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Textbook of
Prosthodontics
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Textbook of
Prosthodontics
Karthikeyan Ramalingam
Department of Prosthodontics
Saveetha Dental College and Hospitals
Chennai
Vinaya Bhat
Department of Prosthodontics
Saveetha Dental College and Hospitals
Chennai
JAYPEE BROTHERS
MEDICAL PUBLISHERS (P) LTD
New Delhi
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Textbook of Prosthodontics
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or
transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise,
without the prior written permission of the editors and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every
effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held
responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under
Delhi jurisdiction only.
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TO
MY
FATHER—DR NM VEERAIYAN
MOTHER—MRS SARASWATHY
SISTER—DR V SAVEETHA
NIECE—MISS KEERTHANYA
PROFESSOR OF ANATOMY—PROF DR SARATHA KATHIRESAN
ZOOLOGY TEACHER—MRS NS KARTHIKEYANI
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Special Contributors
Dr Sharmila Hussain
Dr Harish Babu
Dr Padma V Narayanan
Contributors
Dr Devi Priya
Dr Chitra Pandurangan
Dr Uma Maheswari
Dr Sheeba Abraham
Dr S Subramanian
Dr P Muthushankar
Dr Krishnan Bharani
Dr Anandha Vadivoo
Dr Shilpa Reddy
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Foreword
Even though many books are available on different sections in prosthodontics, there is no
comprehensive textbook available in this subject. Dr. Deepak Nallaswamy et al have undertaken
this venture as a challenge. I had the opportunity to evaluate this book right from the conceptual
stage to the completed level. The unique feature of this book is the use of simple crisp explanations
accompanied with over 3000 illustrations, which will aid the students to read and understand the
subject in a better way. Three years of hard work have gone into this book and I believe that this
unstinted effort will be fruitful to the students. I wish this book would become an essential companion
for all dental graduates.
Dr. NM Veeraiyan
President
Saveetha Dental College and Hospitals
Chennai
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Foreword
As the Vice-Chancellor of the Tamil Nadu Dr MGR Medical University, I envisioned to make medical
education a pleasurable and hassle-free experience. It is said that the root of education is bitter but
the fruit is sweet. But as academicians, I believe every one should work to make even the roots of
education sweet. The book Textbook of Prosthodontics authored by Dr Deepak et al takes a path similar
to my vision. Writing a book is a work of art. But very few Indian dental academicians have excelled
in this art. Prosthodontics is a vast and ever expanding specialty that requires a minimum of three
books to cover the university undergraduate syllabus. The lack of a comprehensive textbook in this
subject makes it difficult for an undergraduate student to cover the syllabus. A commendable and
arduous task has been taken up by these authors in bringing out a comprehensive prosthodontic
textbook that is unique in its contents, coverage, language and illustrations.
I wish them success in their noble but humble mission. I believe that this book ‘tailor-made’ to
our university syllabus will aid to fulfill the needs of all prosthodontic students.
Dr CV Bhirmanandham
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Preface
Textbook of Prosthodontics provides a comprehensive idea about the principles and procedures involved
in the construction of complete dentures, removable partial dentures, fixed partial dentures,
maxillofacial prostheses/appliances and implants. I wrote this book in order to make learning
Prosthodontics, a more easy, simple and pleasurable experience.
I always intended to write a book from my school days. Prosthodontics was conducive in that,
both the subject and the time was suitable to start writing a book. When I began writing this book, I
had two goals to fulfill namely, the book should be simple enough for anybody to read and understand
at the first glance. Secondly, I did not want any gross omissions. Hence, I took great caution to refer
maximum literature before writing any section.
The book follows the sequence of the procedures done in practice in order to make learning easy
and to improve the applicability of the subject in general practice. Though this book is tailor-made
for an undergraduate student, certain topics have been covered in-depth, which may be of use for
postgraduate reference.
The book carries more than 3000 illustrations that improve the visualization of the reader. What
makes this book unique is that all the five branches of prosthodontics are discussed under one roof
making it easy for immediate cross reference and helps to avoid repetition of similar procedures.
It is important for the student to realise that a sound knowledge on the principles and concepts
that underlie any procedure is important for general practice. Reading this book in-depth is essential
to obtain a sound basic knowledge on the principles followed in prosthodontics.
I always dreamt of writing a book, which has become a reality, hence, I conclude quoting, ‘dream
high as they always come true’.
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Acknowledgements
Writing this book happens to be one of the greatest achievements in this phase of my life. I’m extremely
thankful to Dr Karthikeyan Ramalingam for his sincere and enthusiastic support without which I
would not have been able to write this book.
I would also like to thank Dr Harish Babu who helped me in almost every phase to make this
dream come true. I extend my gratitude to a role model teacher and an excellent academician
Dr Vinaya Bhat for all her contributions and academic guidance in making this book more informative
and of a respectable standard.
I would like to thank Dr Sharmila Hussain for her contributions, support and encouragement. I
thank all my friends and classmates who encouraged me and provided a very conducive environment
to make the most of my time. I would like to thank Dr. Padma Narayanan for suggesting, contributing,
encouraging and cooperating on this project.
I thank Prof Dr R Subramaniam and Prof Dr TV Padmanabhan for their support and
encouragement on this project. I thank the Dean Dr MF Baig who helped me writing this book.
I would like to thank my Father and President, Saveetha Medical and Educational Trust for all the
resources he provided upon which this book has been built from the ground up.
I am thankful to Mr JP Vij, Chairman and Managing Director, Mr Tarun Duneja, General Manager
Publishing and Mr PS Ghuman, Senior Production Manager of M/s Jaypee Brothers Medical
Publishers Pvt Ltd for publishing the book according to my preference. I thank Mrs Ritu Chawla for
her whole hearted contribution while formatting the book. I also thank Mr RK Majumdar for making
the figures attractive.
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Contents
Section 1
Complete Dentures
Chapter 1 Chapter 6
Introduction to Complete Dentures .......... 4 Lab Procedures Prior to Master
• Definition ........................................................... 4 Impression Making .................................... 70
• Component Parts of a Complete Denture ....... 4 • Finishing the Primary Cast ............................. 70
• Steps in the Fabrication of a • Fabrication of a Special Tray........................... 70
Complete Denture ........................................... 10
Chapter 7
Chapter 2 Secondary Impressions in
Diagnosis and Treatment Planning ......... 13 Complete Dentures ..................................... 80
• Diagnosis ......................................................... 14 • Techniques for Making the
• Patient Evaluation ........................................... 14 Master Impression .......................................... 80
• Clinical History Taking .................................... 16 • Making a Secondary Impression Using a
• Clinical Examination of the Patient ................ 19 Special Tray ...................................................... 80
• Radiographic Examination ............................. 31 • Inspecting the Impression .............................. 90
• Treatment Plan ................................................. 31 • Disinfecting the Impression ........................... 90
• Adjunctive Care ............................................... 31 • Remaking the Impression ............................... 90
• Prosthodontic Care ......................................... 32
Chapter 3 Chapter 8
Diagnostic Impressions in Lab Procedures Prior to Jaw Relation ..... 92
Complete Dentures ..................................... 34 • Preparing the Master Cast .............................. 92
• Diagnostic Impression .................................... 34 • Indexing the Master Cast ................................ 95
• Making the Diagnostic Cast ............................ 35 • Fabricating the Temporary Denture Base ...... 97
• Stabilizing the Base Plates ........................... 102
Chapter 4 • Fabrication of Occlusal Rims ....................... 103
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Textbook of Prosthodontics
Section 2
Removable Partial Dentures (RPD)
Chapter 16 Chapter 18
Introduction and Classification ............. 266 Removable Partial Denture Design ...... 307
• Common Terminologies Used in • Surveying ....................................................... 307
Removable Partial Denture ........................... 266 • Determining the Path of Insertion and
• Indications for Removable Partial Dentures 267 Guiding Planes .............................................. 320
• Classification of Partially • Designing the Component Parts of a RPD .. 327
Edentulous Arches ........................................ 270 • Principles of a Removable Partial Denture .. 380
• Steps in the Fabrication of a • Principles of Design/ or Philosophy of
Removable Partial Denture ........................... 287 Design ............................................................ 392
• Parts of a Removable Partial Denture .......... 290 • Essentials of Design ..................................... 395
• Laboratory Design Procedure ...................... 396
Chapter 17
Diagnosis, Treatment
Planning and Mouth Preparation .......... 293 Chapter 19
• Clinical Diagnosis ......................................... 293 Prosthetic Mouth Preparation ................ 400
• Derived Diagnosis or • Introduction ................................................... 400
Post-clinical Diagnosis ................................. 295 • Preparation of Retentive Undercuts ............ 400
• Treatment Planning ....................................... 299 • Guide Plane Preparation ............................... 402
• Preprosthetic Mouth Preparation ................. 300 • Rest Seat Preparation ................................... 403
• Making the Primary Cast .............................. 305
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Contents
Chapter 20 Chapter 22
Secondary Impression and Types of Removable Partial Dentures .. 449
Master Cast for RPD................................. 409 • Introduction ................................................... 449
• Introduction ................................................... 409 • Unilateral RPD ............................................... 450
• Dual Impression Procedures ........................ 411 • Implant Supported RPD ................................ 450
• Preparing the Master Cast ............................ 420 • Removable Partial Overdenture ................... 451
• Guide Plane Removable Partial Denture ..... 454
Chapter 21 • I-Bar Removable Partial Dentures ................ 456
• Swing-lock Removable Partial Dentures ..... 461
Fabrication of A Removable
• Temporary Partial Dentures ......................... 464
Partial Denture .......................................... 426 • Immediate Partial Denture ............................ 472
• Framework Fabrication ................................. 426 • Spoon Dentures ............................................ 473
• Framework Try-in ........................................... 436 • Every Dentures .............................................. 474
• Fabrication of the Temporary • Two-part Dentures ......................................... 475
Denture Base and Occlusal Rims ................ 437 • Claspless Dentures ....................................... 476
• Jaw Relation .................................................. 438 • Disjunct Denture ........................................... 477
• Mounting the Casts ....................................... 438
• Denture Base Selection ................................ 438 Chapter 23
• Teeth Selection .............................................. 439
Correction of Removable
• Arranging the Artificial Teeth ....................... 441
• Processing ..................................................... 443 Partial Dentures ........................................ 479
• Insertion ......................................................... 443 • Relining .......................................................... 479
• Rebasing of Removable Partial Dentures .... 481
• Reconstruction of Removable
Partial Denture ............................................... 482
• Repairs of Removable Partial Dentures ....... 482
Section 3
Fixed Partial Dentures (FPD)
Chapter 24 Chapter 26
Introduction to Fixed Partial Dentures 490 Design of a Fixed Partial Denture ......... 520
• Introduction ................................................... 490 • Introduction ................................................... 520
• Common Terms Used in • Design Considerations for Individual
Fixed Prosthodontics .................................... 490 Conditions ..................................................... 520
• Indications for FPD ....................................... 491 • Material Selection .......................................... 520
• Contraindications for FPD ............................ 491 • Biomechanical Considerations .................... 521
• Diagnosis and Treatment Planning .............. 492 • Abutment Selection ....................................... 522
• Classification of FPD .................................... 497 • Special Cases ................................................ 525
• Condition of the Residual Ridge .................. 525
Chapter 25 • Occlusion with the Opposing Teeth ............. 526
Parts of a Fixed Partial Denture ............. 503
• Introduction ................................................... 503 Chapter 27
• Retainers ........................................................ 503 Occlusion in Fixed Partial Dentures ..... 528
• Pontics ........................................................... 506 • Concepts of Occlusion in
• Connectors .................................................... 515 Fixed Partial Dentures .................................. 528
xvii
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Textbook of Prosthodontics
xviii
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Contents
Section 4
Maxillofacial Prosthetics (MFP)
Chapter 35 • Fixed Partial Dentures in
Maxillofacial Prosthetics .............................. 705
Introduction to Maxillofacial • Implants ........................................................ 706
Prosthodontics ........................................... 684 • Obturators and Velo-pharyngeal
• Introduction .................................................. 684 Prosthesis ..................................................... 706
• Classification of Maxillofacial Prostheses . 684 • Extra-oral Prosthesis ................................... 708
• Treatment Prosthesis ................................... 709
Chapter 36
Types of Maxillofacial Defects ............... 687 Chapter 38
• Maxillary Defects .......................................... 687 Materials Used in Maxillofacial
• Velo-pharyngeal Defects .............................. 692 Prosthetics .................................................. 714
• Extraoral Defects .......................................... 694 • Acrylic Resin ................................................. 714
• Traumatic Defects ........................................ 694 • Acrylic Copolymers ....................................... 714
• Polyvinyl Chloride and Copolymers ............. 714
Chapter 37 • Chlorinated Polyethylene ............................. 714
Types of Maxillofacial Prosthesis .......... 697 • Polyurethane Elastomers .............................. 714
• Complete Dentures in • Silicones ........................................................ 714
Maxillofacial Prosthetics .............................. 697 • Polyphosphazines ......................................... 715
• Removable Partial Dentures in • Adhesives ...................................................... 715
Maxillofacial Prosthetics .............................. 700 • Metal ............................................................... 715
Section 5
Implant Dentistry (ID)
Chapter 39 • Diagnosis and Treatment
Planning for Implants .................................... 729
Dental Implantology ................................ 720 • Surgical Placement of Implants ................... 732
• Introduction ................................................... 720 • Failures in Implants ....................................... 736
• Classification of Implants ............................. 720 • Materials Used in Dental Implants ............... 738
• Mechanism of Integration of
Endosteal Implants (Osseo-Integration) ..... 726
Section 6
Glossary of Prosthodontics Terms
• Glossary of Prosthodontics Terms .............. 745 Index ............................................................ 835
xix
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Section One
Complete
Dentures
• Introduction to Complete Dentures
• Diagnosis and Treatment Planning
• Diagnostic Impressions in Complete
Dentures
• Mouth Preparation for CD
• Primary Impressions in Complete
Dentures
• Lab Procedures Prior to Master
Impression Making
• Secondary Impressions in
Complete Dentures
• Lab Procedures Prior to Jaw Relation
• Maxillomandibular Relations
• Lab Procedures Prior to Try-In
• Try-In
• Lab Procedures Prior to Insertion
• Complete Denture Insertion
• Relining and Rebasing in
Complete Dentures
• Special Complete Dentures
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Chapter 1
Introduction to Complete Dentures
• Definition
• Component Parts of a Complete Denture
• Steps in the Fabrication of a Complete Denture
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1 Textbook of Prosthodontics
Introduction to
Complete Dentures
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Introduction to Complete Dentures
seated in the mouth. This surface is a negative It is usually made in acrylic resin. In some
1
replica of the tissue surface of the patient. It cases metal denture bases are prepared. The
should be free of voids and nodules to avoid denture base forms the foundation of the denture.
injury to the tissues. It helps to distribute and transmit all the forces
Polished surface (Cameo surface) It is defined acting on the denture teeth to the basal tissues. It
as, “That portion of a surface of a denture which has the maximum influence on the health of the
extends in an occlusal direction from the border of the oral tissues. It is the part of the denture, which is
denture and includes the palatal surfaces. It is the part responsible for retention and support.
of the denture base which is usually polished, and it
includes the buccal and lingual surfaces of the teeth” Acrylic Resin Denture Bases
– GPT. It is the most commonly used denture base
This surface refers to the external surfaces of material (Fig. 1.3). It is easy to fabricate and
the lingual, buccal, labial flanges and the external economical. It is supplied as a powder (polymer)
palatal surface of the denture. This surface should and a liquid (monomer).
be well polished and smooth to avoid collection
Advantages
of food debris.
• Acrylic has a translucent pink colour, which
Occlusal surface It is defined as, “That portion of closely resembles the gingiva, providing good
the surface of a denture or dentition which makes aesthetics.
contact or near contact with the corresponding surface • These dentures can be easily rebased/relined
of the opposing denture or dentition”—GPT. as required in future.
This surface refers to the occlusal surface of • It is also available in various pigmented
the denture teeth. It resembles the natural teeth colours which can be used for characterization.
and usually contains cusps and sluice ways to • The material is quite strong and can withstand
aid in mastication. normal occlusal forces.
Disadvantages
Parts of a Complete Denture (Fig. 1.2)
• It cannot be used in thin sections like a metal
The various parts of a complete denture are: denture base. Hence, it affects the speech of
• Denture base. the patient.
• Denture flange. • It does not transmit any heat. So the patient’s
• Denture border. perception of the temperature of the food is
• Denture teeth. decreased.
Each of these parts have been explained in • Difficult to maintain.
detail here.
Metal Denture Bases
Denture Base Metal denture bases can be fabricated using Gold,
It is defined as, “That part of a denture which rests Gold alloys, Chromium-Cobalt or Nickel-
on the oral mucosa and to which teeth are attached” – Chromium alloys (Fig. 1.4).
GPT.
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1 Textbook of Prosthodontics
Advantages
• Mandibular dentures are heavier. So the Fig. 1.5b: Cross-sectional view Fig. 1.5c: Cross-sectional
of a maxillary denture showing view of a mandibular
retention and stability are improved.
the labial flange denture showing the labial
• Improved thermal conductivity gives good flange
sensory interpretation.
• They are strong even in thin sections. Thin Buccal Flange
sections are very comfortable for the patient.
• Easier to maintain. It is defined as, “The portion of a flange of a denture
which occupies the buccal vestibule of the mouth”—
Disadvantages GPT. It provides the required cheek fullness in
• More expensive. aged edentulous patients. In the mandibular den-
• Require more time for fabrication. ture it also transmits the occlusal forces to the
• Require refractory cast material.
buccal shelf area. The buccal frenum is attached
• Difficult to fabricate.
to active muscle fibres, hence, additional relief
• Cannot be rebased.
should be provided in the buccal flange (Fig. 1.6).
Flange of a Denture
It is defined as, “The essentially vertical extension
from the body of the denture into one of the vestibules
of the oral cavity. Also, on the mandibular denture,
the essentially vertical extension along the lingual side
of the alveololingual sulcus”- GPT.
It has two surfaces, namely, the internal basal Fig. 1.6a: Buccal flange of a maxillary denture
seat surface and the external labial or lingual surface.
The functions of the flange include, providing
peripheral seal and horizontal stability to the
denture. The flanges are named based on the
vestibule they extend into.
Labial Flange
It is defined as, “The portion of the flange of the
6 denture which occupies the labial vestibule of the
Fig. 1.6b: Buccal flange of the mandibular denture
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Introduction to Complete Dentures
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1 Textbook of Prosthodontics
Fig. 1.9: Acrylic resin teeth with amalgam stops Semi-anatomic Teeth
These teeth have cusp angles ranging between
Morphology of Teeth 0o and 30o. The cusp angles are usually around
Anatomic Teeth 20o. They are also called modified anatomic teeth.
Victor Sears in 1922 designed the first semi-
It is defined as, “Teeth which have prominent pointed anatomic tooth, which was called the channel tooth.
or rounded cusps on the masticating surfaces and This consisted of a mesiodistal groove in all
which are designed to occlude with the teeth of the maxillary posterior teeth and a mesiodistal ridge
opposing denture or natural dentition” - GPT. in all mandibular posterior teeth. These teeth were
Anatomic teeth have a 33° cusp angle. Cusp designed for unlimited protrusive movement and
angle can be defined as, “the angle made by the limited lateral movements (Fig. 1.11).
slopes of the cusp with a perpendicular line bisecting
the cusp, measured mesiodistally or buccolingually” -
GPT (Fig. 1.10).
They are the most commonly used of all the
types available because they resemble the natural
teeth and provide good aesthetics and the psycho-
logical benefit to the patient. While choosing the
type of teeth for a patient, the incisal and condylar Fig. 1.11: Victor Sear’s channel tooth (schematic
8 guidance of the patient, should be analyzed. representation)
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Introduction to Complete Dentures
In 1930 Avery Brothers modified the channel Myerson introduced the “trukusp” teeth in
1
tooth to produce what was called the scissor bite 1929. These had a series of buccolingual ridges
teeth. This is exactly the opposite of the channel on the occlusal surfaces of both maxillary and
tooth. The grooves and ridges run buccolingually mandibular teeth. Here the ridges of opposing
so that protrusive movement is limited and lateral teeth were parallel to each other (Fig. 1.14).
movement is free. This was designed to shear
food in the lateral direction (Fig. 1.12).
Advantages
Fig. 1.13: (a) Hall’s inverted cusp teeth (Schematic repre- • In patients with bruxism non-anatomic teeth
sentation) (b) Cross-section of the tooth showing the concen- decrease the forces acting on the basal tissues.
tric ridges around the conical depression (Green arrow) • Greater range of movements is possible. 9
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1 Textbook of Prosthodontics
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Introduction to Complete Dentures
Contd.
1
• Radiological examination
• Examination of previous dentures, examination of 2. Pouring the diagnostic cast using Dental Plaster.
pre-treatment records. • Surveying the diagnostic cast using a surveyor.
— Identifying the presence of an undercut
• Making the diagnostic impression with alginate. — Measuring the depth of the undercut.
(rigid impression material are avoided as undercuts — Determining the amount of mouth preparation
may be present). required.
— Determining the path of insertion.
3. Treatment plan:
• Choosing the type of prosthesis. (Design and material)
• Applying design considerations.
4. Pre-prosthetic surgery (excision of tori, frenectomy, frenotomy,
alveoloplasty, vestibuloplasty, ridge augmentation procedures,
removal of undercuts, etc.)
5. Making the primary impression using impression 6. Pouring the primary cast using Dental plaster. Surveying
compound (material of choice) and refining the impression. the primary cast to determine the path of insertion.
Tripoding the primary cast.
Adapting a spacer and fabricating the special tray over the
primary cast. Providing relief to certain areas
Materials used: shellac, acrylic, polystyrene, etc.
7. Making the secondary impression.
• Border moulding using green stick compound.
• Recording the posterior palatal seal
• Trimming the excess green stick compound.
• Scraping out the wax spacer in the special tray.
• Providing relief holes over areas where additional relief is required
• Making the secondary impression using zinc oxide eugenol
Impression paste.
8. Pouring the master cast.
• Beading the secondary impression using Beading/
modelling wax.
• Boxing the secondary impression using Boxing or
modelling wax.
• Pouring the master cast using Dental stone.
9. Fabricating the temporary denture base using shellac or
acrylic.
Fabricating occlusal rims using modelling wax.
10. Recording the tentative jaw relation
• Vertical jaw relation
• Centric or Horizontal jaw relation 12. Face bow transfer and Articulation
11. Orientation relation using face-bow 13. Attaching the tracers to the occlusal rims
14. Performing the gothic arch tracing to determine the true 15. Remounting the mandibular cast according to the true
centric relation centric relation
16. Protrusive and lateral inter occlusal records are 17. The articulator is programmed according to the inter-
made in eccentric relations occlusal records
18. Anterior teeth arrangement
19. Anterior Try-in 20. Posterior teeth arrangement in balanced occlusion.
21. Try-in Verification
22. Wax-up
25. Insertion 23. Processing the denture
• Check for proper fit and function. 24. Finishing the denture
• Give proper instructions
• Recall after 24 hours to check immediate changes.
• Refine occlusal discrepancies if any.
• Call for review after a week.
• Recall every 3 to 6 months for review.
11
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Chapter 2
Diagnosis and Treatment Planning
• Diagnosis
• Patient Evaluation
• Clinical History Taking
• Clinical Examination of the Patient
• Radiographic Examination
• Treatment Plan
• Adjunctive Care
• Prosthodontic Care
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Diagnosis and Treatment Planning
2
Diagnosis and
Treatment Planning
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2 Textbook of Prosthodontics
• Pre-prosthetic Surgery other hand, female patients are more critical about
• Tissue Conditioning
• Nutritional Counselling
aesthetics and they usually appear to overrule the
❐ Prosthodontics care dentist in treatment planning.
• Patients destined to be edentulous:
— Immediate or Conventional Denture Complexion and Personality
— Definitive or Interim Denture
— Implant or Soft Tissue Supported Denture Evaluating the complexion helps to determine the
• Patients already edentulous: shade of the teeth. Executives require smaller
— Soft Tissue Supported
— Implant Supported (Fixed or Removable)
teeth. More details are discussed under selection
— Material of Choice of teeth in Chapter 10.
— Selection of Teeth
— Anatomic Palate Cosmetic Index
It basically speaks about the aesthetic expec-
DIAGNOSIS tations of the patient. Based on the cosmetic index,
Essential diagnostic data obtained from patient patients can be classified as:
interview, definitive oral examination, consul- Class I: High cosmetic index. They are more
tation with medical and dental specialists, radio- concerned about the treatment and wonder if
graphs, mounted and surveyed diagnostic casts their expectations can be fulfilled.
should be carefully evaluated during treatment Class II: Moderate cosmetic patients. They are
planning. patients with nominal expectations.
Class III: Low cosmetic index. These patients
PATIENT EVALUATION are not bothered about treatment and the aes-
thetics. It is very difficult for the dentist to know
Patient evaluation is the first step to be carried if the patient is satisfied with the treatment or
out in treating a patient. The dentist should begin not.
evaluating the patient as soon as he/she enters
the clinic. This is to obtain a clear idea of what Mental Attitude of Patients
type of treatment is necessary for the patient. De Van stated, “meet the mind of the patient before
meeting the mouth of the patient”. Hence, we
Gait
understand that the patient’s attitudes and opi-
The dentist should note the way the patient walks nions can influence the outcome of the treatment.
into the clinic. People with neuromuscular dis- A doctor should evaluate the patient’s hair
orders show a different gait. Such patients will colour, height, weight, gait, behaviour, socio-
have difficulty in adapting to the denture. economic status, etc right from the moment he/
she enters the clinic. A brief conversation will
Age reveal his/her mental attitude. Actually patient
The decade, which the patient belongs to, is evaluation is done along with history taking but
important to predict the outcome of treatment. since it is usually begun prior to history taking,
For example patients belonging to the fourth we have discussed it in detail here.
decade of life will have good healing abilities and Based on their mental attitude, patients can
patients above the sixth decade will have compro- be grouped under two classifications. Dr. MM
mised healing. House proposed the first one in 1950, which is
widely followed.
Sex
House’s Classification
Male patients are generally busy people who
appear indifferent to the treatment. They are only Dr.MM House in 1950 classified patient’s
14 bothered about comfort and nothing else. On the psychology into four types:
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Obsessive or exacting These persons are natu- and to determine the best form of treatment for
rally of an exacting nature and are accustomed to that patient.
giving directions to others. They state their wants
and are inclined to tell the dentist how to proceed. Name
Patients of this type must be handled firmly. They The name should be asked to enter it in the record.
should be told tactfully at the outset that they When the patient is addressed by his name, it
would not be allowed to direct the denture brings him some confidence and psychological
construction. security. The name also gives an idea about the
Chronic complainers They are a group of people patient’s family and community.
who are habitually faultfinding and dissatisfied.
Appreciating their cooperation and incorporating Age
as many of their ideas as possible with good The importance of knowing the age was dis-
denture construction is the best way to handle cussed in patient evaluation. Some diseases are
them. It is best to have an understanding with limited to certain age groups. Hence, age can be
such patients before work commences. In this used to rule out certain systemic conditions apart
way they are made to share responsibility for the from determining the prognosis.
outcome.
Self-conscious The apprehension here centres Sex
chiefly on appearance. It is wise to give overt
The importance of knowing the sex was also
reassurance to the self-conscious patient and
discussed in patient evaluation. Generally the
permit participation in the reconstruction as far mentality of the patient is affected by the gender.
as feasible in order to establish some responsi- Again certain diseases are confined to a particular
bility in the result. sex. Hence, sex can also be used to rule out certain
systemic conditions.
Uncooperative
These patients present themselves usually upon Occupation
being urged by relatives or friends. They do not Executives and sales representatives require more
feel a need for dentures, though the need exists. idealistic teeth. While other people who work in
Their general attitude is negative. They constitute places with high physical exertion require rugged
an extremely difficult group of potential denture teeth. And people with higher income have
wearers and tax the dentist’s patience to the limit. greater expectations. People who are very busy
In many cases, an attempt to make dentures for will be more critical about comfort.
these individuals is a waste of time.
Along with analyzing the mental attitudes of Race
the patient, the dentist must collect information It helps to select the shade of the teeth.
about the patient’s habits, diet, past dental history
and the physical characteristics, etc. The expec- Location
tations of the patient should be taken into
Some endemic disorders like fluorosis are
consideration to achieve patient satisfaction.
confined to certain localities. People from that
locality may want characterization (pattern
CLINICAL HISTORY TAKING
staining) in their teeth for a natural appearance.
History taking is a systematic procedure for
collecting the details of the patient to do a proper Religion and Community
treatment planning. Personal and medical parti- Gives an idea about the dietary habits and helps
16 culars are gathered to rule out general diseases to design the denture accordingly.
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Previous denture It denotes the dentures, which • The posterior extension of the maxillary
were worn before the current denture. The reason denture should be noted.
for the failure of the prosthesis should be enquired • The posterior palatal seal should be
with the patient. The patients who keep changing examined. It should be marked as acceptable
dentures in a short period of time are difficult to or unacceptable.
satisfy and are risky to deal with. • Proper basal seat coverage and adaptation
should be noted. It should be marked as
Current denture The existing denture, which is
acceptable or unacceptable
worn by the patient at present, should be
• The midline of the denture should be
examined thoroughly. The reason for wanting a
checked. At-least the maxillary denture
replacement should be evaluated. This denture
should coincide with the facial midline. If
gives us information about the denture expe-
there is deviation, the distance should be
rience, denture care, dental knowledge and para-
recorded. It should be marked as acceptable
functional habits of the patient.
(less than 2 mm deviation) or unacceptable
The following factors should be noted on the
(more than 2 mm deviation) (Fig. 2.2).
existing prosthesis:
• The period for which the patient has been
wearing the denture should be determined.
The amount of ridge resorption should be
assessed to determine the amount of
expected ridge resorption after placement
of the new prosthesis.
• Anterior and posterior teeth shade, mould
and material.
• Centric occlusion and also the patient pro- Fig. 2.2
file in centric relation. (Centric occlusion is • The amount of space in the buccal vestibule
“the centered contact position of the occlusal should be examined. It should be marked
surfaces of the mandibular teeth against the as acceptable or unacceptable.
occlusal surfaces of the maxillary teeth”-GPT). • Presence of cross-bite should be checked.
It should be marked as acceptable or It should be recorded as none, unilateral and
unacceptable. bilateral.
• Vertical dimension at occlusion. It should • Characterization or purposeful staining of
be marked as acceptable or unacceptable. the denture for esthetics should be recor-
• Plane of orientation of the occlusal plane. ded.
Improperly-oriented plane will have teeth • Patient’s comfort should be enquired. It
arranged in a reverse smile line (Fig. 2.1). should be marked as acceptable or unaccep-
• The tissue surface and the polished or cameo table.
surface of the palate should be examined. • The denture maintenance should be eval-
Reproduction of rugae should be noted. uated. It can be classified as:
• The patient’s speech pattern should be 1. Good
noted for any valving nasal twang. 2. Fair
3. Poor
• Wear or breakage. This may be an indica-
tion of bruxism. Denture wear can be
classified as:
1. Minimal
2. Moderate
18 Fig. 2.1: (a) Normal smile line (b) Reverse smile line 3. Severe.
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Fig. 2.4: Square facial form Fig. 2.5: Tapering facial form
Muscle Tone
Muscle tone can affect the stability of the denture.
Fig. 2.8: Straight profile Fig. 2.9: Retrognathic profile House classified muscle tone as:
Class I: Normal tension, tone and placement
of the muscle of mastication and facial expression.
No degeneration. It is common in immediate
denture patients because all other patients
generally show degeneration.
Class II: Normal muscle function but slightly
decreased muscle tone.
Class III: Decreased muscle tone and function.
It is usually accompanied with ill-fitting dentures,
decreased vertical dimension, decreased biting
force, wrinkles in the cheeks and drooping of
Fig. 2.10: Prognathic profile commissures.
20
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Mucosa
The colour, condition and the thickness of the Fig. 2.15: Class II mucosa. Which is twice in thickness
mucosa should be examined.
Class III: Soft tissues have excessively thick
Colour of the mucosa The mucosa should have a
investing membranes filled with redundant
healthy pink colour. Any amount of redness
tissues. This requires tissue treatment (Fig. 2.16).
indicates an inflammatory change. This may be
due to ill-fitting denture, smoking, infection or a
systemic disease. Inflamed tissues provide a
wrong recording while making an impression.
Other colour changes such as white patches
should be noted, as this might indicate an area of
frictional keratosis.
Condition of the mucosa House classified the
Fig. 2.16: Class III excessively thick mucosa where
condition of the mucosa as: surgical treatment is mandatory
Class I: Healthy mucosa.
Class II: Irritated mucosa. Saliva All major salivary gland orifices should
Class III: Pathologic mucosa. be examined for patency. The viscosity of the
Thickness of the mucosa The quality of the saliva should be determined. Saliva can be
mucoperiosteum may vary in different parts of classified as:
the arch. Variations in the thickness of mucosa Class I: Normal quality and quantity of saliva.
make it very difficult to equalize the pressure Cohesive and adhesive properties are ideal.
under the denture and to avoid soreness. House Class II: Excessive saliva. Contains much
classified thickness of the mucosa as: mucus.
Class I: Normal uniform density of mucosal Class III: Xerostomia. Remaining saliva is
tissue (approximately 1 mm thick). Investing mucinous.
membrane is firm but not tense and forms the Thick ropy saliva alters the seat of the denture
ideal cushion for the basal seat of the denture (Fig. because of its tendency to accumulate between
2.14). the tissue and the denture. Thin serous saliva does
Class II: (Fig. 2.15). It can be of two types: not produce such effects.
a. Soft tissues have a thin investing mem- Xerostomic patients show poor retention and
brane and are highly susceptible to irri- excessive tissue irritation wheras excessive sali-
tation under pressure. vation complicates the clinical procedures.
b. Soft tissues have mucous membranes that
are twice the normal thickness. Residual Alveolar Ridge
While examining the residual alveolar ridge the
arch size, shape, inter-arch space, ridge contour,
ridge relation and ridge parallelism should be
noted.
Arch size Arch should be observed for two main
22 Fig. 2.14: Class I normal mucosa reasons:
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Fig. 2.18: Medium size Fig. 2.19: Small size Fig. 2.23: High Fig. 2.24: Flat Fig. 2.25: Knife
arch arch ridge ridge edge ridge
Arch form This plays a role in support of a denture There is another classification for ridge cont–
and in tooth selection. The various arch forms are
our. According to that classification, the maxillary
square ovoid and tapered. Discrepancies between
and mandibular ridges are classified separately.
the maxillary and mandibular arch forms can
Classification of maxillary ridge contour:
create problems during teeth setting.
Class I: Square to gently rounded.
House classified arch form as:
Class II: Tapering or ‘V’ shaped.
Class I: Square (Fig. 2.20)
Class III: Flat.
Class II: Tapering (Fig. 2.21)
Classification of mandibular ridge contour:
Class III: Ovoid (Fig. 2.22).
Class I: Inverted ‘U’ shaped (parallel walls,
Ridge contour Ridges should be both inspected medium to tall ridge with broad ridge crest)
and palpated. The ridge should be palpated for (Fig. 2.26). 23
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Ridge relation Ridge relation is defined as, “ The Fig. 2.34: Prognathic ridge relation
positional relation of the mandibular ridge to the
maxillary ridge” - GPT. Ridge parallelism can be classified as:
While examining ridge relation, the pattern of Class I: Both ridges are parallel to the occlusal
resorption of the maxillary and mandibular plane (Fig. 2.35).
arches should be remembered (maxilla resorbs Class II: The mandibular ridge diverts from the
upward and inward while the mandible resorbs occlusal plane anteriorly (Fig. 2.36).
downward and outward).
Ridge relation refers to the anterior posterior
relationship between the ridges. Angle classified
ridge relationship.
Class I: Normal (Fig. 2.32).
Class II: Retrognathic (Fig. 2.33).
Class III: Prognathic (Fig. 2.34).
Ridge parallelism Ridge parallelism refers to the
relative parallelism between the planes of the
ridges. The ridges can be parallel or non-parallel.
24 Teeth setting is easy in parallel-ridges. Fig. 2.35: Normal ridge parallelism
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Hard Palate
The shape of the vault of the palate should be
Fig. 2.38: Class I inter-arch space examined. Hard palates can be classified as: 25
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Diagnosis and Treatment Planning
Fig. 2.48: Class II palatal throat form Fig. 2.52: Class III shallow lateral throat
form
Class III: Usually accompanies a small maxilla.
The curtain of soft tissue turns down abruptly 3
Gag Reflex and Palatal Sensitivity
to 5 mm anterior to a line drawn across the palate
at the distal edge of the tuberosities (Fig. 2.49). Some patients may have an exaggerated gag
reflex, the cause of which can be due to a systemic
Lateral Throat Form disorder, psychological, extraoral, intraoral or
iatrogenic factors. The management of such
Neil classified lateral throat form (retromylohyoid
patients is through clinical, psychological and
fossa) area as Class—I (Fig. 2.50), Class—II (Fig.
2.51) and Class—III (Fig. 2.52). pharmacological means. If the patient lacks pro- 27
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gress he/she should be referred to a specialized On the other hand, lingual tori are a constant
consultant. hindrance to complete denture construction and
House classified palatal sensitivity as: have to be removed surgically.
Class I: Normal Maxillary and mandibular tori can be classified
Class II: Subnormal (Hyposensitive) as:
Class III: Supernormal (Hypersensitive) Class I: Tori are absent or minimal in size. Exis-
ting tori do not interfere with denture construc-
Bony Undercuts tion (Fig. 2.54).
Bony undercuts do not help in retention, rather
they interfere with peripheral seal. Bony under-
cuts are seen both in the maxilla and the
mandible.
In the maxillary arch, they are found in the
anterior region and laterally in the region of the
tuberosities. In the mandibular arch, the area
under the mylohyoid ridge acts as an undercut
(Fig. 2.53).
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2
Fig. 2.57: Class I Fig. 2.58: Class II Fig. 2.59: Class Tongue
border border III border The tongue should be examined for the following:
attachments attachments attachments
• Size: Presence of a large tongue decreases the
Classification of frenal attachments stability of the denture and are also a hind-
Class I: The frenum is located away from the crest rance to impression making. Tongue-biting is
of the ridge (Fig. 2.60) common after insertion of the denture. A small
Class II: The frenum is located nearer to the crest tongue does not provide adequate lingual
of the ridge (Fig. 2.61) peripheral seal. 29
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• Movement and coordination: Tongue movements Class II: The tongue is flattened and broadened
and coordination are important to register a but the tip is in a normal position (Fig. 2.67).
good peripheral tracing. They are also
necessary in maintaining the denture in the
mouth during functional activities like speech,
deglutition and mastication, etc.
House’s classification of tongue sizes
Class I: Normal in size, development and
function. Sufficient teeth are present to maintain Fig. 2.66: Wright’s class I Fig. 2.67: Wright’s class II
this normal form and function (Fig. 2.63). tongue tongue
Class II: Teeth have been absent long enough
to permit a change in the form and function of Class III: The tongue is retracted and depressed
the tongue (Fig. 2.64). into the floor of the mouth, with the tip curled
upward, downward or assimilated into the body
of the tongue (Fig. 2.68).
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the stability and retention of the denture. The Class II: (moderate resorption) loss of upto
2
floor of the mouth can be measured with a two-thirds of the vertical height.
William’s probe. The patient should touch his Class III: (severe resorption) loss of more than
upper lip with the tongue to activate the muscles two-thirds of the vertical height.
of the floor of the mouth (Fig. 2.69).
Radiographic Assessment of Bone Quantity and
Quality
Branemark et al classified bone quantity
radiographically as Classes A,B,C,D and E (Fig.
2.70). He classified bone quality radiographically
as Classes 1,2,3 and 4 (Fig. 2.71).
Fig. 2.69
RADIOGRAPHIC EXAMINATION
The radiograph of choice for the examination of Fig. 2.70: Radiological assessment of bone quantity
a completely edentulous patient is panoramic
radiograph because they image the entire
mandible and maxilla.
Fig. 2.71: Radiological assessment of bone quality
Considerations During Radiographic
Examination TREATMENT PLAN
• The jaws should be screened for retained root
ADJUNCTIVE CARE
fragments, unerupted teeth, rarefaction,
sclerosis, cysts, tumours and TMJ disorders. Elimination of Infection
• The amount of ridge resorption should be
assessed. Wical and Swoope devised a method Sources of infection like infected necrotic ulcers,
for measuring ridge resorption. According to periodontally weak teeth, and nonvital teeth
them, the distance between the lower border should be removed. Infective conditions like
of the mandible and the lower border of the candidiasis, herpetic stomatitis, and denture
mental foramen multiplied by three will give stomatitis should be treated and cured before
the original alveolar ridge crest height. The commencement of treatment.
lower edge of the mental foramen divides the
mandible into upper two-thirds and lower Elimination of Pathology
one-third. Pathologies like cysts and tumours of the jaws
• The quantity and quality of the bone should should be removed or treated before complete
be assessed. denture treatment begins. The patient should be
educated about the harmful effects of these
Radiographic Assessment of Bone Resorption
conditions and the need for the removal of these
The amount of resorption can be classified as lesions. Some pathologies may involve the entire
follows: bone. In such cases, after surgery, an obturator
Class I: (mild resorption) loss of upto one-third may have to be placed along with the complete
of the vertical height. denture.
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32
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Chapter 3
Diagnostic Impressions in
Complete Dentures
• Diagnostic Impression
• Making the Diagnostic Cast
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Diagnostic Impressions in
Complete Dentures
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— There should be an even space of 2 mm should be removed very quickly and gently
3
between the tray and the tissue surfaces. in a snap.
— If the sulcus is too deep, the borders of the • Excessive impression material should not be
tray should be built using utility wax. loaded, because it can produce gagging.
• Required quantity of water is taken in a clean • For patients with hypersalivation, antisia-
rubber bowl. Alginate powder is dispensed logagues like methanthaline bromide, etc. can
(sifted) into it. be used to reduce salivation.
• The alginate can be mixed manually using • If there is a single large undercut, the impres-
‘figure of 8’ motion or mechanically using an sion should be removed along the direction
alginate spatulator (Fig. 3.2). of the undercut. This helps to prevent dis-
tortion of the impression.
Technical Considerations
• If the patient has teeth to be extracted , care
should be taken not to traumatize the remain-
ing teeth while removing the impression. In
such cases, the impression should be with-
drawn along the long axis of the remaining
teeth.
• The impression is inspected for extent and
voids. If there are gross deficiencies, the
impression should be repeated.
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Diagnostic Impressions in Complete Dentures
• The diagnostic cast should be separated from — Land area/periphery should be 3 mm wide
the impression only an hour after its initial set. all around the cast. This is done to preserve
• Since alginate is elastic, it is easy to remove the depth and width of the sulcus.
the impression away from the cast. Care • When the cast is trimmed in a model trimmer
should be taken while removing the impres- the trimmed plaster forms a paste, which is
sion material from the undercut areas. called sludge. Sludge should be removed when
• Small nodules and projections on the impres- it is wet. Removing dry sludge is difficult and
sion surface should be removed. often results in damage to the cast.
• The cast should not be washed under direct • Excess plaster present in the lingual aspect of
water because the superficial surface of the the mandibular casts should be removed using
plaster will dissolve and get washed away. a bevelled chisel.
• If a base former is not used during the third • The base should be properly smoothened
pour, then the base of the cast should be using sandpaper.
trimmed using a model trimmer. • The cast is ready for use.
37
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Surveying the Diagnostic Cast Marking the Height of Contour (Fig. 3.13)
Most of the above-mentioned procedures like This is done to demarcate the undercuts on a cast.
determining the depth of the undercuts, path of • A carbon marker is placed on the surveying
insertion and evaluating the surgical correction arm of the surveyor.
required are all done by a procedure called • The marker is made to run around the ridge.
surveying. Surveying is done using an instrument • Wherever the marker touches the side of the
called Surveyor. Surveyors are discussed in detail ridge, is the highest point or the height of
in the removable partial denture section (Ref contour of the ridge. The area below the height
38 Chapter 18). of contour is called undercut.
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Diagnostic Impressions in Complete Dentures
3
Fig. 3.13: Marking the height of contour using a carbon Fig. 3.14: Measuring the depth of the undercut using an
marker undercut gauge
39
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Mouth
Preparation for CD
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Mouth Preparation for CD
4
Fig. 4.12: (a) Razor- like ridge (b) Ridge with discrete
sharp bony projections
Fig. 4.14: Secondary epithelisation
Excision of Tori (Fig. 4.13)
• These are small bony projections of unknown
etiology, which grow to their maximum size
by the end of third decade of life.
• Indications for removal of maxillary tori:
a. Interference of speech
b. Loss of posterior palatal seal
c. Poor denture stability.
• All mandibular tori should be excised because Fig. 4.15: Epithelial graft vestibuloplasty
the mucosa over the tori is more prone to
irritation due to constant movement of the Mucosal Advancement
denture during mastication.
It involves the dissection and apical repositioning
of the sulcular mucosa using a surgical stent.
43
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Chapter 5
Primary Impressions in Complete Denture
• Introduction and Classification of Impressions
• Anatomical Landmarks
• Principles of Impression Making
• Objectives of Impression Making
• Recording the Primary Impression
• Refining the Primary Impression
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Primary Impressions in
Complete Denture
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mucosa of the denture-bearing area but has poor undisplaced position. Pressure or pressureless
peripheral seal. Thus, these dentures will have impressions can be made using this technique.
good stability but poor retention.
Closed-mouth Impression
Mucocompressive Impression (Carole Jones)
This method records the tissues in the functional
The mucocompressive technique records the oral position. In this technique, record blocks (trays
tissues in a functional and displaced form. The with occlusal rims) are used instead of impression
materials used for this technique include impres- trays.
sion compound, waxes and soft liners. Both upper and lower record blocks are lined
The oral soft tissues are resilient and thus tend with impression material and placed inside the
to return to their anatomical position once the patient’s mouth at the same time. The patient is
forces are relieved. Dentures made by this asked to close his mouth exerting pressure on the
technique tend to get displaced due to the tissue occlusal rims and perform functional movements
rebound at rest. During function, the constant such as swallowing, grinning and pursing of the
pressure exerted onto the soft tissues limit the lips.
blood circulation leading to residual ridge resorp- The impression materials used are impression
tion. compound, waxes and soft liners.
Selective Pressure Impression (Boucher) Disadvantages
• As the tissues are recorded in the functional
In this technique, the impression is made to compressed form, they will rebound at rest
extend over as much denture-bearing area as due to resiliency leading to denture displace-
possible without interfering with the limiting ment.
structures at function and rest. • The denture base exerts constant pressure over
The selective pressure technique makes it the tissues. Hence the blood supply is decrea-
possible to confine the forces acting on the den- sed leading to ridge resorption.
ture to the stress-bearing areas. This is achieved
through the design of the special tray in which Hand Manipulated Functional Movements
the nonstress-bearing areas are relieved and the (Dynamic Impression)
stress-bearing areas are allowed to come in
It is a mucofunctional technique, which involves
contact with the tray (Fig. 5.1).
recording functional movements of the mucosa
while making the impression. Border moulding or
peripheral tracing or muscle trimming is a muco-
functional technique used in CD fabrication.
It is defined as, “The shaping of the borders of an
impression tray to conform accurately to vestibular
areas and border seal areas”.
Fig. 5.1: Selective pressure technique: The area of tissue In this technique, a mouldable material is
contacted by the tray are recorded under pressure and the added along the borders of the tray and seated in
tissues not contacted by the tray are recorded at a state of position.
rest Once this is done, the dentist performs passive
Relief is given using wax in the special tray, functional movements of the lips and cheeks to
which should be removed before impression obtain a functional impression of the vestibular
making. It is discussed in detail in the Chapter 7. areas. The patient is also asked to perform move-
ments of the tongue to record the alveololingual
Open-mouth Impression sulcus. Active opening and closing movements
The open mouth method includes the impression of the jaws are performed to record the disto-
46 techniques, which record the tissues in an buccal portion of both the impressions.
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Condensation polymerizing silicone It is available • The entire oral cavity is lined by the oral
as a reactor paste and an activator paste. Both of mucosa.
them are mixed in the recommended ratio to • The oral mucosa has two layers namely the
produce a uniform mix. This mix is used to make mucosa and a submucosa.
the impression. • The mucosa has a keratinised, stratified
squamous epithelium.
The disadvantage is their dimensional
• The mucosa covering the hard palate and the
instability due to the formation and evaporation
crest of the residual ridge including the resi-
of ethyl alcohol from the impression.
dual attached gingiva is called the Masticatory
Addition polymerizing silicone This is available mucosa.
as two varieties namely tubes and cartridges. • The submucosa varies in thickness and consis-
While using the tube forms, the method of mani- tency and it is responsible for supporting the
pulation is similar to condensation silicones. denture. When it is thin, it easily gets trauma-
When cartridges are used, they have to be dis- tized. When it is loosely attached, inflamed
48 pensed in dispenser guns and used accordingly. or edematous, it gets easily displaced.
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5
Fig. 5.2: Histology of the mucous membrane covering the Fig. 5.4: Histology of the mucous membrane in the postero-
crest of the residual ridge. Notice that the submucosal layer lateral hard palate. Notice the abundance of gland tissue
is sufficiently thick to provide resiliency for support to
complete dentures and that bone covering the crest of the
upper ridge is often compact
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Primary Impressions in Complete Denture
5
Hamular Notch
The hamular notch is a depression situated
between the maxillary tuberosity and the Fig. 5.9: Posterior palatal seal area
hamulus of medial pterygoid plate. It is soft area
of loose areolar tissue. The tissues in this region Functions of the posterior palatal seal The
can be safely displaced to achieve the posterior posterior palatal seal, that is recorded and repro-
palatal seal. The distolateral border of the denture duced in the denture, has the following functions:
base rests in the hamular notch. • Aids in retention by maintaining constant
The denture border should extend till the contact with the soft palate during functional
hamular notch. If the border is located anteriorly movements like speech, mastication and
near the maxillary tuberosity, the denture will not deglutition.
have any retentive properties because the border • Reduces the tendency for gag reflex as it
seal is absent when placed over nonresilient prevents the formation of the gap between the
tissues (Fig. 5.8). denture base and the soft palate during
functional movements.
Posterior Palatal Seal Area (Postdam) • Prevents food accumulation between the
posterior border of the denture and the soft
It is defined as “ The soft tissues at or along the palate.
junction of the hard and soft palates on which pressure • Compensates for polymerization shrinkage.
within the physiological limits of the tissues can be The posterior palatal seal area can be divided
applied by a denture to aid in the retention of the into two regions based upon anatomical land-
denture.”- GPT. marks, namely:
This is the area of the soft palate that contacts Pterygomaxillary seal
the posterior surfaces of the denture base. It Postpalatal seal. 51
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Pterygomaxillary seal This is the part of the poste- • The posterior border of the denture should not
rior palatal seal that extends across the hamular be placed over the mid-palatine raphe or the
notch and it extends 3 to 4 mm anterolaterally to posterior nasal spine.
end in the mucogingival junction on the posterior • If there is a palatine torus, which extends pos-
part of the maxillary ridge. teriorly so that it interferes with the posterior
The hamular notch is located between the palatal seal, then the tori should be removed.
maxillary tuberosity and the hamular process of • The position of the fovea palatina also influ-
the sphenoid bone. It contains loose connective ences the position of the posterior border of
tissue and few fibres of Tensor Veli Palatini muscle the denture. The denture can extend 1-2 mm
covered by a thin layer of mucous membrane. The across the fovea palatina.
position of this membrane changes with mouth • If a mid-palatine fissure is present, then the
opening hence it should be recorded accurately posterior palatal seal should extend in to it to
during impression making .The posterior extent obtain a good peripheral seal.
of the denture in this region should end in the • In patients with thick ropy saliva, the fovea
hamular notch and not extend over the hamular palatina should be left uncovered or else the
process as this can lead to severe pain during thick saliva flowing between the tissue and
denture wear (Fig. 5.10). the denture can increase the hydrostatic
pressure and displace the denture.
Vibrating Line
It is defined as “The imaginary line across the poste-
rior part of the palate marking the division between
the movable and immovable tissues of the soft palate
which can be identified when the movable tissues are
moving.” - GPT.
• It is an imaginary line drawn across the palate
that marks the beginning of motion in the soft
palate, when the individual says “ah”.
Fig. 5.10: Pterygomaxillary seal • It extends from one hamular notch to the other.
Postpalatal seal This is a part of the posterior • It passes about 2 mm in front of the fovea
palatal seal that extends between the two palatina. The fovea is formed by coalescence
maxillary tuberosities (Fig. 5.11). of the ducts of several mucous glands. This
acts as a guide to locate the posterior border
of the denture.
• This line should lie on the soft palate.
• The distal end of the denture must cover the
tuberosities and extend into the hamular
notches. It should end 1-2 mm posterior to the
vibrating line.
Another school of thought considers the
presence of two vibrating lines namely:
• Anterior vibrating line.
• Posterior vibrating line.
Fig. 5.11: Postpalatal seal
Anterior vibrating line It is an imaginary line lying
The following points should be remembered at the junction between the immovable tissues over
52 while recording the posterior palatal seal: the hard palate and the slightly movable tissues of the
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Primary Impressions in Complete Denture
soft palate (Fig. 5.12). It can be located by asking primary stress-bearing area. The rugae area is the
5
the patient to perform the “Valsalva” maneuver. secondary stress-bearing area.
It can also be measured by asking the patient to It was previously considered that the crest of
say “ah” in short vigorous bursts. (Valsalva the ridge was the primary stress-bearing area, the
maneuver: the patient is asked to close his nostrils rugae was the secondary stress-bearing area and
firmly and gently blow through his nose). The anterior the posterior part of the hard palate was the
vibrating line is cupid’s bow-shaped. tertiary stress-bearing area. This concept is not
accepted now.
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5 Textbook of Prosthodontics
Fig. 5.15: Cross-section of the residual alveolar ridge: Note Fig. 5.17: Maxillary tuberosity
the trabecular pattern of bone is perpendicular to the surface
It resorbs rapidly following extraction and A rough prominence formed behind the posi-
continues throughout life in a reduced rate. The tion of the last tooth is called the Alveolar tubercle.
submucosa over the ridge has adequate resiliency
to support the denture. Relief Areas
The crest of the ridge may act as a secondary These areas resorb under constant load or contain
stress-bearing area. Loosely attached tissues along fragile structures within. The denture should be
the slopes of the ridge cannot withstand the forces designed such that the masticatory load is not
of mastication. The posterolateral portion of the concentrated over these areas.
residual ridge is a primary stress-bearing area.
Incisive Papilla
Rugae
It is a midline structure situated behind the central
These are mucosal folds located in the anterior incisors. It is the exit point of the nasopalatine
region of the palatal mucosa. They act as a nerves and vessels. It should be relieved if not,
secondary support area. The folds of the mucosa the denture will compress the vessels or nerves
play an important role in speech. Metal denture and lead to necrosis of the distributing areas (Fig.
bases reproduce this contour making it very 5.18) and paraesthesia of anterior palate.
comfortable for the patient (Fig. 5.16).
Mid-Palatine Raphe
Fig. 5.16: Rugae
This is the median suture area covered by a thin
Maxillary Tuberosity submucosa. It should be relieved during denture
It is a bulbus extension of the residual ridge in fabrication. This area is the most sensitive part of
the second and third molar region. The posterior the palate to pressure (Fig. 5.19).
part of the ridge and the tuberosity areas are con-
sidered as one of the most important areas of sup- Fovea Palatina
port because they are least likely to resorb (Fig. The fovea is formed by coalescence of the ducts
54 5.17). of several mucous glands (Fig. 5.20). This acts as
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Primary Impressions in Complete Denture
ANATOMICAL LANDMARKS IN
5
THE MANDIBLE
They can be broadly grouped into:
Limiting Structures
• Labial frenum.
• Labial vestibule.
• Buccal frenum.
Fig. 5.19: (a) Mid-palatine raphe (b) Cross-sectional view
• Buccal vestibule.
• Lingual frenum.
• Alveololingual sulcus.
• Retromolar pads.
• Pterygomandibular raphe.
Supporting Structures
• Buccal shelf area
• Residual alveolar ridge
Relief Areas
Fig. 5.20: Fovea palatina • Crest of the residual alveolar ridge.
• Mental foramen.
an arbitrary guide to locate the posterior border • Genial tubercles
of the denture. The position of the fovea palatina • Torus mandibularis.
also influences the position of the posterior border
of the denture. The denture can extend 1-2 mm Limiting Structures
beyond the fovea palatina. The secretion of the
fovea spreads as a thin film on the denture there-
Labial Frenum (Fig. 5.22)
by aiding in retention. It is a fibrous band similar to that found in the
In patients with thick ropy saliva, the fovea maxilla. The muscles, incisivus and orbicularis
palatina should be left uncovered or else the thick oris influence this frenum. Unlike the maxillary
saliva flowing between the tissue and the denture labial frenum, it is active. The mandibular labial
can increase the hydrostatic pressure and displace frenum receives attachment from the orbicularis
the denture. oris muscle. Hence, it is quite sensitive and active.
On opening wide, the sulcus gets narrowed.
Cuspid Eminence Hence, the impression will be the narrowest in
It is a bony elevation on the residual alveolar ridge the anterior labial region.
formed after extraction of the canine. It is located
between the canine and first premolar region (Fig.
5.21).
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Buccal Vestibule
Fig. 5.25: Anterior portion of the alveololingual sulcus
It extends posteriorly from the buccal frenum till
the retromolar region. It is bound by the residual
alveolar ridge on one side and buccinator on the Middle region It extends from the pre-mylohyoid
other side. fossa to the distal end of the mylohyoid ridge.
This space is influenced by the action of mas- This region is shallower than other parts of the
seter. When the masseter contracts, it pushes sulcus. This is due to the prominence of the
inward against the buccinator, producing a bulge mylohyoid ridge and action of the mylohyoid
into the mouth. This bulge can be recorded only muscle (Fig. 5.26).
when the masseter contracts. It is reproduced as
a notch in the denture flange called the masseteric
notch.
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Primary Impressions in Complete Denture
• The peripheral seal is maintained during denture. It is a non-keratinized pad of tissue seen
5
function. as a posterior continuation of the pear-shaped
pad. The pear-shaped pad is a triangular keratini-
Posterior region The retro-mylohyoid fossa is
zed soft pad of tissue at the distal end of the ridge.
present here. The denture flange in this region
Sicher described retromolar pad as a triangular
should turn laterally towards the ramus of the
soft elevation of mucosa that lies distal to the third
mandible to fill up the fossa and complete the
molar. It is nothing but a collection of loose con-
typical S-form of the lingual flange of the lower
nective tissues with an aggregate of mucosal
denture (Fig. 5.27). This is also called lateral throat
glands. It is bounded posteriorly by the tendons
form.
of the temporalis, laterally by the buccinator and
medially by the pterygomandibular raphe and
superior constrictor.
These muscles limit the denture extent and
prevent the placement of extra pressure during
impression making. Hence, the denture base
should extend only one half to two third over the
retromolar pad (Fig. 5.29).
Fig. 5.27: Posterior portion of the alveolo-lingual sulcus. It
is commonly known as lateral throat form
Retro-mylohyoid Fossa
It belongs to the posterior part of the alveolo-
lingual sulcus. It lies posterior to the mylohyoid
muscle (Fig. 5.28).
This fossa is bounded:
• Anteriorly by the retro-mylohyoid curtain
• Posterolaterally by the superior constrictor
of the pharynx
• Posteromedially by the palatoglossus and Fig. 5.29: Pear-shaped pad
lateral surface of the tongue Retromolar Papilla It is described as a pear-
• Inferiorly by the sub-mandibular gland. shaped papilla. Craddock coined this term and
described it as a small elevation. It is nothing but
a residual scar formed after the extraction of the
third molar. It lies along the line of the ridge. The
denture should terminate at the distal end of the
pear-shaped papilla. Beading this area improves
retention (Fig. 5.30).
Retromolar Pad
The retromolar pad is an important structure,
which forms the posterior seal of the mandibular Fig. 5.30: Retromolar papilla 57
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5 Textbook of Prosthodontics
The retromolar pad has a stippled and kera- Most patients do not require any clearance. A sim-
tinized mucosa. ple wide-open visual and digital inspection is
sufficient to determine the need for clearance.
Pterygomandibular Raphe
Supporting Structures
Pterygomandibular raphe arises from the hamu-
lar process of the medial pterygoid plate and gets The mandibular denture poses a great technical
attached to the mylohyoid ridge. A raphe is a challenge. The support for a mandibular denture
tendinous insertion of two muscles. In this case, comes from the body of the mandible. The
the superior constrictor is inserted postero- available denture-bearing area for an edentulous
medially and the buccinator is inserted antero- mandible is 14 cm2 but for maxilla it is 24 cm2.
laterally (Fig. 5.31). Hence, the mandible is less capable of resisting
occlusal forces.
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Primary Impressions in Complete Denture
Relief Areas Fig. 5.36: Genial tubercles. The superior one gives
Mylohyoid Ridge (Fig. 5.34) attachment to the genioglossus muscle and the inferior
tubercle gives attachment to the geniohyoid muscle
It runs along the lingual surface of the mandible.
Anteriorly the ridge lies close to the inferior Torus Mandibularis (Fig. 5.37)
border of mandible while posteriorly, it lies flush
with the residual ridge. The thin mucosa over the It is an abnormal bony prominence found
mylohyoid ridge may get traumatized and should bilaterally on the lingual side, near the premolar
be relieved. The area under this ridge is an region. It is covered by a thin mucosa. It has to be
undercut. relieved or surgically removed as decided by its
size and extent.
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5 Textbook of Prosthodontics
• Sufficient space should be provided within the Size of the denture-bearing area Retention incre-
impression tray for the selected impression ases with increase in size of the denture-bearing
material. area. The size of the maxillary denture-bearing
• Impression must be removed from the mouth area is about 24 cm2 and that of mandible is about
without damaging the mucosa. 14 cm2. Hence, maxillary dentures have more
• Selective pressure should be applied on the retention than mandibular dentures (Fig. 5.38).
basal seat during impression making.
• A guiding mechanism should be provided for
correct positioning of the tray within the
mouth.
• The tray and impression material should be
made of dimensionally stable materials.
• The external shape of the impression should
be similar to the external form of complete
denture. Fig. 5.38: (a) Maxillary denture-bearing area: 24 cm2 (b)
Mandibular denture-bearing area: 14 cm2
OBJECTIVES OF IMPRESSION MAKING
Quality of the denture-bearing area The displace-
An impression should be made with the purpose
ability of the tissues influences the retention of
of obtaining the following characteristics in the
the denture. Tissues displaced during impression
dentures to be fabricated.
making will lead to tissue rebound during den-
• Retention.
ture use, leading to loss of retention.
• Stability.
• Support.
• Aesthetics. Physiological Factors
• Preservation of remaining structures. Saliva The viscosity of saliva determines reten-
tion. Thick and ropy saliva gets accumulated bet-
Retention ween the tissue surface of the denture and the
It is defined as “That quality inherent in the pros- palate leading to loss of retention. Thin and
thesis which resists the force of gravity, adhesiveness watery saliva can also lead to compromised
of foods, and the forces associated with the opening of retention.
the jaws”- GPT. Cases with ptyalism can lead to gagging and
Retention is the ability of the denture to with- in patients with xerostomia, dentures can produce
stand displacement against its path of insertion. soreness and irritation.
The factors that affect retention can be
classified as: Physical Factors
• Anatomical factors. The various physical factors which affect
• Physiological factors. retention, are:
• Physical factors. • Adhesion.
• Mechanical factors. • Cohesion.
• Muscular factors. • Interfacial surface tension.
• Capillarity or capillary attraction.
Anatomical Factors • Atmospheric pressure and peripheral seal.
The various anatomical factors that affect Adhesion (Fig. 5.39) It is defined as “The physical
retention, are: attraction of unlike molecules to one another.”- GPT.
• Size of the denture-bearing area. The role of saliva is very important for adhe-
60 • Quality of the denture-bearing area. sion. Saliva wets the tissue surface of the denture
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Primary Impressions in Complete Denture
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Primary Impressions in Complete Denture
Muscular Factors
The muscles apply supplementary retentive
forces on the denture. There is a balance between
the forces acting from the buccal musculature and
the tongue. This balance is obtained in the neutral
zone.
Hence, the artificial teeth should be arranged
in the neutral zone to achieve the best retention
possible. The occlusal plane should be parallel to
the residual ridge and divide the interarch space
equally (Fig. 5.46).
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Primary Impressions in Complete Denture
Fig. 5.49: Snowshoe effect of the denture base distributing all the masticatory forces across all
the resilient tissues 65
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Primary Impressions in Complete Denture
• An impression material with relatively high • After proper positioning, the tray is seated
5
viscosity is preferred as it will displace the over the ridge by applying pressure in the first
tissues and compensate for the deficiencies in molar region, until it touches the posterior
the extent of the tray. palatal seal.
• A sufficient amount of impression compound • The tray is stabilized with a finger placed at
is softened in a water bath at 140° F. Once the its centre.
compound softens, it is kneaded to produce a • Borders are refined by asking the patient to
more uniform workable mass with uniform suck down into the tray, move the mandible
temperature. side to side and then open wide.
• The kneaded material is rolled into a ball and This movement moulds the labial and buccal
placed on the tray. Using the thumb, the vestibules and records the influence of
operator should spread and adapt the material coronoid processes on the shape of the buccal
all over the tray so that it approximates to the vestibules.
ridge contour (Fig. 5.54). • Once the material has set, the cheeks and
upper lip are lifted away from the borders of
the impression to allow air entry. The tray is
removed from the mouth in one motion and
inspected for any deficiency.
• The borders of the custom tray (to be
fabricated) can be marked by,
— Marking the peripheral outline on the
impression (preferred).
— Outlining the cast.
• The outline and the impression are observed
near the patient’s mouth.
Fig. 5.54a: Placing the kneaded impression material on a • The cast is poured with dental plaster and the
maxillary stock tray outline of the custom tray will be evident on
the cast.
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5 Textbook of Prosthodontics
68
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Chapter 6
Lab Procedures Prior to
Master Impression Making
• Finishing the Primary Cast
• Fabrication of a Special Tray
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70
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Lab Procedures Prior to Master Impression Making
Ideal Requirement
A special tray should fulfil the following
requirements: Fig. 6.2: The red dotted lines show the relief areas marked
• It should be well adapted to the primary cast. on the master cast
• It should be dimensionally stable on the cast
and in the mouth. lingual to the crest of the ridge in the mandi-
• The tissue surface should be free of voids or ble). Additionally, relief may be required for
projections. abnormal clinical situations that should be
• It should be at least 2 mm thick in the palatal recorded without pressure (e.g. flabby ridge,
area and lingual flange for adequate rigidity. sharp mylohyoid ridges, sharp glenoid
• It should be rigid even in thin sections tubercles, areas with the mucosal covering,
• It should not bind to the cast. bony spicules, etc).
• It should be easy to remove. • The border of the tray marked on the cast is
• It should not react with the impression grooved deeper using a carver. This will act
material. as a guide to trim the tray later.
• It should be easy to manipulate so that it can
be easily adapted to a required shape. Adapting the Relief Wax
• It should not flow or warp. • Relief wax should be adapted over the relief
• It should have a contrasting colour to make area markings of the cast irrespective of the
its margins appear prominent when placed in impression material.
the patient’s mouth. • Relief is given to prevent the tray from exerting
• It should have 2 mm relief near the sulcus so excessive pressure on these areas during
that green stick compound can be used to do impression making. This also helps to record
border moulding. the relief tissues in a state of anatomical rest
(Fig. 6.3).
Conditioning the Primary Cast before • Modelling wax and non-asbestos casting liner
Special Tray Fabrication are the most commonly used materials for
• The cast should be soaked in slurry water. giving relief.
• The primary impression usually has
overextended borders. Hence the special tray
should be 2 - 4 mm short of the sulcus.
• Severe undercuts should be blocked out using
wax. Failure to block out the undercuts may
result in the breakage of the cast at the time of
removal.
• The borders of the special tray should be
marked using a pencil.
• The relief areas should also be marked in the
Figs 6.3a and b: The area where the relief wax was adapted,
cast (Fig. 6.2). will be recorded in a state of anatomical rest and the area
Some areas are routinely relieved (e.g. incisive where the relief wax was not adapted and the tray directly
papilla, mid-palatine raphe in the maxilla and 71
contacts the tissues will be recorded under pressure
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Lab Procedures Prior to Master Impression Making
separating medium. The separating medium • Next, all the undercuts should blocked out
6
should be applied with a brush using single-sided (filled) with wax.
strokes. • A spacer should be adapted as described
before. A non-asbestos casting liner is used as
Fabrication of a Special Tray a spacer for these trays . Modelling wax should
Fabrication of the special tray depends on the type not be used as a spacer because it may melt
of material used. Most commonly used materials during manipulation.
for making special tray are: • The shellac plate should be positioned on the
• Shellac cast and the brush flame of the Bunsen burner
• Cold cure acrylic should be moved across the plate till it
• Vacuum formed Vinyl or Polystyrene becomes shiny and begins to sag (Fig. 6.6).
• Vacuum formed thermoplastic resin.
• Type II impression compound (Tray com-
pound).
Shellac
It was the most commonly used material for pre-
paring special trays and base plate. This material
is basically a type of wax. It is commercially
available in separate shapes for the maxilla and
the mandible.
Fig. 6.6
Composition
• The palatal surface should be adapted first for
• Resin — 90.9% the maxillary cast using wet cotton or fingers.
• Wax — 4% • For the mandibular cast the lingual flange
• Glutin — 2.8% should be adapted first.
• Moisture — 1.8% • After adapting the palatal or the lingual sur-
• Colouring agent — 0.5% face the plate should be reheated and adapted
Advantages over the crest of the residual alveolar ridge.
• Inexpensive. This prevents the appearance of wrinkles.
• Can be easily manipulated. • After completing adaptation, the material
• Can be readapted even if it distorts. should be cut using a scissor leaving about 5
mm excess material in the borders (Fig. 6.7).
Disadvantages • The shellac should be re-adapted over the
• Very brittle and hence it breaks easily.
entire cast, especially the sulcus area (Fig. 6.8).
• It tends to distort easily.
• Sometimes wires may be required to
strengthen it.
• Very heat sensitive, it loses its flow properties
if over heated.
Technique
• The cast should be treated before adapting
shellac so that it does not stick to the cast. This
can be done by coating the cast with talcum
powder or soaking it in water. Soaking in
water may damage the cast. Tin foil can be
adapted as an alternative. Fig. 6.7 73
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6 Textbook of Prosthodontics
Fig. 6.8
Fig. 6.9
• The margin of the special tray should be
finished and smoothened using a triangular
file (Fig. 6.10).
Fig. 6.12
Fig. 6.10
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Lab Procedures Prior to Master Impression Making
Advantages
• Very strong
• Adapts well to the cast
• Can be trimmed to adequate thickness.
• Good thermal properties.
• Easy to fabricate.
• Good stability.
• Workable at mouth temperature.
Fig. 6.15 • Biocompatible.
Disadvantages
• The special tray and its handle should be sand-
• Cannot be readapted after warpage.
papered for a perfect smooth finish. The
• Trimming and finishing is very time
handle should be 3-4 mm wide 8 mm long and
consuming.
8 mm high.
• In the presence of undercuts, the material may
• Overheating the special tray will produce
get locked into them and may tend to break
smoke, bubbles, blackening and leaching of
the cast.
shellac and wax.
• Over heating may also lead to melting and Technique
flowing of the shellac into the pores of the cast. First, the relief areas and the borders of the special
• These trays should be fabricated 6 hours prior trays are marked. A wax spacer is adapted on the
to impression procedure. relief areas. Separating medium is coated on the
entire cast and over the spacer. Two major
Cold Cure Acrylic-Tray Material techniques are commonly used in the fabrication
of an acrylic special tray.
It is also known as the auto-polymerising resin.
This material is similar to the denture base resin
Sprinkle on Technique
used for the final fabrication of the denture. The
material sets by chemical reaction and hence it is The powder and liquid are loaded in separate dis-
irreversible. pensers. A small quantity of powder is sprinkled 75
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6 Textbook of Prosthodontics
on a particular area over the cast and liquid is • Next is the rubbery stage where the material
sprinkled over the powder. Sprinkling drops of cannot be manipulated any more. Trying
the liquid polymerizes the powder. This is con- to manipulate the material in this stage will
tinued till the entire ridge and the associated land- result in excessive warpage of the tray.
marks are covered. The advantage of this techni- • Next is the stiff stage. The material loses its
que include its ease of use and minimal wastage elasticity and becomes more plastic. After
of material (Fig. 6.16). the stiff stage, the polymerization is almost
complete.
Procedure
• Manipulation is done in the late stringy and
the dough stages. The material is kneaded in
the hand, to achieve a homogenous mix.
• Then the material is shaped into a 2 mm thick
sheet. Flattening the dough can be done using
a roller or a plaster mould or by pressing the
material between two glass slabs (Figs 6.17 and
6.18).
Disadvantages
• An even thickness cannot be obtained.
• Too many porosities may form within the
Fig. 6.17: The dough should be rolled over a glass slab
material. using a plastic roll
• Time consuming.
Dough Technique
The powder and liquid should be mixed in a mix-
ing jar in the ratio of 3:1 by volume. If this ratio is
Fig. 6.18: The dough can also be flattened by pressing it
not maintained and insufficient monomer is used,
between two glass slabs
excessive shrinkage, porosities and granularity
may occur.
After mixing the monomer and polymer the • Separating medium should be applied over
mix undergoes six different stages: the roller or the glass slabs to avoid stickiness.
• The first stage is called the wet sandy stage, • The rolled sheet of acrylic is adapted over the
where the polymer is soaked in monomer. cast from the centre to the periphery. This
• Next is the early stringy stage where if the prevents the formation of wrinkles.
material is touched, fine filaments are seen • Care should be taken not to apply excessive
sticking to the finger. pressure on the ridge areas as it might lead to
• Next is the late stringy stage where long the thinning of the tray.
strings are present. During the end of the • The excess material should be cut out with a
late stringy stage the manipulation should B.P. blade before the material sets (Fig. 6.19).
be started. • After cutting out the excess, the material
76 • Next is the dough stage. In this stage, the should be held in position as shrinkage and
material is very workable. warpage may occur during polymerization.
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Lab Procedures Prior to Master Impression Making
6
Technique
• A vacuum-forming machine is required for
this procedure (Fig. 6.22a).
• A vinyl sheet is placed on the electric heater
coil and heated till it sags
Fig. 6.20 • In the absence of a vacuum former, the vinyl
The handle should be parallel to the long axis sheet can be heated under direct flame (Fig.
of the teeth that are to be placed. The handle 6.22b).
should not arise horizontally from the tray • The cast is placed below the vinyl sheet at the
because it may interfere with lip movements. It centre of the vacuum-forming chamber.
should be 3-4 mm thick, 8 mm long and 8 mm • The chamber is closed and vacuum is created
high. and the vinyl sheet is made to fall on the cast.
77
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Fig. 6.23
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Chapter 7
Secondary Impressions in
Complete Dentures
• Techniques for Making the
Master Impression
• Making a Secondary Impression
Using a Special Tray
• Inspecting the Impression
• Disinfecting the Impression
• Remaking the Impression
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Secondary Impressions in
Complete Dentures
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Secondary Impressions in Complete Dentures
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7 Textbook of Prosthodontics
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Secondary Impressions in Complete Dentures
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7 Textbook of Prosthodontics
• Greenstick compound is removed using a • The tray is seated into position by applying
scalpel and polyether is removed using either alternating pressures on the right and left
a scalpel or a bur. molar regions using the index fingers.
• The thickness of the flanges and the border • Tray placement is complete only when the
should be 2.5 to 3 mm. posterior border of the tray rests in the hamu-
• Holes are drilled on the impression tray to lar notch and is in contact with the palate.
allow escapement of the impression material. • The tray is maintained in this position by plac-
These holes are placed in the areas of the mid- ing a finger in the palatal region of the tray,
palatine raphe, anterolateral and postero- immediately anterior to the posterior palatal
lateral regions of the hard palate and the resi- seal.
dual ridge region. These holes prevent tissue • Passive movements similar to those perfor-
displacement during impression making (Fig. med during border moulding are repeated.
7.10). • After the material is set, the tray is removed
in a single jerk.
• The impression is inspected for deficiencies
and voids and is repeated if necessary.
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• A trial base is fabricated using shellac base • The line marked in the hamular notch is
7
plate or a well-adapted self-cure resin. connected with the posterior vibrating line
• The patient is asked to sit in an upright using an indelible pencil. This will form the
position and asked to rinse his mouth with posterior border of the denture (Fig. 7.13).
some astringent mouth wash.
• The posterior palatal area is wiped with gauze.
• The “T” burnisher is used to locate the hamu-
lar notch by palpating posteriorly to the maxil-
lary tuberosity on both sides. The full extent
of the hamular notch is marked with an
indelible pencil (Fig. 7.11).
Fig. 7.12: The posterior vibrating line is marked between Fig. 7.14: The anterior vibrating line is marked at the junction
the movable and immovable soft palate of the hard and soft palate using an indelible pencil
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7 Textbook of Prosthodontics
line, the patient should perform the Valsalva • A mouth mirror is kept at the distal end of the
maneuver (Refer anterior vibrating line in trial base and checked for any space (Fig. 7.17).
chapter 5). The markings are transferred to the • Presence of a space between the base plate and
master cast as described before for the the soft tissues indicates improper or under
posterior vibrating line. postdamming.
• The area between the anterior and posterior
vibrating line is scrapped in the master cast to
a depth of 1 to 1.5 mm on either side of the
mid-palatine raphe. In the region of the mid-
palatine raphe, it should be only 0.5 to 1 mm
in depth (Fig. 7.15).
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7 Textbook of Prosthodontics
• Fluid wax extending beyond the posterior • When the denture does not cover the fovea
vibrating line should be cut with a hot knife. palatina, the tissue coverage is reduced and
The impression is refined again till feather- the posterior border of the denture is not in
contact with the soft resilient tissue which will
edge margins are produced.
move alongwith the denture border during
Advantages of fluid wax technique functional movements.
• It is a physiological technique. • The dentist may intentionally leave the poste-
• Chances of overcompression of tissues are less. rior borders underextended in order to reduce
• Increased retention of the trial base and the patient’s anxiety to gagging.
convenience in jaw relation. • Improper delineation of the anterior and
• There is no need for scrapping the master cast posterior vibrating lines.
arbitrarily. • Excessive trimming of the posterior border of
the cast by the dental technician.
Disadvantages of fluid wax technique
• Handling of the material is very difficult. Overextension
• Increased chair-side time during patient Overextension of the denture base can lead to
appointment. ulceration of the soft palate and painful deglu-
tition. Covering of the hamular process can lead
Arbitrary Scrapping of the Master Cast to sharp pain in that region. In order to relieve
these areas, indelible pencil markings are made
In this technique, the anterior and posterior vib- on them (hamular process, ulcers, etc.) and trans-
rating lines are visualized by examining the ferred to the denture. These regions are trimmed
patient’s mouth and approximately marked on and polished.
the master cast. The lab technician scrapes 0.5 to
1 mm of stone in the posterior palatal seal area of Underpostdamming
the master cast and fabricates the denture. This • This can occur due to improper head-posi-
technique is inaccurate and not physiological tioning and mouth positioning, e.g. when the
(Fig. 7.21) and should be avoided. mouth is wide open while recording the
posterior palatal seal the mucosa over the
hamular notch becomes taut. This will pro-
duce a space between the denture base and
the tissues.
• Inserting a wet denture into a patient’s mouth
and inspecting the posterior border with the
help of a mouth mirror can identify under-
damming. If air bubbles are seen to escape
under the posterior border, it indicates under-
damming.
Fig. 7.21: Arbitrary scrapping of the master cast
• In order to correct underdamming, the master
cast can be scraped in the posterior palatal area
Errors in Recording the Posterior Palatal Seal or the fluid wax impression can be repeated
with proper patient position.
The following errors can occur while recording
the posterior palatal seal. Overpostdamming
• This commonly occurs due to excess scraping
Underextension of the master cast. It occurs more commonly
This is the most common cause for poor posterior in the hamular notch region.
palatal seal. It may be produced due to one of the • Mild overdamming in the hamular notch
following reasons: region can lead to tissue irritation of the
88
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7 Textbook of Prosthodontics
Tray Preparation after Border Moulding sure, that all the landmarks are recorded accu-
It is similar to the procedure done for maxillary rately. Small voids can be rectified by filling them
impression. But the escape holes should be placed with wax.
10 mm apart in the alveolar ridge region and over
the retromolar pad. DISINFECTING THE IMPRESSION
Making the Final or Master or Wash Impression The impression is disinfected using iodophor or
• Tray placement should be practiced before 2 percent gluteraldehyde. It should be left
making the final impression. undisturbed for ten minutes.
• Dry gauze should be placed in the floor of the
mouth to remove the saliva. REMAKING THE IMPRESSION
• The gauze should be removed before making
the impression. Errors in impression is a common occurrence in
• The impression material is manipulated and clinical practice. The most common reason to
loaded onto the tray. repeat an impression is improper positioning of
• The tray is rotated in a horizontal plane and the impression tray. If the tray placement is
inserted into the mouth using the anterior improper, the flange of the impression which lies
handle. on the side of deviation will be excessively thick
• The tray is seated completely by applying and the flange of the impression opposite to the
alternating pressure over the posterior hand- deviation will be thin.
les. The patient should be asked to touch his Other reasons for repeating an impression
upper lip with his tongue while making the include:
impression. Passive movements similar to • Large voids
those performed during border moulding • Improper consistency of impression mate-
should be repeated.
rial
• After the material is set the impression is
• Movement of the tray during the setting of
removed and examined for any defects.
the impression material.
INSPECTING THE IMPRESSION • Inadequate scrapping of the border mould-
ing material.
The impression made is inspected for air inclu- • Using too much or too little impression
sions and voids. The surface is inspected to make material.
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Chapter 8
Lab Procedures Prior to Jaw Relation
• Preparing the Master Cast
• Indexing the Master Cast
• Fabricating the Temporary Denture Base
• Stabilizing the Base Plates
• Fabrication of Occlusal Rims
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After making the master impression, the master Wax Beading and Boxing
cast should be poured and a temporary denture
Commercially available beading and boxing
base should be fabricated. Occlusal rims are
waxes are used. Beading waxes are generally blue
fabricated over these temporary denture bases to
in colour, boxing waxes are white in colour.
carry out jaw relation. In this chapter we shall
In the absence of beading or boxing waxes,
discuss in detail about pouring the master cast, modelling wax can be used as a substitute. A 5
preparing a temporary denture base and fabri- mm strip of modelling wax is rolled with the palm
cating occlusal rims. on a flat surface. The rolled wax can be used for
beading. Orthodontic tray wax can also be used
PREPARING THE MASTER CAST for beading. A 12 - 15 mm strip of modelling wax
The master cast is poured using dental stone. is used for boxing. The boxing strip should be at
High strength, minimal expansion stone is pre- least 13 mm measured vertically from the highest
ferred. A stone cast is superior to a plaster cast point of the impression.
because the finer particles make it stronger, den- Procedure
ser and smoother. • The impression should be stabilized using soft
The master cast should accurately reproduce wax or modelling clay to make the impression
the anatomy of the residual ridge; hence, care surface parallel to the floor (Fig. 8.1).
should be taken to preserve the depth and width
of the sulcus in a cast. The sulcus can be preserved
by beading and boxing. Other technical conside-
rations are similar to that described for primary
and diagnostic casts.
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8 Textbook of Prosthodontics
Fig. 8.5: After investing the impression in a plaster pumice Fig. 8.7: Adapting the caulking compound to the
mix, the level of the investment should be scrapped to about impression
3 mm below the height of the flange
• Metal strip is boxed around the caulking com-
• A separating medium is applied all over the pound and stabilized using a rubber band. The
plaster pumice mix. compound should be fused to the metal strip
• Boxing wax is adapted around the plaster too. Till this stage this technique resembles
pumice investment. wax boxing (Fig. 8.8).
• A fine mix of dental stone is poured into the
boxed impression (Fig. 8.6).
• The impression is separated an hour later. It
should be smoothened and finished as
required.
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8 Textbook of Prosthodontics
One line is drawn sagitally and another line metal or plastic kits for articulation. A remounting
is drawn transversely (Fig. 8.11). kit consists of two plates (male and female),
which precisely fit to one another and can be
locked with a locking pin. One plate is embedded
into the cast and another into the mounting
plaster during articulation. The plates are
disassembled and reassembled easily without
any difficulty.
Procedure
• The male mounting plate is fused to a 0.5-inch
thick sheet of plexiglass. This is done to avoid
Fig. 8.11: Groove indexing stone contact (Fig. 8.13).
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8 Textbook of Prosthodontics
• Auto-polymerising resins
• Heat cure resins
• Thermoplastic resins
• Shellac
• Base plate wax.
Base plates can be stabilized using the
following materials: Fig. 8.18: Two sheets of wax adapted over the cast.
• Zinc oxide eugenol impression materials
• Elastomeric impression materials
• Soft and hard curing resins.
Base plate stabilization materials are used to
increase the adaptability and stability of the
temporary denture base. These materials also
extend into the undercuts without producing any
difficulty in removing the base plate.
The technique for fabrication of a base plate
varies for each material. In the following section,
we shall discuss in detail about the technique for
each material. Fig. 8.19: Conical depressions are made in the land area
of the cast
Auto-polymerising Resin Base Plate
• The cast is boxed with boxing or modelling
The fabrication of the base plate is similar to that wax. It should be at least 15 mm high (Fig.
described for special tray. It differs from the 8.20).
special tray in that it does not have a spacer. The
denture base extends till the depth of the sulcus.
Auto-polymerising resins can be manipulated
using the following techniques.
1. Sprinkle on
2. Dough:
• Finger-adapted dough technique.
• Stone-mould dough technique. Fig. 8.20: The cast is boxed to the wax
• Wax- confined dough technique.
Finger-adapted technique was described in • A proper mix of dental plaster is poured into
detail under special tray fabrication. Here, we the boxed cast. This plaster is known as the
shall discuss the remaining techniques. boxed plaster (Fig. 8.21).
Stone-Mould Dough Technique: (By Assad Zedic
and Yarmound (1975))
• One or two sheets of base plate wax is adapted
over the primary cast.
• The margins of the wax are fused to fill the
sulcus (Fig. 8.18).
• Small conical depressions are made in the land
area of the cast, which will act like indices. Fig. 8.21: The boxing is filled with dental plaster
Separating medium is applied over the cast
and a surface tension reducing agent is applied • After the boxed plaster sets, it is carefully
98 over the wax (Fig. 8.19). removed from the cast (Fig. 8.22).
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Lab Procedures Prior to Jaw Relation
• It is naturally brown in colour. Some manu- • Some professionals prefer to file away the
8
factures bleach and stain it to a light pink excess material instead of following the roll-
colour. on technique.
• It is available in separate shapes for maxillary • The borders of the base plate are smoothed
and mandibular ridges. using arbor band.
• The base plate is examined for close adaptation
Procedure by gently tapping it to check for rocking.
It is similar to the preparation of shellac special • Presence of glossy tissue surface shows
trays. improper adaptation.
• The cast is coated with talc.
• The base plate is placed in a centered position Wax Base Plate
over the cast.
Boucher, Hickey and Zarg (1975) described a
• Next, it is softened by running a Bunsen flame
technique for making wax base plates. The
over it.
methods of fabrication are similar to that of
• Care should be taken not to overheat the base Shellac base plate. They are not commonly used.
plate to prevent leaching of resins from the
material. Metal Base Plates
• The base plate is adapted by applying pres-
sure with a wet cotton swab. The material They are used as permanent denture base. That
should be adapted from the center to the is the ‘teeth arrangement’ is done over this metal
framework, which is acrylised over it. A metal
periphery. This prevents the occurrence of
denture base is prepared over which the occlusal
folds.
rim is fabricated to carry out jaw relations. After
• An alcohol torch (Blowtorch) can be used to
Jaw relation, teeth arrangement is done. After try-
soften and readapt localized areas of the base in the denture is processed with acrylic resin
plate. The borders of the base plate are along with (without replacing) the metal denture
softened with a blowtorch and adapted upto base. (Heat-cure acrylic can also be used instead
the depth of the sulcus using a blunt spatula. of metal as a permanent denture base material).
• The excess material should not be filed as
described in the fabrication of a special tray. Advantages
Instead, the excess material is folded and fused • No warpage
• More strength even at thin sections
with the base plate (Roll-on technique) (Fig.
• More accurate
8.28).
• Produce less tissue reaction
• Easy to maintain
• Good thermal conductivity.
Disadvantages
• Expensive
• Difficult to reline or rebase
• Time consuming laborious procedure.
Materials used
• Gold alloys
• Chrome base alloys
• Aluminium alloys.
• Titanium and its alloys
Technical considerations
Borders and the extent of the denture base should
101
Fig. 8.28: Roll-on technique of adapting shellac be similar to that of the final denture. Method of
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8 Textbook of Prosthodontics
fabrication is similar to the fabrication of a • A 0.001 inch thick tin foil is adapted on the
removable partial denture framework (Refer RPD cast. Excess tin foil should not be trimmed off
framework fabrication). (Fig. 8.29).
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Lab Procedures Prior to Jaw Relation
the stabilization with zinc oxide eugenol impres- • Relationship of the occlusal rim to the
8
sion paste except for some additional before edentulous ridge
loading the impression material steps: • Standard dimensions used to fabricate an
• Numerous perforations are made on the occlusal rim.
shellac tray for mechanical retention. • Technique of fabrication
• A layer of (tray adhesive) adhesive is painted • Clinical guidelines.
on the shellac tray before loading the impres-
sion material. After the material is set, the tin Relationship of the Natural
foil can be retained or peeled away. Teeth to the Alveolar Bone
Advantages The occlusal rim should be fabricated such that it
The material can be used to extend into minor is parallel to the long axis of the tooth to be repla-
undercuts (Severe undercuts require blockout). ced. The maxillary anteriors are labially inclined,
Disadvantages hence, the occlusal rim in that area should also
• Expensive be labially inclined. All the posterior teeth are
• Excessive thickness of the stabilization placed vertically, hence, the occlusal rim should
material. also be fabricated vertical in this region.
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Lab Procedures Prior to Jaw Relation
• Posterior part of the lower occlusal plane • The rolled cylinder of wax is adapted over the
8
should extend to two-third the height of the base plate such that it follows the arch
retromolar pad. curvature (Fig. 8.37).
• Anterior maxillary occlusal plane should be
parallel to the inter-pupillary line. The antero-
posterior occlusal plane should be parallel to
the ala-tragus line or the Camper’s line or
Bromel’s line.
Fig. 8.39
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Chapter 9
Maxillomandibular Relations
• Mandibular Movements
• Customizing the Occlusal Rims
• Orientation of the Plane of the Occlusal Rim
• Jaw Relation
• Vertical Jaw Relation
• Horizontal Jaw Relation
• Methods of Recording the Centric Jaw Relation
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Maxillomandibular
Relations
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Maxillomandibular Relations
Neuromuscular Factors
The muscles of mastication are the most impor-
tant determinants of mandibular movements. In
a normal patient, the muscles function in a coordi-
Fig. 9.2: The posterior slope of the articular eminence nated smooth manner. But when there is hyper-
forms the condylar guidance trophy or dysfunction of one group of muscles, 109
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Maxillomandibular Relations
Hinge Movement
This is a purely rotational movement of the joint,
which takes place around a horizontal axis till the
patient opens his mouth to about 20 to 25 mm.
The presence of a transverse or terminal hinge
axis was proposed by McCollum and verified by
Fig. 9.5: Rotation around the anteroposterior
Kohno. They proposed the presence of a hinge
or sagittal axis
axis based on the fact that the hinge movement
Rotation Around the Vertical Axis (Fig. 9.6) occurs when there is a 10° to 13° rotation of the
The vertical axis runs through the condyle and condyle in the temporomandibular joint, which
the posterior border of the ramus of the mandible. provides a jaw separation of 20 to 25 mm in the
The mandible rotates around this vertical axis incisal region (Fig. 9.7).
during the lateral movements. If the patient This kind of movement usually occurs while
moves his mandible towards the right, the vertical crushing food or taking in food. The condyle
axis of rotation will pass through the right begins to glide after a certain amount of mouth
condyle and vice versa. opening (beyond 13° rotation) and this is not 111
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Protrusive Movements
This type of movement occurs while incising and
grasping food. This movement occurs after the
condyles rotate for more than 13° in the temporo-
mandibular joint. Once the condylar rotation
exceeds 13° the transverse hinge axis mentioned
above shifts to the level of the mandibular fora-
men. The mandible moves forwards and down-
wards while rotating in its new hinge axis (Fig.
A B 9.9).
Figs 9.7a and b: Pure rotational movement of the condyle When the mandible slides forwards and the
(12° or 20-25 mm incisal separation) mandibular and maxillary anterior teeth are in
an edge-to-edge relation, the protrusive move-
ment is said to be complete. Usually the mandible
is guided by the anterior teeth during protrusive
movement, which is followed by complete dis-
occlusion (separation) of the posterior teeth (Fig.
9.10). This characteristic posterior separation seen
during anterior protrusion is called Christenson’s
phenomenon.
Fig. 9.8: Condylar translation that occurs after 13° of
rotation
Retrusive Movement
considered as a hinge movement (Fig. 9.8). The This occurs when the mandible is forcefully
hinge movement is produced by the action of the moved behind its centric relation. It is achieved
lateral pterygoid and suprahyoid muscles and is by the fibres of the temporalis, digastric and the
aided by gravity.
Fig. 9.9: As the mandible opens and protrudes to grasp the food, the axis of rotation shifts from the condyle
112 to the mandibular foramen
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9 Textbook of Prosthodontics
sur
z
latero re
mesio
de
Fig. 9.12a
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Maxillomandibular Relations
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9 Textbook of Prosthodontics
movement) and then continues to shift in a less Based on the Extent of Movement
rapid fashion. If the major quotient of the Bennett
Based on the extent of movement, mandibular
movement occurs during the first 4 mm of
movements can be classified as border and intra-
anterior movement of the non-working condyle, border movements. Border movements are
then its called Distributed side shift. extreme movements occurring in all three planes
Progressive Side Shift or and intra-border movements are all possible
Bennett Side Shift Movement (Fig. 9.16) movements of the mandible that occur within the
This is the lateral translation (shift) that occurs border envelope.
after 2 to 3 mm of forward movement of the non-
working condyle. The shift of the mandible is Border Movements
gradual and does not change with time.
In most patients, the progressive side shift Border movement is defined as, “mandibular move-
scales gradually and linearly along with latero- ment at the limits dictated by anatomic structures, as
trusion. But in some patients, there may be imme- viewed in a given plane”—GPT. As the definition
diate side shift for about 1 mm before lateral suggests border movements are recorded in three
movement followed by progressive side shift different planes. A pantograph is required to
record all border movements. The pantograph is
along with lateral movement (Fig. 9.17).
an extraoral tracing device, which has six sets of
Bennett Angle styli and flags (four posterior and two anterior).
It is defined as, “The angle formed by the sagittal The styli are designed to draw tracings on their
plane and the path of the advancing condyle during respective flags as the patient moves his mandi-
lateral mandibular movements as viewed in the ble. A detailed description of the pantograph is
horizontal plane”—GPT. given in Chapter 27.
This is the angle formed between the path of In order to achieve a clear understanding of
the non-working condyle and the sagittal plane. the border movements, the individual extreme
Studies have shown that variations in the movements of the mandible should be studied.
direction of progressive lateral translation or Extreme Movements in the Horizontal Plane
Bennett angle to be about 7.5 to 12.8° (Fig. 9.18). Border movements recorded in the horizontal
This Bennett angle is used in articulators with plane produced a characteristic ‘Diamond tracing’
immediate lateral translation capability. To cal- (Fig. 9.19). While recording the tracing, the patient
culate the Bennett angle in a Hanau’s articulator, is instructed to move his mandible from the
Hanau proposed the following equation: centric relation position (CR) to the maximum
Bennett angle (L) = (H/8) + 12. Where it is the right lateral (MRL) position to the maximum
horizontal condylar inclination. protrusive (MP) position, to the maximum left
The validity of this equation is questionable. lateral (MLL) position and return to centric.
Fig. 9.18: Bennett angle (Note the angle formed only between Fig. 9.19: Diamond tracing. Border movement
116 the progressive lateral path and the sagittal plane) recorded in the horizontal plane
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Maxillomandibular Relations
the total duration of these para-functional move- Lip Support and Labial Fullness
9
ments is much greater (4 hours/day) than that of
The occlusal rim should provide adequate lip sup-
all functional movements (10-15 minutes/day).
port. Inadequate or excessive labial support will
Clinically, the Ney’s mandibular excursion
seriously affect the aesthetics of the denture (Figs
guide can be used to train the mandible to
9.24a and b).
perform mandibular movements (Fig. 9.23b).
▼
6
Backward
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Maxillomandibular Relations
Fig. 9.31: The occlusal rim should be reduced till the outer
arm of the fox plane is parallel to the ala tragus line
JAW RELATION
Fig. 9.29: A fox plane used to denote the plane of • Orientation jaw relation
occlusion
• Vertical jaw relation
• Horizontal jaw relation
Jaw relation is defined as, “Any relation of the
mandible to the maxilla”-GPT. We must realise that
we are placing dentures between two bones and
that the function of the denture totally depends
upon the joint between the two bones.
Imagine we are tying a stick to the hand. If
the stick is tied with the elbow relaxed there is
not much discomfort but if the same stick is tied
tightly, overextending the elbow there will be
severe discomfort (Fig. 9.32).
Similarly if we fabricate a denture which is not
Fig. 9.30: The ala-tragus line should be marked on the in harmony with the movements of the temporo-
patients face using a thread dipped in dental plaster mandibular joint, there will be severe discomfort.
Jaw relation is recorded to measure the extensi-
• The maxillary occlusal rim is inserted into the bility and the movements permissible by the
patient’s mouth. patient’s temporomandibular joint. 121
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Maxillomandibular Relations
9
• Condylar rods
• Bite fork
• Locking device
• Orbital pointer with clamp
Here, we have described these component
parts with reference to the widely used Hanau
spring bow.
Figs 9.33a and b: Schematic diagram showing the
orientation of the maxilla in relation to the base of the skull U-shaped Frame
other jaw relations. Orientation jaw relation can It is a U-shaped metallic bar that forms the main
be recorded with a face-bow. (Figs 9.33a and b). frame of the face-bow. All other components are
attached to the frame with the help of clamps.
Face-bow (Snow 1802) It is defined as, “A caliper- This assembly is large enough to extend from the
like device which is used to record the region of the TMJ to at least 2 to 3 inches anterior
relationship of the maxillae and/or the mandible to the face and wide enough to avoid contact with
to the temporomandibular joints”. “A caliper like the sides of the face. This records the plane of the
device which is used to record the relationship of cranium (Fig. 9.35).
the jaws to the temporomandibular joints and to
orient the casts on the articulator to the
relationship of the opening axis of the temporo-
mandibular joint”- GPT.
The structure and functioning of the face-bow
should be thoroughly learned to perform accurate
orientation jaw relation. The face-bow basically
contains three sections. One section represents the
plane of the cranium (U-frame), the second
section represents the plane of the maxilla (bite
fork) and the third section locks the first two Fig. 9.35: ‘ U ‘ shape frame of a face-bow
sections without altering their plane (locking
device) (Fig. 9.34). Condylar Rods
These are two small metallic rods on either side
Parts of a Face-bow
of the free end of the U-shaped frame that contacts
The component parts of a face-bow are: the skin over the TMJ. They help to locate the
• U-shaped frame hinge axis or the opening axis of the temporo- 123
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mandibular joint. They transfer the hinge axis of the bite fork is attached to the occlusal surface of
the TMJ by attaching to the condylar shaft in the the occlusal rim using impression compound in
articulator. Certain face-bows do not have a order to preserve the occlusal rim (Fig. 9.37).
condylar rod. Instead they have an earpiece
which fits into the external auditory meatus. Face-
bows that have a condylar rod, to record the true
hinge axis (centre of the condyle), are called
Kinematic face-bows. Earpiece face-bows do not
record the true hinge axis and hence they are
called Arbitrary face-bows (Figs 9.36a and b).
Note: Arbitrary face-bows may also have
condylar rods (facia type).
But facia type face bows do not record the true Fig. 9.37: Bite fork
hinge axis and are grouped under arbitrary face-
bows. Locking Device
This part of the face-bow helps to attach the bite
fork to the U-shaped frame. This also supports
the face-bow, occlusal rims and the casts during
articulation. It consists of a transfer rod and a
transverse rod. The ‘U’-shaped frame is attached
to the vertical transfer rod. The position of this
transfer rod can be locked with a thumb screw.
The horizontal transverse rod connects the
transfer rod with the stem of the bite fork. After
positioning the ‘U’-shaped frame and the bite
fork, the horizontal transverse rod should be
Fig. 9.36a: Earpiece positioned. It can be positioned automatically by
attaching it to the transfer rod and the bite fork
and tapping it. This type of assembly where the
transverse rod gets automatically positioned
when tapped is called an auto-adjusting or self-
centering assembly (Fig. 9.38).
Orbital Pointer
It is designed to mark the anterior reference point
(infraorbital notch) and can be locked in position
with a clamp. It is present only in the arbitrary
Fig. 9.36b: Condylar rod
face-bow (Fig. 9.39).
Bite Fork
Types of Face-bows
This is a U-shaped plate, which is attached to the
occlusal rims while recording the orientation Face-bows can be classified as follows:
relation. It is attached to the frame with the help Arbitrary face-bow
of a rod called the stem. The bite fork should be • Facia type.
inserted about 3 mm below the occlusal surface • Earpiece type
within the occlusal rim. Some suggest that the • Hanau face-bow (Spring bow)
124 bite fork can be inserted in any depth. Sometimes • Slidematic (Denar)
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9
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9 Textbook of Prosthodontics
lous patients. In an edentulous patient the ante- Fig. 9.41a: Kinematic face-bow
rior reference point is 43 mm superior to the lower
border of the upper lip in a relaxed state. This The face-bow helps to orient the cast in the
anterior reference point is also used for Whipmix patient’s terminal hinge axis. Hinge axis is the
articulators. The anterior reference point can be imaginary line around which the condyles can rotate
marked using a Denar reference plane locator. The without translation. A terminal hinge position is
plane locator is an instrument which resembles a the most retruded hinge position and it is
face-bow. learnable, repeatable and recordable. It coincides
with the centric relation. A 12-15° pure rotational
Twirl Bow movement of the joint is possible in this position.
It is an arbitrary type of face-bow that does not The maximal incisal separation in this position is
require any physical attachment to the articulator. around 20 to 25 mm opening between the incisal
It is not commonly used for CD construction. It edges (Fig. 9.41b).
relates the maxillary arch to the Frankbort’s
horizontal plane. A mounting guide is used to
mount the transfer rod to the articulator. It is
easy to manipulate because the face-bow is not
needed to mount the maxillary cast in the
articulator.
Whipmix Face-bow
These face-bows have a built-in hinge axis locator.
It automatically locates the hinge axis when the
Fig. 9.41b: True condylar rotation. 12° rotation with the
earpieces are placed in the external auditory maximum incisal separation of 22 mm
meatus. It has a nasion relator assembly with a
plastic nosepiece. The nasion relator determines
the anterior reference point. The true hinge axis should be located and
marked before using the face-bow. The location
Kinematic Face-bow of the hinge axis is then transferred to the
This face-bow is generally used for the fabrication articulator with the face-bow. This face-bow
of fixed partial denture and full-mouth requires a fully adjustable articulator to accept the
rehabilitation. It is generally not used for comp- true hinge axis (THA). Since the patient’s hinge
lete denture fabrication because it requires a long axis is transferred to the articulator, the movement
and complex procedure to record the orientation of the articulator will simulate the movements of
126 jaw relation (Fig. 9.41a). the joint made at the terminal hinge position.
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Fig. 9.43: Preparing the occlusal rim to receive a bite fork • Aluwax is softened and shaped to the form of
a horseshoe. The bite fork is embedded into
• The mandibular occlusal rim is placed in the this soft wax. The thickness of the bite fork
patient’s mouth and reduced such that and the wax together should not be more than
sufficient space is available between the two 6 mm (Fig. 9.46).
rims to accommodate the bite fork (Fig. 9.44). • A thin layer of petroleum jelly is applied on
• The U-shaped frame of the face-bow along both the occlusal rims to facilitate easy
with the condylar rods is positioned on the separation. 127
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9
• A record base is fabricated over the mandi- • A tatoo representing the THA should be mar-
bular cast. ked on the patient’s face for further reference.
• An occlusal rim made of impression com-
pound is built upon the record base. VERTICAL JAW RELATION
• The bite fork is attached to this occlusal rim.
It is defined as, “The length of the face as determined
• Extending outside from the bite fork is its
by the amount of separation of the jaws” - GPT. It can
horizontal stem, which lies parallel to the
also be defined as the amount of separation
sagittal (midline) plane.
between the maxilla and mandible in a frontal
Clinical Procedure plane.
This record provides the optimal separation
• The clutch along with the stem is placed in between the maxilla and the mandible. If this
the patient’s mouth. record is not measured accurately, the joint will
• The hinge bow (kinematic face-bow) is attac- be strained (overextended or underextended).
hed to the stem of the bite fork and the The vertical separation between the mandible and
condylar rods are located at a point 13 mm in the maxilla depends on the temporomandibular
front of the auditory meatus on the cantho- joint and the tone of the muscles of mastication.
tragus line. If the vertical dimension is altered there will be
• The patient should be placed in a semi-supine severe discomfort in both the temporomandibular
position and his mandible should be guided joint and the muscles of mastication.
to produce opening and closing movements, This relation is easiest to record but is very
which are purely rotational. The patient critical. Errors in vertical dimension are the first
should also be asked to make eccentric move- to produce discomfort and strain.
ments.
Factors Affecting Vertical Jaw Relation
• The condylar rods will move (either rotate or
translate depending on the movement of the Teeth
condyle) during the mandibular movements. These act as occlusal vertical stops and establish
The point at which the condylar rods show the relationship of the mandible to the maxilla in
pure rotation indicates the terminal hinge axis a vertical direction in dentulous patients.
(THA). If the patient opens his mouth widely
(more than 12°-15° then the condylar rods will Musculature
move anteriorly (translation) (Fig. 9.51). The opening and closing muscles tend to be in a
• The condylar rods are locked in this position state of minimal tonic contraction. This deter-
and the face-bow is removed. mines the vertical jaw relation. 129
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Maxillomandibular Relations
ness, the mandible shifts to a habitual rest posi- • Presence of any neuromuscular disease in the
9
tion. The complete denture should not be fabri- patient can influence the rest position.
cated using the habitual rest position. Hence the • The patient cannot maintain the physiological
physiological rest position should be determined rest position for an indefinite period of time.
in these patients before recording vertical jaw Hence, it should be recorded quickly.
relation. • Incorrect measurement of the rest position can
When functional movements (swallowing, lead to faulty recording of the vertical dimen-
wetting the lips) are performed, the mandible sion at occlusion and can lead to injury to the
comes to the physiological rest position before supporting structures and the temporo-
going to the habitual rest position. mandibular joint.
The physiological rest position is influenced The following methods can be used to
by a number of factors and the following consi- measure the vertical dimension at rest.
derations are to be remembered while recording • Facial measurements after swallowing and
it: relaxing
• The position of the mandible is influenced by • Tactile sense
gravity and the posture of the head. Hence • Measurement of anatomic landmarks
while recording vertical jaw relation the • Speech
patient should be asked to sit upright, with • Facial expression
his/her head upright and eyes looking
straight in front. The Reid’s base line should Facial Measurements after
be parallel to the floor (Fig. 9.54). Swallowing and Relaxing
• Since we are recording a physiological rest
• The patient is asked to sit upright and relax.
position, all the muscles affecting this record
• Two reference points are marked with the help
should be relaxed. Signs like tension, strain,
of a triangular piece of adhesive tape on the
and nervousness can alter the position of the
tip of the nose and the tip of the chin (Fig. 9.55).
mandible.
• The patient is asked to perform functional
movements like wetting his lips and swallow-
ing.
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• Pre-extraction records
9
— Profile photographs
— Profile silhouettes
— Radiography
— Articulated casts
— Facial measurements
• Measurement from former dentures
Physiological Methods
— Power point
— Using wax occlusal rims Fig. 9.57: Distance between the incisive papilla of the maxilla
and the incisal edge of the lower incisor can be used as a
— Physiological rest position
reference to determine vertical jaw relation
— Phonetics Key: a = usually 6 mm, b = usually 2 mm, Hence c = 4 mm
— Aesthetics
— Swallowing threshold The mandible of the patient is adjusted to be
— Tactile sense or neuromuscular perception parallel to the maxilla. This position associated
— Patient’s perception of comfort. with a 5° opening of the jaw in the temporoman-
dibular joint gives a correct amount of jaw
Mechanical Methods separation.
These methods are called so because they do not In patients where the upper and lower teeth
require any functional movement. They are are extracted together, the upper and lower ridges
measured using simple mechanical devices. will be parallel because the length of the clinical
crowns of the opposing anterior and posterior
Ridge relation It is defined as, “ The positional
teeth will be equal.
relationship of the mandibular ridge to the maxillary
This method cannot be taken as a standard in
ridge” – GPT. It can be measured by two methods patients who had periodontal disease and in
namely: patients who lost their teeth at different periods
• Distance from the incisive papilla to mandi- of time.
bular incisors.
• Parallelism of ridges. Pre-extraction Records
Distance from the incisive papilla to mandibular Various pre-extraction records like profile photo-
incisors Incisive papilla is a stable landmark that graphs, profile silhouettes, radiographs, articu-
does not change a lot with the resorption of the lated casts and facial measurements can be used
alveolar ridge. to record the vertical dimension at occlusion.
The distance of the papilla to the maxillary These records give an idea about the vertical
incisor edge is 6 mm. Usually the vertical overlap dimension at occlusion of the patient when the
between the upper and lower incisors is 2 mm teeth were present.
(overbite). Hence the distance between the inci-
sive papilla and the lower incisors will be appro- Profile photographs These photographs are made
ximately 4 mm. Based on this value, the vertical before extraction. They should be taken in maxi-
mum occlusion as the patient can easily maintain
dimension at occlusion can be calculated (Fig.
this position during photographic procedures.
9.57).
The photographs should be enlarged to the
Ridge parallelism The mandible is parallel to the actual size of the patient and the distance between
maxilla only at occlusion. This factor can be used the anatomical landmarks should be measured
to determine the vertical dimension at occlusion. and compared with that of the patient to avoid 133
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9 Textbook of Prosthodontics
errors. The measurements are recorded so that using a face-bow transfer. An inter-occlusal record
they can be used later. is made in the patient’s mouth. This inter-occlusal
While measuring the jaw relation, the mea- record is used to articulate the mandibular cast
surements from the profile photographs are used with the maxillary cast. This is used as the pre-
to determine the vertical dimension at occlusion. extraction record.
Profile silhouettes The word silhouette means After extraction the edentulous casts are arti-
outline. An accurate silhouette is made with card- culated in a separate articulator. The inter-arch
board or contoured with wire using the patient’s distance between the edentulous casts is com-
photograph. This silhouette can be used as a tem- pared with that of the articulated dentulous casts.
plate. Since the silhouette is taken from a pre- Facial measurements Two tattoo points are
extraction photograph it shows the vertical marked on the upper and lower halves of the face
dimension at rest. It is positioned on the patient’s before extraction. The vertical dimension is mea-
face while recording the vertical dimension at sured at occlusion and recorded. This measure-
occlusion. The chin should be at least 2 mm above ment is used after extraction.
the level of the lower border of the silhouette (Fig. The distance between the tattoo marks can be
9.58). measured by recording the distance from the chin
Radiography Cephalometric profile radiographs to the base of the nose using dividers (or) calipers
and radiographs of the condylar fossa are used before teeth are extracted.
to determine the vertical jaw relation. But their Measurement from former dentures Patient’s
use is limited due to the inaccuracy in the existing denture is a valuable pre-extraction
technique. record. A Boley’s gauge is used to measure the
Articulated casts When the patient is dentulous, distance between the border of the maxillary and
the maxillary cast is mounted in the articulator the mandibular denture when both these den-
134 Fig. 9.58: Using profile silhouette to determine vertical jaw relation
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tures are in occlusion. This measurement is used • The occlusal surface of the maxillary occlusal
9
to determine the vertical dimension at occlusion. rim is coated with petrolatum and seated in
the mouth. Denture adhesive powder may be
Physiological Methods used in cases with inadequate retention.
Power Point: (by Boos) • A thin roll of modeling wax with a triangular
cross-section is softened in a water bath at 130°
A metal plate (central bearing plate) is attached F and placed over the mandibular occlusal rim
to the maxillary record base. A bimeter is attached with its apex towards the maxillary rim (Fig.
to the mandibular record base. This bimeter has 9.60).
a dial, which shows the amount of pressure acting
on it.
The record bases are inserted into the patient’s
mouth and the patient is asked to bite on the
record bases at different degrees of jaw separation.
The biting forces are transferred from the central
bearing point to the bimeter. The pressure reading
in the bimeter is noted. The highest value is called
the Power point. The bimeter is observed when
the power point is reached (Fig. 9.59).
Fig. 9.60: Adding a triangular cross-section of modelling
wax to the mandibular occlusal rim
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9 Textbook of Prosthodontics
• Upper and lower occlusal rims which were Phonetics This involves observing the move-
modified according to the clinical guidances ments of the oral tissues during speech and more
(refer occlusal rim fabrication) are inserted and importantly listening and analyzing the speech
the patient is asked to swallow and relax. of the patient. The maxilla and mandible show a
• When the relaxation is obvious, the lips are characteristic relationship during speech. This can
carefully parted to reveal the space present be used to determine the vertical dimension.
between the occlusion rims. This space is There are two common methods in which phone-
called the Free-way space (Fig. 9.61). tics is used to determine jaw relation. They are:
• Silverman’s closest speaking space.
