DIAGNOSIS, TREATMENT PLANNING, DESIGN, TREATMENT SEQUENCING AND MOUTH PREPARATION

Study cast surveyor

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Diagnosis Guiding and verify the appropriate tooth preparation

Mouth preparation goal

Support Stabilization ! Retention
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REMOVABLE PARTIAL DENTURE

CHATCHAI KUNAVISARUT CHANITA SUPA-AMORNKUL

Harmonious occlusion

DIAGNOSIS, TREATMENT PLANNING, DESIGN, TREATMENT SEQUENCING AND MOUTH PREPARATION

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DIAGNOSIS, TREATMENT PLANNING, DESIGN, TREATMENT SEQUENCING AND MOUTH PREPARATION

Take impression with alginate for ascertain the contour of abutment ! Take another impression for master cast ! Master cast
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Mouth preparation sequence

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Proximal tooth surfaces

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Parallel to guiding plane Direct occlusal force along the long axis Spoon shape Resist dislodging force

Occlusal rest seats

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Retentive area
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Survey Draw RPD framework design ! Tripoding

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Reciprocal area

KENNEDYS CLASSIFICATION

CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

APPLEGATES RULE APPLYING THE KENNEDY CLASSIFICATION

COMPONENT OF PARTIAL DENTURE DESIGN

MAJOR CONNECTOR
Join the components on one side of the arch with those on the other side ! Rigidity " Distribution force ! Not impingement subgingival
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MAJOR CONNECTOR

BORDER OF MAJOR CONNECTOR

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Design
Symmetrical Cross midline at right angle ! Avoid torus ! Smooth and round contour ! Self cleansing
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PALATAL BAR
MAXILLARY MAJOR CONNECTOR
Palatal bar Palatal strap ! Anteroposterior palatal bar ! Horseshoe ! Anteroposterior palatal strap ! Complete palate
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Narrow half oval with thickest point at the middle Interim application Uncomfortable Little vertical support All support derive from remaining teeth Short span class III Should not place anterior to second molar

PALATAL STRAP

ANTEROPOSTERIOR PALATAL BAR

Anterior bar = Palatal strap Posterior bar = Palatal bar

Wide thin band of metal At least 8 mm. wide Little interfere tongue Patient accept Resistance to bending and twisting force Distribute stress Patient may complain of palatal coverage

Join two bar with at longitudinal element Rigidity Minimized soft tissue coverage Uncomfortable Little support from palate Not the rst choice Support is not major consideration Widely separate abutment

HORSESHOE CONNECTOR
Thin metal band running along the lingual surface of remaining teeth and extending (6-8 mm.) on to the palatal tissue Symmetry Replaced several anterior teeth Prominent median palatal suture line Inoperable torus Tendency to ex or deform Not good for cross arch stabilization More rigid connector cannot be used

ANTEROPOSTERIOR PALATAL STRAP

Indicated when replace numerous teeth or present of palatine torus Extensive length of border may irritation to tongue Open area in palatal region at least 20x15 mm. Good support from palate Resistance to exure Uncomfortable

COMPLETE PALATE
Ultimate rigidity and support Posterior border extend to hard and soft palate junction Anterior border cover cingular of anterior teeth Greatest amount of tissue coverage Replaced all posterior teeth Periodontal compromised Distribution force to remaining teeth and tissue Stabilization Extensive tissue coverage

INDICATION OF MAXILLARY MAJOR CONNECTOR

Condition Weak periodontal support of remaining teeth Adequate periodontal support of remaining teeth Long span distal extension Replaced anterior teeth Major connector -Wide palatal strap -Complete palate -Palatal strap -Ant.-post. palatal bar -Ant.-post. palatal strap -Complete palate -Ant.-post. palatal strap -Complete palate -Horseshoe

MANDIBULAR MAJOR CONNECTOR

Condition Torus present Major connector -Ant.-post. Palatal strap -Ant. -post. Palatal bar -Horseshoe

Lingual bar Lingual plate ! Double lingual bar ! Labial bar

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Very sparing use horseshoe connector Palatal bar is rarely indicated

LINGUAL BAR

LINGUAL PLATE Half pear shape and thin piece of metal

Indicate for all tooth support unless insufcient space At least 8 mm. between gin. margin and oor of mouth Minimum contact with teeth and soft tissue Half pear shape Simplicity Decrease plaque accumulate Need extreme care for design and construction

Scallop appearance Always support by rests Insufcient vertical space for lingual bar Splinting Existing of mandibular tori Exceptional rigidity More comfortable than lingual bar Extensive coverage

