impressions Final Impressions for RPD s!! Alginate Impressions!! Quick Set Stone 17
18 Trouble Shooting Removable Partial Denture Framework Misfits!! Framework Does Not Fit Cast!! Framework Does Not Fit Mouth Framework Does Not Fit Cast!!Casting Inaccuracies!!Damage During Finishing Framework Does Not Fit Mouth!! Impression Errors 1.! Improper Tray Selection 2.! Impression Materials/ Technique Error!! Distorted Cast!! Tooth Movement Framework Does Not Fit Mouth!! Impression Errors 1.! Improper Tray Selection 2.! Impression Materials/ Technique Error!! Distorted Cast!! Tooth Movement Alginate Impressions Alginate Trays!!Stock or Custom!!Plastic or Metal!!Rimlock or Perforated Tray Selection for Alginate Impressions 1.! Rigid Tray (metal or plastic) 2.! Perforated for Alginate Retention 3.! 4 8 mm of Relief (space) Notes: a.! Rimlock type trays require use of an adhesive b.! Maxillary trays may require modification of palatal vault c. Use an alginate adhesive on any tray where alginate retention is questionable d. Custom trays usually provide more even relief 18
19 Intraoral Technique: 1.! Block out large interproximal spaces (undercuts) 2.! Wipe alginate onto critical areas (e.g. rest seats, palatal vault and areas of framework contact) 3.! Seat tray accurately in mouth 4.! Hold tray in position for several minutes after initial set 5.! Remove tray quickly with a snap 6.! Inspect impression for desired detail/artifacts 7.! Apply disinfection spray 19
20 Alginate Manipulation 1.! Follow manufacturer s recommendations for a. Water : Powder Ratio b. Spatulation Times Notes: 1. Slight variations in water : powder ratio are permissible 2. Mechanical mixers may produce more consistent mixes Laboratory 1.! Pour impression as soon as possible 2.! Stare in atmosphere of 100% humidity until poured 3.! Pour with vacuum mixed die stone 4.! Do not invert impression after pouring with stone 5.! Avoid pressure on alginate ( cut off heels ) Notes: a.! Liquids to improve surface hardness may be used b.! Match stone with alginate for compatibility -Master Cast, Framework & Custom Trays!!Bead, Box & Pour Master Cast!!Design Master Cast!!Send to Laboratory!!Examine Framework & Make Custom Tray for Altered Cast 20
21 -Master Cast, Framework & Custom Trays!!Bead, Box & Pour Master Cast!!Design Master Cast!!Send to Laboratory!!Examine Framework & Make Custom Tray for Altered Cast -Master Cast, Framework & Custom Trays!!Bead, Box & Pour Master Cast!!Design Master Cast!!Send to Laboratory!!Examine Framework & Make Custom Tray for Altered Cast -Master Cast, Framework & Custom Trays Tx. Plan Form & Work Auth. Form!!Bead, Box & Pour Master Cast!!Design Master Cast!!Send to Laboratory!!Examine Framework & Make Custom Tray for Altered Cast 21
22 -Master Cast, Framework & Custom Trays!!Bead, Box & Pour Master Cast!!Design Master Cast!!Send to Laboratory!!Examine Framework & Make Custom Tray for Altered Cast 4 th Clinical Appointment -Frame Try-in & Altered Cast Impression!!Framework Try-in!!Making Altered Cast Impression 4 th Clinical Appointment -Frame Try-in & Altered Cast Impression!!Framework Try-in!!Making Altered Cast Impression -Making the Altered Cast and Record Bases!!Making the Altered Cast!!Making the Record Bases 22
23 -Making the Altered Cast and Record Bases!!Making the Altered Cast!!Making the Record Bases 5th Clinical Appointment -JRR, Facebow & Shade Selection!!Maxillomandibular Relationship Records!!Facebow Transfer!!Tooth Shade Selection 5 th Clinical Appointment -JRR, Facebow & Shade Selection!!Maxillomandibular Relationship Records!!Facebow Transfer!!Tooth Shade Selection 23
24 5 th Clinical Appointment -JRR, Facebow & Shade Selection!!Maxillomandibular Relationship Records!!Facebow Transfer!!Tooth Shade Selection -Mounting Casts, Tooth Selection & Set-up!!Mounting the Master Casts!!Selecting Teeth!!Setting Teeth -Mounting Casts, Tooth Selection & Set-up!!Mounting the Master Casts!!Selecting Teeth!!Setting Teeth -Mounting Casts, Tooth Selection & Set-up!!Mounting the Master Casts!!Selecting Teeth!!Setting Teeth 6 th Clinical Appointment -The Complete Wax Try-in!!Try-in Set-Up!!Verify JRR!!Selection Resin Shade 6 th Clinical Appointment -The Complete Wax Try-in!!Try-in Set-Up!!Verify JRR!!Selection Resin Shade 24
25 6 th Clinical Appointment -The Complete Wax Try-in!!Try-in Set-Up!!Verify JRR!!Selection Resin Shade -Processing RPD s Before Delivery!!Prepare RPD s for Processing!!Laboratory Remount!!Finishing & Polishing -Processing RPD s Before Delivery!!Prepare RPD s for Processing!!Laboratory Remount!!Finishing & Polishing -Processing RPD s Before Delivery!!Prepare RPD s for Processing!!Laboratory Remount!!Finishing & Polishing 25
26 7 th Clinical Appointment -Delivery & Clinical Remount of RPD s!!try-in!!clinical Remount!!Delivery 7 th clinical Appointment -Delivery & Clinical Remount of RPD s!!try-in!!clinical Remount!!Delivery 7 th Clinical Appointment -Delivery & Clinical Remount of RPD s!!try-in!!clinical Remount!!Delivery 26
27 8 th -10 th Clinical Appointments -Post Delivery Adjustments of the RPD!!24, 72 Hour & One Week Adjustments Implant Borne Supported Removable Partial Dentures Implant Borne Supported Removable Partial Dentures!! Need to Replace Hard and Soft Tissue!! Limited Number/Location of Implants!! Enhanced Support, Stability & Retention!! Eliminate the Extension Base!! Reduce/Eliminate Visible Clasp Arms 27
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34 Implant Borne Supported Removable Partial Dentures!! Increased expenses: Surgical & prosthetic!! Adequate interarch distance!!!!! Attachment height requirements vary!! Limited path of placement!! Maintenance considerations 34
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