• The “F” or “V” and “S” speaking anterior
tooth relation.
136 Fig. 9.62: a = b+c. The vertical dimension at rest is equal to the sum of
vertical dimension at occlusion and free-way space
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Maxillomandibular Relations
• The procedure is repeated to avoid errors. Dis- condition that can exist at various degrees of jaw
9
advantages include foreign body obstruction, separation. It occurs around the terminal hinge
etc. axis” (GPT-3)
3. “The most retruded relation of the mandible to the
Patient’s Perception of Comfort maxilla when the condyles are in the most posterior
It is a very simple and easy method of deter- unstrained position in the glenoid fossa from which
lateral movements can be made, at any given degree
mining the vertical relation. Here, the record bases
of jaw separation” (GPT-1)
with excessively tall occlusal rims are inserted in
4. “The most posterior relation of the lower to the
to the patient’s mouth and the excess base plate
upper jaw from which lateral movements can be
wax is removed stepwise till the patient perceives
made at a given vertical dimension” (Boucher)
the occlusal height as comfortable. The dis-
5. “A maxilla to mandible relationship in which the
advantage of this technique is that it depends on
condyles and discs are thought to be in the midmost,
the patient’s co-operation for accurate readings.
uppermost position. The position has been difficult
to define anatomically but is determined clinically
HORIZONTAL JAW RELATION by assessing when the jaw can hinge on a fixed
terminal axis (up to 25 mm). It is a clinically
It is the relationship of the mandible to the maxilla
determined relationship of the mandible to the
in a horizontal plane. It can also be described as
maxilla when the condyle disc assemblies are
the relationship of the mandible to the maxilla in
positioned in their most superior position in the
the anteroposterior direction. Horizontal jaw
mandibular fossa and against the distal slope of
relation can be of two types namely centric and
the articular eminence” (Ash)
eccentric jaw relations.
6. “The relation of the mandible to the maxilla when
Centric relation denotes the relationship of the
the condyles are in the uppermost and rearmost
mandible to the maxilla when the mandible is at
position in the glenoid fossae. This position may
its posterior most position. Eccentric relation not be able to be recorded in the presence of
denotes the relationship of the mandible to the dysfunction of the masticatory system” (Lang)
maxilla when the mandible is at any position 7. “A clinically-determined position of the mandible
other than the centric relation position. placing both condyles into their anterior uppermost
position. This can be determined in patients
Centric Relation without pain or derangement in the TMJ”
The glossary of prosthodontic terms (GPT) (Ramsfjord 1993).
enumerates seven different definitions for centric GPT-5 definition is commonly used and
relation. They are: accepted. Generally speaking, centric relation can
1. “The maxillomandibular relationship in which the be described as the most posterior relation of
condyles articulate with the thinnest avascular mandible to the maxilla at the established vertical
portion of their respective discs with the complex dimension from which lateral movements could
in the anterior-superior position against the slopes be made. Any position of the mandible other than
of the articular eminences. This position is that of the centric relation is called an eccentric
independent of tooth contact. This position is position.
clinically discernible when the mandible is directed Note: Centric relation is the most posterior relation
superior and anteriorly. It is restricted to a purely of the mandible to the maxilla and the antero-
rotary movement about the transverse horizontal superior relation of condyle to the glenoid fossa.
axis” (GPT-5) (most accepted definition).
2. “The most retruded physiologic relation of the Importance of Centric Relation (Significance)
mandible to the maxilla to and from which the We know that proprioceptive impulses (impulses
individual can make lateral movements. It is a of three-dimensional spatial orientation) guide 139
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• The temporalis and the masseter are palpated ric relation. Once the clinician is satisfied with
9
to relax them. the patient’s training, the centric relation position
is recorded on the occlusal rims (using physio-
Difficulties in Retruding Mandible logical, functional or graphic methods). This
Difficulties in retruding the mandible can be record is transferred to the articulator using
classified as indexes like nicks and notches, staple pins, etc.
• Biological
• Physiological Physiologic Methods
• Mechanical. Physiological methods are called so because they
Biological causes are based on
• Lack of co-ordination between groups of • The proprioceptive impulses of the patient.
opposing muscles when the patient is reques- • Kinesthetic sense of mandibular movement
ted to close the mouth in the retruded position. • The visual acuity and sense of touch of the
• Habitual eccentric jaw relation. dentist.
• No pressure is exerted on the interocclusal
Physiological causes record.
Inability of the patient to follow the dentist’s
instructions is one of the major psychophy-
Tactile Sense or Inter-occlusal
siological factors, which produce difficulty in
Check Record Method
retruding the mandible. This is overcome by
instituting stretch relax exercises, training the In this method, tentative centric jaw relation is
patient to open and close his mouth, etc. Central recorded by asking the patient to retrude the
bearing devices can also be used to retrude the mandible. The casts are articulated based on the
mandible in these patients. tentative jaw relation. Teeth arrangement is done
Mechanical causes and an inter-occlusal registration is made. The
Poorly fitting base plates produce difficulty in tentative jaw relation is verified with the inter-
retruding the mandible. The base plates should occlusal record and errors are corrected.
be checked using a mouth mirror for proper adap- Indications
tation. • Abnormally related jaws.
• Displaceable, flabby tissues.
METHODS OF RECORDING THE • Large tongue.
CENTRIC JAW RELATION • Uncontrollable mandibular movements.
The various methods to record centric relation are: • It can also be done for patients already using
Physiological methods: a complete denture.
• Tactile or inter-occlusal check record Factors affecting the success of inter-occlusal
method record method
• Pressureless method. • Uniform consistency of the recording material.
• Pressure method. • Accurate vertical jaw relation records.
Functional method: • Stability and fit of the record base.
• Needleshouse method • Presence of reference points embedded in the
• Patterson method record like metal pins or styli.
Graphic methods: The commonly used materials for making the
• Intraoral inter-occlusal record in this method are waxes,
• Extraoral impression compound, ZnOE and impression
Radiographic method: plaster.
Generally while recording centric relation, the Waxes are technique-sensitive and do not
patient is trained to retrude his mandible to cent-
141
provide uniform resistance to pressure because
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they do not cool uniformly. The advantage of • Before placing the trial dentures, the hori-
waxes is that they harden very quickly and the zontal condylar guide locks in the articulator
record can be made immediately. Hence, they are (Refer chapter 10) are unlocked to allow free
used only in patients with poor muscular control. horizontal movement of the casts.
Impression plaster and ZnOE are usually • The Aluwax on the buccal aspect of mandi-
preferred because they offer uniform resistance bular teeth is scraped off and the articulated
to pressure. The disadvantage of these materials casts (which are free to move horizontally) are
is that they take a long time to set and any adjusted to fit into the Aluwax check record.
movement made while the material hardens, can • If the tentative relation record is accurate and
render the inter-occlusal record useless. is the same as the check record then both the
Procedure condylar elements of the articulator will
It involves two steps. First, a tentative centric jaw contact against the centric stops i.e. the arti-
relation is recorded using wax occlusal rims. In culated casts need not move to fit into the
the second step, an inter-occlusal check record is check records.
made using the trial denture during try-in (Trial • If anyone of the condylar elements (condylar
denture is fabricated using the tentative jaw element represents the condyle in the articulator)
relation). do not contact on the centric stops (centric stop
represents the centric position of the condyle in the
Tentative Jaw Relation
glenoid fossa) it indicates that the tentative
• The maxillary occlusal rim is inserted into the
recording is inaccurate. (Refer chapter 10 for
patient’s mouth. A denture adhesive can be
additional details).
used to improve retention.
• Occlusal indicator wax can be used instead of
• The vertical dimension at rest is established
and the mandibular rim is reduced further for Aluwax for recording trial dentures with non-
excess inter-occlusal distance. anatomical (cuspless) teeth.
• A tentative centric relation is recorded by
using one of the previously mentioned Static or Pressureless Method
methods to retrude the mandible. The occlusal rims are customized as usual and
• The occlusal rims are articulated using the the patient is trained to close at centric relation
tentative jaw relations and the artificial teeth position. Once the patient attains the centric
are arranged. relation position, the denture bases with occlusal
• Now the trial dentures are ready for making rims are indexed/sealed in this position. The nick
the inter-occlusal check record.
and notch method or the stapler pin method can
Making the Inter-occlusal check record be used to index/seal the occlusal rims.
• The upper and lower trial dentures are inser-
Nick and notch method This is the most com–
ted into the patient’s mouth. The artificial teeth
monly used method of indexing the recorded
are prevented from contacting the opposing
centric jaw relation. Here, the final centric jaw
members by keeping a piece of cotton inter-
relation is carried out after establishing a proper
occlusally.
vertical jaw relation. No occlusal check records
• Aluwax is loaded onto the occlusal surface of
are performed during try-in. This procedure
teeth in the mandibular occlusal rim.
derives its name from the shape of the indices
• The patient is asked to slowly retrude the
made on the occlusal rims.
mandible and close on the wax till tooth
contact occurs. Procedure for recording centric relation using a
• The trial dentures are removed and the wax is pressure less method with nick and notch indexing
allowed to cool. • The patient is seated in an upright position,
• Both the maxillary and mandibular trial as it is easier to retrude the mandible in this
142 dentures are placed on their articulated casts. position.
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on the occlusal rims and their attachments affecting functional centric relation are
9
(tracers etc). considered.
• The record bases should be very stable • The patient is asked to close on the occlusal
while recording centric jaw relation. If the rims and make protrusive, retrusive, right and
record base gets displaced, the mandible left lateral movements of the mandible.
will tend to move into an eccentric position. • When the patient moves his mandible, the
• Lack of equalized pressure exerted on the metal styli on the maxillary occlusal rim will
record base can result in inaccuracies in create a marking on the mandibular occlusal
recording centric jaw relation. rim. When all the movements are made, a
• A good neuromuscular coordination is diamond-shaped marking pattern rather than
required from the patient. a line is formed on the mandibular occlusal
rim (Fig. 9.73).
Needleshouse Method • The posterior most point of this diamond
This is one of the most commonly used functional pattern indicates the centric jaw relation.
techniques.
• It involves the fabrication of occlusal rims
made from impression compound.
• Four metal beads or styli are embedded into
the premolar and molar areas of the maxillary
occlusal rim (Fig. 9.72).
• The occlusal rims are inserted into the patient’s
mouth and all the above-mentioned factors
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Fig. 9.80: Correct arrow point tracing Fig. 9.82: Central bearing point 147
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Since it is placed across the tongue space of (coated with chalk) are inserted into the
the mandibular occlusal rim, it cannot be used in patient’s mouth.
patients who cannot retract the tongue suffi- • The central bearing point is adjusted such that
ciently and those who have macroglossia. it contacts the central-bearing plate at a
predetermined vertical dimension (Fig. 9.84).
Central bearing plate It is also a triangular piece
• When the patient closes his mouth, the central
of metal with extensions at the three corners pro-
bearing point contacts the metal plate.
vided to attach the plate to the occlusal rim. It is
usually attached to the maxillary occlusal rim. A
mixture of denatured spirit and precipitated chalk
is coated on this plate. The spirit dries to leave a
fine layer of precipitated chalk. The tracing is mar-
ked on this layer of precipitated chalk (Fig. 9.83).
a
Fig. 9.84: Adjusting the central bearing screw to touch the
central bearing plate
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Maxillomandibular Relations
Fig. 9.85b: Extraoral arrow-point recording plate Pantographic tracing It is defined as, “A graphic
record of mandibular movement in three planes as
The mandibular occlusal rim should be redu- registered by the styli on the recording tables of a
ced to obtain excessive inter-occlusal distance. pantograph; tracings of mandibular movement
The recording plate is attached to the mandibular recorded on plates in the horizontal and sagittal
occlusal rim such that it is at the midline. The planes” – GPT.
stylus or the central bearing point is attached to It is a three-dimensional graphic tracer. It is
the maxillary occlusal rim (This arrangement can the most accurate method available to record
also be reversed if needed). centric jaw relation. Even eccentric jaw relation
• The record bases attached to the recording can be recorded using these instruments. These
devices are inserted in the patient’s mouth. equipments are very sophisticated and are
• The central bearing point is retracted to con- generally not used in the fabrication of complete
duct training exercises. The Ney excursion guide dentures. This is because complete dentures have
(Fig. 9.23b) can be used as an aid to train the a realiff factor that aids to compensate for the
patient. minor fabrication errors. These tracers are
• The recording plate (attached to the mandi- generally used for full-mouth rehabilitation of
bular rim), which projects extra-orally, is dentulous patients. 149
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Maxillomandibular Relations
9
151
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Chapter 10
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• Articulators and Articulation
• Mounting Procedure
• Teeth Selection
• Occlusion
• Arrangement of Artificial Teeth
• Wax up
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MONSON CENTER
10
D OF ROTATION
B
4” RADIUS
BONWILL
TRIANGLE C
BALKWILL
TRIANGLE
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Fig. 10.5: Schematic diagram showing a non-adjustable Fig. 10.6: Schematic diagram showing an “ ARCON “
articulator that is capable of showing only opening and articulator where the condylar elements are attached to the
closing movement lower member 157
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Fig. 10.7
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member. The plane of occlusion should coincide The condylar element of the upper member
with this horizontal bar during articulation. passes through this track. A spring is mounted
within this track (condylar guidance) to stabilize
Incisal guide table or anterior guidance of the
the condylar elements and hold them in their
articulator (Read ‘incisal guidance and condylar
posterior most position (centric relation) when no
guidance of the patient’ explained in factors controlling
movements are made. This condylar guidance
mandibular movements before proceeding).
does not accept face-bow transfer (Fig. 10.12).
Incisal guide Table is defined as, “That part of
the articulator which maintains the incisal guide
angle” - GPT. The incisal guide table gives the
incisal guidance of the articulator. The incisal
guide table can be described as a very short
cylinder whose upper surface is concave. The
vertical rod should rest on the centre of the incisal
guide table during articulation. The depth of the
Fig. 10.12a: Condylar guidance of the
concavity is designed to have a slope equal to the
temporomandibular joint
average incisal guide angle (Fig. 10.11). The incisal
guide angle is fixed and non-customizable.
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10 Textbook of Prosthodontics
rectangular metal strap. The center of the lower vertical arm contains a rollpin or auditory pin. The
member has a provision (dowel) for attaching a rollpin is a small fixed metal pin which projects
mounting ring and also a stand or pivot. The pivot on the outer surface of the vertical arm. The
holds and prevents vertical displacement of the earpiece of the face-bow will fit into these rollpins
upper occlusal rim during articulation (during during articulation. It is the posterior reference
articulation dental plaster is loaded on the maxillary point of the articulator.
cast and the upper member of the articulator is pressed The condylar shaft is seen attached to the inner
over it. This usually pushes the occlusal rim down). surface of the vertical arm 12 to 13 mm anterior
The incisal guide table is located at the anterior to the rollpin. The condylar shaft is a cylindrical
end of the horizontal arm (Fig. 10.15). piece of metal capable of free rotation. The
The vertical arms slope outward and give a condylar element is attached to the free end of
good lingual view. The upper portion of the the condylar shaft. The condylar element is a
metal ball, which represents the condyle of the
mandible. Since the condylar element is attached
to the lower member, this articulator is described
as an arcon articulator. The condylar element
articulates with the condylar guidance (slot or
track) to represent the temporomandibular joint
(Fig. 10.16).
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Fig. 10.19: Open track condylar guidance: Key: Same as A pair of lateral wings is present around the
10.18 except that the condylar rim is open incisal guide table. The lateral wings can be 163
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Fig. 10.22a
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MOUNTING PROCEDURE
Zeroing or Resetting the Articulator Fig. 10.29b: Condylar track set to 30°
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Fig. 10.36: The maxillary mount is contoured to have good Fig. 10.38: The mandibular articulation is contoured as
line angles using a wax knife or plaster knife done for the maxillary cast
168
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TEETH SELECTION
Size of the Anterior Teeth
The next step in the fabrication of a complete den-
ture after articulation is teeth arrangement. Before The tooth size should be appropriate to the size
arrangement, the teeth should be selected. Artifi- of the face and sex of the patient. The following
cial teeth are available in various forms and methods are used as a guide to select the size of
shades. Teeth selection is very important as the the teeth:
selection of the appropriate size, shape/occlusal • Methods using pre-extraction records.
form and colour/shade of the artificial teeth • Methods using anthropological measure-
determines the aesthetics and the function of the ments of the patient.
denture. Aesthetics is a pleasurable feeling crea- • Methods using anatomical landmarks.
ted within an individual against the perception • Methods using theoretical concepts.
of an object. 169
• Other factors.
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Methods Using Pre-extraction Records measuring tape at the level of the forehead. The
width of the upper central incisor can be derived
The pre-extraction records like diagnostic casts,
from this measurement. Sears called this formula
photographs, radiographs, teeth of close relatives
as the anthropometric cephalic index (Fig. 10.40).
and preserved extracted teeth can be used to
determine the size of the artificial teeth. Width of the upper central incisor =
Circumference of the head
__________________________________
13
Diagnostic casts They are prepared before the
extraction of the teeth. The operator can obtain
an idea about the size and shape of the teeth from
these casts. The actual size and shape required
can be determined but the shade of the teeth
cannot be determined using this method.
Pre-extraction photographs Photographs
showing the lateral, anterior and anterolateral
views of the patient should be taken before
extraction. These photographs must show at least
the incisal edges of the anterior teeth. This
method is useful to determine the exact width
and outline of the teeth.
Pre-extraction radiographs This is usually
obtained from the patient’s previous dentist.
Radiographic errors are a major limitation to this
method. The occluso-gingival height and the
Fig. 10.40: Measuring the circumference of the head at
outline of the teeth can be recorded. But the con-
the level of the forehead
tour and size cannot be accurately determined,
because the radiograph is a two-dimensional
The bizygomatic width can be used to deter-
image.
mine the width of the central incisor and also the
Teeth of close relatives This method is usually combined width of the anteriors. The bizygomatic
followed only if the other records are not width is the distance measured between the malar
available. The size and contour of the patient’s prominences on either side. This measurement is
son or daughter’s tooth is taken as reference. also used in Berry’s Biometric index and H.
Preserved extracted teeth This is the best method Pound’s formulae.
to determine the size of the anterior tooth. The Total width of the upper anteriors =
Bizygomatic width
_______________________
exact details about the size and contour can be 3.36
recorded from this method. the width of the
4 th upper anteriors
Total width of the lower anteriors = ______
Methods using Anthropological 5
Measurements of the Patient
Berry’s Biometric index Berry’s bimetric index is
Anthropological measurements are usually post- used to derive the width of the central incisor
extraction records made directly from the using the bizygomatic width and/or the length
edentulous patient. These methods measure of the face. The formula using the length of the
certain anatomical dimensions and derive the size face cannot be used for edentulous patients. The
of the teeth using certain formulae. length of the face is the distance measured
Anthropometric cephalic index The transverse between the hairline and the tip of the chin (Fig.
170 circumference of the head is measured using a 10.41).
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Bi-zygomatic width
_______________________
The width of the maxillary central incisor =
16
Length of the face Fig. 10.43: Combined width of all anterior teeth
The length of the maxillary central incisor = ________________________
16
Location of the buccal frenal attachments The
Based on the width of the nose The width of the attachments of the buccal frenum are marked on
nose is measured with a vernier calliper. This the residual ridge. The distance between the two
measurement is transferred to the occlusal rim. markings recorded along the residual ridge gives
The width of the nose is equal to the combined the combined width of the maxillary anteriors
width of the anterior teeth. (Fig. 10.44).
171
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Fig. 10.45
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a b
Fig. 10.51a
c d
Patient’s Profile
The patient may have a convex, straight or a
concave profile. The labial form of the anterior
teeth should be similar to the facial profile of the
patient. For example, the labial form should be
straight for patients with a straight profile, convex
for a patient with a convex profile (Fig. 10.51).
Dentogenic Concept and Dynesthetics: Figs 10.51a and b: Facial profile and labial convexity
(Sex, Personality, Age or SPA factor)
It was first described by Frush and Fisher.
males, the incisal angles are rounded to a lesser
According to them, the sex, personality and age
degree and the teeth are more angular (Fig.
of the patient determine the form of the anterior
10.52).
teeth.
• The incisal edge of the central incisors is
Sex The form or shape of the teeth differs in parallel to the lips and the laterals are above
males and females. The differences in the shape the occlusal plane in males. But the incisal
of the anterior teeth in males and females are: edges of the central and lateral incisors follow
• In females, the incisal angles are more rounded the curve of the lower lip in females (Fig.
174 and the teeth have a lesser angulation. In 10.53).
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dentine which carries a yellow tinge, is more black or white to produce darker or lighter shades
visible (Refer colour selection). respectively. In people with light skin colour, teeth
with lighter shades should be chosen and vice
Personality The dentist should select and arrange
versa.
the teeth so that it improves the patient’s
personality. The patient can be either vigorous or
Translucency
delicate.
• More squarish, large teeth are selected for It is the property of the object to partially allow
vigorous people. passage of light through it. Enamel has high
• The anteriors should be in a flat plane for brilliance and translucency; hence, artificial teeth
executives. should also show the same properties for a
• For executives, the teeth should be relatively natural appearance.
smaller and more symmetrically arranged The hue and brilliance of a tooth is influenced
(Fig. 10.57). or determined by the following factors:
• Age.
• Habits.
• Complexion.
• Colour of the eyes.
• Colour of the patient’s hair.
Fig. 10.57: Small teeth for executives Age
• Young people have lighter teeth where the
Colour for Anterior Teeth colour of the pulp is shown through the
Before selecting the colour for anterior teeth, some translucent enamel.
basic concepts about colour should be under- • Old people show dark and opaque teeth due
stood. A single colour can be described under four to the deposition of secondary dentin and con-
parameters. sequent reduction in size of the pulp chamber.
• Hue. • Teeth are more shiny in old people as they get
• Saturation or chroma. polished due to regular wear of the teeth.
• Brilliance or value. • Teeth of older people obtain a brownish tinge
• Translucency. because exposed dentin tends to stain.
• Preserved extracted teeth are not used to select
Hue the colour of the teeth because they become
discoloured (as they are non-vital).
It denotes a specific colour produced by a specific
wavelength of light. It should be in harmony with Habits
the patient’s skin colour or else it will produce Smokers, alcoholics and pan chewers have
an artificial look for the denture. discoloured teeth due to stains. In such people,
porcelain teeth are preferred because they are not
Saturation or Chroma porous and do not allow percolation.
It is the amount of colour per unit area of an object. Complexion
In other words, it denotes the intensity of the • The colour of the teeth chosen should be in
colour. Objects with highly saturated colours lack harmony with the complexion of the patient.
depth. • The colour of the face is more important
because the teeth fall into the framework of
Brilliance or Value the face.
It denotes the lightness or darkness of an object. Colour of the Eyes
176 It is actually the dilution of the colour with either • Only the colour of the iris is considered.
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Buccolingual Width
The buccolingual width of the artificial teeth
should be decreased so that the buccal and lingual
surfaces slope out from the occlusal surface to
provide a proper path of escapement of food dur-
ing mastication.
Figs 10.58a to c: Selecting the colour of anterior teeth at It should be such that the forces from the
various reference points tongue neutralize the forces of the cheek. If the
buccolingual width increases, the forces acting on
Squint test It is used to check and compare the the denture will also increase, leading to increase
colour of the teeth with the colour of the face. in the rate of ridge resorption. Broader teeth
The dentist should partially close his eyes to encroach into the tongue space leading to
reduce light and compare artificial teeth of instability of the denture. Also, the teeth should
different shades with the colour of the face. The not encroach into the buccal corridor space to
colour of the teeth that fades first from view is avoid cheek biting (Fig. 10.60). 177
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Occluso-gingival Height
It is determined by the available inter-arch
distance. The occlusal plane should be located at
the midpoint of the interocclusal distance (Fig.
Fig. 10.60a: Placement of posterior teeth in the
10.62). Large teeth selected for cases with
neutral zone inadequate interocclusal distance appear artificial
and require modification before arrangement.
Measures like altering the thickness of the denture
base can also be done to accommodate large teeth.
Mesiodistal Length
Fig. 10.62a: (a) Good inter-arch space to place teeth with
The mesiodistal length of each tooth should be high occluso-gingival height
selected such that the combined length of all the
posterior teeth on that side of the arch does not
exceed the distance between the canine and the
retromolar pad (Fig. 10.61).
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• More shear in the chewing stroke. • Many commercially available forms are poorly
10
• More tongue room. designed and have only “gimmick” value.
Disadvantages of cuspless occlusal schemes
Selection of Teeth Based on the
• Less stability to the upper denture.
Type of Material Used
• No balance in excursive glides (unless plea-
sure curve added). Refer arrangement of teeth. Acrylic, porcelain or new hard acrylics are the
most commonly used. Composite teeth are also
Advantages of 0o teeth
available. Acrylic and porcelain teeth have been
• Easy to set up.
discussed in parts of a complete denture. Hard
• Least lateral stress.
acrylic teeth show more resistant to wear
• Least anterior-posterior interferences after
and stains. Acrylic and porcelain teeth are
settling.
discussed in detail in parts of a complete denture
• Best for patients with poor muscular control.
in Chapter 1.
• Best for patients with poor ridge relationships.
Teeth arrangement is the next step in the
• Reduced buccolingual width, and sharp
fabrication of a complete denture. Before we go
grooves and sluiceways compensate for cusps
into the principles of arrangement of teeth, we
in obtaining equal chewing efficiency.
shall discuss the concepts of occlusion.
Disadvantages of 0° teeth
• Very difficult to obtain balanced occlusion in OCCLUSION
excursive movements.
• Less chewing efficiency especially for fibrous Occlusion is defined as, “Any contact between the
or tough food. incising or masticating surfaces of the maxillary and
• Poor aesthetics. mandibular teeth” –GPT.
• When set on a flat plane, a space develops pos- Another term, which deals with the relation-
teriorly when excursions occur (“Christe- ship of the maxillary and mandibular teeth is
nson’s phenomenon”), causing excessive Dental articulation.
pressure and resorption in the anterior region. Dental articulation is defined as, “The static and
dynamic contact relationship between the occlusal
Special Tooth Forms surfaces of the teeth during function” – GPT (Fig.
10.68).
They include French’s posteriors, cutter bars,
masticators, VO posteriors, Sosin-bladed teeth
and many others. Cutter bars and masticators are
no longer available. These teeth are discussed in
detail in the first chapter under the parts of a
complete denture.
Advantages
• Some can provide moderate to excellent
function
• To date, most efficient design is Sosin bladed
teeth.
Fig. 10.68
Disadvantages
• Often aesthetics is poor. It is generally considered that occlusion deals
• Best forms require meticulous execution and with the static relationship of opposing teeth and
skill. articulation deals with the dynamic (during
• More expensive movement) relationship of the opposing teeth. In
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this chapter, we have grouped for convenience we discussed anatomic and non-anatomic teeth.
occlusion and articulation as a single pheno- Anatomic teeth should be arranged using
menon. balanced occlusion and non-anatomic teeth are
Occlusion is an important factor, which usually arranged using monoplane occlusion.
governs the retention and stability of the complete All occlusal forms should at least have a tripod
denture in vivo. It is important for one to know contact in centric relation. Balanced occlusion
the principles of occlusion before arranging artifi- should have tripod contact even in eccentric
cial teeth. relation. Before we go in detail about each type
of occlusion, let us look at the different concepts
DIFFERENCES BETWEEN NATURAL AND
of occlusion.
ARTIFICIAL OCCLUSION
Occlusion of natural and artificial teeth vary to a Spherical Concept of Occlusion: (Monson)
great extent. It is important for one to know about According to this concept, the anteroposterior and
these differences in order to understand the need mesiodistal inclines of the artificial teeth should
of balanced occlusion in a complete denture be arranged in harmony with a spherical surface.
which is discussed later. (Refer spherical theory in articulators).
Natural teeth Artificial teeth
• Natural teeth function • Artificial teeth function as a
Organic Concept of Occlusion
independently and each group and the occlusal loads Here, the shapes of the teeth are altered to have
individual tooth disperses are not individually
the occlusal load. managed. cusps suitable for the patient. The movement of
• Malocclusion can be non- • Malocclusions pose the condyle determines the direction of the ridges
problematic for a long time immediate drastic problems and grooves of the teeth and the mandibular
• Non-vertical forces are well • Non-vertical forces damage
tolerated the supporting tissues
movements determine other factors like cusp
• Incising does not affect the • Incising will lift the height, fossa, depth of the fissure, and concavity
posterior teeth. posterior part of the denture. of the lingual surfaces.
• The second molar is the • Heavy mastication over
favoured area for heavy the second molar can tilt or
In organic or organized occlusion, the aim is
mastication for better shift the denture base. to relate the occlusal surfaces of the teeth so that
leverage and power. the teeth are in harmony with the muscles and
• Bilateral balance is not • Bilateral balance is manda- joints during function. The muscles and joints
necessary and usually tory to produce stability of
considered a hindrance the denture. determine the mandibular position of occlusion
• Proprioceptive impulses give • There is no feedback and without any tooth guidance. In function, the teeth
feedback to avoid occlusal pre- the denture rests in centric are supposed to have a passive role and do not
maturities. This helps the pati- relation. Any prematurities
ent to have a habitual occlu- in this position can shift
influence or determine the path of mandibular
sion away from centric relation the base movement. (In normal occlusion, tooth factors
determine mandibular movements e.g. incisal
guidance).
GENERAL CONCEPTS OF COMPLETE
DENTURE OCCLUSION Neutrocentric Concept of Occlusion
Unlike natural teeth, the artificial teeth act as a According to this concept, the plane of occlusion
single unit. Hence, there should be a minimum should be flat and parallel to the residual alveolar
of three contact points (usually one anterior and ridge (Fig. 10.69). This concept is similar to the
two posterior) between the upper and lower teeth monoplane occlusion used to set non-anatomic
at any position of the mandible for even force teeth. The term neutrocentric denotes an occlusion
distribution and stabilization of the denture. that eliminates the anteroposterior and bucco-
Complete denture occlusion varies with the lingual inclines in order to direct the forces to the
182 type of teeth selected. In posterior teeth selection posterior teeth.
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Characteristic Requirements of
Balanced occlusion
A balanced occlusion should have the following
characteristics:
• All the teeth of the working side (central inci-
sor to second molar) should glide evenly
against the opposing teeth
Fig. 10.69b: Forces on a denture should be concentrated
• No single tooth should produce any inter-
over the first molar region
ference or disocclusion of the other teeth.
Balancing Units • There should be contacts in the balancing side,
• The second molars should be in contact during but they should not interfere with the smooth
protrusive action (Protrusive balance). gliding movements of the working side.
• They should have contact alongwith the • There should be simultaneous contact during
working side at the end of the chewing cycle. protrusion.
• Smooth gliding contacts should be available
for uninterfered lateral and protrusive Importance of Balanced Occlusion
movements. Balanced occlusion is one of the most important
factors that affect denture stability. Absence of
TYPES OF COMPLETE occlusal balance will result in leverage of the
DENTURE OCCLUSION
denture during mandibular movement.
Complete denture occlusion can be of three types Sheppard stated that, “Enter bolus, Exit balance”
namely: according to this statement, the balancing contact
• Balanced occlusion is absent when food enters the oral cavity. This
• Monoplane occlusion makes us think that balanced occlusion has no
• Lingualized occlusion function during mastication and so, it is not
Each type has its own indications and contra- essential in a complete denture. But this is not
indications, advantages and disadvantages. The true. Brewer reported the importance of balanced
most important type of occlusion employed in occlusion. He reported that on an average, a
184 complete dentures is the balanced occlusion. normal individual makes masticatory tooth
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Protrusive balanced occlusion This type of If this relationship is followed during teeth
balanced occlusion is present when mandible arrangement, then the denture will lose its
moves in a forward direction and the occlusal stability due to lever action (Fig. 10.73a). To
contacts are smooth and simultaneous anteriorly prevent this the teeth should be arranged such
and posteriorly. There should be at least three that there is simultaneous tooth contact in the
points of contact in the occlusal plane (Fig. 10.72). balancing and working sides (Figs 10.73b and c)
Two of these should be located posteriorly and (working side is the side to which the mandible
one should be located in the anterior region. This moves; here right. Balancing side is opposite to
is absent in natural dentition. the working side; here left).
Fig. 10.72: Posterior contact during protrusion Fig. 10.73a: Canine guided disocclusion. This
to maintain balance relationship is seen in natural dentition
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• The buccal cusp heights or inclination of the This adjustment provides space for free move-
10
teeth on the balancing side. ment of the anterior teeth. Without this adjust-
• The lingual cusp heights or inclination on the ment, there will be increased anterior interference
working side. leading to initial instability of the denture base
• The Bennett side shift on the working side. during protrusion. In the long run, this may lead
Steep cusps produce more displacement of the to resorption of the residual alveolar ridge in the
denture base than shallower or cuspless forms. anterior region (Fig. 10.74).
The forces of occlusion acting on a complete
denture should be balanced from right to left Concepts Proposed to Attain Balanced Occlusion
and anterior to posterior direction (Fig. 10.74a Many authors proposed different concepts for
and b). obtaining balanced occlusion. Most of them are
not in use now and carry only a historical signi-
ficance. Any way, we must know these concepts
to understand how the present concepts have
been derived from them.
Gysi’s concept He proposed the first concept
towards balanced occlusion in 1914. He suggested
arranging 33o anatomic teeth could be used under
various movements of the articulator to enhance
the stability of the denture.
French’s concept (1954) He proposed lowering
the lower occlusal plane to increase the stability
of the dentures along with balanced occlusion.
He arranged upper first premolars with 5o incli-
nation, upper second premolars with 10 o
inclination and upper molars with 15o inclination.
He used modified French teeth to obtain balanced
occlusion.
Sears’s concept He proposed balanced occlusion
for non-anatomical teeth using posterior
Figs 10.74a to f: (a) Shallow cusp teeth allow the opposing
balancing ramps or an occlusal plane which
members to slide through during mastication. (b) Teeth with curves anteroposteriorly and laterally (Fig. 10.75).
higher cuspal angle tend to lock the opposing teeth during
Pleasure’s concept Pleasure introduced a pleasure
movement (c,d) Dentures with steep incisal guidance tend
to get displaced during protrusion (e, f) Dentures with shallow curve or the posterior reverse lateral curve (see
incisal guidance produce lesser interference during
protrusion. However, the amount of anterior interference
depends on other factors like condylar guidance, etc.
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10 Textbook of Prosthodontics
compensating curves) to align and arrange the These nine factors are called the laws of balanced
posterior teeth in order to increase the stability articulation. Hanau later condensed these nine
of the denture. factors and formulated five factors, which are
commonly known as Hanau’s quint:
Frush’s concept He advised arranging teeth in a
• Condylar guidance
one-dimensional contact relationship, which
• Incisal guidance
should be reshaped during try-in to obtain
• Compensating curves
balanced occlusion.
• Relative cusp height
Hanau’s Quint (Fig. 10.76) Rudolph. L. Hanau • Plane of orientation of the occlusal plane.
proposed nine factors that govern the articulation These factors are described in detail later.
of artificial teeth. They are:
Trapozzano’s concept of occlusion He reviewed
• Horizontal condylar inclination
and simplified Hanau’s quint and proposed his
• Compensating curve
Triad of Occlusion. According to him, only three
• Protrusive incisal guidance
factors are necessary to produce balanced occlu-
• Plane of orientation
sion. He dismissed the need for determining the
• Buccolingual inclination of tooth axis
plane of occlusion to produce balanced occlusion.
• Sagittal condylar pathway
He said that the plane of occlusion could be
• Sagittal incisal guidance
shifted to favour weak ridges, hence, its location
• Tooth alignment
is not constant and is variable within the inter-
• Relative cusp height
arch distance.
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He also dismissed the need for setting compen- the teeth should be located in their original
10
sating curves, because, he suggested that when position. He believed it was necessary to fulfil
we arrange cusped teeth in principle these curves the anatomical and physiological needs.
are produced automatically. He considered that Boucher also emphasized the need for the
compensating curve as a passive factor, which is compensating curve. He stated that, “the value of
a resultant of setting cusped teeth. the compensating curve is that it permits alteration of
Though his triad was simpler than the Hanau’s cusp height without changing the form of the
quint, it eliminated the important compensating manufactured teeth… If the teeth themselves do not
curves and plane of orientation (Fig. 10.77). have any cusps, the equivalence of a cusp can be
produced by a compensating curve.”
Boucher’s concept Boucher confronted
Trapozzano’s concept and proposed the following Lott’s concept Lott clarified Hanau’s laws of
three factors for balanced occlusion. occlusion by relating them to the posterior sepa-
• Orientation of the occlusal plane, the incisal ration that is a resultant of the guiding factors.
guidance and the condylar guidance. • The greater the angle of the condylar path, the
• The angulation of the cusp is more important greater is the posterior separation during
than the height of the cusp. protrusion (Fig. 10.78).
• The compensating curve enables one to • The greater the angle of the overbite, the
increase the height of the cusp without greater is the separation in the anterior and
changing the form of the teeth. posterior regions irrespective of the angle of
He also stated that, “the plane of occlusion should the condylar path (Fig. 10.79).
be oriented exactly as it was when natural teeth were • The greater the separation of the posterior
present”. According to him, the plane of occlusion teeth the greater or higher must be the
cannot be changed to favour weak ridges and that compensating curve (Fig. 10.80).
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Condyle Incisal
path guidance
▼
POSTERIOR SEPARATION
(or un-balanced occlusion
▲
Figs 10.80a and b: The posterior tooth separation during
protrusion can be decreased by increasing the curvature of
the curve of Spee
▼
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Levin’s concept Bernard Levin believed that it was Factors Influencing Balanced Occlusion
10
not necessary to consider the plane of occlusion
Though many authors questioned the necessity
because it was not very useful practically. Levin
of all the five factors in a Hanau’s quint, it is still
also stated that the plane of occlusion can be
considered as the basic determinant of balanced
slightly altered by 1-2 mm in order to improve
occlusion. The five basic factors that determine
the stability of a denture.
the balance of an occlusion are:
He named the other four factors of occlusion
• Inclination of the condylar path or condylar
as the Quad (Fig. 10.84). The essentials of a quad
guidance.
are:
• Incisal guidance.
• The condylar guidance is fixed and is recorded
• Orientation of the plane of occlusion or
from the patient. The balancing condylar
occlusal plane.
guidance will include the Bennett movement
• Cuspal angulation.
of the working condyle. This may or may not
• Compensating curves.
affect the lateral balance.
There should be a balance within these five fac-
• The incisal guidance is usually obtained from
tors. The incisal and condylar guidances produce
patient’s aesthetic and phonetic requirements.
a similar effect on balanced occlusion (they
However, it can be modified for special
increase posterior tooth separation). Similarly, the
requirements. E.g. the incisal guidance is
other three factors have a common effect on
decreased for flat ridges.
balanced occlusion (they decrease the posterior
• The compensating curve is the most important
tooth separation). The effect of the incisal and
factor in obtaining occlusal balance. Mono-
condylar guidances should be counteracted by
plane or low cusp teeth must employ the use
the other three factors to obtain balanced
of compensating curve.
occlusion . If this counteractive mechanism is lost,
• Cusp teeth have the inclines necessary for
the balance of occlusion is lost (Fig. 10.85).
balanced occlusion but nearly always are used
Let us discuss in general how these factors
with a compensating curve.
affect the balance during protrusion. The incisal
Fig. 10.84: The Quad: The laws of protrusive and lateral balanced occlusion as developed by the author 191
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Fig. 10.85: Key (a) Incisal guidance, (b) Condylar guidance, (c) Cuspal angulation (d) Angle of plane of occlusion
(e) Compensating curve. A balance of these five factors is required for balanced occlusion
guide angle denotes the angle formed by the absent (Fig. 10.88). The condylar guidance has a
palatal surface of the upper anteriors against the similar effect on the denture.
horizontal plane. The incisal guidance can be
raised by altering the labial proclination, overjet
and overbite of the maxillary anteriors, so that
the incisal guide angle becomes steeper (Fig.
10.86).
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10 Textbook of Prosthodontics
the palatal surfaces of the upper incisors. This is Fig. 10.93: The plane of occlusion can be altered to a
known as the protrusive incisal path or incisal gui- maximum of 10°
dance. The angle formed by this protrusive path
to the horizontal plane is called as the protrusive teeth which are used to develop balanced occlusion” –
incisal path inclination or the incisal guide angle (Fig. GPT.
10.92). It is an important factor for establishing balan-
This influences the shape of the posterior teeth. ced occlusion. It is determined by the inclination
If the incisal guidance is steep, steep cusps or a of the posterior teeth and their vertical relation-
steep occlusal plane or a steep compensatory ship to the occlusal plane. The posterior teeth
curve is needed to produce balanced occlusion should be arranged such that their occlusal sur-
(explained previously). In a complete denture, the faces form a curve. This curve should be in
incisal guide angle should be as flat (more acute) harmony with the movements of the mandible
as possible. Hence, while arranging the anterior guided posteriorly by the condylar path.
teeth, for aesthetics, a suitable vertical overlap and A steep condylar path requires a steep compen-
a horizontal overlap should be chosen to achieve satory curve to produce balanced occlusion. If a
balanced occlusion. Also, the incisal guidance shallow compensating curve is given for the same
cannot be altered beyond limits. The location and situation, there will be loss of balancing molar
angulation of the incisors are governed by various contacts during protrusion (explained before).
factors like aesthetics, function and phonetics, There are two types of compensating curves
etc.The procedure for setting up the incisal namely:
guidance was described under articulation. • Anteroposterior curves
• Lateral curves
Plane of occlusion or occlusal plane It is defined Curve of Spee, Wilson’s curve and Monson’s
as, “An imaginary surface which is related curve are associated only with natural dentition.
anatomically to the cranium and which theoretically In complete dentures compensating curves
touches the incisal edges of the incisors and the tips of similar to these curves should be incorporated to
the occluding surfaces of the posterior teeth. It is not a produce balanced occlusion.
plane in the true sense of the word but represents the
mean curvature of the surface” – GPT. Anteroposterior Compensating Curves
It is established anteriorly by the height of the These are compensatory curves running in an
lower canine, which nearly coincides with the anteroposterior direction. They compensate for
commissure of the mouth and posteriorly by the the curve of Spee seen in natural dentition.
height of the retromolar pad. It is usually parallel
to the ala-tragus line or Camper’s line. It can be Compensating Curve for Curve of Spee
slightly altered and its role is not as important as
Curve of Spee is defined as, “Anatomic curvature
other factors. Tilting the plane of occlusion
of the occlusal alignment of teeth beginning at the tip
beyond 10o is not advisable (Fig. 10.93).
of the lower canine and following the buccal cusps of
Compensating curve It is defined as, “The antero- the natural premolars and molars, continuing to the
posterior and lateral curvatures in the alignment of anterior border of the ramus as described by Graf von
194 the occluding surfaces and incisal edges of artificial Spee”- GPT.
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10 Textbook of Prosthodontics
of the denture. It is explained in relation to occlusion, such that repositioning of teeth does
mandibular posterior teeth. The reverse curve not occur due to settling of the base.
was modified by Max. Pleasure to form the In order to prevent the locking of occlusion,
pleasure curve (Fig. 10.95c). the mesiodistal cusps are reduced during occlusal
reshaping. In the absence of mesiodistal cusps,
Pleasure Curve the buccolingual cusps are considered as a factor
“A curve of occlusion which in transverse cross-section for balanced occlusion.
conforms to a line which is convex upward except for In cases with a shallow overbite, the cuspal
the last molars”-GPT. angle should be reduced to balance the incisal
It was proposed by Max. Pleasure. He proposed guidance. This is done because the jaw separation
this curve to balance the occlusion and increase will be less in cases with decreased overbite.
the stability of the denture. Here the first molar Teeth with steep cusps will produce occlusal
is horizontal and the second premolar is buccally interference in these cases.
tilted. The second molar independently follows In cases with deep bite (steep incisal guidance),
the anteroposterior compensating curve and the jaw separation is more during protrusion.
lingually tilted (Fig. 10.95d). This curve runs from Teeth with high cuspal inclines are required in
the palatal cusp of the first premolar to the these cases to produce posterior contact during
distobuccal cusp of the second molar. The second protrusion (Figs 10.96b to 10.96d).
molar gives occlusal balance and the second Thus, we discussed the various concepts and
premolar gives lever balance. factors affecting balanced occlusion. The method
of occlusal reshaping is not discussed in detail
due to its complexity. It is necessary for a dentist
to at least know that occlusal reshaping is done
after teeth arrangement to produce balanced
occlusion.
Fig. 10.95c: Reverse lateral curve Monoplane or Non-Balanced Occlusion
It is an arrangement of teeth with form or pur-
pose. It includes the following concepts of occlu-
sion:
• Spherical theory
• Organic occlusion
• Occlusal balancing ramps for protrusive
balance
• Transographics
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Concepts of Non-balanced Occlusion ture occlusion. Metal insert teeth were also
10
proposed.
The concept of monoplane occlusion was a result
of Sheppard’s statement “Enter Bolus, Exit Occlusal pivot by Sear The pivots were used to
Balance”. This statement questioned the need for place the mandible in equilibrium by concen-
balanced occlusion (Refer importance of balanced trating the load in the molar regions. This scheme
occlusion). reduced the injury to the temporomandibular
Consecutively many clinicians came with joint and also reduced the stress in the anterior
different concepts of non-balanced occlusion for region (Fig. 10.98).
complete dentures.
Pound’s concept He proposed a monoplane occlu-
sion which stresses the importance of phonetic
and aesthetics for anterior teeth. The posterior
teeth on the other hand have a sharp upper
lingual cusp and a wide lower central fossa. The Fig. 10.98: Occlusal pivots by Sear
buccal cusps of the lower posterior teeth were
reduced to avoid non-vertical occlusal forces. Kurth’s concept He proposed a non-balanced
Effectively, it was a lingualized occlusion where occlusion set with flat posterior teeth in a hori-
in there is no buccal contact of upper and lower zontal plane without any balancing ramps. The
teeth and the occlusal surfaces are reduced such
teeth were set in a flat plane anteroposteriorly
that they lie in a triangle formed between the
with a reverse lateral curve (Fig. 10.99). This rev-
mesial end of the canine and the two sides of the
erse lateral curve is not a compensating curve.
retromolar pad (Fig. 10.97).
Philip M. Jones scheme of non-balanced occlusion
In this scheme, non-anatomical teeth were
arranged with the following modifications:
• A different articulator that could fit large casts
were used.
• The maxillary and mandibular teeth were
arranged without any vertical overlap. The
jaw relation determined the amount of
horizontal overlap.
• The maxillary posteriors were set first. The
occlusal plane should fulfil the following
requirements:
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Neutral Zone
10
• Teeth should be arranged in the neutral zone
where the forces of the buccal musculature are
compensated by the lingual musculature.
• If the teeth are arranged buccally, the bucci-
nator will destabilize the denture. Similarly, if
the teeth are arranged lingually, there will be
reduction of the tongue space and the tongue
will destabilize the denture.
Fig.10.119: Maxillary posterior teeth arranged according
to the aligned buccal ridge concept
Tooth to Ridge Relation
The following factors should be considered:
• The mandibular posterior teeth should be
arranged on the ridge for more stability.
• The mandibular anteriors should be inclined
such that the incisive forces are transferred to
the crest of the ridge.
• Generally all posterior teeth should have their
long axis co-inciding with the long axis of the
residual ridge.
Fig.10.120: (a) Overjet and (b) Overbite
Characterization of Dentures
Overbite denotes the vertical overlap of the
maxillary and mandibular anteriors. It is usually Artificial teeth have ideal morphology. This
0.5 mm in a normal individual. frequently imparts an artificial appearance to the
Increase in overjet or overbite can alter the denture, because, it is almost impossible for any
incisal guidance of the occlusion. one to have a perfect set of teeth in the perfect
arrangement especially in old age.
Compensating Curves (Fig. 10.121) Hence the dentist can add his personal touch
and produce small imperfections, which make the
(Refer factors affecting balanced occlusion). The
teeth look natural. These imperfections should
compensating curve for curve of Spee, Wilson’s not compromise the functions of the denture.
curve and the Monson’s curve are normally
Methods of characterization include mild
incorporated to obtain a balanced occlusion.
chipping, occlusal wear facets, small restorations
Arranging the teeth according to the previously on the teeth, staining to depict the endemic
mentioned setting principles will automatically
conditions, mild rotations and alteration in
incorporate the compensating curves.
anterior teeth arrangement.
Though these characterizations produce a
striking resemblance to natural teeth, patient
prefer to have white, unaltered artificial looking
teeth.
WAX UP
Waxing up is defined as, “The contouring of a
pattern in wax generally applied to shaping in wax of
Fig.10.121: Compensated curve of Spee the contours of a trial denture” – GPT. 203
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PROCEDURE
• A roll of base plate wax should be softened
under open flame (Fig. 10.122).
Fig.10.125
Fig.10.122
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Fig.10.127
Fig.10.129
Fig.10.128
205
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Try-In
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Try-In
The middle third should also be visible while to the alatragal line when the patient is in
11
smiling (high lip line). The thickness of the labial an upright sitting position.
and buccal flanges of the trial denture will
determine the labial and buccal fullness of the Occlusal Verification of Mandibular Trial Denture
face. • Intraoral
— Retromolar pad area: The height of mandi-
Evaluation of the Occlusal Plane
bular plane is usually placed at level of
Occlusal Verification of the maxillary Trial Denture the junction between anterior two-third
and posterior one-third of the retromolar
• Intraoral:
pad area (Fig. 11.3).
— Parotid papilla: The maxillary occlusal
plane should be 1/4th inch below the
parotid papilla (Fig. 11.1).
— Linea alba buccalis (Fig. 11.2).
Fig. 11.1: The level of the occlusal plane at the first molar
region should be one-fourth of an inch below the opening of Fig. 11.3: The mandibular occlusal plane when projected
the Stensen’s duct behind, should extend to the level of the junction between
posterior one-third and anterior two-third of the retromolar
pad
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Chapter 12
Lab Procedures Prior to Insertion
• Denture Processing
• Compression Moulding Technique
• Finishing and Polishing the Denture
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Prior to Insertion
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12 Textbook of Prosthodontics
If too little monomer is used (High polymer • The material does not stick to the walls of
monomer ratio). the mixing jar and is easily mouldable.
• Not all the polymer beads will be wetted Stage V: Rubbery stage After the dough stage,
by monomer and the cured acrylic will be the mixture enters a rubbery or elastic stage.
granular. Monomer is dissipated by evaporation and by
• Dough will be difficult to manage and it further penetration into remaining polymer
may not form a continuous plastic mass beads.
during processing. Clinically, the mass rebounds when compres-
Physical stages After mixing, the material goes sed or stretched. Because the mass no longer flows
through various physical stages, before polymeri- freely to assume the shape of its container, it can-
zation reaction. Plastic dough is formed by a not be moulded by conventional compression
partial solution of the polymer and the monomer. techniques.
Stage I: Wet sandy stage During this stage no Stage VI: Stiff stage On standing for an extended
interaction occurs on a molecular level. Polymer period, the mixture becomes stiff. This may be
beads remain unaltered and the consistency of attributed to the evaporation of free monomer.
the mixture may be described as ‘coarse’ or Clinically, the mixture appears very dry and is
‘grainy’. The polymer gradually settles into the resistant to mechanical deformation.
monomer forming a fluid, incoherent mass. Dough forming time The time required for the
Stage II: Early stringy stage The monomer resin mixture to reach a dough-like stage is
attacks the polymer by penetrating into the termed as ‘dough forming time’.
polymer. Some polymer chains are dispersed in Time required to reach the dough stage
the liquid monomer. This polymer chains uncoil depends upon the solubility of the polymer pearls
thereby the viscosity of the mix is increasing. The in the monomer. The solution rate may increase
mass is ‘stringy’ or ‘sticky’ when touched or with increase in temperature. The mixing jar may
pulled apart. be heated in warm water, but care must be taken
Stage III: Late stringy stage: The strings break to avoid water contact with the resin. Under no
off at this stage when touched or pulled apart and circumstances the jar should be heated above
the mass becomes dough-like. 55°C. Polymerization begins at a rapid rate above
Stage IV: Dough stage: The mass enters a dough- this temperature and the resin becomes too
like stage. On a molecular level an increased difficult to mould for dental procedures.
number of polymer chains enter the solution. Another factor, which affects the dough form-
Hence, a sea of monomer and dissolved polymer ing time, is the size of polymer particles. Decrease
is formed. A large quantity of undissolved in size of the particles, shorter the dough-forming
polymer also remains. period. According to ADA specification No: 12,
Clinically the mass behaves as a pliable dough. dough should be mouldable for at least 5 minutes.
The physical and chemical characteristics
exhibited during the latter phases of this stage Working time The working time is the time
are ideal for compression moulding. Hence, the elapsing between the stringy stage and the
material should be packed into the mould cavity beginning of rubbery stage. The working time is
during this stage. affected by temperature. Decrease in temperature
Characters exhibited by the mix during the dough increases the working time.
stage:
• The mix is smooth and dough-like. Packing
• The material has lost much of its tackiness Introduction of denture base resin into the mould
and can be separated without the formation cavity is termed packing. It is essential that the
214 of strings. mould cavity is completely filled at the time of
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12 Textbook of Prosthodontics
Deflasking
• Deflasking is done using a deflasker and a
pribar. Using hammer to deflask will ruin the
flask and can cause breakage of the denture.
• The lid of the flask should be removed by Fig. 12.12: Spliting the second and third pour investment
prying with wax knife.
• The flask is inverted and placed on the • The 2nd and 3rd pour investments are
deflasker and tightened with a thumbscrew separated with the help of a wax knife and a
(Fig. 12.10). plastic mallet. The middle pour will contain
the entire denture.
• Three incisions are made (one in the anterior
mid-point and two at the posterior corners)
by sawing with a fretsaw blade (Fig. 12.13).
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Fig. 12.14: Frenal relief Fig. 12.15: Polishing the denture flange
• Tissue surface nodules are removed with a • Pumice powder mixed with water is coated
hand piece or a lathe-mounted bur. over the rag wheel.
• The thickness of palatal surface is reduced • The finished denture should be polished by
using a large, egg-shaped bur. Reduction intermittently pressing against the rotating rag
should never be carried out on the tissue wheel. Care should be taken to avoid excessive
surface pressure on the denture to prevent warpage.
• A handpiece mounted rubber cup or a
Guide for trimming
medium bristle brush can be used to polish
• The denture should be held against the light the inaccessible areas.
and checked for translucency. Areas of opacity • After polishing, the denture should be
or darkness indicate excessive thickness of the thoroughly washed in soap water.
denture base. Uniform thickness of 2 to 2.5 mm • A toothbrush can be used to remove the
must be maintained. remaining plaster and pumice.
• Small irregularities should be removed using After finishing, the dentures are stored in water
a ‘paintbrush motion’ against a lathe mounted and stored till the day of the insertion appoint-
acrylic trimmer. ment.
217
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Chapter 13
Complete Denture Insertion
• Checking for Fit and Function
• Patient Instructions
• Tissue Conditioners
• Use of Denture Adhesives
• Sequelae of Wearing Complete Dentures
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Complete Denture Insertion
13
Complete
Denture Insertion
CHECKING FOR FIT AND FUNCTION palatal seal is reverified. Refer post-damming
(Chapter 7). Adaptation of the mandibular
During the insertion appointment, all the factors denture should be checked at the distolingual
verified during try-in are rechecked. The two extension.
major characteristics that determine the success
of a denture are its fit and function. Fit includes Checking for Border Extension
the proper adaptation, patient comfort, adequate
extension and aesthetics of the denture. Function • The cheeks are elevated and the denture
includes occlusal harmony, speech, accurate jaw borders are examined.
relation, retention and stability during masti- • The buccal and labial mucosa are stretched to
cation, etc. check for any denture displacement. If the
denture has overextended borders, it will get
CHECKING FOR THE FIT OF THE displaced while stretching the mucosa.
PROSTHESIS
Checking for Frenal Relief
Examining the Dentures Next frenum relief is examined. The labial frenum
• Before inserting the denture, the clinician is thin and hence requires a deep notch-like relief
should feel the borders of the denture to check at the middle of the labial flange. The buccal
for any sharp projections or rough ends. frenum is more compressible (less sensitive to
• The tissue surface of the denture is examined compression than labial frenum . This frenum tends to
for the presence of voids or nodules. bend and adapt to the denture) hence, it does not
require a critical relief. Secondly there are multiple
Examining the Patient’s Mouth frena on either side, hence providing a shallow
notch in this region will be sufficient. It should
• The oral mucosa is examined thoroughly to
be remembered that the buccal frena are attached
rule out over extension of the denture.
to active muscle fibers and if not relived, may tend
Checking for Adaptation to displace the denture during function.
The denture is placed in the patient’s mouth along
its path of insertion. First the adaptation of the Evaluating the Denture Aesthetics
denture is checked at the posterior palatal seal Patient’s lip support, cheek support, vertical
area using a mouth mirror. There should not be height, low lip line, high lip line, smile line, etc.
any space left between the posterior border of the are examined. These factors are usually examined
denture and the tissues. The patient is asked to thoroughly during try-in hence, a simple verifi-
say ‘ah’ in unexaggerated short bursts and the cation would be sufficient.
219
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CHECKING OF THE DENTURE FUNCTION • Bilabial sounds (b, p, and m) are controlled
by the lip support and become defective
Evaluating the Retention and due to the absence of lip support or
Stability of the Denture alteration in the vertical dimension at
occlusion.
After checking for adaptation, border extension
• Labiodental sounds (f and v) are governed by
and frenal relief, the retention and stability of the
the relation of the incisal edges of the upper
denture are evaluated. Retention can be evaluated anterior teeth to the lower lip. If the teeth
by checking for the peripheral seal of the denture.
are set too high then ‘f’ will sound like ‘v’
First, posterior seal is checked followed by ante-
(Fig. 13.1).
rior seal. Posterior seal is checked by gently
pressing the anterior teeth perpendicular to the
path of insertion. This procedure tends to lift the
posterior part of the denture. If there is adequate
seal, the dentist can feel the resistance offered by
the denture against this force.
Anterior seal is evaluated after posterior seal.
The denture is pulled against the path of Fig. 13.1b: If the teeth are
Fig. 13.1a: Normal lip
insertion. The resistance offered by the denture arranged high, ‘F ‘ will sound
support like ‘ V ‘
against this force gives the anterior seal. Actually
this procedure can be used to determine both
anterior and posterior peripheral seal. • Linguodental sounds (‘th’) are governed by
Stability of the denture is examined by the position of the tongue between the
checking for any kind of displacement during the upper and lower anteriors. Normally the
chewing cycle, speech, etc. tongue should project 3 mm anteriorly
between the teeth. If the tongue gets
Checking the Jaw Relation positioned about 6 mm in front of the teeth,
then, it means, the teeth have been set very
Vertical and horizontal jaw relations are examined lingually (Fig. 13.2).
thoroughly as done in try-in and patient’s
perception of comfort is also verified.
Speech
One of the most challenging functions that should
be reproduced in a denture is speech. Usually
denture wearers have a shallow pronunciation
because of the smooth palatal surface. In a natural Fig. 13.2a: Normal tongue Fig. 13.2b: Abnormal ton-
environment, the rugae enhance speech. In a position indicating normal gue position due to lingua-
denture, speech is affected due to the absence of teeth arrangement lised arrangement of teeth
rugae. • Linguoalveolar sounds (t, d, s, z, v, and l) are
Using metal denture base, improves speech made when the tongue touches the anterior
because the metal can be fabricated thin enough part of the palate. These are the most
to reproduce the rugae on the external surface. important of all sounds in a complete
Other factors that affect speech like injury to the denture because it is determined by the
external laryngeal nerve, presence of tongue-tie, thickness of the denture base. If the denture
etc. should also be ruled out. is very thick, the patient is forced to
Dentures play different roles in the production pronounce the sounds in a shallow blunt
220 of different sounds. manner (Fig. 13.2).
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• ‘S’ sound is controlled by the anterior part • Valar sounds (k, g and kg) are dependant on the
13
of the palatal plate of the denture base. It is posterior part of the palate and are not affected
considered separately because it is by the prosthesis (Fig. 13.5). The movements
produced in two tongue positions. Hence of the palate can be traced using a palatograph.
it is also called as the dental and alveolar
sound. A narrow groove formed by the
tongue in the midline against the palate,
results in a space. The size of this space
determines the quality of the sound (Fig.
13.3).
Occlusal Harmony
Before insertion, occlusal harmony is evaluated
in the lab by remounting in an articulator. All
major occlusal errors are usually corrected in the
Fig. 13.3
lab itself. Remaining errors are corrected chair
side by selective occlusal grinding. If the jaw relation
During the ‘s’ sound the following articulatory is accurate, errors in occlusion are very rare.
characteristics are noticed. The tip of the tongue
Usually occlusal disharmony is not corrected dur-
is near (not touching) the upper anteriors (Fig.
ing the insertion appointment. The patient is
13.4). The dorsum of the tongue is flat and a asked to wear the denture continuously for 24
groove is formed in the midline of the tongue.
hours and then the occlusal corrections are made.
The mandible moves forward and upward till the
Occlusal disharmony can be identified using an
teeth are almost in contact. interocclusal check record or an articulating
paper.
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Complete Denture Insertion
the mucosa does not have any rest to improve its Contd.
13
blood supply. This may lead to bone resorption • Inelasticity of cheeks e.g. • Slight reduction in the depth
and mucosal degeneration. Ageing, scleroderma, sub- and width of the borders
mucous fibrosis.
Nightwear may be allowed for the following conditions:
II. Air beneath the impression
• In patients with bruxism where damage to surface of the denture/lack of seal
the oral tissues is more if the prosthesis is 1. Poor fit to supporting tissues • Relining the dentures/
rebasing
not worn. • Deficient impression • Addition of tissue condi-
• In cases where the patient has a maxillary • Damaged cast tioners restores retentive
complete denture and mandibular partial • Warped denture forces
• Over-adjustment of
denture. If the patient insists on wearing impression surface
the upper denture for aesthetics, then the 2. Resorption of residual ridge • Relining of dentures
lower denture also must be worn along 3. Change of fluid content of
supporting tissues due to:
with the upper denture. • Lack of recovery of tissues • Reline/rebase the denture
from pressure of old dentures with minimum pressure
Periodic Recall (latter should not be worn technique. Ensure old den-
for atleast 72 hours prior tures are not worn for atleast
Regular recall is done to check for proper denture to impression making) 72 hours prior to making
impressions.
extension and occlusion. The patient is called 24 • Effect of medication: e.g.
hours after the insertion appointment to correct Diuretics.
occlusal disharmony and to check for immediate • Effect of change in posture
of patients with high volume
tissue reaction. of tissue fluid
Next, the patient is called after a week to check 4. Undercut residual ridges. • Add softened tracing com-
Eg. Bimaxillary tuberosities. pound and extended upto
for tissue reaction. His/her comfort is also the depth of the undercut
enquired and the problems are corrected. area and replaced with
Next, the patient is recalled every 3 to 6 months acrylic.
5. Excessive relief over areas of • Reline/rebase denture.
to determine tissue reaction and the amount of reduced tissue displaceability. Outline the area on cast to be
residual alveolar ridge resorption. Postinsertion relieved and indicate the
instructions should be reinforced during recall technician the amount of
relief required.
visits. III. Xerostomia:
The patient is advised to report immediately Reduced ability to form seal • Supplement with artificial
along borders and the polished saliva.
whenever there is any problem. In case of tissue surfaces of denture. • Modify dentures to maxi-
reactions like ulcers, soreness, etc. the patient is mize retentive forces and
advised to stop wearing the prosthesis and report minimize displacing forces.
IV. Neuromuscular control:
to the dentist as soon as possible. Yearly recall • Forces generated during • Temporary use of denture
visits to check the necessity for relining/rebasing. mastication are sufficient to adhesive may help patient
destabilize dentures. to learn necessary skills.
Post-insertion management of a denture. Decreased stability
Common problem associated with denture wear I. Denture borders:
Causes Correction (Overextension in depth • Use pressure indicating
and width) paste and correct the
Decreased retention
borders. (Fig. 13.11)
I. Lack of seal: II. Poor fit to supporting tissues:
• Border under extension in • Addition of tracing com- (Recoil of displaced tissues • Reline/rebase using mini-
depth and width (Fig. 13.9) pound to the required lifts dentures.) mal pressure technique
• Under extension of posterior extension and processing III. Denture not in optimal space:
border. it with acrylic resin (Denture borders are not in • Reshape overextended
(Fig. 13.10) neutral zone.) regions so that it does not
• Residual ridge resorption • Relining of denture interfere with muscular
movement
Contd. Contd.
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13 Textbook of Prosthodontics
Contd.
TISSUE CONDITIONERS
IV. Occlusion:
(Uneven initial contact can Adjust occlusion by selective Kydd and Mandley (1967) stated that tissue-
cause displacement) grinding either in the mouth or lining materials permit wider dispersion of forces
in the articulator after remount
procedure and hence, aid to decrease the force per unit area
Problems in support transmitted to the supporting tissues. Such soft
(Basically associated with the contour of the ridges) liners could serve as an analog of the mucoperio-
I. Lack of ridge support:
steum with its relatively low elastic modulus.
(Progressive Residual Ridge • Optimal border extension
Resorption.) in the depth and width. Currently for practical purposes, denture base
• Extend the lingual flange materials are made of rigid materials. The dentist
II. Fibrous displaceable ridge: must recognize that the prolonged contact of
(During mastication, the • Rebase/reline.
denture tends to sink-in) • Optimize occlusal balance
these bases with the underlying tissues is bound
III. Bony prominence covered to elicit changes in the tissues. Mucosal health
with thin mucosa usually seen in: may be promoted by hygienic and therapeutic
• Prominent maxillary midline • Relieve the denture in these measures and tissue-conditioning techniques
suture areas
• Tori may be applied when appropriate.
• Posterior nasal spine
IV. Non-resilient soft tissue: Composition
(Usually do not adapt to tissue • Rebase/reline
surface of dentures). • Optimal border extension Tissue conditioners are composed of polyethyl-
can be produced using low
viscosity impression
methacrylate and a mixture of aromatic ester and
material. ethyl alcohol. Tissue conditioners are available as
three component systems.
• Polymer (Powder)
• Monomer (Liquid)
• Liquid plasticizer (Flow control)
A gel is formed when these materials are
mixed, with the ethyl alcohol having a greater
affinity for the polymer.
Fig. 13.9: Border extension Uses of Tissue Conditioners
The major uses of these tissue conditioning mate-
rials include:
• Tissue treatment
• Temporary obturator
• Baseplate stabilization
• To diagnose the outcome of resilient liners
Fig. 13.10: Restoring improper border extension • Liners in surgical splints
• Trial denture base
• Functional impression material.
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Fig. 13.13: Tissue conditioner used to fill undercuts while Mixing and placement of the tissue conditioner
fabricating a temporary denture base Tissue conditioners are available as three
component systems.
Adjunct to an Impression or • Polymer (Powder)
as a Final Impression Material • Monomer (Liquid)
These materials are used when it is difficult to • Liquid plasticizer (Flow control).
determine the extent of the denture base due to The mixing ratio can be changed according to
the presence of movable oral structures. These the consistency required. A ratio of 1.25 parts of
materials record the extensions of the denture in polymer, 1 part monomer and 0.5cc plasticizer is
a dynamic form that will later help in preparing usually recommended. The plasticizer should be
an impression tray for the final impression. added to the monomer. The ingredients are mixed 225
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13 Textbook of Prosthodontics
to form a gel, which is applied in sufficient thick- According to the ADA, a denture adhesive
ness to the tissue surface of the denture. The should have the following characters:
denture is inserted and border movements are • Product composition should be supplied.
carried out to mould the setting material. This • Should not affect the integrity of the
method is similar to functional relining explained denture.
in Chapter 14. • Biologically acceptable.
• Effective function as adherent.
Care and Maintenance
Tissue conditioners should not be cleaned by Composition
scrubbing with a hard brush in order to prevent All denture adhesives have seven basic ingre-
tearing of the material. The use of soft brush dients, which are listed below. Commercially
under running water is recommended. available products are different recipes of these
The greatest virtue of tissue conditioners is ingredients.
their versatility and ease of use. Their biggest flaw
is that they are so easily misused. Their longevity Basic Ingredients
against wear is very limited and they tend to They swell and become viscous. E.g. Carbonyl
harden and roughen within 4 to 8 weeks due to methyl cellulose (CMC), Vegetable gums e.g.
the loss of plasticizer. Hence, they require close Karaya (food additive) Tragacanth, Xantham
observation. acacia, Vinyl methyl ether/maleic anhydride
compounds (PVM/MA salts), Polyethylene oxide
USE OF DENTURE ADHESIVES polymers, Cationic polyacryl amide polymers
and Polyvinyl pyrrolidone (povidone). Long
Dental professionals have been slow to accept acting (slow releasing) less soluble gantrez salts
denture adhesives as a means to enhance denture (Ca-2n Gantrez) which display molecular cross
retention, stability and function. Despite consider- linking can also be used.
able documentation advocating patient’s use of
adhesives, many view adhesive usage as a poor Colouring Agents
reflection of a clinician’s skills and prosthetic E.g. Red dye.
expertise.
Denture adhesives were first used in the late Flavoring Agents
18th century. Till the early 19th century denture Menthol, peppermint, etc.
adhesives were used only for the following
situation: Wetting Agents
• To hold base plates while recording jaw
Preservatives
relations.
• In immediate denture construction until a Sodium borate, methyl paraffin, polyparaffin.
well-fitting denture is fabricated.
• When the dentist is incompetent or incapable Plasticizers
of making a tight-fitting denture. They are added to improve the handling pro-
However, presently statistical data shows an perties of the material. E.g. polyethylene, mineral
increase in the use of denture adhesives. It helps oil or petrolatum.
in initial retention of the denture increasing the
psychological comfort of the patient. Dispersion Agents
Available Forms They are used to prevent powders from clumping.
• Magnesium oxide
226 It is available as soluble and insoluble powders, • Sodium phosphate
gels, pastes, or soluble and insoluble wafers.
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Powder Form
• The prosthesis should be moistened.
• Even coating of the adhesive is sprayed on the
tissue surface of the denture (Fig. 13.15).
• Excess material wiped away.
• If patient has inadequate saliva, the denture
must be moistened before insertion. Fig. 13.17: Placement of cream denture adhesive in the
form of drops
Cream Form Instructions
It can be applied using two approaches. • The patient should be advised to clean the
residual adhesive on the surface of the denture
Ist Approach
everyday.
Thin beads or drops of adhesive are placed along • As usual the dentures should be soaked in
228 the depth of the dry denture in the incisor and water or medicinal solution overnight. If the
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denture is soaked overnight, the adhesive diseases of the overdenture abutments, peri-
13
absorbs more water and becomes more mplantitis (inflammation of the peri-implantal
soluble. It can be easily rinsed away the next membrane), chemical degradation or corrosion
morning. of prosthesis. All these disorders produced/
• Rinsing the denture in hot water and accelerated in the oral tissues due to the presence
scrubbing with a brush is sufficient to remove of a denture are grouped as sequelae of wearing
the adhesive on the denture. complete dentures.
• Adhesive can be removed from the alveolar Sequelae of complete denture wear can be
ridge by washing with warm or hot water and divided into direct and indirect types depending
then firmly wiping with a piece of gauze or a on the effect of the prosthesis on the tissues.
wash cloth soaked in hot water.
• Annual recall should be conducted to evaluate DIRECT SEQUELAE OF WEARING
the condition of the oral mucosa. COMPLETE DENTURES
Denture adhesives can improve patient accep-
tance, comfort and function. They are an integral Denture Stomatitis
part of professional service and their adjunctive It is the pathological reaction of the palatal portion
benefits must be recognized. of the denture-bearing mucosa. It is commonly
known as ‘Denture induced stomatitis’, ‘Denture sore
SEQUELAE OF WEARING mouth’, ‘Denture stomatitis’, ‘Inflammatory papillary
COMPLETE DENTURES hyperplasia’ (or) ‘Chronic atrophic candidiasis’.
The use of complete dentures is not free of trouble. It is seen in 50% of the complete denture
The dentures can produce severe side effects, wearers. According to Newton, denture stomatitis
which if left unchecked will produce: can be classified as:
• Destabilization of occlusion. • Type I: Localized simple infection with
• Loss of retention. pinpoint hyperemia (Fig. 13.18).
• Decreased masticatory efficiency.
• Poor aesthetics.
• Increased ridge resorption.
• Tissue injury.
These problems will progress till the stage
where the patient will be considered ‘prosthetically
maladaptive’ and cannot wear dentures any more.
The interaction of prosthesis and oral environ- Fig. 13.18
ment has several aspects. The surface properties
of the prosthesis may affect plaque formation. • Type II: (Erythematous type) Generalized
Surface irregularities and microporosities can simple type presenting a more diffuse ery-
enhance microbial colonization. Plaque formation thema involving a part or the entire denture
is also influenced by: covered mucosa (Fig. 13.19).
• Design of prosthesis. • Type III: Granular type involving the central
• Health of adjacent mucosa. part of the hard palate and alveolar ridge.
• Composition of saliva. Often seen in association with type I and II
• Salivary secretion rate. (Fig. 13.20).
• Oral hygiene. Type I is usually trauma induced, type II and
• Denture wearing habits. III are associated microbial plaque accumulation.
Thus, a prosthesis may promote infection of Candida associated denture stomatitis is often
the underlying mucosa, caries and periodontal seen along with angular cheilitis (or) glossitis.
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13 Textbook of Prosthodontics
Systemic factors
• Old age
• Diabetes mellitus
• Nutritional deficiency: Iron, folate, Vit.B12, etc.
• Malignancy: Acute leukemia, agranulocytosis
Fig. 13.19 etc.
• Immune defects: Due to the use of
corticosteroids and other immune
suppressants.
Local factors
• Dentures:
— Environmental changes due to dentures.
— Trauma.
— Denture usage, nightwear.
— Denture cleanliness.
Fig. 13.20 • Xerostomia:
— Sjögren’s syndrome
Diagnosis — Irradiation
The presence of Candida associated denture — Drug therapy
stomatitis (CADS) is confirmed by the presence • High carbohydrate diet: Increases plaque
of mycelia or the pseudohyphae in a direct smear. accumulation.
It can also be diagnosed by the isolation of more • Use of broad-spectrum antibiotics: They
than 50 candidial colonies from the lesions. The destroy normal symbiotic colonies leading to
candida usually resides on the fitting surface of the formation of pathological colonies.
the denture. • Smoking tobacco: Affects oral hygiene and
also produces other effects.
Etiology
Management and Preventive Measures
One of the direct factors that produce denture
stomatitis is the presence of the denture in the Supportive measures
oral cavity. It is usually seen in patients who wear • Institution of efficient oral and denture
their dentures both day and night. Trauma from hygiene habits. Correction of denture wearing
the denture in addition to plaque accumulation habits. The patient is advised to store the
can stimulate the turnover of palatal epithelial dentures in 0.2 to 2% chlorhexidine during the
cells there by reducing the degree of keratini- night.
zation and barrier function. • The patient should be instructed to remove the
‘CADS’ is also correlated with angular chei- denture after meals and scrub before
litis. The infection may start beneath the maxillary reinserting it. The mucosa in contact with the
denture should be hygienically maintained
denture and later spread to the angle of the
and massaged with a soft toothbrush.
mouth. The clinical manifestations of the disease
• Patient is advised not to use the dentures at
gives an idea about the overall health of the
night or leave it exposed to air. Rough areas
patient.
in the tissue surface of the denture should be
smoothened or relined using a soft tissue
Predisposing Factors
conditioner.
These factors do not directly produce denture • Polishing of the external surface of the
stomatitis but they favour the progress or dentures should be done routinely in order to
230 initiation of the lesion. facilitate denture cleansing.
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Epidemiology Treatment
It is common in post-menopausal women above Generally BMS patients are more psychologically
50 years of age. The general complaint includes affected. They consider that their psychiatric
burning sensation of the supporting structures of disorders are due to poor dentures. These patients
the denture and the tongue. The syndrome is may need counselling to understand the irrele-
aggravated by fatigue, tension, and intake of hot vance of the dentures with regard to their mental
foods. The intensity of pain and burning sen- health and also to eliminate their fears. The
sation is reduced during eating, sleeping, mental patient’s symptoms are given first priority.
distraction, etc.
Clinical Features Gagging
• This condition does not have any overt clinical • The gag reflex is a normal, healthy defense
signs or symptoms. mechanism, which functions to prevent
• Pain starts in the morning and aggravates foreign bodies from entering the trachea.
during the day. • It can be triggered by tactile stimulation of the
• Burning sensation is usually accompanied soft palate, posterior part of tongue and fauces.
with dry mouth and persistant altered taste • Other stimuli like sight, smell, taste, noise, and
sensation. psychological factors can produce gagging.
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These stimuli may occur alone or in a combi- is more common in women due to osteoporotic
13
nation. changes in the bone.
• In sensitive patients, new dentures may sti- RRR is nothing but alveolar remodeling,
mulate gagging but this will disappear as the which occurs due to change in the functional sti-
patient adapts to the dentures. mulus of bone tissue. Ridge resorption is a chronic
• Persistent gagging can occur due to over- progressive change in the bone structure, which
extended denture borders especially in the results in severe impairment in the fit and func-
posterior part of maxillary denture and the tion of the prosthesis. Alveolar remodeling is
distolingual part of mandibular denture (Fig. more important in areas with thick cortical bone
13.22). Gagging usually produces displace- especially the buccal parts of the maxilla and
ment of the denture. lingual parts of the mandible which are load-
bearing regions.
Etiopathogenesis
The pathogenesis of residual ridge resorption is
very simple. Wherever there is pressure, bone
resorbs due to activation of osteoclasts. We have
learned that resorption due to pressure is minimal
Fig. 13.22a: Palatal overextension of a maxillary denture at the stress-bearing areas of the jaws. Hence,
excessive pressure applied to the non-stress bear-
ing areas can produce RRR.
Continuous pressure is required for activation
of osteoclasts, hence, RRR is common in patients
who wear their dentures continuously overnight.
Pattern of Resorption
Fig. 13.22b: Distolingual overextension of
a mandibular denture • Resorption occurs more rapidly in the first six
months after extraction of teeth and at a slower
• Commonly, gagging may occur due to pace till 12 months.
unstable occlusal conditions. E.g. increase in • The rate of resorption progresses after 65 years
vertical dimension of occlusion is predisposed of age.
to gagging because the unbalanced occlusal • In general, residual ridge resorb more rapidly
contacts may displace the denture and trigger in females than males.
gagging. • It can be precipitated by certain systemic
• Gagging can also result from other systemic diseases or ill-fitting dentures.
conditions like GIT disorders, adenoids or All denture patients should be examined
tumors in the upper respiratory tract, alcoho- periodically on an annual basis. Rate of osseous
lism and severe smoking. changes can be retarded when complete dentures
• Limiting the posterior extension of the den- are readapted during the first signs and symp-
tures and exercises help to decrease gagging. toms of loss of adaptation. When such changes
are observed, the dentist may choose to reline or
Residual Ridge Resorption (RRR) rebase the dentures.
This is the most common and important sequel
of wearing complete dentures. There is conti- Rate of RRR
nuous loss of bone after tooth extraction and even During the first year after extraction, the amount 233
after the placement of a complete denture. RRR of RRR is about 2-3 mm in the maxilla and 4-5 mm
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Relining and Rebasing in Complete Dentures
The occlusion in the mouth cannot, therefore, • When the adaptation of the denture to the
14
be used as a guide to the horizontal repositioning ridge is poor due to residual ridge resorption
of either dentures. A new vertical dimension • Economical reasons where the patient cannot
should be measured with a correct inter-occlusal afford a new denture.
distance. The relation of the teeth to the ridges • Geriatric or chronically ill patients who cannot
must be observed for accuracy. If shrinkage has withstand physical and mental stress of
been only in the vertical direction (allowing the construction of new dentures
jaws to approach each other more closely than they
Contraindications for Relining and Rebasing
should when occlusal contacts are made), the
occlusion cannot be corrected, even though there • When the residual ridge has resorbed
has been no anterior or posterior movement of excessively.
the dentures. • Abused soft tissues due to an ill-fitting
denture.
Changes in the Maxilla • Temporo-mandibular joint problems.
• Patient dissatisfied with the appearance of the
Resorption of the bone of the maxillae usually
existing dentures.
permits the upper denture to move up and back
• Unsatisfactory jaw relationships in the
in relation to its original position. However, the denture.
occlusion also may force the maxillary denture • Dentures causing major speech problems.
forward. The lower denture usually moves down • Severe osseous undercuts.
and forward, but it may move down and
backward relative to the mandible as resorption Advantages
occurs (Refer Chapter 13).
• Eliminates frequency of patient visits.
• Economical for the patient.
Changes in the Mandible
• Improves fit of the denture.
Concurrently, the mandible moves to a higher • A soft liner can be incorporated in this denture,
position when the teeth are in occlusion than the if necessary.
position it occupied before resorption. This leads
to a decrease in the inter-arch space. This move- Disadvantages
ment is rotatory around a line approximately • Likelihood of altering the jaw relationship
through the condyles. (Refer Chapter 13). during the process.
• Cannot correct aesthetics, or jaw relations.
RELINING • Cannot correct occlusal arrangement.
• Cannot be used when excessive resorption has
Definitions occurred. Hence it cannot be a substitute for a
Relining is defined as, “A procedure to resurface the new denture.
tissue surface of the denture with new base material to Treatment Rationale:
make the denture fit more accurately” - GPT. When should one Reline or Rebase
“It refers to the process of adding base material to the
tissue surface of the denture in a quantity sufficient to The magnitude of the soft and hard tissue changes
fill the space, which exists between the original denture observed during the recall is what determines the
contour and the altered tissue contour.” (Sharry) treatment plan. If a new thin layer of resin is
added to the denture base, the resurfacing proce-
dure is termed Relining. If more material is added,
Indications for Relining
extensive refitting is necessary, it is called
• Immediate dentures after 3-6 months where Rebasing.
maximum residual ridge resorption would Relining or rebasing should be carried out
based on a careful diagnosis and treatment plan.
239
have occurred.
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Relining and Rebasing in Complete Dentures
• Dentures should not be worn during sleep. using the denture as the special tray. After the
14
• Dentures should not be worn for at least 2 to 3 maxillary and mandibular impressions are made
days prior to final impression appointment. a new centric relation record is accomplished. All
these procedures are done in one appointment.
Preparation of the Dentures for Impression Exactly 15 seconds after the denture has been
• Pressure areas on the tissue surface of the placed in the mouth, the patient is asked to pull
denture should be relieved. the upper lip down and to open his mouth wide
• Minor occlusal disharmony should be these actions mould the impression material over
corrected by selective grinding. the border of the denture. The lower impression
• Border inadequacies should be corrected. is made after making the upper impression.
• Borders should be shortened by 1 mm, to allow
Advantages
space for new impression material.
• Posterior palatal seal area should be • Selective trimming helps to make a selective
established using greenstick compound or pressure impression.
autopolymerizing resin. • Making a separate inter-occlusal record will
• All large undercuts should be removed. allow the operator to concentrate on recording
the jaw relation.
Relining Procedures • It is possible to verify the centric relation
record if necessary.
• Clinical procedures:
• The inter-occlusal record is reliable.
• Static methods:
• Open-mouth technique.
Disadvantages
• Closed-mouth technique.
• Functional methods • Difficult procedure.
• Chair-side technique • It requires more clinical and laboratory time.
• Laboratory procedures: Laboratory procedures are carried out as
• Articulator method explained in the later part of the chapter.
• Jig method
• Flask method Closed-mouth Technique
Maxillary and mandibular relining/rebasing
Clinical Procedures
should be done separately. Various techniques
Clinical procedures for relining and rebasing are have been explained.
similar. Only the laboratory procedures vary. • Technique A
• Technique B
Static Methods • Technique C
Open-mouth technique Carl.O.Boucher • Technique D
Boucher’s technique is the only one described in Technique A requires recording a new centric
the literature that explains a method for relining relation record using modeling wax or com-
the mandibular and maxillary denture at the same pound. Techniques B, C and D, use the existing
time. It has been emphasised that in this techni- centric relation record in the existing denture.
que the impressions are made independently Technique A It is a two step technique wherein
without utilising the existing centric occlusion. the centric relation is recorded using an inter-
Actually, the dentures are used as special trays occlusal record and is used to guide the dentures
for making the secondary impression. ZnOE is in to position while making the reline impression.
the material of choice. It is loaded on the tissue Centric relation (inter-occlusal record) is recorded
surface of the denture and the impression is made using wax or compound. 1.5 to 2 mm relief should 241
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Advantages
It will reduce the possibility of extreme forward
movement of the maxillary denture.
Disadvantages
Fig. 14.2: Palatal relief for visibility
Wax impression materials are difficult to work
Advantages with and can distort easily. If the existing centric
relation record is wrong then the impression
• Palatal opening will allow better seating of the
becomes inaccurate.
denture and alleviate the increase in vertical
dimension. Technique C Centric relation record is obtained
• Pre-made inter-occlusal record helps to posi- as in Technique B. The denture is prepared as in
tion the denture during impression making. Technique A. Also, labial and palatal flanges are
• It also helps in orienting dentures in an perforated to decrease the pressure inside den-
articulator. tures during impression making (Fig. 14.4).
• It is a two-step procedure and it reduces the Border moulding is the same as in technique A.
possibility of moving the maxillary denture Advantages and disadvantages are same as in
forward during final impression making. techniques A and B because this technique is a
242 Hence, its more reliable combination of both A and B.
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Disadvantages
• Material produces a chemical burn in oral
mucosa.
• Material is porous and develops a bad odour.
244 Fig. 14.9a: Making the tissue conditioner impression • Poor colour stability.
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• Material is not easy to remove if not placed be trimmed to just leave 2 mm of acrylic around
14
correctly. the existing teeth (Fig. 14.11). After trimming, the
Recently, visible light cure (VLC) resin has dentures are placed in the articulator and waxed
been developed which is similar to tissue condi- up without altering the vertical height.
tioners. This material can be regulated by selec-
tion of appropriate viscosity and partial intraoral
polymerization with a hand-held curing light. It
is then taken to the laboratory for curing the
unpolymerized molecules. This material seems
to hold considerable promise.
Fig. 14.11: After mounting, the denture base is trimmed to
Laboratory Procedures upto 2 mm near cervical margins of the artificial teeth
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Causes
• Failure to remove denture undercuts before
impression making.
• Denture teeth not seated properly into the
indentations.
• Wax shrinkage withdrew teeth from inden-
tations, resulting in lack of occlusal contact.
Fig. 14.14: Mounting a denture ( with impression) in a jig
• Occlusion not properly maintained while
against a plaster template making the rebase impression.
• Flask halves have a poor fit.
• When the key has set, the top and the bottom • Posterior palatal seal not placed in cast.
members of the jig are separated. Denture is • Initial impression not adequate.
removed from the cast.
Solution
• All of the impression material is removed from
the denture and the denture is prepared • Remove undercuts using bur prior to making
(trimmed) according to the treatment selected the rebase impression.
(relining or rebasing). • Seat the denture firmly.
• If rebasing is selected, the entire denture base • Add chips of cooled wax to the space between
is removed from the teeth (if they are tooth ridge laps and cast, in order to minimize
porcelain), and all but a small connecting wax shrinkage.
bridge of acrylic is removed (if the teeth are • Make rebase impression at proper occlusal
246 plastic or acrylic). relationship.
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Relining and Rebasing in Complete Dentures
Flask Method
• The poured impression alongwith denture is
invested into the base of a flask (Fig. 14.15). Fig. 14.17: Investing the counter of the flask
Fig. 14.15: Investing the denture (with impression) and Fig. 14.18a: After trimming the denture it is placed back
into the silicone mould
cast on the base of a flask
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Chapter 15
Special Complete Dentures
• Introduction
• Conventional Complete Dentures with
Mechanical Retentive Components
• Single Complete Dentures
• Immediate Denture
• Tooth-Supported Overdentures
• Implant-Supported Overdentures
• Obturators
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Special
Complete Dentures
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have the tendency to confine their masticatory discrepancies (e.g. High points) are recorded.
15
load to areas where natural teeth are present. This These discrepancies are reduced in the diagnostic
produces an unfavourable force distribution, cast. The reduced cast is used as a guide to reduce
which can lead to adverse soft tissue reactions the natural teeth.
like hyperplasia, ridge resorption, etc.
Bruce Technique
Indications
The occlusal discrepancies are arbitrarily reduced
• In patients with discrepancies in jaw size who in the diagnostic cast. An acrylic resin template
require a complete denture, it is advisable to is made over the reduced cast (Fig. 15.2). The
retain teeth on the retrognathic mandible.
• In patients with inoperable cleft or perforated
palates, it is advisable to retain teeth in the
maxillary arch. This is because the conven-
tional maxillary complete denture would be a
failure in this case due to the absence of
a
peripheral seal.
Disadvantages
• Malposed, tipped or supra-erupted teeth in the
lower arch will interfere with balanced occlu-
b
sion. This imbalance may produce soreness,
mucosal changes and ridge resorption in the
maxilla and the maxillary denture will tend
to get displaced.
• As the lower anteriors are present in a fixed
position, it is difficult to obtain an aesthetic c
teeth arrangement.
• Use of acrylic teeth opposing natural teeth will
produce abrasion of the acrylic teeth whereas
use of porcelain teeth opposing natural teeth
will produce abrasion of the natural teeth.
Occlusal Modification d
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15 Textbook of Prosthodontics
natural teeth are reduced till the acrylic template be considered during the construction of these
seats properly against them. dentures are:
• The morphology of the natural teeth will
Boucher et al Technique determine the selection of the artifical teeth.
The casts are articulated using a tentative jaw E.g. the size and shade of the artificial teeth
relation. Artificial porcelain teeth are set on the should match the natural teeth.
edentulous cast and this arrangement is made to • If the mandibular teeth are attrited, 0 o or
move against the teeth of the opposing cast (made cuspless teeth are preferred.
of dental stone). (Fig. 15.3). As the porcelain is • If the mandibular teeth are not attrited,
hard, it will abrade the occlusal discrepancies. The anatomic teeth are preferred.
denture is processed and finished. During
insertion, the abraded opposing cast is used as a Maxillary Complete Denture Opposing
guide to reduce the occlusal discrepancies of the A Mandibular Partial Denture
natural teeth in the patient’s mouth. These dentures are clinically very significant due
to their complications. Teeth selection is very
important in the fabrication of the denture.
Artificial teeth for these dentures should be
selected based on the following factors:
• If the opposing partial denture has porcelain
teeth, porcelain teeth are preferred.
• If the opposing natural teeth have gold or
metal crowns then acrylic teeth are preferred.
• Acrylic teeth are preferred in dentures
opposing normal natural teeth or a partial
Figs 15.3a and b: Boucher’s technique of reducing denture with artificial acrylic teeth.
occlusal discrepancies
Complications
Single complete dentures can be of the
• Combination syndrome.
following types:
• Wear of the natural teeth.
• Maxillary complete denture opposing a
• Fracture of the denture.
complete mandibular natural dentition.
• Maxillary complete denture opposing a
Combination Syndrome
mandibular partial denture.
• Mandibular complete denture opposing a It was identified by Kelly in 1972 in patients
maxillary natural dentition. wearing a maxillary complete denture opposing
• Mandibular complete denture opposing a a mandibular distal extension prosthesis. This
maxillary partial denture. complication is not seen in cases of complete
dentures opposing natural mandibular posterior
Maxillary Complete Denture Opposing a teeth (Fig. 15.4).
Complete Mandibular Natural Dentition Pathogenesis
These dentures are maxillary complete dentures Combination syndrome progresses in a sequen-
opposing a complete set of mandibular natural tial manner. The group of complications which
teeth. Gross occlusal discrepancies are very represent as a syndrome are interlinked to one
common and require occlusal adjustment and another. The progress of the disease can occur in
orthodontic correction. Some important points to any one of the following sequences.
252
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• The shift of the occlusal plane posteriorly • The supra-erupted anteriors increase the
downwards produces resorption in the mandi- amount of force acting on the anterior part of
bular distal extension denture bearing area. the complete denture and the vicious cycle
• Due to the tilt of the occlusal plane, the mandi- continues.
ble shifts anteriorly during occlusion.
Sequence 2 (Fig. 15.6) (Craddock)
• The vertical dimension at occlusion is decrea-
• There is gradual resorption of the distal exten-
sed. The retention and stability of the denture
sion residual ridge in the mandible.
is also decreased.
• This leads to tilting of the occlusal plane poste-
• The tilt in the occlusal plane disoccludes the
riorly downwards and anteriorly upwards.
lower anteriors causing them to supra-erupt.
• Rest of the vicious cycle continues as in
This reduces the periodontal support of the
sequence 1.
anterior teeth.
Figs 15.6a to e: Sequence 2 of combination syndrome (a) Ridge resorption in the mandibular edentulous area (b)
Downward movement of the posterior part of maxillary denture and the formation of flabby tissue (c) Supra-eruption of
lower anteriors (d) Increased load in the anterior maxillary region of the complete denture (e) Resorption in the anterior
254 portion of maxillary ridge and the formation of flabby tissue
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Combination syndrome should be identified can be best treated with endosseous implants
15
at an early stage and prevented. Planning over- after thorough evaluation of the patient. Some
dentures and designing implant-supported den- cases may be treated along with a resilient liner
tures are some methods to prevent combination to reduce the load on the ridge. Anyhow some
syndrome. authors firmly believe that a mandibular single
denture have a very poor prognosis.
Wear of Natural Teeth
When porcelain teeth are used, severe abrasion IMMEDIATE DENTURE
of the opposing natural teeth will occur. Hence, a
Immediate denture is defined as, “A complete or
proper selection of the tooth material is very
removable partial denture constructed for insertion
important. Care should be taken to avoid any
immediately following the removal of natural teeth” -
occlusal discrepancies.
GPT. An immediate denture is one that is
fabricated before all the remaining teeth have
Denture Fracture
been removed and inserted immediately after the
Denture fracture is common in cases with single removal of the teeth. They can also be over-
complete dentures. This is because the denture dentures. Generally immediate dentures can be
will receive excessive load from the natural teeth. classified into two types namely:
The precipitating factors, which produce denture • Interim immediate denture.
fracture, are: • Conventional immediate denture.
• Excessive anterior occlusal load.
• Deep labial frenal notches. Interim Immediate Denture
• High occlusal load due to excessive action
Interim denture is defined as, “A dental prosthesis
of the masseter.
to be used for a short interval of time for reasons of
aesthetics, mastication, occlusal support, or con-
Precautions
venience or to condition the patient to the acceptance
• Check for the occlusion. of an artificial substitute for missing natural teeth until
• Maintain adequate thickness of the denture more definitive prosthetic therapy can be provided” -
base. GPT.
• Never deepen the labial notch. These are immediate dentures used tempo-
• For cases with high fracture potential, use a rarily, during the healing period of the patient to
cast metal denture base. preserve ridge contour, until the permanent den-
ture can be fabricated. They are mainly indicated
Mandibular Single Dentures in patients with periodontal disease going in for
They can be either opposing a fully dentulous total extraction. They help to preserve the contour
maxilla or opposing a maxillary partial denture. of the ridge until a permanent denture can be
In any case, there will be severe ridge resorption fabricated.
of the edentulous mandible. This is because of
two reasons: Advantages of Interim Dentures
• The constant movement of the tongue adds to • The shape and height of the ridge is preserved.
the forces on the residual ridge increasing the • Psychologically beneficial to the patient.
amount of resorption. • It can be used as a temporary replacement
• The amount of firmly attached mucosa to the when the permanent denture is being fabri-
denture, bearing area is less in the mandible cated or undergoing any repair or rebasing.
than in the maxilla. • The dentist will be able to get an idea of the
A conventional denture is usually avoided vertical dimension and jaw relation of the
opposing maxillary natural teeth . This condition patient. 255
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• For patients who show atrophic changes due • A base plate is adapted and occlusal rims are
to long-term edentulousness the interim fabricated on the master cast.
denture helps to rehabilitate the temporo- • Jaw relation is recorded. The master casts are
mandibular joint and the oral musculature. articulated using the jaw relation records and
the artificial teeth are arranged (Fig. 15.9).
Treatment Procedure
• An alginate impression is made and dupli-
cated. One impression is used to make a cast
for processing the denture (duplicate cast). The
other impression is used to make a cast to
prepare the base plate, occlusal rims, record
Fig. 15.9: Wax pattern fabricated on a refractory cast
jaw relation and teeth arrangement (master
cast). • Try-in verification is carried out
• Before pouring the duplicate cast, molten wax • After try-in, the trial denture is shifted to the
is poured into the teeth (to be extracted) of the refractory cast. Remember the teeth to be
refractory impression (Fig. 15.7). Once the wax replaced are composed of wax in the refractory
cools; the duplicate cast is poured in dental cast. Hence, we have a trial denture, which
stone. The duplicate cast will have all the replaces the missing teeth and a wax form,
anatomical structures in dental stone except which replaces the teeth to be extracted (Fig.
the teeth to be extracted, which will be in wax 15.10).
(Fig. 15.8).
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15
Fig. 15.11b: Filling the sockets of teeth to be replaced Fig. 15.12b: Insertion of the immediate denture
with acrylic
• For socially active people who are very self-
• Insertion of the interim denture is the beginn- conscious about their appearance.
ing and not the end of treatment. The patient
should be recalled frequently to make occlusal Advantages
adjustments and placement of tissue
• It gives a psychological benefit to the patient.
conditioning materials, etc. (Fig. 15.12b).
The patient does not appear edentulous at any
point of time.
Conventional Immediate Denture
• Muscle tone, tongue size and vertical
It is an immediate denture, which can be later dimension are preserved.
modified to serve as the permanent prosthesis. It • Centric jaw relation is easy to record.
is usually done for patients undergoing total • Less post-operative pain, because the extrac-
extraction. The treatment outline while preparing tion sockets are protected.
a conventional immediate denture consists of the • Postoperative haemorrhage and infection are
extraction of the posterior teeth followed by the also prevented due to the protective action. It
extraction of the anterior teeth. The ridges in the acts like a splint for the tissues (Fig. 15.13).
posterior region are allowed to heal before the • Tooth size, shape, shade selection and arrange-
extraction of the anterior teeth. The denture is ment are easy.
inserted on the appointment of extraction of the • It is easier for the patient to adapt to the
anterior teeth. permanent prosthesis.
Indications Disadvantages
• For patients with periodontally weak teeth • Requires more chair time.
indicated for extraction. • More expensive. 257
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Treatment Procedure
• The posterior teeth are extracted and the
sockets are allowed to heal (This does not
affect the aesthetics of the patient).
• An alginate impression is made with the help
of a stock tray. A diagnostic cast is prepared
from the impression. Figs 15.15a and b: Arbitrary trimming of the
• Two layers of wax are used to block out the teeth to be replaced in the master cast
undercuts in the dentulous areas of the cast. A
custom tray is fabricated over this diagnostic • Artificial teeth are arranged over the area
cast as described in Chapter 6. The borders of where the teeth are to be extracted. The teeth
the tray are trimmed 1 mm below the sulcus arrangement should be in harmony with the
for border moulding (Fig. 15.14). existing teeth as well as the prosthetic teeth.
• The denture is flasked, de-waxed, packed, pro-
cessed and finished.
• During the insertion appointment, the remain-
ing anterior teeth are extracted as atrauma-
tically as possible, preserving the soft tissues
and bone. The finished denture is seated in
the patient’s mouth.
• If the denture does not seat properly, the tissue
Fig. 15.14: Fabricating a temporary denture base on the surface of the denture should be reduced till
258 diagnostic cast the denture seats properly.
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• Occlusion should be refined. If the denture has • Dentures for patients with maxillo-facial
15
poor adaptation, tissue conditioners should be trauma.
used to line the tissue surface of the denture. • Patients with worn-out dentition
• For congenital anomalies like microdontia,
Patient Instructions amelogenesis imperfecta, dentinogenesis
• The patient should be advised to wear the imperfecta and partial anodontia.
denture continuously for the next 48 hours. • Patients with abnormal jaw size and position
• A soft diet is recommended. where orthognathic surgery is contrain-
• Cold packs can be used to reduce postextrac- dicated.
tion edema and pain. This treatment is usually indicated for:
• The patient should be recalled frequently to • Group1: Patients with few remaining teeth
check for ulcers, soft tissue irritation and to that may be healthy or periodontally
reline the denture. involved, with intact or grossly destroyed
crowns.
TOOTH-SUPPORTED OVERDENTURES • Group2: Patients with severely compro-
mised dentition. Selective extraction
It is defined as, “a dental prosthesis that replaces the should be carried out after a thorough
lost or missing natural dentition and associated struc- examination of the patient.
tures of the maxilla and/or mandible and receives par-
tial support and stability from one or more modified General Considerations during Diagnosis and
natural teeth”. It is also known as Hybrid dentures Treatment Planning for an Overdenture
or tooth-supported complete dentures (Fig.15.16). Maintenance of Periodontal Health
Once an overdenture is planned and constructed,
it is the duty of the patient to maintain his teeth
free from plaque. The dentist should check for
pocket formation around the abutments. Failure
to do this may lead to the loss of an abutment.
Fig. 15.16: Tooth supported overdenture
Reduction in Crown-root Ratio
Retaining natural teeth as abutments for den- Reduction in crown size during abutment
tures can considerably reduce the progress of preparation can be beneficial for the tooth, as it
residual ridge resorption. Multiple abutments can reduces the crown-root ratio and decreases the
be used for this purpose. Even abutments which leverage forces acting on the tooth.
are coronally modified or restored can be used.
Success of Endodontic Therapy
Endodontic treatment is usually done for most
cases. Endodontic therapy may be necessary for most
The stress concentration can be shared between abutment teeth because they need extensive
the denture-bearing areas and the abutments. crown reduction. A two-to-four week interval
These overdentures can reduce the impact of should be provided after completion of
residual ridge resorption, loss of occlusal stability, endodontic therapy in order to determine its
loss of aesthetics and compromised mastication. success before starting further treatment.
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food debris and to evenly distribute the force • Additional designing and laboratory work
acting on the denture. is needed.
• Cannot be used in cases with reduced inter-
Design of the Denture arch space, bony undercuts adjacent to the
abutments, etc.
As the denture base for overdentures are thin,
• Improper maintenance of the overdenture
they have to be reinforced with metal. At the same
may lead to periodontal breakdown of the
time they should be easy to fabricate and
overdenture abutments and the patient may
maintain. lose all his remaining teeth.
Ease of Use Patient Selection
The patient should be able to easily insert and Possibility of a Fixed or Removable Partial Denture
remove the denture without any harm to the
denture base or the abutment tooth. If the periodontal condition and position of the
remaining teeth favour the use of a fixed partial
Advantages of Overdentures denture or removable partial denture, then an
overdenture should not be considered for that
• Maintains the integrity of the residual ridge. patient.
• Improves the retention and stability of the
denture. Condition of the Abutment Teeth
• Improved proprioception leads to better
neuromuscular control. This helps in regu- The crowns of teeth should be free from caries.
lating the biting force over the denture. There should be sufficient width of attached
• Psychological effect on the patient as extrac- gingiva around the abutments. The abutment
tion can be avoided. should be free from any periodontal disease.
• It can almost be used universally.
Age of the Patient
• Even if there is abutment failure, the abut-
ments can be extracted and the overdenture Overdentures are always recommended for
can be relined and used as a conventional young patients because they have a favourable
complete denture. psychological effect.
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15 Textbook of Prosthodontics
to be trimmed/relieved in order to avoid • The teeth planned for extraction are removed
impingement. This area is later lined with atraumatically and the immediate overdenture
resilient liner to close the dead space between is inserted.
the gingiva and the denture (Fig. 15.17).
IMPLANT-SUPPORTED OVERDENTURES
Implants are the latest trend in prosthodontia
these days. Implants are used as a part of remo-
vable and fixed partial dentures. They play an
important role in complete dentures too.
Some patients will not be able to wear their
dentures irrespective of its perfect contour. These
patients are termed as “Mal-adaptive”. The
implant-supported denture can be designed for
these patients (Fig. 15.18).
(FOR FURTHER DETAILS- REFER IMPLANTS CHAPTER 39)
262
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Section Two
Removable
Partial
Denture •
•
Introduction and Classification
Diagnosis, Treatment Planning and
(RPD)
Mouth Preparation
• Removable Partial Denture Design
• Prosthetic Mouth Preparation
• Secondary Impression and Master
Cast for RPD
• Fabrication of a Removable Partial Denture
• Types of Removable Partial Dentures
• Correction of Removable Partial Dentures
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Chapter 16
Introduction and Classification
• Common Terminologies Used in
Removable Partial Denture
• Indications for Removable Partial Dentures
• Classification of Partially Edentulous Arches
• Steps in the Fabrication of a
Removable Partial Denture
• Parts of a Removable Partial Denture
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Introduction and
Classification
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Introduction and Classification
never be used as a permanent or prolonged form that which remains is of utmost importance and not
16
of treatment because of the danger of destroying the meticulous replacement of that which has been
the remaining oral tissues. lost.”
Interim Denture Length of Edentulous Span
It is a temporary partial denture used for a short Removable partial dentures are preferred for
period to fulfil aesthetics, mastication or conve- longer edentulous arches. Unlike fixed partial
nience until a more definitive form of treatment dentures, removable partial dentures can take
can be rendered. support from the tissues all along the ridge.
Transitional Denture Similarly the removable partial dentures also
helps to distribute forces around the ridge evenly
May be used when loss of additional teeth is (Fig. 16.1).
inevitable but immediate extraction is not advi-
sable or desirable. Artificial teeth may be added
to the transitional denture as and when the
natural teeth are extracted.
Treatment Denture
It is used as a carrier for treatment material. It is
used when the soft tissues have been abused by
ill-fitting prosthetic devices. It may also be used
after surgery to protect a surgical site or to
reposition soft tissue.
Centric Relation
It is the most posterior relation of mandible to
the maxilla at the established vertical dimension Fig. 16.1: Removable partial dentures are preferred for long
from which lateral movements could be made span edentulous spaces because the denture base aids to
(Refer Chapter 9). evenly distribute forces all along the edentulous portion of
the ridge
Eccentric Relation
Fixed partial dentures are avoided in cases
Relationships of the mandible to the maxilla other with long span edentulous arches because they
than centric relation that occur in horizontal produce excessive force on the abutment teeth.
plane. Ante’s law determines if a fixed prosthesis can
Centric Occlusion be used or not.
“Ante’s Law”: The pericemental surface area
It is the maximum intercuspation between the of the abutment teeth to be used for a fixed partial
upper and lower teeth. The latest terminology for denture must be equal to or exceed the peri-
centric occlusion is inter-cuspal position (ICP) or cemental surface area of the teeth being replaced
maximal intercuspal position. (Fig. 16.2). The GPT definition of the Ante’s law
for removable and fixed partial dentures is
INDICATIONS FOR REMOVABLE explained in Chapter 26.
PARTIAL DENTURES
Age
The following statement should be considered
before planning any treatment for a patient. In patients under the age of 17 years, a fixed
Muller De Van (1952) stated, “the preservation of partial denture is contraindicated because they 267
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Cross-arch Stabilization
When the remaining teeth have to be stabilized
against lateral and anterior-posterior forces, a
removable partial denture is indicated. A fixed
partial denture will provide only antero-posterior
Abutment Tooth
Fixed partial dentures can be used only if there is
a posterior tooth for support. When there is no
tooth posterior to the edentulous space to act as
an abutment, a removable partial denture is
preferred. Exceptions: Cantilever fixed partial
denture (here, the fixed partial denture is
prepared projecting posteriorly like a cantilever Fig. 16.3c: A removable partial denture base will concentrate
from the abutment. But they are avoided it’s load to the tissue relieving the abutment from excessive
268 nowadays. stress
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Introduction and Classification
16
Fig. 16.4: The RPD framework helps to provide stability Fig. 16.5a: The denture base aids to allow flexibility teeth
against levering forces acting on one side of the denture. arrangement
This ability is termed cross-arch stabilization
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CLASSIFICATION OF PARTIALLY
EDENTULOUS ARCHES
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does not cross the midline of the arch, with III situation where the anterior abutment
teeth present on both sides (anterior and cannot be used for any support. Hence, it
posterior) of it (Fig. 16.12). cannot be treated like a conventional class III
edentulous space (Fig. 16.14).
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Introduction and Classification
Points to remember:
16
Class I arches are most common and class IV are
least common.
Class I and class II, long span class III and IV
partial dentures are tooth-tissue supported
prostheses.
Short span class III and IV are tooth supported
partial dentures.
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Fig. 16.16a: Bailyn’ P1 partially edentulous condition Fig. 16.16d: Bailyn’s A3 partially edentulous condition
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275
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Fig. 16.23: Neurohr’s class II division 1 variation 2a Fig. 16.26: Neurohr’s class II division 2 variation 1b
partially edentulous condition partially edentulous condition
Division 2: When there are teeth posterior in all • Variation 2: Missing anteriors predominate.
spans, but when there are more than four teeth a. Anteriors missing, posteriors in place
(including a canine) in any one or more spans. (bilaterals only) (Fig. 16.27).
• Variation 1: Missing posteriors predominate. b. Anteriors missing, some posteriors missing
a. None (Fig. 16.25). (Fig. 16.28).
b. Posteriors missing, some anteriors missing Class 3: Tissue-bearing complete dentures (Fig.
276 (Fig. 16.26). 16.29).
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16 Textbook of Prosthodontics
Fig. 16.38
6. Wild’s Classification
7. Godfrey’s Classification
Proposed a simple yet self-explanatory classi-
fication. It is not very well-known in English Proposed in 1951, it is based on the location and
278 dental literature. size of edentulous spaces. The speciality of this
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Introduction and Classification
8. Friedman’s Classification
He introduced the ‘ABC’ classification in 1953.
According to this classification:
a. A: Anterior (Fig. 16.43).
b. B: Bounded posterior (Fig. 16.44).
c. C: Cantilever (Fig. 16.45).
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Fig. 16.44: Friedman’s type B partially Fig. 16.46: Beckett and Wilson’s class I partially
edentulous condition edentulous condition
Fig. 16.45: Friedman’s type C partially Fig. 16.47: Beckett and Wilson’s class IIa partially
edentulous condition edentulous condition
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Introduction and Classification
16
Fig. 16.49: Beckett and Wilson’s class III partially Fig. 16.51: Craddock’s class II partially
edentulous condition edentulous condition
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Fig. 16.53: Skinner’s class I partially edentulous condition Fig. 16.56: Skinner’s class IV partially
edentulous condition
Fig. 16.54: Skinner’s class II partially edentulous condition Fig. 16.57: Skinner’s class V partially edentulous condition
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Introduction and Classification
16
Fig. 16.59: Austin and Lidge class A2 partially Fig. 16.62: Austin and Lidge class P2 partially
edentulous condition edentulous condition
Fig. 16.61: Austin and Lidge class P1partially Fig. 16.64: Austin and Lidge class AP1 partially
edentulous condition edentulous condition 283
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Fig. 16.65: Austin and Lidge class AP2 partially Fig. 16.67: Span of a Watt et al’s entirely tooth-borne
edentulous condition partial denture
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Introduction and Classification
• Class I: All remaining teeth anterior to bilateral • Class IV: The edentulous space anterior to the
16
edentulous areas (Fig. 16.70). remaining natural teeth, which bound it both
• Class II: Remaining teeth of either right or left to the right and left of the midline (Fig. 16.73).
side anterior to the unilateral edentulous area • Class V: A space bounded by teeth at its
(unilateral free-end) (Fig. 16.71). anterior and posterior terminals. (It differs
• Class III: The edentulous space bounded by from class 3 in that the edentulous space is
teeth anteriorly and posteriorly (Fig. 16.72). long with weak anterior teeth) (Fig. 16.74).
Fig. 16.70: Kennedy-Applegate’s class I partially Fig. 16.73: Kennedy-Applegate’s class IV partially
edentulous condition edentulous condition
Fiset’s Modification
Fiset added four additional classes to Kennedy-
Fig. 16.72: Kennedy-Applegate’s class III partially Applegate’s classification and made it a total of
edentulous condition ten classes. 285
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Introduction and Classification
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16 Textbook of Prosthodontics
table articulators are used only for complete occlusal The first five are cast in metal and the other
rehabilitation patients). Teeth selection and arrange- two may be fabricated using other materials.
ment is done on the occlusal rims. The trial
denture is waxed up as explained for complete Major Connector
dentures. It is defined as, “A part of a removable partial denture
Try-in of the Trial Denture which connects the components on one side of the arch
to the components on the opposite side of the arch”-
The trial denture is placed in the patient’s mouth GPT.
for aesthetic and functional evaluation before It is the largest and most important component
processing. Error correction and modifications of the removable partial denture. The major con-
according to the requirement of the patient is nector functions to connect all the other compo-
completed. nent parts of the prosthesis (explained later) and
provide indirect retention. The types of major con-
Processing the Trial Denture nectors and their design concepts have been dis-
After try-in, wax up, flasking de-waxing, packing, cussed in detail in Chapter 18.
curing, finishing and polishing procedures are
carried out as described in Chapter 12. Minor Connector
It is defined as, “The connecting link between the
Denture Insertion
major connector or base of a removable partial denture
The denture is inserted and evaluated. Premature and other units of the prosthesis, such as clasps,
occlusal contacts and minor errors are corrected. indirect retainers and occlusal rests” - GPT.
Post-insertion instructions are given to the It is the component, which connects the other
patient. The patient is recalled frequently to components of the removable partial denture to
evaluate the tissue response, obtain feedback and the major connector. Minor connectors can be of
determine periodically the success of the denture. four types namely:
All the above-mentioned procedures will be • Minor connectors that connect the direct
explained in detail in the following chapters. retainer to the major connector.