DOUBLE LINGUAL BAR

Characteristics of both lingual bar and plate Join 2 bars with rigid minor connector Contact with remaining anterior teeth indicated Marginal gingival receives natural stimulation Horizontal stabilization Tendency to trap debris Not comfortable

LABIAL BAR

MANDIBULAR MAJOR CONNECTOR

Run across the mucosa on facial surface Indicated in the presence of a gross uncorrectable interference Half pear shape Swing-lock Tipped remaining mandibular teeth Poor patient acceptance Distort lower lip Discomfort
Condition Tooth support -Insufficient space -Inoperative torus -High lingual frenum attachment -Reduced periodontal support in anterior teeth -Large interproximal space -Modified lingual plate (step back design) -Double lingual bar Mandibular major connector Lingual bar Lingual plate

Condition Replace all posterior teeth

Mandibular major connector Lingual plate

Labial bar is rarely indicated

MINOR CONNECTOR

MINOR CONNECTOR
Join the remaining component of RPD to the major connector ! Distribute force to supporting teeth and oral tissues ! Rigidity
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TYPE OF MINOR CONNECTOR

Join clasp to major connector Join direct retainers or auxiliary rest to major connector ! Join denture base to major connector ! Serve as approach arms for bar- type clasp
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JOIN CLASP TO MAJOR CONNECTOR

JOIN INDIRECT RETAINERS OR AUXILIARY REST TO MAJOR CONNECTOR

Right angle with the major connector

Rigid Locate on proximal surface Broad buccolingually but thin mesiodistally

Gently curve junction Positioned in lingual embrassure

JOIN DENTURE BASE TO MAJOR CONNECTOR

OPEN CONSTRUCTION FORM LADDER LIKE NETWORK

Strong enough to anchor denture base Open construction form ladder like network Mesh construction Bead, wire or nail head components on metal base Distal extension In maxillary arch, extend as far posterior as practical In mandibular arch, extend two thirds the length of edentulous ridge

SERVE AS APPROACH ARMS FOR BAR- TYPE CLASP

Not required to be rigid Must not cross tissue undercut

RESTS AND REST SEAT

PRIMARY REST
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A rest that is part of a retentive clasp is referred to a primary rest A rest that is responsible for additional support or indirect retention is called an auxiliary rest or secondary rest

Prevent vertical movement Transmit force to supporting tissue ! Ball and socket joints
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AUXILIARY REST
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MAJOR FORM OF REST

Occlusal rest Lingual or cingulum rest ! Incisal rest
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Indirect retainer in extension base Place anterior or posterior to the axis of rotation

OCCLUSAL REST

OCCLUSAL REST

Triangular 1/3 1/2 of mesiodistal diameter Approximate 1/2 of bucco lingual width

Floor of rest seat slightly inclined toward the center of the teeth Deepest portion located near the center At least 0.5 mm. thick at thinnest point 1.0-1.5 mm. thick at the marginal ridge

LINGUAL AND CINGULUM REST

INCISAL REST

Primarily used on maxillary canine V shape Ball and socket assembly

Frequently used in mandibular canine Small V shaped notch Located approximately 1.5 to 2.0 mm. from the proximal incisal angle

DIRECT RETAINER
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Engage abutment and resist dislodging forces Two type

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Intracoronal direct retainer

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Precision attachment Semiprecision attachment

Extracoronal direct retainer

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DIRECT RETAINER

Retentive clasp
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Suprabulge Infrabulge

Attachment

RETENTIVE CLASP ASSEMBLIES

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RETENTION
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Structure of clasp assembly

Rest ! Retentive arm ! Reciprocal element ! Minor connector
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The quality of clasp that resists forces acting to dislodge component from supporting tissue Depend on
Type of clasp Flexibility ! Undercut
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CLASP ARM FLEXIBILITY

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RECIPROCATION

Depend on
Length " increase Cross-sectional diameter "circular ! Longitudinal taper ! Clasp curvature " single plane ! Metallurgical properties of alloy "gold , wrought wire
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The quality of clasp that counteracts lateral displacement of an abutment when retentive clasp terminate

RECIPROCATION ELEMENT
Cast clasp Lingual plate ! Combination of mesial and distal minor connector
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ENCIRCLEMENT
The characteristic of clasp that prevent movement of abutment away from associated clasp assembly ! Contact over at least 180
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Prepared parallel to path of insertion