• Minor connectors that connect auxillary rests
PARTS OF A REMOVABLE to major connectors.
PARTIAL DENTURE • Minor connectors that connect the denture
base to the major connector.
Before we go into the details about the removable
• Minor connectors that extend as the approach
partial denture, I wish to give a brief introduction
arm of a bar clasp.
about the various parts of a removable partial
Structural details and design concepts have
denture. A detailed description about each of
been discussed in detail in Chapter 18.
these parts is discussed in chapter 18.
Various components are used in a fixed partial Rest
denture. Each one has a specific function. The
design, position and location of each component It is defined as, “A rigid extension of a fixed or remo-
vary according to individual needs. The vable partial denture which contacts a remaining tooth
components of a removable partial denture are: or teeth to dissipate vertical or horizontal forces” -GPT.
• Major connector Rests are metallic extensions in the denture
• Minor connector framework that extend over the occlusal/lingual
• Rest surface of the supporting teeth. The main function
• Direct retainer of a rest is to transmit the occlusal forces acting
• Indirect retainer on the denture along the long axis of the abutment
290 • Denture base tooth. Since an occlusal rest extends over the
• Artificial tooth replacement occlusal surface, care should be taken to design
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Introduction and Classification
the rest such that it does not produce any occlusal displacement of distal extension denture bases by
16
interference. A depression is created on the functioning through lever action on the opposite side
occlusal surface of the tooth where the rest is to of the fulcrum line”- GPT.
be placed. This depression where the rest is This is not a separate component. Instead, it
fabricated to fit in is called a rest seat. The purpose is a combination of the above-mentioned compo-
of preparing a rest seat is to avoid occlusal inter- nents, which offer indirect retention. Direct reten-
ference, protect and position the rest and also tion is the ability of the component to prevent
direct the forces along the long axis of the abut- the displacement of the denture. Indirect reten-
ment. The method of preparation of a rest seat is tion is the ability of the component to retain the
described in detail under prosthetic mouth pre- denture in place. Methods of obtaining indirect
paration (Chapter 19). The types of rest and their retention are described in detail in Chapter 18.
design concepts are described in Chapter 18.
The indirect retainer is a separate component
in a distal extension denture base. It is a must
Direct Retainer
and it assists the direct retainer to obtain retention
It is defined as, “A clasp or attachment placed on an of the denture. Mechanism is explained in
abutment tooth for the purpose of holding a removable Chapter 18.
denture in position”- GPT.
A direct retainer is the part of the fixed partial
Denture Base and Tooth Replacements
denture, which helps to prevent the displacement
of the denture. The direct retainer functions based Denture base is the part of the denture that forms
on certain principles. It is the most critical the tissue surface of the denture over the eden-
component for a removable partial denture. The tulous area. It is usually made of acrylic resin. It
parts, functions, and design concepts have been helps to distribute the forces acting on the denture
discussed in detail in Chapter 18. over the entire residual ridge. The denture base
also functions to hold the tooth replacements in
Attachment
position.
It is defined as, “A mechanical device for the fixa- Tooth replacements reproduce the contour and
tion, retention and stabilization of a dental prosthesis” function of the missing teeth. There are different
- GPT. It is a type of direct retainer. Generally, the types of tooth replacements used in a removable
term ‘attachment’ refers to an intracoronal partial denture. They have been discussed in
retainer, which extends into the abutment tooth. detail alongwith the design of an fixed partial
denture (Chapter 18). The denture base should
Indirect Retainer have maximum possible tissue coverage within
It is defined as, “A part of a removable partial denture the limiting structures. It should also have a close
which assists the direct retainers in preventing adaptation to the tissues.
291
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Chapter 17
Diagnosis, Treatment Planning and
Mouth Preparation
• Clinical Diagnosis
• Derived Diagnosis or Post-clinical Diagnosis
• Treatment Planning
• Preprosthetic Mouth Preparation
• Making the Primary Cast
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Diagnosis, Treatment
Diagnosis, Treatment Planning and Mouth Preparation
17
Planning and Mouth
Preparation
CLINICAL DIAGNOSIS health like inflammation of the gingiva, bleeding
on probing, periodontal breakdown, and mobility
As described in the previous chapter, diagnosis of the teeth etc. should be evaluated (Fig. 17.1).
is the determination of the nature of the disease.
Diagnosis can be broadly classified as clinical diag-
nosis and post-clinical or derived diagnosis. Clinical
diagnosis includes personality evaluation,
clinical examination and radiographic exami-
nation. Post-clinical or derived diagnosis deals
with the evaluation of the patient’s condition
using the diagnostic data collected during clinical
diagnosis.
Clinical diagnostic procedures like patient
evaluation and clinical examination have been
discussed in detail for complete dentures in Fig. 17.1: The periodontal status can be clinically
Chapter 2. Most of the diagnostic procedures evaluated using periodontal probes
described in Chapter 2 are used in the diagnosis
of a partially edentulous condition. Hence, I have Oral hygiene is evaluated using the oral
skipped the detailed description of the repeating hygiene index, gingival inflammation and bleed-
topics. ing are evaluated using the gingival index. The
In this section, we will discuss only about the periodontal breakdown and mobility of teeth are
additional clinical diagnostic procedures required evaluated using the Russel’s index. Mobility of
to diagnose a partially edentulous condition. teeth can be measured using instruments like
forcemeters and periodontometers.
Clinical Evaluation of the Existing Teeth All these indices are diagnostic procedures
This is very important for the success of a partial carried out to collect diagnostic data, which will
denture. The remaining teeth are the primary be analysed later to arrive at a derived diagnosis.
supporting structures for most removable partial For example, oral hygiene index is used to mea-
dentures. sure the amount of debris that is accumulated on
Evaluation of existing teeth comes under the the clinical crown based on which prosthodontic
local clinical examination stage in diagnosis. The prognosis is predicted.
following factors should be evaluated on the The periodontal health can also be determined
remaining natural teeth. radiographically. The amount of horizontal or
vertical bone loss is measured on a radiograph.
Periodontal Health (Fig. 17.2). Radiological signs of periodontal
The periodontal condition of the existing teeth breakdown are also included in the Russel’s
should be examined. Clinical signs of periodontal index. 293
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17
Fig. 17.11: The maxillary cast should measure atleast 10 After making the diagnostic casts, they should
mm in height at its thinnest portion namely the depth of the be evaluated to determine the problems that the
palatal vault clinician might face during the fabrication of the 297
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denture in other words to determine the derived be replaced with a special knife and can be used
diagnosis. to scrape the cast till the undercut is eliminated.
The diagnostic casts can be evaluated using This procedure of reducing the cast to evaluate the
two procedures both of which are essential: amount of surgical reduction required is known as
• Surveying the diagnostic cast using a surveyor. mock surgery (Fig. 17.16).
• Mounting the diagnostic cast in an articulator.
Surveying the diagnostic cast Survey of a cast is
done using an instrument called Surveyor. The
structure, assembling and surveying procedures
are described in detail in the next chapter. Here,
we shall discuss about the purpose/uses of
surveying a diagnostic cast:
• To locate and demark the soft tissue undercuts,
and severe undercuts located on the surface
of the existing teeth. Fig. 17.16: Mock preparation done to evaluate the need
• To determine the need for preprosthetic mouth for preprosthetic surgery
preparation and also perform mock surgeries. Some cases will have unilateral undercuts
• To determine the path of insertion of the (undercut on one side of the alveolar slope alone).
denture. This also rules out the use of dentures Altering the path of insertion will help to seat
that may require a different path of insertion. the denture in such cases. The path of insertion
Let me explain, consider a deep undercut on can be changed to a maximum 10°. The diagnostic
the buccal surface of the maxillary tuberosity. The cast should be surveyed to determine if the path
denture base cannot extend to the depth of the of insertion which can be altered to aid in the
sulcus in this area. Hence, the undercut should insertion of the prosthesis (Fig. 17.17). The proce-
be eliminated. The diagnostic cast is surveyed in dure is described in detail in the next chapter.
a surveyor which has a vertical marker, that can Hence, we understand that a diagnostic cast
be used to mark the height of contour of the bone can be used to determine the presence and depth
or soft tissue above the undercut. The marked of an undercut. Other uses of a diagnostic cast
height of contour should be surgically reduced are enumerated in Chapter 3.
to remove the undercut. The depth of the under-
cut can be measured from the height of contour
using an undercut gauge (Fig. 17.15).
The diagnostic cast can be surveyed to deter-
mine the extent of preprosthetic procedures
required. The vertical marker in a surveyor can
a b
Figs 17.17a and b: Altering the path of insertion to
facilitate inserting a denture into an undercut
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Diagnosis, Treatment Planning and Mouth Preparation
are similar to the procedures described in fabri- nostic casts also help to explain the treat-
17
cation of a complete denture. ment plan to the patient.
The uses of mounting diagnostic casts are: • It is a valuable legal pre-treatment record.
• As an adjunct to clinical examination:
Extruded teeth, overhanging tuberosities, Derived Diagnosis Using other Diagnostic Data
lack of interarch space, malaligned teeth,
abnormal occlusal contacts, improper resto- Other diagnostic data like pre-extraction radio-
rations etc., can be examined more accu- graph and photograph give a mental picture
rately on mounted diagnostic casts (Fig. about the previous condition of the patient. Using
17.18). these records, abnormalities like malocclusion
etc., can be diagnosed.
TREATMENT PLANNING
After evaluating the clinical and derived diag-
nosis, the mode of treatment that would best suite
the patient is determined. The outline of
treatment is framed before starting the treatment.
Prosthodontic treatment for partially edentu-
lous patient’s can be divided into six separate
phases or stages.
Phase I
Fig. 17.18: Mounting the diagnostic casts using a tentative
jaw relation record in order to evaluate the inter-arch space • Collection and evaluation of diagnostic data
(e.g. Diagnostic impressions).
• For a detailed analysis of patient’s occlu- • Treatment of emergency conditions. Relief of
sion: The lingual view of the occluded teeth pain and infection.
can be examined only on mounted casts. • Determining the type of prosthesis to be
This helps to select and design the type of fabricated.
prosthesis required for a patient (Fig. 17.19). • Patient motivation.
• Patient education: They help to educate the
patient about his oral condition and Phase II
emphasize on the need for treatment. Diag- • Preprosthetic mouth preparation.
• Making the primary impression.
• Patient motivation
Phase III
• Designing the RPD.
Phase IV
• Prosthetic mouth preparation
• Making the final impression
• Patient motivation.
Phase V
Fig. 17.19: Lingual view of occlusion can be evaluated
using diagnostic data • Fabrication of the removable partial denture. 299
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Diagnosis, Treatment Planning and Mouth Preparation
Crowns
A full veneer crown is given in cases, which
require a change in the occlusal plane along with
the following requirements:
• Additional change in the height of contour.
• Additional retentive undercuts.
• Additional guiding planes.
The diagnostic cast is mounted on a surveyor
and the amount of tooth reduction necessary is Fig. 17.26b: Retaining intermediary teeth can aid to
measured. The clinician has to decide if the tooth prevent the formation of long span edentulous spaces 303
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Diagnosis, Treatment Planning and Mouth Preparation
305
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Chapter 18
Removable Partial Denture Design
• Surveying
• Determining the Path of Insertion and
Guiding Planes
• Designing the Component Parts of a RPD
• Principles of a Removable Partial Denture
• Principles of Design/ or Philosophy of Design
• Essentials of Design
• Laboratory Design Procedure
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18
Removable Partial
Denture Design
Denture design is defined as “ A planned visuali- Surveying is defined as, “An analysis and
zation of the form and extent of a dental prosthesis comparison of the prominence of intraoral contours
arrived at after a study of all factors involved ”- associated with the fabrication of a prosthesis”- GPT.
GPT. As mentioned before, surveying is done using
Designing a removable partial denture comes a surveyor. Before we go into the surveying
under phase III of treatment planning. After procedure, let us read about the surveyor.
completing phase II (preprosthetic mouth
Surveyor
preparation) a primary cast is made and the
RPD is designed using this cast. A surveyor is defined as “An instrument used in
Designing a RPD includes determining the the construction of a removable partial denture to
path of insertion of the denture and also the locate and delineate the contours and relative
location, position and type of components to be positions of abutment teeth and associated
used in the prosthesis. A RPD is designed using structures”-GPT.
an instrument known as surveyor. As the name The surveyor is a parallelometer; an instru-
suggests, this instrument surveys or studies the ment used to determine the relative parallelism
contours and morphology of the supporting of surfaces of teeth or other areas on a cast. Dr.
tissues replicated on a cast. A.J. Fortunati (1918) was the first person to use
The primary cast is mounted on a surveyor a surveyor.
and surveyed. According to the contours of the Objectives of Surveying
tissues in the cast, the RPD is designed. The • To design a RPD such that it’s rigid and
determined design of the prosthesis is outlined flexible components are appropriately
on the primary cast. A thorough knowledge positioned to obtain good retention and
about surveying is essential for one to bracing.
understand the designing procedure of a remo- • To determine the path of insertion of a
vable partial denture. prosthesis such that there is no interference
to insertion along this path.
SURVEYING • To mark the height of contour of the area
It is the first step in the design of a RPD. The (hard or soft tissues) above the undercut.
term ‘survey’ is defined as a procedure done, • To mark the survey lines. (height of contour
“To examine as to condition, value, or situation; to of a tooth)
appraise” or “To determine the form and position • To mark the undesirable undercuts into which
of a given entity by means of taking linear and the prosthesis should not extend.
angular measurements” or “To inspect or
scrutinize” or “The procedure of locating or Types of Surveyors
delineating the contour and position of the abutment The surveyors commonly used are:
teeth and associated structures before designing a • Ney surveyor (widely used).
removable partial denture”—GPT-1. The fourth • Jelenko or Will’s surveyor. 307
definition is the most relevant one to this topic. • Willam’s surveyor.
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The structure of these surveyors is basically path of insertion of the denture will also change,
similar with mild differences from one another. ultimately requiring excessive mouth opening
Generally, the William’s surveyor is more flexible. during insertion. (If a change in path of insertion
is planned, the clinician should prepare the rest
Parts of a Surveyor (Fig. 18.1a) seats and guiding planes accordingly).
Surveying platform It is a metal plate parallel to
the floor where a cast holder can be placed. It
forms the base of the surveyor onto which all
the other components are attached and
supported (Fig. 18.1b).
3
1. Cast holder or surveying table Fig. 18.2: Surveying table with a ball and socket joint and
cast positioning screws. When tightned, the screws aid to
4
lock the cast to the table. The ball and socket joint aids to tilt
2. Vertical arm the platform
Vertical arm It arises vertically from the
3. Horizontal arm 5 surveying platform. It supports the
3 superstructure (horizontal arm and the
2
surveying arm) (Fig. 18.3).
4. Surveying arm
5. Surveying tools 1
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rod, the cast mounted on the surveyor is rotated wax patterns and also to eliminate and block
against the carbon marker. This will produce a out undesirable undercuts parallel to the path
line along the most convex area of the object of insertion (Fig. 18.8).
being surveyed (E.g. teeth). The resultant line
formed by the carbon marker is known as a
survey line.These survey lines help us in
positioning the various component parts of a
removable partial denture.
Undercut gauges: A gauge is a high precision
instrument used to measure the linear dimension Fig. 18.8: Surveying wax knife used to
of any structure. Undercut gauges are used to contour wax patterns
measure the depth and location of the undercuts Survey Lines
on the analyzed tooth in three dimensions.
Stewart states the availability of undercut gauges Survey lines are nothing but the height of
in three standard sizes namely, 0.010 inch, 0.015 contour of the abutment teeth marked by a
inch, and 0.020 inch. Mc Cracken states the carbon marker during surveying. A survey line
availability of undercut gauges at 0.010, 0.020 is defined as “A line drawn on a tooth or teeth of a
and 0.030 inch. All these gauges have the same cast by means of a surveyor for the purpose of
shank only the size of the tip or bead varies (Fig. determining the positions of the various parts of a
18.7b). The gauges are of standard sizes and the clasp or clasps”- GPT (Fig. 18.9).
area of the tooth that matches the gauge is
chosen as the undercut.
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clasp (occlusally approaching), or L or T type Fig. 18.16: The surveying arm is adjusted and locked in
roach clasp (gingivally approaching). position such that the surveying tools extend upto the soft
tissue undercuts in the cast
Set Up for Surveying
Setup for surveying includes mounting the • Once the proper position of the horizontal
primary cast on a cast holder, locking it in arm is determined, it is locked to the vertical
position with “zero” degree tilt. The cast holder arm with the help of a thumbscrew. In Ney’s
is placed on the surveying platform. After surveyor the surveying arm should also be
positioning the cast, the surveying arm is adjusted and locked such that it can contact
positioned in relation to the cast. the cast is atleast three different points on the cast from
analyzed after positioning the surveying arm. this plane. The horizontal arm cannot be
vertically adjusted in a Ney’s surveyor.
Mounting the cast The primary cast should be
mounted on the surveying table. The cast can Analyzing the cast (Fig. 18.17a)
be fixed tightly to the clamps on the surveying • The analysing rod is the first surveying tool
table. The cast should be mounted such that the that should be used during any survey proce-
occlusal surfaces of the remaining teeth are dure. It should be attached to mandrel of the
surveying arm.
• The cast is rotated against the analyzing rod
to analyse the presence of undercuts (favour-
able and unfavourable). At this stage, the
operator will develop a mental picture about
a design that would best suit the clinical
condition. Favourable undercuts should be
present on the abutment teeth to place the
Fig. 18.15: After positioning the primary cast on the surveying retentive components of a clasp.
table, it should be locked in place by tightening the screws
Unfavourable undercuts (soft tissue, bony
undercuts) should be eliminated. If
parallel to the base. (The cast should never be tilted favourable undercuts are absent during
before analyzing) (Fig. 18.15). analyzing, undercuts favourable to that path
Positioning the surveying arm of insertion should be created. Favourable
• After mounting the cast, the horizontal arm undercuts can be created by preparing
is positioned in the surveyor. The horizontal crowns over the abutment teeth (the
arm should be vertically adjusted such that depression is prepared in the crown to act as
the surveying arm can contact atleast three an undercut), or by enameloplasty (the
different spaced out points on the cast (Fig. enamel is contoured using a bur-dimpling) or
312 18.16). by slightly tilting the cast (not preferred- tilting
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18
Fig. 18.23b: Notice that the tripod marks are at the same
horizontal plane. Each tripod point can be accentuated by
placing two intersecting lines about 4 mm length enclosed Fig. 18.25a: Tripoding a cast
in a circle
• As the surveying arm is moved, two addi- is used, it may abrade and provide a faulty
tional points in the cast that come in contact reading.
with the carbon marker, are marked. Since • As an alternative to tripoding, the orientation
carbon marker is in the same horizontal plane, of the cast can also be recorded by scribing a
all the three points marked using it will also vertical line on the base of the cast (Fig.
lie in the same plane (Fig. 18.25). 18.25b).
• One technical consideration to be
3. Transferring the Tripod Marks
remembered is that the side and not the tip
of the carbon marker should be used to mark This procedure is done to orient the master cast
the tripoding points. This is because if the tip using the same angulation of the primary cast. 317
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planes. This procedure can even be done • A simple method to establish an ideal path
18
alongwith surveying. A brief explanation about of insertion is to alter the tilt/angulation of
determining the path of insertion was explained the cast on the surveyor. Changing the tilt
under setup for surveying. will change the guiding plane and the amount
of mouth opening needed to seat a denture.
Path of Insertion Exaggerated tilts (beyond 10o to the hori-
zontal plane) should be avoided to prevent
It is defined as “the direction in which a prosthesis excessive mouth opening during insertion.
is placed upon and removed from the abutment
teeth” -GPT. Clinical Considerations
• The path of insertion or path of withdrawal • Multiple paths of insertion are possible in a
is the angle made by the direction of the class I case. A single path of insertion is
removable partial denture with the remaining obtained by preparing additional guiding pla-
teeth during insertion (Fig. 18.35). nes on the lingual surfaces of remaining teeth.
Since the denture is constructed such that it
is forced to contact all these guiding planes
during insertion it reduces the occurrence of
multiple paths of insertion (Fig. 18.36).
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Removable Partial Denture Design
Fig. 18.40b: Enameloplasty done to eliminate Denture base Shape and extent of the denture
unfavourable undercuts base determines the path of insertion. If a distal
extension denture base is made to extend ante-
riorly on both sides it tends to embrace the abut-
ment limiting multiple paths of insertion (Fig.
18.42).
Location of the vertical minor connector The
vertical minor connector connects the auxiliary
Fig. 18.40c: The proximal surface of such teeth can also rest to the major connector. This minor connector
be recontoured using a crown will be parallel to the guide plane on the abut- 323
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ment. We know that the path of insertion should Fig. 18.44b: Coronal view of the approach arm showing
be parallel to the guide planes (Fig. 18.43). it’s relationship with the soft tissue
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Removable Partial Denture Design
Fig. 18.47: Arrow mark depicts the guiding plane (blue line)
prepared on a secondary abutment. The proximal plate of
the vertical minor connector should be in close association
with the guide plane
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Structure
Guide planes are usually 2-3 mm in occluso-
Fig. 18.53: Guide planes for a distal extension
gingival height parallel to the path of insertion. denture base
The guide planes should be flat and contain no
undercuts (Fig. 18.51). Guide planes do not occur
naturally on the abutment teeth, instead they
should be prepared by the clinician during pros-
thetic mouth preparation. They are prepared
by selective grinding of teeth (enameloplasty) or
by appropriate shaping of wax patterns, crowns
or cast restorations on the abutment teeth.
Fig. 18.54: Guide planes on a secondary abutment
supporting an auxiliary rest
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• Aids to stabilize the prosthesis against hori- • It should provide vertical support and protect
18
zontal stresses. soft tissues.
• Aids to stabilize individual teeth. • It should provide a means of indirect
• Reduces the blockout area and eliminates the retention whenever required. (explained
space between the minor connector and the under indirect retainers).
tooth. Hence, it improves oral hygiene along • It should provide opportunity for positioning
with easy maintenance. denture base where needed.
• Contributes to indirect retention and frictional • It should be comfortable to the Patient.
retention. • It should not allow any food accumulation.
• It should be self-cleansing.
DESIGNING THE COMPONENT
PARTS OF A RPD Design Considerations for all Major Connectors
After surveying the primary cast, determining The following general design considerations are
the path of insertion and location of the guiding followed while designing any major connector.
planes; the component parts of the RPD are These considerations help to improve the success
designed. In this section, we will discuss in detail of the prosthesis.
about the structure, function, design conside- • Intentional relief: The border of the major
rations, indications, contraindications and some connector should be 6 mm away from
specific design considerations for each compo- gingival margins in the maxillary arch in order
nent used in a partial denture. The design proce- to avoid any injury to the highly vascular
dure is described in detail consecutively under marginal gingiva (Fig. 18.56).
each component.
Major Connector
It is defined as “A part of a removable partial
denture which connects the components on one side
of the arch to the components on the opposite side of Fig. 18.56: 6 mm intentional relief is mandatory for
the arch”- GPT. maxillary major connectors to protect the gingival tissues
It connects all the parts on one side of an arch
to those on the opposite side. It forms the basic • In the mandible, the border of the major
framework of the partial denture. They are connector is placed 3 mm away from the
basically classified as maxillary and mandibular marginal gingiva. If this is not possible, it is
major connectors. extended across the marginal gingiva as a
lingual plate (Fig. 18.57).
General Ideal Requirements for Maxillary and • The borders of the major connector should
Mandibular Major Connectors be parallel to the gingival margins (Fig. 18.58).
• The metal framework should cross the gin-
A major connector should have certain char- gival margin only at right angles (Fig. 18.59).
acteristics. Generally, all major connectors are • The part of the framework adjoining the tooth
designed such that they fulfil the following surface should be hidden in the embrasures
requirements. to avoid discomfort.
• Rigidity: A major connector should not be • The borders of the major connector should
flexible. It should be rigid enough to uniformly be rounded to avoid interference to the
distribute the occlusal forces acting on any tongue (Fig. 18.60).
portion of the prosthesis without undergoing • The major connector should be symmetrical
distortion. and should cross the palate in a straight line. 327
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Fig. 18.58: The gingival margin of the major connector Fig. 18.61a: The anterior margin of a maxillary major
should be parallel to the free gingival margin connector should always end on valley of the rugae
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• The major connector should not extend over The beading is created by making a 0.5 to 1-
18
bony prominences like tori. Relief is given for mm groove on the master cast with a spoon
a small tori, surgical excision is done for a excavator. The size of the beading should thin
large one (Fig. 18.62). out 6mm near the marginal gingiva (Fig.
18.64).
• Usually relief should not be given for a
maxillary major connector. Close adaptation
is necessary for retention and stability of the
denture. Exceptions include cases with palatal
tori or a prominent mid palatine suture
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Fig. 18.68: Single broad palatal major connector Fig. 18.69: Antero-posterior double palatal bar
• Complete or partial cast plate extending • Posterior bar is half-oval like a single posterior
posteriorly to the junction of the hard and palatal bar.
soft palate. • The strap and the bar are connected by two
• Anterior palatal connector with a longitudinal elements along the lateral slopes
provision for extending an acrylic denture of palate giving a circular configuration (Fig.
base posteriorly. 18.70). This circular configuration provides
Indications rigidity.
• Class I cases with little vertical ridge • The anterior strap lies in three planes like the
resorption. broad palatal major connector. This also
• Cases with ‘V’ or ‘U’ shaped palate. contributes to the rigidity of the prosthesis
• Cases with strong abutments (L-beam or L-bar principle: discussed later).
• Cases with more than six remaining anterior
teeth
Advantages:
• Intimate contact with the palatal tissues over
a large area provides good retention due to
the presence of interfacial surface tension.
• Provides good vertical support.
• Numerous surface corrugations due to very
thin metal provide a very natural feel.
Disadvantages
• Can cause papillary hyperplasia.
Antero-posterior or double palatal bar
• It is a combination of an anterior palatal strap
and a posterior palatal bar (Fig. 18.69).
• The anterior strap is narrower than a conven-
tional palatal strap.
• The margins of the strap should lie on the Fig. 18.70: Circular configuration of an antero-posterior
valley and not on the crest of the rugae. double palatal bar aids to increase resistance
331
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Fig. 18.73: Closed horseshoe maxillary major connector Fig. 18.74: Complete palate maxillary major connector
• It is used in cases with Kennedy’s Class I and (acrylic will get interlocked with the mesh-
Class II cases with anterior tooth replacement. work (Fig. 18.75).
Advantages: • All cast metal.
• Rigid due to a circular configuration.
• Additional strength due to L-beam effect and
a circular configuration (discussed later).
• Greater support from palate
Disadvantages:
Interference with phonetics, annoyance to
tongue and discomfort.
Complete palate This major connector covers
the entire palate. Anterior border should be 6mm
away for the gingival margin or extend up to
the cingula of the anterior teeth. The Posterior
border of complete palate should extend to the
junction of the hard and soft palate (Fig. 18.74). Fig. 18.75: Combination of metal and acrylic denture base.
The anterior half is metal and the posterior half is acrylic
A slight border seal can be obtained by giving
a beading posteriorly, but a peripheral seal
cannot be obtained equivalent to a complete Indications:
denture. The loss of peripheral seal is due to • Used when many posterior teeth are
rebounce of soft tissue after compression. The replaced.
beading helps to prevent food accumulation • In cases where anterior teeth are to be
between the palate and the connector. replaced along with a Kennedy’s class I
It can be constructed using: condition.
• All acrylic • For patients with well developed muscles of
• A combination of metal and acrylic. Here mastication or presence of all mandibular
the metal extends over the anterior half of teeth. In such cases there will be excessive
the palate, while the acrylic covers the load and displacing forces, which can only
posterior part of the palate. the posterior be distributed by a complete palate.
border of the metal contains small projec- • In cases with flat ridges and shallow vaults
tions (meshwork) for retention with acrylic where high stability is required. 333
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• Step 5: Unification: After deciding on the type • Relief is given in all cases. The amount of relief
18
of the major connector to be used, the various varies based on:
markings on the master cast (denture base • Type of major connector.
and connector) are connected. This gives the • The amount of slope in the tissue lingual
design and extent of the major connector to the anterior teeth.
(Fig. 18.79). • Additional relief should be given for distal
extension cases. This is because rotational
movement of the denture base can trau-
matize the gingiva. For Kennedy’s class
III cases where there is minimal rotation,
less relief is sufficient. If the lingual mucosa
slopes towards the tongue, maximum
relief should be given. On the other hand
if the lingual mucosa is vertical, (without
a slope) minimum relief is given (Fig.
18.81).
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Fig. 18.82: The depth of the lingual sulcus can be measured Lingual Bar
using a graduated probe when the muscles in the floor of It is the most commonly used mandibular major
the mouth are made active. The floor of the mouth can be
connector
activated by asking the patient to touch his upper lip with his
tongue • It is half pear-shaped in cross-section with
the thickest portion placed inferiorly (Fig.
Using tracing compound: An impression tray 18.84).
whose lingual border is about 3 mm short of an • It is made from a thick (6-gauge) half pear-
elevated floor of the mouth is used. The lingual shaped wax pattern.
sulcus is recorded with the help of tracing com-
pound. After border moulding, the impression
is made using this tray. The exact sulcus depth
and width are reproduced in the cast poured/
made from this impression. This cast is used to
fabricate the framework (Fig. 18.83).
There are six common types of mandibular
major connectors.
• Lingual bar
• Lingual plate
• Kennedy bar or double lingual bar.
• Sublingual bar
• Mandibular cingulum bar (continuous
bar) Fig. 18.84: Half pear-shaped cross-section of a lingual bar
336 • Labial bar major connector
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Advantages:
• Most rigid and stable.
• Provides indirect retention when rests are
provided on the premolars.
• Additional tooth replacements can be easily
added.
Disadvantages:
• Decalcification of tooth structure due to food
Fig. 18.89: Lingual plate major connectors supported with a and plaque accumulation.
rest at the mesial marginal ridge of the first premolar on • Irritation of oral mucosa.
either side
Double lingual bar/Kennedy bar
• When remaining teeth are not periodontally • It is also called lingual bar with cingulum bar
sound. (continuous bar) retainer.
• When there is no space for lingual bar. • It differs from lingual plate in that the middle
• Presence of inoperable mandibular tori. portion is taken off.
• When patient has bilateral distal extension • Lower part is pear-shaped, similar to single
edentulous areas and resorbed ridges and lingual bar.
when anterior teeth lack bony support. • Upper bar is half oval, 2-3 mm high and 1
• When one or more incisor teeth have to be mm thick (Fig. 18.91).
replaced in the future. The lingual plate is
preferred because additional teeth can be
added by attaching retention loops to it (Fig.
18.90).
• When there is excessive vertical ridge resorp-
tion in Kennedy’s class I cases to resist hori-
zontal rotations.
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Contraindications:
• Lingual tori
Fig. 18.93: The vertical major connector supporting the
mesial premolar rests serves to unite the double lingual bar • High frenal attachment (lingual frenum).
• Excessive elevation of the floor of the mouth
• The minor connector is also used to place rests during functional movements.
on the mesial fossa of the first premolar.
Cingulum bar
Indications:
• It is also known as the ‘continuous bar retainer’.
• In cases with large interproximal embrasures
• It is located on or slightly above the cingula
needing indirect retention.
of the anterior teeth (Fig. 18.95).
• In cases with large diastema to avoid
• It may be used alone or with a lingual bar.
unaesthetic display of metal.
Advantages: • Step-back design is followed for diastema
• Provide indirect retention patients.
• Horizontal stabilization
• Inter-proximal embrasures and gingival tis-
sues are not covered allowing free flow of
saliva.
Disadvantages:
• Interference with the free movements of the
tongue.
• If upper bar is not properly fitting food
entrapment may occur. Fig. 18.95: Cross-sectional view of a cingulum
bar major connector
Sublingual bar It is a modification of the lingual
bar. The cross-section is similar to the lingual Indications:
bar except that it is placed more inferiorly and • In cases with large interproximal embrasures
posteriorly than the lingual bar i.e. overlying the requiring indirect retention.
anterior part of the floor of the mouth (Fig. 18.94). • In cases with large diastema to avoid
Indications. unaesthetic display of metal.
• It can be used alongwith a lingual plate if the Labial bar
lingual frenum does not produce any • It is a mandibular major connector similar to
interference. a lingual bar placed on the labial surface, but
• It is used in the presence of anterior lingual it is broader and thicker than a lingual bar
undercut. (Fig. 18.96).
• If the sulcus depth is too little and a lingual • It is also half-pear-shaped in cross-section.
bar cannot be placed with atleast 4mm clea- • It runs along the mucosa labial to the anterior
rance from the free gingival margin. 339
teeth.
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344 Fig. 18.112: External finish line (red line) Fig. 18.114a: Approach arm of a bar or roach clasp
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Auxiliary rests are usually placed where the Fig. 18.121: Semilunar cingulum rest
perpendicular drawn from the midpoint of the
terminal abutment axis meets the dentition. The
auxiliary rests are connected to the major con- Incisal rest: Placed on the incisal edge of a
nector by a minor connector (Fig. 18.119). The tooth, usually in a mandibular canine and
346 auxiliary rest along with the minor connector incisors (Fig. 18.122).
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Design
18
• The occlusal rest seat is a triangular-shaped
depression, with its base at the marginal ridge
and apex at the center of the tooth. Its margins
should be smooth and gently curved (Fig.
18.124).
Fig. 18.122: ‘V’ shaped incisal rest
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Fig. 18.138: Rest seat prepared on a wax pattern. Notice • The rest seat should be 2.5 mm wide and
the accentuated cingulum contoured in the pattern to 1.5 mm deep. The deepest part of preparation
facilitate the placement of the rest should be towards the long axis of the tooth
mesiodistally. The notch should be smooth
(Fig. 18.140).
Indications for lingual or cingulum rests Lingual
rest seat preparation on the enamel is prepared
only if:
• The cingulum is prominent
• The patient practices good oral hygiene
• The caries index is low.
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Fig. 18.141: Facial extension of the incisal rest to provide Direct Retainers
a lock for the rest
Definitions
Direct retainer “A clasp or attachment applied to
an abutment tooth for the purpose of holding a
removable denture in position”.
“It is that component part of a removable partial
denture that is used to retain and prevent dislodge-
Fig. 18.142a: A shallow channel like preparation should be ment, consisting of a clasp assembly or precision
prepared on the lingual surface of the abutment for the attachment”—GPT
placement of the minor connector
Retention “Retention is that quality inherent in
• Multiple incisal rests should be connected the prosthesis which resists the force of gravity, the
lingually by a plate of metal (Fig. 18.142b) adhesiveness of foods, and the forces associated with
the opening of the jaws” – GPT.
Direct retention “Retention obtained in a removable
partial denture by the use of clasps or attachments
which resist removal from the abutment teeth” -
GPT.
Indirect retention “Retention obtained in a removable
Fig. 18.142b: When multiple incisal rests are placed, each. partial denture through the use of indirect retainers”
One is not individually connected to the major connector.
- GPT.
Instead they are interconnected with a metal plate which is
connected to the major connector
Classification
Indications: Full incisal rests may be given in the Direct retainers are broadly classified as:
following clinical conditions: • Extracoronal direct retainers (Clasps):
• Tooth morphology does not permit other • Manufactured retainers (Dalbo)
designs. • Custom-made retainers:
• When the incisal edge is completely lost, the • Occlusally approaching (Circumferen-
incisal rest can restore the lost contour. tial or Aker’s clasp)
• When more stability is required. • Gingivally approaching (Bar or
• Guidance is required for placement of the Roach’s clasp)
restoration. • Intracoronal direct retainers (Attachments):
After designing the location and position of • Internal attachment
the rests, the rest seats should be prepared. The
• External attachment
rest seats are prepared during prosthetic mouth
• Stud attachment
preparation phase (phase IV) prior to making
• Bar attachment
the secondary impression. The outcome of the
• Special attachments
rest is totally dependent on the rest seat
preparation. The rest is fabricated along with
Extracoronal Direct Retainers (Clasps)
the framework.
The technique for the preparation of each rest An extracoronal direct retainer is defined as, “A
seat is described in detail in the next chapter part of a removable partial denture which acts as a 351
‘Prosthetic mouth preparation’. Students should direct retainer and/or stabilizer for the denture by
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Types of clasps
18
The types of clasps are:
• Circumferential or Aker’s clasps
• Vertical projection or Bar or Roach clasps
• Continuous clasp
Cast circumferential clasp: “A clasp that
encircles a tooth by more than 180 degrees, including
opposite angles, and which usually has total contact
with the tooth (throughout the extent of the clasp),
with atleast one terminal being in the infrabulge Fig. 18.166: Notice that a cast circumferential clasp alters
(gingival convergence) area” - GPT. the width of the tooth and hence the occlusal table
Vertical projection clasp / Bar clasp / Roach clasp: • If these clasps are placed high (more
“A clasp having arms which are bar type extensions occlusally) on the tooth, the width of the food
from major connectors or from within the denture table increases leading to generation of
base; the arms pass adjacent to the soft tissues and greater occlusal forces.
approach the point or area of contact on the tooth in • All cast circumferential clasps should never
a gingivo-occlusal direction” - GPT. be used to engage the mesiobuccal undercut
Continuous clasp: “A metal bar usually resting of an abutment adjacent to the distal
on the lingual surface of teeth to aid in their edentulous space (Fig. 18.167). Hence, they
stabilization and to act as an indirect retainer”-GPT. cannot be used for cases with an undercut
away from the edentulous space.
Cast Circumferential Clasp
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Fig. 18.169: Reverse circlet clasp Fig. 18.170: Multiple circlet clasp
• It engages the undercut, located away from 3. Multiple circlet clasp (Fig. 18.170)
the edentulous space. • It is a combination of two simple circlet clasps
• Clasp can be adjusted only in one direction joined at the terminal end of the reciprocal arms.
(i.e. buccolingually but not occlusogingivally). • It is used for sharing the retention with addi-
• They cannot be used for distal extension cases tional teeth on the same side of the arch when
as they engage a mesio buccal undercut. the principal abutment tooth has poor perio-
2. Reverse, circlet or reverse approach clasp dontal support.
(Fig. 18.169) • It is a mode of splinting weakened teeth.
• This clasp is used when the retentive undercut • It’s disadvantages are similar to that of simple
on the abutment tooth is located adjacent to and reverse circlet clasps.
the edentulous space. 4. Embrasure clasp or modified crib clasp
• Consider a distal edentulous condition. (Fig. 18.171a)
Usually the clasp will arise from the distal • It is a combination of two simple circlet clasps
surface of the abutment to reach the mesial joined at the body.
undercut. But this clasp is designed in such a • It is used on the side of the arch where there
way that the clasp arises from the mesial side is no edentulous space.
and ends on the distal undercut. • The clasp crosses the marginal ridges of two
• Usually Bar clasps are preferred for distal teeth to form the double occlusal rest. The
extension cases. These clasps are used when clasp emerges on the facial surface and splits
a bar clasp is contraindicated. E.g. into two retentive arms. Each retentive arm
• If there is an undercut area in the ridge engages the undercut located on the opposite
• Presence of a soft tissue undercut caused side of the tooth.
by buccoversion of the abutment tooth. • Interproximal tooth structure should be remo-
• These clasps are used in distal extension den- ved to provide sufficient thickness of the
ture base to control the stresses acting on the metal. The clasp may break if the metal is too
terminal abutment teeth on the edentulous thin.
side.
Disadvantages:
• If sufficient occlusal clearance is not present,
the thickness of the clasp has to be reduced.
This will affect the strength of the clasp.
• The occlusal rest away from the edentulous
space does not protect the marginal ridge of
the abutment tooth adjacent to the
edentulous space. Hence, an additional rest Fig. 18.171a: Embrasure clasp
must be placed to provide the necessary
protection.
• Poor aesthetics as the clasp runs from the
mesial to the distal end of the facial surface.
• Wedging may occur between the abutment
360 and its adjacent tooth if the occlusal rest is
not well prepared. Fig. 18.171b: Pontic clasp
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• It has a rigid minor connector. • It has a flexible minor connector. The minor connector for
the bar clasp is called approach arm.
• It is easier to remove. This is because only the retentive • It is easier to seat but difficult to remove because the minor
terminal should flex to be relieved from the undercut. connector should flex alongwith the retentive arm to be
relieved from the undercut.
• It has a pull type retention. That is the retentive tip • It has a push type retention. That is the retentive tip
should pull occlusally to engage the undercut. should push occlusally to engage the undercut.
• Due to continuous tooth contact, it has a good • Due to limited 3-point tooth contact, it has less bracing effect.
bracing effect.
• It is less aesthetic, due to more metal exposure. • More aesthetic as it is present below the height of contour.
• It has reduced food debris accumulation as it adapts • Increased food debris accumulation, because a space exists
more closely to the tooth. between the minor connector and the abutment surface
and the length of the clasp assembly is more.
• Easy to repair due to it’s simple design. • Difficult to repair as the design is more complex.
• It increases the width of the occlusal table because the • No such problem as it is placed in a lower position.
retentive arm arises near the occlusal surface of the
abutment. It increases the occlusal load on the abutment.
• Due to increased tooth coverage it may cause • No decalcification due to limited 3-point contact.
decalcification.
• It can be used in tilted abutments and in cases • It cannot be used in cases with tilted abutment and
with soft tissue undercuts. soft tissue undercuts.
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External Attachment: e.g. ASC52, DALBO, Bar Attachment: e.g. DOLDER, HADER
CEKA, and ERA It is used when there is bone loss around the
These attachments are more aesthetic, resilient abutment teeth (Fig. 18.192).
and easy to insert. They are indicated for an Advantages:
anterior prosthesis in a young patient with a • Rigid splinting
large pulp chamber (Fig. 18.190). • Cross-arch stabilization
Disadvantages: • It can be used along with other attachments
• Bulky attachment requires more space within or implants for a combined fixed-removable
the removable partial denture. prosthesis. 367
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Advantages:
• Highly aesthetic as the visible clasp compo-
nents are absent.
• It reduces torque and tipping forces on the Figs 18.195a and b: Neurohr-Williams shoe attachment:
abutment. (a) lateral view, (b) proximal view
Special attachments are also classified as
locking and non-locking types. The non-locking A short retentive clasp arm made up of
types can be used for Kennedy’s class I and class wrought wire is fabricated to engage the small,
368 II case. Commonly used special attachments are: horizontal, distobuccal groove made on the abut-
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ment. The wrought wire is fabricated such that major connector. It is separated from the major
18
it is hidden within the denture base. The part of connector by an incomplete cut made by either
the wrought wire submerged inside the acrylic machining or by placing a matrix during casting
is called the shoe. The lateral walls of the rest are to increase its flexibility.
parallel and help to resist horizontal rotation. Advantages:
Indications: • No contact of the prosthesis with the
• Can be used for tilted abutments where a abutment.
conventional clasp cannot be given. • The flexible lingual arm provides a stress
• It can be used for anterior abutments for breaking effect.
aesthetic reasons. • Less food accumulation.
Advantages: • Aesthetic and easy to maintain.
• It acts as a stress breaker during distal • Can be used alongwith fixed partial dentures.
rotation. Disadvantages:
• Lowered leverage point of applied force. • Limited horizontal stability.
• Multiple options for the placement of a reten- • More force is transmitted to the edentulous
tive area. ridge.
• Internal reciprocation.
Zest Anchor device (Fig. 18.197a) It has a nylon
• Internal indirect retention.
male post attached to the denture base, which
• Very aesthetic.
fits into the female insert in the abutment.
• Simple in form.
• More stable.
Disadvantages:
• The abutment may migrate anteriorly.
• Poor retention in cases with short or tapered
abutments, deep bite and large pulps.
• Extensive and requires a complex procedure.
Dowel rest attachment (Fig. 18.196) Dr.
Morris.J.Thompson developed this design. It has
a box shaped rest seat. A dimple (depression) is
created on the lingual surface of the abutment. Fig. 18.197a: Zest Anchor device
A box (projection) is fabricated on the lingual
arm of the denture framework such that it fits
into the dimple. Intracoronal magnets (Fig. 18.197b) Magnets
There are no visible clasps but retention is with opposite polarity are placed on the rest seats
achieved by the locking of the dimple and the and the denture base. The magnetic attraction
box. The lingual arm is an extension from the produces retention.
Hannes Anchor or IC plunger (Fig. 18.198) Here
the male plunger fits in to a dimple on the
Fig. 18.196: Dowel rest attachment Fig. 18.197b: Intracoronal magnets 369
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fulcrum line established by the posterior most Movement towards the teeth
18
occlusal rests (Fig. 18.203). (away from the tissue)
These forces affect the retention of the denture.
This movement is prevented by the activation of
the direct retainer, which is passive in normal
conditions (Fig. 18.205).
Fulcrum Lines
When any one of the above mentioned forces
act on a denture, the denture tends to rotate
around a fulcrum line (axis of rotation). This
fulcrum line is usually formed at the terminal
Fig. 18.204: Occlusal (primary and auxiliary) rests prevent
abutment axis (line joining the two posterior-
the tissue-ward movement of the denture due to vertical most rests). A fulcrum line is defined as “An
forces imaginary line around which a partial denture tends
371
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to rotate” - GPT (Fig. 18.207). There are two types In order to prevent the rotation of the denture,
of fulcrum lines namely: the fulcrum line should be moved away from
the area of force application. This is achieved by
adding an additional rest away from the
edentulous area (Fig. 18.209).
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Types of Indirect Retainers Fig. 18.216a: Lug seat extension from the adjacent premolar
primary abutment. It serves as an indirect retainer by shifting
The most commonly used type of indirect the fulcrum line anteriorly
retainer is a rest connected to a minor connector.
In some cases indirect retention is obtained
without a rest. In the following section, we shall
discuss about the different types of indirect
retainers and their salient features.
1. Auxiliary occlusal rest
• Most frequently used.
• It is located on the occlusal surface as far as
possible away from the distal extension base.
Fig. 18.216b: Lug seats do not require a separate minor
• It is placed perpendicular to the midpoint of connector for support. They are superior to a conventional
the fulcrum line. If this perpendicular ends cingulum rest in that they require less tooth preparation and
374 on the incisal area it is avoided. do not produce any tipping forces on the canine
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Metal pontics
It may be a full-metal crown or metal crown with
a tooth-coloured veneer. They are given in cases
where acrylic or porcelain teeth cannot be given.
Example—When there is reduced occlusal clear-
ance or when there is limited inter-dental space.
Fig. 18.225: Reinforced acrylic pontics
It is made up of gold or chrome alloy. Chrome
Advantages: alloy abrades the natural teeth very quickly.
• High strength Hence, the occlusal surface should be covered
• Better aesthetics with tooth coloured resin. Gold is preferred as it 379
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has adequate strength and restores occlusion to factors. A.H.Schmidt in 1956 stated the following
the maximum limit. five principles to be considered during the fabri-
cation of a removable partial denture. They are:
Metal pontics with acrylic windows
• The dentist must have a thorough knowledge
In cases with reduced space and aesthetic
of both the mechanical and biologic factors
requirement, the buccal surface of the pontic is
removed and tooth coloured acrylic is packed involved in removable partial denture design.
into the buccal surface. He must know about the various forces
acting on the denture and soft tissues and
Tube teeth their response to these forces.
It is mostly used for posterior tooth replacements • The treatment plan must be based on a com-
especially for maxillary premolars. They are not plete examination and diagnosis of the indivi-
used for distal extension prosthesis. dual patient. Any negligence in the
Reinforced acrylic pontics (RAP) appropriate diagnosis will lead to failure of
These are nothing but acrylic teeth reinforced the prosthesis.
with metallic loops extending into the gingival • The dentist must correlate the pertinent
half of the lingual surface. The acrylic is factors and determine a proper plan of
processed around the metal projections. The treatment. He must examine the existing oral
metal projections give strength to the teeth. condition and do the necessary modifications
Advantages: before designing a removable partial denture.
• Excellent strength and aesthetics. • A removable partial denture should restore
• Can be designed such that the opposing teeth form and function without injury to the
contact only the acrylic. remaining oral structure. It should produce
• Strong even in small sizes. Hence, it can be adequate aesthetics and function without
used in cases with reduced inter-arch space. compromising on the health of the soft tissues.
Disadvantages: • A removable partial denture is a form of
• Contraindicated for cases with unhealed or treatment and not a cure. Even after insertion,
excessively resorbed ridges. the patient should be recalled and reviewed
• Little support can be obtained from the ridge. to ensure success of the treatment.
• Cannot be relined.
The Various Principles Involved in the
Bonding between the Teeth and the Denture Base Functioning of a Removable Partial
Denture
The mechanism of bonding varies according to
the type of denture base and tooth replacement • Different forces acting on a denture in the
used. Denture base-teeth bonding can be broadly mouth.
grouped into: • The response of the denture to the forces
• Mechanical acting on it.
• Chemical • Design methods, which help to limit the
• Chemicomechanical effects of these harmful forces.
• Acid etching (Microretention) In this section, we will discuss about the
• Silanation (Tribo-chemical method). This is forces acting on a denture, the response of the
a combination of acid etching and denture to these forces and the methods of
chemical bonding. modifying the response of the denture (designing
the denture to reduce the stress developed within
PRINCIPLES OF A REMOVABLE it).
PARTIAL DENTURE Different Forces Acting on the
A denture should be designed to obtain a balance Denture Inside the Oral Cavity
380 between both the mechanical and biological The oral cavity is a complex structure enclosed
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Removable Partial Denture Design
within a lot of muscles. The forces acting on the equilibrium (Fig. 18.228). Artificial teeth on the
18
denture arise from different sources in different denture should be placed on this zone to achieve
directions. The various forces and their origin good stability for the denture.
are:
Response of the Denture to Various
Occlusal force It acts on the occlusal surface of
Forces Acting on it
the denture. It is of very high magnitude. This
force pushes the denture on to the tissues on the Generally tissue supported partial dentures
edentulous ridge. Excessive occlusal forces can respond like a lever or like an inclined plane
produce residual ridge resorption (Fig. 18.227). when a force is applied on them. Tooth
supported partial dentures (Kennedy’s Class III)
are not supported by resilient structures, and
they transmit all the forces acting on the
prosthesis along the long axis of the abutment
tooth. A tooth supported partial denture is rarely
subjected to induced stresses because.
• Leverage type of forces are not involved.
• There is no fulcrum line around which the
Fig. 18.227: Tissue supported partial dentures transfer most partial denture can rotate.
of the forces acting on them to the residual ridge and produce Kennedy’s Class I, II and IV (long span)
resorption
removable partial dentures take support both
Forces from the tongue The tongue tends to push from the teeth and the soft tissues. Hence, the
the denture buccally and labially. Excessive force forces acting on the denture are shared between
from the tongue can displace the denture the tooth and the soft tissues. Since two tissues
frequently during function. of different resiliency support the denture, stress
is precipitated within the denture due to uneven
Forces from the surrounding musculature (lip and
settlement during occlusal loading (Fig. 18.229).
cheek muscles) These forces compensate the
The following design principles aid to control
forces of the tongue. Excessive forces tend to
the effect of the various forces:
displace the denture (Fig. 18.228).
• Maximum coverage of soft tissue
• Efficient use of the direct retainer
• Proper placement of the components in their
most favorable position.
Fig. 18.228: The forces of the tongue and the cheek are
neutralized in the neutral zone. Artificial teeth should be
arranged in this zone to obtain best stability
Fig. 18.229a: Tooth tissue supported dentures are subjected
to leverage forces due to the difference in the compressability
A balance is usually maintained between the
of the supporting structures (periodontal ligament of
buccinator and the tongue. This balance results abutments is less resilient compared to the mucosa overlying
in a ‘dead zone of nil force’. This zone is called the residual ridge hence the denture will settle more in the
neutral zone or zone of minimal conflict or zone of tissue support areas) 381
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Fig. 18.230: Ist order lever Fig. 18.232: IInd order lever
382 E = Effort, F = Fulcrum, L = Load F = fulcrum, L = load, E = effort
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18
Lever action in a Kennedy’s Class I prosthesis: over the crest of the residual ridge (Fig. 18.236).
In a distal extension partial denture rotation In a Class I condition, there are two such
occurs around 3 principal fulcrums. They are: fulcrums extending posteriorly from each
Horizontal fulcrum line passing between two primary abutment to the respective retromolar
principal abutment teeth: It acts along the x-axis pads (Fig. 18.237). These forces also have severe
of the denture. This controls the rotational effects on the soft tissues.
motion of the denture towards or away from Third fulcrum line (Vertical): It is vertical and
the supporting soft tissues. Forces across this is located on the midline, lingual to the anterior
lever produce the most deleterious effect on the teeth. It acts along the y-axis of the denture. It
supporting tissues and the abutment teeth (Fig. controls the movement of the denture around
18.235). the y-axis (Fig. 18.238).
Second rotational fulcrum line (Sagittal): It When the forces acting on the denture are
extends posteriorly from the occlusal rest of the vertical, most of the periodontal ligament fibres
terminal abutment. It passes along the alveolar are activated which provides good resistance to
crest till the posterior extent of the residual ridge the force. If the forces acting on the denture are
on the same side. It acts along the z-axis of the not vertical, only a part of the periodontal fibres
denture. This fulcrum controls rocking or side- are activated. This can produce damage to the
to-side movement of the denture that takes place abutment tooth (Fig. 18.239). 383
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18 Textbook of Prosthodontics
Fig. 18.238: Third rotational fulcrum line passing through Designing a RPD to Limit the Effects of
the Y-axis or vertical axis of the partial denture
Harmful Forces
In order to get a complete understanding about
the various design concepts available, to limit
the effects of harmful forces on the denture, we
must have a thorough knowledge about the
various factors that affect the magnitude of these
forces.
Factors influencing magnitude of stresses
transmitted to abutment teeth The various factors
that control the amount of stress transmitted to
the abutment are:
1. Length of the edentulous span.
Fig. 18.239: Vertical forces are well distributed all across
2. Quality of support of the ridge.
the pericemental area of the supporting tooth whereas 3. Response of oral structures to previous stress.
384 oblique forces are partially distributed producing damage to 4. Occlusal relationship of the remaining teeth
the periodontium and orientation of the occlusal plane.
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18 Textbook of Prosthodontics
Disclosing wax can be used to test the proper denture should be designed in such a way that
placement of a framework. the retention obtained from the clasp is just
A clasp should be designed so that the reci- enough to provide adequate retention to prevent
procal arm contacts the tooth before the retentive dislodgement of the denture. It should also be
tip passes over the greatest bulge of the tooth remembered that the retentive clasp should be
during insertion and it should be the last compo- designed such that it is active only during
nent to lose tooth contact during removal of the insertion and removal.
prosthesis.
2. Forces of adhesion and cohesion Adhesion is
7. Length of the clasp The flexibility of a clasp defined as “The physical attraction of unlike
depends on its length. Doubling the length incre- molecules for one another” - GPT. Here, adhesion
ases the flexibility by five times. This decreases refers to the attraction of saliva to the denture
the stress on the abutment tooth. Using a curved and the tissues. Cohesion is defined as “The
rather than a straight clasp on an abutment tooth physical attraction of like molecules for one another”-
will aid to increase the clasp length (Fig. 18.244). GPT. Here, cohesion refers to the internal
attraction of the molecules of saliva for each
other.
Forces of adhesion and cohesion can be
increased by:
• Recording an accurate impression so that
the denture base fits accurately to the
supporting tissues.
Fig. 18.244: Longer clasp arms offer greater flexibility hence, • Increasing the denture bearing area.
retentive arms can be looped to increase their length Atmospheric pressure may also contribute to
retention. Generally, major connectors are
8. Material used in clasp construction A clasp
beaded at their margins so that a tight valve seal
constructed of chrome alloy will exert more stress
on the abutment tooth than a gold clasp because is obtained.
of its greater rigidity. To decrease the stress, the 3. Frictional control: Partial dentures should be
chrome alloy clasps are constructed with a designed to have maximum number of guide
smaller diameter. planes. Guide planes are flat surfaces on the teeth
9. Abutment tooth surface The surface of a gold that are created such that they are parallel to
crown or restoration will offer more functional one another and also to the path of insertion.
resistance to the movement of a clasp arm than As the name suggests, guide planes help to guide
enamel. Therefore, more stress is exerted on the the denture during insertion. Various parts of
tooth restored with gold than on the tooth with the partial denture slide along the guide planes
intact enamel. during insertion.
Preparation of guide planes on the proximal
surfaces of teeth adjacent to edentulous spaces
Controlling Stress by Design Considerations will increase the retention by frictional contact.
A removable partial denture will always have a These planes may be created on the enamel
destructive effect within the oral cavity. The best surface of the teeth or on the surface of the resto-
we can do is minimizing these destructive effects. rations placed on the teeth. During displace-
The following factors can be modified to reduce ment, the components of the denture produce
the stresses developed within a denture. frictional retention along the surface of the guide
planes (Fig. 18.245).
1. Direct retention The retentive clasp arm is
responsible for transmitting the destructive 4. Neuromuscular control The action of lips,
386
forces to the abutment teeth. A removable partial cheeks and tongue can be a major factor in the
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Removable Partial Denture Design
Now apply this concept in the design of a Fig. 18.258: Circular concept in maxillary major
major connector. The palate has a flat vault and connectors 391
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18 Textbook of Prosthodontics
Strut configuration: According to this configu- such that it does not interfere with the placement
ration, a straight bar bent at its ends near the of the artificial teeth, tongue etc. The minor
support is more rigid because, the bent slopes of connectors used for auxiliary rest aid in indirect
the bar aid to transfer the load acting on the retention. It has the following functions:
horizontal portion (Fig. 18.259). This is similar • It provides horizontal stability to the partial
to the linear bar theory (L-beam discusses stress denture against lateral forces on the
concentration but struts discuss stress distribu- prosthesis.
tion). The major connector on a narrow vault is • The abutment tooth receives stabilization
more rigid than a major connector extending against lateral forces by the contact of the
over a shallow vault. In other words, the major minor connector.
connector extending in two different planes has 13. Rests Rests help control stress by directing
more rigidity. This concept is seen in the anterior the forces acting on the denture to the long axis
plate of the double palatal bar, where the slope of the abutment teeth. The floor of the rest seat
of the rugae area acts as an additional strut (Fig. should be less than 90° to a tangent line drawn
18.260). parallel to the long axis of the tooth. In class I
and class II partial dentures, the rest seat
preparation must be saucer shaped. Adding rests
on additional teeth decrease the amount of
occlusal load on each tooth and helps to
distribute the occlusal load equally to all the
Fig. 18.259a: A bar supported only at its ends is subjected abutment teeth.
to greater stress and poor force distribution. Red Zone is
the stressed area PRINCIPLES OF DESIGN/OR
PHILOSOPHY OF DESIGN
The various philosophies of design deal with the
methods employed to design a denture such that
it evenly distributes the forces acting on it across
the hard and soft tissues of the oral cavity.
Fig. 18.259b: Same bar additionally supported by struts is All design characteristics of a partial denture
stronger and more efficient in force distribution
should be such that the supporting structures
are not stressed beyond their physiological limits.
Usually a tooth supported removable partial
denture (Kennedy’s class III) has a better soft
tissue response than a tissue supported partial
denture (Kennedy’s class I and II).
Fig. 18.260a: Anteroposterior struts seen in double palatal There are four design concepts, which can
bars be used to distribute the force evenly along the
soft tissues and supporting tooth structure. They
are:
• Conventional rigid design.
• Stress equalization.
• Physiologic basing.
Fig. 18.260b: Lateral struts seen in most maxillary major • Broad stress distribution.
connectors
Conventional Rigid Design
12. Minor connector The minor connector joins The denture is designed with rigid components,
the major connector to the clasp assembly and which act like a raft foundation to evenly distri-
392 the guiding planes located on the abutment tooth bute the forces on the supporting tissues. This
surface. The minor connector should be designed design is used in all general cases. The only
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Removable Partial Denture Design
Advantages
• Easy to construct and economical.
• Equal distribution of stress between the
abutment and the residual ridge. Fig. 18.261: Stress breakers can be added to the junction
• Reduced need for relining as the ridge and between the tooth supported portion and tissue supported
abutment share the load. portion of the denture to avoid leverage forces
• Indirect retainers prevent rotational move- As the tissues are more compressible, the
ment and also stabilize the denture during amount of stress acting on the abutments is
horizontal movements. increased. This can produce harmful effects on
• Less susceptible to distortion. the abutment teeth.
In order to protect the abutment from such
Disadvantages conditions, stress breakers are incorporated in
• Increased torquing forces on the abutment to a denture. A stress breaker is something like a
teeth. hinge joint placed within the denture
• Rigid continuous clasping may damage the framework, which allows the two parts of the
abutment teeth. framework on either side of the joint to move
• Dovetail intracoronal retainers cannot be used freely. There are two types of stress breakers:
in these cases as tipping forces from the
denture base will be directly transmitted to Type I
the abutment teeth. Here a movable joint is placed between the direct
• Tapered wrought wire retentive arm (combi- retainer and denture base. This joint may either
nation clasp) cannot be used, as it is difficult be a hinge or a ball and socket or a sleeve and
to construct. cylinder. Adding these stress breakers to the
• Relining is difficult and inappropriate relining junction of the direct retainer and the denture
leads to damage of the abutment teeth. base, allows the denture base to move indepen-
dently (Fig. 18.262).
Stress Equalization or Stress Breaker or This decreases the amount of force acting on
Stress Directing Concept the abutment. The combined resiliency of the
periodontal ligament and the stress director will
A stress breaker is defined as, “A device which
be equal to the resiliency of the oral mucosa
relieves the abutment teeth of all or part of the
overlying the ridge. Examples for hinges include
occlusal forces” - GPT.
DALBO, CRISMANI, ASC 52 attachments.
“A stress director is a device that allows
movement between the denture base and the direct
retainer which may be intracoronal or extracoronal”.
Dentures with a stress breaker are also called
as a broken stress partial dentures or articulated
prostheses. We know that the soft tissues are more
compressible than the abutment teeth. In a
tooth-tissue supported partial denture, when an
occlusal load is applied, the denture tends to rock
due to the difference in the compressibility of
the abutment teeth and the soft tissues (Fig. Fig. 18.262: The denture base shows independent
18.261). movement with type I stress breakers 393
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18 Textbook of Prosthodontics
Physiologic Basing
This technique distributes the occlusal load
between the abutment teeth and the soft tissues
by fabricating a denture based on a functional
record. Functional record is obtained by
Fig. 18.263: Split major connector or type II stress breaker recording the tissues under occlusal load or by
relining the denture under functional stress. This
retainers are connected to the upper unit (Fig. technique involves making an impression of the
18.263). soft tissues in a compressed state.
The denture fabricated using a functional
Advantages impression has one major disadvantage. That is
the denture tends to compress the soft tissues
• The alveolar support of the abutment teeth is
even at rest. This can lead to excess ridge resorp-
preserved as the stress acting on the abut-
tion (Fig. 18.264).
ment teeth are reduced.
• The stress on the residual ridge and the
abutment teeth are balanced.
• Weak abutment teeth are well splinted even
during the movement of the denture base.
• Abutment teeth are not damaged even if
relining is not done appropriately (after the
denture wears out). Fig. 18.264: Physiologically based dentures compress
tissues even at rest. Hence, during occlusal loading, the
• Minimal requirement of direct retention.
tissues cannot be compressed further. The already
• Movement of the denture base produces a compressed tissues offer greater resistance to compression
massaging effect on the soft tissues. equivalent to that of the periodontal ligament thereby
• This avoids the frequent need for relining and preventing stresses within the denture
rebasing. Since the denture is fabricated using a func-
tional record (compressed tissues), the soft tissues
Disadvantages offer more resistance to further compression.
• Design is complicated and expensive. This increased resistance to compression
• The assembly is very weak and tends to frac- provided by the oral mucosa equates to that of
394 ture easily. Distorts to rough handling. the periodontal ligament of the abutment tooth.
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18 Textbook of Prosthodontics
harmony with the remaining natural teeth. The • Retaining the natural teeth as an intermediate
artificial teeth should be selected and positioned abutment or as an over denture abutment.
on the denture base so that the stress is mini- • Shorter the edentulous area, the lesser are the
mized. tipping forces.
• Preservation of the labial alveolar bone.
Denture Base Four clasps should be placed to obtain a
A broad coverage without any functional inter- quadrilateral design. The major connector should
ference is required. A selective pressure impres- be rigid and have a broad coverage. The indirect
sion technique (discussed later) is needed. retainer should be placed posterior to the fulcrum
line. A functional impression is needed for a large
edentulous span.
Design Consideration for Kennedy’s
Class III Case LABORATORY DESIGN PROCEDURE
Direct Retention Step-by-Step Sequence
The damage to the abutment teeth is very less It is assured that the reader is aware of the
compared to other cases. The position of the different components of a partial denture to
undercut is not critical. make meaningful decisions during designing.
Clasp Armamentarium Required
Four clasps should be placed to obtain a quadri- • Surveyor and accessories
lateral design. It should fulfil all the ideal • Articulator (Galetti-Luongo type)
requirements. • It does not utilize plaster to hold casts in
position. It is an excellent diagnostic tool.
Indirect Retention
• Casts are held with the help of clamps only.
It is usually not needed. But if a clasp is not • When the clamps are released, the casts
placed on the posterior tooth, indirect retention can move independently in 3 dimensions.
should be provided as in class I and class II cases. • Pencils for colour coding: Red, blue, brown or
green crayon and black lead pencil (2H or
Rest, Major Connector, 3H). The most commonly used colour code
Minor Connector and Occlusion key for laboratory design is as follows:
Similar to that of class I or II designs. • Red (solid): for rest seats
• Red (outline only): for tooth surfaces that
Denture Base are to be contoured and prepared
• Blue: for acrylic resin portions
A functional impression is not required. It should • Brown: for metallic portions. (Green can
fulfil all the ideal requirements discussed also be used here)
previously. • Black: for survey lines, tripod marks, soft
tissue undercuts, type of tooth, use of
Design Consideration for Kennedy’s wrought wire clasps.
Class IV Case
Procedure
The stress pattern on the abutment teeth is unique
to this case. The anterior teeth are placed • The proposed rest areas are marked on the
anterior to the crest of the ridge for aesthetic base of the cast just below the tooth (Fig.
reasons. This leads to the formation of tilting or 18.265)
lever forces against the abutment teeth. These • Next the occlusal rest areas are marked by
396 forces can be minimized by: drawing a (solid) red area (Fig. 18.266).
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Removable Partial Denture Design
18
Fig. 18.267
Fig. 18.265
• The type of tooth to be replaced is written on in repositioning any casts of the same patient
the base of the cast. in the same tilt, that is, the same path of
• Tube tooth: T insertion is maintained throughout treatment.
• Facing: F • The survey lines are scribed (drawn) against
• Metal pontic: M abutment teeth using a carbon marker. This
• Reinforced Acrylic Pontic: RAP is done by rotating the cast (on the holder)
• Denture teeth: No symbol against the side of the carbon marker (Fig.
• Next the cast should be placed on the cast 18.269). Area below this line will be the
holder horizontally. The teeth should be undercut to that path of insertion.
examined for retentive under cuts. Soft • The extent of the denture base is outlined
tissue undercuts should also be examined. using a blue (for acrylic resin) or brown
• Based on the aesthetics and the location of pencil (for metal base) (Fig. 18.270).
favourable retentive undercuts, the tilt of the • The framework outline is drawn with brown
cast is determined. This is the path of pencil. Other structures like major connector,
insertion for the prosthesis. indirect retainer, minor connector etc are
• A red outline is given for areas that require designed and marked/drawn along with this
re-contouring (Fig. 18.267). step (Fig. 18.271).
• Once the tilt is determined, the cast is • The carbon marker is removed and an
tripoded. The tripod points should be marked undercut gauge is placed on the surveying
as the intersection of two 4 to 5mm lines arm. For chrome cobalt alloy 0.010’’ gauge is
within a circle (Fig. 18.268). Tripoding helps adequate, 0.015’’ gauge is required for a gold
397
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18 Textbook of Prosthodontics
Fig. 18.272
Fig. 18.269
Fig. 18.273
398
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Chapter 19
Prosthetic Mouth Preparation
• Introduction
• Preparation of Retentive Undercuts
• Guide Plane Preparation
• Rest Seat Preparation
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Prosthetic
Mouth Preparation
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Prosthetic Mouth Preparation
19
Dimpling (Enameloplasty)
Fig.19.3: The crown wax pattern should be recontoured using
a surveying wax carver to establish the guiding planes Enameloplasty is defined as, “The intentional
alteration of the occlusal surface of the teeth to
• After analysing the pattern the guide planes change their form” - GPT. The enameloplastic
are prepared using a wax carver tool of the procedure done to produce a retentive undercut
surveyor (Fig. 19.3). is known as dimpling. The preparation made on
• After contouring the guide planes on the wax the tooth by dimpling is known as a dimple.
pattern, the undercuts are checked. If there A dimple is nothing but a gentle depression
is no favourable retentive undercut, it is created on the enamel surface of the abutment
contoured directly on the wax pattern being teeth to provide a retentive undercut. It is done
surveyed (Fig. 19.4). when the abutment tooth does not provide any
surface undercut, that can be utilised by some
form of clasp. It can also be done to modify an
existing undercut on the tooth surface and also
on an existing cast restoration without a favour-
able undercut.
Design
Fig. 19.4: Required favourable undercuts should also be • It is a gentle depression, not a pit or hole (Fig.
contoured on the wax pattern
19.6).
• The wax pattern is invested and cast. The
resulting prosthesis with proper contour is
cemented to the tooth. Consecutively, the par-
tial denture treatment is continued.
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19 Textbook of Prosthodontics
Figs 19.10a and b: (a) Some teeth may not have undercuts
when viewed vertically (1) but when viewed at an angle
(2), a favourable undercut may be present (b) The path of
insertion of the denture can be altered such that favourable
Fig. 19.9: Ideally a dimple should be 4 mm mesiodistally undercuts are engaged
and 2 mm occlusogingivally
The cast can be tilted only to a maximum of
10°, beyond which it is not advisable because
• The surface of a dimple should be highly the patient will require excessive mouth opening
polished. for insertion and removal. Generally, tilting the
Indications cast to obtain a retentive undercut is the least
sorted procedure and is not advisable in the
• Small non-retentive undercuts that require presence of other alternatives.
modification.
• Teeth with nearly vertical buccal and lingual GUIDE PLANE PREPARATION
surfaces.
They are prepared by selective grinding of teeth
Procedure (Enameloplasty) or by appropriate shaping of
• A small round ended tapered diamond stone wax patterns of abutment crowns. The design
is used. position and purpose of a guide plane was dis-
• The bur should be moved in the antero- cussed in detail in the previous chapter. In this
posterior direction near the line angle where section we shall read in detail about the
the undercut is to be prepared. procedure for preparing a guide plane.
402
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19 Textbook of Prosthodontics
the master impression. The location position and • Sufficient occlusal clearance must be present
extent of the rest seat is determined using a sur- to accommodate the rest seat and the gold
veyor on a diagnostic cast. The procedure for restoration (Fig. 19.15).
rest seat preparation is different for enamel
(natural tooth structure) and for restorations.
On Enamel
• A depth orientation groove is drawn along
the desired outline form to create an island
of enamel.
• The island of enamel is removed using the
same bur used to make the depth orientation
grooves (Fig. 19.13).
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Prosthetic Mouth Preparation
On Amalgam Restorations
• They are least preferred.
• Occlusal rests are not prepared on multi
surface amalgam restorations. Amalgam Fig. 19.18: Preparation for an embrasure clasp
tends to flow under constant pressure (creep). • Buccal and lingual extensions should extend
• The junction between the proximal portion to the buccal and lingual embrasures.
and isthmus of the restoration should not be • Finishing and polishing is done as usual with
weakened (made thin) as the restoration may a No: 4 round steel bur.
fracture. • Sufficient occlusal clearance should be
• No.4 round bur is used instead of diamond present so that there is no highpoint between
stone. the opposing teeth and the clasp even during
• Procedure is similar to that on enamel. occlusion. This is checked by keeping two 18-
• Polishing is done with No.4 round bur in gauge wires, one beside the other in the
reverse revolutions. embrasure area (Fig. 19.19). (Note: Relieving
• Regular amalgam polishing can also be done. the metal after casting will result in internal
fracture of the rest, hence, the wax pattern itself
Rest Seat Preparation for Embrasure Clasp should be carved properly so that the occlusal
Embrasure clasps are two clasps fused at the clearance is preserved).
body to fit into a single embrasure (Fig. 19.17). • Biting on utility wax makes an impression of
Rest seats for such clasps should be prepared on the area. The thickness of the rest is measured
the mesial and distal fossae of two approximating using a Boley’s gauge.
posterior teeth. The speciality of this preparation
is that the marginal ridges are also reduced for
better strength of the clasp.
Procedure
• A small round or cylindrical diamond stone
is used. The two occlusal rest seats are
prepared simultaneously as described for the Fig. 19.19: Checking for occlusal clearance of an embrasure
405
rest seat preparation on enamel. rest seat preparation using two 18 gauge stainless steel wires
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Prosthetic Mouth Preparation
19
Fig. 19.23: Cingulum rest seats should be prepared from Fig. 19.24: Incisal rest seats should be prepared as a 1.5 to
one corner moved incisally to the centre and continued 2.0 mm deep notch 2-3 mm away from the proximo-incisal
gingivally to the other end. This helps to obtain a half moon angle
configuration
mesioincisal angle (when a vertical projection The enamel wall near the center of the tooth
clasp is used) (Fig. 19.24). is rounded (to remove stress concentration).
• A small safe-sided diamond disc or knife • A flame-shaped diamond point is used for
edged stone is used to carryout tooth reduc- finishing.
tion.
• The cutting instrument should be held CONCLUSION
parallel to the path of insertion. As mentioned previously, prosthetic mouth pre-
• A vertical cut about 1.5 to 2.0 mm deep and paration is done during phase V of treatment
2 to 3 mm away from the proximal angle before making the secondary impression. These
along the incisal edge is made (Fig. 19.24). preparations should be recorded accurately in
• The notches are rounded. Unsupported ena- the secondary impression using which, the
mel proximal to the notch is slightly reduced. denture will be fabricated.
407
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Chapter 20
Secondary Impression and
Master Cast for RPD
• Introduction
• Dual Impression Procedures
• Preparing the Master Cast
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Secondary Impression and Master Cast for RPD
20
Secondary Impression and
Master Cast for RPD
INTRODUCTION
Now we enter the second part of phase V of treat-
ment planning, i.e. fabricating the partial denture.
And it is obvious that to fabricate a prosthesis,
we require a master impression. Generally,
impressions can be classified into anatomical and
functional impressions.
Fig. 20.2: Dentures prepared using anatomic impressions
compress the tissues under occlusal load and rotate around
Anatomical Impressions the terminal abutment axis
‘Anatomical form’ is the surface contour of the
ridge when it is not under any occlusal load (Fig. weakening of the abutment due to torsional forces
20.1). This resting form is recorded with soft acting on it and residual ridge resorption.
impression materials like zinc oxide eugenol, Thus we understand that when an impression
plaster of Paris, etc. Other impression materials is made in the anatomical form, the deleterious
like elastic putties tend to displace and distort forces of the denture are concentrated on the
the soft tissues due to their high viscosity. abutment teeth. The RPD should be designed
with a stress breaker to avoid damage to the
abutment teeth. This complicates the design of
the prosthesis. Hence, anatomical impressions are
avoided for tooth-tissue supported partial
dentures (e.g. distal extension denture base).
Generally anatomic impressions are preferred
for tooth supported partially edentulous arches
Fig. 20.1: An anatomic impression records the tissues (Kennedy’s class III and class IV cases). Anato-
without any displacement mical impressions are contraindicated for distal
Disadvantages extension cases due to the reason explained above.
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Fig. 20.3: Functional impressions record the Impression Making for Distal
tissue in a compressed form Extension Denture Bases
procedure, the occlusal load can be evenly distri- Before we go into the details about impression
buted between the soft tissues and the abutment making for a distal extension denture base, we
teeth. This prevents the concentration of dele- should discuss about the support for such a
terious forces on the abutment teeth. denture. Support is one of the most important
Functional impressions are required only to principles of impression making.
record edentulous saddles. The existing teeth do A Few Words About the Support
not change form under load and hence they do for the Partial Denture
not require a functional impression. These
impressions are indicated for tooth-tissue sup- Support for a distal extension denture is obtained
ported partial dentures. from both the teeth and the tissues. Hence, we
expect complex forces to act on the denture due
to the difference in the settlement of the support-
Impression Making for Kennedy’s Tooth
ing tissues. For example, the teeth are less com-
Supported Partial Denture
pressible and intrude little to the occlusal load
Generally Kennedy’s class III and class IV arches compared to the supporting soft tissues. Com-
are considered as tooth supported partial denture. pressibility depicts the shock absorbing capacity
Since maximum support is obtained from the and sponginess of the periodontal ligament.
abutment teeth, it is not necessary to record a There are many factors that influence the
functional impression. Conventional anatomic support of a distal extension base, they are:
impressions are made. The material of choice to
Quality of the soft tissues covering the
make a master impression for these partial den-
edentulous ridge
tures is irreversible hydrocolloid. Elastomers are
• A firm, tightly attached mucosa of adequate
used when there are severe undercuts and for
thickness can provide the best support to the
cases which use internal attachments for
denture.
retention. Alginate is preferred for its ease of use,
• If the soft tissues are flabby and mobile, the
economic price.
ridge cannot provide adequate support.
The procedure for impression making is
Hence, the excess tissue should be removed
similar to the procedure described for making a
surgically.
diagnostic impression in Chapter 17. Additional
care should be given to accurately record rest Alveolar architecture of the denture bearing area
seats, guide planes, dimples, etc. prepared during • The residual ridge should have a cortical plate
prosthetic mouth preparation. A small quantity of adequate thickness to provide support by
of alginate is spread over the prepared tooth resisting the occlusal load.
surfaces before placing the tray material. This • If the ridge is made up of cancellous bone, it
small quantity acts like a syringe material and cannot resist occlusal forces of higher magni-
records the finer details accurately. tude and will undergo resorption. The rough
After making the impression, it is gently margins of the cancellous bone can act as a
410 washed under flowing tap water to clear the source of chronic irritant leading to inflam-
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Secondary Impression and Master Cast for RPD
mation. Hence, the crest of the ridge should Fit of the denture
20
not be considered for support. The fit of the denture should be such that the
Design of the partial denture forces can be transmitted to the stress-bearing
• The partial denture should be designed such areas without any hindrance. This can increase
that the forces acting on the edentulous ridge the life of the prosthesis.
can be minimized. Type of impression registration
• Additional components like minor connectors The soft tissues can be recorded in their anato-
are added to the design to avoid the rotation mical form. They can also be recorded in func-
of the denture around the terminal abutments. tional form (displaced under occlusal load).
Amount of tissue coverage of the denture base Sometimes, a part can be recorded in the func-
• Based on broad stress distribution theory, tional form and the remaining areas can be
wider tissue coverage distributes the occlusal recorded in the anatomical form.
load more evenly thereby protecting the soft
tissues and the teeth from damage during DUAL IMPRESSION PROCEDURES
function.
• The borders of the denture should not be over- One of the most common problems affecting the
extended because the overextended margins success of distal extension dentures is that the
can produce discomfort, soft tissue ulcera- tissues get compressed during function leading
tions, etc. to the vertical displacement of the denture. This
type of tissueward movement of the denture will
Amount of occlusal force
produce rotation of the prosthesis around its ter-
• The occlusal load can affect the support of the
denture. minal abutment axis (Fig. 20.4). This should be
• The residual ridge should be covered to its avoided, as it may weaken the abutment due to
maximum physiological extent. excessive stress.
• The occlusal table of the artificial teeth can be
narrowed to reduce the occlusal load.
• Adding supplemental grooves on the occlusal
surface can increase the efficiency of the
artificial teeth. This reduces the biting force
thereby reducing the occlusal load.
Nature of the denture bearing area
• Stress bearing areas should be identified in the
Fig. 20.4: Rotation of the denture around the distal
maxillary and the mandibular arch to derive abutment permitted by compressable soft tissues
support.
• In the maxillary arch, the buccal slopes of the
We can prevent tissueward movement of the
ridge can resist lateral forces. The hard palate
can act as a secondary stress-bearing area. The denture by recording a functional impression.
crest of the ridge provides the maximum That is, the tissues are recorded in a compressed
support to the denture. form (under pressure). Hence, the denture fabri-
• In the mandibular arch, the buccal shelf area cated from this impression will seat and compress
acts as a primary stress-bearing area. It has a the tissues even during rest and there will be no
thick cortical plate covered with a firm additional tissueward movement (tissue comp-
mucosa. It is also placed almost perpendicular ression) during function (occlusion, chewing, etc)
to the occlusal stress. The slopes of the ridge (Fig. 20.5).
can act as secondary stress-bearing areas and Generally, functional impressions require a
they resist horizontal stress. special tray to closely adapt to the tissues and 411
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Secondary Impression and Master Cast for RPD
Procedure
20
• A custom-made impression tray is fabricated
over the edentulous areas of the preliminary
cast. A spacer is not adapted because we intend
to record only the supporting tissues with this
tray (we do not record any relieving tissues
with the tray) (Fig. 20.7).
Fig 20.9: Alginate ‘pick-up’ over impression made over the
special tray with the functional impression
Fig. 20.8: The patient is asked to close on the special tray • A cast is poured into the impression. This cast
with the occlusal rim to apply pressure while making the will reproduce the teeth in the anatomical form
impression and the tissues in the functional form.
• After making the impression, the custom tray Disadvantage
should not be removed from the mouth. Finger pressure used to settle the functional
• An alginate over-impression (this impression impression while making the over impression is
is made over the existing impression) is made not equal to the biting force used while making
using a large stock tray (Fig. 20.9). the functional impression. Hence, the supporting
• When the overimpression is removed, the tissues may not be as compressed as they were
functional master impression comes along while making the functional impression. This can
with it. Since the alginate over impression lead to errors.
carries the functional impression along with Secondly, there will be a small quantity of
it, it is called a pick up impression (Fig. 20.10). alginate between the occlusal rim of the custom 413
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Secondary Impression and Master Cast for RPD
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Fig. 20.15: Constant pressure from the denture will stimulate osteoprogenitor cells to form osteoclast which resorb bone
Fig. 20.16: Constant pressure from the denture can produce ischemia. Ischemia can produce bone resorption via
various chemical mediators that stimulate osteoclasts
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Secondary Impression and Master Cast for RPD
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Secondary Impression and Master Cast for RPD
Advantage
Fig. 20.27: Wax should be painted in excess
over the borders It equalizes the stress acting on the abutment teeth
and the soft tissues. The rate of ridge resorption
plastic wherein the material that contacts the tissue is reduced because relieving areas that cannot
will appear dull after impression making). withstand any load are not stressed.
• Additional wax is painted over the dull areas
and the procedure is repeated until glossy Procedure
borders are obtained. Hard wax can be applied
• The special tray is fabricated on the master cast
to increase the thickness of the wax in the made from an anatomical impression. The tray
borders. is fabricated without a wax spacer.
• Each time the wax impression is inserted into • The tissue surface of the special tray is trim-
the mouth, the operator must wait for atleast med with burs to provide adequate relief.
5 minutes before removing the impression. (About 1mm of acrylic is trimmed along the
• The impression should be placed in the mouth crest of the ridge and the stress-bearing areas
finally for 12 minutes. The cast is then poured in the tray are left untouched) (Fig. 20.28).
using altered cast technique. • The impression material (preferably zinc oxide
• It is a very accurate technique but the proce- eugenol) is loaded on the prepared special tray
dure is laborious and time consuming. and inserted into the patient’s mouth.
Selective Pressure Functional Dual
Impression Technique
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Preparing the master cast includes pouring the Fig. 20.30: Contoured second or base pour
master cast, altering the anatomical master cast
if required, correcting the master cast and finally to various reasons like entrapment of the sub-
trimming and finishing the master cast. lingual salivary gland in the lingual sulcus etc.
The master cast can be corrected using three
Pouring the Master Cast methods:
1. The area that was not recorded properly is
The technique is similar to the one explained in
arbitrarily reduced in the cast with the help of
chapter 3 for a diagnostic cast for a complete den-
the clinician’s perspective (Fig. 20.31).
ture. Any way I will summarise the procedure
here.
• Minimal expansion dendrite dental stone is
used.
• The cast is poured with two-pour technique.
• The cast should be poured within 12 minutes
after making the impression.
• Stone mix is made under vacuum and the first
pour is made.
• The thickness of the first pour should be atleast
6 mm (Fig. 20.29).
Fig. 20.31: Arbitrarily trimmed master cast
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Secondary Impression and Master Cast for RPD
Altering the Master Cast Figs 20.34a and b: Slicing away the edentulous area (a)
occlusal view (b) diagonal view
This is done for functional reline, fluid wax and
functional selective pressure dual impression
techniques. In all these techniques, the master cast
is made using the anatomical impression (first
impression). This anatomical master cast is
altered according to the functional impression,
which is made later (second impression). Remem-
ber, all the following procedures are made after
making the functional impression.
Procedure
• The edentulous area in the anatomical master
cast is cut away with a saw. The cast is sliced Fig. 20.35: The buccolingual cut should be placed 1 mm
using two cuts one buccolingual and one away from the primary abutment. The anteroposterior cut
anteroposterior (Fig. 20.34). should be placed 1 mm lingual to the lingual sulcus
• The buccolingual cut is made 1 mm behind
the terminal abutment across the edentulous • Vertical grooves are prepared on the cut walls
ridge (Fig. 20.35). of the cast (Fig. 20.36).
• The anteroposterior cut is made 1 mm lingual • The framework along with the functional
or medial to the lingual suclus. Note: the impression is placed over the cut anatomical
lingual sulcus should be cut away alongwith master cast. Since the edentulous areas are cut
the edentulous ridge (Fig. 20.35). away from the cast, the edentulous areas of 421
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Secondary Impression and Master Cast for RPD
20
Fig. 20.41b
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20 Textbook of Prosthodontics
424
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Chapter 21
Fabrication of A Removable
Partial Denture
• Framework Fabrication
• Framework Try-in
• Fabrication of the Temporary Denture
Base and Occlusal Rims
• Jaw Relation
• Mounting the Casts
• Denture Base Selection
• Teeth Selection
• Arranging the Artificial Teeth
• Processing
• Insertion
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Fabrication of a Removable
Partial Denture
Fabrication of a partial denture comes under cast to the master cast”—GPT. The outline of the
phase V of treatment planning. The chapter is proposed partial denture is drawn on the primary
extremely condensed because these procedures cast during design. This out line is transferred to
are not very important in the undergraduate the master cast with the help of a surveyor. The
syllabus. colour codes used in the primary cast should be
followed in the master cast also.
FRAMEWORK FABRICATION Design transfer includes the following steps:
• Marking the height of contour
After recording the master impression, the frame- • Measuring the undercut
work is fabricated for a cast partial denture. The • Drawing the clasps
framework is essential for other procedures like • Drawing the connectors.
preparing occlusal rims, jaw relation, etc. Frame-
work fabrication involves the following steps: Marking the height of the contour The tripod
• Wax-up marks of the primary cast are transferred to the
• Duplication and preparation of refractory master cast. The master cast can be repositioned
casts on the surveyor using these tripod marks. After
• Waxing positioning the master cast, the survey lines are
• Investing drawn on the abutment teeth with reference to
• Burn out the survey lines marked in the diagnostic cast (Fig.
• Casting 21.1).
• Finishing and polishing.
Wax Up Procedure
It deals with all the procedures done to the master
cast prior to duplication. We know that the master
cast is duplicated to produce the refractory cast,
which is used to cast the framework. The refrac- Fig. 21.1: As a first step in design transfer, the height of
tory cast will not resemble the master cast because contour is marked on the master cast using the primary cast
the contours of the master cast are altered by as the guide
various wax up procedures before duplication.
Wax up includes design transfer, block out, relief Measuring the undercut The undercut gauge is
and beading of the master cast. attached to the survey arm and the undercut areas
are marked and measured. The procedure is as
Design Transfer described in Chapter 18.
Design transfer is defined as, “Conveying the Drawing the clasps The clasp should be drawn
426 outline of the proposed prosthesis from the diagnostic so that the retentive terminal descends gracefully
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Fabrication of a Removable Partial Denture
into the infrabulge (undercut) area of the tooth. refractory cast duplicated from the master cast
21
The clasps are drawn in reference to the primary will not have these undercuts.
cast. The shape of the clasp should be similar in Before block out, the master cast is coated with
both primary and master cast (Fig. 21.2). a sealer (a special liquid sealer or bees wax is
used) so that it forms a protective film over the
cast (Fig. 21.4). Based on the purpose, blockout
can be classified into three types namely parallel
blockout, arbitrary blockout and formed blockout.
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Fabrication of a Removable Partial Denture
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A Few Words on Duplicators and Duplicating flasks The duplicating flask has two
Duplicating Flasks parts namely, the body and a reservoir ring or
counter. The body of the duplicating flask forms
Duplicators A duplicator is a machine designed
the base of the flask where the cast to be
to prepare and load the duplicating material into
duplicated is positioned. The reservoir ring is a
the duplicating flask. The apparatus resembles
dome shaped structure with vent holes through
an Italian softy ice cream vending machine.
There is an upper reservoir compartment or which the duplicating material can be poured in.
storage unit where the duplicating material is The reservoir ring is designed such that the flange
heated and constantly mixed to improve homo- extension of the dome seats on the body of the
geneity and prevent graininess. The duplicating flask (Fig. 21.13). The vent hole present on the
material is maintained in a particular constant upper surface of the counter should be aligned
temperature with the help of a thermostat inbuilt with the dispensing nozzle of the duplicator
within the system. The reservoir has a dispensing during duplication procedures.
nozzle to dispense the material. The duplicating
flask should be placed below the dispensing
nozzle of the duplicator during duplication
procedure. The duplicator has a horizontal table
to hold the duplicating flask. The horizontal table
is perforated and a fan is present below the table
to cool the duplicating flask. Sophisticated dupli-
cators, which help to pour the duplicating
medium in a vacuum chamber, are also available.
Vacuum based duplicators prevent porosity in the
duplicating material (Fig. 21.12).
Procedure
• The master cast should be soaked in slurry
water for atleast 5 minutes before duplication.
• The soaked cast is positioned on the base of
the duplicating flask such that there is at least
1/4th inch clearance all around the cast.
• The cast is secured in place on the base of the
duplicating flask with the help of modelling
clay (Fig. 21.14).
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Fabrication of a Removable Partial Denture
• The reservoir ring is positioned to fit in the • After the agar cools, the base of the duplicating
21
body of flask. cast is gently removed. The clay used for
• The duplicating flask with the positioned cast stabilization is removed.
is placed in the duplicating unit. The vent • A jet of cold air can be blown at the junction
holes of the flask should be aligned below the of the cast for the set duplicating material to
dispensing nozzle of the duplicating unit (Fig. loosen and remove the cast embedded in the
21.15). duplicating medium (Fig. 21.17).
Fig. 21.17: After the agar cools, the master cast can be
separated by applying a jet of air spray
Fig. 21.15: Duplicating material can be filled by aligning • Refractory investment (used to make the
the nozzle with the vent holes of the flask refractory cast) is poured into the impression
of the master cast present in the duplicating
• The nozzle is opened till the agar from the material (Fig. 21.18). The cast is dried in an
storage unit fills the entire reservoir ring of oven and treated.
the flask.
• When the agar completely fills the reservoir
ring it will flow out through the other vents
present in it (Fig. 21.16). (Vacuum is created at
this stage when a vacuum based unit is used).
• The agar is allowed to cool in the duplicating
unit with the help of the fan placed below the
perforated table holding the flask in the unit.
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Procedure
• A sheet of the pattern material (plastic or wax)
Fig. 21.21: Stopper holes in the spacer will be replicated as is roughly cut according to the shape of the
depressions within the elevated zone on the refractory cast outline of the major connector and gently
• The gingival relief will appear as an elevated adapted over the refractory cast (Fig. 21.23).
band on the refractory cast (Fig. 21.22). • If the major connector is designed to extend
over the lingual surface of the teeth, the
pattern should be extended on to the lingual
Waxing
Waxing is nothing but fabricating the wax pattern
for the framework. Commercially available wax
or plastic patterns can be used to fabricate the
framework pattern. Wax patterns for Cobalt- Fig. 21.23: Pattern wax is cut to an approximate shape
432 chromium alloy frameworks should be waxed and adapted over the refractory cast
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Fabrication of a Removable Partial Denture
surface of the teeth stopping just short of the • A 12-14-gauge half round pattern wax is used
21
cervical edge line of the tooth (Fig. 21.24). to adapt the outer strut around the edentulous
ridge (Fig. 21.28). (Refer denture base minor
connectors).
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21 Textbook of Prosthodontics
tern, which is totally surrounded by the invest- Procedure Before we go into the stepwise proce-
ment. dure, there are a few facts to be considered. The
The casting ring is a cylindrical structure, cast is invested such that its, base faces the sprue
which is used to hold the invested pattern. The former. This type of placement positions the
ring has two ends namely the casting end (has patterns near (6 mm) the free end of the inves-
the inlet for the molten metal) and the free end. tment (Fig. 21.31). Hence, the sprue should pass
The sprue is designed to open into the casting through the cast to reach the investment. A hole
end of the investment. The wax pattern should is drilled to allow the placement of the sprue
be positioned close (maximum 1/4th inch or 6 through the cast (Fig. 21.32).
mm) to the free end of the investment. This helps
proper burnout.
Now that you have an idea about the invested
pattern let us read in detail about spruing the
pattern.
Spruing
Fig. 21.31: Hole created at the base of the refractory cast
As casting involves a large quantity of metal, for sprue placement (CS view)
special attention must be given to points of
attachment of a sprue, which directs the flow of
the molten metal. Each sprue has a sprue former
from where the cast metal flows in and a reservoir
placed about 1 mm away from the pattern along
the path of the sprue which acts as a storage tank
for the molten metal. The end of the sprue
opposite to the sprue former is attached to the
wax pattern (Fig. 21.30).
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Fabrication of a Removable Partial Denture
21
Burnout
The burnout operation is done to
• Dry the moisture out of the mould: The mould is
Fig. 21.35: Horizontal sprue leads are placed to connect heated at 212F (100°C) for 1 hour to vapourize
the pattern with the main sprue the moisture content in the investment. 435
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Fabrication of a Removable Partial Denture
The framework is fitted onto the teeth by inserting A tin foil substitute is applied over the cast.
it along the determined path of insertion. Finger Auto polymerizing resin is made into a dough
pressure should be applied in a direction parallel and placed over the framework. The resin should
to the path of insertion to seat the clasps and rests flow in-between the framework and the tissue
in position. surface of the cast. The excess resin extending
beyond the required borders are trimmed using
Adjusting the Clasp
a Le Cron’s carver (wax carver) before the resin
The clasp arm should be adjusted if it produces polymerizes (Fig. 21.41). The cast with the resin
any obstruction to the insertion of the framework. is placed in a pressure pot for complete polymeri-
Special contouring pliers like smooth beak pliers zation and to avoid porosities. The polymerized
can be used to alter the clasp arms. Gold alloys resin is trimmed and smoothened using an acrylic
are more pliable compared to cobalt-chromium trimmer.
alloys. Cobalt chromium alloy clasps can be
modified by making a series of minute bends till
the desired configuration is obtained (Fig. 21.39).
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21 Textbook of Prosthodontics
Fig. 21.44: Transferring the jaw relation record to the Denture bases can be broadly classified as acrylic,
438 master cast metal and metal acrylic resin bases. Let us discuss
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Fabrication of a Removable Partial Denture
about the indications, advantages and disadvan- • Cannot be used in patients who are allergic to
21
tages of each. metal.
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Fabrication of a Removable Partial Denture
Porcelain Denture Teeth • Heavy hence it may add to the weight of the
21
Indications prosthesis.
• When the opposing teeth have porcelain or Pressed-on Acrylic
resin restoration.
Indications
Advantages • Any posterior edentulous space.
• Excellent aesthetics.
• Excellent wear resistance. Advantages
• Very high efficacy. • Fits easily into small edentulous spaces.
• Adequate strength.
Disadvantages
• Brittle Disadvantages
• Weak in thin sections • Aesthetics is inferior to porcelain and acrylic
• More difficult to process because it tends to denture teeth.
break easily.
• May abrade the opposing natural teeth. Amalgam Occlusal Surfaces on Acrylic Teeth
(Fig. 21.46)
Acrylic Teeth with Gold Occlusals (Fig. 21.45)
Indications
Indications • Same indication as acrylic teeth.
• Where plastic is indicated but cannot be used
due to poor wear resistance. Advantages
• Improved wear resistance compared to acrylic
Advantages teeth.
• Excellent wear resistance • Cheaper than gold occlusals.
• Good chewing efficiency • Simple technique; easy to fabricate.
• Fracture Resistance
Disadvantages
Disadvantages
• Inferior wear resistance compared to gold.
• Fabrication process is time consuming and
• Cannot be used opposing metallic resto-
expensive.
rations.
• Increase in the weight of the prosthesis.
Fig. 21.45: Acrylic teeth with gold occlusals Fig. 21.46: Acrylic teeth with amalgam occlusals
Cast Metal
ARRANGING THE ARTIFICIAL TEETH
Indications
• Small and restricted posterior edentulous The framework with the occlusal rim is seated
space where aesthetics is not very important. on the articulated master cast. The artificial teeth
are arranged over the occlusal rim such that the
Advantages occlusal relationship in the articulator is
• Easy to maintain. maintained. Articulating paper is used to check
• Good wear resistance. premature contacts on the occlusal surface.
• Good fracture resistance.
Rules for Arranging Posterior Teeth
Disadvantages
• Very hard surface may produce discomfort The universal setting principles described in
during mastication. Chapter 10 should be applied while setting the 441
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Fabrication of a Removable Partial Denture
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Fabrication of a Removable Partial Denture
base should be reduced first without thinning or Criteria to be followed before adjusting occlusion
21
weakening the structure (Fig. 21.53). If the • It is best to consider one arch as an intact arch
interference still exists, the mandibular flange so that the other one can be adjusted according
should be adjusted and shortened till there is no to the intact arch.
interference during excursive movements. • If one partial denture is tooth supported and
the other tissue supported, the tooth-sup-
Equilibration of occlusion Adjustment of occlu-
ported arch is first adjusted and is considered
sion can be done in two ways:
as the intact arch for adjustment of the tissue
• Laboratory remount after processing: After
supported denture.
processing, the partial denture is remounted
• If both partial dentures are entirely tooth
in the articulator and adjusted. This method
borne, the one occluding with the most natural
is best suited to adjust tissue-borne partial
teeth is adjusted first, and considered as the
dentures.
intact arch.
• Intraoral adjustment: This is done by using
articulating paper and simulating mandibular • If both dentures are tissue supported, the final
movements intraorally. adjustment of occlusion on opposing tissue-
supported base is usually done on the mandi-
bular denture, since this is the moving mem-
ber. Hence, even if the mandibular denture
opposes more natural teeth and is considered
as the intact arch, the final occlusal adjust-
ments are made only on it.
Procedure
Fig. 21.53a: Distal heel of a mandibular denture base Laboratory remount procedure
interfering with the maxillary tuberosity following processing
• The maxillary cast and mandibular casts are
recovered from the investing medium. The
casts should be deflasked gently without
damaging the natural teeth.
• The restoration and the recovered casts are
mounted in the articulator in their original
relationship. (The original relationship of the
casts in the articulator can be reproduced with
the help of remounting plates or indices
Fig. 21.53b: The distal heel can be reduced in
created on the cast).
thickness to avoid interference
• The mandibular cast is oriented against the
maxillary cast with the help of an inter-
occlusal check record.
• The interferences (between the opposing natu-
ral/artificial teeth) are detected by simulating
condylar movements in the semi adjustable
articulator. Articulating paper can be used to
locate these contacts.
• Occlusal discrepancies are corrected on the
Fig. 21.53c: The distal heel can be shortened to denture by selective grinding until the move-
avoid interference ments become smooth and uninterrupted. 445
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• Maxillary and mandibular restorations are • The wax is removed and inspected under
recovered, finished and polished. transillumination for perforations (Fig. 21.55).
• All perforated areas are either premature
Clinical method There are two clinical methods
contacts or excessive contacts.
commonly used to correct occlusal discrepancies
• Articulation ribbon may be used to mark the
in the prosthesis. Each one has been described as
excessive contacts in occlusion.
follows:
• The excessive contacts can also be identified
Method I It basically involves using, either an
by using the wax record as reference and
articulating paper or occlusal indicator wax to
relieved accordingly.
check for the interferences:
• Occlusal indicator wax or two strips of 28-
gauge soft green wax (casting wax) is placed
between opposing dentition.
• The strips are folded in the centre to form a V-
shaped structure. The V-shaped band of wax
is now placed in-between the teeth and the
patient is guided to close in centric occlusion
two or three times (Fig. 21.54).
Fig. 21.55: Perforations in the occlusal indicator wax
depict premature contacts
Method II:
• Wax strips are placed on the occlusal surface
Fig. 21.54a: Occlusal indicator wax
of the teeth. The strips are folded over the
buccal and lingual surfaces of the teeth for
retention (Fig. 21.56).
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21
Flange Extension
Flange extension should be examined for evi-
dence of overextension by simulating muscle
movements (Fig. 21.59).
Frenum Relief
• The notch like frenum relief is inspected in the
denture to ensure adequate clearance (Fig. Figs 21.60a and b: Frenal relief should be a
21.60). sharp notch resembling a rat tail
• The margins of the relief should also be
examined to avoid tissue injury. A periodic recheck of occlusion at intervals of
• Excessive frenum relief will allow air entry 6 months is advisable to avoid traumatic inter-
between the denture and the tissues leading ference resulting from changes in denture support
to loss of peripheral seal. or tooth migration.
447
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Chapter 22
Types of Removable Partial Dentures
• Introduction
• Unilateral RPD
• Implant Supported RPD
• Removable Partial Overdenture
• Guide Plane Removable Partial Denture
• I-Bar Removable Partial Dentures
• Swing-lock Removable Partial Dentures
• Temporary Partial Dentures
• Immediate Partial Denture
• Spoon Dentures
• Every Dentures
• Two-part Dentures
• Claspless Dentures
• Disjunct Denture
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22
Types of Removable
Partial Dentures
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22 Textbook of Prosthodontics
attachment and bar attachments (discussed in • The buccal and lingual surfaces of the
Chapter 11). abutment teeth should be parallel to resist the
rotational forces (Fig. 22.2).
RPD with Maxillofacial Prosthesis
They are used in cases with acquired, surgical,
congenital or traumatic defects in the maxilla and
the mandible. The removable partial denture is
fabricated alongwith a maxillofacial prosthesis.
UNILATERAL RPD
It is defined as “A dental prosthesis restoring lost or Fig. 22.2: Abutments for unilateral RPD’s should have
missing teeth on one side of the arch only” - GPT. It is parallel, buccal and lingual surfaces to withstand rotation
used for replacing a single tooth or short span
edentulous spaces. It has limited contact with soft • Retentive undercuts should be present on both
tissues and remaining teeth. This denture is purely the buccal and lingual surfaces of the abut-
tooth supported. ments, without which, the denture can get
easily dislodged during mastication (Fig. 22.3).
Disadvantages Usually, a tube tooth placed over a cast metal
denture base is used as the tooth replacement.
• Reduced retention- easy to dislodge
The denture base should have an accurate fit with
• May produce soft tissue injury
the edentulous ridge to avoid any accumulation
• Being small can easily be aspirated/swal-
of food debris.
lowed during deglutition.
Design
There are certain additional requirements for
designing a unilateral RPD, they are:
• The clinical crown of the abutment teeth
should be long enough to resist rotational for-
ces that tend to displace the prosthesis (Fig.
22.1).
Fig. 22.3: Abutments should have both buccal and
lingual retentive undercuts
450
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• The movements of the denture are minimized • Used for supporting a removable partial den-
thereby reducing stresses on the abutment ture in cases with few remaining teeth.
teeth and the residual ridge. • Used for supporting an interim prosthesis.
• It is not necessary to fabricate overdentures
with long flanges for support because the Criteria for Selecting Overdenture
overdenture abutment provides the necessary Abutment Teeth
support. Generally, the labial flange is not Careful case selection and clinical evaluation
fabricated for anterior overdentures where should be done before planning a removable
there is nil or minimal ridge resorption (Fig. partial overdenture. The criteria for selecting
22.7). overdenture abutment teeth are:
Positional Considerations
Position of the remaining teeth and the length of
the edentulous span should be considered. Pre-
sence of soft tissue undercuts is not very critical
because it is not necessary to extend the denture
base into the vestibular sulcus for support.
Fig. 22.7: Labial flanges for overdentures can be omitted
for aesthetics Periodontal Considerations
The abutment tooth should be free from perio-
Indications dontal pockets, have atleast 2mm of attached
• Retaining the posterior most abutment will gingiva and good oral hygiene. The periodontium
help to prevent the tissueward movement of (periodontal ligament, cementum and alveolar
the denture. bone and gingiva) should be healthy (Fig. 22.9).
• When an additional support for a distal exten-
sion denture base is required to reduce the
leverage forces acting on the abutment teeth
mesial to the edentulous space (Fig. 22.8).
Endodontic Considerations
Most of the overdenture abutments should be
endodontically treated so that the clinical crown
can be reduced to 2 or 3 millimetres in height.
Teeth with calcified pulp canals do not need
Fig. 22.8: Overdenture abutments retained in distal extension
endodontic treatment.
cases prevent the action of torquing forces on the terminal
healthy abutment
Caries Considerations
• Anterior teeth should be retained to avoid the Root caries should be eliminated (For cases with
tissueward movement of the prosthesis, which extensive caries, endodontic treatment is done.
in turn decreases residual ridge resorption. If the tooth is susceptible to fracture, the abutment
• To provide additional support to weak is covered with a coping (“Thin metal covering”-
452 abutments. GPT).
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Fig. 22.14a: The buccal surface of overdenture abutments Fig. 22.17: Escape hole made on the denture to allow
should have a taper of 35° whereas the lingual surface should escapment of excess acrylic
have a taper of 10-15°
• Self-cured acrylic resin is placed over the
abutment tooth and the denture base is seated.
• Pressure is applied by finger pressure or biting
on a cotton roll, until the resin sets.
• Excess acrylic is trimmed and the denture is
finished and polished.
Fig. 22.14b: Unsupported enamel should be removed and
the line angles should be rounded Post-insertion Care
Oral hygiene should be maintained. Fluoride
Insertion
application can be done over the prepared teeth
• The prosthesis is seated on the overdenture to prevent caries. Frequent recall visits are
abutment at the time of insertion. conducted to verify the outcome.
• A bur is used to relieve the contact between The prognosis depends on the design, accu-
the denture base and the overdenture abut- racy of fit of the denture and occlusal harmony
ment (Fig. 22.15). and last but not the least the maintenance by the
patient.
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Disadvantages
Because multiple clasps, proximal plates of minor
connectors are used, the denture is not so aesthe-
tic. It cannot be used in cases with esthetic require-
ment (Kennedy’s class IV).
Fig. 22.18a: A distal extension edentulous condition to be
restored using a guide plane RPD. Notice the multiple rests Alternative Treatment
and guide planes (highlight areas)
Total extraction and placement of a complete
which extends to the opposite side of the eden- denture.
tulous space.
Role of Lingual Plate in a Guide Plane RPD
Design
The factors to be considered for evaluating the Usually the muscular action of the lips during
periodontal status of the weak teeth are: speech and mastication, stabilize the weak
• Protection of the teeth from continuous or anterior teeth on the labial/buccal side. In cases
with anterior tongue thrust or severe bone loss,
intermittent movement.
the lingual plate is used for stabilization.
• Protection of the gingiva and the inter-
Mesial and distal incisal rest seats are prepared
proximal tissues from food impaction.
on the remaining anterior teeth. These are
• Prevention of unnecessary occlusal forces.
engaged by metallic extensions (minor con-
Usually a broad stress distribution concept is
nectors) from the lingual plate (Fig. 22.19). The
used. A rigid major and minor connector with
lingual plate should fill the interproximal spaces
multiple rests and clasps are used. Most clasps
between the weakened teeth to avoid food impac-
are not retentive, i.e. when multiple buccal clasps
tion. The plate should have an accurate, thin,
are used only two clasps on each side have
knife-edged fit on the lingual aspect of the teeth.
retentive function and the remaining clasps are
Thus the lingual plate has three functions namely:
designed only to provide stability.
The stabilizing clasps are designed such that
the retentive tip of the clasp contacts the tooth at
or above the height of contour so that the retentive
tip will not produce any tooth movement during
insertion or removal of the denture (Fig. 22.18b).
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Types of Removable Partial Dentures
Fig. 22.27a and b: (a) Extension of proximal plate in a Fig. 22.29: The I-bar retainer should extend 2 mm above
conventional RPD (b) Extension of a proximal plate in a the gingival margin to engage an undercut mesial to the
I-bar RPD mesiodistal height of contour
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The position of the I-bar in relation to height Modifications are made according to the ana-
of contour is important to this design. When tomical requirements. Maxillary major connectors
occlusal loading takes place on the denture base, are not relieved, as close adaptation prevents
the flexible tip of the I-bar engages the undercut mucosal hypertrophy and food impaction.
mesial to the mesiodistal height of contour. As
the I-bar is flexible it engages the undercut Minor Connectors
passively without producing any deleterious You must have noticed that in an I-bar retainer
forces on the abutment tooth. All the forces the body of the direct retainer is eliminated and
produced by the I-bar push the abutment distally. the components of the clasp like rest, retentive
The proximal plate placed on the distal surface tip and proximal plate etc are separated from one
of the abutment reciprocates the distal tipping another. All these components are connected
force produced by the I-bar retainer (Fig. 22.30). separately to the major connector with the help
of minor connectors (Fig. 22.31). Hence, the minor
connector becomes more vital in providing direct
and indirect retention and encirclement for the
clasp. Minor connectors are designed such that
they cross the tooth tissue junction at right angles
to avoid food impaction.
Advantages
• As maximum tooth surface is left uncovered,
food accumulation is decreased.
• Minimal tooth coverage. Hence, it is more
Fig. 22.31a: Buccal view of the minor connector (MC)
aesthetic and preferred for anterior abutments. connecting the rests and retainer:
• I-bar has a passive relationship to the Key: 1—Proximal plate MC, 2—I-bar MC,
abutment tooth. 3—Mesial rest MC (lingual side)
• Can be used to even engage a 0.01 inch
undercut.
Disadvantages
• Reduced retention due to a flexible tip.
• It provides less horizontal stability than its
counterparts (rest and proximal plate).
Major Connector
For a maxillary partial denture, an anteroposterior
palatal strap is preferred and for a mandibular
partial denture, a lingual bar is preferred.
Maxillary major connectors are placed 5 to 6
mm away from gingival margin and the mandi-
bular major connectors are placed 3 to 4 mm away
from the gingival margin or on the unattached Fig. 22.31b: Minor connector connecting the rests and
458 mucosa. retainer: Occlusal view
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22
Fig. 22.39: Design modification III of RPI proximal plates Fig. 22.41a: Facial view
I-bar Modification
• The tip of the I-bar is modified to have a pod-
shape in order to allow more tooth contact. It
is placed more mesially so that it shifts towards
the mesial embrasure space under occlusal
load and increases reciprocation (Fig. 22.40).
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They can be used in cases where the teeth have Selection of Metal for Swing-lock Framework
questionable prognosis. E.g. when a key abut-
Chrome alloy is chosen instead of gold alloy. This
ment is lost after placement of the conven-
is because gold alloy shows wear (due to constant
tional removable partial denture, the design
movement of the hinge) after a short time of use.
becomes a failure. But the swing lock denture If gold alloy is to be used a greater deal of metal
can take support even from teeth that are not has to be incorporated into the framework to
the key abutments. increase rigidity and strength.
• Presence of few remaining teeth (a conven-
tional RPD cannot be given in these cases). Surveying and Design
• Presence of unfavourable tooth contours like
excessive inclination, etc. The cast is mounted on a surveyor with the
• When the position of natural teeth are not occlusal plane parallel to the base and surveyed
conducive (facilitative) for a conventional as described in Chapter18. The path of insertion
design. is from a lingual direction with the labial arm
• Presence of unfavourable soft tissue contours open. Now we shall read about the design consi-
derations to be followed for each part of the
like soft tissue undercuts, etc.
denture.
• For retention and stability of a maxillofacial
prosthesis. Lingual plate It should be designed to end above
• To retain the prosthesis for patients who have the survey line and hence it prevents the tissue-
lost large segments of teeth and a resorbed ward displacement of the denture.
alveolar ridge. Occlusal rest The occlusal rests also help to
prevent tissueward displacement of the denture.
Contraindications They are designed according to the standard
• Poor oral hygiene. requirements.
• Shallow vestibule. Major connector The mandibular major con-
• High frenal attachment. nector of choice is a lingual plate. It extends above
the survey line with scallops extending up to
Advantages contact points.
It provides an inexpensive method of using all The maxillary major connector of choice is a
or most of the remaining teeth for retention and complete palate or a closed horseshoe with bor-
stability of the prosthesis. If in case a tooth has to ders extending up to or above the survey line.
be removed, it can be extracted and an artificial Remember that the major connector helps to
tooth can be added to the existing swing lock encircle the teeth along with the labial arm (Fig.
framework at ease. 22.43).
Labial arm design The vertical projections of the
Disadvantages labial bar should be designed to touch the teeth
• Poor aesthetics, especially in patients with
short or extremely mobile lips.
• In a distal extension case, the leverage forces
produced due to tissue ward movement of the
denture base can cause tipping of the teeth that
are grasped (encircled by the labial bar and
the lingual plate major connector).
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Tray Selection
• A custom tray is essential for recording
maximum labial and buccal vestibular depths.
• Secondary impression procedures should be
carried out.
• About 5 to 6 mm spacing should be present
between the teeth and the tray when placed
in the mouth.
Fig. 22.43b: Closed horseshoe major connectors are
preferred for maxillary swing-lock dentures
• Holes should be made in the tray to help retain
the alginate.
below the height of contour (Fig. 22.44). Hence,
they prevent occlusal movement. The design of Making the Impression
the labial arm can be of two types: • Impression procedure for swing lock dentures
Conventional design: It consists of a labial bar is similar to conventional dentures.
with metallic vertical I-bar or T-bars attached to • Dual impressions may be required for distal
it. They contact the teeth below the survey line. extension cases.
Framework Fabrication
A master cast is poured from the secondary
impression. The master cast is waxed and
undercuts are blocked out before duplication. The
master cast is duplicated to form the refractory
Fig. 22.44: Conventionally designed labial arms with cast. The design of the denture is transferred to
metallic retentive extensions
the refractory cast. After design transfer, the wax
Using acrylic resin retention loops: It is indicated pattern is fabricated on the refractory cast.
for patients with short or hypermobile lips and The refractory cast is invested, wax is burned
where aesthetics is of concern. The acrylic loops out and casting is done. The resultant framework
are translucent or tooth coloured hence, they are is trimmed, finished and polished.
more aesthetic.
Fitting the Framework
• Rests are placed on teeth adjacent to the
edentulous ridge. • A framework is tried in the patient before
• Placement of hinge is determined by the arranging the artificial teeth.
patient comfort. • The procedure is similar to that done for con-
ventional removable partial dentures except
Selection of Impression Material that the fit of the labial bar and the rest of the
As wide gingival embrasures will usually be framework are checked separately.
present in these cases, the impression material
Jaw Relations
should tear in the interproximal areas during
removal. This will allow easy removal of the After framework try-in, a temporary denture base
impression without any damage to the teeth. This is fabricated using the framework. Occlusal rims
is not possible in rubber base impression are fabricated over the temporary denture base.
materials. Heavy-bodied alginate is preferred. If The framework with the temporary denture base 463
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and occlusal rim is inserted into the patient’s • Teeth can be added to the framework at later
mouth and all the three jaw relations are recorded. stages after the removal of any tooth.
After jaw relation, the casts with the jaw relation
records are mounted in an articulator. TEMPORARY PARTIAL DENTURES
Indications
It is given when some or all the remaining teeth
Fig. 22.45: Waxed-up swing lock prosthesis ready for
processing
have periodontally poor prognosis but immediate
extraction of all teeth are not indicated for
Insertion physiological and psychological reasons.
Basically transitional dentures are used as a
• A lingual path of insertion is used. supportive therapy when the patient is expected
• Pressure indicator paste is used to detect to transit from a partially edentulous condition
pressure areas. to a completely edentulous condition due to poor
• Occlusion is evaluated in centric and eccentric periodontal prognosis of the existing teeth.
relations.
• In case of distal extension RPD, the vertical Fabrication Procedure
projections should be bent away from the teeth
using two prong pliers, so that the anterior The transitional denture may be prepared using
teeth are not tipped lingually by the labial bar a metal framework or an acrylic denture base.
under occlusal load. Metal-based transitional dentures are preferred
because they are more biocompatible. Acrylic
Post-insertion Care denture bases can produce severe tissue reaction
under improper use. The step-wise procedure for
• Oral hygiene measures must be emphasized. the fabrication of a transitional partial denture is
• Distal extension RPD has to be frequently described as follows:
relined.
• Loosened lock mechanisms should be Impression making Mouth preparation and
464 tightened. impression making procedures are similar to
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those done for conventional designs. The adapted. Shellac is the material of choice and
22
impression material of choice is alginate. After auto-polymerizing resin is the second material of
impression making the primary cast is poured choice. The temporary denture base is fabricated
using a two-pour technique. The primary cast in as described in chapter 6. The base plate should
this case alone is poured using hydrocal (dental extend upto the depth of the sulcus.
stone). The denture base material to be used in the
final prosthesis determines the fabrication of the
Fabricating retentive clasp The close adaptation
temporary denture base. If an acrylic denture is
of the denture base with the soft tissues provides
planned, the temporary denture base is fabricated
sufficient retention. A 0.020 wire `c’ clasp is
directly on the master cast as described in chapter
fabricated only when needed. The clasp wire is
6, but, if a cast metal denture (used for long-term
fabricated using orthodontic pliers. The clasp
cases) is planned, a refractory cast is made and a
should have smooth curves and adapt closely to
framework is fabricated and cast. The framework
the abutment teeth. The free end of the clasp
is tried in and the temporary denture base is
should engage the undercut on the buccal surface
fabricated using this framework. (Remember that
of the tooth (Fig. 22.46). Other end should be
acrylic based transitional dentures are generally
looped for retention within the denture base (Fig.
avoided).
22.47).
Designing the extent of the denture base: The
Fabricating the temporary denture base After labial flange of the denture is omitted if there is
adapting the clasp, a temporary denture base is little or no resorption of the edentulous ridge. If
labial flange is not planned, the crest and labial
portion of the ridge is scrapped on the cast so
that there is an intimate contact between the teeth
and the ridge (Fig. 22.48). If a labial flange is used,
scrapping of the ridge is not necessary.
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Acrylizing the trial denture The transitional and the occlusal corrections are made. After
22
denture is usually fabricated using auto-poly- occlusal verification, the denture is removed,
merising resin. Hence, a compression moulding trimmed and polished.
technique is not essential here. After try-in, the
Insertion
modelling wax is elimianted by de-waxing.
• The denture is coated with pressure indicating
Diatorics (retention holes) are drilled into the
paste. Areas of interference are examined and
tissue surface of the artificial teeth. (Fig. 22.53).
trimmed with a vulcanite or acrylic bur.
The denture teeth are placed back in position with
• There should be no interference between
the help of the matrix we fabricated using a thick
artificial anterior teeth and opposing natural
mix of dental stone.
teeth. Light occlusal contact should be present
between posterior teeth. Occlusal rests can be
incorporated to prevent rapid alveolar ridge
resorption.
Instructions
• It should never be worn continuously.
• It should not be worn during sleep.
Fig. 22.53: Preparing diatoric holes • If no metal has been used, chlorine containing
Separating medium is painted over the tissue solution may be used safely for soaking and
surface of the cast immediately after de-waxing. cleaning.
Gross undercuts (more than 0.3 inch) on the • Disclosing tablets can be used to locate and
lingual side of teeth are eliminated using base clean plaque and calculus adherent to the teeth
plate wax or mix of hydrocal and slurry solution. and also the denture.
With the teeth locked in the matrix, the denture • Periodic dental visits should be advised for
base is fabricated with auto-polymerising resin follow up.
using sprinkle-on or salt-pepper method (Fig.
22.54). Addition of Teeth
Since transitional dentures are usually used along
with teeth of poor prognosis, frequently addition
of teeth to the denture may be required. Addition
of teeth is a simple procedure if the existing den-
ture has an acrylic denture base. Freshly mixed
auto-polymerising acrylic is easily added to the
existing denture (Fig. 22.55).
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Design considerations
• Design should be such that teeth may be
added to the original framework, to prevent
the necessity of remaking the partial denture
after every extraction. Fig. 22.58: Soldered loops offer superior retention
• As the teeth are extracted, metal retention
loops are soldered to the lingual plate and the • Denture teeth are attached to the metal reten-
artificial teeth are attached to them. Holes can tive loops using auto-polymerizing resin. The
also be drilled through the lingual plate to act denture teeth should be trimmed to fit-in the
as points of retention. denture.
• Sometimes, an existing RPD may be used as • The tooth is extracted from the patient’s
the original framework and teeth added to it. mouth.
• Pressure indicating paste is coated on the
Procedure
tissue surface of the denture and the denture
• The RPD is seated and an alginate over-
is seated in place. Pressure points shown by
impression is made with an over-sized tray.
the pressure indicating paste are relieved with
The impression picks up the RPD along with
a vulcanite or acrylic bur.
it during removal.
• Patient instructions are given as enlisted
• Undercut areas in the denture base are blocked
before.
out using base plate wax, modelling clay or
wet paper. Follow up
• Cast is poured with a hard densite stone. • The patient should be followed up after 24
• Teeth to be extracted are cut away from the hours to review the surgical procedure and the
cast. A concave depression about 2mm is pre- transitional denture.
pared on the areas where the teeth were cut • Routine recall visits should be carried out
(Fig. 22.57). every 3 months.
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Mode of action
• Evenly distributes the occlusal load over the
denture.
• Produces an intimate tissue contact and has a
massaging effect on the soft tissues.
• Increases the blood flow and reduces
inflammation.
Fig. 22.60: Applying the tissue conditioner
Preparing/Fabricating the Treatment Partial
Denture If an existing RPD can be used for this • The working time of the mixed conditioner is
purpose, the tissue surface of the denture beneath about a minute.
the area of tissue irritation should be relieved to • The denture is seated in the mouth with light
give space to carry the treatment material. If the pressure. The pressure is maintained as the
existing partial denture is unsuitable for this material flows. Border tissues are manipulated
purpose, a new treatment partial denture is as the material sets in order to mould the
fabricated. material at the borders.
The fabrication of a treatment partial denture • For establishing a proper lingual extension,
is similar to that of a transitional denture except various movements of the tongue are perfor-
that a wax spacer is adapted over the tissue med.
surface of the cast before acrylising the denture • Occlusion is established by asking the patient
base using auto-polymerising resin (Fig. 22.59). to gently close (bite) on the teeth.
After the denture base is cured, the spacer is • Once the denture is aligned, the patient is
removed and the space created is used to carry asked to remain still for 4 to 5 minutes till the
the treatment material. gel stage is reached.
• The denture is then removed and examined.
Voids on the tissue surface are filled with new
material using a paintbrush.
• If the denture base is visible through the mate-
rial, the denture is trimmed and new material
is added and inserted. This procedure is done
Fig. 22.59: Spacer adapted in the treatment partial denture until a smooth tissue surface is obtained.
base to allow placement of tissue conditioning material • The denture is washed in cool running water.
• The borders are trimmed with a scalpel blade
and smoothened with a sharp knife or scissors.
Using the tissue conditioner The treatment partial
• Please refer the uses of a tissue conditioner in
denture is coated with a pressure indicating paste
a complete denture.
and a try-in procedure is carried out. Areas of
interference are relieved and the occlusion is
Changing the Vertical Dimension using
corrected. The procedure for applying a tissue
Treatment Partial Denture
conditioner can be described as follows:
• The external polished surface of the denture A change in vertical dimension should not be
is coated with a separating medium. made directly on the RPD. The vertical dimension
• The tissue conditioner is mixed in a disposable should be altered incrementally with the help of
cup to a heavy cream consistency and allowed temporary appliances, which come under
to flow on the denture. It is distributed evenly treatment partial dentures.
on the tissue surface of the denture using a These appliances are similar to cap splints that
cement spatula (Fig. 22.60). cover the teeth. They distribute the occlusal stress
470
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Surgical Splints
Surgical splints are used to protect post-operative
surgical sites in the oral cavity to improve the
healing. They are most commonly used on the
maxillary arch and the lingual side of the mandi-
bular ridge where tori and exostoses are most
likely to occur.
Clinical procedure
Fig. 22.61a: Closing on the interocclusal wax: • Impression is made with irreversible hydro-
Anterior teeth
colloid.
• The contour of the surgical site after surgery
is determined by the operator or surgeon.
• A mock surgery can be prepared on the cast to
determine the contour of the site after surgery.
Laboratory procedures
Fig. 22.61b: Closing on the interocclusal wax: • The master cast is scraped off to the desired
Posterior teeth configuration (Fig. 22.63).
• The adapted/recorded wax should be
removed carefully without distortion. It is then
fitted over the maxillary cast according to the
record.
• The mandibular cast should be remounted
against the interocclusal record.
• The interocclusal record is invested, flasked
and processed.
• After acrylization, the interocclusal record
resembles a cap splint (Fig. 22.62). The cap
splint is verified against the articulated casts. Fig. 22.63a: A mock surgery preparation on the cast
471
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Types of Removable Partial Dentures
22
Design Considerations
The following points should be considered while
c selecting this denture;
• Nature of mucosa: The mucosa should be firm
Figs 22.66a to c: (a) Tooth to be removed (b) Tooth scrapped
with the presence of submucosa.
in the cast upto its cervical margin (c) Creating a depression • Form of hard palate: The palatal area should
to resemble a shallow socket on the cast be large with steep sides to provide adequate 473
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22 Textbook of Prosthodontics
Design Principles
The Every denture is designed based on the
following principles:
• The denture should contact the natural teeth
to transfer the axio-mesio-distal stress acting
on the denture (Fig. 22.71).
Fig. 22.69: Palatal extension of a spoon denture
(cross-sectional view)
Advantages
• Easy to fabricate, requires less time.
• The gingiva is not affected because it is
relieved.
• Since extensive tooth contact is not present,
incidence of caries is considerably decreased.
Disadvantages
Fig. 22.71: Limited tooth contact in an Every denture
• Poor retention
• Tends to get displaced during insertion. • The proximal surfaces of the denture teeth
should be convex and have a high survey line.
EVERY DENTURES This design helps to shift the contact point
with the natural abutments occlusally (Fig.
These dentures are called so because they were 22.72).
first described by Every. Craddock termed them • Since the contact points are placed occlusally,
474 as “Precision plastic base dentures”. They are used the gingival embrasures are widened. This
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Types of Removable Partial Dentures
Fig. 22.75: Distal part of the two part denture (notice the
direction of insertion)
TWO-PART DENTURES
Described by Lee, these dentures were designed
to overcome the technical problems in using the
proximal undercuts in unilateral dentures.
These dentures are constructed in 2 parts, Fig. 22.76: Mesial part of the two part dentures (notice the
which have different paths of insertion. Together, direction of insertion) 475
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Types of Removable Partial Dentures
Fig. 22.83: Collar of the casing that controls the movement Mucosa or Tissue Borne Part
of the nipple out of the casing
This part includes the artificial tooth replacements
Advantages and the denture base on the saddle area. They
• This attachment is quite small; hence, it can have a slot incorporated into the denture base,
be used even in a single tooth removable par- which is designed to accept the disjunct bar (Fig.
tial denture. 22.85). The bar slot connection is not rigid and
allows free movement of the two parts of the
Disadvantages denture. Since the bar slot joint is not rigid the
load on the mucosa-borne part of the denture is
• Metal nipple might abrade the tooth.
• Nylon nipple may wear out soon not transferred to the tooth-borne part of the
• Requires frequent replacement denture. Thus, the periodontally weak teeth are
protected by this design.
DISJUNCT DENTURES
These are nothing but Kennedy’s class I dentures
with special stress breakers between the tooth-
supported part and the tissue-supported part of
the denture. The stress breaker is special in that
it is a bar and slot and not a conventional hinge.
The bar of the stress breaker is called a disjunct Fig. 22.85: Disjunct slot in the tissue-supported portion of
bar. the denture that accepts the disjunct bar
These dentures are indicated when the
remaining teeth are periodontally weak. This
Advantages
denture has two parts connected by a stress
breaker. The two parts are termed based on the • Periodontally weak teeth are preserved.
structures from which they obtain support.
Disadvantages
Tooth Borne Part
• Technically difficult to construct.
It consists of a lingual plate major connector • Movement of the two parts separately during
(lingual plate because the remaining teeth are use (due to its design) can lead to patient
periodontally weak) and the retentive clasps discomfort.
477
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Chapter 23
Correction of Removable
Partial Dentures
• Relining
• Rebasing of Removable Partial Dentures
• Reconstruction of Removable Partial Dentures
• Repair of Removable Partial Dentures
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Correction of Removable Partial Dentures
23
Correction of Removable
Partial Dentures
RELINING
Relining is the addition of new denture base
material to the existing resin to make up for the
loss of tissue base contact caused by the
resorption of the alveolar ridge. Relining is
defined as “To resurface the tissue side of a denture
base with new base material to make the denture fit
Fig. 23.1: Using alginate to measure tissue support
more accurately” - GPT.
indirect retainer is clinically evaluated. If
Indications the indirect retainer lifts two or more
millimetres, then the patient is a candidate
• Loss of occlusion between the denture and the
for relining (Fig. 23.2).
natural teeth.
• Fit of the denture is altered. Loss of retention.
The need for relining is assessed by visual
examination of the loss of support from the
supporting tissue:
• Using alginate: A thin mix of alginate is
made (one scoop of powder with 2 mea-
sures of hot water). This provides a mix,
which is thin enough to prevent displace- Fig. 23.2a: Dentures with good support,
ment of soft tissues, yet sets quickly. The resist tissueward movement
thin mix of alginate is loaded under the
denture base and the partial denture is
seated in the mouth. The position is main-
tained until the alginate sets. The amount
of alginate is clinically evaluated. If two or
more millimeters of alginate is present,
then the patient is a candidate for relining
(Fig. 23.1).
• Using finger pressure: Finger pressure is Fig. 23.2b: Dentures with poor tissue support
rotate under finger pressure
applied to the retromolar pad area of the
distal extension denture base. If there is loss
Techniques for Relining
of supporting tissues, then the anterior
indirect retainer will lift from its rest pre- • Laboratory technique or extraoral technique.
paration. The amount of space under the • Intraoral reline technique. 479
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23 Textbook of Prosthodontics
Laboratory Technique
• A uniform amount of resin is removed from
the tissue side of the denture base. This is done
for two reasons:
— Space must be created so that the impres-
sion material does not displace the soft
tissues.
— The tissue surface of the denture base Fig. 23.3: Evaluating tissue support after relining
should be removed so that the new resin
can bond to the underlying dense, unconta- finishing burs. De-waxing can be done to
minated resin in the existing denture. remove Zinc oxide eugenol base impression
• The reduced denture base is used as a special material or mouth temperature wax. Poly-
tray to make an impression of the edentulous sulphide rubber or silicones can be separated
ridge. The impression material of choice varies without heating.
for individual cases: • A separating medium is applied in the mould
• Mobile tissue on the - Free flowing space. The resin is kneaded and placed in the
crest of ridge zinc oxide flask. Tight closure of flask is necessary.
eugenol • After the resin is completely polymerized, de-
• Dense, firm eden - Polysulphide, flasking is done carefully with a sand blaster
tulous ridges silicone, mouth to prevent distortion of clasp arms and
temperature wax damage to the removable partial denture (Fig.
• Tissue conditioners can be used for either cases 23.4).
but they distort the tissues.
• The most important factor to be preserved
during relining procedure is the maintenance
of tooth-framework relationship. This is
accomplished by holding the framework
against the abutment teeth until the reline
material sets.
• Small defects in the impression are corrected
using mouth temperature wax.
• The extensions beyond the denture border
should be removed and the rough edges Fig. 23.4: Sand blasting with alumina
created during removal are covered with a thin
coat of mouth temperature wax. • Another laboratory technique involves the
• The completed reline impression is reinserted mounting of the relined impression on a
in the mouth. During this procedure, the duplicating device. The entire partial denture
framework is moved around its fulcrum to should be in the top half of the duplicating
verify whether the reline has restored the device. Auto-polymerizing denture resin is
desired support to the denture base (Fig. 23.3). used with this device. Refer relining jigs in
• The impression is forwarded to the laboratory Chapter 14.
for processing. • The relined removable partial denture is
• The removable partial denture with the reline finished and polished.
impression is directly flasked in the lab.
• After the plaster in the flask is set, the flask is Intraoral Reline Technique
opened up.
• The denture base area should be completely All the four intraoral techniques described in the
480 cleared of impression material using denture- relining of a complete denture can be used for
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Correction of Removable Partial Dentures
Technique
• The tissue surface of the denture base is
relieved and trimmed to provide space for re-
adaptation of borders with modelling plastic.
• Border moulding is done.
Fig. 23.6: Loading the reline material
• After border moulding, a final impression is
made using the framework.
• The inner surface is wetted with monomer and • A cast is poured against the rebase impression.
the prepared resin is applied with the spatula • The modelling plastic and the final impression
with care to avoid air entrapment (Fig. 23.6). material is scrapped away from the denture
• The removable partial denture is inserted in base.
the mouth and held in proper relationship. • The denture base extending over the area to
• The denture is removed and any excess should be rebased should be trimmed leaving just
be trimmed off with a sharp curved scissors about 2-3 mm adjacent to the base of the teeth.
in the dough stage itself. • When the anterior teeth are involved, the
• The denture is reseated after trimming while junction of the new resin and the existing
the resin is still plastic and held in position till denture base should be kept in an area that is
it sets. Then it is removed and placed in pres- not visible. A faint line will always exist at this
sure pot to complete residual or final curing. junction and it may be visible when the patient
• Complete polymerization occurs in 12 to 15 smiles (Fig. 23.7).
minutes after mixing. • This observable line is reduced when the
• Later finishing and polishing is done. borders of the resin are at 90° to the external 481
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23 Textbook of Prosthodontics
Indications
• When the denture base is damaged beyond
repair.
• When the fit of the denture is not satisfactory.
• Loss of aesthetics, function, etc.
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Correction of Removable Partial Dentures
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23 Textbook of Prosthodontics
• Auto-polymerizing resin is added with a fine • An internal finish line should be created for
brush (Fig. 23.15). better adaptation of resin (Fig. 23.17).
• This procedure varies according to the design • Alginate over-impression is made over the
of the major connector. partial denture.
• If there is a lingual plate, a retention loop for • A cast is poured.
the added tooth can be directly soldered to the • An opposing cast with a centric occlusion
framework (Fig. 23.16a). Later the denture record is articulated.
tooth is trimmed and placed over this reten- • Denture base is prepared with resin (Fig.
tion loop. 23.19).
• If there is no plate on the lingual side then a
new retentive loop with a plate is cast and
soldered to the existing framework (Fig.
23.16b).
Fig. 23.19: The major connector near the newly lost teeth
is coverd with a resin denture base for addition of teeth
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Correction of Removable Partial Dentures
• This clasp arm is not indicated for single tooth Repair of Major and Minor Connectors
23
addition.
• Sectioning of the framework is done if the
• The teeth are added as described earlier.
major connector is distorted and does not
adapt properly. The framework is sectioned
Metal Repair
with a carborundum disc (Fig. 23.22).
• The most common of the metal repairs is reten- • A full mouth impression is made and a cast is
tive clasp arm. poured. The sectioned framework is seated on
• A repair cast is made. The design of the the cast.
replacement clasp is drawn on the abutment
tooth. The cast and denture are submitted to
the laboratory (Fig. 23.20).
Fig. 23.20: Broken terminals or clasp assemblies are drawn • A high-heat platinum 0.001-inch foil is
on the cast. Fresh clasps are made and soldered to the adapted to the cast in the areas where the
existing connectors
major connector was sectioned. Fluoride flux
• The replacement clasp can be embedded in the is used. (Fig. 23.23).
resin of the denture base or electro-soldering • A precious metal solder or industrial brazing
to the framework itself (Fig. 23.21). alloy can be used with the electro-soldering
• Both infra-bulge clasps and circumferential machine to complete the repair.
clasps are used.
• They may be cast or made of wrought metal.
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23 Textbook of Prosthodontics
is soldered to the existing framework (Fig. Constructing a Crown under Existing RPD
23.24).
• If the abutment is grossly decayed, a crown
• An internal finish line is created for better resin
should be inserted such that it synchronizes
adaptation.
with the design of the existing RPD.
• The tooth preparation is similar to a conven-
tional crown preparation.
• Additional reduction is done in the area of rest
seat preparation.
• Impression for the crown is made with the
RPD in place.
• The wax pattern is contoured such that it has
the least interference with the existing RPD.
• The crown is fabricated in the conventional
Fig. 23.24: While extending the denture base into newly manner.
edentulous areas, additional minor connector struts are • Porcelain veneering of the crown can be done
fabricated and soldered to the existing framework if needed.
486
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Section Three
Fixed
Partial
Dentures •
•
Introduction to Fixed Partial Dentures
Parts of a Fixed Partial Denture
(FPD)
• Design of a Fixed Partial Denture
• Occlusion in Fixed Partial Dentures
• Types of Abutments
• Tooth Preparation
• Types of Fixed Partial Dentures
• Impression Making in Fixed Partial
Dentures
• Temporization or Provisional Restoration
• Lab Procedures Involved in the
Fabrication of FPD
• Cementation of Fixed Partial Dentures
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Chapter 24
Introduction to Fixed Partial Dentures
• Introduction
• Common Terms Used in Fixed Prosthodontics
• Indications for FPD
• Contraindications for FPD
• Diagnosis and Treatment Planning
• Classification of FPD
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Introduction to Fixed
Partial Dentures
INTRODUCTION
A fixed partial denture is defined as “A partial
denture that is cemented to natural teeth or roots
Fig. 24.1: Full veneer crown
which furnish the primary support to the
prosthesis”-GPT. it is referred to as a Partial Veneer Crown (PVC)
A fixed prosthesis is defined as, “A restoration (Fig. 24.2).
or replacement which is attached by a cementing
medium to natural teeth, roots, implants.”–GPT.
These dentures are often termed as Bridges.
In the previous section, we discussed about
removable partial dentures, which can be Fig. 24.2: Partial veneer crown
removed and inserted by the patient. In this
section, we will be studying about fixed partial Retainer A crown that is used as a part of the
dentures. These dentures are fabricated in a fixed partial denture for retention and support
complex manner. The prosthesis is cemented to from the abutment tooth is called as a Retainer.
the supporting teeth and cannot be removed by
the patient. Laminate Veneers or Facial Veneers
These are prosthesis, which are made of ceramic.
COMMON TERMS USED IN They are used as a thin layer over the facial
FIXED PROSTHODONTICS surface of the tooth, primarily for aesthetic
reasons (Fig. 24.3).
Crown
It is a cemented extracoronal restoration that
covers or veneers the outer surface of the clinical
crown. The primary function of a crown is to
protect the underlying tooth structure and
restore the function, form and aesthetics.
Crowns may be of three types, namely, clinical
crowns, anatomical crowns and artificial Fig. 24.3: Labial veneer
crowns. “Clinical crown” depicts the intraorally
visible tooth structure. “Anatomical crown”
depicts the area of the tooth covered by enamel. Inlay
If the prosthetic crown covers all five surfaces It is an intracoronal restoration, which is used
of the clinical crown it is referred to as a Full for medium sized single tooth proximo-occlusal
490 veneer crown (FVC) (Fig. 24.1). If the prosthetic and gingival lesions. They are usually made of
crown does not cover the entire clinical crown, gold alloy or ceramic material (Fig. 24.4).
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Introduction to Fixed Partial Dentures
Onlay
It is an intracoronal restoration, which is used
to restore a more extensively damaged posterior
Fig. 24.7: Connector
tooth with a wide mesio-occluso-distal lesion.
An onlay can be termed as an inlay
supplemented (fused) with an occlusal veneer INDICATIONS FOR FPD
in order to restore large lesions (Fig. 24.5). A fixed partial denture is preferred for the
following situations:
• Short span edentulous arches
• Presence of sound teeth that can offer
sufficient support adjacent to the edentulous
space.
Fig. 24.5: Onlay • Cases with ridge resorption where a remo-
vable partial denture cannot be stable or
Abutment
retentive.
It is any tooth, root or implant which, gives • Patient’s preference
attachment and support to the fixed partial • Mentally compromised and physically
denture. handicapped patients who cannot maintain
the removable prosthesis.
Pontic
CONTRAINDICATIONS FOR FPD
The artificial tooth that replaces a missing tooth
in a fixed partial denture is called a pontic. Fixed partial dentures are generally avoided in
Pontics are attached to the retainers. All forces the following conditions:
acting on the pontic are transferred to the • Large amount of bone loss as in trauma.
abutment through the retainers (Fig. 24.6). • Very young patients where teeth have large
pulp chambers.
• Presence of periodontally compromised abut-
ments.
• Long span edentulous spaces.
• Bilateral edentulous spaces, which require
cross arch stabilization.
• Congenitally malformed teeth, which do not
have adequate tooth structure to offer
support.
Fig. 24.6: Pontic (P) • Mentally sensitive patients who cannot co-
operate with invasive treatment procedures.
Connectors
• Medically compromised patients (e.g. leuke-
It is the connection that exists between the pontic mia, hypertension). 491
and retainer. They may be rigid or non-rigid. • Very old patients.
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Introduction to Fixed Partial Dentures
Treatment Planning
Fig. 24.8: Conventional tooth supported FPD
Treatment planning should be based on the
choice of design of the partial denture that best Resin bonded fixed partial denture: (Fig. 24.9) It
suits the patient. is indicated in:
Treatment planning for fixed prosthesis • Presence of defect-free abutments.
includes: • Presence of single missing anterior tooth or
• Intraoral examination and selection of an premolar.
appropriate prosthesis. • Sometimes a single missing molar with
• Evaluation of the abutment and selection minimal opposing occlusal load.
of an appropriate prosthesis (discussed in • Presence of sound abutments on either side
Chapter 26). of the edentulous space. 493
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Introduction to Fixed Partial Dentures
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24 Textbook of Prosthodontics
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Introduction to Fixed Partial Dentures
24
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24 Textbook of Prosthodontics
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Introduction to Fixed Partial Dentures
24
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24 Textbook of Prosthodontics
posterior teeth. Hence, it is a cantilever design In other words, it is a posterior pier abutment
and is grouped under Division I. The abut- case with healthy abutments.
ment, which is used to derive support, is
ideal and healthy, hence, it falls under sub- Other Systems of Classification
division I.
FPDs can also be classified as follows:
Since a single molar cannot support two
I. Depending on the type of connector:
missing premolars, the adjacent second molar
• Fixed fixed partial denture
is also used as an abutment. Since support is
• Fixed movable partial denture
taken from more than one abutment tooth
• Removable fixed partial denture
on one side of the edentulous space the case
II. Type of material used:
is classified as Sub-division I-B.
The classification of this case is denoted as • All metal crowns
“Class I, Division I, Sub-division I-B”. • Metal ceramic crowns
2. “Class I, Division II, Sub-division IV-A”. (Fig. • All ceramic crowns
24.36). • All acrylic crowns
Denotes a posterior edentulous situation with • Ceramic veneer
teeth present on either side of the edentulous • Acrylic veneer
space capable of providing support, III. Length of the span:
additional support from adjacent teeth is not • Short span bridges
required. One or both abutments are • Long span bridges
extensively damaged requiring special IV. Duration of use:
designs like inlay, onlay, precision attach- • Permanent fixed partial dentures
ment or a dowel core, etc. • Long span bridges
—Interim prosthesis
—Periodontally weak abutment (Mary-
land bridge)
—Splints
V. Type of abutment:
• Normal / ideal abutment
• Cantilever abutment
Fig. 24.36: Class I division II sub-division
• Pier abutment
IV-A edentulous space
• Mesially tilted abutment
—Mesial half crown
3. “Class I, Division III, Sub-division I-A” (Fig.
—Telescopic crown
24.37).
It talks about more than one posterior • Endodontically treated abutment
edentulous space sharing a single abutment. (depending on the amount of remaining
All other abutments are healthy and are tooth structure)
capable of providing support independently. — Core: plastic core materials
• Amalgam
• Composite
• Glass-Ionomer cements
• Pin-retained amalgam
— Post core restorations
• Custom-made posts
Fig. 24.37: Class I, Division III, Sub-division I-A • Prefabricated posts
500
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Introduction to Fixed Partial Dentures
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Chapter 25
Parts of A Fixed Partial Denture
• Introduction
• Retainers
• Pontics
• Connectors
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Parts of a Fixed Partial Denture
25
Parts of a Fixed
Partial Denture
Types of Retainers
Retainers in fixed partial dentures can be broadly
classified as:
Based on tooth coverage:
• Full veneer crowns
• Partial veneer crowns
• Conservative (minimal preparation) retainers Fig. 25.1: Full veneer crown
503
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Parts of a Fixed Partial Denture
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25 Textbook of Prosthodontics
• Buccal/facial surface should be conserved. The success of a fixed partial denture depends
• Partial veneer crowns are more conservative on the proper design of the pontic. If the pontic
than full crowns. is not designed to restore function and aesthe-
• All ceramic crowns are the least conservative. tics, the chances of failure are dramatically
increased.
PONTICS The objective of designing a pontic includes
the construction of a substitute that favourably
A pontic is a suspended member of a FPD that compares with the tooth it replaces. Each surface
replaces the lost natural tooth, restores function of the pontic should be designed carefully to fulfil
and occupies the space of the missing tooth (Fig. this objective.
25.10). There are three important factors that control
the design of the pontic.
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Parts of a Fixed Partial Denture
cation of a good pontic. But in many cases, due success of the partial denture. We shall see the
25
to a long period of edentulousness the adjacent design consideration to be followed for each
teeth tend to be tilted or drifted towards this surface of the pontic.
space. In such cases a proper pontic cannot be
Gingival surface The gingival surface is the most
placed and the design of the pontic should be
compromised. interesting aspect of the pontic design. The
Fabrication of a small anterior pontic gives an material used and the degree of tissue contact
ugly appearance. In posterior teeth, small pontics affect the success of the restoration (Fig. 25.11).
tend to collect more food debris and hence is very
difficult to maintain.
For cases with deficient pontic space, the
following procedures can be done:
• Orthodontic movement of adjacent teeth.
• Placement of modified full coverage retainers.
Residual ridge contour During treatment plan-
ning the diagnostic cast should be thoroughly
examined. The contour of the ridge and texture
of the soft tissues should be observed during
intra-oral examination.
A smooth rounded ridge is best for the place-
ment of a pontic. In cases with overhanging
hyperplastic tissues, surgical excision of these
tissues should be carried out. Fig. 25.11a: (1) The gingival surface of the pontic should be
Cases with severe residual alveolar ridge preferably finished using ceramic for better tissue response
resorption should be treated with ridge augmen- (2) The tissue contact of the gingival surface should be
tation, tissue grafts, etc. (Refer chapter 24). minimal to prevent adverse tissue reaction
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25 Textbook of Prosthodontics
than the material used in maintaining tissue to reduce the occlusal load on the tooth (Fig.
health. 25.13).
• Tissue contact is very important for a pontic.
The pontic should not be designed to pres-
surize the alveolar mucosa, as it may ulcerate.
Tissue contact should be minimal (Fig. 25.12).
Previous concepts of close tissue adaptation
are not followed lately. It should be remem-
bered that patient’s maintenance (flossing) is
more important than the pontic design itself.
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Parts of a Fixed Partial Denture
• The facial surface should be designed with • Contact with the labial slope of the ridge
25
aesthetics as the primary concern. It should should be minimal (pin point) and pressure
resemble the adjacent teeth. free (modified ridge lap design).
• The lingual surface is designed with hygiene • A larger contact with the ridge is provided for
as the primary concern. a natural look. If a pinpoint contact is given
• The embrasures are wider lingually than for a case with ridge resorption, unaesthetic
facially. black spaces may become visible.
• The lingual surface should be designed such • Lingual contour should be in harmony with
that it is similar to an adjacent teeth from the that of the adjacent teeth.
cusp tip till the height of contour, then it
should recede sharply and concavely from the Classification of Pontics
height of contour towards the facial surface Pontics can be classified in the following ways:
to form a pinpoint contact on the labial surface • Mucosal contact.
of the residual alveolar ridge (Fig. 25.14). • Type of material used.
• Method of fabrication.
Classification of pontics
Mucosal Contact
Based on the amount of mucosal contact, pontics can be
classified as:
• With mucosal contact
— Saddle Pontic
— Ridge Lap Pontic
— Modified Ridge Lap Pontic
Fig. 25.14: The lingual surface of the pontic should — Ovate Pontic
sharply descend concavely from the height of contour • Without mucosal contact
— Bullet Pontic
Design Considerations for a Posterior Pontic — Hygienic or Sanitary Pontic
Type of Material Used
A correctly designed posterior pontic should have Based on the type of material used, pontics can be classified
the following characteristics: as:
• Metal and Porcelain Veneered Pontic
• All surfaces should be convex, smooth and
• Metal and Resin Veneered Pontic
properly finished. • All Metal Pontic
• Contact with the buccal slope of the ridge • All ceramic pontic
should be minimal (pin point) and pressure Method of Fabrication
free (modified ridge lap design- discussed later). Based on the method of fabrication pontics can be classified
as:
• The occlusal table should be in harmony with
• Custom made pontic
the occlusion of all the other teeth. • Prefabricated pontic
• The buccal and lingual shunting mechanism — Trupontic
should correspond to that of the adjacent teeth. — Interchangeable facing
• The overall length of the buccal surface should — Sanitary Pontic
— Pin-facing Pontic
be equal to that of the adjacent abutments or
— Modified Pin-facing Pontic
pontics. — Reverse Pin-facing Pontic
— Harmony Pontic
Design Considerations for an Anterior Pontic — Porcelain Fused to Metal Pontic
• Prefabricated Custom Modified Pontic
A correctly designed anterior pontic should have
the following characteristics: Now we shall discuss in detail about the
• All surfaces should be convex, smooth and design and advantages of each of the above-
properly finished. mentioned pontics. 509
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Fig. 25.15: Saddle pontic with buccal and lingual do not overlap the ridge on either sides like saddle
tissue contact pontics instead the tissue contact is limited to the
Though some researchers have demonstrated buccal surface of the ridge crest.
acceptable short-term results, it is not a widely This pontic is designed with a slight bucco-
accepted design. The short-term success may be lingual concavity wherein food entrapment can
due to close adaptation of the pontic to the ridge. occur. Food entrapment is avoided by designing
The close adaptation could have prevented the a convex mesiodistal surface. The mesiodistal
collection of food debris in-between the pontic surface should be more convex to avoid food
and the mucosa. entrapment.
These pontics are generally avoided because Tissue surface of the pontic shows a ‘T’ shaped
they are very difficult to maintain and it is contact. The vertical arm of the ‘T’ ends at the
impossible to avoid accumulation of food debris. crest of the ridge. The horizontal arms form the
contact along the buccal surface of the ridge.
Ridge lap pontics Contact with the facial/buccal surface of the ridge
This pontic resembles a natural tooth (Fig. 25.16). is essential to provide a natural appearance (Fig.
It is designed to adapt closely to the ridge. It is 25.18a).
avoided because it is difficult to maintain and
often leads to inflammation of the tissues in
contact.
Modified ridge lap pontic
Ridge lap pontics evolved from saddle pontics.
Fig. 25.18a: T-shaped tissue contact of modified
Though the ridge lap pontics had relatively less
ridge lap pontics
tissue contact, they were also difficult to maintain.
Hence, ridge lap pontics were modified and Customized ridge lap designs are fabricated
evolved as the modified ridge lap pontics. in patients with nervous habits who show
Modified ridge lap pontics were designed to irritation on the lingual surface. Generally, this
510 further reduce the tissue contact (Fig. 25.17). They pontic is avoided because the buccolingual
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Parts of a Fixed Partial Denture
Ovate pontics
These pontics are used in cases where the residual
ridge is defective or incompletely healed. They
can also be used in broad and flat ridges. The
pontic is designed such that its cervical end
extends into the defect of the edentulous ridge
(Fig. 25.19). The pontics should be reduced as Figs 25.20b and c: (b) Spheroidal pontic
(c) Modified spheroidal pontic
healing progresses. This pontic is more aesthetic
as it appears to arise from the ridge like a natural the appearance of an exaggerated occluso-
tooth. It is said to have evolved from root extended gingival dimension.
or root tipped pontics.
Sanitary or hygienic pontics
These pontics have zero tissue contact. Though
they are easy to maintain, they are highly unaes-
thetic. Hence, they are used only for posterior
teeth. The pontic should be atleast 3 mm high
occluso-gingivally and at the same time provide
adequate tissue clearance for easy maintenance.
Three common designs can be employed
while fabricating a sanitary pontic. They are:
Fig. 25.19: Ovate pontic
Bar sanitary pontics These pontics have a flat
Bullet-shaped or conical or heart-shaped pontic gingival surface that has sufficient gingival
This pontic has a convex tissue surface, which clearance (Fig. 25.21a).
contacts the tissue at one single point without any
pressure (Fig. 25.20a). This pontic is very easy to
clean and maintain. The only disadvantage of this
design is its poor aesthetics, which results due to
wide embrasures. It is indicated for the
replacement of mandibular posterior teeth where Fig. 25.21a: Bar sanitary pontic
aesthetics is not a major concern.
Spheroidal and modified spheroidal pontics Conventional sanitary or fish belly pontic The
(Figs 25.20 b and c) gingival surface of the pontic is convex both
• These pontics contact the tissue only at the buccolingually and mesiodistally. The pontic
ridge crest. resembles the belly of a fish and hence the name
• They do not have concave gingival surfaces (Fig. 25.21b). This design has two disadvantages
• They are indicated for cases with reduced namely, the size of the connectors are decreased,
inter-arch space, where the pontic should give hence, the strength of the prosthesis is reduced 511
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Parts of a Fixed Partial Denture
Trupontic
This pontic consists of a large gingival bulk,
Fig. 25.26: Tissue contact should be made by the
which can be adapted to the ridge. It has a backing and not the facing backing junction
horizontal tubular slot running in the centre of
the lingual surface of the facing. It has two Sanitary facings
proximal slopes/bevels on either side of the These are prefabricated pontic facings, which
central bulk (Fig. 25.24). This slot and the proxi- resemble sanitary pontics described before. These
mal bevels provide retention. It is indicated in pontics have slots on the proximal surface to fit
cases with limited inter-arch distance. It cannot into the metal projections made in the fixed partial
be used when there is reduced inter-occlusal dis- denture (Fig. 25.27). The facing has a flat occlusal
tance due to the presence of a large gingival bulk. surface which is customised as needed.
Interchangeable facing or flat back facing Fig. 25.27a and b: (a) Sanitary facing (2) Customised
It consists of a vertical slot in its flat lingual occlusal form over a sanitary facing
surface. The facing is retained by a backing with Pin facing
a lug (elevation), which is designed to engage the The lingual surface of this facing is flat and
retention slot (Fig. 25.25). The tissue contact consists of two pins for retention (Fig. 25.28). It
should be a part of the backing (not the backing should be positioned over the backing such that
facing junction) to ensure a smooth finish (Fig. the gold porcelain junction does not contact the
tissues (Fig. 25.29). It is indicated in cases with
reduced occluso-gingival height.
Modified pin facing
Here, the flat lingual surface of the pin facing is
modified by adding additional porcelain onto the
Fig. 25.25: Interchangeable facing gingival portion of its lingual surface (Fig. 25.30). 513
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Parts of a Fixed Partial Denture
Pontic Modification
The design of the pontic is probably the most
If the edentulous ridge is heavily resorbed, then important factor in determining the success of the
the large gingival embrasures between the pon- restoration. If the patient is unable to effectively
tic(s) and retainer(s) will appear highly unaes- clean and maintain the pontic, the restoration will
thetic. These large embrasures or so-called ‘black be unsuccessful. Special considerations are
triangles’ act as a source of plaque accumulation needed to create a design that combines ease of
and flossing interference (Fig. 25.37). maintenance with a natural appearance and
Such cases can be treated by two methods. One adequate mechanical strength.
is to modify the pontic and fill the entire
embrasure space with pink porcelain (Fig. 25.38). CONNECTORS
This can be done in aesthetically low profile areas
like lower anteriors and upper posteriors. The Connector in a fixed partial denture can be
other method is the fabrication of an Andrew’s defined as, “The portion of a fixed partial denture
bridge system discussed in detail in chapter 30 that unites the retainer(s) and pontic(s)”- GPT.
(Fig. 25.39). Connectors can be broadly classified as: 515
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Non-Rigid Connectors
These connectors are indicated in cases where a
single path of insertion cannot be achieved due
Fig. 25.39: In some cases, larger anterior defects may be non-parallel abutments. These connectors allow
better managed by an Andrews bridge system with a limited movement between the retainer and
removable acrylic insert that clamps down over a bar linking pontics. The common non-rigid connectors are
the abutments discussed below.
Tenon Mortise connectors (TMC) with a male
• Rigid connectors and female component or Dovetail connectors:
• Non-rigid connectors The non-rigid connector (incorporated during
— Tenon-Mortise connectors the wax pattern stage) consists of a Mortise
— Loop connectors (female) prepared within the contours of the
— Split pontic connectors retainer and a Tenon (male) attached to the pontic
— Cross pin and wing connectors (Fig. 25.42). The alignment of this dovetail con-
nection is critical; it must parallel the path of with-
Rigid Connectors drawal of the other retainer. Paralleling is nor-
They are used to unite retainers and pontics in a mally accomplished by means of a dental sur-
fixed-fixed partial denture. These connectors are veyor. The female component may be prepared
used when the entire load on the pontic is to be free hand in the wax pattern or with a precision
transferred directly to the abutments. milling machine. Alternatively a special mandrel
516
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Fig. 25.44a: The mesial segment, which is cemented first, Fig. 25.46: The retainer-pontic segment is seated finally
has a distal shoe in the gingival portion of the pontic
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Chapter 26
Design of A Fixed Partial Denture
• Introduction
• Design Considerations for Individual
Conditions
• Material Selection
• Biomechanical Considerations
• Abutment Selection
• Special Cases
• Condition of the Residual Ridge
• Occlusion with the Opposing Teeth
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Design of a Fixed
Partial Denture
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Design of a Fixed Partial Denture
In the following section we shall study about has been replaced by Bis-GMA. Bis-GMA
26
the properties of different materials, which affect improves strength and wear resistance.
the design of an FPD. Specific design concepts
and tooth preparation should be followed for Fibre Reinforced Resin
each material to improve the success of the
prosthesis. This is a type of fibre-reinforced composite. It
provides a good fit and finish and is very
Plastic Materials aesthetic. Long-term results are yet under study.
These materials require considerably less amount
of tooth preparation. But their success is limited Complete Ceramic
due to their poor strength, e.g. resins. It has the best aesthetics but the worst marginal
finish. Another major disadvantage is that it
Cast Metal
requires maximum tooth reduction. It is very
The material is strong and provides a very good brittle material (due to low elastic strain) hence,
fit and finish. They have an excellent success rate the restoration should be more bulky to attain
and hence are most commonly used. Cast metals sufficient strength. Recent systems with high
are generally classified as intracoronal and strength fillers like alumina and zirconia promise
extracoronal replacements. to improve the tensile strength of porcelain.
Intracoronal Replacements
BIOMECHANICAL CONSIDERATIONS
Gold is the metal most commonly used for
intracoronal restorations. It gives an excellent fit The design of a fixed partial denture is deter-
and finish. The major disadvantage is that they mined by the physical factors affecting the
require extensive tooth preparation even for small prosthesis. The major biomechanical factors
lesions. which affect the design of an FPD are:
• Length of the edentulous span
Extracoronal Replacements • Occlusogingival height of the pontic.
They are used for teeth with extensive carious • Arch curvature.
lesions. The material requires extensive tooth • The direction of forces acting on the FPD.
preparation. Since the margins are placed near
the gingival margin, periodontal health may be Length of the Edentulous Span and
affected. Occlusogingival Height of the Pontic
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Fig. 26.2: The pontic should lie within the interabutment axis
to best distribute forces acting on it. If the pontic is located
outside interabutment axis, undue stress will be developed
Fig. 26.1a: A bridge of shorten length will flex less within it
compared to a longer bar with the same dimension
buccolingual direction. But in a fixed partial
denture, the dislodging forces act in a mesiodistal
direction. In order to resist these dislodging for-
ces, grooves may be used on the buccal and
lingual surfaces of the prepared abutment in order
to enhance resistance and structural durability of
the retainer (Fig. 26.3).
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Design of a Fixed Partial Denture
Root Support
The supporting alveolar bone should be healthy.
It should have good trabecular architecture and
show no signs of bone defects or bone loss. Intra-
Fig. 26.4: Teeth with flat roots resist rotation and hence oral radiographs should be used to evaluate the
are preferred to as abutments bone architecture (Fig. 26.9). The alveolar bone 523
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26
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Chapter 27
Occlusion in Fixed Partial Dentures
• Concepts of Occlusion in Fixed Partial Dentures
• Anatomy of the Temporomandibular
Joint and Related Structures
• Kinematic Face-bows and
Fully Adjustable Articulators
• Occlusal Rehabilitation
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Occlusion in Fixed
Partial Dentures
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Occlusion in Fixed Partial Dentures
Stylomandibular Ligament
It limits protrusive movement of the mandible. It
is a thickening of the deep cervical fascia. It arises
from the styloid process and is inserted on the
lower part of the posterior border of the mandi-
bular ramus mainly at the angle of the mandible
and the fascia of the medial pterygoid muscle
(Fig. 27.3).
Fig. 27.1: Temporomandibular joint
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Early concepts include those of Bonwill (1858), allow a certain amount of freedom of movement
Balkwill (1866) and Von Spee (1890). Then came in an antero-posterior direction. The concept of
the age of occlusal theories and occlusal “long centric” or “freedom in centric” was pro-
articulators which include, Monson’s spherical posed. A few years later Schuyler joined Pankey
theory (1916), Hall’s conical theory (1918), and and Mann to evolve what is now known as the
Hanson’s theory (1923) and Meyer’s functionally PMS (Pankey, Mann, Schuyler) system. This
generated path technique (1940). system retained the Monson spherical theory and
The occlusal concepts proposed during this Meyer’s functionally generated path technique,
period of dental history from 1800 to 1930, can be however, under Schuyler’s influence.
summarized as being basically formulated for • The balancing side contacts were eliminated
complete denture patients in whom bilateral • The importance of incisal guidance was
balanced occlusion in eccentric movements was elevated.
considered essential. • The concept of ‘long centric’ was proposed.
However, as the principles of bilateral balan- • The Hanau occlusal instrument with arbitrary
ced occlusion were introduced into fixed prostho- face-bow and Broadrick occlusal plane analy-
dontics, there was a high rate of failure even with zer were adopted.
specific attention to detail and the use of sophisti-
cated articulators. Failure was due to factors like Mutually Protected System of Occlusion
occlusal wear, periodontal breakdown and tem-
poromandibular joint disturbance. When poste- Gnathologic researchers namely Stallard and
rior contacts on the non-working side were elimi- Stuart (1960’s), felt that the basic theory of
nated, these symptoms were generally relieved. collinear hinge axis and border movements was
Thus, the concept of a group function or unilateral correct, but it’s application was misdirected. They
balance was proposed. proposed the “Cuspid Protection Theory” according
In a unilaterally balanced articulation (dyna- to which, the balancing contacts during eccentric
mic occlusion), during excursive movements, jaw movements were eliminated by making the
contact occurs between opposing posterior teeth canines on the working side disocclude the poste-
on the working side only. In natural dentitions, rior teeth. The cuspid protection theory deve-
intercuspal position rarely coincided with centric loped into the “Mutually protected system” were
relation. again CR=CO. There are no posterior occlusal
In 1950’s-60’s, another group of researchers contacts during lateral/protrusive excursions.
headed by Mc Collum believed that if the The relationship of the anterior teeth or anterior
rotational centres in the condyles could be located guidance is critical in achieving this occlusal
and if the border movements of these rotational scheme.
centres were recorded and reproduced on a
sophisticated three-dimensional articulator, then Rationale
all functional movements for the patient could
also be reproduced by that instrument. (i.e.) The anterior teeth have a distinct mechanical
• Establishing the hinge axis (location of the advantage over the posterior teeth; the effective-
rotational centres of condyles). ness of the force exerted by the muscles of masti-
• Using a pantographic tracing to record the cation is notably less when tooth contact occurs
three-dimensional envelope of motion. more anteriorly. The more anterior the initial tooth
• Centric relation (CR) = Centric occlusion (CO) contact occurs, (Class III lever) the longer the lever
or intercuspal position (ICP). arm and hence, the forces exerted by the muscu-
• Bilateral balance with eccentric jaw lature will be less effective and therefore the load
movements. placed on the teeth will also be small (Fig. 27.7).
These concepts became known as gnathology. The canine with its long root, pressoreceptors
532 Schuyler suggested that it is advantageous to in the periodontal ligament (sensitive to mechani-
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Occlusion in Fixed Partial Dentures
Biological Occlusion
27
The flexible concept of occlusion is termed bio-
logical occlusion and its goal is to achieve an
occlusion that functions to maintain health. This
occlusion may include malposed teeth, evidence
of wear, missing teeth and CR=CO, etc. most of
these conditions may not require occlusal therapy.
But when therapy is indicated, then basic
guidelines for occlusal design should be followed.
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Patient Adaptability
There may be significant differences in the adap-
tive response of a patient to occlusal abnormali- Fig. 27.8b: Cusp to marginal ridge relationship
ties. Individuals with a lower threshold will be
unable to tolerate even trivial occlusal deficien- KINEMATIC FACE-BOWS AND FULLY
cies. Patients with a raised threshold may adapt ADJUSTABLE ARTICULATORS
to distinct malocclusions without obvious symp-
toms. Management of defective occlusion has In this section we will discuss about the special
been discussed under full mouth rehabilitation. equipments required to carry out full mouth reha-
bilitation. This face-bow/articulator have been
Occlusal Morphology omitted in the complete denture section (Chapter
10) because these equipments are not widely used
An ideal occlusal scheme for a restoration should
during complete denture construction.
be established in the wax pattern. Hence, it is
necessary to know the classification based on the
Kinematic Face-bow (Hinge Bow) (Fig. 27.9a)
location of the tooth contact made by the func-
tional cusp on the opposing tooth in centric It is a type of face-bow that locates the absolute
relation, in order to carve out the scheme of the hinge axis or true hinge axis. Hinge axis is an
wax pattern itself. imaginary line passing through the centre of the
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Uses of a Pantograph
A pantograph records the mandibular movement
c
in all three planes and hence, it is useful in the
following treatment procedures: Figs 27.20a to c: Pantograms: (a) Left laterotrusion
• To record the envelope of motion (b) Right laterotrusion (c) Protrusion
538
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• Designing the occlusal surface of the restora- • When there is a change in vertical dimension.
27
tion in harmony with the mandibular move- • When the remaining teeth have supra-erupted
ments. with an altered occlusal plane.
• Producing organic occlusion (canine protec-
tive occlusion where CR=CO). General Consideration Regarding Full
• Developing eccentric relation of cusps. Mouth Rehabilitation
• Directing the forces on a restoration along the
The operator should be thoroughly know-
long axis of the tooth.
ledgeable about:
• The functions of the temporomandibular joint
Full Mouth or Oral Rehabilitation
• Mandibular movements around hinge axis
When the restoration of missing teeth involves • The relationship between the cusps and fossae
complete rehabilitation of the oral cavity (func- to the hinge axis.
tional and aesthetic) it is termed as full mouth • Factors that control optimum occlusion in
rehabilitation. Examples for aesthetic, functional harmony with the stomatognathic system.
rehabilitation that may be required while They include condylar guidance, incisal gui-
replacing missing teeth include: dance, plane of occlusion, compensating cur-
• Restoring the vertical dimension. ves and cuspal angulation (Of these factors,
• Treating joint dysfunction. condylar guidance is a fixed factor and the other
• Treating muscular dysfunction. factors are called variable factors).
• Alveoloplasty. • The functioning and usage of instruments like
• Ridge augmentation. kinematic face-bow, pantograph, etc used to
• Optimizing occlusal discrepancies. carryout full mouth rehabilitation.
• Modifying mandibular movements.
Of all the above-mentioned procedures, occlu-
Treatment Procedure
sal rehabilitation is one of the most important
treatment procedures followed during full mouth We know that full mouth rehabilitation is a combi-
rehabilitation. The role of occlusal rehabilitation nation of multiple procedures done to restore the
can be understood from the fact that full mouth oral cavity to its original condition. Increasing the
rehabilitation is often referred to as occlusal vertical dimension using treatment partial
rehabilitation. dentures has been dealt with in chapter 23. Here,
Full mouth rehabilitation is a complex form the basic steps to be followed while carrying out
of treatment, which follows the gnathological a complete oral rehabilitation procedure have
concepts. Gnathological concept considers that been enumerated.
the true hinge axis is the centre of all joint • Diagnosis and treatment planning.
functions. • Diagnostic casts should be accurately moun-
ted on an adjustable articulator to study the
Indications for Full Mouth Rehabilitation mandibular movements and premature con-
Common conditions, which require full mouth tacts that occur during eccentric movements.
rehabilitation include: • Three sets of impressions are necessary
• When both anterior and posterior teeth are to — One, for diagnosis and permanent record.
be replaced. — Second, for the construction of clutches.
• When a combination of prostheses (removable — Third, for mock preparation. This includes
and fixed partial dentures) are to be inserted preoperative estimation of tooth reduction
for a patient. and development of articulation (dynamic
• For maxillary single complete dentures are to occlusion) in wax.
oppose a mandibular distal extension denture • After face-bow transfer using an arbitrary face-
base. bow, the first set of casts (study casts) are 539
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Occlusion in Fixed Partial Dentures
OCCLUSAL REHABILITATION
Selective grinding is an important constituent of
oral rehabilitation procedures. It is defined as,
“The intentional alteration of the occlusal surfaces of
teeth to change their form” - GPT.
Occlusal rehabilitation is done as a diagnostic Fig. 27.24: The patient is asked to close at centric. He should
stop closture once he obtains feather contact. The patient
procedure prior to the construction of fixed partial should not move his mandible anteriorly to obtain occlusion
dentures. Ideally, these procedures are to be con-
ducted for all patients.
Occlusal rehabilitation becomes more impor- • Once feather touch contact is established bet-
tant when fixed partial dentures are fabricated ween the natural dentition and denture, the
against complete dentures and removable partial patient is asked to close the mouth tightly (Fig.
dentures. In this section, we have discussed 27.25).
occlusal rehabilitation procedures with regard to • If the patient slides his mandible to obtain tight
a maxillary complete denture opposing a closure it indicates the presence of occlusal
mandibular fixed partial denture. discrepancies (Fig. 27.26).
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• Teeth end-to-end (Fig. 27.39a) • Grinding cuspal inclines (lingual inclines of maxilla and
buccal inclines of mandible). Cusps are not shortened (Fig. 27.39B)
• Too much horizontal overlap (Fig. 27.40a) • Maxillary lingual and mandibular buccal cusps are
made narrow, not short (Fig. 27.40b).
In working side during eccentric movements Correction
(Six types of errors require shortening of cusps)
• Maxillary buccal and mandibular lingual • Maxillary buccal and mandibular lingual cusps
cusps are too long (Fig. 27.41a) are shortened (Fig. 27.41b)
• Only buccal cusps contact (Fig. 27.42a) • Shorten the buccal cusps (from the central
fossa to the cusp tip) (Fig. 27.42b)
• Only lingual cusps contact (Fig. 27.43a) • Buccal incline of the mandibular lingual cusp should be
corrected in order to shorten the cusp (Fig. 27.43b)
• Maxillary cusps are mesial to the • Grinding should be done on the mesial inclines of the maxillary
intercuspating position (Fig. 27.44a). buccal and distal inclines of mandibular buccal cusps (Fig. 27.44b)
• Maxillary cusps are distal to the inter- • Grinding should be done on the distal inclines of the maxillary
cuspating position (Fig. 27.45a) buccal and mesial inclines of mandibular buccal cusps (Fig. 27.45b)
• No contact due to excessive contact on the • Buccal cusps of the mandibular teeth (balancing side)
balancing side (Fig. 27.46a) are altered on their inclines (Fig. 27.46b)
• No contact on the balancing side (Fig. 27.47a) • Grinding should be done on the working
side as described for the previous error (Fig. 27.47b)
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27
Fig. 27.36
Fig. 27.37
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27 Textbook of Prosthodontics
Fig. 27.47b
Fig. 27.47a correction is done on the lingual portion of the
occlusal surface of maxillary second molar.
Correcting the Identified Occlusal
• Abrasive paste (carborundum paste) is placed
Errors in Non-anatomic Teeth
between the teeth and the teeth are milled as
• After identifying the deflective contacts with eccentric movements are made on the upper
an articulating paper, grinding is done on the member of the articulator. Carborundum paste
occlusal surface of teeth that appear to have should never be used on anatomic teeth as it
been tipped or elongated during processing. may reduce the vertical dimension.
• During eccentric movements, grinding should • Spot grinding can be done to correct minor
not be done on the disto-buccal portion of the discrepancies in centric relation after grinding
mandibular second molar. Balancing side with abrasive paste.
548
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Chapter 28
Types of Abutments
• Introduction
• Healthy/Ideal Abutments
• Cantilever Abutments
• Pier Abutments
• Tilted Abutments
• Extensively Damaged Abutments
• Implant Abutments
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Types of Abutments
We know that the type of abutment determines The selection of a cantilever abutment is more
the design of a fixed partial denture. Abutments critical because this prosthesis is going to face/
are grouped based on their location and condi- withstand more than normal forces. Cantilever
tion. In this chapter we will have a detailed dis- abutments were discussed to a certain extent
cussion about the various abutments and the under special designs in Chapter 26. Hence, I
design modifications (of the prosthesis) required have enumerated the ideal requisites for a canti-
to manage the abutment. lever abutment here. The requisites for a canti-
lever abutment are:
HEALTHY/IDEAL ABUTMENTS • More than average bone support should be
present.
An un-restored vital tooth in its normal anatomic • Sufficient amount of tooth structure should be
position is considered as an ideal abutment. Ade- available because the final retainer should be
quate tooth structure should be present to deve- more retentive.
lop retention and resistance forms (discussed in • The abutment should be selected such that its
tooth preparation (Fig. 28.1). position favours the development of an ideal
occlusal scheme.
• Endodontically treated teeth are not preferred.
Endodontically treated teeth with excessive
crown damage are contraindicated.
• Teeth with short roots are contraindicated.
• Certain ideal cantilever situations include:
— Replacement of lateral incisor with canine
support.
— Replacement of first premolar with second
premolar and first molar support.
Fig. 28.1: Ideal abutment • If strong abutments are not available, adjacent
to the edentulous space, spring cantilever
designs can be incorporated.
An ideal abutment should have the following
characteristics:
PIER ABUTMENTS
• Ideal crown root ratio.
• Adequate thickness of enamel and dentin. A Pier abutment is a single tooth with two adja-
• Adequate bone support cent edentulous spaces on either side. In this case,
• Absence of periodontal disease the single tooth will have to act as an abutment
• Proper gingival contour for both the edentulous spaces (Fig. 28.2).
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Fig. 28.4: Non-rigid connector fabricated at the junction of the pier abutment and distal pontic.
The key way is placed on the pier abutment and the key is placed on the pontic 551
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TILTED ABUTMENTS
Orthodontic Treatment
The abutment teeth can be orthodontically altered
Fig. 28.7: When the abutments are tilted in relation to one (until it is parallel to the other abutments) so that
552 another, it is difficult to obtain a single path of insertion a conventional FPD can be given (Fig. 28.9b).
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28
Fig. 28.9a: A modified partial veneer crown can be used Fig. 28.11: Telescopic crowns modify the path of insertion
when a single path of insertion is required with minimal tooth
preparation
alters the contour of the crown. This crown should
be fabricated with vertical slots so that it can
receive a second crown (telescopic crown) in a
vertical direction (Fig. 28.11).
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28 Textbook of Prosthodontics
Figs 28.12a and b: (a) The ‘Central core’ of the tooth is the
cylinder of pulp and 1 mm thickness of surrounding dentine Fig. 28.14: A pin can be incorporated into a crown to augment
(b) Any carious lesion extending beyond the central core retention and resistance (A); or pins can be used to retain a
should be restored before fabricating the retainer of the fixed core, which in turn will help to retain a crown (B).
partial denture
— Non-parallel pins screwed into the dentin: This
• Retentive grooves should not extend more technique involves the drilling of non-
than 1.5 mm below the cervical line. parallel pins into dentin to help retain an
amalgam core (Fig. 28.15).
Grooves
• A groove can be placed to provide retention
to the preparation (Fig. 28.13).
• Too many grooves may interfere with the Fig. 28.15: A core retained by pins, slots, amalgampins, or
seating of a full veneer crown. extension into the pulp chamber is used to build up a molar
• A groove should be at least 1 mm wide. with some coronal tooth structure
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Fig. 28.17: Interproximal caries may interfere with the Fig. 28.19: A-Core B-Dowel or post
placement of a groove (dotted line) (a). Use of a box in this
situation accommodates caries removal and provides A dowel/post provides the necessary amount
retention (b).
• The box functions to provide both retention of retention and acts as a substitute for the lost
and resistance. tooth structure. But studies have shown that the
• If two boxes are placed within 180° on a tooth, dowel does not take up any masticatory load and
the tooth will be weakened and will fracture that the dowel weakens the tooth structure rather
due to excessive reduction (Fig. 28.18). In such than strengthening it.
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28 Textbook of Prosthodontics
Fig. 28.20: The length of the dowel (DL) should equal the
crown length (CL) or two-thrids the length of the root,
whichever is greater. The length of the remaining apical fill
(AF) should be at least 4.0 mm Fig. 28.23a: A key way provided on the prepared canal wall
functions to guide the dowel during placement and also as
• While preparing a dowel core for a premolar, an anti-rotational groove
the operator should be cautious to avoid canal
perforation near the proximal root concavities,
thin walled areas and other steeply tapered
parts (Fig. 28.21).
Fig. 28.23b
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because they are easier to work with and require Fabrication of a custom made dowel cores
28
lesser bulk of material, therefore, they can be used The steps in the fabrication of a dowel core are:
on smaller teeth. • Tooth preparation
The most commonly used materials for • Canal preparation
making dowels are stainless steel, titanium, nickel • Canal pattern fabrication
or chromium containing alloys. Titanium, high • Casting
Palladium and Cobalt Chromium Molybdenum • Finishing and cementation
alloys are preferred for their corrosion resistance. General considerations
Dowels can be parallel sided (cylindrical) or We know that the design of the dowel core will
tapering. Dowel systems are broadly classified as vary according to the tooth on which it is to be
passive (cemented) and active (threaded) types fabricated.
(Fig. 28.24). Threaded dowels are more retentive • The preparation of a dowel for a mandibular
than cemented dowels. premolar is similar to that of a central incisor.
In a maxillary premolar with two canals, the
second canal is utilised for anti rotation.
• Custom-made dowels are not used for molars
because they have divergent roots.
• Sometimes parallel pins should be added as a
parapost for anti-rotation and increased
retention.
• Nylon bristles can be used in these pinholes
while fabricating the pattern.
In the following section, we have discussed
about the fabrication of a dowel core in relation
to an endodontically treated maxillary anterior
tooth (central incisor), for which a metal ceramic
Fig. 28.24: Threaded dowel crown is planned.
Custom Cast Dowel Core Tooth preparation
• The tooth is prepared as usual (as for any
They are cast from the wax patterns fabricated in crown).
the canal. A brass wire or a paper clip may be • Unsupported enamel is removed.
used to make the wax pattern within the canal. • Only weak enamel is removed and it is not
Types of custom made dowel core systems necessary to remove all of the coronal tooth
Based on the technique used, custom made dowel structure.
cores can be classified in to: • The tooth should be evaluated for residual
• Prefabricated noble metal dowels, which are caries (especially under previous restorations)
designed to accept custom-made cores. to assess its strength. Any weak enamel wall
• Resin pattern fabrication or restoration should be removed.
• Wax pattern fabrication Canal preparation
Resin pattern is preferred over wax pattern • Peeso reamer is the instrument of choice for
because of increased strength and dimensional removing the gutta-percha (GP) and for
stability. If a tooth has more than one canal, only enlarging the canal. These instruments do not
one canal is used to prepare the dowel since the perforate the canal because they have non-
second canal does not significantly increase reten- cutting tips, which follow the path of least
tion. The second canal can be used as a stop to resistance (i.e. the reamer will try to move
prevent rotation. E.g. dowels are usually prepared along the length of the canal instead of cutting
only on the distal root of maxillary premolars. the walls and perforating it) (Fig. 28.25). 557
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28 Textbook of Prosthodontics
Fig. 28.25: A Peeso reamer. Notice the non cutting tip which
aids the reamer to take the path of least resistance without
making ledges on the canal walls
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28 Textbook of Prosthodontics
Contraindications
• Acute and Terminal illness.
• Pregnancy.
Fig. 28.32: Sprued resin pattern in a ring ready for investing • Uncontrolled metabolic disease.
• Tumoricidal radiation given at the implant
• The dowel should be checked for proper fit. site.
• If it binds to the canal, air abrasion should be • Unrealistic patient expectation.
done till the shiny spots are removed. • Improper patient motivation and poor oral
• The coronal portion should be polished to a hygiene.
satin finish using a Burlow wheel. • Lack of operator experience.
• A groove should be cut along the length of the • Inability to restore with a prosthesis.
dowel from the apical end to the contra bevel
to act as an escape way for the luting cement Treatment Planning
(Fig. 28.33).
Treatment planning for an implant is carried out
successive to diagnosis. Diagnosis for implant
cases is similar to the procedures explained in
Chapter 2. However, we have enumerated the
important factors that are to be considered while
placing an implant.
After diagnosis, the diagnostic data is
analysed and an appropriate treatment plan is
Fig. 28.33: A groove is cut in the side of the dowel to allow
derived.
cement escape during cementation
Clinical Evaluation
• The cement is loaded into the canal using a
Clinical evaluation for implant cases include the
lentulospiral.
evaluation of the following structures:
• The dowel should be inserted till it seats
• Adequate bone for implant placement. Can be
properly.
evaluated by inspection and palpation.
• Final impression is made after cementation of
• Anatomic structures that could interfere with
the dowel and the temporary crown is
implant placement.
prepared.
• The permanent crown is cemented later.
Radiographic Evaluation
IMPLANT ABUTMENTS The following radiographic studies should be
carried out prior to implant placement.
Indications for Implant Placement • Orthopantomograph: to evaluate the width
• In a partially edentulous patient who is unable and height of the bone.
to wear a removable partial denture or • Cephalometric analysis: To evaluate the bone
560 in the anterior maxilla and mandible.
complete denture.
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Parts of an Implant
Implant Body
• The implant body is the component that is
Fig. 28.35: Healing screw in place during the initial implant
placed within the bone during first stage of healing phase. Soft tissue is sutured over the implant. A
surgery. It could be threaded or non-threaded removable prosthesis can be worn over this area during
(Fig. 28.34). healing
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28 Textbook of Prosthodontics
range in length from 2 to 10 mm. They project abutment) to a similar position on the cast (Fig. .
through the soft tissue into the oral cavity (Fig. 28.37).
28.36a). They function to prevent overgrowth of
tissues around the implants during the healing
phase.
Abutments
Abutment is the super structure part of the
implant, which resembles a prepared tooth, and
is designed to be screwed into the implant body
(Fig. 28.36b). It is the primary component, which
provides retention to the prosthesis (fixed partial
denture).
Fig. 28.37a: While making the impression, the impression
post is placed on the implant body
Fig. 28.36a: Two types of healing caps. Both allow for soft
tissue healing after second-stage surgery. (a) Implant that
screws directly into the implant body. (b) Implant that screws Fig. 28.37b: The impression post will come away along
into the implant abutment with the impression after making the impression
Fig. 28.36b: (a) Standard abutment with supra-gingival margins (b) Standard abutment with sub-gingival margins
(c) Tapered abutment used for larger teeth (to harmonize the transition of the restoration) (d) Non-segmented
562 abutment used in areas with decreased inter-arch space and high aesthetic demand
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Fig. 28.38b: The cast poured over the impression with Implant Surgery
impression post-laboratory analogue complex, effectively
submerging the laboratory analogue into the cast like the
It involves the surgical placement of the implant.
implant body is placed on the bone The procedure can either be done in one or two
stages. Before we go into the details, let us discuss
about the surgical guide template.
Waxing Sleeves
Waxing sleeves are designed to be attached to the Surgical Guide Template
body of the implant. It is actually fixed to the ana- As the name suggests, these appliances act as a
logue during the fabrication of the superstructure. guide in placing the implant during implant
They will form a part of the super structure of surgery. The uses of a surgical guide template
the implant (Fig. 28.39). are: 563
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28 Textbook of Prosthodontics
• To delineate the embrasures that would occur The most common difficulties that occur in
between two adjacent implants. connecting the implant to the natural teeth are:
• Locate the implant on the ridge. • Intrusion of natural teeth.
• Align implants along with the long axis of the • Implant fractures.
completed restoration.
• To identify the level of cemento-enamel junc- Intrusion of Natural Teeth
tion (CEJ) or tooth emergence profile of the When an implant is connected to a natural tooth,
implant. it may get intruded. This is because the implant
is tightly integrated to the bone and do not show
Single Stage Surgery any movement during occlusion. Where as the
• Surgical access and implant placement is done natural tooth which is in the same plane will be
as a single procedure. subjected to tissueward movement. This
consistent downward force will lead to intrusion.
Two Stage Surgery Methods to Prevent Intrusion
• Ideally a natural tooth should never be com-
• During the first stage of surgery, the surgical bined along with an implant in any prosthesis.
site is exposed and the implant is placed and • A T-block type of stress relief attachment with
is allowed to osseointegrate. a transverse retaining screw can be used to
• The second stage is done after six months (time prevent migration or separation of teeth.
varies according to the site), here the implant • More implants should be placed to convert a
site is re-exposed and a super structure placed long multiunit restoration into many short
Both these procedures are described in a single unit restorations.
greater detail under section V (implants). • Using at least two implants, if only one tooth
is available to support three pontics.
Biomechanical Factors Affecting • Intra-coronal connectors (precision
Long-term Implant Success attachments) should not be used to fix the
Implant Occlusion partial denture, unless they are necessary for
path of insertion.
• All masticatory forces should be directed • The following design guide lines should be
along long axis of the implant. followed to prevent intrusion:
• Lateral forces on the implant should be — Telescopic crowns can be placed to orient
minimized. the stress. These crowns help to distribute
• If lateral forces are unavoidable they should stress and prevent intrusion.
be directed as far anteriorly in the arch as — Avoid using setscrew implants because
possible. these implants do not show any movement
• When it is impossible to minimize or move and thereby concentrate stresses on the
the lateral forces anteriorly, atleast they should natural teeth.
be distributed over as many teeth and — Composites can be used to cement the
implants as possible. retainers so that the natural teeth are held
tightly by the fixed partial denture against
Connecting Implants to Natural Teeth apical movement.
Implants do not show any movement under occ- Complications of Implant Abutments
lusal forces but the natural teeth (due to the
cushioning effect of the periodontal ligament) Bone Loss
show mild displacement under the same occlusal One of the most important and primary compli-
load. cation with dental implants therapy is bone loss
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around the implant. Any loss exceeding 0.2 mm cantilevers, poor access for maintenance, etc).
28
per year requires attention. • Excessive occlusal force.
• Deficient fit of abutment components (i.e. gaps
Factors Associated with Bone Loss are between the implant parts that allow bacterial
• Inappropriate size and shape of implant. colonization)
• Inadequate number and/or positioning of the • Inadequate oral hygiene
implants. • Other environmental factors like tobacco
• Poor quality/inadequate amount of available chewing/smoking, diabetes, etc.
bone.
Prosthesis Fracture
• Initial instability of the implant.
• Compromised healing phase (trauma during This may occur due to:
the healing phase, etc). • Biomechanical overload.
• Inadequate fit of the prosthesis. • Improper fabrication in the laboratory.
• Improper design of the prosthesis (e.g. large • Improper designing of the prosthesis.
565
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Chapter 29
Tooth Preparation
• Principles of Tooth Preparation
• Preparations for Full Veneer Crowns
• Preparation for Partial Veneer Crowns
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Tooth Preparation
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29 Textbook of Prosthodontics
Length
Greater the height of the crown, better the
retention of the restoration. The length of crown
improves retention in two ways:
First, the height of the prepared tooth should
be greater than the tipping arc of displacement,
to prevent displacement of the restoration. This
Fig. 29.2: Lingually tilted premolars should be prepared is more evident in molar teeth wherein prepara-
for a lingual path of insertion and not a vertical path of tions are usually shorter than the arc of displace-
insertion ment. Short preparations can be modified with
grooves, which significantly decrease the arc of
displacement (Fig. 29.5).
Second, increase in height increases the area
of cementation there by improving retention.
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Tooth Preparation
Path of Insertion
“It is an imaginary line along which the restoration
will be placed onto or removed from the preparation.”
It should be accurately determined using a sur-
veyor as minor undercuts in the preparation tend
to be hidden by the human binocular vision (Fig.
29.6). Fig. 29.7a: Intraorally, preparations are viewed through a
mouth mirror using one eye
Structural Durability
Durability comes with the thickness of the resto-
ration. A restoration should contain sufficient
bulk to withstand forces. The ability of the
restoration to withstand destruction due to external
forces is known as structural durability.
Adequate reduction during preparation is
mandatory to obtain adequate thickness of the
Fig. 29.6: If both eyes are open when the preparation is restoration. The amount of reduction required for
viewed undercuts may remain undetected structural durability depends on the type of 569
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29 Textbook of Prosthodontics
restorative material being used and the design of • Additional thickness in this region is necessary
the restoration. Here, I have discussed about the because the functional cusp of the tooth is the
amount of preparation required for the commonly one, which bears the maximum load during
used restorative materials. mastication.
• It is prepared on the palatal cusps of maxillary
Occlusal Reduction and buccal cusps of mandibular posterior
teeth.
Occlusal strength is the most vital as most of the
forces affecting the restoration, act directly on the
Axial Reduction
occlusal surface. Inadequate clearance may lead
to a weaker restoration, which is prone to fracture Adequate axial reduction is necessary for
or perforation (Fig. 29.8). Additional reduction structural durability. Inadequate axial reduction
(about 1 mm) should be done while preparing may lead to over-contoured proximal surfaces,
malposed teeth. The amount of occlusal reduction which can lead to periodontal problems (Fig.
required for commonly used materials is: 29.10). The required taper should be obtained,
during axial reduction. Over-reduction will lead
to loss of retention. Usually the axial reduction is
done such that it aligns the abutments parallel to
one another. But in mandibular premolars, the
tooth is inclined by 9o; hence, the preparation is
also inclined in the same angle to avoid excessive
Fig. 29.8: Inadequate occlusal reduction wil not provide the
tooth reduction.
required space for a cast restoration of adequate thickness
Marginal Integrity
Marginal adaptation and the seating of the
restoration affect marginal intergrity. Poor
Fig. 29.9a: The functional Fig. 29.9b: Lack of a functional marginal adaptation will lead to percolation of
cusp bevel is an integral cusp bevel can cause a thin oral fluids (marginal leakage`) and secondary
570 part of occlusal reduction area or perforation in the casting caries. Casting shrinkage may lead to marginal
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Tooth Preparation
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Fig. 29.15: Chamfer finish line Fig. 29.17: Sloping shoulder finish line
572 Fig. 29.16: Shoulder finish line Fig. 29.19: Shoulder with bevel finish line
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Tooth Preparation
Fig. 29.19a: Unbevelled preparations have an even perpendicular marginal discrepancy because
the angle of the margin (θ) is around 90°
Fig. 29.19b: In bevelled preparations, the marginal discrepancy (i.e. the effective distance between the tooth and the
restoration) decreases from D1 to D2 because the angle of the margin (θ) is reduced. Theoretically, if θ decreases to 0°, the
marginal discrepancy will also decrease to zero
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Fig. 29.21: Knife edge preparation Fig. 29.22: The finish line should be atleast 3 mm away
from the alveolar crest to preserve the periodontium
• Difficult to produce a smooth margin.
• Susceptible to distortion.
• Overcontoured restorations may result while • If an extensive inter-proximal bone reduction
building the bulk of the margins. is required during the preparation of a
proximal finish line in order to ensure the
Indications placement of a deep proximal finish line, it is
better to extract the abutment rather than
• Lingual surface of mandibular posterior teeth. affecting the adjacent healthy tooth.
• Very convex axial surface. • The cavosurface finish line should be smooth
• For the undercut surface of tipped teeth. and continuous to fabricate a restoration with
Preservation of Periodontium well-adapted margins.
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Tooth Preparation
Contraindications
29
A full crown is not given for patients with uncon-
trolled caries
Procedure
The steps to be followed for preparing a posterior
tooth are as follows:
• Occlusal reduction
• Axial reduction
— Buccal reduction
— Lingual reduction
— Proximal reduction
• Establishing the Finish lines
Fig. 29.23: Dental diamond points The above-mentioned procedures vary accor-
ding to the choice of material for the restoration.
used alongwith a rubber dam to avoid damage
Commonly used full veneer crowns include:
to soft tissues.
• Full metal or all metal crowns
• Grooves, boxes, offsets and isthmus can be
• Metal ceramic crowns
smoothened with No: 169L, 170C and 171L
non-dentate tapered burs. • All ceramic crowns
• Cross cut or dentate burs are used to remove In the following section we shall discuss about
old restorations but they produce horizontal these procedures in relation to the selected
ridges on the tooth surface. Hence, they cannot restorative material.
be used for planing tooth surfaces.
All Metal Full Veneer Crowns
• Small diamond points with air-water spray in
a high-speed hand piece can precisely remove It is usually given for posterior teeth.
tooth structure and also produce a smooth
finish when compared with conventional Armamentarium
procedures.
• Handpiece
• No: 171L bur
PREPARATIONS FOR FULL
• Round-end tapered diamond
VENEER CROWNS
• Short needle diamond
A full veneer crown is one, which encompasses • Torpedo bur
the entire crown structure. These crowns cover • Red utility wax
all the tooth surfaces. Hence, they require Note: The term “bur” is usually used to denote a
extensive tooth reduction. (TC) Tungsten Carbide rotary cutting instrument.
Diamond rotary cutting instruments are called
Indications “Diamond points” or “Diamonds”.
It is indicated when:
• The abutment tooth is small Occlusal Reduction
• The edentulous span is long • The principle of occlusal reduction is to
• When the partial veneer crown lacks in achieve an occlusal clearance of 1.5 mm for
retention, resistance, coverage or esthetics the functional cusps and 1.0 mm for the non-
• When the abutment is extensively decayed or functional cusps. (Fig. 29.24). This provides
decalcified or previously restored adequate metal thickness to resist fracture
• For endodontically treated teeth. under occlusal load. 575
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Tooth Preparation
Axial Reduction
29
• The buccal and lingual walls are reduced with
a torpedo diamond as it has the advantage of
forming the chamfer finish line alongwith the
axial reduction thereby avoiding the need of
Fig. 29.32: Completed preparation with
changing the diamonds for establishing the an axial seating groove
finish line. (Fig. 29.30).
• The seating groove will prevent the rotation
of the crown during cementation and acts as a
guide during insertion of the crown.
• Buccal and lingual grooves can be placed for
preparations involving long span fixed partial
dentures.
Fig. 29.30: Axial reduction is done using a torpedo Features Their functions
diamond to establish a chamfer finish line
• Planar occlusal reduction: Occlusal stability
• The chamfer finish line provides adequate • Axial reduction: Retention, Resistance and
Structural durability
bulk of metal along with a good adaptation.
• Functional cusp bevel: Structural durability
• The proximal reduction is started with a short • Seating groove: Marginal integrity
needle diamond. This diamond point is used • Chamfer finish line: Marginal integrity and
in a sawing motion to break the contact point. Periodontal preservation.
The sawing motion can be done in an occluso-
gingival or bucco-lingual direction. Care Metal-Ceramic Full Veneer Crowns
should be taken to avoid damage to the It is also known as Porcelain-Fused-to-Metal
adjacent teeth (Fig. 29.31). restoration. It has a thin metal coping with a facial
ceramic layer. This crown has the strength and
accurate fit of a metal crown and esthetics of a
ceramic crown.
Metal ceramic crowns are stronger than all
ceramic crowns and can be used as a fixed partial
Fig. 29.31: Proximal reduction should be started by carefully denture retainer.
breaking the contact using a thin tapering diamond point For ceramic veneering, a cutback design is
provided to on the facial surface of the metal cop-
• After gaining enough space, torpedo dia- ing in order to provide space for the ceramic layer
mond is used to prepare the proximal surface and the lingual reduction is similar to a full metal
and establish the finish line. crown (Fig. 29.33a). The procedure for tooth pre-
• The axial surfaces are smoothened with a tor- paration for metal ceramic crowns varies
pedo carbide finishing bur.
• The finish line should be smooth and con-
tinuous.
Seating Groove
• A seating groove is made on the buccal surface
of mandibular teeth and on the palatal surface
of maxillary teeth. It is usually made on the
axial surface with the greatest bulk, using a
No: 171L diamond (Fig. 29.32). Fig. 29.33a: Features of an anterior metal-ceramic preparation 577
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Preparation of an Index
Fig. 29.34: Cut the index into a labial and a lingual half
• An index is made before the preparation to
check for reduction produced by the prepara-
tion.
• If the tooth has proper contours, the index can
be made intraorally. If the tooth is extensively
damaged or the existing contours are to be
changed by the restoration, the index is made
from the pre-operative wax-up on the diag-
nostic cast. Here, we shall discuss about intra-
oral indexing.
• A half scoop of putty elastomer is kneaded
with adequate accelerator. The kneaded mix
is adapted over the entire facial and lingual Fig. 29.35: The labial half of the index is cut
surface of the tooth to be prepared plus the across into a gingival and an incisal half
facial and lingual surfaces of at least one
tooth structure. The lingual index is verified
adjacent tooth. It is allowed to polymerize for
for adaptation over the incisal edges.
two minutes (Fig. 29.33b).
• The index is removed from the teeth. A
Labial Reduction
Laboratory knife with a No: 25 blade is used
to cut along the incisal edges of the index to • Depth-orientation grooves are placed on the
split it into a labial and lingual half (Fig. 29.34). labial and incisal surfaces using a flat-end
• The labial half of the index is cut transversly tapered diamond point. The depth of
to form an incisal and gingival half (Fig. 29.35). reduction can be measured using the uncut
• The individual halves are placed over the outer surface of the remaining tooth structure
578 tooth and verified for adaptation over the as a guide.
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Tooth Preparation
• If the reduction is done without these grooves, incisal edge leading to an over-contoured
29
more time will have to be wasted in checking restoration or poor aesthetics.
for reduction with the index. — If the reduction is done following the inci-
• The labial grooves should be atleast 1.2 mm sal plane, the labial surface will be over-
in depth to provide adequate thickness of tapered and will be in close proximity to
ceramic. Insufficient reduction will lead to: the pulp.
— A poorly contoured restoration that lacks • The amount of reduction can be verified by
in aesthetics and it may affect the health of placing the corresponding halves of the index
the surrounding gingiva. over the prepared tooth (Fig. 29.38).
— The shade and translucency of the
restoration will not match the adjacent
natural teeth.
• The labial grooves are prepared as two sets in
order to obtain a two-plane reduction:
— One set should be parallel with the gingi-
val half of the labial surface (Fig. 29.36).
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29 Textbook of Prosthodontics
Proximal Reduction
• A long needle diamond point is used to break
Fig. 29.43: Axial shoulder finishing is done using:
the contact and gain access into the proximal Radial fissure bur
region without damaging the adjacent teeth.
Features Their functions
• Radial shoulder: Structural durability and
Periodontal preservation
• Chamfer: Marginal integrity and
Periodontal preservation.
• Axial reduction: Retention, Resistance and
Structural durability
• Incisal reduction: Structural durability
• Wing: Retention, Resistance and
580 Preservation of tooth structure.
Fig. 29.41: Cingulum reduction
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Tooth Preparation
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29 Textbook of Prosthodontics
Proximal Reduction
• It is started with a short needle diamond point
to avoid damage to the adjacent teeth.
• The bur can be moved either in an up-down
Fig. 29.49: Depth orientation grooves on the motion on the facial aspect of the inter-
occlusal half of the buccal surface proximal region or in a facio-lingual motion
on the occlusal aspect of the inter-proximal
• Subsequently the diamond point is aligned region (Fig. 29.52).
parallel to the gingival third of the buccal • This is done to attain adequate separation
surface and the sides of the diamond point are between the teeth without over-tapering the
used to prepare the tooth with the diamond abutment or damaging the adjacent teeth.
point tip in a supra-gingival position (Fig. • The proximal walls are planed using the
29.50). needle diamond bur.
582
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Lingual Reduction
• It is done with a torpedo diamond.
• Tooth reduction is done on the lingual and
proximal walls to attain a chamfer finish line.
• The preparation to be covered with metal is
smoothened with a torpedo carbide-finishing
bur.
• The facial surface and the regions to be covered Fig. 29.54: Shoulder with gingival bevel done using a:
with ceramic are smoothened with a H158-012 Flame diamond and finishing bur
radial fissure bur.
Features Functions
• A wing of tooth structure will be formed in
the proximal wall, as there is a transition from • Planar occlusal reduction: Structural durability
a deeper facial reduction to the shallow lingual • Functional cusp bevel: Structural durability
• Wing: Retention, Resistance and
reduction.
Preservation of tooth
• This wing is usually placed lingual to the structure
proximal contact as the proximal portion of • Axial reduction: Structural durability,
the ceramic veneer lacks translucence. Resistance and Retention
• If the entire proximal surface is veneered with • Radial shoulder: Periodontal preservation
ceramic, then the wing is avoided on the and Structural durability
• Gingival bevel: Marginal integrity
proximal surface. (optional)
• The radial shoulder formed on the facial • Chamfer finish: Periodontal preservation
surface with the flat end tapered diamond is and Marginal integrity
smoothened with the radial fissure bur.
• The shoulder is then planed with a RS-1 All-Ceramic Full Veneer Crowns
Binangle chisel which preserves the rounded It provides the best aesthetics. As ceramic is brittle
internal line angle. in nature, it is susceptible to fracture. It is mostly
• Lips of enamel or reverse bevel in the enamel used as a replacement of missing anterior teeth
are removed to avoid any interference (Fig. especially incisors. But newer reinforced ceramics
29.53). are available which make the material suitable
for posterior restorations.
A Half-Moon fracture (Fig. 29.55) of an all
ceramic crown is the most common form of
failure. It usually occurs in:
— Teeth with an edge-to-edge occlusion
— When the opposing teeth occlude on the
cervical fifth of the lingual surface.
Fig. 29.53: : Lipping or reverse bevel formation — Teeth with short crowns
due to over instrumentation — Teeth with an overshortened preparation 583
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Incisal Reduction
• It is done alongwith the preparation of the
labial surface.
• Depth orientation grooves should be made
across the incisal edge. They should be about
2.0 mm deep.
Fig. 29.55: Half moon fracture or notching of
the restoration • Islands of enamel between these grooves
should be reduced using a flat end tapering
It usually occurs in the labio-gingival area of diamond bur.
the restoration due to stress concentration in that • The incisal reduction should be perpendicular
region. to the plane of the incisal half of the labial
Next we shall read about the steps in the reduction.
preparation of an all ceramic crown.
Lingual Reduction
Armamentarium
• Cingulum should be reduced with a small
• Handpiece wheel diamond (Fig. 29.56).
• Flat-end tapered diamond • Care should be taken to prevent over reduc-
• Small wheel diamond tion at the junction between the cingulum and
• H158-012 radial fissure bur lingual wall. A short lingual wall reduces the
• RS-1 Binangle chisel retention of the restoration.
• The reduction of lingual axial surface is done
Labial Reduction
with a flat end tapered diamond
• Depth orientation grooves are prepared using • The lingual wall should be parallel to the gin-
a flat end tapered diamond gival portion of the labial wall.
• The grooves should be 1.2 to 1.4mm deep on
the labial surface and 2.0 mm on the incisal
surface.
• The first set of three labial grooves is made
parallel to the gingival third of the facial
surface.
• A second set of two grooves is made parallel
to the incisal two-thirds of the uncut labial
surface.
• This two-plane reduction on the facial surface
Fig. 29.56: Lingual reduction done using a small
provides adequate aesthetics without affecting wheel diamond
the pulp.
• The tooth structure left between the grooves
Proximal Reduction
is removed following the morphology of the
tooth to a depth of 1.2 to 1.4 mm. • Its preparation is similar to anterior metal
• The facial reduction should extend around the ceramic crown except that a radial shoulder
facio-proximal line angles and fade out on the finish line is provided along the entire pre-
lingual aspect of the proximal surfaces. paration (Fig. 29.57).
• The end of the flat end tapered diamond forms • The shoulder should be atleast 1.0 mm wide
the shoulder while the sides of the bur reduces and should be in uniform contour along the
the axial surface. line angles of the restoration.
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Buccal Bevel
• It is made with a No: 170 bur
• A 0.5 mm bevel is placed along the bucco-
occlusal finish line perpendicular to the path
of insertion (Fig. 29.69).
• It extends over the mesial and distal corners
and blends into the proximal flares
Fig. 29.65: Occlusal offset
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Tooth Preparation
2. Mandibular posterior three-quarter crowns: (Fig. — It is used as a restoration for teeth in which
29
29.71). They vary from maxillary preparations the distal cusp must be covered e.g. teeth
in the following aspects: with caries or decalcification on the distal
— The occlusal finish line on the buccal aspect of buccal surface.
surface is gingival to the occlusal contacts — It is usually placed on maxillary molars as
— An occlusal shoulder is prepared on the a fixed partial denture retainer.
buccal aspect of buccal cusps. It connects — It can also be placed on mandibular
the proximal grooves and strengthens the premolars and molars.
bucco-occlusal margin. 4. A Reverse Three-quarter crown: It is used on
— Offset need not be placed on the lingual mandibular molars with an intact lingual
inclines of the buccal cusps. surface. As the name suggests, these crowns
are opposite to three quarter crowns. That is,
these crowns cover the proximal and buccal
surface and leave the lingual surface intact
(Fig. 29.73).
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Tooth Preparation
Lingual Reduction
Figs 29.81a and b: (a) Single plane cingulum reduction
• A small wheel diamond is used to create a for incisors (b) two plane cingulum reduction for canines
concave lingual reduction incisal to the
cingulum (Fig. 29.79). • The lingual axial wall is reduced using a
• A clearance of at least 0.7mm with the torpedo diamond point and a chamfer finish
opposing teeth should be established. line is established. The inclination of the
• Depth orientation grooves are placed on the diamond point should be parallel to the path
lingual surface with a small round diamond of insertion (i.e. the incisal two-thirds of the
labial surface) (Fig. 29.82).
Fig. 29.79: Lingual reduction done with a Fig. 29.82: Lingual axial reduction prepared using a
small wheel diamond Torpedo diamond 591
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29 Textbook of Prosthodontics
Lingual Reduction
• It is similar to conventional anterior three-
quarter-crowns preparation and few addi-
tional features are incorporated.
• A lingual incisal bevel is prepared with a
wheel diamond. The bevel should be approxi-
mately 1.5 mm in width. It should be parallel
Fig. 29.88: Pin modified three quarter crown
to the uncut incisal edge.
• It should end lingual to the labio-incisal line
coverage. It does not affect the periodontal health. angle to avoid the display of metal.
It has better esthetics due to minimal metal • The lingual axial wall should be prepared with
display. a chamfer finish line using a torpedo diamond
It is used for rehabilitation of incisors and point.
canines with severe lingual abrasion. Pin retained • The lingual wall should be parallel to the
restorations are usually less retentive than the gingival two-thirds of the labial surface.
conventional restorations. Retention can be • The chamfer finish line should stop lingual to
improved by increasing the number, depth or the proximal contact of the tooth surface
diameter of the pins. Serrated pins are more adjacent to the edentulous space in order to
retentive than smooth pins. The pins should be improve the accessibility for the operator and
atleast 2.0 to 3.0 mm in length. maintenance by the patient.
Short pins may eventually lead to the failure • The preparation should not be overextended
of the restoration as the pinholes act as channels into the proximal embrasure near the proximal
through which the oral fluids and microbes surface opposing the retentive feature like pins
percolate and damage the tooth. etc (Fig. 29.89).
Contraindications
• On teeth with caries or restorations
• In mouth with extensive caries
• Malpositioned teeth
• Small teeth with thin enamel and dentine, but
large pulps.
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29 Textbook of Prosthodontics
• Depth orientation grooves for • Tapered carbide or diamond • Minimum clearance on non-centric cusps; 1.5 mm
occlusal reduction Minimum clearance on centric cusps
• Functional cusp bevel • Same • Flatter than cuspal plane, to allow addtional
reduction functional cusp
• Occlusal reduction • Regular-grit, round-tipped • Should follow normal anatomic configuration of
(half at a time) occlusal surface
• Alignment grooves for axial • Same • Chamfer allows 0.5 mm of thickness of wax
at margins reduction
• Axial reduction half at a time) • Same • Reduction performed parallel to the long axis
• Finishing of chamfer • Wide, round-tipped diamond • Smooth mesiodistally and bucco-lingually;
or carbide resistance to vertical displacement by tip of explorer
or periodontal probe
• Additional retentive • Tapered carbide • Grooves, boxes, pinholes as described for
features if needed partial-coverage restoration
• Finishing • Fine-grit diamond or carbide • Rounding of all sharp line angles to facilitate
impression making, die pouring, waxing, and casting
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Tooth Preparation
• Reduction of marginal ridge and • Round-tipped, tapered diamond • Should provide space for adequate bulk of metal
contact area adjacent to in area of connector
edentulous space
• Lingual reduction • Football-shaped diamond • Should provide for clearance at least 0.7 mm
• Ledges • Straight carbide fissure bur • Ledges must be parallel to one another when viewed
from lingual and from incisal; maximum width 1 mm
• Indentations • Straight carbide fissure bur • Indentation should provide at least 0.5 mm of space
for metal reinforcement around opening of pinhole
• Pilot channels and pinholes • Tapered carbide bur • Pinholes must be between 2 and 3 mm deep; minimal
width of ledge around pinholes is 0.5 mm
• Finishing • Finishing stones or carbides • All surfaces must be as smooth as possible (obtain
with finegrit rotary instruments) to facilitate removal
of the delicate wax pattern from die
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Chapter 30
Types of Fixed Partial Dentures
• Introduction
• Conventional Fixed Partial Dentures
• Cantilever Fixed Partial Dentures
• Spring Cantilever Fixed Partial Dentures
• Fixed Fixed Partial Dentures
• Fixed Movable Partial Dentures
• Fixed Removable Partial Dentures/
Removable Bridges
• Modified Fixed Removable Partial Dentures
• All Metal Fixed Partial Dentures
• Metal-ceramic Fixed Partial Dentures
• All Ceramic Fixed Partial Dentures
• All Acrylic Fixed Partial Dentures
• Veneers
• Short Span Bridges
• Long Span Bridges
• Permanent or Definitive Prosthesis
• Long Term Temporary Bridges
• Fixed Partial Denture Splints
• Fibre-reinforced Composite Resin Bridges
• Resin-bonded Fixed Partial Dentures
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Types of Fixed
Partial Dentures
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Types of Fixed Partial Dentures
a different soldering alloy. Sometimes a single unit prepared independently according to its
30
wax pattern is cast and sectioned using a saw and requirements.
then soldered. • Allows minor movements between the
Each technique has its own advantages. components of the prosthesis.
Casting is preferred because it avoids galvanic • Parts of the prosthesis can be cemented
corrosion. Soldered connectors are more uniform, separately.
flat and parallel because the flow of the solder
alloy is easily controllable. Disadvantages
• Complex design.
FIXED MOVABLE PARTIAL DENTURES • Prefabricated connector components are very
expensive.
It is defined as, “A fixed partial denture having one • Difficult to maintain.
or more non-rigid connectors” – GPT. • Movable parts tend to wear out under constant
Here, a non-rigid connector is used/fabricated usage.
to connect the components of the fixed partial • Cannot be used for long span bridges
denture. Non-rigid connectors have been descri- • Complicated laboratory procedures
bed in Chapter 25. These partial dentures are • Difficult temporisation
designed to have any one of the non-rigid connec- The methods of fabrication of non-rigid con-
tors described there. Commonly used non-rigid nectors have been briefed in Chapter 25.
connectors include Tenon Mortis connectors
(TMC), loop connectors, split pontic connectors FIXED REMOVABLE PARTIAL DENTURES/
and cross pin and wing connectors (Fig. 30.6) REMOVABLE BRIDGES
(Refer Chapter 25).
One of the major disadvantages of long span fixed
partial dentures is that if one abutment fails, the
entire prosthesis has to be sacrificed. To overcome
this disadvantage, fixed removable bridges were
introduced. These dentures cannot be removed
by the patient but can be easily removed by the
dentist.
Design
Individual cast gold copings are cemented over
the abutments. Threaded sleeves are incorporated
into the copings of few abutments. The bridge is
Fig. 30.6: If a nonrigid connector is placed on the mesial retained over the copings by using weak cements
side of the middle pier abutment, mesially directed movement and screws, which pass through a hole in the
will unseat the key
retainer into the threaded sleeves of the coping
(Fig. 30.7).
Advantages
• They act like stress breakers while transmitting
unwanted leverage forces.
• The abutment is pressurized only during
occlusal loading.
• Improves the health of the abutment.
• The tooth preparations need not be parallel to
one another. Each abutment tooth can be Fig. 30.7: A fixed removable partial denture 605
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Types of Fixed Partial Dentures
Advantages
Fig. 30.11: Metal ceramic retainer with a metal coping • Superior aesthetics.
• Excellent translucency.
formed by metal and the labial and gingival • Requires slightly more preparation of the facial
surface is alone formed by porcelain. These surface.
restorations are also termed as porcelain facings or • The appearance can be influenced and
porcelain veneers (Fig. 30.12). modified by selecting different colors of luting
agent.
Disadvantages
• Reduced strength due to lack of reinforcement
with metal
• It is very difficult to obtain a well-finished
margin because the ceramic edges tend to chip
easily.
Fig. 30.12: Metal ceramic retainer with core metal and • These crowns cannot be used on extensively
only facial porcelain veneering
damaged teeth because they cannot support
Advantages these restorations.
• Due to porcelain’s brittle nature, large connec-
• Aesthetically pleasing tors have to be used, which usually leads to
• Stronger metal substructure impingement of the inter-dental papilla. This
• Characterization possible with use of internal increases the potential for periodontal disease.
and external stains. • Wear of opposing natural teeth.
Disadvantages ALL ACRYLIC FIXED PARTIAL DENTURES
• Significant tooth preparation necessary; not
Characteristics
conservative.
• To achieve better aesthetics, the facial margin • Only indicated for long-term temporary or
of an anterior restoration is often placed interim prostheses.
subgingivally, this increases the potential for • Can be used for making fixed periodontal
gingival destruction. splints.
• Slightly inferior in aesthetics compared to all • Poor wear resistance.
ceramic restorations. • Easy to fabricate and adjust
• Brittle fracture can occur due to failure at the • Aesthetically pleasing.
metal ceramic junction.
• More expensive. VENEERS
ALL CERAMIC FIXED PARTIAL DENTURES Veneer is a layer of restoration placed over the
labial surface of a tooth. They are primarily used
All ceramic partial dentures are fabricated using as aesthetic adjuncts to discolored or fractured
only ceramic. All ceramics are less fracture teeth.
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Acrylic
Tooth colored acrylic can be used with metallic
restorations as a veneer. They are not considered
as a permanent material due to poor wear
resistance. Recent advances include use of indirect
composite resins as veneer materials.
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Permanent Splints
Permanent splints serve as constant adjuncts to
the maintenance of periodontal health. They help
to prevent further progression of periodontal
disease. (Note: Splints can never improve the perio-
dontal status. They can only prevent or slacken the
progression of the disease). Complete fixation is
necessary for proper stability of the splint.
Fig. 30.18: Unilateral splint
The following prosthesis can be used as
Bilateral Splints permanent splints:
• Resin-bonded retainers or Maryland bridges
A bilateral or cross-arch splint is a splint, which can be used.
crosses the midline. It may involve two or more • Fiber reinforced composite resin bridges can
segments of an arch or involve the entire arch. also be used.
Here the splinting action is resistive to forces in These dentures are described in detail
all directions (Fig. 30.19). separately.
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Types of Fixed Partial Dentures
Disadvantages Advantages
30
• It is contraindicated for short abutment teeth
• Optimal aesthetics
with narrow embrasures
• Metal free
• Unaesthetic due to the presence of more bulk
• Decreased wear of opposing teeth
near the embrasures
• May require complex treatments like ortho- Tooth Preparation
dontic movements, root sectioning of adjacent
teeth to maintain good oral hygiene • Tooth preparation is done on the lingual or
• Complex design palatal surface with a flat end-tapering
• Not economical diamond as done for a Resin bonded FPD.
• Additionally a thin box or a groove like
FIBRE REINFORCED COMPOSITE preparation is done on the palatal surface near
RESIN BRIDGES the edentulous side on the coronal half of
enamel (Fig. 30.20a).
These, basically, are bridges, which are reinforced
by a bar of glass fibres over which indirect
posterior composites are built.
Materials Used
Fibre reinforced composites have two parts
namely the reinforcing constituent (provides Fig. 30.20a: Anterior tooth preparation for a fibre
strength and stiffness) and surrounding matrix reinforced bridge
(supports the reinforcement and provides
workability).
Commercially, polymer or resin matrices
reinforced with glass, polyethylene or carbon
fibers are available. The reinforcing fibres may
Fig. 30.20b: Posterior tooth preparation for a
be unidirectional (long, continuous and parallel),
fibre reinforced bridge
braided or woven.
Classification
• In the posterior teeth, a shallow channel (0.5
Fibre reinforced composites can be classified into: mm deep and 2-3 mm wide) is prepared on
• Pre-impregnated (e.g. Fibrekor, Splint-it): The the occlusal surface. This produces an I-beam
manufacturer impregnates them with the configuration which helps to take up load (Fig.
resin. 30.20b).
• Impregnation required (e.g. Ribbond, Cpost): • A shoulder or chamfer margin should be
fibre impregnation has to be done by the created for the remaining part of the
dentist preparation (Fig. 30.20c).
Contraindications Fabrication
• It cannot be used when fluid control is not
The denture can be fabricated using two
possible
techniques:
• Cannot be used for long span bridges
• It should be avoided in patients with para-
Pre-fabricated Technique
functional habits
• It should not be used opposing unglazed • Here, a wax pattern of the restoration is made
porcelain teeth. on the cast.
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Types of Fixed Partial Dentures
Advantages
• Non-invasive to dentin with lingual and
proximal tooth preparation including occlusal
rests. Decreased pulpal irritation.
• Conservative with undeniable patient appeal/
comfort.
• Decreased tissue irritation due to the place-
ment of supragingival margins.
• Does not require cast alterations or removable
die preparation.
Fig. 30.23a: Rochette bridge. Notice the conical
• Reduced cost with less chair time. perforations on the retainer for retention
Disadvantages
• Criteria for choosing the patient are not
discrete.
• Demanding technique and tooth preparation.
• Even minor laboratory errors cannot be Fig. 30.23b: Cross-sectional view of a conical
corrected easily. perforation in the retainer
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retention. This was one of the most widely accep- electrical gradient. Before etching, the retainer is
ted designs. Etched retainers coated with pyro- coated using paraffin wax. The wax should cover
lized silane showed upto 47% superior retention. the entire retainer except for the area to be etched.
The major disadvantage of Rochette Bridge is that Commonly used electrochemical techniques
the resin exposed through the metal perforations include:
is subjected to external stress, abrasion and • For non-Beryllium Nickel Chromium alloys:
marginal leakage. Etching is done in two stages. In the first stage,
the retainer is immersed in 3.5% nitric acid
Maryland Bridges
under a current of 250 mA/cm2 for 5 minutes.
Many scientists developed different designs to Next the retainer is cleaned by immersing it
overcome the shortcomings of Rochette bridges; in 18% HCl in an ultrasonic cleaner for 10
• Dunn and Reisbick used electrochemical pit minutes.
corrosion to study ceramic bonding to base • For Beryllium containing Nickel Chromium
metals. alloys: It is also a two-step technique. During
• Tanaka et al studied the retention of acrylic the first step, retainer is immersed in 10%
resin on metal copings. H2SO4 under a current of 300 mA/cm2. The
• Finally, Livaditis and Thompson from
second step is similar to the one described for
University of Maryland School of dentistry
the previous technique.
used Dunn’s study and developed Maryland
bridges. • Mc Laughlin technique or One-step technique:
Here mechanical retention was developed by It is a single step technique. Here the alloys
the micro-porosities present on the tissue surface are etched by immersing the retainer in a
of the retainer. Micro-porosities are created by beaker with a mixture of HCl and H2SO4. The
etching the tissue surface of the retainer (Fig. beaker with the retainer is directly placed in
30.24). an ultrasonic cleanser for 99 seconds under an
electrical field. This technique increases the
speed of etching.
Disadvantages is electrochemical etching:
• Expensive.
• Very technique sensitive. Tedious proce-
dure, difficult to control the area to be
etched.
Non-electrochemical Etching Commonly used
non-electrochemical etching techniques include:
• Livaditis proposed a technique wherein
Fig. 30.24: The Maryland resin-bonded fixed
Nickel-Chromium-Beryllium alloys were suc-
partial denture cessfully etched in a etching solution placed
in a water bath for one hour at 70oC.
Etching Techniques • Doukoudakis proposed the use of stable aqua
The suggested etching techniques that can be regia gel to etch enamel.
employed while fabricating Maryland bridges Advantages of non-electrochemical etching
can be broadly divided into: • Does not require special equipments.
• Electrochemical etching. • Etching is comparable to more expensive
• Non-electrochemical etching. techniques.
Electrochemical etching Here etching is done • The prosthesis can be fabricated and
using a chemical electrolyte in the presence of an bonded in two stages.
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Cast Mesh Fixed Partial Denture sufficient. Tanaka et al proposed few techniques
30
to improve the bonding of these dentures:
Here a nylon mesh is placed on the tissue surface
• He suggested the immersion of the retainer in
of the retainer wax pattern. The nylon mesh is
Sulfuric acid for proper oxide layer formation.
placed on the cast before fabricating the wax
• For noble metal alloys, he suggested inducing
pattern. These retainers do not require acid
a heat-accumulated copper oxide deposition.
etching (Fig. 30.25).
This gives the necessary oxide layer.
Drawbacks of this design include:
• He also proved that air abrasion with alu-
• The nylon mesh may not adapt well to the
minium oxide aids to improve retention.
cast during pattern fabrication
• The wax may flow in between the mesh Advantages
locking all the undercuts. • Even noble metal alloys can be used.
• Surface treatment of the retainer is not
necessary.
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• The resin is allowed to polymerize. Excess A note on causes for failure of Resin bonded
material can be removed using a hand instru- fixed partial dentures:
ment. After polymerization is complete, the 1. Inappropriate patient selection:
external surface of the resin is finished and a. Mal-alignment of teeth results in poor path
polished. of insertion.
• Most Resin bonded FPD resins are anaerobic b. Insufficient vertical length of the abutment
resins. Hence, they do not set while mixing or teeth.
loading but set once the prosthesis is seated c. Inadequate enamel for bonding.
and the atmospheric contact is abolished. d. History of metal sensitivity.
But these resins fail to polymerize at the e. Decreased labio-lingual dimension of
margins of the restoration where they are abutments.
exposed. Hence, a varnish like separating 2. Incomplete tooth preparation:
material should be applied at the margins of a. Insufficient proximal and lingual surface
the restoration. Commonly oxyguard® is used reduction.
for this purpose. b. Incomplete or less than 180 degree exten-
sion of the retainer.
c. Lack of accommodation to mandibular
Post-insertion Management
protrusion.
All resin-bonded restorations should receive 3. Bonding failure:
significant attention after insertion. Hence, fre- a. Contamination
quent recall appointments should be followed to b. Prolonged mixing
ensure the success of the prosthesis. c. Inappropriate luting agent.
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Chapter 31
Impression Making in Fixed
Partial Dentures
• Introduction
• Fluid Control and Soft Tissue Management
• Impression Making for Fixed Partial Dentures
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Impression Making in
Fixed Partial Dentures
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Impression Making in Fixed Partial Dentures
31
Saliva Ejector
• It is an adjunct to high volume evacuation (Fig.
31.2).
• It can be used for evacuation when the
maxillary arch is being treated.
• It is effective on the maxillary arch during Fig. 31.3b: Isolation with a Svedopter and cotton rolls
impressions and cementation.
• It is placed at the corner of the mouth, opposite • Since it is a metallic device, care must be taken
to the quadrant being operated. to avoid any injury to the floor of the mouth.
• Presence of mandibular tori precludes its use.
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Impression Making in Fixed Partial Dentures
Chemicals Used
The following chemicals are generally local
vasoconstrictors which produce transient
gingival shrinkage.
• 8 per cent Racemic epinephrine Fig. 31.6: Retracting the cord from dispensing bottle
• Aluminium chloride
• The cord is twisted to make it tight and small
• Alum (Aluminium potassium sulphate)
(Fig. 31.7).
• Aluminium sulphate
• Ferric sulphate.
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Fig. 31.9: The cord should be inserted starting from the Fig. 31.11b: The instrument should be angled slightly toward
626 mesial surface of the tooth till the distal surface the root to facilitate the subgingival placement of the cord
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Impression Making in Fixed Partial Dentures
Technique
• It is usually done simultaneously along with
finish line preparation.
Fig. 31.13a: Excess cord is cut off near interproximal
area of the mesial surface
• The torpedo diamond point (used to create a
chamfer finish line) is carefully extended into
the gingival sulcus (to half its depth) to remove
a portion of the sulcular epithelium (Fig.
31.14).
Fig. 31.13b: After cutting off the excess at the mesial end,
the distal end of the cord is a tucked in until it overlaps the
tucked mesial end
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Disadvantages
• Very technique sensitive.
• Application of excessive pressure may Fig. 31.17: Partially rectified, damped
628 produce severe tissue damage. (half-wave modulated) current
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Impression Making in Fixed Partial Dentures
Fig. 31.18: Fully rectified (full-wave modulated) current Fig. 31.20: An electrosurgical unit with active electrode
(A) and ground electrode (B)
• Fully rectified, filtered current: Here the peak
waves are repeated so that there is continuous may occur to the patient if a single electrode is used.
flow without any dip. Lower frequency waves The ground plate helps to stabilise the electrical flow
are filtered in this current. It produces excellent within the patient’s body). The ground plate should
cutting. Hence it is the most preferred (Fig. be placed under the thigh or the back of the
31.19). patient. The ground plate should not be placed
close to bony tubercles as it may generate enough
electricity to produce a burn.