PASSIVITY
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LOCATION OF RETENTIVE CLASP TERMINUS

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Quality of clasp that prevent the transmission of the adverse forces to the associated abutment

Mesial or distal line angle Facial surface better than lingual surface
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Length " Flexibility Contraindicated in premolar

SIMPLE CIRCLET DESIGN (Akers clasp)

REVERSE AKER DESIGN

Widely used Tooth support RPD Engage undercut remote from edentulous area Half round cross sectional Disadvantages - Increase circumference clinical crown - Increase tooth coverage

Undercut located adjacent to edentulous area Infrabulge clasp is contraindicated Kennedy class I ,II Disadvantage - Reduced strength - Lack of rest adjacent to edentulous area - Poor esthetic

MULTIPLE CIRCLET DESIGN

EMBRASURE CLASP

2 simple circlet clasp joined at the terminal aspect of their reciprocal elements Principle abutment is periodontal compromised Disadvantage - The same as simple circlet and reverse circlet

2 simple circlet joined at bodies Used on no edentulous area side Insufcient tooth preparation results in Inadequate cross sectional dimension Compromised clasp strength

RING CLASP DESIGN

Indicated on tipped mandibular molar Engage mesiolingual or mesiobuccal undercut Auxiliary bracing arm Distal and mesial occlusal rest Disadvantage - Tooth coverage - Difcult correction Contraindication - Limit vestibular depth - Soft tissue undercut Lingual Buccal

C-CLASP DESIGN (Back action clasp)

WROUGHT WIRE CIRCUMFERENTIAL CLASP

Fishhook or Hairpin clasp Simple circlet clasp with loop back retentive arm Sufcient crown height Disadvantage - Insufcient exibility - Tooth coverage - Esthetic compromised

Combination clasp - Occlusal rest - Cast metal reciprocal arm - Wrought wire retentive arm Circular cross sectional Kennedy class I and II Mesiobuccal undercut Minimal tooth coverage Disadvantage -Breakage -Minimal stabilizing

COMBINATION CLASP IN

INFRABULGE CLASP
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Bar type Flexibility

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Length Taper

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More esthetics T-clasp, modified T clasp, Y clasp and I bar

DESIGN RULES
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Disadvantage
Food accumulate ! Flexibility ! " Horizontal stability "
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Approach arm
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must not impinge soft tissue cross perpendicular to free gingival margin

Uniformly tapered " Flexibility Terminate clasp positioned " Apically on the abutment ! Rigid minor connector " Bracing and Stabilization
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T-CLASP DESIGN

I-CLASP OR I BAR

Kennedy class I and II Undercut locate adjacent edentulous area O.01 undercut Contraindication - Severe soft tissue undercut - High of contour locate near occlusal surface
A = Approach arm B= Vertical projection of approach arm C= Location where B cross perpendicular to free gingival D=Point of rst tooth contact E=Terminus of the retentive clasp F= Encirclement portion

Contact area 2-3 mm. in height 1.5-2 mm. in width Mesial rest Kennedy class I and II RPI - Mesial rest - Proximal plate - I bar

MODIFIED T-CLASP

Y-CLASP DESIGN

Equivalent to T-clasp
No retentive horizontal projection Kennedy class I and II Undercut locate near adjacent edentulous area Canine and premolar Advantage - Improve esthetic compare with conventional T clasp

Mesial and distal projection terminate near occlusal surface

INDIRECT RETAINER

INDIRECT RETAINER
Framework component that resists rotational displacement of an extension base from the supporting tissue ! Require for Kennedy class I, II and IV
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EFFECT OF ROTATIONAL MOVEMENT

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Occlusal dislodging forces

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Denture base move away from supporting tissue Anterior segment of major connector impinge upon underlining tissue

FACTOR DETERMINE INDIRECT RETAINER

Position on the opposite site of fulcrum line Perpendicular and far from fulcrum line ! Canine and premolar ! Rest at each end of lingual plate
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FORM OF INDIRECT RETAINER

Auxiliary occlusal rest Cingulum rest ! Incisal rest
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Distal Extension RPD

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Direct retainer design

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Indirect retainer

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SUPPORT FOR DISTAL EXTENSION DENTURE BASE

Maximum border extension Accurate border detail ! Primary supporting area ! Form of the ridge under function
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Impression technique
Final impression with custom tray and elastomeric impression material ! Altered-cast technique
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Miscellaneous
Retentive arms should be on the same side ! Dimpling ! Treatment denture ! RPD drawing - in paper - on the cast
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THANK YOU

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