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Impression Making in Fixed Partial Dentures
31
Fig. 31.23: Incisions for gingival crevice enlargement are made with a small, straight electrode,
without repeating any strokes on all the surfaces: a—facial; b—mesial; c—lingual; d—distal
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31 Textbook of Prosthodontics
Impression Techniques
In this section, we will discuss about the various
impression techniques. The technique for impres-
sion making varies according to the type of
impression material used and the type of tray
Fig. 31.27: Edentulous cuff selected. The techniques based on impression
material used are generally described in detail in
any material science book. Here, we have
discussed about impression techniques based on
the tray selected. Impression techniques can be
classified based on the type of impression tray
used as follows.
• Stock Tray/Putty-wash Impression
— Double mix
Fig. 31.28: Removing the edentulous cuff — Single mix
using a loop electrode
• Custom tray impression
— Single mix technique.
IMPRESSION MAKING FOR FIXED • Closed Bite Double Arch Method or triple tray
PARTIAL DENTURES technique.
Impression making for fixed partial dentures is • Copper tube impressions.
very important because only an accurate • Post space impressions.
impression can produce a successful restoration.
Impression Making using a Stock Tray
Ideal Requirements of Impression (Putty wash technique)
Materials used for Fixed Partial Dentures
Here a primary impression is made with
Impression materials used for fixed partial a stock tray and a final impression is made
dentures should fulfil the following additional, using the preliminary impression as the custom
632 critical requirements: tray.
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Impression Making in Fixed Partial Dentures
Indication
31
It is used for most clinical situations where a
combination of medium to heavy bodied elasto-
mer and light bodied elastomer is necessary.
Advantages
• Trays are readily available (no need to
fabricate).
• Metal trays are rigid and do not distort.
Disadvantages
• Need to sterilize the trays.
• More impression material is required. Fig. 31.30: Putty impression material is placed in the tray
Technique
There are two methods to make a putty wash
impression namely double mix putty wash tech-
nique and single mix putty wash technique.
Double mix Putty-wash technique
• A suitable stock tray is selected.
• Tray adhesive is applied uniformly into the
tray (Fig. 31.29).
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31 Textbook of Prosthodontics
Advantages
• Lesser amount of impression material is
required
• More hygienic as it is used for a single patient
• Uniform thickness of impression material
Fig. 31.32: The polythene spacer is removed
reduces the chances of distortion.
Disadvantages
• Increased time required for fabrication.
• Cannot be used in patients sensitive to acrylic
Technique
An acrylic special tray is constructed over the cast
with two sheets of tinfoil spacer to provide space
for the impression material as described in
Chapter 6.The technique for making an impres-
sion using a special tray is called ‘Single mix
technique’.
Fig. 31.33: Light bodied impression material is loaded on
a syringe and injected into the sulcus area
• Step I: Tray adhesive is applied over the acrylic
special tray because the elastomers do not
adhere to acrylic.
• Step II: Medium viscosity elastomer is loaded
on the tray.
• Step III: The light body elastomer is syringed
around the tooth preparation.
• The tray with the impression material is then
seated over the tooth surface.
• The light body silicone records the details of
the preparation with the medium or heavy
viscosity elastomer.
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Impression Making in Fixed Partial Dentures
Indications
Fig. 31.35: Stock tray used to make a triple tray
impression • Single tooth preparation. 635
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31 Textbook of Prosthodontics
Advantages
• Saves time, as the entire impression need not
be repeated.
• An accurate finish line can be obtained.
Disadvantages
• Requires additional impressions. Fig. 31.37: Light bodied impression material is
• Proper orientation of the die with the dies of injected into the enlarged sulcus
adjacent/opposite teeth is difficult.
Impressions for Pin-retained Restoration or
Preparing the Copper Band Post Space Impression for Endodontically
Treated Teeth
A copper band or tube is selected and customized
The technique for making a dowel core (post
according to the patient. The band should be
space) impression using a resin was described in
adapted well around the tooth. The area around
Chapter 28. Here, we shall discuss the technique
the finish lines are trimmed and rounded off. An for making an impression using irreversible
orientation hole is made on the facial surface of hydrocolloid for both pin-holes and post-spaces.
the tube (Refer Fig. 31.4).
Procedure
Procedure • A seperating medium should be applied on
• Fingers are coated with a thin layer of the pin-holes or post space (space for cast
petroleum jelly to prevent the compound from post).
sticking. • Next, light bodied secondary impression
• The green stick compound is heated over an material is injected over the pin-hole or post
open flame. space.
• The softened mass is then placed into the • A lentulospiral (slow speed, clockwise
rotation) is used to move the impression
copper band and filled to one-third of the tube
material into the pin-hole post space.
through the open end of the tube.
• This is then placed onto the tooth preparation.
The tube should not be pushed too deep and
only a part of the occlusal surface should be
recorded (Refer Fig. 31.5).
• Light bodied material is then syringed over
the prepared tooth (Fig. 31.37).
• The surface of the compound is coated with
adhesive and seated over the syringed
material.
• The finer details are recorded in light bodied
elastomer.
After the impression procedure, all the impres-
sions should be disinfected in 2 per cent glutar- Fig. 31.38: Impression of the pin-hole stabilized
636 aldehyde before preparing the die or cast. using an orthodontic wire
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Impression Making in Fixed Partial Dentures
• Orthodontic wires (preferred) or elastomeric • Before the syringe material gels, the tray mate-
31
bristles can be used to stabilize the impression rial is loaded with medium or heavy bodied
material within the pin hole or post space (Fig. irreversible hydrocolloid and an over impres-
31.38). sion is made. The syringe and tray materials
• A tray adhesive (methyl cellulose) should be are allowed to gel together as a single unit.
applied on the stablizing bristle or wire. • The whole assembly is removed carefully.
637
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Chapter 32
Temporization or Provisional Restoration
• Introduction
• Ideal Requirements of Provisional Restorations
• Types of Provisional Restorations
• Limitations of Provisional Restorations
• Direct Fabrication of an Anterior Polycarbonate
Provisional Restoration
• Direct Fabrication of Preparing a Metal Provisional
Restoration on a Posterior Tooth
• Fabrication of an Acrylic Provisional Restoration for a
Posterior Tooth Using Indirect Technique
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Temporization or Provisional Restoration
32
Temporization or
Provisional Restoration
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32 Textbook of Prosthodontics
• Good aesthetics: Translucency, colour, con- and material that would best suit the patient and
tourable, colour stable place it as a provisional restoration. Before cemen-
• Good patient acceptance: the material should tation these crowns are slightly altered and
be non-irritant to the oral tissues. modified to fit the tooth.
• It should be easy to repair or to add more
Advantages
material.
• Less time consuming
• Chemical compatibility with provisional
luting agents: It should not react adversely Disadvantages
with the luting agents used to fix the • Rarely satisfies the requirements of contour.
restoration. It has to be customized with self-cure resin.
• Generally limited to single tooth restorations.
TYPES OF PROVISIONAL RESTORATIONS
Materials Available in Preformed Crowns
Provisional restorations can be classified based
on the following methods: Here I have discussed about the common
• Method of fabrication materials and their salient features that are used
• Type of material used in commercially available preformed crowns.
• Duration of use Commonly available preformed crowns include
• Technique for fabrication polycarbonate, cellulose acetate, aluminium, and
tin-silver.
Depending on the Method of Fabrication
Polycarbonate
Based on the method of fabrication, provisional
restorations can be classified into custom made • Has the most natural appearance
and preformed restorations. • Usually available in a single shade
• But can be altered by the shade of the luting
Custom Made Provisional Restorations agent
• Available for incisor, canine and premolar
Here, the restoration is fabricated to reproduce teeth.
the original contours of the tooth. An impression
of the prepared tooth is made and a cast is poured. Cellulose Acetate
The prepared tooth on the cast is waxed up and
carved to reproduce the original contours. • It is available as shells into which auto-poly-
merising resin can be filled and inserted over
Advantages the prepared tooth. As the resin does not bond
• Minimum interference to the shell, it can be easily removed.
• A wide variety of materials can be used • It is a thin (0.2 to 0.3 mm), transparent mate-
• Helpful in evaluating the adequacy of tooth rial.
reduction. By measuring the thinness of the • It is available in all tooth types (incisors,
restoration, the tooth preparation can be molars, etc).
altered. • The shade of this temporary crown depends
Disadvantages entirely on the auto-polymerising resin. Shade
• Additional lab procedure involved. matching can be done by adding colours to
• Time consuming. the resin.
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Temporization or Provisional Restoration
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32 Textbook of Prosthodontics
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Temporization or Provisional Restoration
32
DIRECT FABRICATION OF AN ANTERIOR POLYCARBONATE
PROVISIONAL RESTORATION (FIGS 32.1 TO 32.13)
Fig. 32.3: Next, the crown size is selected using Fig. 32.6: The corrected shell is tried again and
a mould guide compared with the adjacent teeth
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32 Textbook of Prosthodontics
Fig. 32.8: The preformed crown shell filled with resin is Fig. 32.11: Axial surfaces near the margins of the
placed onto the prepared tooth on the plaster cast restorations are smoothed with a Burlew disc
644
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Temporization or Provisional Restoration
32
645
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32 Textbook of Prosthodontics
646
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Temporization or Provisional Restoration
32
FABRICATION OF AN ACRYLIC PROVISIONAL RESTORATION FOR A POSTERIOR TOOTH
USING INDIRECT TECHNIQUE (FIGS 32.25 TO 32.47)
647
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32 Textbook of Prosthodontics
Fig. 32.32: The cast is tried in the over Fig. 32.35: Resin is placed into the overimpression
impression before proceeding
648
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Temporization or Provisional Restoration
32
Fig. 32.38: Cross-sections of casts seated in overimpressions: correctly seated (a); if the cast is pushed to one side, the
provisional restoration will be deficient (b); overseating of the cast will produce a provisional restoration with a thin
occlusal surface (c)
649
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32 Textbook of Prosthodontics
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Chapter 33
Lab Procedures Involved in the
Fabrication of FPD
• Introduction
• Dies and Working Casts
• Wax Pattern Fabrication
• Casting
• Soldering
• Ceramic/Acrylic Veneering
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33 Textbook of Prosthodontics
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Lab Procedures Involved in the Fabrication of FPD
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33 Textbook of Prosthodontics
technique.
Advantages
• Easy to prepare
• No special equipment is necessary
Disadvantages
• The pins may get displaced while pouring the
cast.
Curved Dowel Pin System
This is similar to straight dowel pin technique
except that curved pins are used. The curved
pins will project from the sides of the base of the
cast. When the projecting pins are pressed, the
die unit attached to the respective pin will pop
out from its place (Fig. 33.6).
Disadvantages
• Requires special equipments.
Fig. 33.6: Curved dowel pin system (pushing the
pin from the side pops the die out). Pindex System
This system is similar to the post-pour dowel pin
Di-lok Tray System technique. Here a special drill press equipment
This technique uses a special tray to pour the is used to do die sectioning. The drill press has a
platform with a slot like opening through which
cast. This special tray has orientation grooves
the drill pin will project during the procedure.
on the inner aspect. Actually the tray is made of
The entire platform is spring mounted and when
multiple components, which can be assembled
pressed down automatically starts the drill,
or dismantled as required (Fig. 33.7).
which will project through the slot. The unit has
Impression is poured using a two-pour
a red pilot light lamp on top, which will shoot a
technique. The first pour is poured upto the level
point exactly on the drill. This red pilot pointer
of the impression and the second or base pour is
will act as a guide while drilling (Fig. 33.8).
poured after positioning the rim of the di-lok tray
Die sectioning procedure is simple wherein
over the impression. Before the second pour is
the cast of 15 mm base is placed on the drill press
set, the base of the di-lok tray is assembled and
and drill holes are prepared in the under surface
the cast is allowed to set. Later, the di-lok tray is of the base of the cast using the pilot light as a
dismantled and the grooves on the base of the guide. After making the drill holes to the required
cast formed by the di-lok tray is used as a guide depth, sleeved die pins are placed and cemented
to do die sectioning. using cyanoacrylate adhesive. Remember that
Advantages the holes will not be very deep. Hence a portion
• Simple and easy to prepare of the pins wil be projecting from the base of the
654 • The cast can be mounted in an articulator cast (Fig. 33.9).
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Lab Procedures Involved in the Fabrication of FPD
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33 Textbook of Prosthodontics
Direct Technique
Here the pattern is fabricated directly over the
prepared tooth in the oral cavity. It is done with
type I wax. The procedure is tedious and techni-
que sensitive. Hence, it is not used for fixed
partial denture patterns.
Fig. 33.10: Wax patterns prepared using
Indirect Technique
indirect technique
Here the pattern is fabricated over the prepared
tooth in the die/cast. It is made using type II
wax. prepared and cast using a metal ceramic alloy.
It is more preferred due to the following advantages: The contours and margins are directly prepared
• The pattern can be done in the lab thereby using ceramic and fired. For metal ceramic
reducing the chairside time. restorations with ceramic facings, all areas
• The lab work can be done by the techni- where metal is to occupy are contoured to a
cian thereby decreasing the work load of greater detail. The area where the facing is to
the dentist occupy is left to the level of the coping and a
• It allows better visualisation of the mar- sharp cut back design should be provided in the
gins of the restoration especially from the wax pattern to mark the metal-ceramic junction.
gingival aspect.
Since it is the commonly used technique, we Coping Preparation
have discussed it in greater detail. • It can be done either using wax or heated
A note on waxes used for indirect technique: sheet of resin. Usually wax is preferred.
The type II wax (inlay wax) should fulfil the • Wax can be coated on the tooth either using
following ideal requirements: a wax spatula or by dipping the die into hot
• It should have a contrasting colour so that wax (Figs 33.11a and b).
the margins of the pattern can be disting- • While adding new layers of wax, the previous
uished from the cast. layer should be melted in order to avoid the
• It should have a slightly lower melting formation of voids or flow line on the inner
point compared to type I wax. surface of the restoration.
• It should satisfy the ADA specification No: • The coping should be waxed in excess mesio-
4. distally so that the proximal contacts are
• It must flow readily when heated without preserved, even after finishing and soldering
losing its properties. (Fig. 33.12).
• It should be rigid at low temperatures.
• It should not flake or chip during carving. Preparing the Axial Contours
Axial contours include the contour of the buccal,
Procedure
lingual and proximal surfaces. They should be
The indirect wax pattern is fabricated by prepar- prepared based on the following principles:
ing a wax coping followed by adding layers of • Establishing the proximal contact is the most
wax to build up the axial and occlusal contours. important component of axial contouring.
Finally the margins of the patterns are finished The proximal contacts determine the health
before casting (Fig. 33.10). of the gingiva (interdental papilla).
Coping preparation, surface contouring and • Usually posterior proximal contacts occur at
marginal finish are necessary for all metal or the occlusal third when viewed from the side.
656 DICOR ceramic retainers whereas in case of Exceptions include maxillary molars where
metal ceramic retainers, the coping is alone it occurs in the middle third (Fig. 33.13).
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Lab Procedures Involved in the Fabrication of FPD
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33 Textbook of Prosthodontics
Figs 33.16a to c: (a) A flat proximal surface below the point profile as the part of the axial contour that
of contact (preferred) (b) A concave proximal surface below extends from the base of the gingival sulcus past
the point of contact (preferred) (c) A convex proximal surface the free margin of the gingiva. The emergence
below the point of contact (not preferred)
profile is a straight plane extending up to the
• All the axial contours should be in harmony height of contour.
with the adjacent teeth. • Overcontouring the axial surface can lead to
• The heights of contour on the lingual surface food entrapment and gingival inflammation.
of maxillary posteriors occur in the cervical • Any depressions in the wax pattern should
third. The same in the mandibular posteriors be removed by filling with wax. If the wax is
occur in the middle third (Fig. 33.17). removed by smoothening the pattern, the
axial contours may get altered.
• Establishing a smooth surface is more impor-
tant them achieving a highly polished surface.
Preparing the Occlusal Contours or
Developing the Occlusal Morphology
The occlusal surface of the retainer should be
built after completing the axial contours. The
Fig. 33.17: The height of contour of the lingual surface of occlusal morphology of a retainer should be in
maxillary posterior is located in the cervical third but the harmony with the adjacent/opposite teeth and
same is located in the middle third for mandibular posteriors should follow all the concepts of occlusion descri-
• The lingual prominence is greater for mandi- bed in Chapter 27. Special instruments like P.K.
bular posteriors compared to maxillary Thomas carvers are used to carve the occlusal
posteriors (Fig. 33.18). surface of the restoration.
Procedure
• The tail end of the PKT carver should be used
to build cones of wax over the areas where
cusps are to be formed. E.g. while carving a
mandibular molar, five cones of wax are built.
The cones should be placed exactly on the
Fig. 33.18: Greater lingual prominence of the mandibular cusp location (Fig. 33.20).
lingual surface relative to the maxillary lingual surface • After building the cones, the marginal ridges
• The subgingival axial surface should be flat and the cusp ridges are built using the same
to promote efficient cleaning. The part of the instrument (Fig. 33.21).
axial surface that extends sub-gingivally • Additional wax is added near the peripheral
forms a part of the emergence profile (Fig. ridges and contoured in harmony with the
658 33.19). Stein and Kuwata described emergence axial surface. The parabola of the axial
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Lab Procedures Involved in the Fabrication of FPD
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Lab Procedures Involved in the Fabrication of FPD
Pontic Fabrication
In this section, we have described the fabrication Fig. 33.30a: A small piece of inlay wax is attached to the
retainers like a bridge over the edentulous areas. This will
of metal ceramic pontics, resin veneered pontics
form the pontic
and all metal pontics separately.
Step-by-step Procedure
• The axial surfaces are contoured as described Fig. 33.30b: The gingival surface of the pontic is
for a retainer. waxed up according to the design of the pontic 661
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CASTING
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Lab Procedures Involved in the Fabrication of FPD
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33 Textbook of Prosthodontics
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Lab Procedures Involved in the Fabrication of FPD
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33 Textbook of Prosthodontics
SOLDERING
Soldering is done to fabricate connectors in fixed
partial dentures. When long patterns are cast,
the occurrence of casting defects increase, hence,
it is more advisable to cast multiple smaller units
which can be soldered later. Soldering also aids
to rectify minor casting discrepancies. It is
usually done after casting the metal framework
and before porcelain build-up (pre-ceramic
solders). Sometimes soldering is done after
Fig. 33.39: Casting crucible porcelain firing, and these solders are called post-
ceramic solders.
Weighing the Alloy
Definition
The following standard weighing measurements
can be used to avoid excessive wastage of the Soldering involves joining two components of metal
alloy: with an intermediate metal whose melting
• 6 grams for premolar retainer castings temperature is lower than the parent metal.
• 9 grams for molar retainer castings
• 12 grams for pontic castings. Requirements of a Solder
A solder metal should have the following
Casting the Alloy properties:
The alloy is placed in the crucible and heated • It should fuse safely below the sag or creep
using a open flame from a torch. The reducing temperature of the parent alloy.
part of the flame should be used in order to • It should resist tarnish and corrosion
prevent oxidation of the alloy. A little flux should • It should be non-pitting
be added to metal ceramic alloys and heated • It should be free flowing
further till they ball up (like mercury) and obtain • It should match the color of parent metal
a mirror like surface that appears to spin. In case • The joint should be strong.
of Nickel Chromium alloys, casting can be done Composition of Solders
once the sharp edges get rounded. Once the alloy
is ready to be cast, the locking pin of the machine Most commonly used solders in fixed partial den-
is released and casting is completed. tures include gold and silver. Dental gold solders
are designated by fineness to indicate the
Recovery proportion pure gold contained in 1000 parts of
the alloy.
Recovery of casting involves the removal of Composition and flow temperature of commonly
residual investment adherent to the cast surface. used dental solders
Gypsum-bonded investments quickly disinte- Fineness Au Ag Cu Sn Zn Flow temp (oc)
grate when quenched in water. However, resi- 490 49 17.5 23 4.5 6 780
dual investment should be removed using a 585 58.5 14 19 3.5 4.5 780
615 61.5 13 17.5 3.5 4.5 790
toothbrush or an ultrasonic cleanser. On the 650 65.0 12 16.0 3.0 4.0 790
other hand, phosphate-bonded instruments do 730 73.0 9.0 12.5 2.5 3.0 830
666 not disintegrate easily and should be removed
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Lab Procedures Involved in the Fabrication of FPD
• Borax glass Na2 B4 O7 (55 parts) • The metal framework can be soldered and
• Boric acid (35 parts) tried-in prior to ceramic build up.
• Silica (10 parts) • Minor casting errors can also be patched up
during ceramic build-up.
Anti-flux
Disadvantages of Pre-ceramic Soldering
It is a chemical agent used to control the flow of
the metal. Soldering anti-fluxes are used to cont- • Difficult to build ceramic on already soldered
rol the flow of the solder metal. These materials units.
are very essential to produce a parallel/even
Advantages of Post-ceramic Soldering
continuous connector. One of the most common
anti-fluxes used is graphite. But pencil graphite • Porcelain can be properly built up due to
vaporizes. Hence, better fluxes like Rouge (Iron better access.
oxide) in chloroform can be used.
Disadvantages of Post-ceramic Soldering
Soldering Investment
• The metal and porcelain may sag at high
These are silica-bonded investments that contain soldering temperatures.
fused quartz. Fused quartz is used because it is • It is more technique sensitive.
the lowest thermally expanding form of silica. • The solder joint should be re-glazed and re-
fired.
Types of Soldering
Oven Soldering
Based on the technique, soldering can be
classified into: Furnace or oven soldering is performed under
• Soldering for metal ceramic restoration. vacuum or in air. A piece of solder is placed in
• Oven soldering the joint space and it is heated to a standard
• Torch soldering temperature in the furnace. The major advan-
• Infrared soldering tage of these solders is that they produce supe-
• Laser welding rior joint strength.
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33 Textbook of Prosthodontics
Disadvantages
• The parent metal will sag or melt if heated
for a long time.
Torch Soldering
Here, soldering is done under direct flame. A Fig. 33.40: A uniform space of 0.25 mm should be
gas air torch is used for this purpose. The torch available between the components to be soldered
flame has two parts namely the reducing part
• The smaller units are inserted separately in
and the soft brush part. The reducing part is at
the mouth (Fig. 33.41).
a higher temperature compared to the soft brush
flame. The solder should be melted using the soft
brush flame. The flame should be constantly
swiped over the solder for a period of 4 to 5
minutes. At no point of time the flame should
be held in a stationary position.
Infrared Soldering
Fig. 33.41: The individual components to be soldered are
• It can be used for low-fusing connectors. inserted in the patients mouth
• Good accuracy is possible and the heating is
controlled. • A thick mix of quick setting plaster is molded
• Joints have similar strengths as conventional over the inserted units (Fig. 33.42).
soldering.
• Protective eyewear is necessary for the
operator.
Laser Welding
• It is done to join titanium components of
dental crowns, bridges and partial denture
frameworks.
• Pulsed high power Neodymium lasers with
very high density are used.
• Because of its low thermal influence, they are Fig. 33.42: A plaster index is made over the inserted
more preferred in dentistry. Since low heat is components and removed along with the components
generated, the parts can be hand held.
• The maximum penetration depth of the laser- • Once the plaster sets, it is removed along with
welding unit is 2.5mm. the inserted units.
• Superior joint strength can be obtained. • When the plaster index is inverted, the tissue
surface of the components of the prosthesis
Soldering Technique will be visible.
• The design of the connector is determined • A triangular piece of utility wax should be
while fabricating the wax pattern. (All solder placed to the indexed restoration in order to
connectors require about 0.25 mm parallel shape the soldering assembly. For the metal
spaced between the parent components) (Fig. ceramic restorations. It is added over the
33.40). porcelain regions for protection (Fig. 33.43).
668
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Lab Procedures Involved in the Fabrication of FPD
Porcelain Application
• After preparing the metal, an opaque layer
of porcelain should be applied over the metal
surface (Fig. 33.44).
Fig. 33.43: A triangular-shaped piece of utility wax is placed
in the solder joint area. This will act as a channel for the
solder metal to flow
Disadvantages
• Not economical
CERAMIC/ACRYLIC VENEERING
The ceramic or acrylic veneers in metal resin or
metal ceramic restorations are usually added Fig. 33.45a: Coating the gingival surface
after soldering. These veneers are added onto with cervical porcelain
the cutback area provided in the cast framework.
• Layers of cervical, body and incisal porcelains
Ceramic Veneering should be used to build up the facial surface
(Fig. 33.46).
Ceramic veneering is done in three steps namely • When two or more adjacent units are built
preparation of the metal surface, porcelain up together, the porcelain in the interdental
application, and porcelain firing. area should be sectioned to demarcate
junction of the two units.
Metal Preparation
• A separating liquid is applied over the eden-
• Any minor casting defects in the cut back area tulous ridge prior to building up the gingival
should be corrected. The casting should be surface of the pontic. 669
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Acrylic Veneers
The procedure is similar to ceramic veneering
except for a few differences. One of the major
differences is that only mechanical bonding exists
between the metal and resin. Hence, the bond
strength is considerably less.
Procedure
The steps to be followed for resin veneering are:
Fig. 33.45b: Excess porcelain should be • Mechanical undercuts (for retention) should
separated out carefully
be made over the entire metal surface to be
veneered.Mechanical undercuts can be created
by sprinkling plastic retentive pearls over the wax
pattern before casting.
• The surface of the cast metal can be roughened
using Al2O3 air abrasive unit.
• A small quantity opaque resin is added onto
the metal surface. Body shade resin is added
over the opaque resin and contoured using a
modelling instrument.
• The resin should be polymerised under pres-
sure in a warm water bath. Light cure resins
are also available.
• The resin core should be carved to remove
Fig. 33.46: The labial surface is built with body porcelain
excess material. Space should be provided to
accommodate incisal shade resin.
• Next the porcelain is fired as per the manu- • Finally incisal shade resin is added and
facture’s instructions. contoured using a modelling instrument.
• After firing the core porcelain, glaze porcelain • After polymerization of the incisal resin, the
is added and fired as usual. restoration is finished and polished.
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Chapter 34
Cementation of Fixed
Partial Dentures
• Finishing and Polishing
• Luting Agents
• Try-In
• Cementation
• Failures in Fixed Partial Dentures
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Cementation of Fixed
Partial Dentures
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34 Textbook of Prosthodontics
CEMENTATION
Cementation is defined as, “The process of attaching
parts by means of a cement” – GPT. It is the process
by which the restoration is cemented to the tooth
using a suitable luting agent. In this section, we
shall discuss the step-wise procedure to be
followed during cementation:
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Cementation of Fixed Partial Dentures
34
Fig. 34.3d: The inner walls of the crown are coated with a thin layer of cement,
using the small end of an instrument (A) or a brush (B)
Fig. 34.3e: While the cement hardens, the patient maintains pressure by
biting on a resilient plastic wafer (A) or a wooden stick (B)
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34 Textbook of Prosthodontics
Contd.
2. Mechanical breakdown
a. Flexion, fracture of metal – Inadequate thickness
– Improper casting
technique – Remake bridge
– Improper occlusion
b. Solder joint failure – Insufficient width and
depth of the joint
– Insufficient bulk of joint
metal
– Improper soldering
technique – Remake bridge
c. Pontic failure – Inadequate strength
– Faulty occlusion in lateral – Remake bridge
excursions
d. Failure of bonded porcelain – Faulty design – Correct tooth preparation and remake
– Incorrect occlusal preparation
on the teeth
– Inadequate strength at inter-
proximal metal
3. Gingival irritation – Plaque retention – Give correct instructions on home care
Gingival recession – Improper design
– Faulty retainer margin
– Incorrect occlusal anatomy – Remake bridge
– Over contoured retainer
– Inadequate embrasure
4. Periodontal breakdown
– General
– Remake
– Local
– Poor bridge design
– Incorrect assessment of
abutment strength – Remake
– Insufficient abutment
selected
– Traumatic occlusion
5. Caries
– Directly on the margins
– Indirectly starting
elsewhere in mouth
– following cementation – – Conventional filling materials
failure
6. Pulpal necrosis – Improper tooth – Remove and recement/remake
preparation technique
– Increased occlusal load For anterior: Apicectomy and retrograde filling
due to improper occlusion For posterior: Endodontic therapy
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Section Four
Maxillofacial
Prosthetics
(MFP) •
•
Introduction to Maxillofacial
Prosthodontics
Types of Maxillofacial Defects
• Types of Maxillofacial Prosthesis
• Materials Used in Maxillofacial
Prosthetics
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Chapter 35
Introduction to
Maxillofacial Prosthodontics
• Introduction
• Classification of
Maxillofacial Prostheses
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Introduction to
Maxillofacial Prosthodontics
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685
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Chapter 36
Types of Maxillofacial Defects
• Maxillary Defects
• Velo-pharyngeal Defects
• Extraoral Defects
• Traumatic Defects
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36
Types of
Maxillofacial Defects
MAXILLARY DEFECTS Cleft lip and cleft palate Cleft lip occurs due to
improper fusion between the fronto-nasal and
In the following section we shall discuss about maxillary process. If this occurs on one side it
the types of maxillary defects, prosthetic impli- leads to a unilateral cleft. If it occurs on both sides,
cations of their surgical management and the it leads to a bilateral cleft. In Mohr’s syndrome, a
restoration of these defects with modified partial median (midline) cleft lip is seen (Fig. 36.1).
or complete dentures.
Patients with maxillary defects will have diffi-
culties in mastication, speech and deglutition.
The aim of a maxillofacial prosthesis should be
to restore the normal physiological function in
these patients. The fabrication of various
prosthesis used in the management of these
defects are described in the next chapter.
Figs 36.1a and b: (a) Bilateral cleft lip
Types of Maxillary Defects (b) Single median cleft lip
Maxillary defects can be broadly classified as Aetiology includes infections, drugs (pheny-
follows: toin, ethanol and barbiturates), poor diet, and
— Congenital hormonal imbalance in the first trimester and
– Cleft lip genetic factors (13 trisomy Ptau’s syndrome).
– Cleft palate Cleft lip with or without cleft plate occurs in a
— Acquired ratio of 1:1000. It is twice as common in males
– Total maxillectomy when compared to females. It can either be
– Partial maxillectomy unilateral or bilateral. Unilateral cleft lip is more
In the following section, we shall discuss common on the left side.
about the clinical considerations of common
maxillary defects in detail. Classification of Clefts
Classification based on the extent of the defect:
Congenital Maxillary Defects
Clefts can be classified into three types under this
The most common congenital maxillary defects category,
include cleft lip and cleft palate. Other defects • Class I : Cleft lip with cleft alveolus (primary
like sub-mucous cleft palate, Pierre Robin syn- palate) (Fig. 36.2).
drome, hemifacial microsomia are treated using • Class II : Cleft of hard and soft palate
the same basic principles followed in the (secondary palate) (Fig. 36.3).
management of cleft lip/palate cases. • Class III: Combination of I and II (Fig. 36.4).
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36 Textbook of Prosthodontics
Fig. 36.5
Fig. 36.2
Fig. 36.3
Fig. 36.6
Fig. 36.4
Fig. 36.7
Veau’s Classification of Cleft Palate
Veau (1922) classified cleft palate into four types
mainly,
• Class I: Cleft involving the soft palate. It can
also be a sub-mucous cleft, which appears
normal (Fig. 36.5).
• Class II: A midline cleft involving the bone,
present only on the posterior part of the palate
(Fig. 36.6).
• Class III: A unilateral cleft extending along the Fig. 36.8
mid-palatine suture and a suture between pre-
maxilla and palatine shelf (Fig. 36.7).
• Class IV: A unilateral cleft extending along the between pre-maxilla and palatine shelf (Fig.
mid-palatine suture and both the sutures 36.8).
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• Class II: It is a unilateral defect involving one • Class V: It is a bilateral posterior defect (teeth
side of the arch posterior to the canine (teeth anterior to the second premolar are present)
posterior to the canine are absent) (Fig. 36.11). (Fig. 36.14).
• Class III: It is a defect involving the centre of • Class VI: It is a bilateral anterior defect ((teeth
the palatine shelves (all the teeth are present) anterior to the second premolar are absent).
(Fig. 36.12). (Fig. 36.15).
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Mandibular Defects
36
Congenital Defects of the Mandible
Congenital mandibular defects that require a
maxillofacial prosthesis are uncommon. Common
congenital defects of the mandible include
micrognathia, mandibulofacial dysostosis,
ankylosis of the temporomandibular joint, etc.
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Treatment of Velo-pharyngeal Defects and the eyelids. Most of the ocular defects are
acquired (by surgical procedures like evisce-
• Congenital velo-pharyngeal defects due to
ration–removal of the eyeball preserving the
palatal insufficiency can be restored by
surgical reconstruction followed with the sclera, enucleation and excentration).
insertion of an obturator to correct the residual • Lip and cheek defects like double lip, hemifacial
palatal insufficiencies. microsomia etc.
• Congenital velo-pharyngeal defects due to • Combination of the above mentioned defects.
poor structural integrity can be treated with Aesthetics is the major principle behind the
palatal surgery. placement of these prosthetic appliances. Hence,
• Acquired velo-pharyngeal defects due to most of these prostheses are non-functional.
surgical resection can be treated by surgical Commonly used extraoral maxillofacial pros-
reconstruction and prosthodontic rehabili- theses are described in the next chapter.
tation (E.g. obturator).
• Acquired velo-pharyngeal defects due to TRAUMATIC DEFECTS
trauma and neurological deficiencies can be
treated by prosthodontic rehabilitation using Common causes of trauma include physical
a palatal lift prosthesis. trauma and trauma due to heat and electrical
agents. Trauma can be classified under Inter-
EXTRAORAL DEFECTS national classification of diseases as intentional
and unintentional. Suicide, an intentional injury
Extraoral defects occur due to trauma, neoplasm is the second most common cause for death. The
or congenital malformation. Extraoral defects that common causes for unintentional injuries are
occur due to trauma are dealt separately under listed below according to their order of incidence:
traumatic defects.
• Moving vehicle accidents or Road traffic
The common neoplasia of the head and neck
accidents
include:
• Falls
• Epithelial tumours: epithelial facial tumours
may have a melanocytic, keratinocytic or • Fires and burns
adrenal origin. • Drowning
• Connective tissue tumours: adenomas, • Poisoning
fibromas, leiomyomas and lymphomas. • Aspiration of objects
After surgical resection, the patients are • Fire arms
referred for prosthodontic rehabilitation. The • Air plane crashes
types of prosthesis required vary according to the • Water transport
size, extent and location of the tumours. • Electric current
Traumatic defects differ from neoplastic
Extraoral congenital malformations that require
defects in the following ways:
maxillofacial prostheses include:
• Auricular defects: • They do not occur in predictable locations
— Microtia (small ear) associated with atresia • The patient usually does not have any
of the external auditory meatus. associated systemic problems (the patients
— Anotia (complete absence of the auricle). with neoplastic defects are often accompanied
— Smaller ear defects. with systemic complications). Hence, these
• Nasal defects: The defects arising due to surgery patients respond favourably to reconstruction
are known as Rhinotomy defects. than neoplastic defects.
• Ocular defects: It involves the defects in the • Patients with traumatic defects are more
eyeball with intact eyelids (lacrymal appara- critical about their aesthetics than those with
tus. An orbital defect involves both the eyeball neoplastic defects.
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Chapter 37
Types of Maxillofacial Prosthesis
• Complete Dentures in
Maxillofacial Prosthetics
• Removable Partial Dentures in
Maxillofacial Prosthetics
• Fixed Partial Dentures in
Maxillofacial Prosthetics
• Implants
• Obturators and Velo-pharyngeal
Prosthesis
• Extra-oral Prosthesis
• Treatment Prosthesis
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37
Types of
Maxillofacial Prosthesis
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37 Textbook of Prosthodontics
• The tooth adjacent to the labial scar usually engaged to maximise the retention of the
(lateral incisor) should be set above the occlu- prosthesis.
sal plane with a slight lingual rotation. This • Similarly the height and contour of the
helps to make the scar less conspicuous (Fig. remaining residual alveolar ridge will deter-
37.2). mine the stability of the denture.
• The portion of the complete denture that
extends into the defect is denoted as the obtu-
rator of the denture (Fig. 37.3). This obturator
Fig. 37.2: The lateral incisor near the cleft scar should be
lingually rotated and arranged above the occlusal plane for
aesthetic reasons
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Types of Maxillofacial Prosthesis
Removable Partial Dentures for a Cleft Lip • The edentulous area (defect) may extend from
37
and Cleft Palate Patient the midline anteriorly to the soft palate
posteriorly. Hence, these patients will require
• Fabrication is similar to that for a normal
a Kennedy’s class II partial denture with a
patient.
long lever arm.
• Removable partial dentures with a palatal lift
• Square or ovoid arch forms have a better
prosthesis with/without an obturator should
prognosis than tapered arch forms. Tapered
be provided for patients with cleft lip asso-
arch forms have reduced surface area. This
ciated with soft palate defect (velopharyn-
can lead to rotation and movement of the
geal deficiency).
• Tortuous fistula like openings may be present prosthesis into the defect during mastication.
in patients where a bone graft was not provi- • Preservation of remaining teeth is a primary
ded to fill the cleft. In order to prevent the concern of treatment. The prosthesis should
impression material from entangling into be designed such that the abutment teeth are
these defects, gauze dipped in petroleum jelly protected from excessive forces. The occlu-
should be placed over the site during impres- sion on the defective side will determine the
sion making. occlusal forces acting on the abutment teeth.
• There will be severe scarring in the healed • The location of the defect influences the out-
soft tissue. These tissue scars will appear as come of the treatment. Maximum retention,
tortuous folds of firm mucosa. In such cases, stability and support can be obtained by
the removable partial denture should be utilising the defect. The defect must be
designed such that its margins follow the engaged by the prosthesis to avoid the lateral
scars and do not cross the scars. torquing forces on the abutment teeth.
• The thickness of the beading along the • The basic principles of partial denture design
margins of the major connector should be should be followed.
reduced for these patients. • The diagnostic casts should be surveyed to
determine the favourable undercuts, location
Removable Partial Dentures for and contour of the guiding planes and the
Total Maxillectomy Defects path of insertion.
• A compound path of insertion may be needed
• The prognosis is dependent on the number to utilise the favourable undercuts in the
of remaining teeth. The remaining natural defect. For example, if the posterior and
teeth enhance the comfort, aesthetics and the lateral defects are engaged, the prosthesis
functioning of the prosthesis. should be first inserted into the defect and
• The size of the defect influences the stability then rotated into position.
of the prosthesis. Bigger defects provide • Multiple rests can be used to improve the
minimal support and the prosthesis will be stability. The rest seats should be rounded and
heavy and bulky. The prosthesis will have polished such that the rest of the prosthesis
maximal rotation on the defective side and can rotate without torquing the abutment
the gravitational forces (downward pull) may teeth.
aggravate the problem. • Complete or Full veneer crowns may be given
• The displacement of the prosthesis is to establish ideal contours for retention,
dependent on the quality of the edentulous guiding planes and occlusal rests.
ridge and the palate. The prosthesis should • When anterior abutment teeth are labially
be designed to distribute masticatory forces placed and with high survey lines, swing-lock
to the edentulous ridge and the remaining type of dentures can be used. The vestibule
teeth in a balanced manner. The mucosal and should have adequate depth for the
bony support will be compromised due to placement of the labial gate. The length of
surgical resection. the gate should be minimal to reduce the stress 701
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prosthesis is constructed primarily for speech • A framework with retainers that disengage
and aesthetics. An undercut should be during function cannot be given, as there are
created during surgery to enhance the altered patterns of force generation.
stability of the prosthesis. Engagement of the • Special attention should be given to record
nasal aperture can be done. the lingual extension of the unresected side.
• Removal of large portions of the orbital floor This extension provides additional retention
can lead to misalignment of the eyeballs and and stability for the prosthesis.
diplopia. A flexible superior orbital extension • Coverage of the buccal shelf area on the
can be attached with the obturator to uplift unresected side maximizes the support.
the orbital contents. Care must be taken to • The impression should extend onto the soft
avoid excessive contact and trauma to the tissues beyond the region of bony resection.
fragile nasal mucosa. This extension in the prosthesis can provide
support to the cheek on the resected side and
Removable Partial Dentures thereby improve the facial appearance of the
Mandibular Defects patient (Figs 37.9a and b).
• Altered cast impression is made for most of
The prognosis is poor for patients with mandi- the cases.
bular defects. The urgency for immediate place- • If the patient has 3 or less contiguous teeth
ment is absent and many mandibulectomy on the defective side neighbouring a long
patients are not dependent on the prosthesis for edentulous span, it will be difficult to stabi-
oral functions. Most patients opt for replacement lise the remaining smaller teeth segments dur-
only if the anterior teeth are missing. ing the procedure. Hence, a pickup impres-
As the partial dentures complicate the oral sion is made with alginate, after completing
hygiene, they are contraindicated for replace- the altered cast impression with light body
ment of few teeth if aesthetics and mastication impression material.
are not the major factors.
As time is not the major factor, all conven-
tional procedures like mandibular guidance
therapy should be completed to restore an
acceptable occlusion.
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• Fabrication is similar to a conventional remo- prosthesis. Long mesial rests should be pre-
37
vable partial denture with emphasis on the pared on the second molars to provide
restoration of occlusion. An occlusal ramp indirect retention.
can be fabricated on the palatal aspect of the • Proximal plates and the distal aspect of the
maxillary posterior teeth. minor connectors should be relieved to allow
• The over-extension of the prosthesis on the mild movement of the anterior segment.
resected side should be verified, as these areas • The rest of the procedure is same as described
have limited sensory innervation. earlier.
• Frequent recall visits are needed for finer
adjustments of the prosthesis. Removable Partial Dentures for Lateral Defects
• These patients will have posterior teeth only
Removable Partial Dentures for Continuity on one side of the arch. Presence of long lever
Maintained or Re-established Mandibular arms and compromised supporting tissues
Defects may complicate the situation.
These defects can be considered as two variables • During mastication, the anterior and
namely, anterior defects and lateral defects. posterior proximal plates move freely during
function. The labial retainer on the cuspid
Removable Partial Dentures for Anterior Defects disengages under occlusal load. Thus excess
load on the abutments is avoided.
• These patients have posterior teeth and an • The posterior retainer and lingual plating aid
extensive anterior edentulous area similar to in retention and bracing.
a Kennedy’s class IV situation. • Maximum coverage of the edentulous area is
• The length of the edentulous span depends needed.
on the extent of the surgery and the number • The patient is instructed to bite on the non-
and location of the posterior teeth. defective side with the remaining mandibular
• The anterior edentulous segment shows unus- teeth.
ual soft tissue configurations and compro-
mised bony support. Large defects show FIXED PARTIAL DENTURES IN
obliterated vestibules and lack of attached MAXILLOFACIAL PROSTHETICS
mucosa. These cases may require vestibulo-
plasty and placement of skin grafts. Fixed partial dentures are not commonly used
• A scar band is usually present across the resi- for patients with maxillofacial defects. One
dual anterior alveolar ridge between the lip common condition in which fixed partial
and the tongue. These bands can displace the dentures play an important role is in alveolar
prosthesis and can be traumatised by the cleft palate patients.
prosthesis.
Fixed Partial Denture for a Cleft
• Occlusal abnormalities will occur in cases
Lip and Cleft Palate Patient
with anterior discontinuity defects, which
were improperly restored with poorly posi- • If bone graft was done to complete an
tioned segments. The occlusion is rarely alveolar cleft, an implant supported single
altered in cases with continuity defects and tooth replacement or a regular three-unit
the pattern of mandibular movement is bridge can be fabricated (Fig. 37.10).
normal. • If bone graft was not provided to fill the
• Masticatory efficiency may be compromised alveolar cleft, a fixed partial denture with
when there is a large anterior defect. Implants additional secondary abutments on either side
may be needed for additional support. of the defect should be involved.
• The design of the prosthesis should consider • Discoloured natural teeth should be restored
705
the movement of the anterior segment of the with composite or porcelain veneers.
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• Preliminary impression using alginate: Care • The immediate surgical obturator is retained
37
should be taken to record the undercuts. The for 7 to 10 days after surgery.
junction of the graft and the mucosa should • A delayed surgical obturator is inserted 7 to
be properly recorded, as it is an important 10 days after surgery.
retentive feature. • This may be converted into an interim
• Fabrication of custom tray: A custom tray is obturator by the addition of a lining material.
fabricated using any of the methods described • This obturator is retained for 3 to 4 months
in Chapter 6. Additional care should be given post surgically. It is replaced with an interim
to orient the tray into the defect. or definitive obturator after complete healing
• Border moulding: The velo-pharyngeal of the surgical wound.
extension can be recorded by asking the
patient to swallow. Additional exercises like Uses
turning the head from side to side, placing • Provides a stable matrix for surgical packing
the chin down onto the chest may also be • Reduces oral contamination
required. Acrylic special trays are preferred • Speech will be effective post-operatively
for these patients. • Permits deglutition
• Final impression with elastic impression material: • Reduces the psychological impact of the
It can be made using alginate or elastomeric surgery
impression materials. The tray should be • May reduce the period of hospitalisation.
positioned properly and the scar band area
must be accurately reproduced.The elastic Meatal Obturator
recoil (purse string action) seen in the scar band • It is a special type of obturator that extends
tissues is responsible for the retention of the upto the nasal meatus.
obturator. If the scar band is not effective, • It establishes closure with the nasal structures
implants can be placed into the defect to at a level posterior and superior to the
improve retention. posterior border of hard palate. The closure
• Jaw relation: It is very challenging to record is established against the conchae and the
the jaw relation for these patients. Acrylic roof of the nasal cavity.
denture bases are preferred because it is • It separates the oral and the nasal cavities.
difficult to position other denture bases. • It is indicated in patients with extensive soft
• Teeth arrangement should be done such that palate defects.
balanced occlusion is obtained.
• Insertion and post-insertional management is Disadvantages
carried out as usual. • Nasal air emission cannot be controlled
because it is in an area where there is no
Clinical Considerations muscle function.
• Surgical obturator is inserted on the day of • Nasal resonance will be altered.
the surgery.
• A preliminary cast is obtained before surgery Palatal Lift Prosthesis (Fig. 37.11)
on which a mock surgery is performed. • It is a special type of obturator, which is a
• A clear acrylic plate is fabricated and inserted definitive prosthesis with a posterior
after surgery. extension.
• If the patient is dentulous, retention is • It is helpful in restoring palato-pharyngeal
obtained with simple clasps. incompetence where the soft palate muscu-
• If the patient is edentulous, the obturator is lature is compromised. E.g. myasthenia
wired into the alveolar ridge and the gravis, bulbar poliomyelitis, cerebral palsy.
zygomatic arch. • It can be clubbed with an obturator if needed. 707
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EXTRA-ORAL PROSTHESIS
In the previous chapter we discussed about the
different extra-oral defects and their manage-
ment. Now we shall discuss about the restoration
of common extra-oral prosthesis.
Auricular Prosthesis
• It is an ear prosthesis
• It is fabricated from impressions made with
silicone or irreversible hydrocolloids. During
impression making, the patient is made to lie
Fig. 37.11b: Palatal lift prosthesis used to restore a in a supine position. The defect area should
physiological velo-pharyngeal insufficiency be confined with wax. 50% additional water
Advantages can be added while mixing irreversible
hydrocolloids to increase the flow.
• Minimised gag response • A plaster with gauze backing can be used to
• Tongue physiology, swallowing, mastication support the impression.
and speech are not compromised • The shape of the ear can be formed with
• Access to the nasopharynx for the obturator reference to a pre-surgical cast or using the
is facilitated healthy ear. This procedure of shaping the
• The palatal lift portion can be added later as ear is known as sculpting.
desired. • Stippling is done to match the texture of the
Contraindications prosthesis with the adjacent skin. It also faci-
• If adequate retention is not available for the litates extrinsic tinting. It provides mechanical
basic prosthesis retention for extrinsic colorants.
• If the palate is not displaceable • Feathering is done on the margins of the wax
708 • Un-cooperative patients pattern.
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Types of Maxillofacial Prosthesis
• The prosthesis is flasked in a three part mould • It is tried in the eye socket and evaluated for
37
and the material (acrylic or silicone) is lid contours.
processed as usual. • Following which, it is flasked and de-waxed.
• The retention of the prosthesis is through ear- • Special scleral white acrylic resin is available
glass frames or tissue adhesives or extension for such procedures.
of prosthesis into ear canal. Nowadays osseo- • Scleral resin is packed, processed, trimmed
integrated implant retained prosthesis are and polished as usual.
given. • Next the ocular ball prosthesis is tried in the
patient’s defect.
Nasal Prosthesis
• The position of the iris is determined during
• It is fabricated for rhinectomy patients the trial procedure. The patient is made to
• There are two types of nasal prosthesis relax. The dentist should mark the location
namely temporary and permanent. of the iris by comparing it with the unaffected
• The temporary prosthesis is placed 3 to 4 eye on the other side.
weeks after surgery. It is usually made of heat • The iris is placed and fused to the scleral
cure acrylic as it can be relined. Most of the prosthesis. A cut back is created in the sclera
temporary prosthesis are retained with adhe- to seat the iris button.
sives. It can be used for a maximum of 3 to 4
• Characteristic pigmentations on the iris can
months.
be applied according to the shade of the other
• The permanent prosthesis is fabricated as
eye. This procedure is known as Iris painting.
described for auricular prosthesis.
• During impression making, care should be It is done in five parts or phases namely, the
taken to block the nasal passages and prevent pupil, base colour, detail, collaratte and
the entry of impression material. limbus. The paints used include oil paint on
• A facial moulage is made first and a special acetate discs, oil paint and linseed oil, acrylic
tray is fabricated over the defect area. paints and watercolour.
• Before making the master impression, syringe • It should be remembered that this prosthesis
material is injected over the skin creases and could not give a life-like appearance. Hence,
undercuts to obtain a perfect record. the patient is advised to wear glasses.
• Sculpting is done as usual.
• Processing is done with a two-piece mould. Patient’s Instructions
The technique is similar to the one described • The patient is asked to remove the prosthesis
for auricular prosthesis. atleast once a day for cleaning.
• The prosthesis should never be exposed to
Ocular Prosthesis alcohol as it may discolour the prosthesis and
• It is used to replace enucleated eyes. One the painting.
should remember that the lacrimal apparatus
(eyelids and associated glands) is intact in TREATMENT PROSTHESIS
these patients. Hence, the prosthesis only
replaces the eyeball. A treatment prosthesis can be defined as, “A
• The impression is made with irreversible prosthetic appliance used for the purpose of treating
hydrocolloids. or conditioning the tissues that are called on to
• A special tray is fabricated. support and retain it”
• The secondary impression is made with Commonly used treatment appliances include
irreversible hydrocolloids. surgical obturators, mandibular training flanges
• Casts are poured in two sections with two and radiation appliances. Surgical obturators
key-ways in the first pour and separating have been discussed under obturators. In this
medium. section, we shall discuss about the remaining
• Sclera is fabricated with wax. appliances in detail. 709
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Chapter 38
Materials Used in
Maxillofacial Prosthetics
• Acrylic Resin
• Acrylic Copolymers
• Polyvinyl Chloride and Copolymers
• Chlorinated Polyethylene
• Polyurethane Elastomers
• Silicones
• Polyphosphazines
• Adhesives
• Metal
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38 Textbook of Prosthodontics
Materials Used in
Maxillofacial Prosthetics
These materials are preferred for restoring defects It is a new material where clinical trials have just
that require minimal movement like ocular been initiated. Louis and Castleberry were the
prosthesis. first to test this material, which is similar to
This material has advantages like ready polyvinyl chloride.
availability and familiarity among the prac- The disadvantage is that it requires metal
titioners. Intrinsic and extrinsic coloration can be moulds for processing.
used to simulate natural teeth.
Heat-cure resin is preferred to auto-polymeris- POLYURETHANE ELASTOMERS
ing resin because it has better colour stability
They are elastomers with urethane linkages.
when exposed to UV radiation.
Hence, they are known as polyurethanes. The
The disadvantages include the rigid property
urethane linkages are formed by combination of
of the material and difficulty in duplicating the
one isocyanate group with a hydroxy group.
prosthesis (the mould is destroyed during
recovery). These materials have excellent properties like
elasticity without compromised edge strength
ACRYLIC COPOLYMERS (this helps to thin the material at the margins).
They can be used to restore defects with mobile
These are plasticized methyl methacrylate tissue beds.
polymers, which show elastic properties. But The disadvantages include the moisture
these materials are not commonly used because sensitivity during processing and poor colour
they get tacky leading to the collection of dust stability.
and stains. They have poor edge strength and
poor durability. They also degrade under SILICONES
sunlight.
It is the most commonly used material for facial
POLY VINYL CHLORIDE AND restoration but properties like poor tear strength
COPOLYMERS and life-less appearance have limited them from
universal acceptance.
It is a hard, clear, tasteless and odourless resin. It Silicones are a combination of organic and
was extensively used in the beginning but their inorganic compounds. They are manufactured
use decreased due to various factors like from silica. Silica is first reduced to silicon and
excessive shrinkage, long processing time, then it is reacted with metal chloride to form
discolouration and hardening of the margins due Dimethyl-dichloro-siloxane. Dimethyl-dichloro-
to plasticizer migration and loss. They absorb siloxane reacts with water to form a polymer. This
sebaceous secretions and tend to get soiled due polymer is a translucent, white, watery fluid
714 to their tackyness. whose viscosity is determined by the length of
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715
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Section Five
Implant
Dentistry (ID)
• Dental Implantology
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Chapter 39
Dental Implantology
• Introduction
• Classification of Implants
• Mechanism of Integration of Endosteal Implants
(Osseo-Integration)
• Diagnosis and Treatment Planning for Implants
• Surgical Placement of Implants
• Failures in Implants
• Materials Used in Dental Implants
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Dental
Implantology
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Dental Implantology
a b
Figs 39.3a and b: (a) Root form implants
(b) Plate form implants
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39 Textbook of Prosthodontics
Fig. 39.4a: Kennedy’s class I division A bone . > 10 mm bone height . 7 mm bone length. crown implant ratio <1
Fig. 39.4b: Kennedy’s class I division B bone. Moderate bone width (2.5 to 5 mm). Adequate bone height
(> 10 mm). Adequate bone length (> 15 mm). Crown implant ratio is < 1
Fig. 39.4c: Kennedy’s class I division C bone. Inadequate Fig. 39.4d: Kennedy’s class I division D bone. Edentulous
bone width, height and thickness not sufficient for endosteal areas with severly resorbed ridges. Crown implant ratio
722 implant placement. Crown implant ratio is > 1 is > 5
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Dental Implantology
39
Fig. 39.4e1: Kennedy’s class II condition with division A bone in the upper arch and division B bone in the lower arch
Fig. 39.4e2: Kennedy’s class II condition with division C bone in the upper arch and division D bone in the lower arch
Fig. 39.4f1: Kennedy’s class III condition with division A bone in the upper arch and division B bone in the lower arch
Fig. 39.4f2: Kennedy’s class III condition with division C bone in the upper arch and division D bone in the lower arch
723
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Fig. 39.4g1: Kennedy’s class IV condition with division A bone in the upper arch and division B bone in the lower arch
Fig. 39.4g2: Kennedy’s class IV condition with division C bone in the upper arch and division D bone in the lower arch
Fig. 39.4h: Completely edentulous jaw is divided into three Fig. 39.4i: Type 1 division A arch
segments for convenience . Anterior component (Ant) is
between the mental foramina. Right (RP) and left (LP) present in the different components, the clinical
posterior segments correspond to patient’s right and left conditions are grouped as Type I, Type II and Type
sides
III.
In case of completely edentulous patients,
Misch segmented each arch into three segments Depending on the Treatment Options
namely anterior (Ant), right posterior (RP) and Misch in 1989 reported five prosthetic options of
left posterior (LP) components. The clinical implants. Of the five, the first three are fixed
conditions are classified based on the density of prosthesis (FP) that may be partial or complete
bone (Refer treatment planning—discussed later) replacements, which in turn may be cemented or
724 in each segment. According to the bone density screw-retained. The fixed prostheses are classified
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39
Fig. 39.4j: Type 1 division C arch Fig. 39.4k: Type 1 division D arch
Fig. 39.4l: Type 2 division A, B arch Fig. 39.4m: Type 2 division B, C (B and C) arch
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39 Textbook of Prosthodontics
Laboratory Analogues
These are machined structures, which represent
the body of the implant. They are placed on the
laboratory cast in order to fabricate an implant-
supported prosthesis.
During surgery, after the implant body is
inserted into the prepared bone cavity, the impres-
sion post is placed over it. Consecutively, the
analogue is fixed over the impression post.
An impression is made and the analogue-
impression post complex gets attached to the
impression and comes away with it. When the
impression is poured, the impression post
analogue complex will get embedded to the cast.
Waxing Sleeves
Waxing sleeves are designed to be attached to the
body of the implant. It is actually fixed to the
laboratory analogue during the fabrication of the
super structure. They will later form a part of the
super structure of the implant (Fig. 39.8).
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Dental Implantology
bridges, fixed detachable bridges and single • The super structure is usually cemented over
39
crowns. Most super structures are connected to the implant.
the implant via an attachment.
Implant Supported Fixed Detachable Bridges
Implant Supported Overdentures • This super structure is designed to be removed
They can be either a complete or a partial over by the dentist and not by the patient.
denture. The implants are placed on suitable sites • They are mostly implant borne and difficult
on the edentulous ridge. The implant abutments to fabricate.
may either be present individually or be con- • The bridge is attached to the implants with
nected to one another with a bar. Various specia- screws or weak cements.
lised attachments are available to suit the interface
between the implant abutment and the
Implant Supported Single Tooth Replacements
overdenture (Fig. 39.9). They are of two types namely,
• Replacement of a single tooth without obtain-
ing support from adjacent teeth. It should be
designed with anti-rotational features.
• Replacement of a single tooth with support
from the adjacent tooth. The practitioner
should be aware that the supporting natural
teeth might undergo intrusion.
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Dental Implantology
prosthesis require lesser number of implants due machine or Stereo lithography (developing 3D
39
to decreased masticatory load. images using two laser beams).
Fourth, the location of the implant within the • Measurement of mucosal thickness: It is usually
arch is analysed. Implants placed in the posterior done by piercing the mucosa with a needle on
quadrants should be designed to accept higher an anaesthetised region. It is mainly indicated
load. for maxillary edentulous spaces. The depth of
Fifth, the forces that may act on the implant penetration is marked on the needle and this
should be analysed. All forces should be is used to mark the amount of bone present in
transmitted along the long axis of the implant. the cross-section of the model (bone mapping).
Torquing and levering forces should be avoided The mucosal thickness can also be measured
as they produce increased bone loss. with special compasses and gauges.
Lastly, the crown implant ratio should be
Treatment Planning for Implant Therapy
determined. Crown is the height of the super
structure and the implant is the height of the In this section we shall read in detail about the
implant submerged into the bone. Greater the characteristics of commonly available implant
crown root ratio, greater is the moment of force systems.
that is formed under lateral loads.
Root form Endosteal Implants
Diagnostic Evaluation
• Availability of adequate amount of bone is the
It involves the radiographic evaluation of bone. primary requisite for these implants. A
• Periapical radiographs: It gives a detail picture minimum of 8 mm vertical, 5.25 mm medio-
about the amount and the quality of bone lateral and 6.5 mm bucco-lingual bone is the
remaining. minimal requirement.
• Occlusal radiographs: They provide information • It is available in press-fit and self-tapping
about the facio-lingual width of the bone. forms. Press-fit is smooth surfaced and usually
• Lateral cephalometric radiograph: It is used to coated with hydroxyapatite or titanium
determine and evaluate the loss of vertical plasma spray. Self-tapping forms are usually
dimension, skeletal inter-arch relationships threaded implants (Fig. 39.3a).
and the crown-implant ratio. Indications
• Panoramic radiograph: It is the most frequently • Fixed bridges
used radiograph. Vertical height of the bone • Fixed detachable prosthesis
can be evaluated. It also gives an idea about • Over dentures
the location and extent of limiting anatomical • Single tooth replacement
structures.
• Computed tomography: It gives a detailed view Blade form Endosteal Implants
of the cross-sectional anatomy of the alveolar
ridges. The advantage is that superimpositions • It may be either pre-fabricated or custom made
of structures do not occur and the dis- (Fig. 39.3b).
advantage is its cost. It is the primary indi- • It is indicated when the width of the bone is
cation to determine pre-implantation proce- not adequate for placement of a root form
dure evaluation. implant. It requires a minimum of 8 mm
It can also help to create three-dimensional vertical bone height and 3mm bone width.
representations of edentulous arch segments Indications
destined to receive implants. These 3D images • When the implant has to support a fixed
can be used to develop a 3D model of the prosthesis along with natural teeth
operative site using a computer guided milling • Full arch edentulous reconstruction
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39 Textbook of Prosthodontics
Ramus Blade or Ramus Frame Implants • It should obtain sufficient stability and
retention from the remaining teeth
These implants are used when insufficient bone
• It should provide an adequate overview of the
(less than 6 mm bone height and 3 mm bone
surgical site
width) is present in the body of the mandible to
support an endosteal implant. These are one- • It should provide enough space for the
piece blade implants, which take support from reflected mucoperiosteal flap
the bone in the ramus region. Fabrication
They are indicated for atrophied completely
edentulous mandibular ridges. The stent is fabricated using the compression
moulding technique. A pattern of the stent is
SURGICAL PLACEMENT OF IMPLANTS prepared (it resembles a denture base). The stent
should extend into the gingival embrasures like
Implant placement procedure includes three steps the collars of a denture base. Posteriorly, it is limi-
namely, preparation of study models, preparation ted to the posterior palatal seal area (Fig. 39.11).
of surgical stents and surgical placement of the
implants.
Preparation of the Surgical Stents After acrylizing the stent, it should be checked
on the master cast. The area where the placement
A surgical or a guiding stent is a prosthetic of an implant is planned should be marked on
appliance, which helps to orient and position the the stent and drilled. Hence, the stent will contain
implants. The term stent was coined after an holes at the sites where implants are to be placed
English dentist Charles R. Stent. (Figs 39.12 and 39.13).
A stent can be defined as, “Eponym for a device
used in conjunction with a surgical procedure to keep
a skin graft in place; often modified with acrylic resin
or dental modelling impression compound that was
previously termed Stent’s mass; also refers to any
device or mold used to hold a skin graft in place or
provide support for anastomosed structures.” – GPT.
A surgical stent is, “An appliance named for the
dentist who first described its use, Charles R. Stent, a
stent is used to apply pressure to soft tissues to facilitate
healing and prevent cicatrisation or collapse” – GPT.
(Synonyms include COLLUMELLAR STENT, Fig. 39.12: Acrylized surgical stent
PERIODONTAL STENT, SKIN GRAFT STENT).
In case of edentulous arches opposing den-
Ideal Requirements tulous ones, the stents are fabricated on the
opposing arch and a small wire is incorporated
A surgical stent should fulfil the following onto the stent along the long axis of the existing
732 requirements: teeth. When placed in the patient’s mouth, the
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Dental Implantology
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39 Textbook of Prosthodontics
fixture is uncovered so that the prosthetic 39.18). The advantage of this technique is that it
component can be placed over the implant (Fig. offers superior primary stability.
734
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Dental Implantology
Fig. 39.18: The flap over the implant is retracted after 6 weeks
to expose the implant body and place the prosthetic
component
The first step in the surgical procedure is making Arcuate vestibular incision It is made in the
the primary incision. The following criteria vestibule like a half circle with its lateral extension
should be fulfilled in a primary incision: up to the canine region (Fig. 39.21). The flap is
• The flap should have adequate blood supply reflected in two stages. The mucosa is retracted
• Adjacent anatomical structures should not be first, followed by the mental nerve and the muco-
endangered. periosteum. It may also be done in the maxilla.
• The flap should provide adequate view of the
surgical field.
• It should ensure complete coverage of the
implant.
• The incision should be extendable if needed.
Types of Incision
There are three types of incisions widely used in
implant dentistry. Fig. 39.21
Crestal incision This incision extends longi- Incision for a single tooth implant If there is
tudinally along the crest of the edentulous ridge. sufficient bone available, the primary incision can
It can be modified with vertical releasing incisions be made at a safe distance from the natural tooth
to adequately expose the operative field (Fig. in order to preserve the interdental papilla. This
39.19). provides the best aesthetics. The length of the flap
should not be more than twice its width to
maintain good blood perfusion.
Insertion Procedure
We know that the insertion procedure varies
according to the implant system used. Here, we
have described the general outline to be followed
for root form double stage endosteal implants.
• The location of the placement site is
Fig. 39.19 determined using a surgical stent. 735
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Dental Implantology
• Tissue support can be improved by choosing the arch form can lead to loosening of the
39
a specific implant system considered ideal for screw attachment and fracture of the super-
the tissue. structure.
In such cases, the loosened component of the
Failure due to Surgical Complications implant screw attachment should be replaced.
Implant surgery is an invasive procedure and all The prosthesis should be re-cemented.
precaution to maintain asepsis should be • Implant loss: It is a rare complication, which
followed. Factors which affect normal wound occurs due to sudden loss of alveolar bone. If
healing can produce implant failure. Infection of this occurs in edentulous patients, the fixed
the surgical site can lead to loss of osseo- prosthesis should be converted into a remo-
integration. vable implant supported overdenture. In all
other cases, an additional implant should be
Management placed.
• Implant fracture: In an implant system, the
Every precaution should be taken until bone and
wound healing is complete. Aseptic procedures, abutment and prosthesis are connected to the
antibiotic cover and good post-operative care are implant with screws. The system is designed
essential to ensure proper healing. such that the screws act as stress breakers there
by protecting the implant. Causes for fracture
Failure Due to Implant Prosthetic include lack of inter-maxillary space and
Component Failure excessive implant loading (Fail and safe
mechanism).
The most common problem faced in this category Management includes the use of 2-screw
includes screw loosening and framework failure. systems. Larger diameter implants with large
wide platforms and large screws are recom-
Causes
mended.
The common causes for an implant prosthetic • Cantilever extensions: The greater the cantilever
component failure are: distance, the greater is the chance for implant
• Screw design: Conical screws in the implant fracture. The factors, which modify cantilever
superstructure tend to loosen. This problem length, include implant length, arch form,
can be overcome by using implants wotj flat spacing, bone quality, occlusal considerations
head screw design. and parafunctional habits.
• Inadequate torque application: Torque is the Failure in such cases can be prevented by the
amount of force required to tighten the use of the recommended cantilever length (15
implant. Proper torque should be applied for mm or less in mandible and 10 mm or less in
all implant prosthesis. If inadequate torque is the maxilla)
applied, the screw attachment may get • Inaccurate framework-abutment interface: The
loosened. The torque value for gold screws is prosthetic components are usually designed
about 10 to 20 Ncm. such that there is a precise junction between
In such cases, the implant prosthesis should the abutment surface and the prosthetic
be removed and thoroughly examined. The framework. Inaccurate fit can lead to constant
loose gold screw should be removed and tension in the components, which may lead
replaced. to screw loosening or fracture.
• Arch form: The arch form should be maintained Management includes the removal, indexing
because it provides cross-arch splinting and and re-soldering the framework until a proper
tripod effect, which balance the prosthesis fit is obtained.
against masticatory forces. Failure to maintain • Occlusal factors: There should be an equal dis- 737
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Dental Implantology
• Modulus of elasticity: 28 *106.psi The alloys can also contain traces of Nitrogen,
39
• Tensile strength: 70 to 145 psi Carbon and Hydrogen.
• Elongation to fracture is more than 30%. Properties
Disadvantages • Has a density of 4.5g/cm3. Hence it is 40%
• It cannot be used in nickel sensitive patients lighter than steel.
• It is susceptible to pit and crevice corrosions • High strength : weight ratio.
• Direct contact with a dissimilar metal crown • Low modulus of elasticity: 17psi*10 6. This
should be avoided to prevent galvanism. signifies the importance of design for the
proper stress distribution.
Cobalt-Chromium-Molybdenum Alloys • Low tensile strength: 95psi
• Elongation to fracture is more than 8
They can be cast and annealed for custom-made
• It has a high corrosion resistance. The titanium
implant designs.
oxide layer will release small amounts of
Composition titanium into the electrolytic environment over
• 63% Cobalt: Provides a continuous phase for a long period of time.
bi-phasic properties • Titanium is more ductile than titanium alloy.
• 30% Chromium: Provides corrosion resistance Hence it is preferred for endosteal blade form
(oxide formation) implants.
• 5% Molybdenum: Serves to stabilise the • It has high di-electric property which is
structure responsible for its osseointegration
• Traces of carbon: Hardener
Advantages
• Traces of Manganese and Nickel
• Osseointegration
Properties • Bio-degradative products from aluminium
• It has an outstanding resistance to corrosion. and vanadium produce favourable tissue
• Tensile strength: 95 psi response
• Modulus of elasticity: 34 *106psi • High corrosion resistance
• It has very low ductility
• If properly fabricated, it has good bio- Surface Coated Titanium
compatibility It is new implant design where the titanium
Advantages implant is coated with a plasma spray of
• Economical hydroxyapatite, which improves the rate and
• Long term clinical success quality of osseointegration. Hann and Palich
developed it.
Disadvantages
• Poor ductility Procedure
• Molten droplets of Titanium in the plasma
Titanium and its Alloys state are bombarded against the implant
Titanium is a highly reactive metal. It is the surface with high velocity at high tempe-
material of choice because of its predictable ratures (15000°C).
interaction with the biological environment. • The plasma spray will form a layer of 0.04 to
0.05mm after solidification.
Composition • Under microscopic examination, small-inter-
• Commercially pure Titanium (99.999% Pure connected pores are found on the plasma
Titanium) is available for the use in dental spray.
implants
• Commonly used Titanium alloys contain 90% Advantages
by weight Titanium, 6% by weight of • Promotes bone growth
Aluminium and 4% by weight of Vanadium. • Improves osseointegration 739
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Dental Implantology
Aluminium Oxide
It is found either in the poly-crystalline form or
mono-crystalline form (sapphire). It is well
tolerated by bone but it does not promote bone
formation. Hence it is bio-inert.
Fig. 39.23d: The leached out Ca2+ and PO43– ions condense
locally and attract collagen forming fibroblasts to the region
Properties
• High strength, stiffness and hardness
• Available in blade or screw form
• Bone and soft tissue integration has been
demonstrated.
Uses
• Used as abutments for partially edentulous
arches
• It is advantageous for tissue interface related
Fig. 39.23e: The fibroblasts get anchoed in the Ca2+ and investigations
PO43– ionic matrix and lay fresh collagen
Polymers and Composites
• Local changes in pH near the surface of the
bio-glass produce dissolution of the ions (Na+, • They are used primarily as internal force
Ca++, PO43- etc) from the material and hydro- distribution connectors for osseointegrated
gen and hydroxyl ions diffuse in return to the implants.
material.
Fig. 39.23f: The collagen formed is thus directly anchored onto the apatite depecting complete osseo-integration 741
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742
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Section Six
Glossary of
Prosthodontic
Terms—JPD 2001
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Glossary of Prosthodontic Terms
Glossary of
Prosthodontic Terms
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Textbook of Prosthodontics
ac.quire vt ac.quired; ac.quir.ing (15c) 1: to obtain as one’s adaptive occlusion: see MAXIMAL INTERCUSPAL
own; to come to have as a new or additional trait, POSITION
characteristic or capability 2: attained with time additive color mixture: the perceived color that results when
acquired centric: see ECCENTRIC RELATION, MAXIMAL the same area of the retina of the eye is illuminated by lights
INTERCUSPAL POSITION of different spectral distribution such as by two colored
acquired centric occlusal position: see ECCENTRIC lights—comp SUBTRACTIVE COLOR SYSTEM
RELATION, MAXIMAL INTERCUSPAL POSITION ad.duct vt (1836): to draw toward the median plane or
acquired centric position: see ECCENTRIC RELATION, toward the axial line—comp ABDUCT
MAXIMAL INERCUSPAL POSITION ad.her.ence n (1531): the act, quality, or action of adhering;
acquired centric relation: see ECCENTRIC RELATION, persistent attachment
MAXIMAL INTERCUSPAL POSITION ad.he.sion n (1624) 1: the property of remaining in close
acquired eccentric relation: any eccentric relationship proximity, as that resulting from the physical attraction of
position of the mandible relative to the maxilla, whether molecules to a substance or molecular attraction existing
conditioned or learned by habit, which will bring the teeth between the surfaces of bodies in contact 2: the stable joining
into contact of parts to each other, which may occur abnormally 3: a
acquired occlusal position: the relationship of teeth in fibrous band or structure by which parts abnormally
maximum intercuspation regardless of jaw position—see adhere—comp CAPSULAR FIBROSIS, FIBROUS A.,
MAXIMAL INTERCUSPAL POSITION INTRACAPSULAR A., MYOFIBROTIC CAPSULAR
CONTRACTURE
acquired occlusion: see MAXIMAL INTERCUSPAL
1ad.he.sive adj (1670): sticky or tenacious
POSITION
2 adhesive n (1912) 1: any substance that creates close
acrylic resin 1: pertaining to polymers of acrylic acid,
methacrylic acid, or acrylonitrile; for example, acrylic fibers adherence to or on adjoining surfaces 2: a luting agent—see
or acrylic resins 2: any of a group of thermoplastic resins DENTURE A., MAXILLOFACIAL PROSTHETIC A.
made by polymerizing esters of acrylic or adhesive capsulitis: within the temporomandibular joint,
methylmethacrylate acids any situation in which the disk is in normal position, joint
acrylic resin base: a denture base made of acrylic resin space volume is decreased, and motion is restricted
activated resin obs: see AUTOPOLYMERIZING RESIN adhesive failure (1998): bond failure at an interface between
1
ac.ti.va.tor n: a removable orthodontic device intended to two materials due to a tensile or shearing force—see
stimulate perioral muscles COHESIVE FAILURE
2activator (1998): 1: any chemical agent which triggers an adi.a.do.cho.ki.ne.sia n: inability to perform rapid
initiator chemical to begin a chemical reaction 2: a substance alternating movements such as opening and closing the jaws
used in small proportions to increase the effectiveness of an or lips, raising and lowering the eyebrows, or tapping the
accelerator chemical finger
acute closed lock: a form of temporomandibular joint adipose atrophy: reduction of fatty tissue
dysfunction characterized by limitation in jaw movement adjustable anterior guidance: an anterior guide on an
of a short duration with pain, limitation of jaw opening to articulator whose surface may be altered to provide desired
25 to 30 mm (as measured in the incisor area) and, with jaw guidance of the articulator’s movement mechanism; the
opening, a deflection of the mandible toward the affected guide may be programmed (calibrated) to accept eccentric
joint interocclusal records
acute pain: pain having a brief and relatively severe course
adjustable articulator: an articulator that allows some
ad.ap.ta.tion n (1610) 1: the act or process of adapting; the limited adjustment in the sagittal and horizontal planes to
state of being adapted 2: the act of purposefully adapting replicate recorded mandibular movements—see
two surfaces to provide intimate contact 3: the progressive ARTICULATOR
adjustive changes in sensitivity that regularly accompany
continuous sensory stimulation or lack of stimulation 4: in adjustable axis face-bow: see FACE-BOW
dentistry, (a) the degree of fit between a prosthesis and adjustable occlusal pivot obs: an occlusal pivot that may be
supporting structures, (b) the degree of proximity of a adjusted vertically by means of a screw or other device
restorative material to a tooth preparation, (c) the adjustment (GPT4)
of orthodontic bands to teeth ad.just.ment n (1644) 1: the act or process of modifying
adaptation syndrome: a syndrome characterized by physical parts 2: in dentistry, a modification made on a dental
alterations in response as an accommodation to the prosthesis or natural tooth to enhance fit, function, or
746 environment acceptance by the patient—see OCCLUSAL A.
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Glossary of Prosthodontic Terms
ad.sorp.tion n (1882): the adhesion, in an extremely thin air conduction: the normal process of conducting sound
layer, of molecules to the surfaces of liquids or solids with waves through the ear canal to the tympanic membrane
which they are in contact—comp ABSORPTION— air dose: in therapeutic radiology, the amount of energy
ad.sorp.tive adj absorbed per unit mass of tissue at a given site, in air
adult speech aid prosthesis: a definitive prosthesis that can Akers clasp [Polk E. Akers, Chicago, III, dentist]: eponym
improve speech in adult cleft palate patients either by for a one-piece cast partial denture with cast clasps. He is
obturating (sealing off) a palatal cleft or fistula or said to have improved and standardized the one-piece
occasionally by assisting an incompetent soft palate. Both casting method for fabricating gold partial dentures in the
mechanisms are necessary to achieve velopharyngeal early 1920s—see SUPRABULGE CLASP
competency—syn PROSTHETIC SPEECH APPLIANCE,
Akers PE. Partial dentures. J Amer Dent Assoc 1928;15:717-22.
SPEECH AID, SPEECH BULB
ala n, pl alae (1738): a wing or a wing like anatomic part or
af.ter.im.age n (1874): in visual acuity, a prolongation or
process—alar adj
renewal of a visual sensory experience, ascribable to residual
excitation after external stimuli have ceased to operate ala nasi n: in anatomy, the cartilaginous processes forming
the wing-like flares of each nares
afterloading technique: in therapeutic radiology, the use of
applicators for brachytherapy so designed that they may be ala.tragus line: a line running from the inferior border of
quickly loaded with radioactive sources after placement the ala of the nose to some defined point on the tragus of the
within the patient ear, usually considered to be the tip of the tragus. It is
frequently used, with a third point on the opposing tragus,
agar n (1889): a complex sulfated polymer of galactose units,
for the purpose of establishing the ala tragus plane. Ideally,
extracted from Gelidium cartilagineum, Gracilaria the ala-tragus plane is considered to be parallel to the occlusal
confervoides, and related red algae. It is a mucilaginous plane. The occlusal plane is at an angle of approximately 10
substance that melts at approximately 100°C and solidifies degrees relative to the Frankfort horizontal plane, when
into a gel at approximately 40°C. It is not digested by most viewed in the midsagittal plane—see CAMPER’S LINE
bacteria and is used as a gel in dental impression materials
and a solid culture media for microorganisms al.gi.nate n (ca. 1909): see IRREVERSIBLE HYDROCO-
LLOID
age atrophy: the normal diminution of all tissues due to
advanced age al.lo.dyn.ia n: pain resulting from a non-noxious stimulus
to normal skin or mucosa
agen.e.sis n (ca. 1879): absence, failure of formation, or
al.lo.ge.ne.ic adj (1963): in transplantation biology, denoting
imperfect development of any body part—see CONDYLAR
individuals (or tissues) that are of the same species however
AGENESIS
antigenically distinct—called also homologous
ag.na.thia n: a developmental anomaly characterized by
allogeneic graft: see HOMOGRAFT
absence of the mandible
al.lo.graft n (1964): a graft of tissue between genetically
ag.no.sia n (ca. 1900): diminution or loss of the ability to
dissimilar members of the same species—called also
recognize the import of sensory stimuli; the varieties
allogeneic graft and homograft
correspond with the senses and are distinguished as
auditory, gustatory, olfactory, tactile, and visual al.lo.plast n 1: an inert foreign body used for implantation
within tissue 2: a material originating from a nonliving
ag.o.nist n (ca. 1626) 1: In physiology, a muscle that is
source that surgically replaces missing tissue or augments
controlled by the action of an antagonist with which it is
that which remains
paired 2: in anatomy, a prime mover 3: in pharmacology, a
drug that has an affinity for and stimulates physiologic alloplastic graft: a graft using an inert material
activity in cell receptors normally stimulated by naturally alloplastic material: any nonbiologic material suitable for
occurring substances implantation as an alloplast
air abrasion: see AIRBORNE PARTICLE ABRASION al.loy n (14c): a mixture of two or more metals or metalloids
that are mutually soluble in the molten state; distinguished
air.bone gap: in audiology, the difference in patient acuity
as binary, ternary, quaternary, etc., depending on the number
to sound produced by air and through bone that reflects
of metals within the mixture. Alloying elements are added
hearing loss due to middle ear dysfunction or pathology
to alter the hardness, strength, and toughness of a metallic
airborne particle abrasion: the process of altering the surface element, thus obtaining properties not found in the pure
of a material through the use of abrasive particles propelled metal. Alloys may also be classified on the basis of their
by compressed air or other gases behavior when solidified—usage see BASE METAL, NOBLE
air chamber: see RELIEF AREA METAL
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alloying element (1998): metallic or nonmetallic elements amor.phous: without crystalline structure, having random
added to or retained by a pure metal for the purpose of giving arrangement of atoms in space
that metal special properties an.al.ge.sia n (ca. 1706): absence of sensibility to pain,
alpha particle n (1903): a positively charged nuclear particle designating particularly the relief of pain without loss of
identical with the nucleus of a helium atom that consists of consciousness
two protons and two neutrons and is ejected at high speed 1an.al.ge.sic adj: relieving pain
in certain radioactive transformations 2analgesicn: an agent that alleviates pain without causing
altered cast: a master cast that is revised in part before loss of consciousness—see A. BLOCKING AGENT, A.
processing a denture base—called also corrected cast, modified DIAGNOSTIC BLOCK
cast analgesic blocking agent: any analgesic that blocks or
altered cast partial denture impression: a negative likeness prohibits sensory perception
of a portion or portions of the edentulous denture bearing analgesic diagnostic block: the selective use of a local
area(s) made independent of and after the initial impression anesthetic injection or application of a topical anesthetic to
of the natural teeth. This technique utilizes an impression identify and localize pain
tray(s) attached to the removable partial denture framework
or its likeness an.a.log n (1826) 1: in dentistry, something that is analogous
in part or whole to something else; ie, a replica of a portion
aluminum oxide 1: a metallic oxide constituent of dental of an implant body made of brass, aluminum, steel, or plastic
porcelain that increases hardness and viscosity 2: a high 2: an organ similar in function to an organ of another animal
strength ceramic crystal dispersed throughout a glassy phase or plant but with different structure and origin—spelled also
to increase its strength as in aluminous dental porcelain used analogue
to fabricate aluminous porcelain jacket crowns 3: a finely
ground ceramic particle (frequently 50 μm) often used in an.am.ne.sis n, pl.ne.ses (ca. 1593) 1: a recalling to mind; a
conjunction with air-borne particle abrasion of metal castings reminiscence 2: the past history of disease or injury based
before the application of porcelain as with metal ceramic on the patient’s memory or recall at the time of interview
restorations and examination 3: a preliminary past medical history of a
medical or psychiatric patient
aluminous porcelain: a ceramic material composed of a glass
matrix phase with 35% or more of aluminum oxide, by anatomic crown: the portion of a natural tooth that extends
volume coronal from the cementoenamel junction—called also
anatomical crown
al.ve.o.lar adj (1799): that part of the jaws where the teeth
arise anatomic landmarks: a recognizable anatomic structure used
as a point of reference
alveolar augmentation: any surgical procedure used to alter
the contour of the residual alveolar ridge anatomic occlusion: an occlusal arrangement wherein the
posterior artificial teeth have masticatory surfaces that
alveolar bone: the bony portion of the mandible or maxillae closely resemble those of the natural healthy dentition and
in which the roots of the teeth are held by fibers of the articulate with similar natural or artificial surfaces—called
periodontal ligament—called also dental alveolus also anatomical occlusion
alveolar crest: see RESIDUAL RIDGE CREST anatomic teeth 1: artificial teeth that duplicate the anatomic
alveolar mucosa: the mucosal covering of the alveolar forms of natural teeth 2: teeth that have prominent cusps on
process, loosely attached to the bone the masticating surfaces and that are designed to articulate
alveolar process: the cancellus and compact bony structure with the teeth of the opposing natural or prosthetic dentition
that surrounds and supports the teeth 3: anatomic teeth have cuspal inclinations greater than 0
degrees and tend to replicate natural tooth anatomy—usage
alveolar reconstruction: any surgical procedure used to
cusp teeth (30 to 45 degrees) are considered anatomic teeth.
recreate a severely resorbed residual alveolar ridge
Modified occlusal forms are those with a 20-degree cusp
alveolar resorption: see RESIDUAL RIDGE RESORPTION incline or less—called also anatomical teeth
alveolar ridge: see RESIDUAL RIDGE Boucher CO. J Prosthet Dent 1953;3:633-56.
al.ve.o.lec.to.my n: see OSTEOTOMY anat.omy n, pl.mies (14c) 1: a branch of morphology that
al.ve.o.lo.plas.ty n: see OSTEOTOMY involves the structures of organs 2: the structural makeup
al.ve.o.lus n, pl.li (ca 1706): one of the cavities or sockets esp. of an organ or any of its parts 3: separating or dividing
within the alveolar process of the maxillae or mandible in into parts for examination—an.a.tom.ic or an.a.tom.i.cal adj
which the attachment complex held the root of a tooth after ANB angle: in cephalometric analysis, the angle formed
748 the tooth’s removal between the nasion point A line and the nasion point B line
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Glossary of Prosthodontic Terms
anchorage area: that area which, by its situation, major groups depending on the anteroposterior jaw
configuration and/or preparation, is suitable for the relationship. Class IV is no longer used. Class I (normal
retention of a prosthesis occlusion or neutroocclusion) the dental relationship in which
anchorage component: see ENDOSTEAL DENTAL there is normal anteroposterior relationship of the jaws, as
IMPLANT BODY indicated by correct interdigitation of maxillary and
mandibular molars, but with crowding and rotation of teeth
anchorage element: see ENDOSTEAL DENTAL IMPLANT elsewhere, i.e., a dental dysplasia or arch length deficiency.
ABUTMENT ELEMENT(S) Class II (distocclusion): the dental relationship in which the
Anderson splint (Roger Anderson, American orthopedic mandibular dental arch is posterior to the maxillary dental
surgeon, 1891-1971): eponym for a skeletal traction splint arch in one or both lateral segments; the mandibular first
with pins inserted into proximal and distal ends of a fracture. molar is distal to the maxillary first molar. Further
Reduction is obtained by an external plate attached to the subdivided into two divisions. Division 1: bilateral distal
pins—called also byphasic splint retrusion with a narrow maxillary arch and protruding
Anderson R. Ambulatory method of treating fractures of the shaft maxillary incisors. Subdivisions include right or left
of the femur. Surg Gynecol Obstet 1936;62:865. (unilaterally distal with other characteristics being the same).
Division 2: bilateral distal with a normal or square-shaped
Andrews bridge: the combination of a fixed partial denture
maxillary arch, retruded maxillary central incisors, labially
incorporating a bar with a removable partial denture that
malposed maxillary lateral incisors, and an excessive vertical
replaces teeth within the bar area, usually used for
overlap. Subdivisions include right or left (unilaterally distal
edentulous anterior spaces. The vertical walls of the bar may
with other characteristics being the same). Class III
provide retention for the removable component. First (mesioocclusion): the dental relationship in which the
attributed to James Andrews, DDS, Amite. LA mandibular arch is anterior to the maxillary arch in one or
Everhart RJ, Cavazos E Jr. Evaluation of a fixed removable partial both lateral segments; the mandibular first molar is mesial
denture. Andrews Bridge System. J Prosthet Dent 1983;50(2):180-4. to the maxillary first molar. The mandibular incisors are
an.es.the.sia n (ca. 1721): loss of feeling or sensation; also usually in anterior cross bite. Subdivisions include right or
spelled anaesthesia left (unilaterally mesial with other characteristics being the
same). Class IV: the dental relationship in which the occlusal
anesthesia dolorosa: pain within an area or region that is
relations of the dental arches present the peculiar condition
anesthetic or anesthetized
of being in distal occlusion in one lateral half and in mesial
1
an.es.thet.ic adj (1846) 1: capable of producing anesthesia occlusion in the other (no longer used)
2: lacking awareness or sensitivity Angle EM. Classification of malocclusion. Dental Cosmos
2anestheticn (1848) 1: a substance that produces anesthesia 1899;41:248-64,350-7.
2: something that brings relief Angular cheilitis: inflammation of the lip or lips with
angle of gingival convergence 1: according to Schneider, redness and the production of fissures radiating from the
the angle of gingival convergence is located apical to the angles of the mouth—called also perleche
height of contour on the abutment tooth. It can be identified angulated abutment (1998): any endosteal dental implant
by viewing the angle formed by the tooth surface gingival abutment which alters the long axis angulation between the
to the survey line and the analyzing rod or undercut gauge dental implant body and the dental implant abutment—syn
in a surveyor as it contacts the height of contour 2: the angle ANGLED ABUTMENT
formed by any surface of the tooth below the survey line of
an.ky.lo.glos.sia n: restricted movement of the tongue, often
the height of contour, with the selected path of insertion of a
due to the position of the lingual frenulum, resulting in
prosthesis 3: the angle formed by the tooth surface below
speech impediments; may be complete or partial—called also
the height of contour with the vertical plane, when the
adherent tongue, lingua frenata, and tongue-tie
occlusal surface of the tooth is oriented parallel to the
horizontal plane ankylosis n, pl .lo.ses (1713): immobility and consolidation
of a joint or tooth due to injury, disease, or a surgical
Schneider RL. J Prosthet Dent 1987;58:194-6.
procedure—see BONY A., EXTRACAPSULAR A., FIBROUS
angle of incidence: the angle formed between the axis of a A., INTRACAPSULAR A.; spelled also anchylosis
light beam and the perpendicular to the object’s surface
an.neal vt (1580) 1: to heat a material, such as metal or glass,
angle of reflection: the angle formed between the axis of a followed by controlled cooling to remove internal stresses
reflected light beam and the perpendicular to the object’s and create a desired degree of toughness, temper, or softness
surface to a material 2: to heat a material, such as gold foil, to
Angle’s classification of occlusion [Edward Hartley Angle, volatilize and drive off impurities from its surface, thus
American orthodontist, 1855-1930]: eponym for a increasing its cohesive properties. This process is termed
classification system of occlusion based on the interdigitation degassing 3: to homogenize an amalgam alloy by heating in
of the first molar teeth originally described by Angle as four an oven 749
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an.nu.lar n (1571): a term used to describe a ringlike anatomic ANTERIOR PROTECTED ARTICULATION, GROUP
structure FUNCTION, MUTUALLY PROTECTED ARTICULATION
an.odon.tia n: a rare dental condition characterized by anterior guide: see ANTERIOR GUIDE TABLE
congenital absence of all teeth (both deciduous and anterior guide pin: that component of an articulator,
permanent)—comp HYPODONTIA, OLIGODONTIA generally a rigid rod attached to one member, contacting
an.odon.tism n: see ANODONTIA the anterior guide table on the opposing member. It is used
anomalous trichromatic vision: a form of defective color for the purpose of maintaining the established vertical
vision in which three stimuli are required for color matching, separation. The anterior guide pin and table, together with
but the proportions in which they are matched differ the condylar elements, direct the movements of the
significantly from those required by the normal trichromat. articulators separate members
There are three forms of anomalous trichromatic vision: anterior guide table: that component of an articulator on
protanomalous, deuteranomalous and tritanomalous which the anterior guide pin rests to maintain the occlusal
anom.a.ly n, pl.lies (1664) 1: something different, abnormal, vertical dimension and influence articulator movements. The
peculiar, or not easily classified 2: an aberration or deviation guide table influences the degree of separation of the casts
from normal anatomic growth, development, or function 3: in all relationships—see also ANTERIOR PROGRAMMING
marked deviation from the normal standard, especially as a DEVICE
result of congenital defects anterior nasal spine: a sharp median bony process, adjacent
to the inferior margin of the anterior aperture of the nose,
ANS: acronym for Anterior Nasal Spine. The outline of the
formed by the forward prolongation of the two maxillae
anterior nasal spine as seen on the lateral cephalometric
radiograph. It is used as a cephalometric landmark anterior open bite (obs): see ANTERIOR OPEN OCCLUSAL
RELATIONSHIP
an.tag.o.nist n (1599) 1: a tooth in one jaw that articulates
with a tooth in the other jaw—called also dental antagonist anterior open occlusal relationship: the lack of anterior
2: a substance that tends to nullify the actions of another, as tooth contact in any occluding position of the posterior teeth
a drug that binds to cell receptors without eliciting a biologic anterior programming device: an individually fabricated
response 3: a muscle whose action is the direct opposite of anterior incisal guide table that allows mandibular motion
another muscle without the influence of tooth contacts and facilitates the
Ante’s Law [Irwin H: Ante, Toronto, Ontario, Canada, recording of maxillomandibular relationships; also used for
dentist]: eponym, in fixed partial prosthodontics for the deprogramming—see also DEPROGRAMMER
observation that the combined pericemental area of all anterior protected articulation: a form of mutually protected
abutment teeth supporting a fixed partial denture should articulation in which the vertical and horizontal overlap
be equal to or greater in pericemental area than the tooth or of the anterior teeth disengage the posterior teeth in
teeth to be replaced; as formulated for removable partial all mandibular excursive movements—see CANINE
prosthodontics, the combined pericemental area of the PROTECTED ARTICULATION.
abutment teeth plus the mucosa area of the denture base anterior reference point: any point located on the midface
should be equal to or greater than the pericemental area of that, together with two posterior reference points, establishes
the missing teeth a reference plane
Ante IH. The fundamental principles, design and construction of anterior teeth: the maxillary and mandibular incisors and
crown and bridge prosthesis. Dent Item Int 1928;50:215-32. canines
an.te.ri.or adj (1541) 1: in front of or the front part; situated anterior tooth arrangement: the positioning of the anterior
in front of 2: the forward or ventral position 3: a term used teeth for esthetics and phonetics
to denote the incisor or canine teeth or the forward region anterior tooth form: the outline form as viewed in any
of the mouth anterior determinant of occlusion—see selected plane and other contours of an anterior tooth
DETERMINANTS OF MANDIBULAR MOVEMENT
anteroposterior curve: the anatomic curve established by
anterior disk displacement: see DISK DISPLACEMENT the occlusal alignment of the teeth, as projected onto the
anterior guidance 1: the influence of the contacting surfaces median plane, beginning with the cusp tip of the mandibular
of anterior teeth on tooth limiting mandibular movements canine and following the buccal cusp tips of the premolar
2: the influence of the contacting surfaces of the guide pin and molar teeth, continuing through the anterior border of
and anterior guide table on articulator movements—usage the mandibular ramus, ending with the anterior most
see ANTERIOR GUIDE TABLE 3: the fabrication of a portion of the mandibular condyle. First described by
relationship of the anterior teeth preventing posterior tooth Ferdinand Graf Spee, German anatomist, in 1890—see
contact in all eccentric mandibular movements—see CURVE OF SPEE
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Glossary of Prosthodontic Terms
antiflux n: materials that prevent or confines solder position of the transverse horizontal axis is estimated on
attachment or flow the face before using this device—comp AVERAGE AXIS
an.ti.me.tab.o.lite n (1945): a substance that competes with, FACE-BOW
replaces, or antagonizes a particular metabolite arc of closure: the circular or elliptic arc created by closure
anti.Monson curve: see REVERSE CURVE of the mandible, most often viewed in the mid-sagittal plane,
using a reference point on the mandible (frequently either
an.ti.neo.plas.tic adj (1969) 1: inhibiting or preventing the
mandibular central incisors’ mesial incisal edge)
development of neoplasms; inhibiting the maturation and
proliferation of malignant cells 2: an agent having such arc therapy: in therapeutic radiology, external beam
properties radiation in which the source of radiation is moved about
the patient on an arc during treatment. Multiple arcs may
antineoplastic drug: an agent used in treatment or palliation
be used. In some cases the beam is stationary, and the patient
of the symptoms of cancer
is rotated in a vertical plane
anti.rotation (1998): a structural feature of some endosteal
arch bars: a system of rigid wires and/or other retainers
dental implant components that prevents relative rotation used for intermaxillary fixation in treatment of fractures of
of fastened parts. This feature may exist between a dental the maxillae and mandible and/or stabilization of injured
implant body and the dental implant abutment, and/or the teeth, generally attached to the remaining natural dentition
dental implant abutment and dental implant abutment and/or occlusal splints
element(s)
arch form: the geometric shape of the dental arch when
an.ti.tra.gus n, pl .gi; a projection of the cartilage of the viewed in the horizontal plane (square, tapering, ovoid, etc.)
auricle, in front of the cauda helicis, just above the lobule,
arch length discrepancy: the abnormal relationship between
and posterior to the tragus, from which it is separated by
the size of the mandible and/or maxilla and their component
the intertragal notch
teeth, especially as viewed and analyzed in the occlusal plane
ap.a.tite n (1803): calcium phosphate of the composition
arch-wire n: an orthodontic wire placed intraorally for the
Ca5(PO4)3OH; one of the mineral constituents of teeth and
application of force
bones (with Ca CO3)
ar.con n: a contraction of the words “ARTICULATOR” and
ap.er.ture n (15c): an opening or open space; a hole
“CONDYLE”, used to describe an articulator containing the
apex n, pl apex.es or api.ces (1601) 1: the uppermost point; condylar path elements within its upper member and the
the vertex 2: in dentistry, the anatomic end of a tooth root condylar elements within the lower member
apha.gia n: abstention from eating; inability to swallow arcon articulator: an articulator that applies the arcon design.
apha.sia n (1867): defect or loss of the power of expression This instrument maintains anatomic guidelines by the use
by writing, speech or signs, or of comprehending written or of condylar analogs in the mandibular element and fossae
spoken language due to disease of or injury to the brain assemblies within the maxillary element
apho.nia n (1778): loss or absence of voice as a result of the arrow point tracer 1: a mechanical device used to trace a
failure of the vocal cords to vibrate properly pattern of mandibular movement in a selected plane—
usually parallel to the occlusal plane 2: a mechanical device
api.cal adj (1828): of, relating to or pertaining to the top or
with a marking point attached to one jaw and a graph plate
apex—api.cal.ly adv
or tracing plane attached to the other jaw. It is used to record
apla.sia n: defective development or congenital absence of the direction and range of movements of the mandible—see
an organ or tissue GOTHIC ARCH TRACER
aplas.tic adj: devoid of form; without development arrow point tracing: see STYLUS TRACING
ap.pli.ance n (1561): see DEVICE, RESTORATION ar.thral.gia n (ca 1848): pain in a joint or joints
ap.po.si.tion n (15c): the condition of being placed or fitted ar.thri.tis n (14c): inflammation of a joint or joints
together; in juxtaposition or coadaptation
arthrodial joint: a joint that allows gliding motion of the
ap.prox.i.ma.tion n (15c) 1: the process of drawing together surfaces
2: the ability of being close or near—ap.prox.i.ma.tive adj
arthrodial movement: gliding joint movement
aprax.ia n (1888): the loss of ability to carry out familiar,
ar.throg.ra.phy n 1: roentgenography of a joint after injection
purposeful movements in the absence of paralysis or other
of an opaque contrast material 2: in dentistry, a diagnostic
sensory or motor impairment, especially the inability to
technique that entails filling the lower, upper, or both joint
make proper use of an object
spaces of the temporomandibular joint with a contrast agent
apron n: see LINGUAL PLATE to enable radiographic evaluation of the joint and
arbitrary face-bow: a device used to arbitrarily relate the surrounding structures; used to diagnose or confirm disk
maxillary cast to the condylar elements of an articulator. The displacements and perforations 751
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ar.throp.a.thy n (ca. 1860): a disease of a joint particular culture or stage in its technologic development 2:
ar.thro.plas.ty n: the surgical formation or reformation of a a product of an artificial character due to extraneous
joint agency—used in medicine to signify details or conditions
that are misleading or unnatural due to imperfect materials
ar.thro.sis n (1634) 1: a joint or articulation 2: a disease of a
or techniques
joint
artificial crown: a metal, plastic, or ceramic restoration that
ar.tic.u.lar adj (15c): of or relating to a joint
covers three or more axial surfaces and the occlusal surface
articular capsule: the fibrous ligament that encloses a joint or incisal edge of a tooth
and limits its motion. It is lined with the synovial membrane
artificial denture: see COMPLETE DENTURE
articular cartilage: a thin layer of hyaline cartilage located artificial stone: see DENTAL STONE
on the joint surfaces of some bones but not usually found
on the articular surfaces of the temporomandibular joints, asep.sis n (1892) 1: free from infection 2: the prevention of
which are covered with an avascular fibrous tissue contact with microorganisms
articular temporomandibular joint: see DISK asep.tic adj (ca. 1859): free of infection or septic material;
1ar.tic.u.late
sterile; free from pathogenic microorganisms—asep.ti.cal.ly
vb (1691) 1: to join together as a joint 2: the adv
relating of contacting surfaces of the teeth or their artificial
asym.met.ri.cal adj (1690): characterized by or pertaining
replicas in the maxillae to those in the mandible
to asymmetry
ar.tic.u.late adj (1586): in speech, to enunciate clearly or be
asym.me.try n (1690): absence or lack of symmetry or
clearly spoken
balance; dissimilarity in corresponding parts or organs on
articulating paper: ink-coated paper strips used to locate opposite sides of the body
and mark occlusal contacts
asymmetry of movement: the condition observed when
ar.tic.u.la.tion n (15c) 1: the place of union or junction mandibular movement has a lateral component on opening
between two or more bones of the skeleton—see and closing, especially when viewed in the frontal plane
CRANIOMANDIBULAR A., TEMPOROMANDIBULAR A.
asymmetry of the mandible: the condition that exists when
2: in speech, the enunciation of words and sentences—see the right and left sides of the mandible are not mirror images
SPEECH A. 3: in dentistry, the static and dynamic contact of one another
relationship between the occlusal surfaces of the teeth during
function—see ANTERIOR PROTECTED A., BALANCED A., atrophic fracture: spontaneous fracture due to atrophy
DENTAL A., FUNCTIONAL A., MONOPLANE A., at.ro.phy n, pl .phies (1601) 1: a wasting away 2: a
MUTUALLY PROTECTED A. diminution in size of a cell, tissue, organ or part—atro.phic
ar.tic.u.la.tor n: a mechanical instrument that represents the adj.atrophy vb—see ADIPOSE A., AGE A., BONE A.,
temporomandibular joints and jaws, to which maxillary and DISUSE A., MUSCULAR A., POSTMENOPAUSAL A.,
mandibular casts may be attached to simulate some or all SENILE A.
mandibular movements—usage articulators are divisible into attached gingiva: the portion of the gingiva that is firm,
four classes Class I articulator: a simple holding instrument dense, stippled, and tightly bound to the underlying
capable of accepting a single static registration. Vertical periosteum, bone, and tooth
motion is possible—see NONADJUSTABLE A. Class II attachment n (15c) 1: a mechanical device for the fixation,
articulator: an instrument that permits horizontal as well as retention, and stabilization of a prosthesis 2: a retainer
vertical motion but does not orient the motion to the consisting of a metal, receptable and a closely fitting part;
temporomandibular joints. Class III articulator: an the former, the female (matrix) component, is usually
instrument that simulates condylar pathways by using contained within the normal or expanded contours of the
averages or mechanical equivalents for all or part of the crown of the abutment tooth and the latter, the male (patrix)
motion. These instruments allow for orientation of the casts component, is attached to a pontic or the denture
relative to the joints and may be arcon or nonarcon framework—see FRICTIONAL A., INTERNAL A., KEY and
instruments—see SEMI-ADJUSTABLE A. Class IV KEYWAY A., PARALLEL A., PRECISION A., RESILIENT A.,
articulator: an instrument that will accept three dimensional SLOTTED A.
dynamic registrations. These instruments allow for attachment apparatus: in periodontics, a general term used
orientation of the casts to the temporomandibular joints to designate the cementum, periodontal ligament and
and simulation of mandibular movements—see alveolar bone
FULLY ADJUSTABLE A., FULLY ADJUSTABLE attachment screw (1998): see ENDOSTEAL DENTAL
GNATHOLOGIC A. IMPLANT ABUTMENT ELEMENT(S)
ar.ti.fact n (1821) 1: any characteristic product of human attenuation of radiation: the reduction of intensity of
752 activity, i.e., any hand-made object that could represent a radiation as a result of scattering and absorption of radiation.
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Glossary of Prosthodontic Terms
Attenuation of electron beams always lowers the average au.tog.e.nous adj (1846): originating or derived from sources
beam energy within the same individual, self-produced; self-generated;
at.tri.tion n (14c) 1: the act of wearing or grinding down by autologous
friction 2: the mechanical wear resulting from mastication autogenous graft: a graft taken from the patients own
or parafunction, limited to contacting surfaces of the teeth— body—called also autograft
comp ABRASION, EROSION au.to.graft n (ca. 1913): a graft of tissue derived from another
atypical facial pain: a painful syndrome characterized by site in or on the body of the organism receiving it—called
dull aching or throbbing, rather than paroxysms of pain, also autochthonous graft, autologous graft and autoplast
such as seen in trigeminal, glossopharyngeal, or au.tol.o.gous adj (ca. 1921) 1: related to self; designating
postherapeutic neuralgia, occurring in areas supplied by products or components of the same individual organism 2:
various nerve groups, including the fifth and ninth cranial autogenous
nerves and the second and third cervical nerves. The
autonomic nervous system: the part of the nervous system
distribution of atypical facial pain does not follow the
that nervates the cardiovascular, digestive, reproductive, and
established pathways of innervation of the major sensory
respiratory organs. It operates outside of consciousness and
nerves, however (i.e., trigeminal neuralgia). Attacks last from
controls basic life-sustaining functions such as heart rate,
a few days to several months and seem to occur after dental
digestion, and breathing. It includes the sympathetic nervous
work or sinus manipulation, but examination of the teeth,
system and the parasympathetic nervous system.
nose, sinuses, ears, and temporomandibular joints seldom
reveals any abnormalities. A psychogenic etiology has been au.to.pol.y.mer n: a material that polymerizes by chemical
suggested. This is believed by some to not be a specific reaction without external heat, as a result of the addition of
disease entity but rather a symptom, the etiology of which an activator and a catalyst—au.to.pol.y.mer.i.za.tion vb
has not been determined—called also atypical facial neuralgia autopolymerizing resin: a resin whose polymerization is
and facial causalgia initiated by a chemical activator
au.dio.gram n (1927): a record of the thresholds of hearing average axis face.bow: a face-bow that relates the maxillary
of an individual over various sound frequencies teeth to the average location of the transverse horizontal axis
au.di.ol.o.gy n (1946): the study of the entire field of hearing, average value articulator: an articulator that is fabricated
including the anatomy and function of the ear, impairment to permit motion based on mean mandibular movements—
of hearing, and the education or reeducation of the person called also Class III articulator
with hearing loss avul.sion n (1622): forcible separation or detachment, as in
au.di.om.e.ter n (1879): an instrument used to assess hearing a tearing away of a body part surgically or accidentally
at various intensity levels and frequencies avulsion fracture: a tearing away of a part of a bone, usually
au.di.tion n (1599): the power or sense of hearing adjacent to a tendon or ligament
auditory discrimination: ability to discriminate between axial inclination 1: the relationship of the long axis of a body
sounds of different frequency, intensity, and pressure pattern to a designated plane 2: in dentistry, the alignment of the
components; ability to distinguish one speech sound from long axis of a tooth to a horizontal plane
another
axial loading: the force directed down the long axis of a
aug.ment vb (15c): to make greater, more numerous, larger, body. Editorial note—Usually used to describe the force of occlusal
or more intense contact upon a natural tooth, dental implant or other object, “axial
aug.men.ta.tion n (14c): to increase in size beyond the loading” is best described as “the force down the long axis of the
existing size. In alveolar ridge augmentation, bone grafts or tooth” or whatever body is being described. Loading “the axis” is
alloplastic grafts are used to increase the size of an atrophic an error in syntax
alveolar ridge ax.is n, pl ax.es (14c): a line around which a body may rotate
auricular defect: absence or partial absence of the external or about which a structure would turn if it could revolve—
ear see CONDYLAR A., SAGITTAL A., TRANSVERSE
auricular prosthesis: a removable prosthesis that artificially HORIZONTAL A., VERTICAL A.
restores part or the entire natural ear—called also artificial axis of preparation: the planned line or path of placement
ear, ear prosthesis and removal for a dental restoration
auriculotemporal syndrome: sweating and flushing in the axis orbital plane: the horizontal plane established by the
preauricular and temporal areas when certain foods are eaten transverse horizontal axis of the mandible with a point on
aus.cul.ta.tion n (ca. 1828): the process of determining the the inferior border of the right or left bony orbit (orbitale).
condition of various parts of the body by listening to the This plane can be used as a horizontal reference point
sounds they emit ax.le n (14c): a rigid shaft or rod that directs rotary motion 753
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1base vt (1587): the act of placing a lining material under a
B
dental restoration
back pressure porosity: porosity produced in dental castings 2base n (14c): any substance placed under a restoration that
thought to be due to the inability of gases in the mold to blocks out undercuts in the preparation, acts as a thermal or
escape during the casting procedure chemical barrier to the pulp, and/or controls the thickness
back.ing n (1793): a metal support that attaches a facing to a of the overlying restoration—called also base material—usage
prosthesis adjectives such as insulating b., therapeutic b. may also be
used
back.scat.ter or back.scat.ter.ing n (1940): see SCATTERED
3base n (19c): the portion of a denture that supports the
RADIATION
balanced articulation: the bilateral, simultaneous, anterior, artificial dentition and replaces the alveolar structures and
and posterior occlusal contact of teeth in centric and eccentric gingival tissues—see DENTURE B.
positions—see CROSS ARCH B.A., CROSS TOOTH B.A. base material obs: any substance of which a denture base
balanced bite: see BALANCED ARTICULATION may be made, such as acrylic resin, vulcanite, polystyrene,
or metal (GPT-4)
balanced occlusal contact: see NONWORKING SIDE
OCCLUSAL CONTACTS base metal: any metallic element that does not resist tarnish
and corrosion—see NOBLE METAL
balanced occlusion: see BALANCED ARTICULATION
base metal alloy: an alloy composed of metals that are not
balancing condyle: see NONWORKING SIDE CONDYLE
noble
balancing contact: see BALANCING OCCLUSAL
CONTACT baseplate n: see RECORD BASE
balancing interference: undesirable contact(s) of opposing baseplate wax: a hard pink wax used for making occlusion
occusal surfaces, on the nonworking side rims, waxing dentures, and other dental procedures
balancing occlusal contact: see NONWORKING SIDE basket endosteal dental implant: a perforated, cylindric,
OCCLUSAL CONTACTS endosteal dental implant, the implant body of which is
designed in the form of single, double, and/or triple
balancing occlusal surfaces obs: the occluding surfaces of
contiguous cylinder(s)
dentures on the balancing side (anteroposteriorly or laterally)
that are developed for the purpose of stabilizing dentures beading: creating an irregular surface by means of stipples,
(GPT-4) dots, speckles, or the like
balancing side obs: see NONWORKING SIDE beam n, obs: a term once used instead of bar with specific
reference to the bar connector—usage included cantilever
bar n (12c): a straight piece of metal or wood that is longer
than it is wide. It may have several uses including a lever, beam, continuous beam, simple beam (GPT-4)
barrier, fastener, handle, or support. In prosthodontics, it bees’ wax n (1676): a low-melting wax obtained from
serves to connect two or more parts of a removable partial honeycomb and used as an ingredient of many dental
denture or fixed partial denture—usage see B. CONNECTOR impression waxes
bar clasp: a clasp retainer whose body extends from a major Beilby layer [Sir George Thomas Beilby, British chemist,
connector or denture base, passing adjacent to the soft tissues 1850-1924]: eponym for the molecular disorganized surface
and approaching the tooth from a gingivo-occlusal direction layer of a highly polished metal. A relatively scratch-free
bar clasp arm: see BAR CLASP microcrystalline surface produced by a series of abrasives
of decreasing coarseness. Beilby GT. Aggregation and flow
bar connector: a metal component of greater length than
of solids, 1921.
width that serves to connect the parts of a removable partial
denture—usage see LABIAL B.C., LINGUAL B.C., PALATAL bench set: a stage of resin processing that allows a chemical
B.C. reaction to occur under the conditions present in the ambient
environment; also used to describe the continuing
bar retainer obs: a metal bar usually resting on lingual
surfaces of teeth to aid in their stabilization and to act as polymerization of impression materials beyond the
indirect retainers (GPT-4)—see BAR CONNECTOR manufacture’s stated set time
Bennett angle obs: the angle formed between the sagittal
basal adj (1828): pertaining to or situated near the base
plane and the average path of the advancing condyle as
basal bone: the osseous tissue of the mandible and maxillae viewed in the horizontal plane during lateral mandibular
exclusive of the alveolar processes movements (GPT-4)
basal seat: see DENTURE FOUNDATION AREA Bennett’s movement [Sir Norman Godfrey Bennett, British
754 basal surface: see DENTURE BASE dental surgeon, 1870-1947]: see LATEROTRUSION
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Glossary of Prosthodontic Terms
Bennett NG. A contribution to the study of the movements Gargiulo AW et al. J Periodontology 1961;32:261-7.
of the mandible. Proc Roy Soc Med (Lond) 1908;1:79-98 Cohen DW. Lecture at Walter Reed Army Medical Center, June 3,
(Odont Section) 1962.
Bennett’s side shift (Sir Norman Godfrey Bennett, British bio.ma.te.ri.al n (1966): any substance other than a drug that
dental surgeon, 1870-1947]: see MANDIBULAR LATERAL can be used for any period of time as part of a system that
TRANSLATION treats, augments, or replaces any tissue, organ, or function
Bennett NG: A contribution to the study of the movements of the body
of the mandible. Proc Roy Soc Med (Lond) 1908;1:79-98 bio.me.chan.ics n, pl but sing or pl in constr (1933) 1: the
(Odont Section) application of mechanical laws to living structures,
1bevel n (1611): a slanting edge specifically the locomotor systems of the body 2: the study
2bevel vt: the process of slanting the finish line and curve of of biology from the functional viewpoint 3: an application
a tooth preparation of the principles of engineering design as implemented in
living organisms—see also DENTAL B
Bezold.Brucke effect [Helmholtz, 1867]: the apparent
change in hue that accompanies a change in luminance bi.om.e.try n (1831): the science of the application of
statistical methods to biologic facts, as the mathematical
BID: acronym for L Bis in Di’e, twice a day
analysis of biologic data
bifid condyle: a condyle anomaly where an exaggerated
bi.op.sy n, pl .sies (1895): the removal of tissue for histologic
central depression exists
examination and diagnosis
bi.fur.ca.tion n (1615) 1: division into two branches 2: the bio.sta.tis.tics n, pl but sing in constr (1950): the science of
site where a single structure divides into two parts, as in the application of statistical methods to biologic facts, as the
two roots of a tooth mathematical analysis of biologic data—see BIOMETRY
bilaminar zone: see RETRODISCAL TISSUE biphasic pin fixation: the use of extraoral pin fixation in
bi.lat.er.al adj (1775): having or pertaining to two sides the treatment of bone fractures
bilateral distal extension removable partial denture: a biscuit bite slang: see MAXILLOMANDIBULAR
removable partial denture replacing the distal most tooth or RELATIONSHIP RECORD
teeth on each side of one arch of the mouth—see KENNEDY bisque bake: a series of stages of maturation in the firing of
CLASSIFICATION OF REMOVABLE PARTIAL DENTURES ceramic materials relating to the degree of pyrochemical
bimaxillary protrusion: a dental or skeletal protrusion of reaction and sintering shrinkage occurring before
both the maxillary and mandibular jaws and/or teeth vitrification (glazing)—called also biscuit bake
simultaneously bite vb, obs: the act of incising or crushing between the
bi.meter n (20c): a gnathodynamometer equipped with a teeth—see OCCLUSION RECORD
central bearing plate of adjustable height—see bite analysis: see OCCLUSAL ANALYSIS
GNATHODYNAMOMETER
bite block: see OCCLUSION RIM, RECORD RIM
bio.ac.cept.abil.i.ty (1998): the quality of compatibility in a
bite closing: see DECREASED OCCLUSAL VERTICAL
living environment despite adverse or unwanted side effects
DIMENSION
bio.com.pat.i.ble adj: capable of existing in harmony with
bite guard: see OCCLUSAL DEVICE
the surrounding biologic environment
bite opening: see OCCLUSAL VERTICAL DIMENSION
bio.feed.back n (1971) 1: the process of furnishing an
individual information, usually in an auditory or visual bite plane: see OCCLUSAL PLANE
mode, on the state of one or more physiologic variables such bite plate: see OCCLUSION RIM, RECORD RIM
as blood pressure, skin temperature, or heart rate; this bite raising: see OCCLUSAL VERTICAL DIMENSION
procedure often enables an individual to gain some
bite rim: see OCCLUSION RIM, RECORD RIM
voluntary control over the variable being sampled 2: the
instrumental process or technique of learning voluntary biting force: see OCCLUSAL FORCE
control over automatically regulated body functions biting pressure: see OCCLUSAL FORCE
biofunctional orthopedics: see FUNCTIONAL JAW biting strength: see OCCLUSAL FORCE
ORTHOPEDICS blade endosteal dental implant: a faciolingual narrowed,
bio.in.te.gra.tion n (1998): the benign acceptance of a foreign wedge-shaped dental implant body with openings or vents
substance by living tissue—see OSSEOUS INTEGRATION through which tissue may grow
biologic width (1998): the combined width of connective blade implant: see BLADE ENDOSTEAL DENTAL
tissue and epithelial attachment superior to the crestal bone IMPLANT 755
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blockout adj 1: elimination of undesirable undercuts on a bone curettage: the surgical shaving or smoothing of the
cast, 2: the process of applying wax or another similar bones external surface
temporary substance to undercut portions of a cast so as to bone expansion: manipulation of a bony ridge by placement
leave only those undercuts essential to the planned of an osteotome to split the cortical ridge and hence enhance
construction of a prosthesis. A blocked out cast may also bone width
include other surface modifications needed relative to the
bone factor: relative response of alveolar bone to stimulation
construction of the prosthesis
or irritation. The ratio of osteogenesis to osteolysis
bo.lus n (1562): a rounded mass, as a large pill or soft mass
bone marrow: the soft vascular tissue that fills bone cavities
of chewed food
and cancellus bone spaces which consists primarily of fat
blowout fracture: a fracture of the orbital floor caused by a cells, hematopoietic cells, and osteogenetic reticular cells
sudden increase in intraorbital pressure due to traumatic
Bonwill triangle [William Gibson Arlington Bonwill,
force
American dentist, 1833-1899]: eponym for a 4-inch equilateral
board-certified prosthodontist: in the United States, as triangle bounded by lines connecting the contact points of
defined by the American Board of Prosthodontics, a the mandibular central incisor’s incisal edge (or the midline
prosthodontist who has passed the certifying examination of the mandibular residual ridge) to each condyle (usually
administered by the American Board of Prosthodontics its mid point) and from one condyle to the other, first
board-eligible prosthodontist: in the United States, as described in 1858 while introducing his Anatomical
defined by the American Board of Prosthodontics, a Articulator
prosthodontist whose application for examination for
Bonwill WGA. Scientific articulation of the human teeth as founded
certification is current and has been accepted for examination
on geometrical, mathematical and mechanical laws. Dental Items
by the American Board of prosthodontics
Int 1899;21:617-56, 873-80.
boil out: see WAX ELIMINATION
bony ankylosis: the union of bones of a joint by proliferation
bond n (12c) 1: the linkage between two atoms or radicals of of osteoblasts, resulting in complete immobility
a chemical compound 2: the force that holds two or more
bor.der n (14c): the circumferential margin, edge or surface,
units of matter together—see SECONDARY BONDS,
a bounding line, edge, or surface—see DENTURE BORDER
VANDERWALL’S BOND
border molding 1: the shaping of the border areas of an
bond strength: the force required to break a bonded
assembly with failure occurring in or near the adhesive/ impression tray by functional or manual manipulation of
adherens interface the tissue adjacent to the borders to duplicate the contour
and size of the vestibule 2: determining the extension of a
bonded bridge: see RESIN-BONDED PROSTHESIS prosthesis by using tissue function or manual manipulation
bond.ing n (1976) 1: joining together securely with an of the tissues to shape the border areas of an impression
adhesive substance such as cement or glue 2: the procedure material
of using an adhesive, cementing material or fusible
border movement: mandibular movement at the limits
ingredient to combine, unite, or strengthen
dictated by anatomic structures, as viewed in a given plane
bonding agent: a material used to promote adhesion or
border position: see POSTERIOR B.P.
cohesion between two different substances, or between a
material and natural tooth structures border seal: the contact of the denture border with the
underlying or adjacent tissues to prevent the passage of air
bone n (bef. 12c): the hard portion of the connective tissue
or other substances
which constitutes the majority of the skeleton; it consists of
an inorganic or mineral component and an organic border tissue movements: the action of the muscles and
component (the matrix and cells); the matrix is composed of other tissues adjacent to the borders of a denture
collagenous fibers and is impregnated with minerals, chiefly boxing an impression: the enclosure of an impression to
calcium phosphate (approx. 85%) and calcium carbonate produce the desired size and form of the base of the cast
(approx. 10%), thus imparting the quality of rigidity to and to preserve desired details
bone—called also osseous tissue—see ALVEOLAR B.
boxing wax: wax used for boxing an impression
BASAL B. CANCELLOUS B. COMPACT B., CORTICAL B.
brac.ing adj: the resistance to horizontal components of
bone atrophy: bone resorption noted internally by a decrease masticatory force
in density and externally by an alteration in form
brack.et n: an orthodontic device attached to an individual
bone augmentation: see AUGMENTATION tooth to hold arch wires
bone conduction: the conduction of sound to the inner ear brazing investment: an investment having a binding system
through the bones of the skull—called also cranial conduction, consisting of acidic phosphate such as monoammonium
756 osteotympanic conduction, and tissue conduction phosphate and a basic oxide such as magnesium oxide
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Glossary of Prosthodontic Terms
brazing material: an alloy suitable for use as a filler material bur.nish vt (14c): to make shiny or lustrous by rubbing; also
in operations with which dental alloy(s) are joined to form to facilitate marginal adaptation of restorations by rubbing
a dental restoration the margin with an instrument
braze vt (1677): to join with a nonferrous alloy that melts at bur.nish.i.bil.i.ty n: the ease with which a material can be
a lower temperature than that of the metals being joined burnished
breakdown potential: the last noble potentia where pitting burn out adj: see WAX ELIMINATION
and/or crevice corrosion will initiate and propagate butt v (14C): to bring any two flat-ended surfaces into contact
bridge n, slang: see FIXED PARTIAL DENTURE without overlapping, as in a butt joint
bridge work slang: see FIXED PARTIAL DENTURE butt margin: see SHOULDER FINISH LINE
brittle 1: easily broken or shattered; fragile on crisp 2: prone button implant: see MUCOSAL IMPLANT
to fracture or failure; the fracture that occurs when the
proportional limit of a material is exceeded C
brux.ism n (ca. 1940) 1: the parafunctional grinding of teeth
2: an oral habit consisting of involuntary rhythmic or Ca: acronym for Carcinoma or Cancer
spasmodic nonfunctional gnashing, grinding, or clenching CAD-CAM: acronym for Computer Aided Design-Computer
of teeth, in other than chewing movements of the mandible, Aided Manufacturer (or Computer Assisted Machining)
which may lead to occlusal trauma—called also tooth
calcium hydroxide: an odorless white powder that is very
granding, occlusal neurosis
slightly soluble in water and insoluble in alcohol. Aqueous
bruxo.ma.nia vb, obs: the grinding of teeth occurring as a
and nonaqueous suspensions of calcium hydroxide are often
neurotic habit during the waking state (GPT-4)
used as cavity liners to protect the pulp from the irritant
buc.cal adj (ca. 1771): pertaining to or adjacent to the cheek action of restorative materials; also used in pulp capping,
buccal flange: the portion of the flange of a denture that pulpotomy and apexification procedures
occupies the buccal vestibule of the mouth calcium sulfate: a product obtained by calcination of gypsum
buccal vestibule: the portion of the oral cavity that is under steam pressure. The alpha form is composed of
bounded on one side by the teeth, gingiva, and alveolar ridge regularly shaped grains, with low porosity, and requiring
(in the edentulous mouth, the residual ridge) and on the little water for a satisfactory mix. Forms include alpha, alpha-
lateral side by the cheek posterior to the buccal frenula modified and beta.
buccolingual relationship: any position of reference relative calcium sulfate plaster: compounds occurring in anhydrous
to the tongue and cheeks form as anhydrite, and in the natural form as gypsum or
buc.co.ver.sion n: a deviation toward the cheek gypsum dihydrate. The term “plaster” also applies to a
mixture consisting of water and calcium sulfate hemihydrate
bulb n, slang: see OBTURATOR, SPEECH AND
(CaSO4½ H2O)
PROSTHESIS
BULL: acronym for Buccal of the Upper, Lingual of the Lower cameo surface: the viewable portion of a denture; the portion
(cusps); applies to Clyde H. Schuyler’s rules for occlusal of the surface of a denture that extends in an occlusal
adjustment of a normally related dentition in which those direction from the border of the denture and includes the
cusps contacting in maximum intercuspation (mandibular facial, lingual, and palatal surface. It is the part of the denture
buccal and maxillary lingual) are favored by adjustment of base that is usually polished and includes the buccal and
those cusps which are not in occlusal contact in maximum lingual surfaces of the teeth
intercuspation (maxillary buccal and mandibular lingual)— Camper’s line: see ALA-TRAGUS LINE
called also the BULL RULE
Camper’s plane 1: a plane established by the inferior border
bur n (14c): a steel or tungsten carbide rotary cutting
of the right or left ala of the nose and the superior border of
instrument
the tragus of both ears 2: a plane passing from the avanthion
bur head: the cutting portion of a dental bur to the center of the bony external auditory meatus; called
bur head length: the axial dimension of the bur head also acanthion-external auditory meatus plane—see also ALA-
bur head shape: the geometrical outline form of the cutting TRAGUS LINE
surface edges, usually described successively by proximity can.cel.lous bone (1836): the reticular, spongy or lattice-like-
from the shank to the tip end portion of the bone; the spongy bone tissue located in the
bur shank: that component of a dental bur which fits into medulla of the bone; this bone is composed of a variable
the hand piece; the shaft section of the dental but that may trabecular network containing interstitial tissue that may
be friction gripping or latch-type in form be hematopoietic 757
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can.dle n (12c): a unit of luminous intensity, equal to 1/60 of case n, substand (13c): a dental patient
the luminous intensity of a square centimeter of a black body 1cast vb (13c): to produce a shape by thrusting a molten liquid
heated to the temperature of the solidification of platinum or plastic material into a mold possessing the desired shape
(1773°C) 2cast
n (14c): a life-size likeness of some desired form. It is
candle power: luminous intensity expressed in candles formed within or is a material poured into a matrix or
canine eminence: the labial prominence on the maxillary impression of the desired form—comp MODEL—see
alveolar process corresponding to the position of the root of DENTAL C, DIAGNOSTIC C, FINAL C, PRELIMINARY C,
the canine tooth REFRACTORY C, REMOUNT C
canine guidance: see CANINE PROTECTED ARTICU- cast relator: a mechanical device that orients opposing casts
LATION to each other without reference to anatomic landmarks—
canine protected articulation: a form of mutually protected see ARTICULATOR
articulation in which the vertical and horizontal overlap of castable n (1998): any refractory material that has a bonding
the canine teeth disengage the posterior teeth in the excursive agent added and can be mixed with water or other liquid
movements of the mandible—comp ANTERIOR agents and poured in a mold to set
PROTECTED ARTICULATION castable ceramic: for dental applications, a glass-ceramic
canine protection: see CANINE PROTECTED material that combines the properties of a restorative material
ARTICULATION for function with the capability to be cast using the lost wax
can.ti.lever n (1667): a projecting beam or member supported process
on one end 1cast.ing n (14c): something that has been cast in a mold; an
cantilever bridge slang: see CANTILEVER FIXED PARTIAL object formed by the solidification of a fluid that has been
DENTURE poured or injected into a mold
2cast.ing
vt: the act of forming an object in a mold—see
cantilever fixed partial denture: a fixed partial denture in
which the pontic is cantilevered, i.e., is retained and VACUUM C.
supported only on one end by one or more abutments casting flask: a metal tube in which a refractory mold is
cap splint: a plastic or metallic device used in the treatment made for casting dental restorations
of maxillary or mandibular fractures and designed to cover casting ring: the inferior portion of a refractory flask that
the crowns of the teeth and usually luted to them provides a negative likeness or dimple into which a metal is
capillary attraction: that quality or state which, because of cast in the refractory investment
surface tension, causes elevation or depression of the surface casting wax: a composition containing various waxes with
of a liquid that is in contact with the solid walls of a vessel desired properties for making wax patterns to be formed
cap.su.lar adj (ca. 1730): pertaining to a capsule into metal castings
capsular contracture: see CAPSULAR FIBROSIS cat.a.lyst n (1902): a substance that accelerates a chemical
capsular fibrosis: fibrotic contracture of the capsular reaction without affecting the properties of the materials
ligament of the temporomandibular joint involved
capsular ligament: within the temporomandibular joint, a cath.ode n (1834): the negative pole in electrolysis
ligament that separately encapsulates the superior and CAT: acronym for Computerized Axial Tomography
inferior synovial cavities of the temporomandibular cau.tery n, pl-ter.es (15c): the application of a caustic
articulation substance, hot instrument, electric current, or other agent
cap.sule n (1693): a fibrous sac or ligament that encloses a used to burn, scar, or destroy tissue
joint and limits its motion. It is lined with synovial membrane cavity varnish: a combination of copal resin or other
capsulitis n: the inflammation of a capsule, as that of the synthetic resins dissolved in an organic solvent such as
joint, lens, liver, or labyrinth chloroform or ether
car.at n (15c): a standard of gold fineness. The percentage of CD: acronym for Complete Denture
gold in an alloy, stated in parts per 24. Pure gold is designated CDA: acronym for Certified Dental Assistant
24 carat CDL: acronym for Certified Dental Laboratory
car.ti.lage n (15c): a derivative of connective tissue arising
CDT: acronym for Certified Dental Technician
from the mesenchyme. Typical hyaline cartilage is a flexible,
rather elastic material with a semitransparent glass-like cel.lu.li.tis n (1861): diffuse and especially subcutaneous
appearance. Its ground substance is a complex protein inflammation of connective tissue
through which there is distributed a large network of 1ce.ment n (14c) 1: a binding element or agency used as a
758 connective tissue fibers substance to make objects adhere to each other, or something
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Glossary of Prosthodontic Terms
serving to firmly unite 2: a material that, on hardening, will centric jaw relation: see CENTRIC RELATION
fill a space or bind adjacent objects—syn luting agent centric occlusion: the occlusion of opposing teeth when the
2
ce.ment vt (15c): to unite or make firm by or as if by cement; mandible is in centric relation. This may or may not coincide
to lute with the maximal intercuspal position—comp MAXIMAL
ce.men.ta.tion obs 1: the process of attaching parts by means INTERCUSPAL POSITION
of a cement 2: attaching a restoration to natural teeth by centric position obs: the position of the mandible when the
means of a cement (GPT-4) jaws are in centric relation (GPT-1)
cemented pin: a metal rod luted into a hole drilled in dentin centric range: see INTERCUSPAL CONTACT AREA
to enhance retention centric record: see CENTRIC RELATION RECORD
cemento-dentinal junction: the area of union of the dentin centric relation 1: the maxillomandibular relationship in
and cementum which the condyles articulate with the thinnest avascular
cemento-enamel junction: that area where the enamel and portion of their respective disks with the complex in the
cementum meet at the cervical region of a tooth anterior-superior position against the shapes of the articular
ce.me.ntoid n: the uncalcified surface layer of cementum eminencies. This position is independent of tooth contact.
including incorporated connective tissue fibers This position is clinically discernible when the mandible is
directed superior and anteriorly. It is restricted to a purely
ce.men.tum n (1842): the thin calcified tissue of
rotary movement about the transverse horizontal axis (GPT-
ectomesenchyme origin that covers the root of a tooth
5) 2: the most retruded physiologic relation of the mandible to
cementum fracture: the tearing of fragments of the the maxillae to and from which the individual can make
cementum from the tooth root lateral movements. It is a condition that can exist at various
center of the ridge: the faciolingual or buccolingual midline degrees of jaw separation. It occurs around the terminal
of the residual ridge hinge axis (GPT-3) 3: the most retruded relation of the mandible
center of rotation: see ROTATION CENTER to the maxillae when the condyles are in the most posterior
unstrained position in the glenoid fossae from which lateral
central bearing obs: application of forces between the movement can be made, at any given degree of jaw
maxilla and mandible at a single point that is located as near separation (GPT-1) 4: the most posterior relation of the lower
as possible to the center of the supporting areas of the to the upper jaw from which lateral movements can be made
maxillary and mandibular jaws. It is used for the purpose at a given vertical dimension (Boucher) 5: a maxilla to
of distributing closing forces evenly throughout the areas of mandible relationship in which the condyles and disks are
the supporting structures during the registration and thought to be in the midmost uppermost position. The position
recording of maxillomandibular relations and during the has been difficult to define anatomically but is determined
correction of occlusal errors (GPT-4) clinically by assessing when the jaw can hinge on a fixed
central bearing point obs: the contact point of a central terminal axis (up to 25 mm). It is a clinically determined
bearing device (GPT-4) relationship of the mandible to the maxilla when the condyle
central bearing tracing: the pattern obtained on the disk assemblies are positioned in their most superior position
horizontal plate used with a central bearing tracing device in the mandibular fossae and against the distal slope of the
articular eminence (Ash) 6: the relation of the mandible to
central bearing tracing device: a device that provides a
the maxillae when the condyles are in the uppermost and
central point of bearing or support between the maxillary
rearmost position in the glenoid fossae. This position may
and mandibular dental arches. It consists of a contacting
not be able to be recorded in the presence of dysfunction of
point that is attached to one dental arch and a plate attached
the masticatory system 7: a clinically determined position
to the opposing dental arch. The plate provides the surface
of the mandible placing both condyles into their anterior
on which the bearing point rests or moves and on which the
uppermost position. This can be determined in patients
tracing of the mandibular movement is recorded. It may be
without pain or derangement in the TMJ (Ramsfjord)
used to distribute occlusal forces evenly during the recording
Boucher CO. Occlusion in prosthodontics. J Prosthet Dent
of maxillomandibular relationships and/or for the correction
1953;3:633-56.
of disharmonious occlusal contacts. First attributed to Alfred
Ash MM. Personal communication, July 1993.
Gysi, Swiss prosthodontist, in 1910
Lang BR, Kelsey CC. International prosthodontic workshop on
cen.tric adj (1590) 1: located in or at a center; central 2: complete denture occlusion. Ann Arbor: The University of Michigan
concentrated about or directed toward a center School of Dentistry; 1973.
centric check bite: see CENTRIC RELATION RECORD Ramsfjord SP. Personal communication, July 1993.
centric interocclusal record: see CENTRIC RELATION centric relation interocclusal record: see CENTRIC
RECORD RELATION RECORD
centric jaw record: see CENTRIC RELATION RECORD centric relation occlusion: see CENTRIC OCCLUSION 759
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Textbook of Prosthodontics
centric relation position: see CENTRIC RELATION cermet (1998): fused glass powder with silver particles
centric relation record: a registration of the relationship of through high temperature sintering of a mixture of the two
the maxilla to the mandible when the mandible is in centric particles
relation. The registration may be obtained either intraorally cervical adj (1681) 1: in anatomy, pertaining to the cervix or
or extraorally neck 2: in dentistry, pertaining to the region at or near the
centric slide obs: the movement of the mandible while in cementoenamel junction
centric relation, from the initial occlusal contact into cer.vix n, pl cer.vi.ces (15c) 1: the neck 2: a constricted portion
maximum intercuspation (GPT-4) of a part or organ
1cham.fer n 1: a finish line design for tooth preparation in
centric stop: opposing cuspal/fossae contacts that maintain
the occlusal vertical dimension between the opposing arches which the gingival aspect meets the external axial surface at
an obtuse angle 2: a small groove or furrow 3: the surface
ceph.a.lo.gram n: see CEPHALOMETRIC RADIOGRAPH
found by cutting away the angle of intersection of two faces
ceph.a.lo.m.e.ter n: an instrument for measuring the head of a piece of material (i.e. stone, metal, wood): a beveled
or skull, an orienting device for positioning the head for edge
radiographic examination and measurement 2cham.fer vt cham.fer.ed; cham.fer.ing; cham.fers 1: to cut
cephalometric radiograph: a standardized radiograph of the a furrow in 2: to make a chamferon; to cut or reduce to a
skull chamfer bevel 3: generally thought of as producing a curve
cephalometric tracing: a line drawing of structural outlines from the axial wall to the cavosurface
of craniofacial landmarks and facial bones, made directly chamfer angle n: the angle between a chamfered surface
from a cephalometric radiograph and one of the original surfaces from which the chamfer is
cut
cephalometry n, cephalometric adj 1: the science of
measurement of the dimensions of the head 2: in dentistry, char.ac.ter.ize: to distinguish, individualize, mark, qualify,
certain combinations of angular and linear measurements singularize, or differentiate something
developed from tracing frontal and lateral radiographic head characterized denture base: a denture base with coloring
films used to assess craniofacial growth and development that simulates the color and shading of natural oral tissues
on a longitudinal basis and to determine the nature of check bite slang: see INTEROCCLUSAL RECORD
orthodontic treatment response
che.ili.tis: inflammation of the lip
ceph.a.lo.stat n: an instrument used to position the head to che.ilo.sis: a fissured condition of the lips and angles of the
produce spatially oriented, reproducible radiographs or mouth often associated with riboflavin deficiency
photographs
chew.in record: see STEREOGRAPHIC RECORD
ce.ram n: heat treatment process that converts a specially chewing cycle: see MASTICATORY CYCLE
formulated glass into a fine grained glass-ceramic material
chewing force: see MASTICATORY FORCE
1
ce.ram.ic adj (1850): of or relating to the manufacture of Christensen’s phenomenon (Carl Christensen, Danish,
any product made essentially from a nonmetallic mineral dentist and educator): eponym for the space that occurs
(as clay) by firing at a higher temperature between opposing occlusal surfaces during mandibular
2
ce.ram.ic n (1859): the product of ceramic manufacture protrusion
ceramic crown: a ceramic restoration that restores a clinical Christensen C. The problem of the bite. D Cosmos 1905;47:1184-95.
crown without a supporting metal substructure chroma n (1889) 1: the purity of a color, or its departure from
ceramic flux: a glass modifier; metallic ions such as calcium, white or gray 2: the intensity of a distinctive hue; saturation
potassium or sodium; usually as carbonates, which interrupt of a hue 3: chrome describes the strength or saturation of
the oxygen/silica bond, thus enhancing fluidity the hue (color)—see also SATURATION
Munsell AH. A color notation. Baltimore: Munsell Color Co. Inc
ce.ram.ics n 1: compounds of one or more metals with a
1975;14-7.
nonmetallic element, usually oxygen. They are formed of
chemical and biochemical stable substances that are strong, chromatic stimulus: a stimulus that under prevailing
hard, brittle, and inert nonconductors of thermal and conditions of adaptation gives rise to a perceived chromatic
electrical energy 2: the art of making porcelain dental color
restorations chromaticity coordinates: the two dimensions of any color
order system that exclude the lightness dimension and
ce.ram.ist or cer.am.i.cist n (1855): one who engages in describe the chromaticity. Unless otherwise specified, the
ceramics term refers to the CIE coordinates x, y and z for illuminant
ceramometal restoration: see METAL CERAMIC C and 2 degrees (1931) Standard Observer—called also color
760 RESTORATION coordinates
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Glossary of Prosthodontic Terms
chromaticity diagram: a plane diagram in which each point clasp n (14c): the component of the clasp assembly that
represents a different combination of dominant wave length engages a portion of the tooth surface and either enters an
and purity and which is usually constructed in some form undercut for retention or remains entirely above the height
of a triangle with calorimetric primaries represented at the of contour to act as a reciprocating element. Generally, it is
corners. The CIE standard chromaticity diagram is used to stabilize and retain a removable prosthesis—see BAR
essentially a right angle triangle representing hypothetical C, CIRCUMFERENTIAL C, COMBINATION C,
primaries and the complete chromaticity gamut of the CIE CONTINUOUS C
standard observer clasp arm: see CLASP
chro.mat.ic.ness n: the intensity of hue as expressed in the clasp assembly: the part of a removable partial denture that
Natural Color System acts as a direct retainer and/or stabilizer for a prosthesis by
chro.ma.top.sia n: an abnormal state of vision in which partially encompassing or contacting an abutment tooth—
colorless objects appear colored; a visual defect in which usage: components of the clasp assembly include the clasp,
colored objects appear unnaturally colored and colorless the reciprocal clasp, the cingulum, incisal or occlusal rest, and
objects appear color tinged the minor connector
chron.ic adj (1601): marked by long duration or frequent clasp bridge slang: see UNILATERAL REMOVABLE
recurrence; not acute; always present—chron.ical.ly adj— PARTIAL DENTURE
chro.nic.i.ty n clasp guideline: see SURVEY LINE
chronic closed lock: with respect to the temporomandibular clear.ance n (1563) obs: a condition in which bodies may
joint, a restriction in motion of the joint characterized most
pass each other without hindrance. Also, the distance
frequently by long duration, pain, crepitus and radiographic
between bodies (GPT-4)
evidence of joint asymmetry 1cleft n 1: a space or opening made through splitting 2: a
chronic pain: pain marked by long duration or frequent hollow between ridges or protuberances
recurrence 2cleft adj: partially split or divided
CIE: acronym for Commission Internationale d’Eclairage
cleft palate n (1841) 1: a congenital fissure or elongated
CIE LAB system: CIE LAB relates the tristimulus values to opening in the soft and/or hard palate 2: an opening in the
a color space. This scale accounts for the illuminant and the hard and/or soft palate due to improper union of the
observer. By establishing a uniform color scale, color maxillary process and the median nasal process during the
measurements can be compared and movements in color second month of intrauterine development—syn PALATAL
space defined CLEFT—see COMPLETE CP, OCCULT CP.
CIE standard illuminant: the illuminants A, B, C, D65 and cleft palate prosthesis: see SPEECH AID PROSTHESIS
other illuminants, defined by the CIE in terms of relative
spectral power distributions; A = Planckion radiation (a cleft palate speech aid prosthesis: see SPEECH AID
theoretical body that absorbs all incident optical radiant PROSTHESIS
energy) a temperature of about 2856° K;B = Director solar clench.ing vt (13c): the pressing and clamping of the jaws
radiation 48,000°K;C = Average day-light; D65 = Daylight and teeth together frequently associated with acute nervous
including the ultraviolet region: 6500°K tension or physical effort
cine.flu.o.ros.co.py n: dynamic fluoroscopic images recorded click n (1611): a brief sharp sound; with reference to the
on motion picture film temporomandibular joint, any bright or sharp sound
cine.ra.di.og.ra.phy n: the making of a motion picture record emanating from the joint—see CLICKING, EARLY
of successive images appearing in a fluoroscopic screen CLOSING C, EARLY OPENING C, LATE CLOSING C, LATE
OPENING C, MID OPENING C, RECIPROCAL C.
cin.gu.lum n, pl.la (1845) 1: an anatomical band or encircling
ridge—cin.gu.late adj 2: the lingual lobe of many anterior click.ing n (611): a series of clicks, such as the snapping,
teeth; a convex protuberance at the lingual cervical one third cracking, or noise evident on excursions of the mandible; a
of the anatomic crown distinct snapping sound or sensation, usually audible (or
by stethoscope) or on palpation, which emanates from the
cingulum rest: a portion of a partial denture that contacts
temporomandibular joint(s) during jaw movement. It may
the prepared or natural cingulum of the tooth, termed the
or may not be associated with internal derangements of the
cingulum rest seat
temporomandibular joint
circumferential clasp: a retainer that encircles a tooth by clin.i.cal adj (ca. 1755) 1: of or related to or conducted in or
more than 180 degrees, including opposite angles, and which
as if within a clinic 2: analytical or detached—clin.i.cal.ly
generally contacts the tooth throughout the extent of the
adv
clasp, with at least one terminal located in an undercut area
clinical crown: the portion of a tooth that extends from the
circumferential clasp arm: see CIRCUMFERENTIAL CLASP occlusal table or incisal edge to the free gingival margin 761
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clinical remount: see REMOUNT PROCEDURE Coble LG. A complete denture technique for selecting and setting
cli.nom.e.ter n (1811): a device for measuring angles of up teeth. J Prosthet Dent 1960;10:455-8.
elevation or inclination—cli.no.met.ric adj—cli.nom.e.try co.he.sion n (1660) 1: the act or state of sticking together
n tightly 2: the force whereby molecules of matter adhere to
clip n (15c) slang 1: any of numerous devices used to grip, one another; the attraction of aggregation 3: molecular
clasp, or hook 2: a device used to retain a removable attraction by which the particles of a body are united
prosthesis intraorally to a fixed abutment; i.e., a bar, crown, throughout their mass
or other retainer cohesive failure: bond failure within a dental material due
closed bite slang: see DECREASED OCCLUSAL VERTICAL to a tensile or shearing force—see ADHESIVE FAILURE
DIMENSION Cold curing resin: see AUTOPOLYMERIZING RESIN
closed lock: an internal derangement of the collarless metal ceramic restoration: a metal ceramic
temporomandibular joint in which the disk is dislocated restoration whose cervical metal collar has been eliminated.
anteriorly and, usually, medial to the condyle; displacement Porcelain is placed directly in contact with the prepared
or dislocation of the disk without spontaneous reduction— finish line
see ACUTE CLOSED LOCK, CHRONIC CLOSED LOCK collateral ligaments: two or more ligaments paired to a
closed reduction of a fracture: reduction (repositioning) and single joint for the specific purpose of restricting extension
fixation of fractured bones without making a surgical and flexion within one plane only
opening to the fracture site colloid: a material in which is suspended a constituent in a
closest speaking space: the space between the anterior teeth finely divided state that is invisible to the eye but capable of
that, according to Dr Earl Pound, should not be more or less scattering light
than 1 to 2 mm of clearance between the incisal edges of the col.or n (13c) 1: a phenomenon of light or visual perception
teeth when the patient is unconsciously repeating the letter that enables one to differentiate otherwise identical objects
“S” Dr Meyer M silverman termed this speaking centric, which 2: the quality of an object or substance with respect to light
was defined as the closest relationship of the occlusal reflected or transmitted by it. Color is usually determined
surfaces and incisal edges of the mandibular teeth to the visually by measurement of hue, saturation, and luminous
maxillary teeth during function and rapid speech. This was reflectance of the reflected light 3: a visual response to light
later called closest speaking level by Dr Silverman and finally consisting of the three dimensions of hue, value and
the closest speaking space saturation—see PERCEIVED C, PSYCHOPHYSICAL C.
Silverman MM. Speaking centric. Dent Digest 1950;55:106-11. color blindness: abnormal color vision or the inability to
Silverman MM. Accurate measurement of vertical dimension by discriminate certain colors, most commonly along the red-
phonetics and speaking centric space. Dent Digest 1951;57:261-5. green axis
Silverman MM. The speaking method in measuring vertical
color constancy: relative independence of perceived color
dimension. J Prosthet Dent 1953;3:193-9.
to changes in color of the light source
Pound E. Esthetics and phonetics in full denture construction. J Calif
Dent Assoc 1950;20:179-85. color deficiency: a general term for all forms of color vision
Pound E. The mandibular movements of speech and their seven
that yield chromaticity discrimination below normal limits,
related values. J Prosthet Dent 1966;16:835-43.
such as monochromatism, dichromatism, and anomalous
Pound E. The vertical dimension of speech, the pilot of occlusion.
trichromatism
J Calif Dent Assoc 1975;6:42-7. color difference: magnitude and character of the difference
Pound E. Let/s/be your guide. J Prosthet Dent 1977;38:482-9. between two colors under specified conditions, referred to
as delta E
clutch n: a device placed in both the maxillary and
mandibular arches for the purpose of supporting color difference equations: equations that transform CIE
components used to record mandibular movement (Commission Internationals d’Eclairage) coordinates into a
more uniform matrix such that a specified distance between
co.adapt.ed adj (1836) 1: mutually adapted, especially by two colors more nearly proportional to the magnitude of an
natural selection 2: in medicine, the proper realignment of observed difference between them regardless of their hue
displaced parts—co.ad.ap.ta.tion n
color notation: the use of symbols in some orderly fashion
Coble balancer [Lucian G Coble, North Carolina, US dentist] by which the attributes of color may be defined or may be
1: an intraoral balancing device used to determine centric set down in written formula
relation and the centric relation record 2: used to equilibrate
color rendering index: a number from 1 to 100 given to a
complete dentures intraorally—see CENTRAL BEARING
light source to indicate its relative equivalence to pure white
TRACING DEVICE
light which has a color rendering index (CRI) of 100. The
Coble LG. Correct centric position must be established for good closer the number is to 100, the more it resembles pure white
762 denture fit and function. Dent Survey 1951;27:1391-3. light
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Glossary of Prosthodontic Terms
color scale: an orderly arrangement of colors showing compensating curve 1: the anteroposterior curvature (in the
graduated change in some attribute or attributes of color as mediar plane) and the mediolateral curvature (in the frontal
a value scale plane) in the alignment of the occluding surfaces and incisal
color solid: a symbolic figure in three dimensions that edges of artificial teeth that are used to develop balanced
represents the relations of all possible colors with respect to occlusion 2: the curve introduced in the construction of
their primary attributes of hue, lightness, and saturation. complete dentures to compensate for the opening influences
Usually, value (lightness) appears as the vertical axis of the produced by the condylar and incisal guidances during
figure with hue and saturation represented in polar lateral and protrusive mandibular excursive movements—
coordinates about the lightness axis, saturation being radial. called also compensating curvature, compensating curve
The boundaries of the solid are actually irregular, but it is compact bone: any bone substance that is dense or hard
sometimes represented as a cylinder, a sphere, or a cube complementary colors 1: two colors that, when mixed
color standard: a color whose psychophysical dimensions together in proper proportions, result in a neutral color.
have been accurately measured and specified Colored lights that are complementary when mixed in an
color stimulus: visible radiation entering the eye and additive manner form white light and follow the laws of
producing a sensation of color, either chromatic or additive color mixture. Colorants that are complementary
achromatic when mixed together form black or gray and follow the laws
of subtractive colorant mixture 2: colors located in directly
color temperature: the temperature in degrees Kelvin
opposite positions on the color wheel. Colorants that are
(Celsius plus 273°) of a totally absorbing or black body
complementary when mixed together form black or gray
(object) that produces colors as the temperature changes. The
and follow the laws of subtractive color.
range is from a dull red to yellow to white to blue. This term
is sometimes used incorrectly to describe the color of “white” complete arch subperiosteal implant: a device placed under
light sources. The correct term to describe the color of light the periosteum on the residual ridge to provide abutments
sources is correlated color temperature for supporting a removable or fixed prosthesis in a fully
edentulous arch—usage such implants should be described
col.or.im.e.ter n (ca. 1863): a device that analyzes color by
by means of their relationship to their bases of support, the
measuring it in terms of a standard color, scale of colors or
alveolar bone. As such, at placement, such as implant is
certain primary colors; an instrument used to measure light
described as an eposteal dental implant—see EPOSTEAL
reflected or transmitted by a specimen
DENTAL IMPLANT
col.or.ing n (14c) 1: the act of applying colors 2: something
complete cleft palate: an opening extending through the
that produces color or color effects 3: the effect produced by
anterior alveolar ridge, primary and secondary palates—
applying or combining colors—see EXTRINSIC C,
see PALATAL CLEFT
INTRINSIC C
complete crown: a restoration that covers all the coronal
combination clasp: a circumferential retainer for a
tooth surfaces (mesial, distal, facial, lingual, and occlusal)
removable partial denture that has a cast reciprocal arm and
a wrought wire retentive clasp complete denture: a removable dental prosthesis that
replaces the entire dentition and associated structures of the
combination syndrome: the characteristic features that occur
maxillae or mandible
when an edentulous maxilla is opposed by natural
mandibular anterior teeth, including loss of bone from the complete denture prosthetics obs 1: the replacement of the
anterior portion of the maxillary ridge, overgrowth of the natural teeth in the arch and their associated parts by artificial
tuberosities, papillary hyperplasia of the hard palate’s substitutes 2: the art and science of the restoration of an
mucosa, extrusion of the lower anterior teeth, and loss of edentulous mouth (GPT-4)—see COMPLETE DENTURE
alveolar bone and ridge height beneath the mandibular PROSTHODONTICS
removable partial denture bases—also called anterior complete denture prosthodontics: that body of knowledge
hyperfunction syndrome. and skills pertaining to the restoration of the edentulous arch
comminuted fracture: a fracture in which the bone has with a removable prosthesis
several lines of fracture in the same region; a fracture in complete facial moulage: an impression procedure used to
which the bone is crushed and splintered record the soft tissue contours of the whole face
com.mi.nu.te vt-nut.ed;.nut.ing (1626) obs: the reduction complicated fracture: a fracture with significant injury to
of food into small parts (GPT-4)—com.mi.nu.tion n adjacent soft tissue (i.e., neurovascular injury) components
com.mis.sure n (15c): a point of union or junction especially of mastication: those factors of food manipulation and
between two anatomic parts—com.mis.sur.al adj comminution that follow ingestion and precede deglutition
commisure splint: a device placed between the lips that com.po.mer (1998): a poly-acid modified composite resin,
assists in achieving increased opening between the lips— composed of glass filler, acid-modified dimethacrylate resin,
called also lip splint and a photoinitiator 763
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Textbook of Prosthodontics
components of occlusion: the various elements that are 1condylar guidance vt: mandibular guidance generated by
involved in occlusion, such as the temporomandibular joints, the condyle and articular disc traversing the contour of the
the associated musculature, the teeth, their contacting glenoid fossae
surfaces and investing tissues, and/or the denture 2condylar
guidance n: the mechanical form located in the
supporting structures—see also DETERMINANTS OF upper posterior region of an articulator that controls
MANDIBULAR MOVEMENT movement of its mobile member
com.pound n, slang (19c): see MODELING PLASTIC condylar guide assembly: the components of an articulator
IMPRESSION COMPOUND that guide movement of the condylar analogues
compound joint: a joint involving three or more bones condylar guide inclination: the angle formed by the
compression molding: the act of pressing or squeezing inclination of a condylar guide control surface of an
together to form a shape within a mold; the adaptation, articulator and a specified reference plane—see LATERAL
under pressure, of a plastic material into a mold CONDYLAR INCLINATION
compression of tissue: see TISSUE DISPLACEMENT condylar hinge position obs: the position of the condyles of
compressive stress: the internal induced force that opposes the mandible in the glenoid fossae at which hinge axis
the shortening of a material in a direction parallel to the movement is possible (GPT-4)
direction of the stresses; any induced force per unit area that condylar inclination obs: the direction of the lateral condyle
resists deformation caused by a load that tends to compress path (GPT-4)
or shorten a body condylar path: that path traveled by the mandibular condyle
Computerized tomography (CT): the technique by which in the temporomandibular joint during various mandibular
multidirectional X-ray transmission data through a body is movements
mathematically reconstructed by a computer to form an condylar path element: the member of a dental articulator
electrical cross-sectional representation of a patient’s that controls the direction of condylar movement
anatomy. CT is used as an acronym to designate any technical
condylar path tracing: a graphic registration of the
field associated with these techniques
movement of the condyle—see MANDIBULAR TRACING
con.cres.cence n: the union of roots of approximating teeth
condylar slant: see CONDYLAR PATH, LATERAL
via deposition of cementum
CONDYLAR PATH
con.cre.tion n: any inorganic mass in a natural cavity or
condylar subluxation: an incomplete or partial dislocation
organ
of the condyle
condensable composite resin: a highly filled composite resin
con.dy.lar.thro.sis n: an ellipsoidal articulation, a
in which the filler particles have been altered so that the
modification of the ball/socket type of synovial joint in
material is condensable in a manner similar to amalgam
which the articular surfaces are ellipsoid rather than
condensation reaction: any chemical reaction between two spheroid. Owing to the arrangement of the muscles and
molecules to form a larger molecule, with the elimination of ligaments around the joint, all movements are permitted
a smaller molecule except rotation about a vertical axis—called also articulation
conditional color match: a pair of colors that appear to match ellipsoidea, condylar articulation, condylar joint, condyloid joint,
only under limited conditions, such as a particular light or ellipsoidal joint
source and a particular observer, a metameric match con.dyle n (1634): an articular prominence of a bone, i.e. in
condylar agenesis: a developmental abnormality the mandible, an ellipsoidal projection of bone, usually for
characterized by the absence of a condyle articulation with another bone—con.dy.lar adj—see
condylar articulator: an articulator whose condylar path CONDYLAR PATH, LATERAL CONDYLAR PATH,
components are part of the lower member and whose MANDIBULAR CONDYLE, NECK OF THE CONDYLE
condylar replica components are part of the upper member— condyle chord: see CONDYLAR AXIS
called also nonarcon articulator condyle head: see CONDYLE
condylar axis: a hypothetical line through the mandibular condyle path: see CONDYLAR PATH
condyles around which the mandible may rotate cone n (1562): one of the receptors of color vision found in
condylar dislocation: a condition in which the mandibular the retinal layer of the eye and concentrated in the macula
condyle is displaced within the temporomandibular joint, lutea
usually forward of the condylar eminence—called also con.gen.i.tal adj (1796): existing at, and usually before birth;
luxation referring to conditions that are present at birth, irrespective
condylar displacement: see MANDIBULAR DISLOCATION of their causation
764
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Glossary of Prosthodontic Terms
connecting bar: see MAJOR CONNECTOR to the mouth, after which different mineral compounds,
connective tissue: a tissue of mesodermal origin rich in made to represent the natural gums, roof, etc., are applied
interlacing processes that supports or binds together other to the plate and teeth in a plastic state, then carved and
tissues trimmed in proper form, and by means of a strong furnace
1con.nec.tor n (15c): in removable prosthodontics, the portion
heat these compounds, which are called the body and the
gum enamel, are fused, thus producing a continuous gum,
of a removable partial denture that unites its components— root, and rugae of the mouth, without seam or crevice. The
usage: see BAR C., CONTINUOUS BAR C., MAJOR C., technique is attributed to Dr John Allen (American)
MINOR C.
2
Richardson J. A practical treatise on mechanical dentistry.
con.nec.tor n: in fixed prosthodontics, the portion of a fixed Philadelphia: Lindsay and Blakinton; 1880 p 307-35.
partial denture that unites the retainer(s) and pontic(s)—
usage: see INTERNAL C., NONRIGID C., RIGID C., continuous loop wire clasp obs: attributed to J Wright Beach,
SUBOCCLUSAL C. DS, this clasp assembly was used to completely encircle a
tooth, particularly “a straight sided” tooth, by means of one
connector bar: see BAR CONNECTOR wire. If the retained was not continuous, it was described as
con.sul.ta.tion n (15c): a deliberation between those who an open loop wire clasp
render health care on a patient’s diagnosis and/or their Roach FE. Partial dentures. The Dental Summary 1916;35:203-10.
treatment
1con.tact
continuous spectrum: a spectrum or section of the spectrum
n (1626): the union or junction of surfaces; the in which radiations of all wave lengths are present; opposed
apparent touching or tangency of bodies—usage: see to line spectra or band spectra.
PROXIMAL CONTACT 1con.tour
2con.tact
n (1662): an outline, especially of a curving or
vi (1834): to make contact; to bring into contact; to irregular figure: the line representing this outline; the general
enter or be in contact with—usage: see BALANCING form of structure of something—usage: see HEIGHT OF
OCCLUSAL C., DEFLECTIVE OCCLUSAL C., INITIAL CONTOUR TRANSITIONAL CONTOUR
OCCLUSAL C., OCCLUSAL C. 2
con.tour adj (1844): following contour lines or forming
contact surface: the region on the proximal surface of a tooth furrows ridges along them, made to fit the contour of
that touches an adjacent tooth something
continuous bar connector: a metal bar usually resting on 3
con.tour vt (1871): to shape the contour of; to shape so as to
the lingual surfaces of mandibular anterior teeth to aid in the contours; to construct in conformity to a contour
their stabilization and act as an indirect retainer in extension
base removable partial dentures con.tra.be.vel n (20c) 1: an external bevel arising from the
occlusal surface or edge of a preparation and placed at an
continuous bar indirect retainer: see CONTINUOUS BAR angle that opposes or contrasts the angle of the surface it
CONNECTOR arises from 2: an external bevel arising from the occlusal
continuous bar retainer: see CONTINUOUS BAR surface or edge of a preparation—see BEVEL
CONNECTOR, INDIRECT RETAINER
con.trac.tion n (15c): in muscle physiology, the development
continuous beam obs: a beam that continues over several of tension in a muscle in response to a stimulus—usage: see
supports, with those supports not at the beam end bearing ISOMETRIC C, ISOTONIC C, POSTURAL C
equally free supports (GPT-4)
con.trac.ture n (1658): a permanent shortening of a muscle—
continuous clasp obs 1: in removable prosthodontics, a see MUSCLE C, MYOFIBROTIC CAPSULAR C,
circumferential retainer whose body emanates from an MYOSTATIC C
occlusal rest and extends across the buccal or lingual surface con.tra.lat.er.al adj (1882): occurring on or acting in
of more than one tooth before engaging an undercut on the conjunction with similar parts on an opposite side
proximal wall farthest from the occlusal rest 2: any one of
several early 1900 designs for clasping natural teeth to retain contralateral condyle: see NONWORKING SIDE
a removable partial denture; terms for such clasps included CONDYLE
wrought continuous interdental clasp, wrought continuous convergence angle 1: the taper of a crown preparation 2:
interdental support. Current terminology is a lingual bar the angle measured in degrees, formed between opposing
Kennedy E. Partial denture construction. Brooklyn: Dental items of axial walls when a tooth or teeth are prepared for single
interest Publishing; 1928. p. 377-90. crowns or fixed partial dentures—usage: this term is best
described as the total occlusal convergence
continuous gum denture obs 1: an artificial denture
consisting of porcelain teeth and tinted porcelain denture co.or.di.na.tion n (1643): smooth, controlled symmetrical
base material fused to a platinum base (GPT-4) 2: according movement
to Joseph Richardson, plain single teeth, made for the 1cope n (bef 12c): the upper half of any flask used in casting;
purpose, are arranged and soldered to a place properly fitted the upper or cavity side of a denture flask used in conjunction 765
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with the drag or lower half of the flask—see DRAG away by degrees as if by gnawing 3: to wear away gradually
2cope v: to dress, cover, or furnish with a cope; to cover, as if
usually by chemical action
with a cope or coping cor.ro.sion n(15c): the action, process, or effect of corroding;
1cop.ing n 1: a long, enveloping ecclesiastical vestment 2a: a product of corroding; the loss of elemental constituents to
something resembling a cope (as by concealing or covering) the adjacent environment
2b: coping cor.ro.sive adj (14c): tending or having the power to corrode
2cop.ing
n (ca. 1909): a thin covering or crown—usage: see cortical bone: the peripheral layer of compact osseous tissue
C IMPRESSION, TRANSFER C
Costen’s syndrome [James Bray Costen, Aemrican
coping impression: an impression, usually encompassing otolaryngologist, 1895-1962]: eponym for TEMPORO-
an entire dental arch, that uses metal or resin copings placed MANDIBULAR DISORDERS
on prepared teeth. The copings are repositioned before the
Costen JB. A syndrome of ear and sinus symptoms dependent upon
pouring of a working cast
disturbed functions of the temporomandibular joint. Ann Otol
coping pick.up impression: see COPING IMPRESSION Rhinol Laryngol 1934; 43:1-15.
coping prosthesis obs: see OVERDENTURE coun.ter.die n, obs: the reverse image of a die; usually made
copolymer resin: polymers formed from more than one type of a softer and lower fusing metal than the die (GPT-1)
of molecular repeat unit coup.ling n: a device that serves to couple or connect the
copper band: a copper cylinder employed as a matrix for ends of adjacent parts or objects
making an impression coupling lug: a small projecting part of a larger member; a
cor.al.li.form adj: having the form of coral; branched like a projection or a casting to which a bolt or other part may be
coral often with reference to certain types of hydroxylapatite attached
implant materials covalent bond n, (1939): a chemical bond between two atoms
core n (14c): the center or base of a structure or radicals formed by the sharing of a pair (single bond),
co.ro.nal adj (15c) 1: of or relating to a corona or crown 2: or two pairs (double bond), or three pairs (triple bond) of
relating to any longitudinal plane or section that passes electrons—called also primary bond
through a body at right angles to the median plane cover screw: see HEALING SCREW
3: pertaining to the crown of a tooth cranial base: the part of the skull that is thought to be
coronal plane: lying in the direction of the coronal suture, relatively stable throughout life and is used in
of or relating to the frontal plane that passes through the cephalometrics as a landmark from which to measure
long axis of a body changes due to growth, time, or treatment
coronoid maxillary space: the region between the medial cranial prosthesis: a biocompatible, permanently implanted
aspect of the coronoid process of the mandible and the buccal replacement for a portion of the skull bones; an artificial
aspect of the tuberosity of the maxilla, bounded anteriorly replacement for a portion of the skull bones—called also
by the zygomatic arch cranial implant, cranio-plasty prosthesis, skull plate
coronoid process: the thin triangular rounded eminence craniofacial defects: malformations associated with the head
originating from the anterosuperior surface of the ramus of and face craniofacial disjunction fracture—see LE FORT III
the mandible—see HYPERTROPHY OF THE CP FRACTURE
cor.o.no.plas.ty n (20): alteration or change in morphology craniomandibular articulation: both temporomandibular
of the coronal portion of natural teeth by the use of abrasive joints functioning together as a bilateral sliding hinge joint
instruments connecting the mandible to the cranium—syn
corrected cast: see ALTERED CAST TEMPOROMANDIBULAR JOINTS
cra.ter n: in periodontics, a saucer-shaped defect of soft tissue
corrective wax: see DENTAL IMPRESSION WAX
or bone
correlated color temperature: the term describing the color 1craze vb craz.ed; craz.ing vt (14c): to produce minute cracks
of white light sources. Specifically, it is the temperature of
on the surface or glaze of; to develop a mesh of fine cracks
the Planckion (black body) radiator that produces the
2
chromaticity most similar to that produced by the light source craze n (1534): a crack in a surface or coating (as of glaze or
expressed in degrees Kelvin or in mired; it is measured in enamel)
1
degrees Kelvin, to which a black body must be raised to creep vi crept; creep.ing (12c): to slip or gradually shift
provide the closest match, in chromaticity, to a particular position; to change shape permanently due to prolonged
light source stress or exposure to high temperature
2creep n (1818): the slow change in dimensions of an object
cor.rode vt (15c) 1: deterioration of a metal due to an
766 electrochemical reaction within its environment 2: to eat due to prolonged exposure to high temperature or stress
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Glossary of Prosthodontic Terms
crep.i.ta.tion n: a crackling or grating noise in a joint during fabrication of a restoration for a tooth on a natural tooth or
movement, liken to the throwing of fine salt into a fire or dental implant
rubbing hair between the fingers; the noise made by rubbing crown flask: a sectional, box like case in which a sectional
together the ends of a fracture bone mold is made of artificial stone or plaster of Paris for the
crep.i.tus n: see CREPITATION, JOINT C. purpose of processing dentures or other resinous restorations
crest n (14c): a ridge or prominence on a part of a body; in crown-fracture: micro or macroscopic cleavage in the coronal
dentistry, the most coronal portion of the alveolar process portion of a tooth
crest of the ridge: the highest continuous surface of the crown lengthening slang: see LENGTHENING OF THE
residual ridge—not necessarily coincident with the center CLINICAL CROWN
of the ridge crown-root ratio: the physical relationship between the
crevicular epithelium: the nonkeratinized epithelium of the portion of the tooth within alveolar bone compared with
gingival crevice the portion not within the alveolar bone, as determined by
crevicular fluid: the fluid that seeps through the crevicular radiograph
epithelium; this is usually increased in the presence of crown slitter obs: a mechanical device used to slit the axial
inflammation surface of a swayed artificial crown to facilitate its removal
cribriform plate obs: in dentistry, the alveolar bone proper (GPT-4).
cris.to.ba.lite n: an allotropic form of crystalline silica used cru.ci.ble n (15c): a vessel or container made of any refractory
in dental casting investments material (as porcelain) used for melting or calcining any
substance that requires a high degree of heat
cross arch balance: see CAB ARTICULATION
crucible former: the base to which a sprue former is attached
cross arch balanced articulation: the simultaneous contact while that wax pattern is being invested in refractory
of the buccal and lingual cusps of the working side maxillary investment; a convex rubber, plastic, or metal base that forms
teeth with the opposing buccal and lingual cusps of the a concave depression or crucible in the refractory investment
mandibular teeth, concurrent with contact of the
CT: acronym for Computerized Tomography
nonworking side maxillary lingual cusps with the
mandibular buccal cusps crypt n (1789) 1: a chamber wholly or partly underground
2: in anatomy, a pit, depression or simple tubular gland
cross arch stabilization: resistance against dislodging or
rotational forces obtained by using a removable partial cuff n (14c): something that encircles; a band about any body
denture design that uses natural teeth on the opposite side cul.de.sac n (1738): a blind pouch or tubular cavity closed at
of the dental arch from the edentulous space to assist in one end
stabilization cumulative dose: the total accumulated dose resulting from
cross bite: see REVERSE ARTICULATION a single or repeated exposure to radiation of the same region
or of the whole body; if used in area monitoring, it represents
cross bite teeth: see REVERSE ARTICULATION TEETH
the accumulated radiation exposure over a given period of
cross bite occlusion: see REVERSE ARTICULATION time
Cross pinning: the augmentation achieved in retention of a cure vb (14c): see POLYMERIZE
cast restoration by the placement of a pin through the axial 1curve adj (15c): bent or formed into a curve
wall of a dental casting into dentin 2curve vb curved; curv.ing vi (1594): to take a turn, change,
cross tooth balance: see BALANCED ARTICULATION, or deviation from a straight line or plane surface without
CROSS TOOTH BALANCED ARTICULATION angularity or sharp breaks; a non-angular deviation from a
cross tooth balanced articulation: the harmonious contact straight line or surface—see REVERSE C.
of opposing working side buccal and lingual cusps curve of Monson [George S Monson, St Paul, Minnesota,
1crown n (12c) 1: the highest part, as the topmost part of the US dentist, 1869-1933]: eponym for a proposed ideal curve of
skull, head or tooth; the summit; that portion of a tooth occlusion in which each cusp and incisal edge touches or
occlusal to the dentinoenamel junction or an artificial conforms to a segment of the surface of a sphere 8 inches in
substitute for this 2: an artificial replacement that restores diameter with its center in the region of the glabella
missing tooth structure by surrounding part or all of the Monson GS. Occlusion as applied to crown and bridgework. J Nat
remaining structure with a material such as cast metal, Dent Assoc 1920;7:399-417.
porcelain, or a combination of materials such as metal and Monson GS. Some important factors which influence occlusion. J
porcelain Nat Dent Assoc 1922;9:498-503.
2
crown vt (12c): to place on the head, as to place a crown on curve of occlusion: the average curve established by the
a tooth, dental implant or tooth substitute—usage: implies incisal edges and occlusal surfaces of the anterior and 767
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posterior teeth in either arch cuspid lift: see CANINE PROTECTED ARTICULATION
curve of Pleasure [Max A. Pleasure, New York, US dentist, cuspid lifted articulation: see CANINE PROTECTED
1903-1965] 1: eponym for a helicoid curve of occlusion that, ARTICULATION
when viewed in the frontal plane, conforms to a curve that cuspid protected occlusion: see CANINE PROTECTED
is convex from the superior view, except for the last molars ARTICULATION
which reverse that pattern 2: in excessive wear of the teeth,
cuspid rise: see CANINE PROTECTED ARTICULATION
the obliteration of the cusps and formation of either flat or
cupped-out occlusal surfaces, associated with reversal of the cuspid rise articulation: see CANINE PROTECTED
occlusal plane of the premolar, first and second molar teeth ARTICULATION
(the third molars being generally unaffected), whereby the cuspless teeth: teeth designed without cuspal prominence
occlusal surfaces of the mandibular teeth slope facially on the occlusal surface—see NONANATOMIC TEETH,
instead of lingually and those of the maxillary teeth incline ZERODEGREE TEETH
lingually—syn ANTIMONSON CURVE, FREQUENCY custom tray: an individualized impression tray made from
CURVE, PROBABILITY CURVE, REVERSE CURVE a cast recovered from a preliminary impression. It is used in
Pleasure MA. Prosthetic occlusion—a problem in mechanics. J Am making a final impression
Dent Assoc and Dent Cosmos 1937;24:1330-8.
Pleasure MA. Practical full denture occlusion. J Am Dent Assoc Dent cy.a.no.ac.ry.late n (20c): a single component, moisture
Cosmos 1938;25:1606-17. activated, thermoplastic, group of adhesives characterized
curve of Spee [Ferdinard Graf Spee, Prosector of Anatomy, by rapid polymerization and excellent bond strength
Kiel, Germany, 1855-1937]: eponym for ANTEROPOSTERIOR
CURVE D
Spee FG. Die Verschiebrangsbahn des Unterkiefers am Schadell.
Arch Anat Physiol (Leipz) 1890;16:285-94. Davis crown [Wallace Clyde Davis, Lincoln, Nebraska, US
curve of Wilson [George H Wilson, Cleveland, Ohio, US dentist (1866-1950)] obs: eponym for a dental restoration
dentist, 1855-1922] 1: eponym for the MEDIOLATERAL supported by a dowel in the root canal over which was
CURVE 2: in the theory that occlus on should be spherical, cemented a porcelain tube tooth in direct contact with the
the curvature of the cusps as projected on the frontal plane root face of the tooth. A later modification involved a gold
expressed in both arches; the curve in the lower arch being casting that improved the fit between the root and artificial
concave and the one in the upper arch being convex. The tooth
curvature in the lower arch is affected by an equal lingual Davis WC. Essentials of operative dentistry. 1st ed Lincoln, Neb:
inclination of the right and left molars so that the tip points Author as publisher, 1911.
of the corresponding cross-aligned cusps can be placed into Davis WC. Essentials of operative dentistry. 2nd ed. St Louis: CV
the circumferences of a circle. The transverse cuspal Mosby; 1916.
curvature of the upper teeth is affected by the equal buccal de.bride.ment n (ca. 1842): the removal of inflamed,
inclinations of their long axes devitalized, contaminated tissue or foreign material from
Wilson GH. A manual of dental prosthetics. Piladelphia Lea and or adjacent to a lesion
Febiger; 1911;22-37.
deciduous dentition: see PRIMARY DENTITION
cur.vi.lin.ear adj (1710): consisting of or bounded by curved
lines; represented by a curved line de.cor.ti.ca.tion n (ca. 1623) 1: a process of removing the outer
covering (as in enamel, bark, husks, etc.) from something 2:
cusp angle: the angle made by the average slope of a cusp
surgical removal of the cortex of an organ, an enveloping
with the cusp plane measured mesiodistal or buccolingually
membrane or fibrinous covering—de.cor.ti.cate vt—
cusp height: the perpendicular distance between the tip of de.cor.ti.cat.or n
a cusp and its base plane
decreased occlusal vertical dimension: a reduction in the
cusp plane: the plane determined by the two buccal cusp distance measured between two anatomic points when the
tips and the highest lingual cusp of a molar teeth are in occlusal contact
cusp plane angle: the incline of the cusp plane in relation to deep bite: see VERTICAL OVERLAP
the plane of occlusion
deep beat therapy: see DIATHERMY
cuspal interference: see DEFLECTIVE OCCLUSAL
defective color vision: the condition in which color
CONTACT
discrimination is significantly reduced in comparison with
cuspid guidance: see CANINE PROTECTED the normal trichromat. The forms of color defective vision
ARTICULATION can be divided into three main groups—dichromatic vision,
cuspid guided articulation: see CANINE PROTECTED anomalous trichromatic vision and monochromatic vision—
768 ARTICULATION see COLOR BLINDNESS. COLOR DEFICIENCY
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Glossary of Prosthodontic Terms
definitive cast: a replica of the tooth surfaces, residual ridge de.na.sal.i.ty n: the quality of the voice when the nasal
areas and/or other parts of the dental arch and/or facial passages are obstructed to prevent adequate nasal resonance
structures used to fabricate a dental restoration or prosthesis during speech—see HYPONASALITY
defective occlusal contact obs: contact that is capable of de.ner.va.tion n (1905): resection of or removal of the nerves
guiding the mandible from its original path of action into a to an organ or part
different path or motion or capable of disturbing the relation den.tal adj (1594): of or pertaining to the teeth
between a denture base and its supporting tissues (GPT-1)
dental arch: the composite structure of the natural teeth and
definitive obturator: a prosthesis that artificially replaces alveolar bone
part or all of the maxilla and associated teeth lost due to
dental articulation: the contact relationships of maxillary
surgery or trauma
and mandibular teeth as they move against each other—
definitive palatal lift prosthesis: see PALATAL LIFT usage this is a dynamic process
PROSTHESIS
dental biomechanics: the relationship between the biologic
de.flec.tion n (1605) 1: a turning aside or off course 2: a behavior of oral structures and the physical influence of a
continuing eccentric displacement of the mandibular midline dental restoration—syn DENTAL BIOPHYSICS
incisal path symptomatic of restriction in movement
dental cast: a positive life size reproduction of a part or parts
deflective occlusal contact: a contact that displaces a tooth, of the oral cavity
diverts the mandible from its intended movement or
displaces a removable denture from its basal seat— dental casting investment: a material consisting principally
usage: see OCCLUSAL DISHARMONY, OCCLUSAL of an allotrope of silica and a bonding agent. The bonding
PREMATURITY substance may be gypsum (for use in lower casting
temperatures) or phosphates and silica (for use in higher
de.for.ma.tion n (15c): the change of form or shape of an casting temperatures)
object gas vt; de-gassed pt., pp; de-gassing ppr (1920) 1: to
remove gas from an object or substance 2: the name dental dysfunction: abnormal functioning of dental
commonly used to denote the first heat cycle (oxidation structures; partial disturbance or functional impairment of
cycle) in fabrication of a metal ceramic restoration that a dental organ
removes surface impurities from the metallic component and dental element: slang for a dental prosthesis that receives
produces surface oxides prior to the application of opaque part or all support/retention from one or more endosteal,
porcelain eposteal or transosteal dental implants
degenerative arthritis: see OSTEOARTHRITIS dental engineering obs 1: the application of physical,
degenerative joint disease: see OSTEOARTHRITIS mechanical, and mathematical principles to dentistry 2: the
application of engineering principles to dentistry (GPT-4)
de.glu.ti.tion n (1650): the act of swallowing
dental esthetics: the application of the principles of esthetics
de.hisce vt; de.hisced; de.hisc.ing (1658): to split or peal to the natural or artificial teeth and restorations
down along a natural line; to discharge the contents by so
splitting dental geriatrics 1: the branch of dental care involving
problems peculiar to advanced age and aging 2: dentistry
de.his.cence n (ca. 1828): an act or instance of dehiscing for the aged patient—see GERODONTICS, GERODON-
delayed dentition: the eruption of the first teeth of the TOLOGY
primary dentition or the permanent dentition considerably dental implant: a prosthetic device of alloplastic material(s)
later than the normally expected time (after the thirteenth implanted into the oral tissues beneath the mucosal and/or
month of life for the primary dentition and after the seventh periosteal layer, and on/or within the bone to provide
year of life for the permanent dentition in humans) retention and support for a fixed or removable prosthesis; a
delayed disocclusion: see DELAYED DISCLUSION substance that is placed into and/or upon the jaw bone to
delayed disclusion: deferred separation of the posterior support a fixed or removable prosthesis—usage: although
teeth due to the anterior guidance dental implants may be classified by their silhouette or
de.liv.ery: see PLACEMENT geometrical form (i.e., fin, screw, cylinder, blade, basket,
rootform, etc.) generally, dental implants are classified based
delta E: total color difference computed by use of a color on their anchorage component (the dental implant body) as
difference equation. It is generally calculated as the square it relates to the bone that provides support and stability. Thus,
root of the sums of the squares of the chromaticity difference there are three basic types of dental implants: eposteal dental
and the lightness difference. It signifies the difference implants, endosteal dental implants, and transosteal dental
between sample and standard implants. Some dental implants possess both eposteal and
de.min.er.al.iza.tion n (ca. 1903) 1: loss of minerals (as salts endosteal components (by design or subsequent anchorage
of calcium) from the body 2: in dentistry, decalcification change); the decision as to what anchorage system provides 769
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the most support at initial placement determines which denture base: the part of a denture that rests on the
category is used to best describe the dental implant—see foundation tissues and to which teeth are attached—usage:
also ENDOSTEAL DENTAL IMPLANT, EPOSTEAL see TINTED DB
DENTAL IMPLANT, TRANSOSTEAL DENTAL denture base material: any substance of which a denture
IMPLANT—comp MUCOSAL INSERT base may be made
dental impression: a negative imprint of an oral structure denture base saddle obs 1: the part of a denture that rests
used to produce a positive replica of the structure to be used on the oral mucosa and to which the teeth are attached 2:
as a permanent record or in the production of a dental the part of a complete or removable partial denture that rests
restoration or prosthesis—see IMPRESSION on the basal seat and to which the teeth are attached (GPT-
dental impression wax: any thermoplastic wax used to make 4)—see DENTURE BASE
impressions for dental use denture bearing area: see DENTURE FOUNDATION
dental plaster: the beta-form of calcium sulfate hemihydrate. AREA
It is a fibrous aggregate of fine crystals with capillary pores denture border 1: the margin of the denture base at the
that are irregular in shape and porous in character junction of the polished surface and the impression surface
dental prosthesis: an artificial replacement of one or more 2: the peripheral border of a denture base at the facial,
teeth and/or associated structures lingual, and posterior limits
dental prosthetic laboratory procedures: the steps in the denture characterization: modification of the form and color
fabrication of a dental prosthesis that do not require the of the denture base and teeth to produce a more lifelike
presence of the patient for their completion appearance
dental senescence: that condition of the teeth and associated denture curing obs: the process by which the denture base
structures in which there is deterioration due to aging or materials are hardened to the form of a denture mold (GPT-
premature aging processes 4)—see DENTURE PROCESSING
dental shade selection: see TOOTH COLOR SELECTION denture design obs: a planned visualization of the form and
dental stone: the alpha-form of calcium sulfate hemihydrate extent of a dental prosthesis arrived at after study of all
with physical properties superior to the beta-form (dental factors involved (GPT-4)
plaster). The alpha-form consists of cleavage fragments and denture esthetics: the effect produced by a dental prosthesis
crystals in the form of rods or prisms, and is therefore more that affects the beauty and attractiveness of the person
dense than the beta-form
denture flange: the part of the denture base that extends
den.tin n (1840): a calcareous material similar to but harder from the cervical ends of the teeth to the denture border
and denser than bone that comprises the principle mass of denture flask: see CASTING FLASK, CROWN FLASK
the tooth—den.tin.al adj; also spelled den.tine denture foundation: the oral structures available to support
den.ti.tion n (1615): the teeth in the dental arch a denture
dentofacial orthopedics: the branch of dentistry that treats denture foundation area: the surfaces of the oral structures
abnormal jaw and tooth relationships available to support a denture
den.to.form: having the likeness of a tooth; a tooth-like denture occlusal surface: the portion of the surface of a
substitute denture that makes contact with its antagonist
denture packing: the act of pressing a denture base material
den.tu.lous adj (1926) 1: possessing natural teeth 2: a into a mold within a refractory flask
condition in which natural teeth are present in the mouth—
syn DENTATE denture placement: see PLACEMENT
den.ture n (1874): an artificial substitute for missing natural denture polished surface: the portion of the surface of a
teeth and adjacent tissues—usage: see COMPLETE D., denture that extends in an occlusal direction from the border
DIAGNOSTIC D., DUPLICATE D., EXTENSION BASE of the denture and includes the palatal surface. It is the part
REMOVABLE PARTIAL D., FIXED PARTIAL D., of the denture base that is usually polished, and it includes
IMMEDIATE D., INTERIM D., OVERDENTURE, PARTIAL the buccal and lingual surfaces of the teeth
D., PROVISIONAL D., REMOVABLE PARTIAL D., denture processing 1: the means by which the denture base
ROTATIONAL PATH REMOVABLE PARTIAL D., materials are polymerized to the form of a denture 2: the
TRANSITIONAL D., TREATMENT D., TRIAL D., conversion of the wax pattern of a denture or a portion of a
UNILATERAL REMOVABLE PARTIAL D. denture into resin or other material
denture prognosis obs: an opinion or judgement given in
denture adhesive: a material used to adhere a denture to
advance of treatment for the prospects for success in the
the oral mucosa
fabrication of dentures and for their usefulness (GPT-4)
denture basal surface: see DENTURE BASE denture prosthetics obs 1: the replacement of the natural
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Glossary of Prosthodontic Terms
teeth in the arch and their associated parts by artificial de.tru.sion n: downward movement of the mandibular
substitutes 2: the art and science of the restoration of an condyle
edentulous mouth (GPT-4)—see COMPLETE DENTURE deuteranomalous vision: a form of anomalous
PROSTHODONTICS trichromatism in which the viewer requires more green in a
denture resin packing: filling and pressing a denture base mixture of red and green to match spectral yellow than does
material into a mold within a refractory flask—also called a normal trichromat. The relative spectral visual sensitivity
DENTURE PACKING does not differ noticeably from normal. Hue discrimination
denture retention 1: the resistance in the movement of a is poor in the red to green region of the spectrum
denture away from its tissue foundation especially in a deu.ter.an.opia n (ca. 1901): green color blindness
vertical direction 2: a quality of a denture that holds it to the developmental anomaly: unusual sequelae of development;
tissue foundation and/or abutment teeth—see DENTURE a deviation from normal shape or size
STABILITY
developmental dysmorphia: anomaly of growth seemingly
denture service: the procedures that are involved in the related to extrinsic interference from contiguous or adjacent
diagnosis and subsequent fabrication and maintenance of structures
artificial substitutes for missing natural teeth and associated
developmental dysplasia: any abnormality of growth or
structures
disharmony between parts due to growth
denture space 1: the portion of the oral cavity that is or may
developmental hyperplasia: excessive growth development
be occupied by the maxillary and/or mandibular denture(s)
2: the space between and around the residual ridges that is developmental hypoplasia: diminution in growth
available for dentures 3: the area occupied by dentures where development
formerly the teeth, alveolar bone, and surrounding soft and de.vest vb: the retrieval of a casting or prosthesis from an
hard tissues were located investing medium
denture stability 1: the resistance of a denture to movement de.vi.a.tion n (15c): with respect to movement of the
on its tissue foundation, especially to lateral (horizontal) mandible, a discursive movement that ends in the centered
forces as opposed to vertical displacement (termed denture position and is indicative of interference during movement
retention) 2: a quality of a denture that permits it to maintain de.vice n: something developed by the application of ideas
a state of equilibrium in relation to its tissue foundation and/
or principles that are designed to serve a special purpose or
or abutment teeth—see DENTURE RETENTION
perform a special function
denture supporting area: see DENTURE FOUNDATION
de.vit.ri.fi.ca.tion n (1832): to eliminate vitreous
AREA
characteristics partly or wholly; to crystallize
denture supporting structures obs: the tissues (teeth and/
di.ag.no.sis n; .no ses pl (ca 1861): the determination of the
or residual ridges) that serve as the foundation for removable
nature of a disease
partial or complete dentures (GPT-4)
1di.ag.nos.tic n (1625): the practice of diagnosis
denture surfaces: see DENTURE POLISHED SURFACE
2di.ag.nos.tic adj (1625): relating to or used in diagnosis
den.tur.ism n: the fabrication and delivery of removable
dentures by nondentists diagnostic cast: a life-size reproduction of a part or parts of
den.tur.ist n (1965) 1: any nondentist who makes, fits, and the oral cavity and/or facial structures for the purpose of
repairs removable dentures directly for the public 2: a study and treatment planning
nondentist licensed to provide complete dentures directly diagnostic denture: an interim dental prosthesis placed for
to the public the purpose of evaluation and planning later therapy
de.pas.siv.a.tion n: loss of corrosion protection due to diagnostic mounting: see MOUNTING
damage or removal of the protective oxide surface film on a
passivated metal diagnostic radiation: the use of radiographs for the
determination of the nature of a disease
de.pro.gram.mer n: various types of devices or materials
used to alter the proprioceptive mechanism during diagnostic setups: see TOOTH ARRANGEMENT
mandibular closure diagnostic splint: see OCCLUSAL DEVICE
determinants of mandibular movement: those anatomic diagnostic study cast: see DIAGNOSTIC CAST
structures that dictate or limit the movements of the mandi-
diagnostic wax up: see TOOTH ARRANGEMENT
ble. The anterior determinant of mandibular movement is
the dental articulation. The posterior determinants of diarthrodial joint: a freely moving joint
mandibular movement are the temporomandibular di.ar.thro.sis n (1578): a specialized articulation permitting
articulations and their associated structures more or less free movement; a synovial joint
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di.a.ste.ma n, pl .ma.ta (1854): a space between two adjacent disk.condyle complex: the condyle and its disk articulation
teeth in the same dental arch that functions as a simple hinge joint
dia.ther.my n (1909): tissue resistance generated heat disk n (1664): with respect to the temporomandibular joint,
resulting from high-frequency electric current the avascular interarticular tissue—spelled also disc
di.a.tor.ic adj: a channel placed in denture teeth to serve as disk degeneration: degenerative changes in the
a mechanical means of retaining the teeth in a chemically temporomandibular joint articular disk
dissimilar denture base material disk derangement: an abnormal relationship of the articular
dichromatic vision: defective color vision characterized by disk to the condyle, fossa, and or/and eminence
the interpretation of wave lengths from the red portion of disk detachment: a peripheral separation of the disk from
the spectrum matching a given green. There are two known its capsular, ligamentous, or osseous attachments
subclassifications. One requires red light to be approximately
disk dislocation: see DISK DERANGEMENT
10 times brighter than the red selected by the other to achieve
a similar color mismatch disk displacement: see DISK DERANGEMENT
di.chro.ma.tism n (1884): a form of defective color vision in disk displacement with reduction: disk displacement in
which a mixture of only two can match all colors. In which the temporomandibular joint disk is displaced at rest
dichromatic vision, the spectrum is seen as comprising only (usually in an anterior-medial direction) but resumes a
two regions of different hue separated by an achromatic normal position on mandibular movement
band. Dichromatic vision can be subdivided into three types: disk displacement without reduction: disk displacement
protanopia, deuteranopia, and tritanopia. in which the temporomandibular joint disk is displaced at
die n (14c): the positive reproduction of the form of a rest and does not resume a normal position on mandibular
prepared tooth in any suitable substance movement
die spacer: an agent applied to a die to provide space for the disk interference: interference of mandibular movement due
luting agent in the finished casting to disk related pathosis and/or dysfunction
differential diagnosis: the process of identifying a condition disk locking: disk derangement that will not reduce or
by comparing the symptoms of all pathologic processes that restore to its normal place or relationship
may produce similar signs and symptoms disk perforation: a circumscribed tear in the articular disk,
dilaceration 1: a tearing apart 2: in dentistry, a condition usually as the result of degenerative thinning in the central
due to injury of a tooth during its development and portion, usually with longstanding increased compressive
characterized by a band or crease at the junction of the crown forces, permitting communication between the superior and
and root, or alternatively by tortuous roots with abnormal inferior joint spaces. There is no disruption at the peripheral
curvatures attachments to the capsule, ligaments, or bone.
dimensional stability: the ability of a material to retain its disk prolapse: rotation of the disk forward on the condyle
size and form disk space: the radiolucent area on a temporomandibular
dimensions of color: terms used to describe the three joint radiograph between the mandibular condyle and the
dimensional nature of color. In the Munsell Color Order articular fossa
System, the dimensions are named hue, value, and chroma. disk thinning: degenerative decrease in disk thickness,
These are used to describe the color family (hue), the usually as the result of long-standing increased compressive
lightness/darkness (value), and the purity or strength forces
(chroma) dis.clu.sion vb: see DISOCCLUSION
direct bone impression: a negative likeness of bone from dis.junc.tor n: any component of a prosthesis that serves to
which overlying tissues have been reflected allow movement between two or more parts
direct pulp capping: application of a material to exposed dislocated fracture: a fracture of a bone near an articulation,
vital pulp to protect it and promote healing with dislocation of the condyloid process
direct retainer: that component of a removable partial dis.lo.ca.tion n (15c): the state or act of being dislocated, as
denture used to retain and prevent dislodgment, consisting displacement of one or more bones at a joint—usage: see
of a clasp assembly or precision attachment CONDYLAR D., FUNCTIONAL D., MANDIBULAR D.,
direct retention: retention obtained in a removable partial PARTIAL D.
denture by the use of clasps or attachments that resist dis.oc.clude: see DISOCCLUSION
removal from the abutment teeth dis.oc.clu.sion vb: separation of opposing teeth during
dis.ar.tic.u.la.tion n: separation of joint parts eccentric movements of the mandible—see DELAYED D.,
772 disc n: var spelling of disk IMMEDIATE D.
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Glossary of Prosthodontic Terms
displacement of the mandible: any abnormal relationship drag n: the lower or cast side of a refractory flask to which
of the mandible when at rest the cope is fitted
dis.tal adj (1808): remote; farther from the point of reference; draw vt (bef. 12c): the taper or convergence of walls of a
away from the median sagittal plane of the face following preparation for a restoration; slang—DRAFT, DRAUGHT
the curvature of the dental arch duc.til.i.ty n (14c): the ability of a material to withstand
distal extension partial denture: see EXTENSION BASE permanent deformation under a tensile load without
REMOVABLE PARTIAL DENTURE rupture; ability of a material to be plastically strained in
dis.to.clu.sion: see ANGLE’S CLASSIFICATION OF tension. A material is brittle if it does not have appreciable
OCCLUSION plastic deformation in tension before rupture
dis.to.ver.sion vb: deviation toward the distal dum.my n, pl dum.mies (1598) obs: the replacement tooth
or pontic in a fixed partial denture
distraction of the condyle: placement of the condyle farther
than normal from the median plane duplicate denture: a second denture intended to be a replica
of the first
distributed mandibular lateral translation: see
PROGRESSIVE MANDIBULAR LATERAL TRANSLATION du.rom.e.ter n (ca. 1890): an instrument for measuring
hardness
disuse atrophy: diminution in the size of a cell, tissue, organ,
or part as a result of inactivity DWT: acronym for Dime WeighT, called also pennyweight a
measurement of weight in the troy system equal to 24 grains,
di.ver.gence n (1656) 1: a drawing apart as a surface extends
or 0.05 ounce. Its metric equivalent is 1.555 gm—abbr pwt
away from a common point 2: the reverse taper of walls of a
preparation for a restoration—di.ver.gen.cy n, pl .cies (1709) dye n: a colorant that does not scatter light but absorbs certain
wave lengths and transmits others
divergence angle (1998): the sum of the angles of taper of
opposing walls of a tooth preparation that diverge away dynamic relations obs: relations of two objects involving
from each other the element of relative movement of one object to another;
as the relationship of the mandible to the maxillae (GPT-4)
docking device: see RADIATION CONE LOCATOR
dynamic splint: see FUNCTIONAL OCCLUSAL SPLINT
Dolder bar [Eugene J. Dolder, Zurich, Switzerland
prosthodontist]: eponym for one of many bar attachments dys.es.the.sia n: an unpleasant abnormal sensation
that splint teeth or roots together while acting as removable dys.func.tion n (ca. 1916): the presence of functional
partial denture abutments. The bar is straight with parallel disharmony between the morphologic form (teeth, occlusion,
sides and a round top. The sleeve or clip that fits over the bones, joints) and function (muscles, nerves) that may result
bar gains retention by friction only. The bar is of variable in pathologic changes in the tissues or produce a functional
sizes and is pear shaped in cross section, as is its disturbance
accompanying sleeve. This clip allows for some measure of
dys.geu.sia n: any distortion in the sense of taste
rotational movement about the bar
dys.ki.ne.sia n (ca. 1706): impairment of the power of
Dolder EJ. The bar joint mandibular denture. J Prosthet Dent
voluntary movement resulting in fragmentary or incomplete
1961;11:689-707.
movement—see also INCOORDINATION
donor site: an area of the body from which a graft is taken
dys.la.lia n: defective articulation due to faculty learning or
double wire clasp obs: a back-to-back wire circumferential to abnormality of the external speech organs and not due to
clasp lesions of the central nervous system
dove.tail n (1565): a widened portion of a prepared cavity dys.ma.se.sis n: difficulty in mastication
used to increase retention and/or resistance
dys.os.to.sis n: imperfect ossification
dow.el n (13c): a post, usually made of metal that is fitted
into a prepared root canal of a natural tooth. When combined dys.pha.gia n: difficulty in swallowing
with an artificial crown or core, it provides retention and dys.pho.nia n (ca. 1706): an impairment in the voice;
resistance for the restoration difficulty in speaking
dowel core crown: see POST-CORE CROWN dys.pla.sia n (ca. 1923): abnormality of development—see
dowel crown obs: see DAVIS CROWN, RICHMOND MANDIBULAR D, MAXILLOMANDIBULAR D
CROWN dys.to.nia n: acute irregular tonic muscular spasms, often
dowel pin: a metal pin used in stone casts to remove die with contortions of the tongue, jaw, eyes, neck, and
sections and replace them accurately in the original position sometimes the entire body
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Glossary of Prosthodontic Terms
electromyographic biofeedback: an instrumental process empty mouth movement: voluntary or reflex movements
that helps patients learn control over muscle tension levels of the mandible when not engaged in incision or mastication
previously under automatic control en.am.el n (15c): in dentistry, the hard, thin, translucent layer
elec.tro.my.og.ra.phy n (1948): the graphic recording of the of calcified substance that envelopes and protects the dentin
electrical potential of muscle—see NOCTURNAL E of the coronal aspect of the tooth; it is the hardest substance
elec.tron n (1891): the elemental unit of electricity. A stable in the body—called also adamantine layer
elementary particle that is the negatively charged constituent enamel projection: an apical extension of enamel, usually
of ordinary matter, having a mass of about 9.11 × 10–28 g toward a furcation in the roots
(equivalent to 0.511 MeV) and a charge of about –1.602 × en.am.el.o.plas.ty n: see OCCLUSAL RESHAPING
10–19 Coulomb—called also negative electron, negatron
en.ar.thro.sis n (1634): joints with a ball and socket
electron accelerator: a device used in radiation treatment arrangement (e.g., hip)
that accelerates electrons to high energies
endodontic endosteal dental implant: a smooth and/or
electron beam therapy: treatment by electrons accelerated threaded pin implant that extends through the root canal of
to high energies by a machine such as the betatron a tooth into periapical bone and is used to stabilize a mobile
electron volt: a unit of energy equal to the energy acquired tooth
by an electron when it passes through a potential difference
endodontic pin obs: a metal pin that is placed through the
of 1 volt in a vacuum; it is equal to (1.602192 + 0.000007) ×
apex of a natural tooth into the bone to stabilize a mobile
10–19 volt. Abbreviated eV
tooth (GPT-4)—see ENDODONTIC ENDOSTEAL DENTAL
elec.tro.plat.ing vt (ca. 1864): the process of covering the IMPLANT
surface of an object with a thin coating of metal by means of
endodontic stabilizer: see ENDODONTIC ENDOSTEAL
electrolysis
DENTAL IMPLANT
elec.tro.pol.ish.ing vt: the electrolytic removal of a thin layer
en.dog.e.nous adj (1830): developing or originating within
of metal to produce a bright surface
the organism
el.e.ment (1993): any component part of a dental implant
en.do.scope n (1861): a flexible or rigid thin tube used for
abutment elevator muscle: one of the muscles that, on
examining the interior of a structure
contracting, elevate or close the mandible
endosseous blade implant: see BLADE ENDOSTEAL
e.lon.ga.tion n (14c) 1: deformation as a result of tensile force
DENTAL IMPLANT
application 2: the degree to which a material will stretch
before breaking 3: the over eruption of a tooth endosseous implant: see ENDOSTEAL DENTAL IMPLANT
em.bed.ment n (1794): the process of using a ceramic powder endosteal dental implant: a device placed into the alveolar
mixed with water to surround a glass-ceramic casting. The and/or basal bone of the mandible or maxilla and transecting
purpose of the procedure is to prevent distortion and limit only one cortical plate. The endosteal dental implant is
the shrinkage of the casting composed of an anchorage component, termed the endosteal
em.bou.chure n (1760): the position and use of the lips, dental implant body, which, ideally, is within the bone, and a
tongue, and teeth in playing a wind instrument retentive component, termed the endosteal dental implant
abutment. The dental implant abutment connects to the dental
em.bra.sure n (1702) 1: the space formed when adjacent implant body (by means of screws, thread/screw interfacing,
surfaces flair away from one another 2: in dentistry, the space compression/luting agent, etc. that can be termed elements),
defined by surfaces of two adjacent teeth; there are four passes through the oral mucosa, and serves to support and/
embrasure spaces associated with each proximal contact or retain the prosthesis (whether fixed or removable). The
area: occlusal/incisal, mesial, distal, and gingival. dental implant abutment may be for interim or definitive
em.brittle vt: to make brittle or plastic application—usage: interim abutment, definitive abutment.
emergence angle (1993): the angle of the dental implants’ Descriptions of the dental implant body or/and the dental
transitional contour determined by the surface of the implant abutment that use silhouette or geometric forms,
abutment to the long axis of the implant body such as cylinder, conical, pre-angled, angled, blade, basket,
emergence profile: the contour of a tooth or restoration, such or endodontic, may be used as adjectives to enhance
as a crown on a natural tooth or dental implant abutment, understanding of the geometry of any endosteal dental
as it relates to the adjacent tissues implant. Also, descriptive adjectives may be used to delineate
the materials from which they are made, i.e., a ceramic dental
EMG: acronym for ElectroMyoGram implant abutment. Interim or definitive dental implant
em.i.nence n (15c): a prominence or projection, especially abutments may be composed of one or more individual
one on the surface of a bone component parts, each of which is termed an element. The
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dental implant abutment element(s) usually is(are) described epoxy resin: a resin characterized by the reactive epoxy or
by means of their geometric form, function or means of ethyloxyline groups that possess unique characteristics in
adaptation, i.e., screw, coping, cylinder, lug, friction fitting, terms of adhesion to metals, woods, and glasses
pressfit. Hence multiple adjectives may be used to describe epoxy resin die: a reproduction formed in epoxy resin
both the endosteal dental implant body and abutment—see
equalisation of pressure: the act of equalizing or evenly
also BASKET EDI, BLADE EDI, DENTAL IMPLANT,
distributing pressure
ENDODONTIC EDI, EPOSTEAL DI, SCREW EDI,
TRANSOSTEAL DI equil-i-brate v-brat.ed; -brat.ing vt (1635): to bring or to
place in equilibrium
endosteal dental implant body (1998): that portion of the
dental implant that provides the anchorage to the bone equil.i.bra.tion n (1635) 1: the act or acts of placing a body
through the process of tissue integration in a state of equilibrium 2: the state or condition of being in
endosteal dental implant abutment (1998): that portion of equilibrium—usage: see MANDIBULAR E., OCCLUSAL E.
the dental implant which passes through the oral mucosa equil.i.bra.tor n (19c) obs: an instrument or device used in
and provides connection between the endosteal dental achieving or helping maintain a state of equilibrium (GPT-
implant body and the prosthesis 4)
endosteal dental implant abutment element(s) (1998): any equi.lib.ri.um (1608) 1: a state of even adjustment between
component used to secure either the dental implant abutment opposing forces 2: that state or condition of a body in which
to the dental implant body or the prosthesis to the dental any forces acting on it are so arranged that their product at
implant abutment. every point is zero 3: a balance between active forces and
end.to.end bite: see EDGE TO EDGE ARTICULATION negative resistance
end.to.end occlusion: see EDGE TO EDGE ARTICULATION e.ro.sion n (1541) 1: an eating away; a type of ulceration 2:
in dentistry, the progressive loss of tooth substance by
entrance port: the area of the surface of a patient or phantom
chemical processes that do not involve bacterial action
on which a radiation beam is incident
producing defects that are sharply defined, wedge-shaped
envelope of function: the three-dimensional space contained depressions often in facial and cervical areas—comp
within the envelope of motion that defines mandibular ABFRACTION, ABRASION, ATTRITION
movement during masticatory function and/or phonation
Essig splint (Norman S Essig, DDS, Prof of Prosthodontics,
envelope of motion: the three-dimensional space Temple University School of Dentistry]: eponym for a
circumscribed by mandibular border movements within stainless steel wire passed labially and lingually around a
which all unstrained mandibular movement occurs segment of the dental arch and held in position by individual
epithelial attachment: see JUNCTIONAL EPITHELIUM ligature wires around the contact areas of the teeth; it is used
epithelial cuff: a term used to describe the relationship to stabilize fractured or repositioned, teeth and the involved
between the mucosal and the dental implant. The use of this alveolar bone. Variously ascribed to VH Jackson, DDS, (NY),
term implies a close adherence, but not necessarily a CJ Essig, DDS, NS Essig, DDS (Pa), or WH Atkinson, DDS
biochemical attachment, between the implant and mucosa Essig CJ, ed. The American textbook of prosthetic dentistry.
ep.i.the.li.um n, pl-lia (1748): the mucosal tissue serving as Philadelphia: Lea Brothers and Co.; 1896;187:208.
the lining of the intraoral surfaces. It extends into the gingival Essig NS. Prosthetic dentistry. Brooklyn: Dental Items of Interest
crevice and adheres to the tooth at the base of the crevice—
Publishing Co.; 1937.
see CREVICULAR E, JUNCTIONAL E
es.thet.ic 1: pertaining to the study of beauty and the sense
ep.i.the.li.za.tion n (ca. 1934): the process of becoming
of beautiful. Descriptive of a specific creation that results
covered with or converted to epithelium—ep.i.the.lize vt
from such study; objectifies beauty and attractiveness and
eposteal dental implant: any dental implant that receives elicits pleasure 2: pertaining to sensation var of AESTHETIC
its primary bone support by means of resting upon the
bone—usage: a subperiosteal dental implant that conforms esthetic reshaping: modification of the surfaces of teeth to
to the superior surface of an edentulous area of alveolar bone improve appearance
is an eposteal dental implant. Any retaining screws or other es.thet.ics adj (1798) 1: the branch of philosophy dealing
elements that may secure the eposteal framework to the with beauty 2: in dentistry, the theory and philosophy that
alveolar bone and pass endosteally represent endosteal deal with beauty and the beautiful, especially with respect
dental implant components. Should the eposteal framework to the appearance of a dental restoration, as achieved through
penetrate the alveolar bone, technically, the framework its form and/or color. Those subjective and objective
becomes an endosteal dental implant—see ENDOSTEAL elements and principles underlying the beauty and
DENTAL IMPLANT, SUBPERIOSTEAL DENTAL attractiveness of an object, design or principle—see DENTAL
776 IMPLANT, TRANSOSTEAL DENTAL IMPLANT E., DENTURE E.—aes.thet.i.cal.ly adj
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Glossary of Prosthodontic Terms
Estlander’s operation [Jakob August Estlander, Finnish expansion prosthesis: a prosthesis used to expand the lateral
surgeon, 1831-1881]: eponym for a lip switch operation. A segment of the maxilla in a unilateral or bilateral cleft of the
triangular flap of tissue borrowed from the lower lip is soft and hard palates and alveolar processes
transferred to the upper lateral lip ex.po.sure n (1606) 1: the act of laying open, as a surgical or
1 etch vb, vt (1634) 1a: to produce a retentive surface, dental exposure 2: in radiology, a measure of the roentgen
especially on glass or metal, by the corrosive action of an rays or gamma radiation at a certain place based on its ability
acid 1b: to subject to such etching 2: to delineate or impress to cause ionization. The unit of exposure is the roentgen,
clearly called also exposure dose—see ROENTGEN RAY
2etch n (1896) 1: the effect or action of an etching acid on a ex.ten.sion n (15c) 1: the movement by which the two
surface 2: a chemical agent used in etching elements of any jointed part are drawn away from each other,
the process of increasing the angle between two skeletal
etch.ant n: an agent that is capable of etching a surface
levers having end-to-end articulation with each other. The
etch.ing vt (1632) 1: the act or process of selective dissolution opposite of flexion 2: in maxillofacial prosthetics, that portion
2: in dentistry, the selective dissolution of the surface of tooth of a prosthesis added to fill a defect or provide a function
enamel, metal, or porcelain through the use of acids or other not inherent in a dental restoration, e.g., palatal extension,
agents (etchants) to create a retentive surface pharyngeal extension—see SECTION
ethylene oxide: a bactericidal agent occurring as a colorless extension base removable partial denture: a removable
gas with a pleasant ethereal odor; the chemical in gas partial denture that is supported and retained by natural
sterilization system used for many items that cannot be teeth only at one end of the denture base segment and in
sterilized in a high heat system; used as a disinfectant, which a portion of the functional load is carried bythe
especially for disposable equipment residual ridge
etiologic factors: the elements or influences that can be extension bridge: see CANTILEVER FIXED PARTIAL
assigned as the cause or reason for a disease or lesion—see DENTURE
LOCAL EF, SYSTEMIC EF extension outline obs 1: the outline of the area of the entire
eti.ol.o.gy n (1555) 1: the factors implicated in the cause or basal seat of a denture 2: the outline on the surface of a cast
origin of a disease or disorder 2: the study or theory of the or mucous membrane that includes the entire area to be
factors causing disease covered by a denture (GPT-1)
evis.cer.a.tion n: removal of the viscera or contents of a cavity. external oblique ridge: a smooth ridge on the buccal surface
In ophthalmology, the removal of the contents of the eyeball, of the body of the mandible that extends from the anterior
leaving the sclera border of the ramus, with diminishing prominence,
downward and forward to the region of the mental foremen.
evul.sion n (1611): extraction; removed, usually of a sudden
This ridge changes very little in size and direction
nature throughout life
ex.am.in.a.tion n (14c): scrutiny or investigation for the ex.tir.pate vt -pat.ed; .pat.ing (1539) 1: to pull up or out to
purpose of making a diagnosis or assessment destroy completely 2: to cut out by surgery—ex.tir.pa.tion n
ex.cur.sion n (1577) 1: a movement outward and back or extracapsular ankylosis: ankylosis due to rigidity of any
from a mean position or axis; also, the distance traversed 2: structure external to the joint capsule
in dentistry, the movement occurring when the mandible extracapsular disorder: a problem associated with the
moves away from maximum intercuspation masticatory system in which the etiological factors are
ex.cur.sive adj (1673): constituting a digression; located outside of the temporomandibular joint capsule
characterized by digression ex.tra.coro.nal adj: that which is outside or external to, the
excursive movement: movement occurring when the crown portion of a natural tooth; e.g., an extracoronal
mandible moves away from maximum intercuspation preparation, restoration, partial or complete crown
ex.en.ter.a.tion n: removal of an organ. Used in connection extracoronal retainer: that part of a fixed partial denture
with the eye, an orbital exenteration denotes the removal of uniting the abutment to the other elements of a fixed partial
the entire eye and surrounding structures denture that surrounds all or part of the prepared crown
exercise prosthesis: a temporary, removable dental extraoral tracing: a tracing of mandibular movements made
prosthesis, usually without teeth and always without by means of devices that extend outside the oral cavity; a
occluding contact, used for the purpose of reconditioning tracing made outside the oral cavity
the supporting structures (especially the residual ridge) by ex.tra.ver.sion: see LABIOVERSION
means of light, intermittent biting pressure applied against ex.trin.sic adj (1613): external, extraneous, as originating
bilaterally interposed fingers from or on the outside—ex.trin.si.cal.ly adv 777
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extrinsic coloring: coloring from without; applying color to fac.ing n (1566): a veneer of any restorative material used
the external surface of a prosthesis on a natural tooth or prosthesis as a restoration to simulate
ex.tru.sion n (1540): the movement of teeth beyond the a natural tooth
natural occlusal plane that may be accompanied by a similar Farrar appliance [William B. Farrar, Alabama, US dentist]: a
movement of the supporting tissues type of occlusal device used to reposition the mandible
ex.u.date n: exuded molten material anteriorly; used in the treatment of some types of
temporomandibular disorders
F Farrar WB. A clinical outline of temporomandibular joint diagnosis
and treatment. 7th ed. Montgomery: Walker Printing Co.; 1983.
fab.ri.ca.tion n (1670): the building, making, or constructing Farrar device: C.L. Goddard includes descriptions and
of a restoration illustrations of several devices used to retract teeth and “...for
face form obs 1: the outline form of the face 2: the outline many other purposes” that are attributed to J.N. Farrar, DDS.
form of the face from an anterior view, sometimes described Farrar also is credited with various push- and pull-jacks for
geometrically as square, tapering, ovoid, or by various tooth movement, and “appliances” for moving roots forward
combinations of these basic forms (GPT-4)—see FACIAL and backward
FORM Essig CJ, ed. The American textbook of prosthetic dentistry. 1st ed.
Philadelphia: Lea Brothers and Co.; 1986. p. 153-209.
face-bow: a caliper-like instrument used to record the spatial
relationship of the maxillary arch to some anatomic reference fa.tigue: the breaking or fracturing of a material caused by
point or points and then transfer this relationship to an repeated cyclic or applied loads below the yield limit; usually
articulator; it orients the dental cast in the same relationship viewed initially as minute cracks followed by tearing and
to the opening axis of the articulator. Customarily, the rupture; termed brittle failure or fracture
anatomic references are the mandibular condyles transverse fatigue failure: fracture of a material due to cyclic loading
horizontal axis and one other selected anterior point; called and unloading characterized by fracture below its ultimate
also hingebow—see EAR-BOW, KINEMATIC F. tensile strength
face-bow fork: that component of the face-bow used to attach feeding aid: a prosthesis that closes the oral-nasal cavity
the occlusion rim to the face-bow defect, thus enhancing sucking and swallowing, and
face-bow record: the registration obtained by means of a maintains the right and left maxillary segments of infants
face-bow with cleft palates intheir proper orientation until surgery is
performed to repair the cleft—called also feeding appliance,
fac.et n (1625): a small, planar surface on any hard body—
feeding prosthesis
see WEAR FACET—usage: the French spelling of facet, facette,
has continued to confuse the profession regarding feeding appliance obs: see FEEDING AID
pronunciation feeding prosthesis obs: a prosthesis constructed for
facial adj: the surface of a tooth or other oral structure newborns with cleft palates to permit normal sucking and
approximating the face (including both the lips and cheeks) feeding—see FEEDING AID
facial augmentation implant prosthesis: an implantable feld.spar n (1757) 1: any one of a group of minerals,
biocompatible material generally laid upon an existing bony principally aluminosilicates of sodium, potassium, calcium,
area beneath the skin tissues to fill in or selectively raise or barium, that are essential constituents of nearly all
portions of the overlaying facial skin tissues to create crystalline rocks 2: a crystalline mineral of aluminum silicate
acceptable contours—called also facial implant with sodium, potassium, barium, and/or calcium; a major
facial form: the outline form of the face from an anterior constituent of some dental porcelains
view feld.spath.ic adj (ca. 1828): related to or containing feldspar;
facial moulage: a negative reproduction of the face made used especially with reference to porcelain glaze
out of attrificial stone, plaster of paris, or other similar fer.ru.e n (15c) 1: a metal band or ring used to fit the root or
materials—see COMPLETE F.M., MOULAGE, SECTIONAL crown of a tooth 2: any short tube or bushing for making a
F.M. tight joint
1fes.toon n (1630) 1: any decorative chain or strip hanging
facial profile: the outline form of the face from a lateral view
facial prosthesis: a removable prosthesis that artificially between two points 2: in dentistry, carvings in the base
replaces a portion of the face lost due to surgery, trauma, or material of a denture that simulate the contours of the natural
congenital absence—called also extraoral prosthesis dressing tissues that are being replaced by a denture
2
facial prosthetic adhesive: a material used to adhere a facial fes.toon vt (1800): to shape into festoons
778 prosthesis to the skin FGP: acronym for Functionally Generated Path
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Glossary of Prosthodontic Terms
fi.bro.in.te.gra.tion n (1982): see FIBROUS INTEGRATION Fischer’s angle [Rudolf Fischer, Swiss dentist, Zurich,
fibro.osseous integration: see FIBROUS INTEGRATION Switzerland]: eponym for the angle formed by the intersection
of the protrusive and nonworking side condylar paths as
fi.bro.sis n (1873): the formation of fibrous tissue; fibroid or
viewed in the sagittal plane
fibrous degeneration
Fischer R. Beziehungen zwischen den Kieferbewegungen und der
fi.brous adj (1626): composed of or containing fibers Kauflachenform der Zuhne. Schweizerische Monataschrift fur
fibrous adhesion: a fibrous band or structure by which parts Zahnheilkunde Zurich 1926; 74.
abnormally adhere Fischer R. Die Offnungsbewegungen des Unterkiefers und ibre
fibrous ankylosis: reduced mobility of a joint due to Wiedergabe am Atrikulator. Schweizerische Monateschrift fur
proliferation of fibrous tissue Zahnheilkunde 1935;45:867-99.
fibrous integration slang: a misnomer used to describe the fis.sure n (15c): any cleft or grove, normally present or
presence of a layer of intervening fibrous connective tissue otherwise; a cleft or deep ditch in the surface of a tooth,
between a dental implant and the adjacent bone, while no usually due to imperfect fusion of adjoining enamel lobes.
real attachment or integration has occurred between bone Distinguished from a groove or sulcus—called also enamel
and a biocompatible material fissure
field n (bef. 12c) 1: an area or open space, as an operative fissured fracture: a fracture that extends partially through
field or visual field 2: a range of specialization or knowledge, a bone with displacement of the bony fragments
study, or occupation fistula n, pl .las or .lae (14c): a pathologic sinus or abnormal
fil.ter n (1563): in radiology, a solid screen insert, usually of passage resulting from imcomplete healing; a
varying thicknesses and different metals (aluminium, communication between two internal organs or one that
copper, tin) placed to filter out photons of longer wave leads from an internal organ to the surface of a body; usually
lengths designated according to the parts it communicates with, as
oral-nasal f.
final flask closure: the last closure of a dental flask before
polymerizing, after trial packing of the mold with a fit v, fit.ted, also fit; fit.ting vt (1586) 1: to be suitable or to
restorative material be in harmony with 2a: to conform correctly to the shape or
size of 2b: to insert or adjust until correctly in place; to make
final impression: the impression that represents the or adjust to the correct size or shape, i.e., to adapt one
completion of the registration of the surface or object structure to another, as the adaptation of any dental
fine adj (13c) 1: free from impurities 2: of a metal: having a restoration to its site, in the mouth
stated proporotion of pure metal in its composition, fix vt (14c): to make firm, stable, or stationery, to attach to
expressed in parts per thousand > gold coin 0.9265 another object so that separation of the parts cannot be
fine.ness n: the proportion of pure gold in a gold alloy; the accomplished without breaking of the mechanical and/or
parts per 1000 of gold chemical bonds that hold the parts in spatial relationship
finish n (1779): to put a final coat or surface on; the with each other
refinement of form before polishing fixed adj (14c): securely placed or fastened; stationary; not
finish line n (1899) 1: a line of demarcation 2: the peripheral subject to change; immobile
extension of a tooth preparation 3: the planned junction of fixed bridge: see FIXED PARTIAL DENTURE
different materials 4: the terminal portion of the prepared fixed movable bridge obs: a fixed partial denture having
tooth one or more nonrigid connectors
fir.ing: the process of porcelain fusion, in dentistry, specially fixed partial denture: a partial denture that is luted or
to produce porcelain restorations otherwise securely retained to natural teeth, tooth roots,
first stage dental implant surgery: the initial surgical and/or dental implant abutments that furnish the primary
procedure in dental implant placement. For eposteal dental support for the prosthesis—usage: with respect to a fixed
implants, this refers to the reflection of the oral mucosa, the partial denture retained on dental implants, adjectives may
impression of the surgically exposed bone and usually an be used to describe the means of attachment, such as screw
interocclusal record made to fabricate the implant body retained f.p.d., cement retained f.p.d.—called also fixed prosthesis
followed by surgical closure. For an endosteal implant, this fixed partial denture retainer: the part of a fixed partial
refers to the reflection of the oral, mucosa and investing denture that unites the abutment(s) to the remainder of the
tissues, preparation of the implantation site (i.e., removal of restoration
alveola bone, and, occasionally, tapping), placement of the
dental implant body, and surgical closure of the overlying fixed prosthesis: see FIXED PARTIAL DENTURE
investing soft tissues—comp SECOND STAGE DENTAL fixed prosthodontics: the branch of prosthodontics
IMPLANT SURGERY concerned with the replacement and/or restoration of teeth 779
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by artificial substitutes that are not readily removed from FMA: acronym for Frankfort Mandibular plane Angle
the mouth foil n (14c): an extremely thin, pliable sheet of metal, usually
1fix.ture n: something that is fixed or attached, as a structural of variable thickness—see GOLD F., PLATINUM F., TINFOIL
part of a permanent appendage force n (14c): an agency or influence that, when exerted on a
2fix.ture substand (1982): an endosteal dental implant body— body tends to set the body into motion or to alter its present
see ENDOSTEAL DENTAL IMPLANT, IMPLANT BODY state of motion. Force applied to oany material causing
fixture cover substand (1982): the component placed over a deformation of that material—see MASTICATORY F.,
dental implant during the healing phase to prevent tissue OCCLUSAL F.
from proliferating into the internal portion of the implant forces of mastication obs: the motive force created by the
body—see COVER SCREW dynamic action of the muscles during the physiologic act of
flabby tissue obs: excessive movable tissue (GPT-4) mastication (GPT-4)
1
1
flange n (ca.1688): a rib or rim used for strength, for guiding form n (13c): the shape or configuration of anything, as
or attachment of another object—see BUCCAL F., DENTURE distinguished from its material
2form vt (13c): to give shape, to mold, to adapt
F. LABIAL F.
2
flange vt, flang.ed; flang.ing (ca. 1864): to furnish with a for.nix n, pl for for.ni.ces (1681): an anatomical arch or fold
flange forward protrusion obs: a protrusion forward of centric
flange contour obs: the design of the flange of a denture position (GPT-3)
(GPT-4) fossa n, pl fossae (1771): an anatomical pit, groove or
1flask n: a metal case or tube used in investing procedures— depression
see CASTING F., CROWN F. foveae palatinae: two small pits or depressions in the
2flask v: to flask or surround; to invest posterior aspect of the palate, one on each side of the midline,
at or near the attachment of the soft palate to the hard palate
flask closure: the procedure of bringing two halves or parts,
1frac.ture n (15c): the process or act of breaking; state of being
of a flask together—see FINAL F.C., TRIAL F.C.
broken—see AVULSION F., BLOWOUT F., CEMENTUM F.,
flask.ing vt (20c) 1: the act of investing in a flask 2: the
CLOSED REDUCTION OF AF., COMMINUTED F.,
process or investing the cast and a wax replica of the dsired
COMPLICATED F., DISLOCATED F., FISSURED F., GREEN
form in a flask preparatory to molding the restorative
STICK F., GUERIN’S F., IMPACTED F., INDIRECT F.,
material into the desired product
INTRACAPSULAR F., MIDFACIAL F., OPEN F.,
flipper obs: see INTERIM PROSTHESIS; PROVISIONAL PYRAMIDAL F., ROOT F., SECONDARY F., SIMPLE F.,
PROSTHESIS SPONTANEOUS F., SUBCONDYLAR F., SUBPERIOSTEAL
flowable composite resin (1998): composite resin that is less F.
highly filled than conventional composite resin and has 2frac.ture v, frac.tured; frac.tur.ing vt (1612): to cause a
improved wettability fracture in; to break, rupture, or tear
flu.o.res.cence n (1852): a process by which a material fracture strength: strength at fracture based on the original
absorbs radiant energy and emits it in the form of radiant dimensions of the specimen
energy of a different wave length band, all or most of whose frame.work n (1644): the skeletal portion of prosthesis
wave lengths exceed that of the absorbed energy. (usually metal) around which and to which are attached the
Fluorescence, as distinguished from phosphorescence, does remaining portions of the prosthesis to produce a finished
not persist for an appreciable time after the termination of restoration
the excitation process
Frankfort mandibular plane angle: eponym for the angle
flu.o.res.cent adj (1853): having or relating to fluorescence formed by the intersection of the Frnakfort horizontal plane
fluoride gel carrier (20c): a device that covers the teeth and with the mandibular plane
is used to apply topical fluoride in close proximity to tooth Frankfort horizontal plane 1: eponym for a plane established
enamel and dentin for several minutes daily—syn by the lowest point in the margin of the right or left bony
FLUORIDE APPLICATOR orbit and the highest point in the margin of the right or left
flux n (14c) 1: in physics, the rate of flow of a liquid, particles bony auditory meatus 2: a horizontal plane represented in
or energy 2: in ceramics, an agent that lowers the fusion profile by a line between the lowest point on the margin of
temperature of porcelain 3: in metallurgy, a substance used the orbit to the highest point on the margin of the auditory
to increase fluidity and to prevent or reduce oxidation of a meatus; adopted at the 13th General Congress of German
molten metal 4: any substance applied to surfaces to be joined Anthropologists (the “Frankfort Agreement”) at Frankfort
by brazing, soldering or welding to clean and free them from am Main, 1882, and finally by the International Agreement
780 oxides and promote union for the Unification of Craniometric and Cephalometric
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Measurements in Monaco in 1906; called also auriculo-orbital fulcrum line of a removable partial denture: a theoretical
plane, eye-ear plane, Frankfort horizontal (FH), Frankfort line around which a removable partial denture tends to rotate
horizontal line full denture: see COMPLETE DENTURE
Frankfort plane: see FRANKFORT HORIZONTAL PLANE full denture prosthetics obs 1: the replacement of the natural
free gingiva: the part of the gingiva that surrounds the tooth teeth in the arch and their associated parts by artificial
and is not directly attached to the tooth surface substitutes 2: the art and science of the restoration of an
free gingival margin: the unattached gingiva surrounding edentulous mouth (GPT-4)—see COMPLETE DENTURE
the teeth in a collar-like fashion and demarcated from the PROSTHODONTICS
attached gingiva by a shallow linear depression, termed the full thickness graft: a transplant of epithelium consisting
free gingival groove of skin or mucous membrane with a minimum of
free mandibular movement 1: any mandibular movement subcutaneous tissue
made without interference 2: any uninhibited movement of full veneer crown: see COMPLETE CROWN
the mandible
fully adjustable articulator: an articulator that allows
free support obs: support that does not permit translation replication of three dimensional movement of recorded
of the beam perpendicular to its axis and presumably offers mandibular motion—called also Class IV articulator
no restraint to the tendency of the beam to rotate at the
fully adjustable gnathologic articulator: an articulator that
support (GPT-4)
allows replication of three dimensional movement plus
freedom in intercuspal position: see INTERCUSPAL timing of recorded mandibular motion—called also Class IV
CONTACT AREA articulator
freeway space obs: see INTEROCCLUSAL REST SPACE functional articulation: the occlusal contacts of the maxillary
frem.i.tus n (1879): a vibration perceptible on palpation; in and mandibular teeth during mastication and deglutition
dentistry, a vibration palpable when the teeth come into
functional chew.in record obs: a record of the movements
contact
of the mandible made on the occluding surface of the
fren.u.lum n, pl -la (1706): a connecting fold of membrane opposing occlusion rim by teeth or scribing studs and
serving to support or retain a part produced by simulated chewing movements (GPT-4)
fren.um n, pl fren.ums or fre.na: see FRENULUM functional dislocation: dislocation of the articular disk of
frictional attachment: a precision or semiprecision the condyle due to a seriously impaired disk-condyle
attachment that achieves retention by metal to metal contact, complex function
without springs, clips or other mechanical means of functional jaw orthopedics: use of orthodontic appliances
retention—see PRECISION ATTACHMENT that rely on the patient’s own musculature for force
friction retained pin: a metal rod driven into a hole drilled application and that attempt to alter the skeletal structure
into dentin to enhance retention; retained solely by dentinal of the face
elasticity
functional mandibular movements: all normal, proper, or
1frit n (1662) 1: the calcined or partly fused matter of which
characteristic movements of the mandible made during
glass is made 2: a mass of fused porcelain obtained by firing speech, mastication, yawning, swallowing, and other
the basic constituents and plunging them into water while associated movements
hot. The frit is ground to make porcelain powders
2frit vt fri.tted; frit.ing (1805) 1: to prepare substances for functional occlusal harmony obs: the occlusal relationship
of opposing teeth in all functional ranges and movements
glass by heating; to fuse 2: to convert into a frit
that will provide the greatest masticatory efficiency without
frontal plane: any plane parallel with the long axis of the causing undue strain or trauma on the supporting tissues
body and at right angles to the median plane, thus dividing (GPT-4)
the body into front and back parts. So called because this
functional occlusion obs: the contacts of the maxillary and
plane roughly parallels the frontal suture of the skull
mandibular teeth during mastication and deglutition
fulcrum line 1: a theoretical line passing through the point (GPT-4)
around which a lever functions and at right angles to its
functional record: a record of lateral and protrusive
path of movement 2: an imaginary line, connecting occlusal
movements of the mandible made on the surface on an
rests, around which a removable partial denture tends to
rotate under masticatory forces. The determinants for the occlusion rim or other recording surface
fulcrum line are usually the cross arch occlusal rests located functional occlusion splint: a device that directs the
adjacent to the tissue borne components—see F.L. OF A movements of the mandible by controlling the plane and
REMOVABLE PARTIAL DENTURE, RETENTIVE F.L. range of motion
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Glossary of Prosthodontic Terms
pain, burning, itching, and stinging of the mucosa of the grinding.in obs: a term used to denote the act of correcting
tongue, without noticeable lesions; called also burning occlusal disharmonies by grinding the natural or artificial
tongue teeth (GPT-1)—see OCCLUSAL RESHAPING
gnath.ic adj (1882): of or pertaining to the jaw or cheek groove n: a long narrow channel or depression, such as the
gnath.i·on n: the lowest bony point, in the median plane of indentation between tooth cusps or the retentive features
the mandible placed on tooth surfaces to augment the retentive
characteristics of crown preparations
gnatho.dy.na.mom.e.ter n 1: an instrument for measuring
the force exerted in closing the jaws 2: an instrument used group function: multiple contact relations between the
maxillary and mandibular teeth in lateral movements on
for measuring biting pressure
the working side whereby simultaneous contact of several
gnath.ol.o.gy n: the science that treats the biology of the teeth acts as a group to distribute occlusal forces
masticatory mechanism as a whole: that is, the morphology,
groove n (1998): a long narrow channel or depression, such
anatomy, histology, physiology, pathology, and the
as the indentation between tooth cusps or the retentive
therapeutics of the jaws or masticatory system and the teeth
features placed on tooth surfaces to augment retention and
as they relate to the health of the whole body, including
resistance characteristics of crown preparations
applicable diagnostic, therapeutic, and, rehabilitation
procedures Guerin’s fracture [Alphonse Francois Marie Guerin, French
surgeon, 1816-1895]: eponym—see LE FORT I FRACTURE
Goddard’s linear occlusion [William H. Goddard, Louisville,
Kentucky, US dentist, 1808-1883]: see LINEAR OCCLUSION guid.ance n (1590) 1: providing regulation or direction to
movement; a guide 2: the influence on mandibular
gold foil 1: pure gold rolled into extremely thin sheets 2: a
movements by the contacting surfaces of the maxillary and
precious metal foil used in restoration of carious or fractured
mandibular anterior teeth 3: mechanical forms on the lower
teeth
anterior portion of an articulator that guide movements of
gothic arch tracer obs: the device that produces a tracing its upper member—see ADJUSTABLE ANTERIOR G.,
that resembles an arrowhead or a gothic arch. The device is ANTERIOR GUIDANCE, CONDYLAR G.
attached to the opposing arches. The shape of the tracing
guide pin: the component of a dental implant system that is
depends on the relative location of the marking point and
placed within the surgically prepared osseous site for an
the tracing table. The apex of a properly made tracing is
endosteal implant. It assists in determination of location and
considered to indicate the most retruded, unstrained relation
angulation of the site relative to other soft tissue or bony
of the mandible to the maxillae, i.e., centric relation (GPT- landmarks
4)—see CENTRAL BEARING TRACING DEVICE
guide plane obs 1: the plane developed in the occlusal
gothic arch tracing: see CENTRAL BEARING TRACING
surfaces of the occlusion rims (viz. to position the mandible
graft n (14c): a tissue or material used to repair a defect or in centric relation) 2: a plane which guides movement
deficiency—see ALLOGRAFT, ALLOPLASTIC G., (GPT-4)
AUTOGENOUS G., AUTOGRAFT, FULL THICKNESS G.,
guide table: the anterior element of an articulator on which
HETEROGRAFT. HOMOGRAFT, ISOGRAFT, SPLIT- the incisal pin rests. It may be custom contoured or
THICKNESS G., XENOGENIC G. mechanically adjusted—see ANTERIOR G.T.
Grassman’s laws [author unknown]: eponym for three guided tissue regeneration: any procedure that attempts to
empirical laws that describe the color-matching properties regenerate lost periodontal structures through differential
of additive mixtures of color stimuli 1: to specify a color tissue responses. Barrier techniques, using synthetic
match, three independent variables are necessary and materials that may or may not resorb, to exclude epithelial
sufficient 2: for an additive mixture of color stimuli, only in growth that is believed to intefere with regeneration
their tri-stimulus values are relevant, not their spectral
guiding occlusion obs: used in the sense of designating
compositions 3: in an additive mixture of color stimuli, if
contacts of teeth in motion (GPT-4)
one or more components of the mixture are gradually
changed the resulting tri-stimulus values also change guiding planes: vertically parallel surfaces on abutment
gradually. (Laws do not hold for all observing conditions) teeth oriented so as to contribute to the direction of the path
of placement and removal of a removable partial denture
GRAY: a unit of absorbed radiation dose equal to 100 RADS.
Abbreviated Gy guiding surfaces: see GUIDING PLANES
greenstick fracture n (1885): a fracture inwhich the break in gum contour obs: form of supporting structures of the teeth
the bone is not complete. The bone appears to be bent on or of the flanges of dentures around the teeth (GPT-1)
one side while the other side of the bone is broken gums n, obs: the fibrous and mucosa covering of the alveolar
Griffith flaws: eponym—see MICROCRACK process or ridges (GPT-4)—see GINGIVA 783
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Gunning’s splint [Thomas Brian Gunning, English-born hemi.glos.sec.to.my n: resection of one side of the tongue
American dentist, 1813-1889]: eponym for a device fabricated hemi.sec.tion n: the surgical separation of a multirooted
from casts of edentulous maxillary and mandibular arches tooth, especially a mandibular molar, through the furcation
to aid in reduction and fixation of a fracture. His initial work in such a way that a root and the associated portion of the
described four types of splints used in treating jaw fractures crown may be removed
(1866-67), which allowed openings for saliva flow,
heterograft n: a graft taken from a donor of another species—
nourishment, and speech—called also occlusal splint
called also xenograft
Fraser-Moodie W. Mr. Gunning and his splint. Br J Oral Surg
1969;7:112-5. heterotopic pain: a general term designating pain felt in an
area other than the true originating site
gus.ta.tion n (1599): the act of perceiving taste
high lip line: the greatest height to which the inferior border
gyp.sum n (14c): the natural hydrated form of calcium of the upper lip is capable of being raised by muscle function
sulfonate, CaSO42H2O gypsum dihydrate
hinge axis: see TRANSVERSE HORIZONTAL AXIS
H hinge axis of the mandible: see TRANSVERSE
HORIZONTAL AXIS
habitual centric: see MAXIMAL INTERCUSPAL POSITION
hinge axis point: see POSTERIOR REFERENCE POINTS
habitual occlusion: see MAXIMAL INTERCUSPAL
hinge bow: see KINEMATIC FACE-BOW
POSITION
Hader bar [after the Swiss dental laboratory technician, hinge joint: a ginglymus joint; a joint that allows motion
Helmut Hader]: eponym for a rigid bar connecting two or around one axis
more abutments, which, when viewed in cross section, hinge movement: see TRANSVERSE HORIZONTAL AXIS
resembles a keyhole, consisting of a rectangular bar with a
rounded superior (occlusal) ridge that creates a retentive hinge position obs: the orientation of parts in a manner
undercut for the female clip within the removable prosthesis permitting hinge movement between them (GPT-4)
Breim SL, Renner RP. An overview of tissue bars. Gen Dent 1982:406- homograft n (1923): a graft taken from one human and
15. transplanted to another—called also allograft
hamular notch: see PTERYGOMAXILLARY NOTCH horizontal axis of the mandible: see TRANSVERSE
Hanau’s quint [Rudolph L. Hanau, (1881-1930) Buffalo, New HORIZONTAL AXIS
York, US engineer, born Capetown, South Africa]: rules for horizontal plane: any plane passing through the body at
balanced denture articulation including incisal guidance, right angles to both the median and frontal planes, thus
condylar guidance, cusp length, the plane of occlusion, and dividing the body into upper and lower parts; in dentistry,
the compensating curve described by Rudolph Hanau in the plane passing through a tooth at right angles to its long
1926 axis
Hanau R. Articulation defined, analyzed, and formulated. J Am horizontal plane of reference: a horizontal plane established
Dent Assoc 1926;13:1694-709 on the face of the patient by one anterior reference point
hard palate: the bony portion of the roof of the mouth and two posterior reference points from which
healing abutment: see INTERIM ENDOSTEAL DENTAL measurements of the posterior anatomic determinants of
IMPLANT ABUTMENT occlusion and mandibular motion are made
healing component: see INTERIM ENDOSTEAL DENTAL horizontal overlap: the projection of teeth beyond their
IMPLANT ABUTMENT antagonists in the horizontal plane
healing screw: the component of an endosteal dental implant horizontal reference plane: see HORIZONTAL PLANE OF
system used to seal, usually on an interim basis, the dental REFERENCE
implant body during the healing phase after surgical
placement. The purpose of the healing screw is to maintain horseshoe plate obs: a horseshoe or V-shaped removable
patency of the internal threaded section for subsequent prosthesis
attachment of the abutment during the second stage surgery host site: see RECIPIENT SITE
heel n: see DISTAL hue n (bef. 12c): often referred to as the basic color, hue is
height of contour: a line encircling a tooth and designating the quality of sensation according to which an observer is
its greatest circumference at a selected axial position aware of the varying wave lengths of radiant energy. The
determined by a dental surveyor; a line encircling a body dimension of color dictated by the wave length of the
designating its greatest circumference in a specified plane stimulus that is used to distinguish one family of color from
784
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Glossary of Prosthodontic Terms
another—as red, green, blue, etc. The attribute of color by hy.per.na.sal.i.ty n: a perceived voice quality in which the
means of which a color is perceived to be red, yellow, green, nasa cavity acts as a resonating cavity for non-nasal sounds.
blue, purple, etc. White, black, and grays possess no hue Generally associated with palatopharyngeal inadequacy
Munsell AH. A color notation. Baltimore: Munsell Color Co. Inc.; hy.per.os.mia n: abnormally increased sensitivity to odors
1975. p. 14-6. hy.per.pla.sia n (1861): the abnormal multiplication or
hunk bite obs: see INTEROCCLUSAL RECORD increase in the number of normal cells in normal
arrangement in a tissue
hybrid 1: anything of mixed origin 2: offspring of two plants
or animals of different genus or species hyperplastic tissue: excessive tissue proliferation, usually
as a response to chronic irritation
hybrid denture: slang for any modification or alteration in
the usual form of a dental prosthesis hy.per.tro.phy n (1834): an enlargement or overgrowth of
an organ or tissue beyond that considered normal as a result
hybrid ionomer: conventional glass ionomer that has been
of an increase in the size of its constituent cells and in the
modified to include methacrylate groups in the liquid absence of tumor formation
component. It may contain photoinitiators. Setting is by an
acid-base reaction with light and dual cure polymerization— hypertrophy of the coronoid process: pathologic growth of
syn—RESIN-MODIFIED GLASS IONOMER the coronoid process of the mandible after normal growth
has ended—called also osteoma of the coronoid process
hybrid prosthesis: slang for a nonspecific term applied to
hy.po.don.tia n: congenital absence of one or more, but not
any prosthesis that does not follow conventional design.
all of the normal complement of teeth
Frequently it is used to describe a prosthesis that is composed
of different materials, types of denture teeth (porcelain, hy.po.es.the.sia n: diminished sensitivity to stimulation
plastic, composite), variable acrylic denture resins, differing hy.po.geu.sia n: diminished acuteness of the sense of taste—
metals or design, etc. It may refer to a fixed partial denture called also hypogensesthesia
or any removable prosthesis hy.po.na.sal.i.ty n: reduced nasal resonance usually from
hydrocolloid n (1916): a colloid system in which water is obstruction in the nasopharynx or nasal passages resulting
the dispersion medium; those materials described as a in an alteration of m, n, and -ng sounds
colloid solution with water that are used in dentistry as hy.po.pla.sia n (1889): defective or incomplete development
elastic impression materials—see IRREVERSIBLE H., of an organ or tissue
REVERSIBLE H.
hydroxyapatite ceramic: a composition of calcium and I
phosphate in physologic ratios to provide a dense,
nonresorbable, biocompatible ceramic used for dental i.at.ro.gen.ic adj (1924): resulting from the activity of the
implants and residual ridge augmentation clinician applied to disorders induced in the patient by the
hygienic pontic: a pontic that is easier to clean because it clinician
has a domed or bullet shaped cervical form and does not I.bar clasp: see CLASP
overlap the edentulous ridge id.io.path.ic adj (1669): self-originated; of unknown
hygroscopic expansion: expansion due to the absorption of causation
moisture idling condyle: see NONWORKING SIDE CONDYLE
hyp.al.ge.sia n: diminished sensitivity to pain il.lu.mi.nance n (ca. 1938) 1: density of luminous flux on a
hy.per.ac.tiv.i.ty n (1867): excessive motor activity. It is surface 2: luminous flux incident per unit area of a surface
frequently, but not necessarily, associated with internal il.lu.mi.nant adj (15c): mathematical description of the
tension or a neurologic disorder. Usually the movements relative spectral power distribution of a real or imaginary
are more rapid than customary for the person light source that is, the relative energy emitted by a source
hy.per.al.ges.ia n: increased sensitivity or sensibility to at each wave length in its emission spectrum—see CIE
pain—see PRIMARY H. STANDARD ILLUMINANT
hyperbaric chamber: an area in which a patient may be immediate denture: a complete denture or removable partial
subjected to pressure of ambient gases greater than denture fabricated for placement immediately following the
1 atmosphere removal of natural teeth
hyperbaric oxygenation: the administration of oxygen immediate disocclusion: instantaneous separation of the
under greater than atmospheric pressure; called also posterior teeth due to the anterior guidance
hyperbaric oxygen therapy immediate insertion denture: see IMMEDIATE DENTURE
hy.per.ce.men.to.sis n: an excessive deposition of cementum immediate lateral translation: see IMMEDIATE
hy.per.es.the.sia n (1849): increased sensitivity to stimulation MANDIBULAR LATERAL TRANSLATION 785
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immediate loading: placing full occlusal/incisal loading implant connecting bar slang: usage—a connecting bar is
upon dental implant not an implantable device. It receives support and stability
immediate mandibular lateral translation: the translatory from the dental implant(s)
portion of lateral movement in which the nonworking side implant crown slang: see DENTAL IMPLANT, CROWN
condyle moves essentially straight and medially as it leaves usage—a crown or fixed partial denture is not an implantable
the centric relation position—see also EARLY device. The prosthesis receives support and stability from
MANDIBULAR LATERAL TRANSLATION; PROGRESSIVE the dental implant, implant dentistry (1993): the selection,
MANDIBULAR LATERAL TRANSLATION planning, development, placement, and maintenance of
immediate obturator: see SURGICAL OBTURATOR restoration(s) using dental implants
immediate replacement denture: see IMMEDIATE implant denture slang: see DENTAL IMPLANT, DENTURE
usage—a denture is not an implantable device. The prosthesis
DENTURE
(fixed partial denture, removable partial denture, complete
immediate side shift: see IMMEDIATE MANDIBULAR denture) may be supported and retained in part or whole
LATERAL TRANSLATION by dental implants
immediate temporary obturator: see SURGICAL implant fixture: see IMPLANT BODY
OBTURATOR
implant infrastructure slang: usage—while a dental implant
impacted fracture: a fracture in which one fragment is body may have an infrastructure, the proper geometric
driven into another portion of the same or an adjacent bone reference to such an ara of the implant is referenced relative
1
im.plant v (1890): to graft or insert a material such as an to the long axis of the body, in this case, the inferior portion
alloplastic substance, an encapsulated drug, or tissue into of the dental implant
the body of a recipient implant interface: the junction of the surface of a dental
2 im.plant n(1809): any object or material, such as an implant and the surrounding host tissues—see FIBROUS
alloplastic substance or other tissue, which is partially or INTEGRATION, OSSEOUS INTEGRATION
completely inserted and grafted into the body for implant loading: see AXIAL LOADING
therapeutic, diagnostic, prosthetic and experimental
purposes—see DENTAL IMPLANT implant prosthesis: any prosthesis (fixed, removable or
maxillofacial) that utilizes dental implants in part or whole
implant abutment: the portion of a dental implant that for retention, support, and stability
serves to support and/or retain any prosthesis—usage:
implant prosthodontics: the phase of prosthodontics
frequently dental implant abutments, especially those used
concerning the replacement of missing teeth and/or
with endosteal dental implants, are changed to alter
associated structures by restorations that are attached to
abutment design or use before a definitive prosthesis is
dental implants
fabricated. Such a preliminary abutment is termed an interim
abutment. The abutment chosen to support the definitive implant substructure: the metal framework of an eposteal
prosthesis is termed a definitive abutment. Dental implant dental implant that is embedded beneath the soft tissues, in
abutments may be described by the form (i.e., cylindrical contact with the bone, and stabilized by means of endosteal
barrel), material (i.e., ceramic, titanium) or special design screws. The periosteal tissues retain the framework to the
factors (i.e., internal hex lock, external hex lock, spline) bone. The framework supports the prosthesis, frequently by
means of abutments and other superstructure components—
implant attachment 1: slang expression for the means of see IMPLANT BODY
retention of the dental implant abutment to the dental
implant body 2: the biochemical/mechanical interconnection implant surgery (1993): the phase of implant dentistry
between the dental implant and the tissues to which it is concerning the selection, planning, and placement of the
implant body and abutment
attached
implant system (1993): dental implant components that are
implant body: the portion of a dental implant that provides
designed to mate together. An implant system can represent
support for the abutment(s) through adaptation upon
a specific concept, inventor, or patent. It consists of the
(eposteal), within (endosteal), or through (transosteal) the
necessary parts and instruments to complete the implant
bone—usage: an eposteal dental implants’ support system
body placement and abutment components
has, heretofore, been termed the implant frame, implant
framework, or implant substructure; however, this is an integral im.plan.tol.o.gy obs: a term historically conceived as the
component of that dental implant form and is not subservient study or science of placing and restoring dental implants—
to any other component—see DENTAL IMPLANT, see IMPLANT DENTISTRY, IMPLANT SURGERY,
ENDOSTEAL DENTAL IMPLANT, EPOSTEAL DENTAL IMPLANT PROSTHODONTICS
IMPLANT, TRANSOSTEAL DENTAL IMPLANT im.ple.ment n: see DEVICE
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Glossary of Prosthodontic Terms
im.pres.sion n (14c): a negative likeness or copy in reverse incisal rest: a rigid extension of a removable partial denture
of the surface of an object; an imprint of the teeth and adjacent that contacts a tooth at the incsal edge
structures for use in dentistry—see ALTERED CAST incisal restoration: any restoration extending along the
PARTIAL DENTURE I., DENTAL I., DIRECT BONE I., I. incisal edge of a tooth
AREA, I. MATERIAL, I. TRAY, MASTER I., PARTIAL
incisive foramen: a foramen located in the midline on the
DENTURE I., PRELIMINARY I., SECTIONAL I., TUBE I.
anterior of the hard palate. It transmits the nasopalatine
impression area: the surface that is recorded in an nerves and vessels—called also nasopalatine foramen
impression
incisive papilla: the elevation of soft tissue covering the
impression coping (1998): any device that registers the foramen of the incisive or nasopalatine canal
position of the dental implant body or dental implant inclined plane: any of the inclined cuspal surfaces of a tooth
abutment relative to adjacent structures; most such devices
are indexed to assure reproducible three-dimensional incomplete cleft palate: a cleft involving only a part of the
location hard or/and soft palate
impression compound slang: see MODELING PLASTIC I.C. in.co.or.di.na.tion n (1876): inability to move in a smooth,
controlled, symmetrical movement
impression coping: the component of a dental implant
system that is used to provide a spatial relationship of an in.dex n (1571): a core or mold used to record or maintain
endosteal dental implant to the alveolar ridge and adjacent the relative position of a tooth or teeth to one another, to a
dentition or other structures. Impression copings can be cast, or to some other structure
retained in the impression or may require a transfer from indirect fracture: a fracture at a point distant from the
intraoral usage to the impression after attaching the analog primary site of injury due to secondary forces
or replicas indirect pulp capping: a procedure that seeks to stimulate
impression material: any substance or combination of formation of reparative dentin by placing a material over
substances used for making an impression or negative sound or carious dentin
reproduction indirect retainer: the component of a removable partial
impression surface obs: the portion of the denture surface denture that assists the direct retainer(s) in preventing
that has its contour determined by the impression (GPT-4)— displacement of the distal extension denture base by
see IMPRESSION AREA functioning through lever action on the opposite side of the
fulcrum line when the denture base moves away from the
impression technique obs: a method and manner used in
tissues in pure rotation around the fulcrum line
making a negative likeness (GPT-4)
indirect retention: the effect achieved by one or more indirect
impression tray 1: a receptacle into which suitable
retainers of a removable partial denture that rerduces the
impression material is placed to make a negative likeness 2:
tendency for a denture base to move in an occlusal direction
a device that is used to carry, confine, and control impression
or rotate about the fulcrum line
material while making an impression
in.du.rate vb -rat.ed; -rat.ing (1538): to make hard—
impression wax: see DENTAL IMPRESSION WAX
in.du.ra.tion n—in.du.ra.tive adj
incisal guidance 1: the influence of the contacting surfaces
in.du.rat.ed adj (1604): having become firm or hard,
of the mandibular and maxillary anterior teeth on
especially by an increase in fibrous elements
mandibular movements 2: the influence of the contacting
surfaces of the guide pin and guide table on articulator in.fra.bulge n: that portion of the crown of a tooth apical to
movements the survey line
incisal guide obs: the part of an articulator that maintains infrabulge clasp: a removable partial denture retentive clasp
the incisal guide angle (GPT-4)—see ANTERIOR GUIDE that approaches the retentive undercut from a cervical or
TABLE infrabulge direction
incisal guide angle 1: anatomically, the angle formed by the in.fra.erup.tion n: failure in eruption of a tooth to the
intersection of the plane of occlusion and a line within the established plane of occlusion
sagittal plane determined by the incisal edges of the in.fra.oc.clu.sion n: malocclusion in which the occluding
maxillary and mandibular central incisors when the teeth surfaces of teeth are below the normal plane of occlusion
are in maximum intercuspation 2: on an articulator, that infrared radiation: electromagnetic radiation of wave
angle formed, in the sagittal plane, between the plane of lengths between 760 nm and 1000 nm
reference and the slope of the anterior guide table, as viewed in.fra.struc.ture n: a metal framework onto which a second
in the sagittal plane framework or prosthesis will be placed
incisal guide pin: see ANTERIOR GUIDE PIN ingot n: 1: a mold in which metal is cast 2: a mass of metal
incisal guide table: see ANTERIOR GUIDE TABLE cast into a shape convenient for storage and measure that 787
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can be remelted for later casting intercuspal position: see MAXIMAL INTERCUSPAL
initial occlusal contact: the first or initial contact of opposing POSITION
teeth in.ter.cus.pa.tion n, obs: the interdigitation of cusps of
injection molding: the adaptation of a plastic material to opposing teeth (GPT-4)
the negative form of a closed mold by forcing the material in.ter.den.tal adj: between the proximal surfaces of the teeth
into the mold through appropriate gateways—see within the same arch
COMPRESSION MOLDING
interdental papilla: a projection of the gingiva filling the
in.lay n (1667): a fixed intracoronal restoration; a dental
space between the proximal surfaces of two adjacent teeth
restoration made outside of a tooth to correspond to the form
of the prepared cavity, which is then luted into the tooth interdental space: see DIASTEMA, INTERARCH
DISTANCE and INTERPROXIMAL SPACE
inlay wax: see CASTING WAX
interdental splint: a splint for treatment of fractures and
in.ser.tion vb: see PLACEMENT
consisting of metal or acrylic resin prostheses wired to the
instantaneous axis of rotation: the hypothetical center of teeth in the maxilla and mandible and joined to keep the
rotation of a moving body, viewed in a given plane, at any segments immovable—see GUNNING’S SPLINT
point in time; for any body that has planar motion, there
interdigitated occlusion: see MAXIMAL INTERCUSPAL
exists, at any instant, some points that have zero velocity
POSITION
and will be fixed at a given instant. The line joining these
points is the instantaneous axis of rotation. The intersection in.ter.dig.i.ta.tion n: see MAXIMAL INTERCUSPAL
of this line with the plane of motion is called the POSITION
instantaneous center of rotation in.ter.fer.ence n (1783): in dentistry, any tooth contacts that
in.stru.ment n: a tool or implement, especially one used for interfere with or hinder harmonious mandibular movement
delicate work or for artistic or scientific purposes—see interim denture: see INTERIM PROSTHESIS
DEVICE interim endosteal dental implant abutment: any dental
in.tagl.io n, pl -ios (1644) 1: an incised or engraved figure in implant abutment used for a limited time to assist in healing
stone or any hard material depressed below the surface of or modification of the adjacent tissues
the material such that an impression from the design would interim obturator: a prosthesis that is made several weeks
yield an image in relief 2: something carved in intaglio or months following the surgical resection of a portion of
intaglio surface: the portion of the denture or other one or both maxillae. It frequently includes replacement of
restoration surface that has its contour determined by the teeth in the defect area. This prosthesis, when used, replaces
impression; the interior or reversal surface of an object the surgical obturator that is placed immediately following
integration: see FIBROUS I., OSSEOUS I., TISSUE I. the resection and may be subsequently replaced with a
definitive obturator.
interalveolar space: see INTERARCH DISTANCE
interarch distance: the interridge distance; the vertical interim ocular prosthesis: an interim replacement generally
distance between the maxillary and mandibular dentate or made of clear acrylic resin for an eye lost due to surgery or
edentate arches under specified conditions—see REDUCED trauma. No attempt is made to reestablish esthetics—syn
I.D. CONFORMER EYE SHELL, SHELL
interarch expansion device: see TRISMUS APPLIANCE interim platal lift prosthesis: see PALATAL LIFT
PROSTHESIS
interceptive occlusal contact: see DEFLECTIVE OCCLUSAL
CONTACT interim prosthesis: a fixed or removable prosthesis, designed
to enhance esthetics, stabilization and/or function for a
in.ter.con.dy.lar adj: situated between two condyles
limited period of time, after which it is to be replaced by a
intercondylar axis: see CONDYLAR AXIS definitive prosthesis. Often such prostheses are used to assist
intercondylar distance: the distance between the rotational in determination of the therapeutic effectiveness of a specific
centers of two condyles or their analogues treatment plan or the form and function of the planned for
intercuspal contact: the contact between the cusps of definitive prosthesis—syn PROVISIONAL PROSTHESIS,
opposing teeth PROVISIONAL RESTORATION
intercuspal contact area: the range of tooth contacts in interlock n (1874): a device connecting a fixed unit or a
maximum intercuspation removable prosthesis to another fixed unit
intercuspal occlusion: see MAXIMAL INTERCUSPAL intermaxillary relation: see MAXILLOMANDIBULAR
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Glossary of Prosthodontic Terms
intermediary jaw movement obs: all movements between intracapsular fracture: a fracture of the condyle of the
the extremes of mandibular excursions (GPT-3) mandible occurring within the confines of the capsule of
the temporomandibular joint—called also intraarticular
intermediate abutment: a natural tooth located between
fracture
terminal abutments that serve to support a fixed or
removable prosthesis in.tra.con.dy.lar adj: within the condyle
internal attachment: see PRECISION ATTACHMENT in.tra.cor.o.nal adj1: within the confines of the cusps and
normal proximal/axial contours of a tooth 2: within the
internal connector: a nonrigid connector of varying normal contours of the clinical crown of a tooth
geometrical designs using a matrix to unite the members of
in.tra.mu.co.sal adj: situated, formed by, or occurring within
a fixed partial denture
the mucosa
internal derangement: with respect to the
intramucosal implant: see MUCOSAL INSERT
temporomandibular joint, a deviation in position or form
of the tissues within the capsule of the temporomandibular intramucosal insert: see MUCOSAL INSERT
joint; an abnormal relationship of the disk to the condyle, in.tra.or.al adj: within the mouth
fossa, and/or eminence intraoral tracing: a tracing made within the oral cavity—
internal rest: see PRECISION REST see ARROW POINT TRACING
interocclusal adj: between the occlusal surfaces of opposing in.tra.os.seo.us n: within bone
teeth intrinsic coloring: coloring from within; the incorporation
interocclusal clearance 1: the arrangement in which the of a colorant within the material of a prosthesis or restoration
opposite occlusal surfaces may pass one another without in.tru.sion vb: movement of a tooth in an apical direction
any contact 2: the amount of reduction achieved during tooth
invariant color match: a perfect color match under all light
preparation to provide for an adequate thickness of
conditions
restorative material
inverted cusp tooth obs: a nonanatomic posterior porcelain
interocclusal distance: the distance between the occluding
denture tooth that had circular indentations where cusps
surface of the maxillary and mandibular teeth when the
would normally be located
mandible is in a specified position
in.vest vb: to surround, envelop, or embed in an investment
interocclusal gap obs: see INTEROCCLUSAL DISTANCE
material—see VACUUM INVESTING
interocclusal record: a registration of the positional
in.vest.ing v: the process of covering or enveloping, wholly
relationship of the opposing teeth or arches; a record of the
or in part, an object such as a denture, tooth, wax form,
positional relationship of the teeth or jaws to each other
crown, etc. with a suitable investment material before
interocclusal rest space: the difference between the vertical processing, soldering, or casting
dimension of rest and the vertical dimension while in
in.vest.ment n: see DENTAL CASTING I., REFRACTORY I.
occlusion
investment cast: a cast made of a material that will withstand
interproximal contact: the area of a tooth that is in close
high temperature without disintegration—comp
association, connection, or touch with an adjacent tooth in REFRACTORY CAST
the same arch
ion exchange strengthening: the chemical process whereby
interproximal space: the space between adjacent teeth in a the surface of a glass is placed in compression by the
dental arch. It is divided into the embrasure space, occlusal replacement of a small ion by a larger one while maintaining
to the contact point, and the septal space, gingival to the chemical neutrality
contact point
ionizing radiation: any radiation capable of displacing
interradicular space: the space between roots of adjacent electrons from atoms or molecules thereby producing ions
teeth in a dental arch
ir.i.des.cent adj (1796): colors produced by interference,
interridge distance: see INTERARCH DISTANCE refractor, or diffraction
interrupted bridge obs: a fixed prosthesis with one or more irreversible hydrocolloid: a hydrocolloid consisting of a sol
nonrigid connectors of alginic acid having a physical state that is changed by an
intracapsular adhesion: adhesions occurring within the joint irreversible chemical reaction forming insoluble calcium
capsule, resulting in reduced mobility alginate—called also alginate, dental alginate
intracapsular ankylosis: diminishment in joint motion due is.chem.ia n (ca. 1860): local and temporary deficiency of
to disease, injury, or surgical procedure within a joint capsule blood, chiefly resulting from the contraction of a blood vessel
intracapsular disorder: a problem associated with the iso.graft n (1909): a graft from one individual to another of
masticatory system in which the etiologic factors are located the same genetic basis, as in twins—called also isogeneic graft,
within the temporomandibular joint capsule syngraft 789
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lateral condylar inclination: the angle formed by the path at an apex at or near the superior aspect of the nasal bones
of the moving condyle within the horizontal plane compared Le Fort III fracture: eponym for a craniofacial disjunction
with the median plane (anterior-posterior movement) fracture in which the entire maxilla and one or more facial
and within the frontal plane when compared with the bones are completely separated from the craniofacial
horizontal plane (superior-inferior movement)—see skeleton
LATEROTRUSION
leaf gauge: a set of blades or leaves of increasing thickness
lateral condylar path: the path of movement of the condyle-
used to measure the distance between two points or to
distal assembly in the joint cavity when a lateral mandibular
provide metered separation
movement is made
lengthening of the clinical crown: a surgical procedure
lateral incisor: the second incisor
designed to increase the extent of supragingival tooth
lateral interocclusal record: a registration of the positional structure for restorative or esthetic purposes by apically
relationship of opposing teeth or arches made in either a positioning the gingival margin, removing supporting bone,
right or left lateral position of the mandible or both
lateral mandibular movement: see MANDIBULAR LET: acronym for Linear Energy Transfer: the energy
LATERAL TRANSLATION dissipation of ionizing radiation over a given linear distance.
lateral mandibular relation: the relationship of the mandible Highly penetrating radiations such as gamma rays cause
of the maxillae in a position to the left or right of the low ion concentration and thus have a relatively low LET,
midsagittal plane X-rays and beta particles exhibit intermediate LET, and alpha
lateral movement obs: a movement from either right or left particles have a high LET
of the midsagittal plane (GPT-4) light n (bef. 12c): the aspect of electromagnetic radiation of
lateral protrusion: see LATEROPROTRUSION which the human observer is aware through the visual
sensations that arise from the stimulation of the retina of
lateral relation obs: the relation of the mandible to the
maxillae when the lower jaw is in a position to either side of the eye
centric relation (GPT-4) light source: an object that emits light or radiant energy to
lateral side shift: see MANDIBULAR TRANSLATION which the human eye is sensitive. The emission of a light
source can be described by the relative amount of energy,
lateral relation obs: the relation of the mandible to the emitted at each wave length in the visible spectrum; the
maxillae when the lower jaw is in a position to either side of emission may be described in terms of its correlated color
centric relation (GPT-4) temperature
lateral side shift: see MANDIBULAR TRANSLATION light.ness n (bef. 12c) 1: achromatic dimension necessary to
lat.ero.de.tru.sion n: lateral and downward movement of describe the three-dimensional nature of color, the others
the condyle on the working side—see LATEROTRUSION being hue and saturation. The lightness dimension may also
lat.ero.pro.tru.sion n: a protrusive movement of the be called brightness. In the Munsell Color Order System,
mandibular condyle in which there is a lateral component the lightness dimension is called value 2: perception by
lat.ero.re.tru.sion n: lateral and backward movement of the which white objects are distinguished from gray and light
condyle on the working side objects from dark ones; equivalent to shading in grays
lat.ero.sur.tru.sion n: lateral and upward movement of the lim.bus: a border or interface especially if marked by a
condyle on the working side—see LATEROTRUSION difference in color or structure between adjoining parts
lat.ero.tru.sion n: condylar movement on the working side line angle: the point of convergence of two planes in a cavity
in the horizontal plane. This term may be used in preparation
combination with terms describing condylar movement in line of occlusion: the alignment of the occluding surfaces
other planes, for example, laterodetrusion, lateroprotrusion, of the teeth as viewed in the horizontal plane—see
lateroretrusion, and laterosurtrusion OCCLUSAL PLANE
Le Fort fracture [Leon Clement Le Fort, French surgeon, linear occlusion: the occlusal arrangement of artificial teeth,
1829-1893]: eponym for a bilateral horizontal fracture of the as viewed in the horizontal plane, wherein the masticatory
maxilla, classified into three categories (I, II, III) surfaces of the mandibular posterior artificial teeth have a
Le Fort I fracture: eponym for a horizontal segmented fracture straight, long, narrow occlusal form resembling that of a line,
of the alveolar process of the maxilla, in which the teeth are usually articulating with opposing monoplane teeth
usually contained within the detached portion Frush JP. Linear occlusion. III Dent J 1966;35:788-94
Le Fort II fracture: eponym for a pyramidal fracture of the lin.gual adj (15c): pertaining to the tongue; next to or toward
midfacial skeleton with the principal fracture lines meeting the tongue
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Glossary of Prosthodontic Terms
lingual apron: see LINGUAL PLATE longitudinal axis: see SAGITTAL AXIS
lingual bar: see LINGUAL BAR CONNECTOR low lip line 1: the lowest position of the inferior border of
lingual bar connector: a major connector of a removable the upper lip when it is at rest 2: the lowest position of the
partial denture located lingual to the dental arch superior border of the lower lip during smiling or voluntary
retraction
lingual flange: the portion of the flange of a mandibular
denture that occupies the alveololingual sulcus lower impression slang: an impression of the mandibular
lingual inclination: deviation of the coronal portion of a jaw or dental structures (GPT-4)—see MANDIBULAR
tooth from the vertical plane toward the tongue IMPRESSION
lingual plate: the portion of the major connector of a lower ridge slope obs 1: the slope of the mandibular residual
removable partial denture contacting the lingual surfaces of ridge in the second and third molar region as seen from the
the natural teeth—also spelled linguoplate buccal side (GPT-1) 2: the portion of the lower residual ridge,
either lingual, labial, or buccal, between the crest of the ridge
lingual rest: a metallic extension of a removable partial
and mucobuccal fold or flexion line of the peripheral tissues
denture framework that fits into a prepared depression
(GPT-1)
within an abutment tooth’s lingual surface
Lucia jig [Victor O. Lucia, US prosthodontist]: eponym—
lingual rest seat: the depression prepared on the lingual
see ANTERIOR PROGRAMMING DEVICE
surface of an abutment tooth to accept the metal rest of a
Lucia VO. Treatment of the edentulous patient. Chicago:
partial denture (the lingual rest)
Quintessence; 1986.
lingual splint: a dental splint conforming to the inner aspect
of the dental arch lug n: something that projects away from an object and is
generally used as a support or for connection to a body
lingual strap: see LINGUAL PLATE
lu.mi.nance n (1880): the intensity of light per unit area.
lingualized occlusion: first described by S. Howard Payne,
1luten (15c): a substance, such as cement or clay, used for
DDS, in 1941, this form of denture occlusion articulates the
maxillary lingual cusps with the mandibular occlusal placing a joint or coating a porous surface to make it
surfaces in centric working and nonworking mandibular impervious to liquid or gas—see CEMENT
positions. The term is attributed to Earl Pound 2 lute
vt; lut.ed; lut.ing: to fasten, attach, or seal—see
Payne SH. A posterior set-up to meet individual requirements. Dent CEMENT
Digest 1941;47:20-22.
lux.a.tion n (1552): see CONDYLAR DISLOCATION
Pound E. Utilizing speech to simplify a personalized denture service.
J Prosthet Dent 1970;24:586-600.
lin.guo.c.clu.sion n: an occlusion in which a tooth or group M
of teeth is located lingual to its normal position
lin.guo.ver.sion n: lingual or palatal position of a tooth mac.ro.glos.sia n: excessive size of the tongue
beyond normal arch form mac.ula n, pl mac.ula (1863): a patch of tissue that is altered
lip line: see HIGH L.L., LOW L.L. in color but usually not elevated; usually characteristic of
various diseases
lip switch operation: tissues borrowed from one lip and
transferred to the other—see also ABBE FLAP, maintenance dose: the quantity of a drug necessary to
ESTLANDER’S OPERATION maintain a normal physiologic state or a desired blood or
tissue level of drug
loading: see IMMEDIATE LOADING; PROGRESSIVE
LOADING major connector: the part of a removable partial denture
lobe n (1525): a curved or rounded projection or division, that joins the components on one side of the arch to those on
especially of a body organ or part the opposite side
local etiologic factors: the environmental influences that mal.a.lign.ment: see MALOCCLUSION
may be implicated in the causation, modification, and/or mal.le.a.ble adj (14c): capable of being extended or shaped
perpetuation of a disease entity with a hammer or with the pressure of rollers
localization film: a radiograph made with radiopaque mal.oc.clu.sion n (1888) 1: any deviation from a
markers to localize the position of a body (i.e., a tumor) physiologically acceptable contact between the opposing
relative to external landmarks dental arches 2: any deviation from a normal occlusion—
long axis: a theoretical line passing lengthwise through the see ANGLE’S CLASSIFICATION OF OCCLUSION
center of a body mam.e.lon n: one of three tubercles sometimes found on the
long centric articulation: see INTERCUSPAL CONTACT incisal edges of incisor teeth—mam.e.lon.at.ed adj,
AREA mam.e.lon.a.tion n
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man.di.ble n (15c): the lower jawbone mandibular relationship record: any registration of the
man.dib.u.lar adj: of or pertaining to the mandible relationship of the mandible to the maxillae
mandibular repositioning: guidance of the mandible to
mandibular anteroposterior ridge slope: the slope of the
cause closure in a predetermined, altered position
crest of the mandibular residual ridge from the third molar
region to its most anterior aspect in relation to the lower mandibular resection: the surgical removal of a portion or
border of the mandible as viewed in profile all of the mandible and the related soft tissues—called also
mandibulectomy
mandibular axis: see SAGITTAL AXIS, TRANSVERSE
HORIZONTAL AXIS, VERTICAL AXIS mandibular resection prosthesis: a maxillary and/or
mandibular prosthesis delivered after a mandibular resection
mandibular condyle: the articular process of the mandible— to allow the remaining deviated mandibular segment
see also CONDYLE improved occlusal contact with the maxillary dentition. This
mandibular dislocation: displacement of the mandible can require use of a flange, guide, or occlusal platform
mandibular dysplasia: disharmony in size or form between incorporated in the prosthesis to guide the mandibular
the right and left halves of the mandible segment into optimal occlusal contact—syn MANDIBULAR
GUIDE PLANE PROSTHESIS, MANDIBULAR RESECTION
mandibular equilibration 1: the act or acts performed to
PROSTHESIS WITH GUIDE MANDIBULAR RESECTION
place the mandible in equilibirum 2: a condition in which
PROSTHESIS WITHOUT GUIDE, RESECTION
all of the forces acting on the mandible are neutralized
PROSTHESIS
mandibular glide obs: the side to side, protrusive, and
mandibular rest position: see PHYSIOLOGIC REST
intermediate movement of the mandible occurring when the
POSITION
teeth or other occluding surfaces are in contact (GPT-4)
mandibular retraction: a type of facial anomaly in which
mandibular guide plane prosthesis: see MANDIBULAR
gnathionlies posterior to the orbital plane—see also
RESECTION PROSTHESIS
ANGLE’S CLASSIFICATION OF OCCLUSION
mandibular hinge position obs: the position of the mandible
mandibular side shift: see MANDIBULAR TRANSLATION
in relation to the maxilla at which opening and closing
movements can be made on the hinge axis (GPT-4) mandibular staple: a transosteal dental implant placed from
mandibular impression: an impression of the mandibular the inferior border of the mandible with posts (abutments)
that extend through the mucosa into the oral cavity in the
jaw or dental structures
mandibular anterior region—called also transmandibular
mandibular lateral translation: see MANDIBULAR staple
TRANSLATION
mandibular tracing: a graphic representation or record of
mandibular micrognathia: an abnormally small mandible the movements of the mandible within a given plane
with associated recession of the chin
mandibular translation: the translatory (medio-lateral)
mandibular movement: any movement of the lower jaw
movements of the mandible when viewed in the frontal
mandibular nerve: the third division of the trigeminal nerve plane. While this has not been demonstrated to occur as an
that leaves the skull through the foremen ovale and provides immediate horizontal movement when viewed in the frontal
motor innervation to the muscles of mastication, to the tensor plane, it could theoretically occur in an essentially pure
veli palatini m., the tensor tympani m., the anterior belly of translatory form in the early part of the motion or in
the digastric m., and the mylohyoid m. It provides the combination with rotation in the latter part of the motion or
general sensory innervation to the mandibular teeth and both—see also EARLY MANDIBULAR LATERAL
gingivae, the mucosa of the cheek and floor of the mouth, TRANSLATION, IMMEDIATE MANDIBULAR LATERAL
the epithelium of the anterior two thirds of the tongue, the TRANSLATION, PROGRESSIVE MANDIBULAR LATERAL
meninges and the skin of the lower portion of the face TRANSLATION
mandibular orthopedic repositioning splint: a removable mandibular trismus: reduced mobility of the mandible
prosthesis that creates a different, yet temporary, dental resulting from tonic contracture of the masticatory muscles
occlusal position that guides the mandible to close into a mandibulectomy n: the removal of part or all of the mandible
predetermined and altered position
man.drel also man.dril n (1790) 1a: usually a taper or
mandibular plane: in cephalometrics, a plane that passes cylindrical axle, spindle, or arbor placed in a hole to support
through the inferior border of the mandible it during machining 1b: a metal bar which serves as a core
mandibular protraction: a type of facial anomaly in which about which material may be cast, molded, compressed,
gnathionlies anterior to the orbital plane—see ANGLE’S forged, bent or shaped 2: the shaft and bearing on which a
CLASSIFICATION OF OCCLUSION tool is mounted
794
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Glossary of Prosthodontic Terms
Maryland bridge: see RESIN-BONDED PROSTHESIS max.il.la n, pl max.il.lae (15c): their regularly shaped bone
Livaditis, GJ, Thompson, VP: Etched castings: an improved retentive that, with its contralateral maxilla, forms the upper jaw. It
mechanism for resin-bonded retainers. J Prosthet Dent 1982;47: assists in the formation of the orbit, the nasal cavity, and the
52-59. hard palate; it contains the maxillary teeth
mar.gin n (14c): the outer edge of a crown, inlay, onlay, or maxillary impression: an impression of the maxillary jaw
other restoration. The boundary surface of a tooth or dental structures
preparation and/or restoration is termed the finish line or maxillary micrognathia: abnormally small maxillae with
finish curve associated retraction of the middle third of the face
marginal gingiva: the most coronal portion of the gingiva; maxillary protraction: a type of facial anomaly in which
often used to refer to the free gingiva that forms the wall of subnasion lies anterior to the orbital plane
the gingival crevice in health maxillary resection: the surgical removal of a part or all of
marginal ridge: a component of the tooth structure forming the maxilla—called also maxillectomy
the occlusal proximal margin of a premolar or molar maxillary sinus: the anatomic space located superior to the
mask.ing n: the process of applying an opaque covering to posterior maxillary alveolus
camouflage the metal component of a prosthesis maxillary tuberosity: the most distal portion of the maxillary
master cast: see DEFINITIVE CAST alveolar ridge
master impression: the negative likeness made for the max.il.lec.to.my n: the removal of part or all of the maxilla—
purpose of fabricating a prosthesis called also maxillary resection
masticating cycles obs: the patterns of mandibular max.il.lo.fa.cial adj: pertaining to the dental arches, the face,
movements formed during the chewing of food (GPT-1) head and neck structures
mas.ti.ca.tion n (1649): the process of chewing food for maxillofacial stabilization prosthesis: a prosthesis
swallowing and digestion fabricated for the maxillae or mandibule to assist
stabilization, retention or function of an opposing or adjacent
masticatory apparatus: see MASTICATORY SYSTEM
maxillofacial prosthesis. Generally such prostheses are
masticatory cycle: a three-dimensional representation of complete dentures, removable partial dentures or fixed
mandibular movement produced during the chewing of food partial dentures
masticatory efficiency: the effort required in achieving a maxillofacial prosthetic adhesive: a material used to adhere
standard degree of comminution external prosthesis to skin and associated structures around
masticatory force: the force applied by the muscles of the periphery of an external anatomic defect
mastication during chewing maxillofacial prosthetics: the branch of prosthodontics
masticatory movements: mandibular movements used for concerned with the restoration and/or replacement of the
chewing food—see MASTICATORY CYCLE stommatognathic and craniofacial structures with prostheses
that may or may not be removed on a regular or elective
masticatory mucosa: see MUCOSA
basis
masticatory muscle: muscles that elevate the mandible to
maxillomandibular dysplasia: disharmony between one
close the mouth (temporalis m., superficial and deep
jaw and the halves of the mandible
masseter m., medial pterygoid m.)—see ELEVATOR
MUSCLE maxillomandibular record: see MAXILLOMANDIBULAR
masticatory pain: discomfort about the face and mouth RELATIONSHIP RECORD
induced by chewing or other use of the jaws but independent maxillomandibular registration: see MAXILLO-
of local disease involving the teeth and mouth MANDIBULAR RELATIONSHIP RECORD
masticatory performance: a measure of the comminution maxillomandibular relation: see MAXILLOMANDIBULAR
of food attainable under standardized testing conditions RELATIONSHIP
masticatory system: the organs and structures primarily maxillomandibular relationship: any spatial relationship
functioning in mastication. These include the teeth with their of the maxillae to the mandible; any one of the infinite
supporting structures, craniomandibular articulations, relationships of the mandible to the maxillae
mandible, positioning and accessory musculature, tongue, maxillomandibular relationship record: a registration of
lips, cheeks, oral mucosa, and the associated neurologic any positional relationship of the mandible relative to the
complex maxillae. These records may be made at any vertical,
ma.trix n, pl ma.tri.ces (15c) 1: a mold or impression in which horizontal, or lateral orientation
something is formed 2: the portion of an attachment system maximal intercuspal contacts: tooth contact in the maximum
that receives the patrix
795
intercuspal position
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maximal intercuspal position: the complete intercuspation 2met.al vt -aled or -alled; -al.ing or -al.ling (1610): to cover
of the opposing teeth independent of condylar position, or furnish with metal
sometimes referred to as the best fit of the teeth regardless metal base: the metallic portion of a denture base forming a
of the condylar position—called also maximal intercuspation— part or all of the basal surface of the denture. It serves as a
comp CENTRIC OCCLUSION base for the attachment of the resin portion of the denture
mean foundation plane obs: the mean of the various base and the teeth
irregularities inform and inclination of the basal seat metal ceramic restoration: a fixed restoration that uses a
(GPT-4) metal sub-structure on which a ceramic veneer is fused—
me.a.tus n, pl me.a.tus.es or me.a.tus (1665): a natural body see COLLARLESS M.C.R.
passage; a general term for any opening or passageway in metal insert teeth: teeth containing metal cutting edges; teeth
the body designed to contain metal cutting edges in the occlusal
mechanically balanced occlusion obs: a balanced occlusion surface
without reference to physiologic considerations, as on an metal saddle obs: a metal denture base (GPT-4)
articulation (GPT-4)
met.a.mer n: one of a pair of objects whose colors match
median line: the centerline dividing a body into the right when viewed in a described way but do not match under all
and left viewing conditions
median mandibular point obs: a point on the metameric pair: a pair of objects whose colors match when
anteroposterior center of the mandibular ridge in the median viewed in a described way, but which do not match if the
sagittal plane (GPT-4) viewing conditions are changed. Thus a metameric pair of
median plane: an imaginary plane passing longitudinally samples exhibit the same tri-stimulus values for a described
through the body, from front to back, and dividing it into set of viewing conditions (observer, light source, geometry
left and right halves of the illumination and viewing arrangement) but have
median relation obs: any jaw relation when the mandible is different spectral distributions. Hence, they exhibit a match
in the median sagittal plane (GPT-4) that is conditional
median retruded relation: see CENTRIC RELATION me.tam.er.ism n (1877): pairs of objects that have different
mediolateral curve: in the mandibular arch, that curve, as spectral curves but appear to match when viewed in a given
viewed in the frontal plane, which is concave above and hue exhibit metamerism. Metamerism should not be
contacts the buccal and lingual cusps of the mandibular confused with the terms flair or color constancy, which apply
molars; in the maxillary arch, that curve, as viewed in the to apparent color change exhibited by a single color when
frontal plane, which is convex below and contacts the lingual the spectral distribution of the light source is changed or
and buccal cusps of the maxillary molars. The facial and when the angle of illumination or viewing is changed
lingual cusp tips on both sides of the dental arch form the methyl methacrylate resin: a transparent, thermoplastic
curve acrylic resin that is used in dentistry by mixing liquid methyl
me.di.o.tru.sion n: a movement of the condyle medially— methacrylate monomer with the polymer powder. The resultant
see NONWORKING SIDE mixture forms a pliable plastic termed a dough, which is
packed into a mold before initiation of polymerization
mem.brane n (15c) 1: a thin soft pliable sheet or layer,
especially of plant or animal origin 2: a thin layer of tissue mi.cro.crack n: in porcelain, one of the numerous surface
that lines a cavity, envelops a vessel or part, or separates a flaws that contributes to stress concentrations and results in
space or organ strengths below those theoretically possible
me.nis.cus n, pl me.nis.ci: see DISK mi.cro.gnath.ia n: a congenital or acquired condition
characterized by an abnormally small jaw—see
me.si.al adj (1803): near or toward the centerline of the dental
MANDIBULAR M., MAXILLARY M.
arch; toward the median sagittal plane of the face, following
the curvature of the dental arch mi.cro.glos.sia n: presence of a small tongue
mesial drift: movement of teeth toward the midline mi.cro.max.il.lac n: see MAXILLARY MICROGNATHIA
mesioversion: with reference to a tooth, nearer than normal mi.cro.sto.mia n: an abnormally small oral orifice
in its position toward the median line of the face, along the mi.cro.tia n: a developmental anomaly characterized by
dental arch hypoplasia or aplasia of the pinna of the ear, associated with
1
me.tal n (13c): any strong and relatively ductile substance an impatent or absent external auditory meatus
that provides electropositive ions to a corrosive environment midfacial deficiency: failure of the mid third of the face,
and that can be polished to a high luster. Characterized by including the maxilla, to grow in proportion to the upper
796 metallic atomic bonding and lower thirds
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Glossary of Prosthodontic Terms
midfacial fracture: fractures of the zygomatic, maxillary, modeling plastic impression compound: a thermoplastic
nasal, and associated bones dental impression material composed of wax, rosin, resins,
midopening click: the sound emanating from the and colorants
temporomandibular joint that occurs during mid protrusive modeling wax: a wax suitable for making patterns in the
translation of the condyles fabrication of nonmetallic restoration
MIE theory: the theory that relates the scattering of a single modes of appearance: various manners in which colors can
spherical particle in a medium to the diameter of the particle, be perceived, depending on spatial distributions and
the difference in refractive index between the particle and temporal variations of the light causing the sensation
the medium, and the wave length of radiant energy in the
modified cast; see ALTERED CAST
medium that is incident on the particle. This theory relates
to the direct observation of the scattering of a single particle modified ridge lap: a ridge lap surface of a pontic that is
as compared with the Kubel-ka-Munk theory and also takes adapted to only the facial or buccal aspect of the residual
into account the absorption that the particle may also exhibit ridge
1
mill n: a machine or device used for working or forming mod.i.fi.er n: a substance that alters or changes the color or
materials into a desired form, to blend materials, or to properties of a substance
perform other mechanical opertions mo.dio.lus n: the structure near the corner of the mouth
2
mill vt (1570) 1: to subject to an operation or process in a where eight muscles converge that functionally separates
mill; to grind 2: to shape or dress by means of instruments the labial vestibule from the buccal vestibule
mill in v 1: the procedure of refining occluding surfaces modulus of elasticity: in metallurgy, the coefficient found
through the use of abrasive materials—see SELECTIVE by dividing the unit stress, at any point up to the
GRINDING 2: the machining of boxes or other forms in cast proportional limit, by its corresponding unit of elongation
restorations to be used as retainers for fixed or removable (tension) or strain. A ratio of stress to strain. As the modulus
prostheses of elasticity rises, the material becomes more rigid
milled in curve obs: see MILLED IN PATH modulus of resilience: the work or energy required to stress
milled in path: a contour pattern carved into the occlusal a cubicinch of material (in one direction only) from zero up
surface of an occlusion rim during various mandibular to the proportional limit of the material, measured by the
movements by teeth or studs placed in the opposing arch ability of the material to withstand the momentary effect of
mill.ing v: the machining of proximal boxes, recesses, or an impact load while stresses remain within the proportional
other forms on cast restorations to be used as retainers for limit
fixed or removable prostheses mold n (13c) 1: a cavity in which a substance is shaped, as a
milling in obs: the procedure of refining or perfecting the matrix for casting metal or plastics; a negative form in which
occlusion of teeth by the use of abrasives between their an object is cast or shaped 2: the size and shape of an artificial
occluding surfaces while the dentures are rubbed together tooth or teeth
in the mouth or on the articulator (GPT-3)—see MILL IN mold chart: an illustration of the manufacturer’s shapes and
minor connector: the connecting link between the major sizes of denture teeth
connector or base of a removable partial denture and the mold guide: a selection of denture teeth demonstrating the
other units of the prosthesis, such as the clasp assembly, molds offered by a manufacturer
indirect retainers, occlusal rests, or cingulum rests
monochromatic vision: vision in which there is no color
mixed dentition: a stage of development during which the discrimination
primary and permanent teeth function together in the
mouth—syn TRANSITIONAL DENTITION mon.o.mer n (1914): a chemical compound that can undergo
polymerization; any molecule that can be bound to a similar
mo.bile adj (15c): capable of moving or being moved;
molecule to form a polymer
movable—mo.bil.i.ty n
mon.o.plane adj: an arbitrary plane for the arrangement of
mod.el n (1575): a facsimile used for display purposes; a
denture teeth that is flat both medio-laterally and anterior-
miniature representation of something; an example for
posteriorly
imitation or emulation; com CAST
modeling composition obs: see MODELING PLASTIC monoplane articulation: the arrangement of teeth by which
IMPRESSION COMPOUND they are positioned in a single plane
modeling compound obs: see MODELING PLASTIC monoplane occlusion: an occlusal arrangement wherein the
IMPRESSION COMPOUND posterior teeth have masticatory surfaces that lack any cuspal
modeling plastic: see MODELING PLASTIC IMPRESSION height
COMPOUND Monson curve: see CURVE OF MONSON 797
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MORA device: acronym for Mandibular Orthopedic undercuts in a surgically prepared mucosal site—called also
Repositioning Appliance, a type of mandibular occlusal splint button implant, intramucosal insert, mucosal implant
used with the goal of repositioning the mandible to improve mu.co.si.tis n: inflammation of the mucous membrane
neuromuscular balance and jaw relationship
mu.co.sta.tic adj: the state of the oral mucosa when external
Gelb H. Clinical management of head, neck and TMJ pain and forces are not displacing it
dysfunction. Philadelphia: WB Saunders Co.; 1977. p. 314.
muf.fle n: the portion of a furnace, usually removable or
mother matrix mold obs: a negative form, usually in replaceable, in which material may be placed for processing
sections, used for positive casts (GPT-1)
without direct exposure to heating element
mou.lage n (1902) 1: the negative impression of a body
Munsell chrome [Alfred H. Munsell, Massachusetts, US
structure 2: an impression or cast made for use, especially
artist and teacher, 1858-1918]: eponym for the Munsell color
as evidenced in a criminal investigation 3: impression or
system chrome, which is that quality by which a strong color
reverse likeness of a part that produces a model when
is distinguished from one that is weak. The departure of a
converted to a positive replica, i.e., by means of plaster
color sensation from that of white or gray; the intensity of a
1mount.ing v: the laboratory procedure of attaching a cast distinctive hue color intensity—see also SATURATION
to an articulator or cast relater
2mount.ing
Munsell color order system [Alfred H. Munsell,
n: the relationship of dental casts to each other Massachusetts, US artist and teacher, 1858-1918]: eponym for
and the instrument to which they are attached; see also— a color order system; developed in 1905, it places colors in
SPLIT-CAST M. an orderly arrangement encompassing the three attributes
mounting ring: see MOUNTING PLATE of hue, value, and chrome
mounting plate: removable metal or resin devices that attach Munsell AH. A color notation. Baltimore: Munsell Color Co.; 1975.
to the superior and inferior members of an articulator, which p. 14-6.
are used to attach casts to the articulator
Munsell hue [Alfred H. Munsell, Massachusetts, US artist
mouth guard: a resilient intraoral device useful in reducing and teacher, 1858-1918]: eponym for that quality by which
mouth injuries and protecting the teeth and surrounding one color family is distinguished from another, as red from
structures from injury yellow, and green from blue or purple. The dimension of
mouth protector: see MOUTH GUARD color determined by wave length
mouth rehabilitation obs: restoration of the form and Munsell value [Alfred H. Munsell, Massachusetts, US artist
function of the masticatory apparatus to as near normal as and teacher, 1858-1918]: eponym for the relative brightness
possible (GPT-4) of a color. The quality of grayness in comparison to white
mouth stick: a device held in the mouth by a disabled person (high value) and black, (low value); in the Munsell color
that aids in performing certain functions system, the value of a color is determined by which gray on
the value scale it matches in lightness/darkness (black is
MRI: acronym for Magnetic Resonance Imaging
assigned a value of zero; white a value of 10)
mucobuccal fold: the line of flexure of the mucous
mus.cle n (14c): an organ that by contraction produces
membrane as it passes from the mandible or maxillae to the
cheek movements of an animal; a tissue composed of contractile
cells or fibers that effect movement of an organ or part of
mucogingival: see MUCOGINGIVAL JUNCTION the body
mucogingival junction: the junction of gingiva and alveolar muscle contraction: the shortening and development of
mucosa tension in a muscle in response to stimulation
mucolabial fold: the line of flexure of the oral mucous
muscle contracture: a condition of high resistance to passive
membrane as it passes from the maxilla or mandible to the
stretching of a muscle resulting from fibrosis of the tissues
lip
supporting the muscle or the joint; sustained increased
mu.co.peri.os.te.um n: a term synonymous with a full- resistance to passive stretch with reduced muscle length
thickness flap implying the inclusion of both mucosa and
muscle hyperalgesia: increased sensitivity to pain in a
periosteum during flap elevation
muscle evoked by stimulation at the site of pain in the muscle
mu.co.sa n (1880): a mucous membrane comprised of
muscle hypertenseness obs: increased muscular tension that
epithelium, basement membrane, and lamina propria—see
is not easily released but that does not prevent normal
ALVEOLAR M., ORAL M.
lengthening of the muscles involved (GPT-4)
mucosal implant: see MUCOSAL INSERT
muscle hypertonicity: increased contractile activity in some
mucosal insert: a metal insert attached to the tissue surface motor units driven by reflex arcs from receptors in the muscle
798 of a removable prosthesis that mechanically engages and/or alpha motor neurons of the spinal cord
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Glossary of Prosthodontic Terms
muscle marking: see BORDER MOLDING mylohyoid ridge: an oblique ridge on the lingual surface of
muscle relaxant: a drug or therapy that diminishes muscle the mandible that extends from the level of the roots of the
tension last molar teeth and that serves as a bony attachment for the
mylohyoid muscles forming the floor of the mouth
muscle spasm: a sudden involuntary contraction of a muscle
or group of muscles attended by pain and interference with my.o.cen.tric adj: that terminal point in space in which, with
function. It differs from muscle splinting in that the the mandible in rest position, subsequent colonic muscle
contraction is sustained even when the muscle is at rest and contraction will raise the mandible through the interocclusal
the pain/dysfunction is present with passive and active space along the myocentric (muscle balanced) trajectory. Also
movements of the affected part—called also myospasm described as the initial occlusal contact along the myocentric
muscle spasticity: increased muscular tension of antagonists trajectory (isotonic closure of the mandible from rest
preventing normal movement and caused by an inability to position)
relax (a loss of reciprocal inhibition) Jankelson B. Dent Clin North Am 1979;23:157-68
Jankelson BR, Polley ML. Electromyography in clinical dentistry.
muscle-splinting slang: involuntary contraction (rigidity)
Seattle:
of muscles occurring as a means of avoiding the pain caused
Myotronica Research Inc.: 1984. p. 52
by movement of the part (resistance to passive stretch). The
involved muscle(s) relaxes at rest myofascial trigger point: a hyperirritable spot, usually
within a skeletal muscle or in the muscle fascia, that is painful
muscle-trimming slang: see BORDER MOLDING
on compression and can give rise to characteristic referred
muscular atrophy: a wasting of muscular tissue, especially pain, tenderness (secondary hyperalgesia), and autonomic
due to lack of use phenomena
muscular splinting: contraction of a muscle or group of
myofibrotic capsular contracture: muscle conracture
muscles attended by inteference with function and
resulting from the formation of excessive fibrous tissue
producing involuntary movement and distortion; differs
within the muscle or its sheath
from muscle spasm in that the contraction is not sustained
when the muscle is at rest my.o.func.tion.al: relating to the function of muscles. In
dentistry, the role of muscle function in the cause or
musculoskeletal pain: deep, somatic pain that originates in
correction of muscle related problems
skeletal muscles, facial sheaths, and tendons (myogenous
pain), bone and periosteum (osseous pain), joint, joint myofunctional therapy: the use of exercises to improve the
capsules, and ligaments (arthralgic pain), and in soft action of a group of muscles used as an adjunct to orthodontic
connective tissues or craniomandibular dysfunction treatment
mush bite obs: a maxillomandibular relationship record myogenous pain: deep somatic musculoskeletal pain
made in a softened material, frequently beeswax, without originating in skeletal muscles, fascial sheaths, or tendons
the benefit of record bases—see INTEROCCLUSAL Myo-monitor:a digital electronic pulse generator specifically
RECORD optimized for bilateral transcutaneous electrical neural
mutually protected articulation: an occlusal scheme in stimulation of the stomatognathic system; an electrical device
which the posterior teeth prevent excessive contact of the introduced in 1969 by Bernard Jankelson, DDS, as a means
anterior teeth in maximum intercuspation, and the anterior of applying muscle relaxation as a prerequisite to obtain an
teeth disengage the posterior teeth in all mandibular occlusal position that would sustain a relaxed musculature
excursive movements Jankelson B, Radke JO. The Myo-monitor: its use and abuse.
mutually protected occlusion: see MUTUALLY Quintessence In: 1978;9:47-52
PROTECTED ARTICULATION Jankelson B, Spark. S, Crane PF, Radke JC. Neural conduction of
my.al.gia n (1860): pain in a muscle or muscles the Myo-monitor stimulus: a quantitative analysis. J Prosthet Dent
1975;34:245-53.
my.co.tic n: pertaining to a mucosis; caused by fungi
Jankelson BR. Neuromuscular dental diagnosis and treatment. St.
mylohyoid concavity: the fossa in the mandible below the Louis: Ishiyaki Euro America Intl; 1990.p.73-77.
mylohyoid line in the molar region
myostatic contracture: muscle contracture resulting from
mylohyoid groove or canal: the groove in the mandible reduced muscle stimulation
running downward and forward toward the submandibular
my.o.si.tis n (ca. 1819): inflammation of muscle tissue
fossa, which contains the mylohyoid muscle, nerve, and
vessels my.o.spasm n: see MUSCLE SPASM
mylohyoid region obs: the region on the lingual surface of my.o.ton.ia n (1896): increased muscular irritability and
the mandible marked by the mylohyoid ridge and the contractility with decreased power of relaxation; tonic
attachment of the mylohyoid muscle (GPT-4) muscle spasms 799
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nasal stent: a removable intranasal prosthesis to support NMR: acronym for Nuclear Magnetic Resonance; a radiologic
the form of the nose procedure that gives images in any plane without radiation
or any biologic after effect by picking up signals from
na.sal.i.ty n (1656): the quality of speech sounds when the
resonating hydrogen nuclei
nasal cavity is used as a resonator
noble metal: those metal elements that resist oxidation,
nas.ion n: a bony cephalometric landmark at which the
tarnish, and corrosion during heating, casting, or soldering
nasofrontal suture is bisected by the midsagittal plane
and when used intraorally; examples include gold and
nas.o.phar.ynx n (1877): the part of the pharynx situated platinum—comp BASE METAL
above the soft palate
no.ci.cep.tive adj (1904): receiving injury; applicable to a
natural color system: a color order system derived by Anders neuron receptive to painful sensations
Hard that defines six color perceptions using the concept of
nociceptive pathway: an afferent neural pathway that
percentage for localizing nuances within the three-part
mediates pain impulses
system. The six perceptions are white, black, red, green,
yellow, and blue. The dimensions of hue, blackness or no.ci.cep.tor n: a sensory receptor preferentially sensitive to
whiteness, and chrome are used to relate colors within this noxious or potentially noxious stimuli
system nocturnal electromyography: electromyographic
natural dentition: the natural teeth, as considered registrations made during sleep
collectively, in the dental arch, which may be deciduous, nonadjustable articulator: an articulator that does not allow
permanent, or mixed adjustment to replicate mandibular movements—see also
natural glaze: the production of a glazed surface by the CAST RELATOR
vitrification of the material itself and without addition of nonanatomic teeth: artificial teeth with occlusal surfaces that
other fluxes or glasses are not anatomically formed. The term nonanatomic as
neck of the condyle: the constricted inferior portion of the applied to artificial posterior teeth, and especially their
mandibular condyle that is continuous with the ramus of occlusal forms, means that such teeth are designed in
the mandible; that portion of the mandibular ramus to which accordance with mechanical principles rather than from the
the condyle is attached anatomic standpoint. I.R. Hardy, DDS, first introduced
ne.cro.sis n, pl ne.cro.ses (1665): localized death of living nonanatomic teeth with flat occlusal surfaces set to a flat
tissue occlusal plane.
800
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Glossary of Prosthodontic Terms
Sears VH. Thirty years of nonanatomic teeth. J Prosthet Dent obturator prosthesis modification: revision or alteration of
1953;3:596-617 an existing obturator (surgical, interim, or definitive);
Hardy IR. Technique for use of nonanatomic acrylic posterior teeth. possible revisions include relief of the denture base due to
Dent Digest 1942;48:562-6. tissue compression, augmentation of the seal or border
regions to effect adequate sealing or separation between the
nonfunctioning condyle: see NONWORKING SIDE nasal and oral cavities
CONDYLE
oc.clude vb oc.clud.ed; oc.clud.ing vt (1957) 1: to bring
nonpivoting condyle: see NONWORKING SIDE together; to shut 2: to bring or close the mandibular teeth
CONDYLE into contact with the maxillary teeth
nonprecious metal: see BASE METAL occluded gas porosity: a porosity produced in castings due
non.re.sorb.able adj: the property exhibited by substances to the inability of gases in the mold to escape
that demonstrate relatively limited in-vivo degradation oc.clud.er n: a name given to some articulators—see CAST
nonrigid connector: any connector that permits limited RELATOR
movement between otherwise independent members of a occluding centric relation record obs: a registration of centric
fixed partial denture relation made at the established occlusal vertical dimension
nonworking side: that side of the mandible that moves (GPT-4)
toward the median line in a lateral excursion. The condyle occluding frame obs: a name given to a device for relating
on that side is referred to as the nonworking side condyle casts to each other for the purpose of arranging teeth
nonworking side condyle: the condyle on the nonworking (GPT-1)
side occluding jaw record: the registration of centric relation
nonworking side condyle path: the path the condyle made at the occlusal vertical dimension
traverses or the nonworking side when the mandible moves occluding relation obs: the jaw relation at which the
in a lateral excursion, which may be viewed in the three opposing teeth occlude (GPT-4)
reference planes of the body
oc.clu.sal adj (1897): pertaining to the masticatory surfaces
nonworking side interference: undesirable contacts of the of the posterior teeth, prostheses, or occlusion rims
opposing occlusal surfaces on the nonworking side
occlusal adjustment 1: any change in the occlusion intended
nonworking side occlusal contacts: contacts of the teeth on to alter the occluding relation 2: any alteration of the
the side opposite to the side toward which the mandible occluding surfaces of the teeth or restorations—see also
moves in articulation OCCLUSAL RESHAPING
notch n: see PTERYGOMAXILLARY N. occlusal analysis: an examination of the occlusion in which
noxious stimulus: a tissue damaging stimulus the interocclusal relations of mounted casts are evaluated
nu.ance n, nu.anced adj (1781) 1: a subtle distinction or occlusal balance: a condition in which there are
variation, such as in tone or color 2: a subtle quality 3: delicate simultaneous contacts of opposing teeth or tooth analogues
shading (i.e., occlusion rims) on both sides of the opposing dental
null detector: a detector of the point at which there is no arches during eccentric movements within the functional
color difference between two samples. The human eye is an range
excellent null detector; it is considerably less trustworthy in occlusal clearance: see INTEROCCLUSAL CLEARANCE
estimating how large a given difference is occlusal contact 1: the touching of opposing teeth on
elevation of the mandible 2: any contact relation of opposing
O teeth—see DEFLECTIVE O.C, INITIAL O.C
occlusal correction: see OCCLUSAL ADJUSTMENT,
oblique ridge: the elevation in the enamel that runs obliquely OCCLUSAL RESHAPING
across the occlusal surface of a maxillary molar occlusal curvature: the curve of a dentition in which the
ob.tun.dent n: an agent or remedy that lessens or relieves occlusal surfaces lie, when viewed in the frontal and sagittal
pain or sensibility planes
ob.tu.ra.tor n (ca. 1727): a prosthesis used to close a occlusal device: any removable artificial occlusal surface
congenital or acquired tissue opening, primarily of the hard used for diagnosis or therapy affecting the relationship of
palate and/or contiguous alveolar structures. Prosthetic the mandible to the maxillae. It may be used for occlusal
restoration of the defect often includes use of a surgical stabilization, for treatment of temporomandibular disorders,
obturator, interim obturator, and definitive obturator—see or to prevent wear of the dentition
DEFINITIVE O., INTERIM O., SURGICAL O.—comp occlusal disharmony: a phenomenon in which contacts of
SPEECH AID PROSTHESIS opposing occlusal surfaces are not in harmony with other 801
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tooth contacts and/or the anatomic and physiologic occlusal rest arm obs: a minor connector used to attach an
components of the craniomandibular complex occlusal rest to a major part of a removable partial denture
occlusal dysthesia: unusual perceptions of occlusal contact (GPT-1)
occlusal embrasure: the interdental space that is coronal to occlusal rim: see OCCLUSION RIM
the contact area occlusal splint: see OCCLUSAL DEVICE
occlusal equilibration: the modification of the occlusal form occlusal stability: the equalization of contacts that prevents
of the teeth with the intent of equalizing occlusal stress, tooth movement after closure
producing simultaneous occlusal contacts or harmonizing
occlusal stop: see OCCLUSAL REST
cuspal relations
occlusal strength: see MASTICATORY FORCE
occlusal facet: see WEAR FACET
occlusal surface obs: a surface of a posterior tooth or
occlusal force: the result of muscular force applied on
occlusion rim that is intended to make contact with an
opposing teeth; the force created by the dynamic action of
opposing occlusal surface (GPT-1)
the muscles during the physiologic act of mastication; the
result of muscular activity applied to opposing teeth occlusal system obs: the form or design and arrangement
of the occlusal and incised units of a dentition or the teeth
occlusal form obs: the form of the occlusal surface of a tooth
or a row of teeth (GPT-4) on a denture (GPT-4)
occlusal harmony obs: a condition in centric and eccentric occlusal table: the portion of the occlusal surfaces of
jaw relation in which there are no interceptive or deflective posterior teeth that lies within the perimeter of the cusp tips
contacts of occluding surfaces (GPT-4) and marginal ridges; the functional portion(s) of the occlusal
surface(s) of a posterior tooth (teeth)
occlusal interference: any tooth contact that inhibits the
remaining occluding surfaces from achieving stable and occlusal trauma: trauma to the periodontium from
harmonious contacts functional or parafunctional forces causing damage to the
attachment apparatus of the periodontium by exceeding its
occlusal path obs 1: a gliding occlusal contact 2: the path of
adaptive and reparative capacities. It may be self-limiting
movement of an occlusal surface (GPT-4)
or progressive—see PRIMARY O.T., SECONDARY O.T.
occlusal pattern: the form or design of the masticatory
surfaces of tooth or teeth based on natural or modified occlusal vertical dimension: the distance measured between
anatomic or nonanatomic teeth two points when the occluding members are in contact
occlusal pivot: an elevation placed on the occlusal surface, occlusal wear: loss of substance on opposing occlusal units
usually in the molar region, designed to act as a fulcrum, or surfaces as the result of attrition or abrasion
thus limiting mandibular closure and inducing mandibular occlusal n (1645) 1: the act or process of closure or of being
rotation closed or shut off 2: the static relationship between the
occlusal plane 1: the average plane established by the incisal incising or masticating surfaces of the maxillary or
and occlusal surfaces of the teeth. Generally, it is not a plane mandibular teeth or tooth analogues—see CENTRIC O.,
but represents the planar mean of the curvature of these COMPONENTS OF O., ECCENTRIC O., LINE OF O.,
surfaces 2: the surface of wax occlusion rims contoured to LINEAR O., MONOPLANE O., PATHOGENIC O.,
guide in the arrangement of denture teeth 3: a flat metallic SPHERICAL FORM OF O.—comp ARTICUILATION
plate used in arranging denture teeth—comp to CURVE OF occlusal analysis obs: a systematic examination of the
OCCLUSION masticatory system with special consideration to the effect
occlusal position obs: the relationship of the mandible and of tooth occlusion on the teeth and their related structures
maxillary when the jaw is closed and the teeth are in contact; (GPT-4)
this position may or may not coincide with centric occlusion occlusal record obs: a registration of opposing occluding
(GPT-4) surfaces made at any maxillomandibular relationship
occlusal prematurity: any contact of opposing teeth that (GPT-4)
occurs before the planned intercuspation occlusal rim: occluding surfaces fabricated on interim or
occlusal pressure obs: any force exerted on the occlusal final denture bases for the purpose of making
surfaces of teeth (GPT-4) maxillomandibular relation records and arranging teeth—
occlusal reshaping: the intentional alteration of the occlusal called also record rim
surfaces of teeth to change their form Occult cleft palate: a separation of muscle in the soft palate
occlusal rest: a rigid extension of a removable partial denture with mucous membrane covering the defect. This is often
that contacts the occlusal surface of a tooth or restoration, noted as a notch in the hard palate, bifurcation of the uvula,
the occlusal surface of which may have been prepared to displaced musculature, and an attenuated raphe—syn
802
receive it—see REST SEAT SUBMUCOUS CLEFT PALATE
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Glossary of Prosthodontic Terms
ocular prosthesis: a prosthesis that artificially replaces an organic occlusion: see ANTERIOR PROTECTED
eye missing as a result of trauma, surgery, or congenital ARTICULATION
absence. The prosthesis does not replace missing eyelids or or.i.fice n (15c): an opening into a body cavity
adjacent skin, mucosa or muscle—syn ARTIFICIAL EYE,
oronasal fistula: a pathologic opening between the oral and
GLASS EYE—comp INTERIM OCULAR PROSTHESIS
nasal cavities
o.don.tal.gia n: toothache; pain in a tooth
oro.phar.ynx n (1887): the part of the pharynx lying between
odontogenous pain: deep somatic pain originating in dental the soft palate and the upper edge of the epiglottis—called
palps and/or periodontal ligaments also oral pharynx, pars oralis pharyngis, pharyngooral cavity,
o.don.to.graph n: a device used to demonstrate irregularities and vestibule of the pharynx
occuring in the surface of tooth enamel orthodontic band: a metal orthodontic device that holds a
o.don.to.plasty: the reshaping of a portion of a tooth bracket or tube and encircles a tooth
ol.i.go.don.tia: the formation of less than a full complement orthognathic surgery: surgical repositioning of all or parts
of teeth; many such teeth are smaller than normal of the maxillae or mandible
on.lay: a restoration that restores the entire occlusal surface or.tho.gnath.ous adj: pertaining to or characterized by
and is retained by mechanical or adhesive means minimal protrusion of the mandible or minimal prognathism
onlay graft (1998): augmentation of a bony ridge with orthopedic craniofacial prosthesis (1998): a dynamic
autologous bone or bony substitutes by placement on the orthopedic prosthesis to maintain or position craniofacial
crest of the ridge beneath the periosteum to enhance bone osseous segments
height and width
orthotic device: a device designed to brace, activate, or
o.pac.i.ty n (1611): the quality or state of a body that makes supplement a weakened limb or function
it impervious to light
os.seo.in.te.gra.tion n [P.I. Branemark, ca. 1982]: see
o.paque adj (1641): the property of a material that absorbs
OSSEOUS INTEGRATION
and/or reflects all light and prevent any transmission of light
os.se.ous adj (1707): bony
open bite slang: see OPEN OCCLUSAL RELATIONSHIP
osseous integration (1993) 1: the apparent direct attachment
open fracture: one in which there is an external wound
or connection of osseous tissue to an inert, alloplastic
leading to a break in the bone; called also compound fracture
material without intervening connective tissue 2: the process
open occlusal relationship: the lack of tooth contact in an and resultant apparent direct connection of an exogenous
occluding position—see ANTERIOR O.O.R., POSTERIOR material’s surface and the host bone tissues, without
O.O.R. intervening fibrous connective tissue present 3: the interface
open movement obs: movement of the mandible executed between alloplastic materials and bone
during jaw separation; movement executed during jaw
os.si.fi.ca.tion n (1967) 1: the natural process of bone
separation (GPT-1)—see ENVELOPE OF MOTION
formation; the hardening into a bony substance 2: a mass of
oral flora: the various bacterial and other microscopic forms ossified tissue
of life inhabiting the oral cavity
os.te.i.tis n (ca. 1839): inflammation of bone
oral mechanism: the functioning structures of the oral cavity
os.te.o.ar.thri.tis n (1878): chronic degeneration and
oral orifice: the longitudinal opening of the mouth between destruction of the articular cartilage and/or fibrous
the lips that provides the entrance to the oral cavity connective tissue linings of the joint components and disks,
oral mucosa: the lining of the oral cavity leading to bony spurs, pain, stiffness, limitation of
oral orthopedics 1: a concept in dentistry concerned with movement, and changes in bone morphology. Advanced
postural relationships of the jaws, both normal and abnormal conditions may involve erosions and disk degeneration with
2: analysis of the harmful effects of an improper relationship crepitus—syn DEGENERATIVE JOINT DISEASE
of the mandible and the maxillae on dental and other related os.te.o.gen.e.sis n: development of bone; formation of bone
structures 3: the diagnosis and correction of such
os.te.o.in.duc.tion n: the capability of chemicals, procedures,
relationships and the treatment and/or prevention of
etc., to induce bone formation through the differentiation
disturbances resulting therefrom
and recruitment of osteoblasts
orbital prosthesis: a prosthesis that artificially restores the
os.te.o.in.te.gra.tion n: see OSSEOUS INTEGRATION
eye, eye lids, and adjacent hard and soft tissue lost as a result
of trauma or surgery os.te.o.tome n: a chisel for use in cutting bone
orbiting condyle: see NONWORKING SIDE CONDYLE os.tec.to.my n: the excision of bone or a portion of a bone,
organ of mastication: the combination of all the structures usually by means of a saw or chisel, for the removal of a
involved in the reception, mastication, and deglutition of sequestrum, the correction of a deformity, or any other
purpose 803
food
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os.te.ot.o.my n: the surgical cutting of a bone; frequently palatal bar: see PALATAL BAR CONNECTOR
used to also describe smoothing, leveling, or altering external palatal bar connector: a major connector of a removable
contours of the bone partial denture that crosses the palate and is characterized
os.teo.po.ro.sis n, pl .ro.ses (1846): a medical condition by being relatively narrow anterior and posteriorly
characterized by a decrease in bone mass with diminished palatal cleft 1: an opening in the roof of the mouth and/or
density and concurrent enlargement of bone spaces, which
in the functional soft palate. A deformity of the palate from
produces porosity and fragility—os.teo.po.rot.ic adj
improper union or lack of union during the second month
o.ver.bite n, slang: see VERTICAL OVERLAP of intrauterine development of the maxillary process with
o.ver.clo.sure n: an occluding vertical dimension at a reduced the median nasal process 2: a cleft in the palate between the
interarch distance; an occluding vertical dimension that two palatal processes. If both the hard and soft palate are
results in excessive interocclusal distance when the mandible involved, it is termed uranostaphyloschisis, if only the soft
is in the rest position; it results in a reduced interridge palate is divided, it is termed uranoschisis—see CLEFT
distance when the teeth are in contact PALATE, COMPLETE CLEFT PALATE, OCCULT CLEFT
o.ver.den.ture n: a removable partial denture or complete PALATE
denture that covers and rests on one or more remaining palatal drop prosthesis: see PALATAL AUGMENTATION
natural teeth, the roots of natural teeth, and/or dental PROSTHESIS
implants; a prosthesis that covers and is partially supported palatal expansion: the lateral movement of the maxillae to
by natural teeth, natural tooth roots, and/or dental increase palatal width
implants—called also overlay denture, overlay prosthesis,
palatal incompetence: the inability of an anatomically intact
superimposed prosthesis
soft palate to effect a functional palatopharyngeal closure
o.ver.glaze adj (1879): the production of a glazed surface by
palatal insufficiency: an anatomical inadequacy of the soft
the addition of a fluxed glass that usually vitrifies at a lower
palate in which the palatopharyngeal sphincter is incomplete
temperature
palatal lift prosthesis: a removable prosthesis that aids in
o.ver.hang n (1864): excess restorative material projecting velopharyngeal closure by elevating an incompetent soft
beyond a cavity or preparation margin palate that is dysfunctional due to clefting, surgery, trauma,
o.ver.jet n: see HORIZONTAL OVERLAP or unknown paralysis—usage. palatal lift prosthesis can be
o.ver.jut n: see HORIZONTAL OVERLAP divided into definitive p.l.p. and interim p.l.p. based on
expectations of length of utilization, materials in fabrication,
o.ver.lap n (1726): see HORIZONTAL OVERLAP, VERTICAL
and intended use
OVERLAP
palatal lift prosthesis modification: alterations in the
overlay denture: see OVERDENTURE
adaptation, contour, form, or function of an existing palatal
overlay prosthesis: see OVERDENTURE lift necessitated due to tissue impingement, lack of function,
poor clasp adaptation, or the like
P
palatal plate: a major connector of a removable partial
denture that covers a significant portion of the palatal surface
pack vt (14c) 1a: to make into a compact form 1b: to
completely fill 2a: to crowd together 2b: to compress— palatal seal: see POSTPALATAL SEAL
pack.a.bil.i.ty n—pack.able adj palatal stent: see SURGICAL STENT
packing vt: the act of filling a mold—see DENTURE P. palatal strap slang: a maxillary major connector having an
anterior/posterior dimension of ½” to ¾” that directly or
pain n (13c): a subjective unpleasant sensory and emotional
obliquely traverses the palate and is generally located in
experience associated with actual or potential tissue damage
the area of the second premolar and first molar
or described in terms of such damage—see ACUTE P.,
CHRONIC P., HETEROTOPIC P., MASTICATORY P., palatal vault 1: the deepest and most superior part of the
MUSCULOSKELETAL P., MYOGENOUS P., palate 2: the curvature of the palate
NEUROGENOUS P., ODONTOGENOUS P., PRIMARY P., pal.ate n (14c): see HARD P., SOFT P.
PROJECTED P., SECONDARY P., VASCULAR P., pal.a.to.gram n: a graphic representation of the area of the
VISCERAL P. palate contacted by the tongue during a specified activity,
palatal augmentation prosthesis: a palatal prosthesis that usually speech
allows reshaping of the hard palate to improve tongue/ palatopharyngeal closure: a sphincteric action sealing the
palate contact during speech and swallowing due to oral cavity from the nasal cavity during swallowing and
impaired tongue mobility as a result of surgery, trauma, or phonation by the synchronous movement of the middle third
804 neurologic/motor deficits of the soft palate in a superior and posterior direction, the
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Glossary of Prosthodontic Terms
lateral pharyngeal wall medially, and the posterior walls of recording tables of a pantograph; tracings of mandibular
the pharynx anteriorly—syn VELOPHARYNGEAL movement recorded on plates in the horizontal and sagittal
CLOSURE planes
palatopharyngeal inadequacy: a condition where there is pa.pil.la n, pl pa.pil.lae (1713): any small, nipple-shaped
lack of effective closure between the soft palate and one or elevation— see INCISIVE P., INTERDENTAL P.
more of the pharyngeal walls during swallowing or speech para.func.tion adj: disordered or perverted function
sounds that require high intraoral pressure. Nasal reflux
par.al.lax n: a difference in the perceived location of an object
escape of air during speech or hyper nasality may result.
when observed from two different points not on a straight
This lack of closure may be due to palatopharyngeal
line with the object
incompetence, insufficiency or from lack of movement of
the pharyngeal walls—see PALATOPHARYNGEAL parallel attachment: see PRECISION ATTACHMENT
INCOMPETENCE, PALATOPHARYNGEAL INSUFFI- par.al.lel.o.me.ter n 1: an instrument used for determining
CIENCY the exact parallel relationships of lines, structures, and
palatopharyngeal incompetence: the inability or an surfaces in dental casts and prostheses 2: an apparatus used
anatomically intact soft palate to contribute to a functional for making one object parallel with another object, as in
palatopharyngeal closure usually due to disease or trauma paralleling attachments and abutments for fixed partial
of a neurogenic or muscular nature—see PALATO- dentures or precision attachments for removable partial
PHARYNGEAL INADEQUACY, PALATOPHARYNGEAL dentures
INSUFFICIENCY pa.ral.y.sis n (1525): loss or impairment of motor function
palatopharyngeal insufficiency: an acquired or congenital as the result of a trauma or pathosis
anatomic defect of the soft palate that makes the paresthesia n: lacking normal sensation, such as tingling or
palatopharyngeal sphincter incomplete—see PALATO- burning; morbid or perverted sensation; abnormal sensation
PHARYNGEAL INADEQUACY, PALATOPHARYNGEAL
partial denture: a dental prosthesis that restores one or more
INCOMPETENCE
but not all of the natural teeth and/or associated parts and
palatopharyngeal sphincter: the functional sphincter that that is supported in part by natural teeth, dental implant
separates the nasopharyngeal and oropharynx during supported crowns, abutments, or other fixed partial dentures
swallowing and phonation, formed by the posterior and and/or the mucosa; usage: a partial denture should be
superior movement of the middle third of the soft palate, described as a fixed partial denture or removable partial denture
the anterior movement of the posterior pharyngeal wall, and
based on the patient’s capability to remove or not remove
the medial movement of the lateral pharyngeal walls—see
the prosthesis. If the prosthesis is a fixed partial denture that
PALATOPHARYNGEAL CLOSURE—syn VELOPHARY-
can only be removed by a clinician, i.e. a fixed partial denture
NGEAL SPHINCTER
supported by dental implants that has been retained by
pal.lia.tive adj (1543): affording relief but not a cure means of a mechanical system (i.e., screw[s]), this prosthesis
pal.pate vt pal.pat.ed; pal.pat.ing (1849): to examine by is a fixed partial denture. An adjective may be added to the
touch—pal.pa.tion n clinical description, if needed, to designate the means of
panoramic radiograph: a radiograph produced by a mechanical retention, i.e. a screw retained fixed partial denture.
panoramic machine—called also orthopantograph Any such prosthesis luted to dental implants (in the same
manner as luting a fixed partial denture to natural teeth)
panoramic radiography: a method of radiography by which
needs no additional designation as to its means of
continuous radiographs of the maxillary and/or mandibular
dental arches and their associated structures may be retention—see BILATERAL DISTAL EXTENSION
obtained. The X-ray source may be placed intraoral or REMOVABLE P.D., FIXED P.D., REMOVABLE P.D.,
extraoral UNILATERAL REMOVABLE P.D.
Panorex adj—trademark (1966): see PANORAMIC partial denture construction obs: the science and technique
RADIOGRAPH of designing and constructing partial dentures (GPT-4)
pan.to.gram n: see PANTOGRAPHIC TRACING partial denture impression: a negative likeness of a part or
all of a partially edentulous arch
pan.to.graph n (1723) 1: an instrument used for copying a
planar figure to any desired scale 2: in dentistry, an partial denture rest: a rigid extension of a fixed or removable
instrument used to graphically record in one or more planes partial denture that prevents movement toward the mucosa
or paths of mandibular movement and to provide and transmits functional forces to the teeth
information for the programming of an articulator partial denture retention: the ability of a partial denture to
pantographic tracing: a graphic record of mandibular resist movement away from its foundation area and/or
movement in three planes as registered by the styli on the abutments 805
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partial dislocation: dislocation of the articular disk due to a pear.shaped area: see PEAR-SHAPED PAD
seriously impaired disk-condyle complex function pear.shaped pad: the most distal extension of attached
partial veneer crown: a restoration that restores all but one keratinized mucosa overlying the mandibular ridge crest
corom surface of a tooth, usually not covering the facial formed by the securing pattern after extraction of the most
surface posterior molar. It should be differentiated from the
partitive color mixing: color mixing in which both additive retromolar area
and subtractive principles are involved. The eye interprets pediatric speech aid prosthesis: a temporary or interim
tiny dots subtractive color too small to be individually prosthesis used to close a defect in the hard and/or soft
resolved at the viewing distance. The resultant color will be palate. It may replace tissue lost due to developmental or
the average of the color used surgical alterations. It is necessary for the production of
Passavant’s pad: see PASSAVANT’S RIDGE intelligible speech—syn BULB, CLEFT PALATE
Passavant’s ridge [Philip Gustav Passavant, German APPLIANCE, NASOPHARYNGEAL OBTURATOR,
surgeon, 1815, 1893]: eponym for a prominence on the OBTURATOR, PROSTHETIC SPEECH AID, SPEECH
posterior wall of the nasopharynx formed by contraction of APPLIANCE, SPEECH BULB
the superior constrictor muscle of the pharynx during peg lateral: an undersized, tapered maxillary lateral incisor
swallowing. Contraction occurs at the level of the plane of perceived color: attribute of visual perception that can be
the hard palate—called also Passavant’s bar, Passavant’s describe by color names: white, gray, black, yellow, orange,
cushion, Passavant’s pad, and Passavant’s ridge brown, green, blue, purple, etc., or by a combination of names
Passavant PG. Uber die Verschliesung des Schlunmdes beim per.cus.sion n (1544) 1: the act of striking a part with sharp
Sprecher (Virchows) Arch Path Anat (Berlin) Virchows 1869; 1-31. blows as an aid in diagnosing the condition of the underlying
pas.si.vate vt -at.ed; -at.ing (1913): to render inactive or less parts by means of the sound obtained 2: in dentistry, striking
reactive 2: to protect against contamination by coating or a part with short , sharp blows as a diagnostic aid in
surface treating evaluation of a tooth or implant by the sound obtained
pas.si.va.tion n: a process whereby metals and alloys are peri.ap.i.cal adj: relating to tissues surrounding the apex of
made more corrosion resistant through surface treatment. a tooth, including the alveolar bone and periodontal
This process produces a thin and stable inert oxide layer on ligament
the external surfaces—called also passive corrosion peri.implantitis substand: in periodontics, a term used to
conditioning describe inflammation around a dental implant, usually its
pas.sive adj (14c) 1: not active or in operation; inert; latent abutment; editorial note: suggested terminology includes
2: resistant to corrosion 3: existing or occurring without being gingivitis, acute gingivitis, chronic gingivitis since the implant
active direct, or open does not exhibit inflammation
pas.si.vi.ty n (14c): the quality or condition of inactivity or peri.mol.y.sis (1998): acidic erosion of the teeth as a result of
reassumed by the teeth, tissues, and denture when a chronogastric regurgitation
removable partial denture is in place but not under
House RC, et al. Perimolysis: unveiling the surreptitious vomiter.
masticatory pressure
Oral Surg Oral Med Oral Path 1981;51:152-5
pat.ent adj (14c): open or unobstructed path of dislodgement:
peri.odon.tal adj: pertaining to or occurring around a tooth
the specific direction in which a removable partial denture
may be dislodged peri.odon.to.me.try n: the measurement of tooth mobility
path of insertion: see PATH OF PLACEMENT peri.os.te.um n, pl -tea (1597): the membrane of connective
tissue that closely invests all bones except at articular
path of placement: the specific direction in which a surfaces
prosthesis is placed on the abutment teeth
peripheral seal: see BORDER SEAL
pathogenic occlusion: an occlusal relationship capable of
producing pathologic changes in the stomatognathic system pe.riph.ery n, pl -eries (1571): see DENTURE BORDER
pat.tern n (14c): a form that is used to make a mold; a model peri.ra.dic.u.lar adj: around or surrounding a tooth root
for making a mold—see OCCLUSAL P. permanent dentition: the teeth that erupt after the primary
pa.trix n, pl pa.trices 1: a pattern or die used in type founding dentition that do not shed under normal conditions
form a matrix 2: the extension of a dental attachment system pharyngeal flap: tissue elevated from the posterior
through fits into the matrix pharyngeal wall and inserted into the soft palate to correct
pawl n (1626): a pivotal tongue or bolt on one part of a palatopharyngeal inadequacy
machine that is adapted to fall into notches or spaces on pharyngeal speech aid prosthesis: see DEFINITIVE
another part so to permit motion in only one direction, i.e., OBTURATOR, INTERIM OBTURATOR, SURGICAL
a ratchet wheel OBTURATOR
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Glossary of Prosthodontic Terms
pharyngeal walls: posterior and lateral walls of the naso- physiologic rest position 1: the mandibular position
and oropharynx assumed when the head is in an upright position and the
phar.ynx n, pl phar.yn.ges (ca. 1693): a funnel-shaped tube involved muscles, particularly the elevator and depressor
of muscle tissue between the mouth, nares, and the groups, are in equilibrium in tonic contraction, and the
esophagus, which is the common pathways for food and condyles are in a neutral, unstrained position (GPT-1) 2: the
air. The nasopharynx is above the level of the soft palate. position assumed by the mandible when the attacked
The oropharynx lies between the upper edge of the epiglottis muscles are in a state of tonic equilibrium. The position is
and the soft palate, whereas the laryngopharynx lies below usually noted when the head is held upright (GPT-1) 3: the
the upper edge of the epiglottis and the openings into the postural position of the mandible when an individual is
esophagus and larynx resting comfortably in an upright position and the associated
phos.pho.res.cence n (1796): a form of photoluminescence muscles are in a state of minimal contractual activity—comp
OCCLUSAL VERTICAL DIMENSION, REST VERTICAL
based on the properties of certain molecules to absorb energy
DIMENSION
(either ultra violet or visible), and emit it in the form of visible
radition at a higher wave length. Distinguished from physiologic or physiological adj: (1814) 1: characteristic of
fluorescence in that light continues to be emitted for some or conforming to the innate function of a tissue or organ 2:
time after the exciting energy has ceased—see pertaining to organic processes or to functions in an
FLUORESCENCE, LUMINANCE organism or in any of its parts 3: the opposite of pathologic
1pick.le n (15c): a solution or bath for preserving or cleaning;
pho.to.ac.tive adj: reacting chemically to visible light or
any of various baths used in cleaning or processing
ultraviolet radiation—pho.to.ac.ti.va.tion
2pick.le vt pick.led; pick.ling (1552): to treat, preserve, or
pho.tom.e.ter n (1884): an instrument for the measurement
clean in or with an agent
of emitted, reflected, or transmitted light. For the
measurement of luminous intensity, a visual receptor pier n: an intermediate abutment for a fixed partial denture
element (the eye) may be used in the measuring device or a pier abutment: see INTERMEDIATE ABUTMENT
physical receptor element may be used that can be related pig.ment n (14c): finely ground, natural or synthetic,
to the calculated response of a standard observer—see inorganic or organic, insoluble dispersed particles (powder),
PHYSICAL P., VISUAL P. which, when dispersed in a liquid vehicle, may provide, in
addition to color, many other essential properties such as
pho.ton n (ca. 1922): a massless particle, the quantum of the
opacity, hardness, durability, and corrosion resistance. The
electromagnetic field, carrying energy, momentum, and term is used to include an extender, white or color pigments.
angular momentum—called also light quantum The distinction between powders that are pigments and
photopic vision: vision as it occurs under illumination those that are dyes is generally considered on the basis of
sufficient to permit the full discrimination of colors. It is the solubility—pigments being insoluble and dispersed in the
function of the retinal cones and is not dependent on the material, dyes being soluble or in solution as used
retinal rods—called also daylight vision as contrasted with pin n (bef. 12c): a small cylindrical piece of metal—see
twilight or scotopic vision ANTERIOR GUIDE P., CEMENTED P., FRICTION
photoreceptor process: that specific process that is set in RETAINED P., SELF-THREADING P., STEINMANN’S P.
motion in a visual sensory end organ or other photic receptor pinledge (1998): a partial veneer retainer preparation
by the incidence of its adequate stimulus, i.e., light incorporating pins holes to provide retention
physical elasticity of muscle obs: the physical quality of pivoting condole: see WORKING SIDE CONDYLE
muscle of being elastic; that is, yielding to active or passive place.ment v: the process of directing a prosthesis to a
physical stretch (GPT-4) desired location; the introduction of prosthesis into a
physical photometer: a photometer in which the patient’s mouth—sub-stand DELIVERY, INSERTION—called
measurement is made by some physical or chemical effect also denture placement, prosthesis placement
instead of by visual methods plane n (1570): a flat surface defined by three points—see
physiologically balanced occlusion obs: a balanced AXIS ORBITAL P., CAMPER’S P., CORONAL P., CUSP P.,
occlusion that is in harmony with the temporomandibular FRANKFORT HORIZONTAL P., FRONTAL P.,
HORIZONTAL P., INCLINED P., MANDIBULAR P.,
joints and the neuro-muscular system (GPT-4)
MEDIAN P., OCCLUSAL P., SAGITTAL P.
physiologic elasticity of muscle obs: the unique biologic
plane motion 1: motion that is combination of rotation and
quality of muscle of being capable of change and of resuming
translation in a given plane. The motion is described by
its size under neuromuscular control (GPT-4)
instantaneous centers of rotation. When the center of rotation
physiologic occlusion obs: occlusion in harmony with the is fixed, the body is rotating 2: the combined motions of
functions of the masticatory system (GPT-4) translation and rotation of a rigid body within a given plane 807
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plane of occlusion: see OCCLUSAL PLANE includes the buccal and lingual surfaces of the teeth (GPT-4)
plane of reference: any plane with defined landmarks from polished layer: see BEILBY LAYER
which measurements can be made—see HORIZONTAL pol.ish.ing v, obs 1: to make smooth and glossy, usually by
PLANE OF REFERENCE friction; to give luster to (GPT-1) 2: obs: the act or process of
plas.ter n: a paste-like composition (usually of water, lime, making a denture or casting smooth and glossy (GPT-1)
and sand) that hardens on drying and is used for coating polishing agents: any material used to impart luster to a
walls, ceilings, and partitions—slang: in dentistry, a surface
colloquial term applied to dental plaster of paris poly.ether adj: an elastomeric impression material of
plaster of paris (15c): a white, powdery, slightly hydrated ethylene oxide and tetra-hydrofurocopolymers that
calcium sulfate made by calcination of gypsum, used for polymerizes under the influence of an aromatic ester
making casts and molds when combined with water to form poly.mer n (1866): a chemical compound consisting of large
a quick-setting paste. organic molecules built by repetition of smaller monomeric
plaster wash obs: a thin mix of plaster used to improve the units
accuracy of a preliminary impression (GPT-4) polymerization n (1872): the forming of a compound by the
1plas.ticadj (1632) 1: capable of being shaped or formed 2: joining together of molecules of small molecular weights
pertaining to the alteration or reformation of living tissues into a compound of large molecular weight
2
plas.tic n (ca. 1909): any of numerous organic synthetic or po.ly.mer.ize vb: to effect a chemical reaction by joining
processed materials that generally are thermoplastic or together individual molecules to form large molecules made
thermosetting polymers, usually of high molecular weight. up of many repeated units
They can be cast, extruded, molded, drawn, or laminated poly.som.nog.ra.phy n: the all-night recording of a variety
into films, filaments, and objects of physiologic parameters (e.g., brain waves, eye
plastic base obs: a denture or record base made of a plastic movements, muscle tonus, respiration, heart rate) as an aid
material (GPT-4) in the diagnosis of sleep related disorders
plate n, slang: see PROSTHESIS poly.sul.fide n (1849): an elastomeric impression material
platinum foil: a precious-metal foil with a high fusing point of polysulfide polymer (mercaptan) that cross-links under
that makes it suitable as a matrix for various soldering the influence of oxidizing agents such as lead peroxide
procedures as well as to provide an internal form for poly.vi.nyl.si.lox.ane n: an addition reaction silicone
porcelain restorations during their fabrication elastomeric impression material of silicone polymers having
Pleasure curve [Max Pleasure, 1903-1965]: eponym for a curve terminal vinyl groups that cross-link with silanes on
of occlusion which, when viewed in the frontal plane, activation by a platinum or palladium salt catalyst
conforms to a line that is convex in the cephalic direction, pon.tic n: an artificial tooth on a fixed partial denture that
except when viewed through the molar region replaces a missing natural tooth, restores its function, and
plunger cusp: a cusp that tends to force food interproximal usually fills the space previously occupied by the clinical
crown
po.go.ni.on n: the most anterior point on the mandible
por.ce.lain n (known in Europe, ca. 1540): a ceramic material
point A: a bony landmark representing the deepest point of formed of infusible elements joined by lower fusing
the premaxillary concavity between the anterior nasal spine materials. Most dental porcelains are glasses and are used
and prosthion as viewed on a lateral cephalometric in the fabrication of teeth for dentures, pontics and facings,
radiograph metal ceramic restorations, crowns, inlays-onlays, and other
point angle: in the development of a cavity preparation, that restorations
place of convergence of three planes or surfaces—comp LINE porcelain fused to metal restoration: see METAL CERAMIC
ANGLE RESTORATION
point B: see SUPRAMENTALE porcelain labial margin: the extension of ceramic material
1pol.ish vb (14c): to make smooth and glossy, usually by to the finish line of the preparation without visible metal
friction; giving luster; the act or process of making a denture substructure in the marginal area—syn PORCELAIN BUTT
or casting smooth and glossy MARGIN
2polish n (1704): a smooth, glossy surface; having luster po.ros.i.ty n, pl -ties (14c) 1: the presence of voids or
polished denture surface obs: that portion of the surface of pores within a structure 2: the state or quality of
a denture that extends in an occlusal direction from the having minute pores, openings or interstices—see BACK
border of the denture and includes the palatal surfaces. It is PRESSURE P., OCCLUDED GAS P., SHRINK-SPOT P.,
that part of the denture base that is usually polished, and it SOLIDIFICATION P.
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Glossary of Prosthodontic Terms
positional record: an intraoral or extraoral registration of a postural contraction: that minimal tonic muscle activity
specific mandibular position necessary to resist the forces of gravity and thus maintain
post.core: see DOWEL posture; maintenance of muscle tension (usually isometric)
sufficient to maintain posture, dependent on muscle tone
post.core crown: a restoration in which the crown and cast
post in one unit postural position: any mandibular relationship occurring
during minimal muscle contraction
post dam: see POSTPALATAL SEAL
pour hole obs: an aperture in investment or any other mold
post dam area: see POSTPALATAL SEAL AREA material leading to the prosthesis space into which prosthetic
posterior adj (1534) 1: situated behind or in back of; caudal material is poured (GPT-4)
2: in human anatomy, dorsal precious metal: a metal containing primary elements of the
posterior bite collapse: see POSTERIOR OVERCLOSURE platinum group, gold, and silver
posterior border jaw relation obs: the most posterior relation precious metal alloy: an alloy predominantly composed of
of the mandible to the maxillae at any specific vertical elements considered precious, i.e., gold, the six metals of
relation (GPT-4) the platinum group (platinum, osmium, iridium, palladium,
posterior border movement: movements of the mandible ruthenium, and rhodium), and silver
along the posterior limit of the envelope of motion precision attachment: 1: a retainer consisting of a metal
posterior border position: the most posterior position of the receptacle (matrix) and a closely fitting part (patrix); the
mandible at any specific vertical relation matrix is usually contained within the normal or expanded
contours of the crown on the abutment tooth and the patrix
posterior determinants of mandibular movement: the
is attached to a pontic or the removable partial denture
temporary mandibular articulations and associated
framework 2: an interlocking device, one component of
structures—see DETERMINANTS OF MANDIBULAR
which is fixed to an abutment or abutments, and the other
MOVEMENT
is integrated into a removable prosthesis to stabilize and/or
posterior determinants of occlusion: see DETERMINANTS retain it
OF MANDIBULAR MOVEMENT
precision rest: a prefabricated, rigid metallic extension
posterior open bite slang: see POSTERIOR OPEN (patrix) in a fixed or removable partial denture that fits
OCCLUSAL RELATIONSHIP intimately into the box-type rest seat or keyway (matrix)
posterior open occlusal relationship: lack of posterior tooth portion of a precision attachment in a cast restoration
contact in any occluding position of the anterior teeth preextraction cast: see DIAGNOSTIC CAST
posterior opening movement obs: the opening movement preliminary cast: a cast formed from a preliminary
of the mandible about the terminal hinge axis (GPT-4) impression for use in diagnosis or the fabrication of an
posterior overclosure: the loss of occluding vertical impression tray
dimension as result of the loss or drifting of posterior teeth preliminary impression: a negative likeness made for the
posterior palatal seal: see POSTPALATAL SEAL purpose of diagnosis, treatment planning, or the fabrication
posterior palatal seal area: see POSTPALATAL SEAL AREA of a tray
posterior reference points: two points, located one on each premature contact: see DEFLECTIVE OCCLUSAL
side of the face in the area of the transverse horizontal axis, CONTACT
which together with an anterior reference point, establish pre.ma.tur.i.ty n: see DEFLECTIVE OCCLUSAL CONTACT
the horizontal reference plane
preoperative cast: a positive likeness of a part or parts of
posterior tooth form: the distinguishing contours of the the oral cavity for the purpose of diagnosis and treatment
occlusion surfaces of posterior teeth planning—see DIAGNOSTIC CAST
postmenopausal atrophy: atrophy of various tissues, such preoperative record obs: any record made for the purpose
as oral mucosa, occurring after menopause of study or treatment planning (GPT-4)
postpalatal seal: the seal area at the posterior border of a preoperative wax.up: a dental diagnostic procedure in which
maxillary prosthesis planned restorations are developed in wax on a diagnostic
postpalatal seal area: the soft tissue area at or beyond the cast to determine optimal clinical and laboratory procedures
junction of the hard and soft palates on which pressure, necessary to achieve the desired esthetics and function—
within physiologic limits, can be applied by a denture to called also diagnostic wax-up, preoperative waxing
aid in its retention preprosthetic surgery: surgical procedures designed to
postsurgical prosthesis: see DEFINITIVE OBTURATOR facilitate fabrication or to improve the prognosis of 809
INTERIM OBTURATOR prosthodontic care
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pressure area: a region of mucosa that is being subjected to process jig: see ANALOG
excessive from a denture pro.file n (ca. 1656): an outline or contour, especially one
pressure indicating paste: any substance applied to a representing a side view of a human head
prosthesis, which, when seated on a structure, demonstrates profile record: a registration or record of the facial profile of
the adaptation of the prosthesis to the structure it opposes a patient—see also EMERGENCE PROFILE
pressure relief obs: alteration of the denture-bearing surface prog.na.thic n: a protruded position of the mandible in
of a denture to reduce force on the underlying tissues relation to the maxillae—called also caput progeneum,
(GPT-4) exognathia, progenia, and prognathia
pressure welding: bonding of two metals together by prog.na.thism n (ca. 1864): an overgrowth of the mandible
sufficiently large force applied perpendicular to the surface. in an anteroposterior direction; a protrusion of the mandible
Such force must be of magnitude to produce permanent in relation to the maxillae
distortions that expose a film-free metal contact
prog.no.sis n (1655): a forecast as to the probable result of a
pretreatment records: any records made for the purpose of disease or a course of therapy
diagnosis, recording of the patient history, or treatment
progressive loading (1998): the gradual increase in the
planning in advance of therapy
application of force on a dental implant whether
primary colors: three basic colors used to make most other intentionally done with a prosthesis or unintentionally via
colors by mixture, either additive mixture of lights or forces placed by adjacent anatomic structures or
subtractive mixture of colorants parafunctional loading
primary colors additive: three colored lights from which all progressive mandibular lateral translation 1: the translatory
other colors can be matched by additive mixture. The three portion of mandibular movement when viewed in a specified
must be selected so that no one of them can be matched by body plane 2: the translatory portion of mandibular
mixture of the other two. Generally, red, green, and blue are movement as viewed in a specific body plane that occurs at
used. Additive primaries are the complements of the a rate or amount that is directly proportional to the forward
subtractive primaries movement of the non-working condyle—see
primary colours subtractive: colors of three colorants or MANDIBULAR TRANSLATION
colored materials which, when mixed together subtract from progressive side shift: see MANDIBULAR TRANSLATION
one another, result in black or a very dark neutral color.
projected pain: heterotopic pain felt in the anatomical
Subtractive primaries are generally cyan, magenta, and
peripheral distribution of the same nerve that mediates the
yellow
primary pain
primary dentition: the teeth that erupt first and are normally
proportional limit: that unit of stresses beyond which
shed to be replaced by permanent (succedaneous) teeth—
deformation is no longer proportional to the applied load
syn DECIDUOUS DENTITION
pro.prio.cep.tion n (1906): the reception of stimulation of
primary hyperalgesia: stimulation evoked primary pain due
sensory nerve terminals within the tissues of the body that
to lowered pain threshold
give information concerning movements and the position
primary impression: see PRELIMINARY IMPRESSION of the body; perception mediated by proprioceptors
primary occlusal trauma: the effects induced by abnormal prio.the.sis n, pl -the.ses (1900) 1: an artificial replacement
or excessive occlusal forces acting on teeth with normal of an absent part of the human body 2: a therapeutic
periodontal support device to improve or alter function 3: a device used to
primary pain: pain that identifies the true source of aid in accomplishing a desired surgical result—see
nociceptive input result from the dispersion of light rays by DEFINITIVE P., DENTAL P., INTERIM P., PROVISIONAL
means of a prism or diffraction grating P., SURGICAL P.
pro.cess n, pl pro.ces.ses (14c) 1: in anatomy, a prominence prosthesis placement: see PLACEMENT
or projection of bone 2; in dentistry, any technical procedure pros.thet.ic adj, pros.thet.i.cal.ly adv (ca. 1890): relating to
that incorporates a number of steps; the procedure of a prosthesis or prosthetics
bringing about polymerization of dental resins for prostheses
prosthetic dentistry: see PROSTHODONTICS
or bases—see DENTURE PROCESSING
processed denture base: that portion of a polymerized prosthetic restoration obs: an artificial replacement for an
prosthesis covering the oral mucosa of the maxillary and/ absent part of the human body (GPT-4)
or mandible to which artificial teeth will be attached by prosthetic speech aid: see ADULT SPEECH AID
means of a second processing PROSTHESIS, PEDIATRIC SPEECH AID PROSTHESIS
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Glossary of Prosthodontic Terms
pros.thet.ics n, pl but sing or pl in constr (ca. 1894): the art protrusive relation obs: the relation of the mandible to the
and science of supplying artificial replacements for missing maxillae when the mandible is thrust forward (GPT-4)
parts of the human body—see also MAXILLOFACIAL P. provisional denture: see INTERIM PROSTHESIS
pros.the.tist n: a person involved in the construction of an provisional prosthesis: see INTERIM PROSTHESIS
artificial replacement for any part of the human body
provisional splint: an interim device to stabilize teeth during
pros.tho.don.tia n: see PROSTHODONTICS diagnosis or therapy—syn INTERIM SPLINT
pros.tho.don.tics n, pl but sing or pl in constr (1947): the prox.i.mal adj (1727) 1: situated close to 2: next to or nearest
branch of dentistry pertaining to the restoration and
the point of attachment or origin, a central point especially,
maintenance of oral function, comfort, appearance, and
located toward the center to a body—comp DISTAL—
health of the patient by the restoration of natural teeth and/
prox.i.mal.ly adj
or the replacement of missing teeth and craniofacial tissues
with artificial substitutes—see FIXED PROSTHODONTICS, proximal contact: see INTERPROXIMAL CONTACT
IMPLANT PROSTHODONTICS, MAXILLOFACIAL pseudoisochromaticulor tests: tests for detecting color
PROSTHETICS, REMOVABLE PROSTHODONTICS vision deficiency. The charts are made up of colored spots
pros.tho.don.tist n (1917) 1: a specialist in prosthodontics 2: that yield a legible pattern (number, letter, figure, etc.) for a
a dentist who has successfully completed an advanced normal observer but yield no legible, pattern for observers
education program in prosthodontics that is accredited by with anomalous types of color vision
the appropriate accrediting body. In the United States, that psy.cho.phys.i.cal adj (1847): used to describe the sector of
body is the Commission on Dental Accreditation of the color science that deals with the relationship between
American Dental Association—see BOARD-CERTIFIED P., physical description or specification of stimuli and the
BOARD-ELIGIBLE P., EDUCATIONALLY QUALIFIED P. sensory perception arising from them
pro.ta.no.pia: a form of dichromatism in which red and blue- psychophysical color: a specification of color stimulus in
green stimuli are confused terms of operationally defined values, such as three tri-
protonomalous vision: a form of color deficient vision in stimulus values
which the ability to perceive blue and yellow is retained. psychosomatic dentistry 1: dentistry that concerns itself with
Hue discrimination is poor in the red to green region of the the mind-body relationship 2: dentistry that acknowledges
spectrum a relationship between the psychic and normal physiological
pro.tru.sion n (1646): a position of the mandible anterior to functions
centric relation—see LATEROPROTRUSION pterygoid notch: see PTERYGOMAXILLARY NOTCH
pro.tru.sive adj, pro.tru.sive.ly adv, pro.tru.sive.ness n pterygoid plates: broad, thin, wing-shaped processes of the
(1676): thrusting forward; adjective denoting protrusion spheroic bone separated by the pterygoid fossa. The inferior
protrusive checkbite: see PROTRUSIVE INTEROCCLUSAL end of this medial plate terminates in a long curved process
RECORD or hook for the tendon of the tensor veli palatini muscle.
The lateral plate gives attachment to the medial and lateral
protrusive condyle path: the path the condyle travels when
pterygoid muscles
the mandible is moved forward from its initial position
pterygomaxillary notch: the palpable notch formed by the
protrusive deflection: a continuing eccentric displacement
junction of the maxilla and the pterygoid hamulus of the
of the midline incisal path on protrusion, symptomatic of a
sphenoid bone
restriction of movement
pulp n: the richly vascularized connective tissue, with much
protrusive deviation: discursive movement on protrusion
innervation, of mesodermal origin contained in the central
that ends in the centered position and is indicative of
cavity of the tooth
interference during movement
pulp capping: application of a material to protect the pulp
protrusive jaw relation obs: a jaw relation resulting from a
from external influences and promote healing, done either
protrusion of the mandible (GPT-4)
directly and indirectly
protrusive interocclusal record: a registration of the
pulpectomy n: the complete removal of the dental pulp
mandible in relation to the maxillae when both condyles
are advanced in the temporal fossa pulpitis n: inflammation of the dental pulp
protrusive occlusion obs: an occlusion of the teeth when pulpotomy n: surgical amputation of the coronal portion of
the mandible is protruded (GPT-4) the dental pulp
1pum.ice n (15th cent.) 1: a type of volcanic glass used as an
protrusive record: see PROTRUSIVE INTEROCCLUSAL
RECORD abrasive. It is prepared in various grifts and used for 811
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finishing and polishing 2: a polishing agent, in powdered radiation shield/positioner: custom-made prosthesis to
form, used for natural teeth and fixed and removable align and protect adjacent tissues during irradiation
restorations radiation source device: custom-made prosthesis to align a
2pum.ice vt pum.iced; pum.ic.ing (15th cent.): to finish or radiation source to a specific anatomic site
dress with pumice radiation stent: see RADIATION SHIELD
pyramidal fracture: a fracture of the midfacial bones, with rad.i.cle n (1671): the lower part of the axis of an object
the principal fracture lines meeting at an apex in the area of rad.ic.u.lar adj (1830): pertaining to the root of a tooth
the nasion-called also Le Fort II fracture
ra.dio.gram n: see RADIOGRAPH
ra.dio.graph n (1880): an image produced on any sensitive
Q surface by means of electromagnetic radiation other than
light; a X-ray photograph
Q.D.: acronym for L. Qad’que Di’e, every day
radiograph vt (1896): to make a radiograph of
Q.H.: acronym for L. Qua’que Ho’ra, every hour
ra.dio.lu.cent: permitting the passage of radiant energy with
Q.I.D.: acronym for L. Qua’ter In Di’e, four times a day relatively little attenuation by absorption
Q.L.: acronym for L. Quan’tum Li’bet, as much as desired ra.di.opaque (1917): a structure that strongly inhibits the
Q.Q.H.: acronym for L. Qua’que Quar’ta Ho’ra, every 4 hours passage of radiant energy
quad.rant n (15c) 1: any of the four quarters into which ramus endosteal implant: an endosteal dental implant that
something is divided by two real or imaginary lines that is attached, in part, to the ramus of the mandible
intersect each other at right angles 2: in dentistry, one of the ramus frame endosteal implant: a dental implant design
four section; of the dental arches, divided at the midline that consists of a horizontal intraoral supragingival abutment
quartz n (ca. 1631): an allotropic form of silica; the mineral in the form of a bar and endosteal implant body segments
consisting of hexagonal crystals of colorless, transparent that are placed into the rami and symphysis areas as one
silicon dioxide section (implants fabricated from one piece of metal), or two
sections (implants of anterior and horizontal segments that
quick.cure resin: see AUTOPOLYMERIZING RESIN
are connected at the time of placement), or five sections (an
implant consisting of five sections in which the endosteal
R implant body segments are independently placed and
connected with fitted parts)
RAD: acronym for Radiation Absorbed Dose, a unit of range of motion: the range, measured in degrees of a circle,
measurement of the absorbed dose of ionizing radiation. The through which a joint can be extended or flexed. The range
biologic effect on one rad varies with the type of radiation of the opening, lateral, and protrusive excursions of the
tissue is exposed to—also GRAY temporomandibular joint
ra.di.a.tion n (1570): the emission of electromagnetic waves, ra.phe n (1753) 1: line of union of symmetrical parts 2: a
such light, short wave, radio, ultraviolet, or x-rays, or fibrous band or bands where paired muscles meet
particulate such as alpha, beta, and gamma rays
re.at.tach.ment n: in periodontics, the reunion of epithelial
radiation carrier: a device used to administer radiation to and connective tissues with root surfaces and bone such as
confined areas by means of capsules, beads, or needles of occurs after incision or injury
radiation emitting materials such as radium or cesium. Its
re.base n: the laboratory process of replacing the entire
function is to hold the radiation source securely in the same
denture base material on an existing prosthesis
location during the enter period of treatment—syn CARRIER
PROSTHESIS, INTRACAVITY APPLICATOR, receptor sites: specific sites at which molecular binding
INTRACAVITY CARRIER, RADIATION APPLICATOR, occurs that results in specific biologic responses
RADIUM CARRIER, RADIOTHERAPY PROSTHESIS recipient site: the site into which a graft or transplant
radiation cone locator: a prosthesis used to direct and material is placed
reduplicate the path of radiation to an oral tumor during a re.cip.ro.cal adj, obs: the manner in which one part of a
split course of irradiation—syn CONE LOCATOR, prosthesis is made to counter the effect created by another
DOCKING DEVICE part (GPT-1)
radiation shield: an intraoral prosthesis designed to shield reciprocal arm: see RECIPROCAL CLASP
adjacent tissues from radiation during orthovoltage reciprocal clasp: a component of the clasp assembly
treatment of malignant lesions of the head and neck specifically designed to provide reciprocation by engaging
regions—syn LEAD SHIELD, RADIATION STENT, a reciprocal guiding plane; it contacts the action of the clasp
812 TONGUE PROTECTOR during removal and insertion of a removable partial denture
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Glossary of Prosthodontic Terms
reciprocal click: a pair of clicks emanating from the refractory investment: an investment material that can
temporomandibular joint, one of which occurs during withstand the high temperatures used in soldering or casting
opening movements and the other during closing refractory mold: a refractory cavity into which a substance
movements is shaped or cast
re.cip.ro.ca.tion n (1561) 1: the mechanism by which lateral re.gen.er.a.tion n (14c): renewal or restoration of a body or
forces generated by a retentive clasp passing over a height
bodily part after injury or as a normal process—see GUIDED
of contour are counterbalanced by a reciprocal clasp passing
TISSUE REGENERATION
along a reciprocal guiding plane 2: a mutual exchange 3: an
alternating motion—re.cip.ro.ca.tive adj reg.is.tra.tion n (1566) 1: the making of a record of the jaw
relationships present, or those desired, thus allowing their
re.cord vb (14c) 1: to register data relating to specific
transfer to an articulator to assist in proper fabrication of a
conditions that exist currently or previously 2: to register
dental prosthesis
permanently by mechanical means, i.e., jaw relationships—
see CENTRIC RELATION R., ECCENTRIC 2: a record made of the desired maxillomandibular
INTEROCCLUSAL R. INTEROCCLUSAL R., OCCLUDING relationship and used to relate casts to an articulator—see
JAW R., TERMINAL JAW RELATION R. MAXILLOMANDIBULAR RELATIONSHIP RECORD
2rec.ord n (14c) 1: an official document 2: a body of known re.im.plan.ta.tion n: the act of replacing a tooth in the same
or recorded facts about someone or something alveolar socket from which it had been removed, either
surgically or as a result of trauma
record base: an interim denture base used to support the
record rim material for recording maxillomandibular records re.lief adj: the reduction or elimination of undesirable
pressure or force from a specific region under a denture base.
record rim: the occlusal surfaces fabricated on a record base
The creation of space in an impression tray for impression
for the purpose of making maxillomandibular relationship
material
records and/or arranging teeth—called also occlusion rim
relief area: that portion of the denture that is reduced to
reduced interarch distance: an occluding vertical dimension
eliminate excessive pressure
that results in an excessive interocclusal distance when the
mandible is in rest position and in a reduced interridge relief chamber: see RELIEF AREA
distance when the teeth are in contact—called also overclosure re.line vt (1851): the procedures used to resurface the tissue
re.duc.tion n (1546): the correction of a fracture or dislocation; side of a denture with new base material, thus producing
the restoration by surgical or manipulative procedures of a an accurate adaptation to the denture foundation area—comp
part to its normal anatomic location REBASE
reference plane locator: a device used to facilitate location re.mod.el vt: the morphologic change in bone as an adaptive
of the horizontal reference plane on the face of a patient response to altered environmental demands. The bone will
progressively remodel where there is a proliferation of tissue
re.flec.tance n (1926): the ratio of the intensity of reflected
and regressive remodeling when osteoclastic resorption is
radiant flux to that of the incident flux. In popular usage, it
evident
is considered as the ratio of the intensity of reflected radiant
flux to that reflected from a defined reference standard. remount cast: a cast formed of a prosthesis for the purpose
Specular reflection is the angle of reflection equal to the angle of mounting the prosthesis on an articulator
of incidence. Surface reflection is associated with objects remount procedure: any method used to relate restorations
having optically smooth surfaces. These objects are usually to an articulator for analysis and/or to assist in development
termed glossy of a plan for occlusal equilibration or reshaping
re.flec.tion (14c) n 1: the elevation and folding back of all or remount record index: a record of maxillary structures
part of the mucosa to expose underlying structures 2: the affixed to the mandibular member of an articulator useful
return of light or sound waves from a surface in facilitating subsequent transfers
re.frac.tion n (1603): the deflection of light or energy waves removable appliance: see REMOVABLE PARTIAL
from a straight path that occurs when passing obliquely from DENTURE
one medium into another in which its velocity is different removable bridge: see REMOVABLE PARTIAL DENTURE
re.frac.to.ry adj (1606): difficult to fuse or corrode; capable removable partial denture: any prosthesis that replaces
of enduring high temperatures some teeth in a partially dentate arch. It can be removed
refractory cast: a cast made of a material that will withstand from the mouth and replaced at will
high temperatures without disintegrating—called also removable prosthodontics: the branch of prosthodontics
investment cast concerned with the replacement of teeth and contiguous
refractory flask: see CASTING FLASK structures for edentulous or partially edentulous patients 813
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by artificial substitutes that are removable from the mouth acid etching of the metal plate (Maryland Bridge) eliminated
rep.li.ca n (1852) 1: a reproduction or fascimile, especially the need for perforations.
by the makers, of an original 2: a copy or duplicate, i.e., a Rochette, Alain I. Attachment of a splint to enamel of lower anterior
teeth
duplicate of the surface of a component of a dental implant
J Prosthet Dent 1973;30:418-23.
used to process a restoration
Livaditis GJ; Thompson VP. Etched castings an improved retentive
re.po.si.tion.ing adj: the changing of any relative position mechanism for resin-bonded retainers J Prosthet Dent 1982;47:
of the mandible to the maxillae, usually altering the occlusion 52-9.
of the natural or artificial teeth
resin-bonded splint: a splint of heavy wire or cast metal
repositioning splint: an intraoral splinting device that is bonded to the labial or lingual surface of natural teeth
constructed to temporarily or permanently alter the relative with an acid etch technique. It is used to stabilize
position of the mandible to the maxillae traumatically displaced or periodontally compromised teeth
residual bone: that component of maxillary or mandibular resin crown: a resin restoration that restores a clinical crown
bone, once used to support the roots of the teeth, that remains without a metal substructure
after the teeth are lost resin-retained prosthesis: see RESIN-BONDED
residual ridge: the portion of the residual bone and its soft PROSTHESIS
tissue covering that remains after the removal of teeth resistance form: the features of a tooth preparation that
residual ridge crest: the most coronal portion of the residual enhance the stability of a restoration and resist dislodgement
ridge along an axis other than the path of placement
residual ridge resorption: a term used for the diminishing re.sorp.tion n (1818): the loss of tissue substance by
quantity and quality of the residual ridge after teeth are physiologic or pathologic process—see ALVEOLAR
removed RESORPTION
Ortman IIR. Factors of bone resorption of the residual ridge. J rest n (15c): a projection or attachment, usually on the side
Prosthet of an object—see CINGULUM R., INCISAL R., LINGUAL
Dent 1962;12:429-40. R. OCCLUSAL R., PARTIAL DENTURE R., PRECISION R.
Atwood DA. Some clinical factors related to rate of resorption of SEMIPRECISION R.
residual rest area: see REST SEAT
Ridges.J Prosthet Dent 1962;12:441-50.
rest bite: see PHYSIOLOGIC REST POSITION
re.sil.ient adj (1674): characterized or noted by resilience,
rest jaw relation obs: the habitual postural jaw relation when
as a) capable of withstanding shock without permanent
the patient is resting comfortably in an upright position and
deformation or rupture or b) tending to recover from or
the condyles are in a neutral, unstrained position in the
easily adjust to change syn ELASTIC—re.sil.ient.ly adv
glenoid fossae (GPT-4)
resilient attachment (1998): an attachment designed to give
rest occlusion: see PHYSIOLOGIC REST POSITION
a tooth-/soft tissue-borne prosthesis sufficient mechanical
flexion to withstand the variations in seating of the prosthesis rest position: see PHYSIOLOGIC REST POSITION
due to deformations of the mucosa and underlying tissues rest relation: see PHYSIOLOGIC REST POSITION
without placing excessive stress on the abutments rest seat: the prepared recess in a tooth or restoration created
res.in n (14c) 1: any of various solid or semisolid amorphous to receive the occlusal, incisal, cingulum, or lingual rest
natural organic substances that usually are transparent or rest vertical dimension: the distance between two selected
translacent and brown to yellow; usually formed in plant points measured when the mandible is in the physiologic
secretions; are soluble in organic solvents but not water; are rest position
used chiefly in varnishes, inks, plastics, and medicine; and
res.to.ra.tion n (1660): a broad term applied to any material
are found in many dental impression materials 2: a broad
or prosthesis that restores or replaces lost tooth structure,
term used to describe natural or synthetic substances that
teeth or oral tissues
form plastic materials after polymerization. They are named
according to their chemical composition, physical structure, re.tain.er n (1540): any type of device used for the
and means for activation of polymerization—see stabilization or retention of a prosthesis—see DIRECT R.,
AUTOPOLYMERIZING R., COPOLYMER R. FIXED PARTIAL DENTURE R., INDIRECT R.
resin-bonded prosthesis: a prosthesis that is luted to tooth re.ten.tion n (15c): that quality inherent in the prosthesis
structures, primarily enamel, which has been etched to acting to resist the forces of dislodgement along the path of
provide mechanical retention for the resin cement. Early placement—see DIRECT R., INDIRECT R.
design incorporated perforations on the lingual plate retention arm: an extension that is part of a removable partial
(Rochette Bridge) through which the resin bonded material denture and is used to aid in the fixation of the prosthesis; a
814 part of a clasp
passed to achieve a mechanical lock; subsequently, use of
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Glossary of Prosthodontic Terms
retention form: the feature of a tooth preparation that resists re.tru.sion vb: movement toward the posterior
dislodgement of a crown in a vertical direction or along the re.tru.sive adj: denotes a posterior location
path or placement
reverse articulation: an occlusal relationship in which the
retention of denture obs: the resistance of a denture to mandibular teeth are located facial to the opposing maxillary
dislodgement (GPT-4) teeth; the maxillary buccal cusps are positioned in the central
retentive arm: see RETENTIVE CLASP fossae of the mandibular teeth
retentive circumferential clasp: a circumferential clasp arm reverse articulation teeth: posterior teeth designed to
that is flexible and engages the infrabulge area of the accommodate the buccal cusps of the maxillary teeth
abutment tooth at the terminal end of the arm positioned in the fossae of the mandibular teeth
retentive clasp 1: clasp specifically designed to provide reverse curve: a curve of occlusion defined by the cusp tips
retention by engaging an undercut 2: a flexible segment of a and incisal edges, which, when viewed in the sagittal plane,
removable partial denture that engages an undercut on an is curved upward or in a cephalic manner—comp CURVE
abutment and that is designed to retain the prosthesis OF SPEE
retentive fulcrum line 1: an imaginary line connecting the reverse occlusal curve: REVERSE CURVE
retentive points of clasp arms on retaining teeth adjacent to
reverse swallow: see TONGUE THRUSTING
mucosa-borne denture bases 2: an imaginary line, connecting
the retentive points of clasp arms, around which the denture reversible hydrocolloid: colloidal gels in which the gelation
tends to rotate when subjected to dislodging forces is brought about by cooling and can be returned to the sol
condition when the temperature is sufficiently increased
retinal fovea: a small ellipse-shaped depression in the central
region of the retina somewhat less than a degree of visual reversible splint: any means of stabilizing teeth that does
angle in maximum diameter and characterized by the not irreversibly alter the structure of the teeth
sharpest cone vision. The fovea centralis is the normal center Richmond crown [C.M. Richmond, US dentist (1835-1902)]
for visual fixation and attention obs 1: a dowel-retained crown made for an endodontically
retrodiscal tissue: a mass of loose connective tissue attached treated tooth using a porcelain facing 2: an artificial crown
to the posterior edge of the articular disk and extending to consisting of a metal base that fits the prepared abutment of
and filling the loose folds of other posterior capsule of the the natural tooth and carries a post or pivot for insertion
temporomandibular joint—called also bilaminar zone into the endodontically treated root canal: a porcelain facing
ret.ro.gnath.ic n: a retruded position of the mandible in reinforces the metal backing—called also porcelain-faced dowel
relation to the maxillae crown
Richmond CM. New method of attaching gold crowns to natural
retromolar pad: a mass of tissue comprised of
roots of teeth. Am J Dent Sci 1878-79;12:425.
nonkeratinized mucosa located posterior to the retromolar
papilla and overlying loose glandular connective tissue. This ridge n (bef. 12c): an elevated body part; a long, narrow,
freely movable area should be differentiated from the pear- raised crest—see ALVEOLAR R., CENTER OF THE R.,
shaped pad CREST OF THE R., RESIDUAL R.
retromylohyoid area obs: that area in the alveolingual sulcus ridge augmentation: any procedure designed to enlarge or
just lingual to the retromolar pad that extends lingually increase the size, extent, or quality of deformed residual
down to the floor of the mouth and back to the ridge
retromylohyoid curtain. It is bounded anteriorly by the ridge crest: the highest continuous surface of the residual
lingual tuberosity (GPT-4) ridge not necessarily coincident with the center of the ridge
retromylohyoid space: an anatomic area in the ridge lap: the surface of an artificial tooth that has been
alveololingual sulcus just lingual to the retromolar pad shaped to accommodate the residual ridge. The tissue surface
bounded anteriorly by the mylohyoid ridge, posteriorly by of a ridge lap design is concave and envelops both the buccal
the retromylohyoid curtain, inferiorly by the floor of the and lingual surfaces of the residual ridge
alveololingual sulcus, and lingually by the anterior tonsillary
ridge relation: see RIDGE RELATIONSHIP
pillar when the tongue is in a relaxed position
ridge relationship: the positional relationship of the
retruded contact: contact of a tooth or teeth along the
mandibular residual ridge to the maxillary residual ridge
retruded path of closure. Initial contact of a tooth or teeth
during closure around a transverse horizontal axis ridge resorption: see RESIDUAL RIDGE RESORPTION
retruded contact position: that guided occlusal relationship ridge slope obs: the slope of the crest of the mandibular
occurring at the most retruded position of the condyles in residual ridge from the third molar region to its most anterior
the joint cavities. A position that may be more retruded than aspect in relation to the inferior border of the mandible as
the centric relation position viewed in profile (GPT-4) 815
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rigid connector: a cast, soldered, or fused union between rotation center: a point around which all other points in a
the retainer(s) and pontic(s) body move
Roach clasp [Finnis Ewing (Frank) Roach, US rotation line obs: see FULCRUM LINE
prosthodontist, educator and inventor, (1865-1960)]: rotational path removable partial denture: a removable
eponym—see INFRABULGE CLASP partial denture that incorporates a curved, arcuate, or
Roach FE. Principles and essentials of bar clasp partial dentures. J variable path of placement allowing one or more of the rigid
Am Dent Asso: 1930;17:124-38. components of the framework to gain access to and engage
Rochette Bridge [Alain L. Rochette, French physician and an undercut area
dentist]: a resin-bonded prosthesis incorporating holes rogue n (1753): a compound composed of ferric oxide and
within the metal framework and lutes to the lingual aspect binders used for imparting a high luster to a polished surface,
of teeth adjacent to an edentulous space that replaces one or glass metal or gems
more teeth—see RESIN-BONDED PROSTHESIS RPD: acronym for Removable Partial Denture
Rochette, Alain L. Attachment of a splint to enamel of lower anterior
RPI: acronym for Rest, Proximal Plate, and I-BAR; the clasp
teeth.
components of one type of removable partial denture clasp
J Prosthet Dent 1973;30:418-23.
assembly
rod n (bef. 12c.): the photoreceptor in the retina that contains
ruga n, pl ru.gae (ca. 1775): an anatomic fold or wrinkle—
a light-sensitive pigment capable of initiating the process of
usually used in the plural sense; the irregular fibrous
scotopic vision, i.e., low intensity for achromatic sensations
connective tissue ridges located in the anterior third of the
only
hard palate
1
roent.gen adj [W.C. Roentgen, German physicist (1845-
rugae area: see RUGA
1923)]: relating to X-rays
2roentgen n (ca. 1929): the international unit of measurement rugae zone: see RUGA
of X- or gamma radiation in air—abb r or R
S
roentgen ray n, often cap 1st R (1898) 1: the electromagnetic
radiation [greater than 100eV] emitted from a highly sad.dle n, obs: see DENTURE BASE
evacuated tube, excited by the bombardment of the target sag.it.tal adj (1541): situated in the plane of the cranial
anode with a stream of electrons from a heated cathode 2: sagittal suture or parallel to that plane—usage: see SAGITTAL
electromagnetic radiation produced by the excitation of the PLANE
inner orbital electron of an atom
sagittal axis: an imaginary anteroposterior line around
roent.gen.o.gram n (1904): a photograph made with X-rays which the mandible may rotate when viewed in the frontal
roent.gen.o.graph n (ca. 1905): a shadow image record made plane
on a sensitized film or plate by roentgen rays sagittal axis of the mandible: see SAGITTAL AXIS
roentgenographic interpretation obs: an opinion formed sagittal plane: any vertical plane or section parallel to the
from the study of a roentgenograph (GPT-1) median plane of the body that divides a body into right and
root n (bef. 12c): the portion of the tooth apical to the left portions
cementoenamel junction that is normally covered by sanitary bridge obs: see HYGIENIC PONTIC
cementum and is attached to the periodontal ligament and
sat.u.ra.tion n (1554): the attribute of color perception that
hence to the supporting bone
expresses the degree of departure from gray of the same
root form endosteal dental implant: an endosteal dental lightness. All grays have zero saturation
implant shaped in the approximate form of a tooth root scaf.fold n (14c): a supporting surface, either natural or
root fracture: a microscopic or macroscopic cleavage of the prosthetic, that maintains the contour of tissue; a supporting
root in any direction framework
1scal.lop n (15c): one of a continuous series of circles
rotating condyle: see WORKING SIDE CONDYLE
2 scallop
vt (1737): to shape, cut, or finish in scallops;
ro.ta.tion n (1555) 1: the action or process of rotating on or
as if on an axis or center 2: the movement of a rigid body in segments or angular projections forming a border
which the parts move in circular paths with their centers on scattered radiation: radiation that, during passage through
a fixed line called the axis of rotation. The plane of the circle a substance, has been deviated in direction. It may also have
in which the body moves is perpendicular to the axis of been modified by an increase in wave lengths. It is one form
rotation of secondary radiation
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Glossary of Prosthodontic Terms
scat.ter.ing n (14c): diffusion or redirection of radiant energy seg.ment n (1570): any of the parts into which a body
encountering particles of different refractive index; scattering naturally separates or is divided either actually or by an
occurs at any such interface, at the surface, or inside a imaginary line or plane
medium containing particles selective grinding: see OCCLUSAL RESHAPING
scattering coefficient: single scattering coefficient of a self-curing resin: see AUTOPOLYMERIZING RESIN
particle in a medium of different refractive index, expressed
self-separating plaster obs: an impression plaster that
as a ratio between scattering cross section and geometric disintegrates in hot water (GPT-4)
cross section of the particle. It should properly be called
scattering efficiency, but in popular use, called scattering self-threading pin: a pin screwed into a hold prepared in
dentin to enhance retention
coefficient
sella turcica: a cephalometric landmark in the geometric
scotopic vision: vision that occurs in faint light or dark
center of the pituitary fossa of the spheroid bone; a bony
adaptation and is attributable to the retinal rods. The
anatomic landmark
maximum of the relative spectral visual sensitivity is shifted
to 510 nm and the spectrum is seen uncolored semiadjustable articulator: an articulator that allows
adjustment to replicate average mandibular movements—
screw endosteal dental implant 1: any dental implant called also Class III articulator
whose implant body configuration resembles a screw 2: any
screw-shaped dental implant; it may be hollow or solid, and semiprecious metal alloy: an alloy composed of precious
and base metals. There is no distinct ratio of components
usually consists of the dental implant abutment and the
separating semi-precious alloys from another group
dental implant body
semiprecision rest: a rigid metallic extension of a fixed or
scribe vt; scribed; scrib.ing (1678): to write, trace, or mark
removable partial denture that fits into an intracoronal
by making a line or lines with a pointed instrument
preparation in a case restoration
second stage dental implant surgery 1: for eposteal dental
senile atrophy: see AGE ATROPHY
implant surgery, the term refers to the procedure involving
placement of the eposteal framework fabricated after the first separating medium 1: a coating applied to a surface and
serving to prevent a second surface from adhering to the
stage implant surgery 2: for endosteal dental implant surgery,
first 2: a material usually applied on an impression, to
after surgical reflection, the occlusal aspect of the dental
facilitate removal of the case
implant body is exposed, the cover screw is removed, and
either the interim or definitive abutment is placed. After this, sep.tum n, pl sep.ta (1726): a dividing wall or membrane,
the investing tissues are (when needed) anastomosed especially between bodily spaces or masses
secondary bonds: weak interatomic bonds arising from setting expansion: the dimensional increase that occurs
dipoles within atoms or molecules concurrent with the hardening of various materials, such as
plaster of paris dental stone, die stone, and dental casting
secondary crown: see TELESCOPIC CROWN investment
secondary dentition: see PERMANENT DENTITION set up v, obs: see TOOTH ARRANGEMENT
secondary fracture: a fracture occurring as a consequence shade n 1: a term used to describe a particular hue, or
of necrosis or some other disease of the bone variation of a primary hue, such as a greenish shade of yellow
secondary occlusal trauma: the effects induced by occlusal 2: a term used to describe a mixture with black (or gray) as
force (normal or abnormal) acting on teeth with decreased opposed to a tint that is a mixture with white—see TOOTH
periodontal support COLOR SELECTION
secondary pain: heterotopic pain and/or secondary shade selection: see TOOTH COLOR SELECTION
hyperalgesia induced by deep somatic pain as a central
shearing stress: the internal induced force that opposes the
excitatory effect sliding of one plane on an adjacent plane or the force that
sec.tion n: the portion of a maxillofacial prosthesis that serves resists a twisting action
to fill a defect as a part of the prosthesis
shellac base obs: a record base constructed using a shellac-
sectional facial moulage: a sectional facial moulage based wafer that has been adapted to the cast with heat
impression is a procedure used to record the soft tissue (GPT-4)
contours of a portion of the face. Occasionally, several shell crown obs 1: an artificial full-veneer crown swaged
separate sectional impressions are made and then from metal plate 2: an artificial crown that is adapted like a
reassembled to provide a full facial contour cast shell or cap over the remaining clinical crown of a tooth; the
sectional impression: a negative likeness that is made in space between the crown and the shell is filled with cement—
sections called also cap crown
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shoulder finish line n: a finish line design for tooth SNB angle: acronym for Sella-Nasion-B point—in
preparation in which the gingival floor meets the external cephalometrics, an angle showing the anterior limit of the
axis surfaces at approximately a right angle mandibular basal arch in relation to the anterior cranial base
shrink.spot porosity: an area of porosity in cast metal that sock.et n (15c): any opening or hollow that forms a holder
is caused by shinkage of a portion of the metal as it solidifies for something, e.g., a tooth
from the molten state without flow of additional molten soft palate: the movable part of the palatal anatomy posterior
metal from surrounding areas to the hard palate
side shift: see MANDIBULAR TRANSLATION soft palate obturator: see SPEECH AID PROSTHESIS
sil.i.ca n (ca. 1301): silicon dioxide occurring in crystalline, soft splint: a resilient device covering either the maxillary
amorphous, and usually impure forms (as quartz, opal, and or mandibular teeth for the purpose of preventing trauma
sand respectively) to the dentition or acting as a deprogrammer
silent period: a momentary electromy graphic observable 1
sol.der n (15c): a fusible metal alloy used to unite the edges
decrease in elevator muscle activity on initial tooth contact or surfaces of two pieces of metal; something that unites or
presumably due to the inhibitory effect of stimulated cements
periodontal membrane receptors 2solder v, soldered; sol.der.ing, sol.der.abil.i.ty n—sol.der.er
simple fracture: a linear bony fracture that is not in n: to unite, bring into, or restore to a firm union; the act of
communication with the exterior uniting two pieces of metal by the proper alloy of metals
simple joint: a joint in which only two bones articulate solidification porosity: a porosity that may be produced by
simulation film: radiographs made with the same field size, improper spruing or improper heating of either the metal
source to-skin distance, and orientation as a therapy beam or the investment
to mimic the beam and for visualization of the treated volume so.ma.to.pros.thet.ics n (ca. 1950): the art and science of
on a radiograph prosthetic replacement of external parts of the body that are
missing or deformed
single crystal sapphire: a material composed of a single
crystalline alpha aluminium oxide that is identical in son.i.cate vt—cat.ed;.cat.ing (1961): to disrupt (i.e. bacteria)
crystalline structure to a gem sapphire by means of aplication of high frequency sound waves—
son.i.ca.tion n
single denture construction obs: the making of a maxillary
or mandibular denture as distinguished from a set of space n (14c): a delimited, three-dimensional region; physical
complete dentures (GPT-1) space independent of what occupies it—see DENTURE S.,
INTERPROXIMAL S., INTERRADICULAR S., RETRO-
1
sin.ter n (1780): a deposit formed by evaporation of lake or MYLOHYOID S.
spring water
space of Donders [F.C. Donders]: eponym for the space that
2sintervt (1871): to cause to become a coherent mass by lies above the dorsum of the tongue and below the hard and
heating without melting soft palates when the mandible and tongue are in the rest
skia.graph n (1801) obs 1: a figure formed by shading in the position
outline of a shadow 2: a radiograph—called also skiagram Donders FC. Ueber den Mechanismus des Saugens. Pflugers Archiv
(GPT-1) fur die Gesamte Physiologie Des Menschen Und Der Tiere.
sleeper: slang for any dental implant body not used for 1875;10:91-4.
support and stabilization of a dental prosthesis span length: the length of a beam between two supports
sliding movement: see TRANSLATION spat.u.la n (1525): a flat-bladed instrument used for mixing
slotted attachment: see PRECISION ATTACHMENT or spreading materials
1
1sluicen (14c): an artificial passage for water fitted with a spat.u.late adj (1760): shaped like a spatula
2
valve or gate for stopping or regulating the flow spat.u.late ed/.ing/.s: to work or treat with a spatula
2
sluice vb sluiced; sluic.ing vt (1593) 1: to draw off by or spat.u.la.tion the manipulation of material with a spatula
via a sluice 2: to wash with or in water through or from a to produce a homogenous mass
sluice 3: to drench with a sudden flow speaking space: the space that occurs between the incisal
SNA angle: acronym for Sella-Nasion-A point—in or/and occlusal surfaces of the maxillary and mandibular
cephalometrics, an angle measuring the anteroposterior teeth during speech
relationship of the maxillary basal arch on the anterior cranial spectral curve: see SPECTROPHOTOMETRIC CURVE
base; it shows the degree of maxillary prognathism
spectral reflection: reflection in which the angle of reflection
818 snap impression obs: see PRELIMINARY IMPRESSION is equal to the angle of incidence. Associated with objects
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Glossary of Prosthodontic Terms
having optically smooth glossy) surfaces—called also OCCLUSAL S., GUNNING’S S., INTERDENTAL S.,
mirrored reflection KINGSLEY S., LABIAL S., LINGUAL S., PROVISIONAL S.,
spec.tro.pho.tom.e.ter n: photometry device for the RESIN-BONDED S., SOFT S., SURGICAL S., WIRE S.
2splint v (1543): to immobilize, support, or brace
measurements of spectral transmissions, reflectance, or
relative emissions. Spectrophotometers are normally splint.ing v 1: in dentistry, the joining of two or more teeth
equipped with dispersion optics (prism or grating) to give a into a rigid unit by means of fixed or removable restorations
continuous spectral curve or devices 2: in physiology, prolonged muscle spasms that
spectrophotometric curve: a curve measured on a inhibit or prevent movement
spectrophotomoter hence, a graph of relative reflectance or split-cast method obs 1: a procedure for placing indexed
transmittance (or absorption as the ordinate, plotted versus casts on an articulator to facilitate their removal and
wave lengths or frequency as the abscissa. The most common replacement on the instrument 2: the procedure of checking
curves in the visible region use wave length units of a the ability of an articulator to receive or be adjusted to a
nanometer, with the short wave length to the left of the scale. maxillomandibular relation record (GPT-4)
The word spectral is frequently use in place of the longer split-cast mounting: a method of mounting casts wherein
spectrophotometric, but they are not necessarily synonymous the dental cast’s base is sharply grooved and keyed to the
spec.trum n: band of colors produced when sunlight is mounting ring’s base. The procedure allows verifying the
passed through a prism 2: spatial arrangements of accuracy of the mounting, ease of removal and replacement
components of radiant energy in order of their wave lenghts, of the casts
wave numbers, or frequency—spec.tral adj split-dowel crown obs: an artificial crown supported and
speech aid: any therapy or any instrument, apparatus, or retained by a dowel that was split longitudinally in an
device used to improve speech quality attempt to use spring retention in an undersized dowel space
speech aid prosthesis: a removable maxillary prosthesis to split-thickness graft: a transplant of epithelium consisting
restore an acquired or congenital defect of the soft palate of skin or mucous membrane of a thickness allowing
with a portion extending into the pharynx to separate the sectioning between the corium and the basement membrane
oropharynx and nasopharynx during phonation and spontaneous anterior dislocation: see MANDIBULAR
deglutition, thereby completing the parapharyngeal DISLOCATION
sphincter—syn ADULT S.A..P., PEDIATRIC S.A.P.—called
also pharyngeal S.A.P., cleft palate prosthesis spontaneous fracture: a fracture occurring without any
external injury
speech aid prosthesis modification: any revision of a
pediatric on adult speech aid not necessitating its spoon denture obs: a maxillary provisional removable
replacement partial denture, without clasps, whose palatal resin base
resembles the shape of a spoon. The resin base does not
speech articulation 1: the production of individual sounds contact the lingual surfaces of the teeth and is confined to
in connected discourse 2: the movement and placement the central portion of the palate. It was often used during
during speech of the organs that serve to interrupt or modify periodontal treatment because the resin base extension did
the voiced or unvoiced all stream into meaningful sounds 3: not promote plaque accumulation around the teeth and
the speech function performed largely through the permitted surgical procedures to be performed
movements of the lower jaw, lips, tongue, and soft palate
sports dentistry: all aspects of dentistry, either preventive
speech bulb: see SPEECH AID PROSTHESIS
or therapeutic, directly or indirectly involved with sports
speech prosthesis: see SPEECH AID PROSTHESIS and recreation
spherical form of occlusion obs: an arrangement of teeth spot grinding: see OCCLUSAL RESHAPING
that places their occlusal surfaces on the surface of an
imaginary sphere (usually 8 inches in diameter) with its spring plate obs: according to James Harrison Prothero,
center above the level of the teeth (GPT-4) DDS, Emeritus Professor of Prosthetic Dentistry and
Metallurgy at Northwestern University Dental School,
sphinc.ter n (1578): a ringlike band of muscle fibers that Chicago, IL, a spring plate was a denture molded over the
constrict to close an orifice or passage cast of a mouth with teeth bearing the relation to each other
spider partial substand: a unilateral removable partial as stated (providing lingual undercuts, ed.), which would
denture spring as it passes over the points of nearest approach of the
1splint n (14c) 1: a rigid or flexible device that maintains in teeth involved and resume its normal width without undue
position a displaced or movable part; also used to keep in lateral pressure when firmly seated on the oral tissues—
place and protect an injured part 2: a rigid or flexible material called also spring lock bridge
used to protect immobilize, or restrict motion in a part—see sprue n (1880) 1: the channel or hole through which plastic
ANDERSON S., CAP S., ESSIG S., FUNCTIONAL or metal is poured or cast into a gate or reservoir and then 819
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into a mold 2: the cast metal or plastic that connects a casting stat.ic adj: related to bodies at rest or forces in equilibrium
to the residual sprue button static fatigue: the delayed failure of glass and ceramic
sprue button: the material remaining in the reservoir of the materials resulting from stress-enhanced chemical reactions
mold after a dental casting aided by water vapor acting on surface cracks. Analogous
sprue former: a wax, plastic, or metal pattern used to form to stress corrosion occurring in metals
the channel or channels allowing molten metal to flow into static relation: the relationship between two parts that are
a mold to make a casting not in motion
sprue pin: see SPRUE FORMER stayplate n obj: see INTERIM PARTIAL DENTURE
sta.bil.i.ty (15c) 1: that quality of maintaining a constant Steinmann’s pin [Fritz Steinmann, Swiss surgeon, 1872-
character or position inthe presence of forces that threaten 1932): eponym for a firm metal pin that is sharpened on one
to disturb it; the quality of being stable; to stand or end; used for the internal fixation of fractures
endure 2: the quality of a prosthesis to be firm, steady, or ste.no.sis n, pl -no.ses (ca. 1860): a narrowing or constriction
cosntant, to resist displacement by functional horizontal or in the diameter of a passage or orifice—ste.not.ic adj
rotational stresses—see DENTURE S., DIMENSIONAL S.,
stent n [Charles R. Stent, English dentist, 18??-1901]: eponym
OCCLUSAL S.
for device used in conjunction with a surgical procedure to
sta.bi.li.za.tion n, obs: the seating of a fixed or removable keep a skin graft in place; often modified with acrylic resin
denture so that it will not tilt or be displaced under pressure or dental modeling impression compound that was
(GPT-1) previously termed Stent’s mass; also refers to any device or
sta.bil.ize vb -lized; .liz.ing vt, sta.bi.li.za.tion n (1861) 1: mold used to hold a skin graft in place or provide support
to make firm, steadfast, stable 2: to hold steady, as to maintain for anastomosed structures—see NASAL S., SURGICAL S.
the stability of any object by means of a stabilizer ste.reo.graph n (1859): an instrument that records
stabilized base plate: see STABILIZED RECORD BASE mandibular movement in three planes. Engraving, milling,
stabilized record base: a record base lined with a material or burnishing the recording medium by means of styli, teeth,
to improve its fit and adaptation to the underlying abrasive rims or rotary instruments obtains the registrations
supporting tissues stereographic record: an intra or extraoral recording of
stabilizing circumferential clasp arm: a circumferential mandibular movement as viewed in three planes in which
clasp arm that is relatively rigid and contacts the height of the registrations are obtained by engraving, milling, or
contour of the tooth burnishing the recording medium by means of studs, rotary
1 instruments, styli, teeth, and abrasive rims
stain n (1583) 1: a soiled or discolored spot; a spot of color
in contrast to the surrounding area 2: a preparation used in ster.ile adj (1558): free from living microorganisms; aseptic
staining 3: in dentistry, the discoloration of a tooth surface sterile technique: a standard surgical technique in which
or surfaces as a result of ingested materials, bacterial action, an aseptic area is established and maintained, including
tobacco, and/or other substances. This may be intrinsic, proper sterilization of instruments, drapes, gowns, gloves,
extrinsic, acquired or developmental and the surgical area with respect to dental implant
2
stain vb (14c) 1: to suffuse with color 2: to color by processes placement, the systematic maintenance of asepsis with
affecting chemically or otherwise the material itself 3: in special emphasis on non-contamination of instruments and
dentistry to intentionally alter ceramic or resin restorations implant elements throughout an implant placement
through the application of intrinsic or extrinsic colorants to procedure
achieve a desired effect ster.il.iza.tion n: the process of completely eliminating
standard illuminant: the illuminants A, B, C, D (and others microbial viability
defined by the CIE interms of their relative power
stip.ple vt stip.pled; stip.pling (1760) 1: to engrave by means
distribution curves. “A” is an illuminant with a Planckion
of dots and/or flicks 2: to make small short touches that
temperature of approximately 2854°K. It is intended to
together produce an even or softly graded shadow 3: to
represent a common tungsten filament source. “B”
speckle or fleck-stip.pler n
approximates solar radiation—4870°K—and is obsolete. “C”
is average daylight, 6740°K. “D” is daylight with the near sto.ma n, pl sto.ma.ta, also sto.mas (ca. 1684) 1: any or
ultraviolet source included various small simple bodily openings 2: an artificial
standard light source: a reference light source whose spectral permanent opening, usually made surgically
power distribution is known sto.ma.tog.nath.ic adj: denoting the jaws and mouth
standard observer: a hypothetical observer with a visual collectively
response mechanism possessing the calorimetric properties stomatognathic system: the combination of structures
820 defined by the CIE in 1931 as representative of the human involved in speech, receiving, mastication, and deglutition
population having normal color vision of food as well as parafunctional actions
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Glossary of Prosthodontic Terms
sto.ma.tol.o.gy n: the study of the structures, functions, and sublingual crescent: the crescent shaped area on the anterior
diseases of the mouth floor of the mouth formed by the lingual wall of the mandible
stone n: see DENTAL STONE and the adjacent sublingual fold. It is the area of the anterior
alveolo-lingual sulcus
stone die: see MODEL, REPLICA
sublingual fold: the crescent shaped area on the floor of the
stop clasp: as described by James Harrison Prothero, DDS,
mouth following the inner wall of the mandible and tapering
the stop clasp was an early forerunner to the conventional
toward the molar regions. The sublingual gland and
clasp assembly by the addition of a lug (occlusal rest) to the submaxillary duct form it
retentive and reciprocal clasp assembly
Prothero JH. Prosthetic dentistry. 2nd ed. Chicago: Medico-Dental
sublingual fossa: a smooth depression on the lingual surface
Publishing Co.; 1916. p. 332.
of the body of the mandible near the midline, above the
mylohyoid line and below the alveolus. This fossa
strain: change in length per unit length when stress is accommodates part of the sublingual gland
applied; the change in length/original length
sub.lux.a.tion n (ca. 1688): an incomplete or partial
stress n (14c): force per unit area; a force exerted on one body dislocation—see CONDYLAR SUBLUXATION
that presses on, pulls on, pushes against, or tends to invest
submersible endosteal implant obj: see ENDOSTEAL
or compress another body; the deformation caused in a body
DENTAL IMPLANT
by such a force; an internal force that resists an externally
applied load or force. It is normally defined in terms of submersible implant obj: see ENDOSTEAL DENTAL
mechanical stress, which is the force divided by the IMPLANT
perpendicular cross sectional area over which the force submucosal inserts: see MUCOSAL INSERT
is applied—see COMPRESSIVE S., SHEARING S., submucous cleft palate: see OCCULT CLEFT PALATE
TENSILE S.
subocclusal connector: an interproximal nonrigid connector
stress-bearing area: see STRESS-BEARING REGION positioned apical to and not in communication with the
stress-bearing region 1. the surfaces of oral structures that occlusal plane
resist forces, strains or pressures brought on them during subocclusal surface obs: a portion of the occlusal surface of
function 2: the portion of the mouth capable of providing a tooth that is below the level of the occluding portion of the
support for a denture—see also DENTURE FOUNDATION tooth (GPT-1)
AREA subperiosteal dental implant: an eposteal dental implant
stress breaker: see STRESS DIRECTOR that is placed beneath the periosteum and overlying the bony
stress director: a device or system that relieves specific dental cortex—first attributed to Swedish Dentist, G.S. Dahl
structures of part or all of the occlusal forces and redirects Dahl GS. Om mojlighenten for implantation, kaken av metall skelett
those forces to other bearing structures or regions som bas eller retention for fasta eller avatagbara protesor. Odontol
Foren Tidskr 1943;51:440.
study cast obs: see DIAGNOSTIC CAST
Goldberg NI, Gershkoff A. The implant lower denture. Dent Digest
stylus tracin: a planar tracing that resembles an arrowhead 1949;55:490.
or gothic arch made by means of a device attached to the Linkow LI. Evolutionary design trends inthe mandibular
opposing arches. The shape of the tracing depends on the subperiosteal implant. J Oral Implant 1984;11:402-38.
location of the marking point relative to the tracing table, subperiosteal dental implant abutment obs: that portion
i.e., in the incisal region as opposed to posteriorly. The apex of the implant that protrudes through the mucosa into the
of a properly made anterior tracing is considered to indicate oral cavity for the retention or support of a crown or a fixed
the centric relation position, called also arrow-point tracing, removable denture (GPT-4)—see ABUTMENT
gothic arch tracing, needlepoint tracing—see CENTRAL
subperiosteal dental implant substructure: a cast metal
BEARING TRACING DEVICE
framework that fits on the residual ridge beneath the
subantral augmentation: augmentation with autologous periosteum and provides support for a dental prosthesis by
bone or bone substitutes to the antral floor to provide a host means of posts or other mechanisms protruding through
site for dental implants—called also, SINUS LIFT, the mucosa; the implant body
ANTHROPLASTY
subperiosteal dental implant superstructure: the metal
subcondylar fracture: a fracture beneath the condylar head framework usually within a removable prosthesis, that fits
and within the condylar neck on the implant abutment(s) and provides retention for
subdermal implant: see MUCOSAL INSERT artificial teeth and the denture base material of the prosthesis
sub.lin.gual adj (1661): pertaining to the region or structures subperiosteal fracture: a bony fracture occurring beneath
located beneath the tongue the periosteum, without displacement 821
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Glossary of Prosthodontic Terms
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tensile stress: the internal induced force that resists the material (GPT-1) 2: an impression (GPT-1)
elongation of a material in a direction parallel to the direction tissue trimming: see BORDER MOLDING
of the stresses TMD: acronym for Temporo Mandibular Disorders—see
ten.sion n (1533): the state of being stretched, strained, or TEMPORO MANDIBULAR DISORDERS
extended to.mo.gram n (1940): a radiograph made by using a
terminal hinge axis: see TRANSVERSE HORIZONTAL AXIS tomograph
terminal hinge position: see RETRUDED CONTACT 1to.mo.graph n: a device for moving a X-ray source in one
POSITION direction as the film moves in the opposite direction
terminal jaw relation record: a record of the relationship of 2to.mo.graph n: a radiograph produced from a machine that
the mandible to the maxillae made in the terminal hinge has the source of radiation moving in one direction and the
position film moving in the opposite direction
therapeutic prosthesis: see RADIATION CARRIER to.mo.gra.phy n: a general term for a technique that provides
thermal expansion: expansion fo a material caused by heat a distinct image of any selected plane through the body, while
the images of structures that lie above and below that plane
ther.mo.plas.tic adj (1883): a characteristic or property of a
are blurred. Also, the term body-section radiography has been
material that allows it to be softened by the application of
applied to the procedure, although the several ways of
heat and return to the hardened state on cooling—
accomplishing it have been given distinguishing names
ther.mo.plas.tic.i.ty n
tongue habit: conscious or unconscious movements of the
three.quarter crown obs: see PARTIAL VENEER CROWN
tongue that are not related to purposeful functions. Such
tic n (ca. 1822): an intermittent, involuntary, spasmodic habits may produce malocclusion or injuries to tissues of
movement of a group of muscles, often without a the tongue or the attachment apparatus of the teeth
demonstrable external stimulus
tongue thrusting: the infantile pattern of suckle-swallow in
tid.: acronym for L. ter in di’e, three times a day which the tongue is placed between the incisor teeth or
tin.foil n (15c) 1: paper thin metal sheeting usually of a tin- alveolar ridges during the initial stages of deglutition,
lead alloy or aluminium 2: a base-metal foil used as a resulting sometimes in an anterior open occlusion,
separating material between the cast and denture base deformation of the jaws, and/or abnormal function
material during flasking and polymerizing tooth n, pl teeth (bef. 12c): any hard calcified structure in
tin.ni.tus n(1843): a noise in the ears, often described as the alveolar processes of the maxilla or mandible used for
ringing or roaring mastication of food, or a similar structure—see ANATOMIC
T., CUSPLESS T., METAL INSERT T., NONANATOMIC T.,
tinted denture base: a denture base with coloring that
REVERSE ARTICULATION T., BUBE T., ZERO-DEGREE T.
simulates the color and shading of natural oral tissues
tooth arrangement 1: the placement of teeth on a denture
tis.sue n (1771) 1: the various cellular combinations that make
with definite objectives in mind 2: the placement of teeth on
up the body 2: an aggregation of similarly specialized cells
trial bases—see ANTERIOR TOOTH ARRANGEMENT
united in the performance of a particular function—see
HYPERPLASTIC TISSUE tooth borne: see TOOTH SUPPORTED
tissue-bearing area: see DENTURE FOUNDATION AREA tooth color selection: the determination of the color and
other attributes of appearance of an artificial tooth or set of
tissue displaceability 1: the quality of oral tissues that teeth for a given individual
permits them to be placed in other than a relaxed position 2:
the degree to which tissues permit displacement tooth form: the characteristics of the curves, lines, angles,
and contours of various teeth that permit their identification
tissue displacement: the change in the form or position of and differentiation—see ANTERIOR T.F., POSTERIOR T.F.
tissues as a result of pressure
tooth placement: see TOOTH ARRANGEMENT
tissue integration: as clinically observed, the apparent direct
tooth selection: the selection of a tooth or teeth of a shape,
and healthy attachment of living tissue to an alloplastic
size, and color to harmonize with the individual
material, i.e. a dental implant—see OSSEOUS
characteristics of a patient
INTEGRATION
tooth size discrepancy: abnormally sized teeth or groups of
tissue molding: see BORDER MOLDING
teeth
tissue reaction: the response of tissues to an altered condition
tooth supported: a term used to describe a prosthesis or part
tissue registration obs1: the accurate registration of the of a prosthesis that depends entirely on the natural teeth for
824 shape of tissues under any condition by means of a suitable support
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Glossary of Prosthodontic Terms
tooth.supported base: a denture base that restores an transitional denture: a removable partial denture serving
edentulous region that has abutment teeth at each end for as an interim prosthesis to which artificial teeth will be added
support. The tissue that it covers is not used for support as natural teeth are lost and that will be replaced after
tooth.supported denture: see OVERDENTURE postextraction tissue changes have occurred. A transitional
denture may become an interim complete denture when all
tor.que n (ca. 1884): a twisting or rotary force. The movement of the natural teeth have been removed from the dental
of a system of forces producing rotation arch—called also transitional partial denture
tor.us n, pl to.ri (1563): a smooth rounded anatomical transitional prosthesis: see INTERIM PROSTHESIS,
protuberance TRANSITIONAL DENTURE
total elasticity of muscle obs: the combined effect of physical
translating condyle: see NONWORKING SIDE CONDYLE
and physiologic elasticity of muscle (GPT-4)
trans.la.tion n (14c): that motion of a rigid body in which a
tough.ness n: the ability of a material to withstand stresses
straight line passing through any two points always remains
and strains without breaking
parallel to its initial position. The motion may be described
toxic dose: the amount of a drug that causes untoward as a sliding or gliding motion
symptoms in most persons
translatory movement obs: the motion of a body at any
tox.ic.i.ty n: the adverse reactions (dose-response-time instant when all points within the body are moving at the
relationships) of tissues to selected foreign substances same velocity and in the same direction (GPT-1)
resulting in unacceptable in vivo interactions. The toxicity
trans.lu.cen.cy n (1611): having the appearance between
can be at the local or systemic level depending on the
complete opacity and complete transparency; partially
amount, rate of release, and sepcific type of substance
opaque
available to the tissues
trans.mu.co.sal adj: passing through the gingiva or oral
trac.er n (ca. 1552): see ARROW-POINT T.
mucosa
trac.ing n (15c) 1: a line or lines scribed by a pointed
trans.os.teal adj: the penetration of both the internal and
instrument 2: a traced copy of a drawing, photograph,
external cortical plates of a bone
radiograph, or similar entity—see ARROW POINT T.,
CEPHALOMETRIC T. EXTRAORAL T., INTRAORAL T., transosteal dental implant 1: a dental implant that
MANDIBULAR T., PANTOGRAPHIC T., STYLUS T. penetrates both cortical plates and passes through the full
tracing device: a device that provides a central point of thickness of the alveolar bone 2: a dental implant composed
bearing, or support, between maxillary and mandibular of a metal plate with retentive pins to hold it against the
occlusion rims or dentures. It consists of a contacting point inferior border of the mandible that supports transosteal pins
that is attached to one occlusion rim or denture and a plate that penetrate through the full thickness of the mandible
attached to the opposing occlusion rim or denture that and pass into the, mouth in the parasymphyseal region—
provides the surface on which the bearing point rests or called also staple bone implant, mandibular staple implant,
moves transmandibular implant
transcranial oblique radiograph: a flat X-ray projection in transverse axis: see TRANSVERSE HORIZONTAL AXIS
which the central beam travels across the cranium and transverse facial fracture: see LE FORTE III FRACTURE,
through the temporomandibular joint on the opposite side MID-FACIAL FRACTURE
showing an oblique lateral view of the condyle transverse horizontal axis: an imaginary line around which
transcutaneous electrical neural stimulation: application the mandible may rotate within the sagittal plane
of low-voltage electrical stimulation through the skin to trans.ver.sion n: displacement of a tooth from its usual
nerves in order to interfere with the sensation of pain in the position or proper numerical position in the jaw
brain and increase blood flow to the region—colloquial TENS
trau.ma n, pl trau.ma.ta or trau.mas, trau.mat.ic adj—
trans.epi.the.li.al adj: penetrating or passing through the trau.mat.i.cal.ly adv (1693): an injury or wound, whether
epithelium, as in a dental implant physical or psychic
transfer coping: a metallic, acrylic resin, or other covering trauma from occlusion: see OCCLUSAL TRAUMA
or cap used to position a die in an impression (GPT-4)
traumatic occlusion: see OCCLUSAL TRAUMA
transit dose: a measure of the primary radiation transmitted
through the patient and measured at a point on the central trau.ma.to.gen.ic adj: capable of producing a wound or
ray at some point beyond the patient injury
transitional contour: with respect to any restoration traumatogenic occlusion obs: an occluding of the teeth that
supported by a dental implant, the relationship between the is capable of producing injury to oral structures (GPT-4)
abutment and the implant body travelling condyle: see NONWORKING SIDE CONDYLE 825
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treatment denture 1: a dental prosthesis used for the purpose tri.stimulus value: (R, G, B: X, Y, Z, etc.) Amounts of the
of treating or conditioning the tissues that are called on to three reference color stimuli, in a given trichromatic system,
support and retain it 2: a dental prosthesis that is placed in required to match the color of the stimulus considered
preparation for future therapy—see INTERIM PROSTHESIS tri.ta.no.pia n: form of dichromatism in which reddish-blue
treatment plan: the sequence of procedures planned for the and greenish-yellow stimuli are confused. Tritanopia is a
treatment of a patient after diagnosis common result of retinal disease but may be inherited—
trial base: a material or device representing the base of a called also blue blindness, hence tritanope
denture. It is used for making maxillomandibular try in: see TRIAL PLACEMENT
relationship records and for the arrangement of teeth tube impression 1: a cylinder used as a tray to confine and
trial denture: a preliminary arrangement of denture teeth direct impression material to make an impression of a single
that has been prepared for placement into the patient’s tooth 2: the impression resulting from this procedure
mouth to evaluate esthetics and maxillomandibular tube teeth: artificial teeth with an internal, vertical,
relationships cylindrical aperture extending from the center of the base
trial fitting: see TRIAL PLACEMENT upward into the body of the tooth, into which a pin may be
trial flask closure: any preliminary closure made for the placed or cast for the attachment of the tooth to a fixed or
purpose of eliminating excess material and ensuring that removable denture base
the mold is completely filled tu.ber.cule n (1578): a small knobby prominence or
trial placement: the process of placing a trial denture in the excrescence; a nodule
patient’s mouth for evaluation—see TRIAL DENTURE tu.be.ros.i.ty n, pl -ties (ca. 1611): see MAXILLARY T.
trial plate obs: see TRIAL DENTURE tunnel dissection: a dissection of the periosteum from bone
tricalcium phosphate: an inorganic particulate or solid form through a small incision, in a tunnel-like fashion
of relatively biodegradable ceramic that is used as a scaffold tur.gid adj (1620): being on a state of distention; swollen
for bone regeneration. It may be used as a matrix for new
bone growth ty.po.dent: a replica of the natural dentition and alveolar
mucosa, set to average condylar motions, used in training
trichromatic system: a system for specifying color stimuli students in dental care—syn TYPODONT
in terms of the tristimulus value based on matching colors
by additive mixtures of three primary colored lights
tri.chro.ma.tism n: a type of vision in which the colors seen
U
require in general, three independently adjustable primaries
(such as red, green, and blue) for their duplication by UCLA abutment substand: a colloquial term used to describe
mixture; trichromatism may be either anomalous a dental crown that is attached directly to the implant body
trichromatism or normal vision by means of a screw without an intervening abutment
trigger area: see TRIGGER POINT ultimate strength: the greatest stress that may be induced
trigger point: a focus of hyperirritability in tissue, which in a material at the point of rupture—called also ultimate
when palpated, is locally tender and gives rise to heterotopic tensile strength
pain ul.tra.vi.o.let: radiant energy of wave lengths shorter than
trigger spot: see TRIGGER POINT extreme violet and lying beyond the ordinarily visible
spectrum. Usually assigned to wave lengths shorter than
trigger zone: see TRIGGER POINT
380 nm
tripod marking: those marks or lines drawn on a cast in a 1
un.der.cut n (1859) 1: the portion of the surface of an object
single plane perpendicular to the survey rod to assist with
that is below the height of contour in relationship to the path
repositioning the cast on a dental surveyor in a previously
of placement 2: the contour of a cross-sectional portion of a
defined orientation
residual ridge or dental arch that prevents the insertion of a
tri.pod.iza.tion n: an occlusal scheme characterized by a cusp prosthesis 3: any irregularity in the wall of a prepared tooth
to fossa relationship in which there are three points of contact
that prevents the withdrawal or seating of a wax pattern or
about the cusp and opposing fossa with no contact on the
casting
cusp tip
2 un.der.cutv (ca. 1598): to create areas that provide
tris.mus n (ca. 1693): see MANDIBULAR T.
mechanical retention for materials placement
trismus appliance: a prosthesis that assists the patient in
increasing their oral aperture width to eat and maintain oral uniform color space: color space in which equal distances
hygiene—syn DYNAMIC BITE OPENER, INTERARCH are intended to represent threshold or above threshold
EXPANSION DEVICE, OCCLUSAL DEVICE FOR perceived color differences of equal size
826 MANDIBULAR TRISMUS uni.lat.er.al adj (1802): relating to one side; one-sided
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Glossary of Prosthodontic Terms
unilateral partial denture: see UNILATERAL REMOVABLE vertical dimension: the distance between two selected
PARTIAL DENTURE points, one on a fixed and one on a movable member—see
unilateral removable partial denture: a removable denture OCCLUSAL V.D., REST V.D., V.D. OF SPEECH
restoring lost or missing teeth on one side of the arch only vertical dimension decrease obs: decreasing the vertical
unilateral subperiosteal implant: an eposteal dental implant distance between the mandible and the maxillae by
that provides abutments for support of a removable or fixed modifications of teeth, the positions of teeth or occlusion
rims, or through alveolar or residual ridge resorption
dental prosthesis in a partially edentulous arch
(GPT-1)
unstrained jaw relation obs: 1: the relation of the mandible
vertical dimension increase obs: increasing the vertical
to the skull when a state of balanced tonus exists among all
distance between the mandible and the maxillae by
the muscles involved 2: any jaw relation that is attained
modifications of teeth, the positions of teeth, or occlusion
without undue or unnatural force and that causes no undue
rims (GPT-1)—see OCCLUSAL VERTICAL DIMENSION
distortion of the tissues of the temporomandibular joints
(GPT-4) vertical dimension of occlusion: see OCCLUSAL
VERTICAL DIMENSION
upper impression slang: see MAXILLARY IMPRESSION
vertical dimension of rest position: see PHYSIOLOGIC
up.right adj: the movement of a tooth into an erect or normal REST POSITION
position
vertical dimension of speech: that distance measured
between two selected points when the occluding members
V are in their closest proximity during speech
vertical opening: see VERTICAL DIMENSION
vacuum casting: the casting of a metal or plastic in the
presence of a partial vacuum vertical overlap 1: the distance teeth lap over their
antagonists as measured vertically; especially the distance
vacuum investing: the process of investing a pattern within
maxillary incisal edges extend below those of the mandibular
a partial vacuum
teeth. It may also be used to describe the vertical relations of
vacuum mixing: a method of mixing a material such as opposing cusps 2: the vertical relationship of the incisal edges
plaster of paris or casting investment below atmospheric of the maxillary incisors to the mandibular incisors when
pressure the teeth are in maximum intercuspation
val.ue n (14c): the quality by which a light color is ves.ti.bule n (ca. 1728) 1: any of various bony cavities,
distinguished from a dark color, the dimension of a color especially when serving as or resembling an entrance to
that denotes relative blackness or whiteness (grayness, another 2: the portion of the oral cavity that is bounded on
brightness). Value is the only dimension of color that may the medial side by the teeth, gingiva, and alveolar ridge or
exist alone—see MUNSELL VALUE the residual ridge, and on the lateral side by the lips and
Munsell AH. A color notation. Baltimore: Munsell Color Co.; 1975. cheeks—see BUCCAL V., LABIAL V.
p. 14-14. ves.tib.u.lo.plas.ty n: a surgical procedure designed to
van der Walls’ bond [Johannes D. van der Walls, Dutch restore alveolar ridge height by lowering muscles attaching
physicist] (ca. 1926): eponym for a bond that involves weak to the buccal, labial, and lingual aspects of the jaws
interatomic attractions such as variation in physical mass vibrating line: an imaginary line across the posterior part
or location of electrical charge; e.g. molecular polarization, of the palate marking the division between the movable and
electrical dipoles and dispersion effects—hydrogen immovable tissues of the soft palate. This can be identified
bridges—called also secondary bond when the movable tissues are functioning
vascular pain: a type of deep somatic pain of visceral origin videofluoroscopy n: dynamic X-rays recorded on videotape
that emanates from the afferent nerves that innervate blood viewing conditions: various conditions under which visual
vessels observation is made including the size of the stimulus,
ve.lum n (1771): a covering; a general term for a veil or veil characteristics of the surrounding area, nature of the
like structure—see SOFT PALATE illuminant, angle of viewing, area of the retina, etc.
verti.centric [Earl Pound, Us prosthodontist, 1901-1986]: a Virginia bridge: see RESIN-BONDED PROSTHESIS
record used in complete denture fabrication. It involves the visceral pain: deep somatic pain originating in visceral
simultaneous recording of the vertical dimension of structures such as mucosal linings, walls of hollow viscera,
occlusion with the jaws in centric relation parenchyma of organs, glands, dental pulps, and vascular
structures
vertical axis: see VERTICAL AXIS OF THE MANDIBLE
visible spectrum: the section of the electromagnetic
vertical axis of the mandible: an imaginary line around spectrum that is visible to the human eye. It ranges from
which the mandible may rotate through the horizontal plane 380 nm to 760 nm 827
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visual adaptation: adjustive change in visual sensitivity due facial incision used in exposing the maxillary bone in a
to continued visual stimulation or lack of stimulation. Three maxillectomy
recognized types are: 1) scotopic or dark adaptation 2) Zang J. Operationen im Bereich der nase und ibver nebenholen.
photopic or light adaptation 3) chromatic or color adaptation In: Theil R. Opthalmologische, Operationslehre. Leipzig: Vebthieme;
visual photometry: the measurement of luminous radiation 1950.
1weld n (1831): a welded joint; the state or condition of being
on the basis of its effect on the visual receptors
vul.can.ite n: an obsolete denture base material that is a welded
2 weld vb: to unite or fuse two pieces by hammering,
combination of caoutchouc and sulfur. These harden in the
presence of suitable heat and application of pressure compression, or by rendering soft by heat with the addition
vul.ca.nize vb -nized; -niz.ing vt (1846): to produce flexible of a fusible material
or hard rubber, as desired, by subjecting caoutchouc, in the whiting n: pure white chalk (calcium carbonate) that has
presence of sulfur, to heat and high steam pressure in a been ground and washed and that is used for polishing
processing unit, termed a vulcanizer, made for that purpose dental materials
wire splint: a device used to stabilize teeth loosened by an
W accident or by a compromised periodontium in the maxillae
or mandible; a device to reduce and stabilize maxillary or
warp vt (13c): torsional change of shape or outline; to turn mandibular fractures by application to both arches and
or twist out of shape connection with intermaxillary wires or elastic bands
wash impression slang: see FINAL IMPRESSION Wolff’s Law [Julius Wolff, German anatomist, 1836-1902]:
wave length: the distance at any instant between two eponym for a uniform or constant fact or principle, more
specifically, that a bone, either normal or abnormal, will
adjacent crests (or identical phases) of two series of waves
develop the structure most suited to resist those forces acting
that are advancing through a uniform medium. The wave
on it
length varies inversely with the vibration rate or number of
waves passing any given point per unit period of time work n (bef. 12c): the product of a force acting on a body
and the distance through which the point of application of
wax n (bef. 12c): one of several esters of fatty acids with
the force moves
higher alcohols, usually monohydric alcohols. Dental waxes
are combinations of various types of waxes compounded to working articulation: the occlusal contacts of teeth on the
provide desired physical properties—see BASEPLATE W., side toward which the mandible is moved
BOXING W., CASTING W., DENTAL IMPRESSION W., working bite: see WORKING ARTICULATION
MODELING W. working bite relation: see WORKING ARTICULATION
wax elimination: the removal of wax from a mold, usually working condyle: see WORKING SIDE CONDYLE
by heat working contacts obs: contacts of teeth made on the side of
wax expansion: a method of expanding a wax pattern to the occlusion toward which the mandible has been moved
compensate for the shrinkage of gold during the casting (GPT-1)
process working model: see CAST
wax model denture: see TRIAL DENTURE working occlusal surface obs: the surface or surfaces of teeth
wax pattern: a wax form that is the positive likeness of an on which mastication can occur (GPT-1)
object to be fabricated working occlusion obs: the occlusal contacts of teeth on the
wax try in: see TRIAL PLACEMENT side to which the mandible is moved (GPT-1)
wax.ing v obs: the contouring of a wax pattern or the wax working side: the side toward which the mandible moves
base of a trial denture into the desired form (GPT-1) in a lateral excursion
working side contacts: contacts of teeth made on the side of
waxing up obs 1: the contouring of a pattern in wax generally
the articulation towards which the mandible is moved
applied to the shaping in wax of the contours of a trial
during working movements
denture (GPT-1) 2: the process of waxing and carving of the
working side condyle: the condyle on the working side
wax to the shape and contour desired (GPT-1)
working side condyle path: the path the condyle travels on
wear facet: any wear line or plane on a tooth surface caused
the working side when the mandible moves in a lateral
by attrition
excursion
Weber-Fergusson incision [Sir E.S. Fergusson, Scottish wrought adj (13c) 1: worked into shape; formed 2: worked
surgeon, dates vary 1808-1877 or 1871-1944]: eponym for a into shape by tools; hammered
828
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Glossary of Prosthodontic Terms
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Textbook of Prosthodontics
methods in impressions, articulation, occlusion, roofless Hanua RH. Hanau intraoral method vs Gysi extraoral
dentures, refits and renewals. method. Buffalo: Private press; 1927.
Chillicothe, MO: Private press; 1910. Gysi A. Practical conclusions from scientific research in
Haskell LP. Harkell’s manual of plate work or handbook for denture construction. New York: Dentists’ Supply Co.; 1929.
the dental laboratory. Chicago: Private press; 1910. Sears VH. Full denture procedure. New York: Macmillan Co.;
Clapp GW. Prosthetic articulation. New York: The Dentists’ 1929.
Supply Co.; 1914. Bunce EW. The Bunce Kanouse full denture technic. Chicago:
Girdwood J. Tube teeth and porcelain rods. Private printing; Coe Laboratories, Inc.; 1929.
1914. Sears VH. Full denture procedure. New York: Macmillan Co.;
Wilson GH. Dental prosthetics. 2nd ed. Philadelphia: Lea & 1929.
Fabiger; 1914. Nichols IG. Prosthetic dentistry, an encyclopedia of full and
The Dentists’ Supply Co. Trubyte teeth for vulcanite plates: partial denture prosthesis. St. Louis: CV Mosby; 1930.
as designed by J Leon Williams and Alfred Gysi together Swenson MG. Outline of full denture prosthesis. New York:
with a formulation of the law of harmony between faces University Press; 1932.
and teeth and a description of the Trubyte system of Fish EW. Principles of full denture prosthesis. London: John
classifying face forms. New York: The Dentists’ Supply Co.; Bale Sons and Danielsson Ltd.; 1933.
1917. Lott FM. The problem of facsimile reproduction of anterior
Liberthal RH. Advanced impression taking. Scientific and esthet cs in full denture prosthesis. Bulletin no. 17. Toronto:
correct method based upon principles founded by Drs. Canadian Dental Research Foundation; 1933.
Greene. New York: Professional Publishing Co.; 1918. Frahm FW. The principles and technics of full denture
Clapp GW, Tench RW. Professional Denture Service. New construction. Brooklyn: Dental Items of Interest Publishing
York: The Dentists’ Supply Co.; 1918. Co.; 1934.
Leger Derez H. Traite de prosthese dentaire. Paris: C Ash Williams JL. Trubyte teeth for denture restorations. New
and Sons Co.; 1920. York: Dentists’ Supply Co.; 1935.
Wilson GH. A manual of dental prosthetics. 2nd ed. Lott FM. Glass as a denture base. Bulletin no. 23. Toronto:
Philadelphia: Lea and Febiger; 1920. Canadian Dental Research Foundation; 1936.
Clapp GW, Tench RW. professional denture service. Vol. II. Sears VH. Prosthetic papers. Minneapolis: Private press;
New York: The Dentists’ Supply Co.; 1921. 1936.
The Dentists’ Supply Co. Principles of selection and Doxtater LW. Full and partial denture prosthesis. Brooklyn:
articulation. New York: The Detists’ Supply Co.; 1921. Dental Items of Interest Publishing Co.; 1936.
Cummer WE. The Rupert Hall method for entire upper and Sears VH. Prosthetic papers. Minneapolis: Dental Library,
lower dentures. Bulletin no. 2. Hamilton, Ontario: Canadian Bureau of Engraving, Inc.; 1936.
Dental Research Foundation; 1921. Essig NS. Prosthetic dentistry. Brooklyn: Dental Items of
Gabell DP. Prosthetic dentistry. A textbook on the chairside Interest Publishing Co.; 1937.
work for producing plate dentures. London: H Froude; House MM. Full denture technique. Whittier, CA: Private
Hodder and Stoughton; 1921. printing; 1937.
Rupp FW. The mathematics of dental prosthetics, showing House MM, Loop JL. Form and color harmony in the dental
the necessity for the use of various other instruments of art. Whittier, CA: Private printing; 1939.
precision in order to obtain satisfactory dentures from the Schlosser RO. Complete denture prosthesis. Philadelphia:
use of anatomical articulators of any brand. London: J Bale WB Saunders; 1939.
Sons and Danielsson; 1921. Swenson MG. Complete dentures. St Louis: CV Mosby; 1940.
Berthold AHR. Engineering applied to dentistry. Modern Neil E. The upper and the lower. A simplified full denture
retention of artificial dentures from an engineering impression procedure. Chicago: The CAL Technical Library;
standpoint. Chicago: International Dental Manufacturing 1941.
Co.; 1922. Miller RG. Synopsis of full and partial dentures. St Louis:
Ash C. Ash’s all porcelain teeth: dowel crowns and non CV Mosby; 1942.
platinum tube teeth for vulcanite dentures and for all classes Adams CW. Selection and articulation of artificial teeth. New
of crown and bridge work. London: Ash, Julius; 1923. York: Dentists’ Supply Co.; 1943.
Campbell DD. Full denture prosthesis. St Louis: CV Mosby; Hirsekorn H. Denture base readjustment Baltimore: Williams
1924. and Wilkins Co.; 1943.
Goodhugh T. The art of prosthetic dentistry, London: Hunter C, Samson E. Mechanical dentistry; a practical
Bailliere; 1924. treatise on the construction of the various kinds of artificial
Hanau RH. Full denture prosthesis. Intraoral technique for dentures. London: The Technical Press Ltd.; 1945.
Hanau Articulator model H. Buffalo: (Dental engineering); Schwartz MM. You can be happy with dental plates. Private
1926. printing; 1945.
830
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Glossary of Prosthodontic Terms
Tuckfield W. Full denture technique. 2nd ed. Melbourne: Chupein TF. The dental laboratory; a manual of gold and
Australian College of Dentistry; 1945. silver plate work for dental substitutes, crowns, etc.
Landa JS. Practical full denture prosthesis. Brooklyn: Dental Philadelphia: Johnson and Lund: 1889.
Items of Interest publishing Co.; 1947. Abonyi J. Compendium der Zahutechnik fur studirende und
Hordes S. Full denture construction. Albany: University of Krste. Stuttgart: F Enke; 1892.
the State of New York Press; 1949.
Chasman C. Manual of mechanical dentistry. Philadelphia:
Sears VH. New teeth for old. Salt Lake City: University of
private printing; 1932.
Utah Press; 1949.
Sears VH. Principles and techniques for complete denture Schwartz JR. Practical prosthetic procedure. Philadelphia:
construction. St.Louis: CV Mosby; 1949. Universal Dental Co.; 1934.
Fenn HRB, Liddelow KP, Gimson AP. Clinical dental Salzman JA. Manual for dental technicians. New York:
prosthetics. London: Staples Press; 1953. Pitman Publishing Corp.; 1938.
Landy C. Full dentures. St. Louis: CV Mosby; 1958. Chappelle WF. Partial denture technics. Buffalo: Williams
Gold Refining Co.; 1941.
CROWNS Wells AS, Reynolds GW. Laboratory manual for crown and
bridge technique. Ann Arbor: Edwards Brothers, Inc.
Goslee HJ. Principles and practice of crown and bridgework. Lithoprinters; 1944
A practical, systematic modern treatise upon the
Boucher CO. Dental prosthetic laboratory manual. St Louis:
requirements and technique of artificial crown work
CV Mosby; 1947.
including some incidental reference to bridgework. 4th ed.
New York: Consolidated Dental Manufacturing Co.; 1903.
Land CH. Porcelain dental art. Private printing; 1904. DENTAL MATERIALS SCIENCE
Chayes HES. The application of the Davis crown in prosthetic
dentistry. New York: Private printing; 1912. Flagg JF. Plstics and plastic fillings: as pertaining to the filling
of cavities of decay in teeth below medium in structure.
Lochhead Laboratories. The porcelain jacket crown. A treatise
Philadelphia P Blakiston; 1881.
containing interesting and authentic information regarding
the technique, preparation and field of application of Essig CJ. Manual of dental metallurgy. Philadelphia: Lea
porcelain jacket crowns in an everyday practice. New York: Brothers and Co.; 1882.
Private printing; 1918. Gilbert SE. Vulcanite and celluloid: instruction in their
Thompson GA. Porcelain tecnic. Private printing; 1918. practical working for dental purposes. Philadelphia: SS
White Dental Manufacturing Co.; 1884.
Collett HA. Gold shell crowns and how to make them. The
solution of problems in dental mechanics. New York: Private Warren GW. A manual of mechanical dentistry and
printing; 1922. metallurgy Philadelphia: Private printing; 1905.
Ash C. Ash’s all porcelain teeth: dowel crowns and non Hughes CN. Questions and answers on prosthetic dentistry
platinum tube teeth for vulcanite dentures and for all classes and metallurgy. St. Louis: CV Mosby; 1914.
of crown and bridgework. London: Ash, Julius; 1923. Hepburn WB. Notes on dental metallurgy for the use of
LeGro AL. Ceramics in dentistry. Brooklyn: Dental Items of dental students and practitioners. 2nd ed. New York: W
Interest Publishing Co.: 1925. wood and Co. 1915.
Stern MN. Enaemloid acrylics in dentistry. Forest Hills, NY: Capon WA. Porcelain dental restorations. Philadelphia: Lea
Credo Publishing Co.; 1942. & Febiger; 1920.
Engle F. Three quarter crowns; how to construct and apply Hovestad JF. Practical dental porcelains. St Louis: CV Mosby
them. Brooklyn: Dental Items of Interest Publishing Co.; 1924.
1946. LeGro AL. Ceramics in dentistry. Brooklyn: Dental Items of
Levy IR. Acrylic inlays, crowns and bridges. Philadelphia: Interest Publishing Co.; 1925.
Lea and Febiger; 1950. Ray KW. Metallurgy for dental students. Philadelphia: P
Brecker SC. The porcelain jacket crown. St Louis: CV Mosby; Blakiston’s Son & Co.; 1931.
1951.
Felcher FR. The art of porcelain in dentistry. St Louis: CV
Mosby; 1932.
DENTAL LABORATORY SCIENCE
Skinner EW. The science of dental materials. Philadelphia:
WB Saunders; 1936.
Haskell LP. The student’s manual and handbook for the
dental laboratory. Philadelphia: Welch Dental Co.; 1887. Felcher FR. Porcelain in dentistry. St Louis: CV Mosby; 1932.
831
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Salzmann JA. Manual for dental technicians: vulcanite. Chayes HES. Movable removable bridgework. With a
New York: Private printing; 1938. detailed, illuerated technique for the construction of a
Salzman JA. Manual for dental technicians: with a unilateral compound movable removable partial bridge, and
supplement or acrylics. New York: Private printing; 1938. a description of the instruments and attachments employed.
New York: Chayes System Laboratories; 1922.
Cohen M. Ceramics in dentistry. Philadelphia: Lea & Febiger
1940. Columbus Dental Manufacturing Co. Steele’s
interchangeable tooth: illustrated: showing technical detail
Stern MN. Enameloid acrylics in dentistry. Forest Hills, NY:
of construction and manipulation, embracing all features of
Credo Publishing Co.; 1942.
their application. Columbus: Columbus Dental
Orlowski HJ. Dental porcelain. Columbus: College of Manufacturing Co.; 1924.
Engineering, Ohio State University Press; 1944.
Haupl K, Reichborn Kjemerud I. Moderne zahnartzliche
Osborne J. Acrylic resins in dentistry. Oxford: Blackwell; krown und brucken arbeiten. Berlin: H Mausser; 1929.
1944.
Doxtater LW. Procedures in modern crown and bridgework.
Tylman SD, Peyton FA. Acrylics and other synthetic resins The principles and technique of stationary and removable
used in dentistry. Philadelphia: JB Lippincott Co.; 1946. bridges. Brook-lyn: Dental Items of Interest Publishing Co.;
Osborne J. Acrylic resins in dentistry. Springfield: CC 1931.
Thomas Co.; 1948. Knapp KW. Manual of fixed bridgework. New York: NY
University Press Book Store; 1935.
FIXED PARTIAL DENTURE Schwartz JR. Cavity preparation and abutment construction
PROSTHODONTICS in bridgework. Brooklyn: Dental Items of Interest Publishing
Co.; 1936.
Clifford IE, Clifford RE. Crown, bar and bridgework: new
Hildebrand GY. Studies in dental prosthodontics. Vol. 1.
methods of permanently adjusting artificial teeth without
Stockholm: Fahlerantz; 1937.
plates. London: Simpkin, Marshall & Co.; 1885.
Knapp KW. Inlays and fixed bridgework. Buffalo: Williams
Evans G. Practical treatise on artificial crown and bridge
Gold Refining Co.; 1939.
work Philadelphia: SS White Dental Manufacturing Co.;
1888. Tylman SD. Theory and practice of crown and bridge
prosthesis. St. Louis: CV Mosby; 1940.
Brown P. A treatise on crown and bridge work, or the
adjustment of teeth without plates. Philadelphia: Private Coelho DH. A complete fixed bridge procedure. St Louis:
printing; 1892. CV Mosby; 1949.
Reigner H. Kronen und bracken arbeitem, sin lehrbuch. Ewing JE. Fixed partial prosthesis. Philadelphia: Lea &
Leipzig: A Felix; 1895. Febiger; 1954.
Sheffield LT. An easy account of crown work and bridgework
in dentistry. New Work: Private printing; 1895. GENERAL PATHOLOGY
Mason Detachable Tooth Co. Mason detachable porcelains
Kissane JM, editor. Anderson’s pathology. 9th ed. St.Louis:
for crown and bridge work: with instructions in the method
CV Mosby; 1990.
of mounting. Mason Detachable Tooth Co.; 1900.
Myers EN, Suen JY. Cancer of the head and neck. 2nd ed.
Goslee HJ. Principles and practice of crown and bridgework.
New York: Churchill Livingstone, Inc.; 1989.
A practical, systematic modern treatise upon the
requirements and technique of artificial crown work Guepp DR, editor. Contemporary issues in surgical
including some incidental reference to bridgework. 4th ed. pathology, vol. 10, Pathology of the head and neck. New
New York: Consolidated Dental Manufacturing Co.; 1903. York: Churchill Livingstone, Inc.
Roussel GA. Traite theorique et practique des couronnes
artificielles et du bridge work. Paris: D Doin; 1906. GENERAL PROSTHODONTICS
Chance PR. Ash’s tube teeth in aesthetic crown and Fauchard P. Le Chirurgien Dentiste ou Traute des Dents (in
bridgework. London: Private printing; 1907. two volumes). Paris: 1728 (section on aritificial tooth
Havestadt JF. Principles and techniques of crowns and replacements in vol. II).
bridges. Boston: Kitter and Flebee; 1915. Mouton C. Essai d’Odontotechnique, ou Dissertation sur les
Peeso FA. Crown and bridgework for students and Dents Artificielles. Paris: Private printing; 1746. (First
practitioners. Philadelphia: Lea & Febiger; 1916. complete book on artificial tooth replacements).
Krummnow F. Lehrbuch der kronen brucken und porzel- Hunter J. The natural history of the human teeth. London: J
832 lantechnick. Berlin: Halensee Zahntechmischer Verlag; 1920. Johnson; 1755. (Section on artificial tooth replacements).
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Glossary of Prosthodontic Terms
Wooffendale R. Practical observations on the human teeth. attained:together with directions for the development and
London: J Johnson; 1783. (Section on artificial tooth subsequent preservation of the natural teeth. Philadelphia:
replacements). Private printing; 1860.
Dubois de Lhemant N. A dissertation on artificial teeth: Mosely E. Teeth, their natural history: with the physiology
evincing the advantages of teeth made of mineral paste, over of the human mouth, in regard to artificial teeth. London:
every denomination of animal substance: to which is added, Robert Hardwicke; 1862. (Section on artificial tooth
advise to mothers and nurses on the prevention and cure of replacements.)
those diseases which attend the first dentition. 1797 ~ Eskell FA. A new system for treating and fixing artificial
(Section on artificial tooth replacements.) teeth: the art to prevent the loss of the teeth: the instructions
Fox J. The history and treatment of the diseases of the teeth, calculated to enable heads of families to adopt the author’s
the gums, and the alveolar processes, with the operations practice of treating and preserving the teeth. Private printing;
which they respectively require. To which are added, 1862.
observations on other diseases of the mouth, and on the Coles JO. On deformities of the mouth, congenital and
mode of fixing artificial teeth. London: Thomas Cox; 1806. acquires, with their mechanical treatment. Philadelphia:
(Section on artificial tooth replacements.) Lindsay and Blakiston; 1870. (Section on artificial tooth
James B. A treatise on the management of the teeth. replacements.)
Philadelphia: Private printing; 1814. (First illustrated United Coles JO. A manual of dental mechanics. 2nd ed. London: J
States dental work with a section on artificial teeth.) & A Churchill; 1876. (Section on artificial tooth replacement.)
Delabarre CF. Traite de la partie mecanique de l’art du chiru Dejardin A Jr. Restaurations prosthetiques faites dans les
dentiste (in two volumes). Paris: Private printing; 1820. hopitaux de paris, precede de l’hygiene de la bouche. Paris:
(Section on artificial tooth replacements.) E Bicheron; 1877.
Jobson DW. Outlines of the anatomy and physiology of the Burnot G. Contribution a l’etude de la graffe dentaire.
teeth, etc. Their diseases and treatment. With practical Paris: JB Balilliere; 1886.
observations on artificial teeth. Edinburgh: William Tait; Cigrand BJ. The rise, fall and revival of dental prosthesis.
1834. (Section on artificial tooth replacements.) Chicago: Periodical Publishing Co.; 1892.
Koecker L. An essay on artificial teeth, obturators and plates, Parreidt J. Handbuch der Zahnersatakunde. Leipzig: A Felix;
with the principles for their construction and application, 1893.
illustrated by 26 cases and 21 plates. London: for S Highley;
Cingrand BJ. A compendium of dental prosthesis arranged
1835. (Section on artificial tooth replacements.)
in questions and answers. Chicago: Periodical Publishing
Saunders E. Mineral teeth: their merits and manufacture: Co.; 1894.
with observations on those cases in which they are or are
Essig CJ, editor. The American textbook of prosthetic
not applicable: and on the best means of preserving artificial
dentistry. In contributions by eminent authorities.
teeth. Philadelphia: Private printing; 1841. (Section on
Philadelphia Lea Brothers and Co.; 1896.
artificial tooth replacements.)
Richarson J. A practical treatise on mechanical dentistry.
Arthur R. A popular treatise on the diseases of the teeth:
Philadelphia: P Blakiston’s Sons and Co.; 1903.
including a description of their structure and modes of
treatment; together with the usual mode of inserting artificial Cigrand BJ. The lower third of the face or the dental domain:
teeth. Philadelphia: Lindsay and Blakiston; 1845. (Section a study of art in dentistry. Chicago: Blakely Printing Co.,
on artificial tooth replacements.) 1904.
Harbert SC. A practical treatise on the operations of surgical Wilson GH. A manual of dental prosthetics. Philadelphia:
and mechanical dentistry. Philadelphia: Barrett & Jones; 1847. Lea & Febiger; 1911.
Howard T. On the IOBB of teeth; and on the best means of Prothero JH. Prosthetic dentistry. 2nd ed. Chicago Medico
restoring them. London: Simpkin and Marshall; 1857. Dental Publishing Co.; 1916.
(Section on artificial tooth replacements.) Bodee CA, Rabell UL. Text book on prosthetic dentistry. New
Lukyn E. Dental surgery and mechanism. A popular treatise York: Private printing; 1921.
on the preservation, management, and surgical treatment Martinier P. Villian G. Prothese. Paris: JB Bailliere and fils;
of the teeth and gums: with the most modern and improved 1922.
modes of supplying the lobs of teeth. London: Savill and Clapp GW. The life and work of James Leon Williams. New
Edwards; 1859. (Section on artificial tooth replacements.) York: The Dental Digest; 1925.
Allen J. Teeth: an improved method of constructing artificial Logan JD. Dental prosthetics. Edinburgh: E & S Livingstone;
dentures: combining five important points not heretofore 1926. 833
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834
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Index
Index
A Aluminium and tin-silver 640 Aqua regia gel 614
Aluminium chloride 625 Aramany 689
A cingulum rest 348 Aluminium clutches 536 Arbitrary block out 427
A crucible former 664
Aluminium phosphate 672 Arbitrary face-bow 124
AH Schmidt 380 aluminium poly salts 675 Arc-fixed partial denture 512
A J Fortunati 307 Aluminium potassium sulphate 625 Arch curvature 522
Abrasive paper discs 574
Aluminium sulphate 625 Arch form 23, 201
Abutment 266, 491, 562 Alveololingual sulcus 56 Arch size 22
Abutment selection 522 Amalgam occlusal surfaces on acrylic Arcon 157
Abutment tooth surface 386 teeth 441 Arrow-point tracing 146
Accu-bite 634 Amphotericin B 231 Articulated pontics 512
Accutrac system 652, 655 Analyzing rod 309 Articulating paper 221
Acid itching 380 Analyzing the cast 312, 314 Articulation 438
Acquired defects of the mandible 691 Anatoline teeth 180 Articulator method 245
Acquired maxillary defects 689, 703 Anatomic replica palatal major connector Articulators 153
Acquired velo-pharyngeal defects 693 330 ASC 52 attachments 393
Acrylic 608 Anatomic teeth 8, 179 Aspergillosis 689
Acrylic copolymers 714 Anatomical crown 490 Aspiration of objects 694
Acrylic denture teeth 439 Anatomical impressions 409 Assessment of pulpal health 524
Acrylic resin 714 Anatomical landmarks 48 Atmospheric pressure 62
Acrylic resin denture bases 5, 377 Andrew’s bridge 515 Atrophy of masticatory muscles 236
Acrylic resin with amalgam stops 8 Andrews’s bridge system 496, 606 Attachment 291
Acrylic teeth with gold occlusals 441 Angioblastoma 689 Auricular prosthesis 685, 708
Acrylic veneers 670 Angioleomyoma 689 Austin and lidge classification 282
Adding multiple teeth 484 Angiosarcoma 689 Auto-polymerising resin 75, 98
Adenocarcinoma 689 Angular cheilitis 230 Auxiliary occlusal rest 374
Adenoid cystic carcinoma 689 Anotia 694 Auxiliary rests 346
Adenomas 694 Ante’s law 524 Avant’s classification 287
Adhesion 60, 386 Anterior defects 705 Axial reduction 570, 577, 586
Adhesives 715 Anterior determinant 109
Adjusting the clasp 437 Anterior guidance of the articulator 160 B
Adjusting the framework 437 Anterior teeth replacements 378
Aesthetic characterizations 677 Anterior teeth selection 169 Back-action clasp 362
Aesthetic try-in 206 Anterior three-quarter crowns 590 Backing 512
Aesthetics 322, 677 Anterior vibrating line 52 Bailyn’s classification 273
Agar 431 Anteroposterior curves 194 Baker attachment 366
AHGS 300 Anteroposterior double palatal bar and Balanced occlusion 184
Air plane crashes 694 closed horse shoe palatal major Balanced retention 354
Aker’s clasps 359 connector 391 Balancing condyle 113
Ala tragus 120 Antero-posterior or double palatal bar Balkwill 532
Alginate 296 331 Bar attachment 367
Aligned buccal ridge concept 202 Anticariogenic 674 Bar clasp 359, 363
Aligned occlusal groove concept 202 Anti-flux 667 Bar sanitary pontics 511
All acrylic fixed partial dentures 607 Anti-monson curve 195 Bard Parker blade 496
All acrylic retainers 505 Anti-oxidants 715 Base 211
All ceramic fixed partial dentures 607 Anti-sialogogues 623 Base plate 97
All ceramic retainers 504 ANUG 300 Bead, wire or nail head minor connector
All metal fixed partial dentures 606 Appearance 695 343
All metal retainers 504 Applegate’s classification or Kennedy- Beading 92, 329, 429
All-ceramic dull veneer crowns 583 Applegate’s classification 284 Beak tracing 116
Altered-cast technique 412 Applegate’s modification (1960) 272 Beckett and Wilson’s classification 280
Altering the master cast 421 Applegate’s rules 272 Bench curing 215
Alum 625 Appliance 266 Benign mesenchymal tumours 689
Alumina 673 Approach arm 344, 363 Bennett angle 116, 163
Aluminium 640, 641 Approach arm of a bar clasp 324 Bennett movement 114 835
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Bennett side shift 115 Cantilever abutments 550 Clasp position 387
Bergstrom 157 Cantilever fixed partial dentures 603 Claspless dentures 476
Berry’s biametric index 170 Capillarity or capillary attraction 62 Classification of FPD 497
Bevel 571, 573, 597 Carbon markers 309 Classification of maxillofacial prostheses
Bilabial sounds 220 Cardiovascular diseases 492 684
Bilateral balanced occlusion 186 Carrier prosthesis 711 Classification of partially edentulous
Bilateral configuration 388 Carriers 685 arches 270
Bilateral splints 610 Cast circumferential clasp 359, 388 Classifications of articulators 154
Bimeter 134 Cast holder/surveying table 308 Clean grade 715
Biological occlusion 533 Cast mesh fixed partial denture 615 Cleft 705
Biomechanical considerations 521 Cast metal Cleft lip 684, 687, 697, 701
Bismuth and aluminium oxide 674 Cast metal 441, 494, 521 Cleft palate 684, 687, 697, 701, 705
Blatterfien 310, 334 Cast restorations 400, 401 Clinical crown 490
Block out 427 Casting 436 Clinical diagnosis 293
Body 211, 353 Casting machine 665 Clinical history taking 16
Bona ball 370 Casting ring 435 Clinical remount procedures 543
Bonding agents (Cements) 619 Casting the alloy 666 Clinical remounting using centric relation
Bonding of resin bonded fixed partial Castleberry 714 record 543
dentures 618 Ceka 370 Closed bite double arch method 634
Bone loss 565 Cellulose 665 Closed horseshoe or anteroposterior
Bonwill 532 Cellulose acetate 640, 641 palatal strap 332
Bonwill theory articulators 154 Cementation 619, 640, 678 Closed mouth impression 46, 634
Border extension 219 Cemented dowels 557 Closed track 162
Border moulding 81 Cemented pin technique 653 Clotrimazole 231
Boucher et al technique 252 Cemento-enamel junction 564 Clutch(s) 128, 535
Boucher’s concept 189 Central arrow-point tracing 146 Coagulating probe 629
Boucher’s technique 241 Central bearing plate 146 Cohesion 61, 386
Box forms 554 Central-bearing device 146 Cold mould seal 72, 213
Boxes 575 Central-bearing point 146 Colour for anterior teeth 176
Boxing 92 Centric jaw relation 122 Combination clasp 362, 389
Bridges 490 Centric occlusion 267, 528 Combination syndrome 252
Brilliance 176 Centric relation 138, 139, 267 Compensating curves 202
Broad stress distribution 395 Ceramic 608 Complete ceramic 495, 521
Broadrick occlusal plane analyzer 532 Ceramic restorations 677 Complete palate 333
Bruce technique 251 Ceramic veneering 669 Components of occlusion 528
Buccal bevel 588 Ceramic/acrylic veneering 669 Composite prosthesis 685
Buccal flange 6 Chamfer 571 Compression moulding technique 210
Buccal frenum 50, 56 Channel tooth 8 Concept of harmony 173
Buccal fullness 119 Characterization of dentures 203 Concepts of occlusion 531
Buccal shelf area 58, 704 Cheek support 119
Condition of the residual ridge 525
Buccal vestibule 50, 56 Chemical bonding of resin 619
Conditioning of abused and irritated
Buccolingual width of the undercut 356 Chemical cleansers 222
tissues 301
Buffer salts 673 Chemical etching 619
Condylar element 162
BULL rule 546 Chemicomechanical methods of gingival
Condylar guidance 160, 162
Bullet-shaped pontic 511 retraction 625
Condylar guidance (Posterior determi-
Burning mouth syndrome (BMS) 232 Chemotherapeutic supplements 685
nant) 109
Burnout 435, 665 Chew-in method 144
Condylar shaft 162
Chewing cycle 117
Condylar track 162
C Chin clamp 535
Congenital defects of the mandible 691
Chlorhexidine 222
Calanga 495 Chlorinated polyethylene 714 Congenital maxillary defects 687
Calcium polysalts 675 Choleric 173 Congenital velo-pharyngeal defects 693
Calcium salts 673 Chondrosarcoma 689 Conical pontic 511
Calcium-fluoro-alumino-silicate 675 Chopping block 9 Conical theory articulators 154
Calculus 300 Chronic atrophic candidiasis 229 Connectors 491, 515
Camper’s line 120, 207 Cingulum bar 339 Conservative retainers 504
Candida associated denture stomatitis Cingulum proximal groove 596 Continuity defect 691
(CADS) 230 Cingulum rest 346 Continuous bar retainers 375
Canine extension from the occlusal rest Cingulum rest seat 406 Contouring crowns and cast restorations
374 Circular configuration 391 318
836 Canine key of occlusion 201 Circumoral competence 695 Contouring wax patterns 318
Canine rest 375 Clasp design 385, 388 Contra bevel 558, 593
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Index
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Textbook of Prosthodontics
Extracoronal partial denture 266 Fluoride ions 674 Group function 532
Extracoronal replacements 494, 521 Flux 667 Guide plane preparation 402
Extraction 304 Foaming silicones 715 Guide plane removable partial denture
Extraoral defects 694 Forcemeters 293 454
Extraoral technique 479 Forces from the tongue 381 Guide plane RPD 449
Extrinsic coloration 714 Formed block out 428 Guide planes 318, 324
4 Methacryloxy ethyl trimellitic anhydride Guiding planes 323, 324, 356
F 675 Gypsum 665
Fovea palatina 54 Gypsum bonded investments 665
Fabricating the frame work 289 Fracture 695 Gysi’s concept 187
Face-bow 122 Framework try-in 436
Facia type 125 Frankfort’s horizontal plane 87 H
Facial form 19 Franklin Smith 368
Facial profile 19 Freedom in centric 532 H Pound’s formula 171
Facial proximal groove 596 Freedom of displacement 567 Hader 367
Facial reduction 582 Frenal relief 219 Hader clips 451
Facial veneers 490 French’s concept 187 Hairpin clasp 361
Facing 512 Frenum relief 447 Half and half clasp 362
Falls 694 Frictional control 386 Half pear-shaped 336
Far zone 311 Friedman’s classification 279 ½ round bur 594
Feather edge preparation 573 Frontal plane 530 Half wave modulated 628
Ferric sulphate 625 Frush and Fisher 174 Half-moon fracture 583
Ferrule 556 Frush’s concept 188 Hall articulator 156
Fiber reinforced composite resin bridges Fulcrum lines 371, 383 Hall automatic articulator 155
610 Full mouth rehabilitation 539 Hall’s conical theory 532
Fiber reinforced resin 495, 521 Full veneer crown 490, 503, 575 Hamular notch 51
Fibrekor 611 Full wave modulated 628 Hanau face-bow 125, 126
Fibrolipoma 689 Fully adjustable articulators 158, 534 Hanau wide vue articulator 161
Fibroma 689, 694 Fully rectified current 628 Hanau’s quint 188
Finish line 344, 571, 702 Functional cusp bevel 570, 576 Hand chisels 574
Finish line configurations 571 Functional dual impressions 412 Hand fabricated technique 612
Finish line exposure 624 Functional impression 45, 409 Hannes anchor 369
Finishing 672 Functional mandibular movements 108 Hanson’s theory 532
Finishing and polishing 436 Functional method 144, 243 Hard palate 53
Finishing and polishing the denture 217 Functional relining method 415 Hardy’s concept 197
Finishing the margins 660 Functional requirements of a clasp 354 Harmony facing 514
Fire arms 694 Functional teeth 180 Healing caps 561
Fires and burns 694 Furnace or oven soldering 667 Healing screw 561
Fischer packing instrument 626 Heart shaped pontic 511
Fiset’s modification 285 G Height of contour 314, 320
Fishhook 361 HEMA (Hydroxy ethyl methacrylate) 675
Fitting the framework 437 Gagging 233 Hemangioma 689
Fixed fixed partial dentures 604 Garnet disks 559 Hemifacial microstomia 687
Fixed movable partial dentures 605 Gauged pattern wax sheets 432 High survey line 311
Fixed partial denture splints 609 Genial tubercles 59 High volume vacuum 622
Fixed prosthesis 490 GERBER 367 Hindle 414
Fixed removable partial dentures 605 Gingettage 627 Hindle’s methods 414
Fixed splinting 305 Gingival diseases 300 Hinge axes 535
Flabby ridge 231 Gingival retraction 623 Hinge bow 534
Flame diamonds 574 Gingival sulcus enlargement 630 Hinge movement 111
Flange extension 447 Gingivectomy 631 Hippocrates 173
Flange of a denture 6 Ginglymo arthroidal 528 Hollow metal sprues 663
Flash 215 Glacial acetic acid 673 Hooper’s duplicator 245
Flasking procedure 210 Glossitis 230 Horizontal determinants of occlusal
Flat back facing 513 Godfrey’s classification 278 morphology 531
Flat end tapered diamonds 574 Gold occlusals 8 Horizontal jaw relation 138
Flow 667 Gothic arch tracers 146 Horizontal plane 530
Fluid control 622 Grasso’s clasp or VRHR clasp 363 Horizontal relation 121
Fluid resin base plates 100 Grid 537 Horseshoe or U-shaped connector 332
Fluid wax 86 Groove indexing 95 Hot spots 712
838 Fluid wax functional impression 417 Grooves 554, 575 House’s articulator 156
Fluoride 673 Ground electrode 629 HTV-silicones 715
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Index
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Textbook of Prosthodontics
Long term temporary bridges 609 McLean’s physiologic impression 412 Monson’s articulator 156
Long-term temporary restorations 641 Mean value articulator 156, 159 Monson’s curve 195
Loop connectors 517 Mechanical bonding of resin 618 Monson’s spherical theory 532
Loop electrodes 632 Medial pterygoid 529 Mounting the diagnostic casts 298
Lott’s concept 189 Median jaw relation 122 Mouth protective devices 472
Louis 714 Medical grade 715 Mucocompressive impression 45
Low survey line 311 Mediotrusive condyle 113 Mucocompressive technique 46
Lower facial height 19 Medium survey line 311 Mucoepidermoid carcinoma 689
Lug seat 374 Mental attitude of patients 14 Mucormycosis 689
Luting agents 672, 674 Mental foramen 59 Mucostatic or passive impression 45
Lymphomas 694 Meshwork 342 Mucous membrane 48
Lymphosarcoma 689 Mesial rest 456 Muller De Van 567
Mesial rest modification 460 Multiple circlet clasp 360
M META 675 Multiple spruing 434
Metal 715 Muscle development 21
Macroscopic retention 619 Metal ceramic retainers 504 Muscle tone 20
Magnesium 674 Metal ceramics 494, 521 Muscles of mastication 529
Magnesium oxide 672, 674 Metal chloride 714 Mutually protected system 532
Maintenance of the prosthesis 222 Metal clutches 536 Mylohyoid ridge 59
Major connector 290, 327, 390 Metal denture bases 5, 377 Myocentric occlusion 533
Major retainers 503 Metal insert teeth 10 Myxoma 689
Maleic 675 Metal obturator 706, 707
Malignant mesenchymal tumours 689 metal occlusal rim formers 106
N
Mandibular canine 200 Metal pontics 379
Mandibular central incisor 200 Metal pontics with acrylic windows 380 Nasal defects 694
Mandibular defects 691, 704 Metal repairs 485 Nasal prosthesis 685, 709
Mandibular first molar 200 Metal styli 537 Near zone 310
Mandibular first premolar 200 Metal teeth with facing 378 Needlehouse method 144
Mandibular guidance flange (Training Metal-ceramic fixed partial dentures 606 Neurofibrosarcoma 689
flange) 710 Metal-ceramic full veneer crowns 577, 581 Neurohr 368
Mandibular lateral incisor 200 Methyl cellulose 637 Neurohr spring-lock attachments 368
Mandibular major connectors 335 Methyl triacetoxy siloxane 715 Neurohr’s classification 273
Mandibular movement 108, 530 Meyer’s functionally generated path Neurohr-Williams shoe attachment 368
Mandibular posterior three-quarter technique 532 Neuromuscular control 386
crowns 589 Micorazole 231 Neuromuscular coordination 21
Mandibular realignment 695 Microfilled composite 641 Neutral zone 203, 381
Mandibular second molar 201 Microscopic retention 618 Neutrocentric concept of occlusion 182
Mandibular second premolar 200 Microtia 694 Ney excursion guide 149
Mid-palatine raphe 54
Mandibular single dentures 255 Ney surveyor 308
Minor connector 290, 340, 354, 392
Marginal fit 677 Ney-Chayes attachment 366
Minor connector that join the indirect
Marginal integrity 570, 676 Nick and notch method 142
retainer 341
Maryland bridges 610, 614 Nickel-chromium 641
Minor connectors that join the clasp
Masseter 529 Night guards 472
assembly to the major connector 340
Master or wash impression 84 Nightwear of the prosthesis 222
Minor connectors that join the denture
Mauk’s classification 277 Niswonger’s method 135
base to the major connector 342
Max. pleasure 195 Non-adjustable articulators 157
Minor retainers 503
Maxillary canine 199 Non-anatomic teeth 9
Mirror view clasp 364
Maxillary central incisor 198 MM DeVan 364 Non-electrochemical etching 614
Maxillary defects 687 Modelling plastic impression 48 Non-lock tooth 9
Maxillary first molar 199 Modified crib clasp 360 Non-parallel pins 554
Maxillary first premolar 199 Modified Meyer’s technique 698 Non-retentive finger 363
Maxillary lateral incisor 198 Modified pin facing 513 Non-rigid connector 551, 553, 516, 605
Maxillary major connectors 329 Modified restorations 553 Notch-indexing 96
Maxillary posterior three-quarter crowns Modified ridge lap pontic 510 Number and placement of clasps 387
585 Modified sanitary pontic 512 Nutritional deficiencies 236
Maxillary second molar 199 Modified spheroidal pontic 511 Nylon bristle 594
Maxillary second premolar 199 Modified T clasp 364 Nystatin 222, 231
Maxillary tuberosity 54 Modified-cusp or low-cusp teeth 180
Maxillofacial prosthodontia 684 Mohr’s syndrome 687 O
Maximum intercuspation 528 Molar key of occlusion 201
Mc Collum 532 Monoplane or non-balanced occlusion Objectives of impression making 60
840 Obturator(s) 262, 698, 684, 706
Mc Laughlin technique 614 196
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Index
Occlusal arrangements 534 Parallelism of the abutment teeth 315 Pleomorphic adenoma 689
Occlusal discrepancies 677 Parallelism of the guiding plane 320 Point of contact 537
Occlusal force 381 Parotid papilla 207 Poisoning 694
Occlusal harmony 221 Partial veneer crowns 585 Polished surface 5
Occlusal morphology 534 Partial maxillectomy 687 Polishing 672
Occlusal offset 587 Partial maxillectomy defects 699, 703 Poly vinyl chloride and co-polymers 714
Occlusal pivot by Sear 197 Partial veneer crown 490, 504 Polyacrylic acid 674, 675
Occlusal plane 194 Partially rectified, damped current 628 Polyanion chains 675
Occlusal reduction 575, 581, 585 Passivity 358 Polycarbonate 640, 641
Occlusal rehabilitation 541 Path of insertion 321, 355, 569 Poly-methyl methacrylate 641
Occlusal rest 346, 347 Path of insertion of the denture 315 Polyphosphazines 715
Occlusal rim 103, 437 Pathologic occlusion 533 Poly-R methacrylate 641
Occlusal surface 5 Patient evaluation 14 Polyurethanes 714
Occlusion 181, 497, 526, 528, 676 Patient instructions 222 Polyvinyl chloride 714
Occlusion plane 528 Patient’s perception of comfort 138, 139 Pontic 491
Ocular defects 694 Patterson’s method 145 Pontic design 506
Ocular prosthesis 685, 709 Peeso reamer 558 Pontic fabrication 661
Offsets 575 Perel pontic 512 Pontics 506
One-step technique 614 Periapical bone 295 Porcelain denture teeth 440
Onlay 302, 491 Periodontal ligament area 524 Porcelain fused to metal facing 515
Onlay clasp 303, 361 Periodontal therapy 301 Porcelain teeth 378, 379
Open condylar guidance 162 Periodontometers 293 Positioners 685
Open margins 661 Peripheral seal 62 Positioning stents 710
Open-mouth impression 46 Peripheral tracing 81 Positioning the sprues 664
Optimum occlusion 533 Permanent 608 Posselt 117
Oral cancer in denture wearers 232 Permanent immediate partial denture 472 Post-ceramic soldering 667
Oral positioning stents 710 Permanent splints 610 Post-clinical diagnosis 295
Oral rehabilitation 539 Per-oral cone positioning devices 711 Posterior border jaw relation 122
Organic concept of occlusion 182 Personality 176 Posterior palatal seal 84
Orientation jaw relation 122 Phase of definitive management 695 Posterior palatal seal area (Postdam) 51
Orientation relation 121 Phase of intermediate management 695 Posterior teeth replacement 379
Orthodontic realignment 304 Philip M. Jones scheme of non-balanced Posterior teeth selection 177
Orthodontic treatment 552 occlusion 197 Posterior vibrating line 53
Osborne and Lammie’s classification 287 Phlegmatic 173 Post-insertion management 620
Osteosarcoma 689 Phosphate 665 Post-pour technique 653
Oudin or telsa current 628 Phosphoric acid 672, 673 Pound’s concept 197
Ovate pontics 511 Physiologic basing 394 Power point 134
Oven soldering 667 Physiological dual impression 412 Power point: (by Boos) 134
Overdenture abutments 235, 305 Physiological velo-pharyngeal defects 693 Precautions to prevent and/ or control of
Over-impression 413 Pick up impression 412, 413 sequelae 237
Overjet 119 Pier abutments 525, 550 Pre-ceramic soldering 667
Overjet and overbite 202 Pierre Robin syndrome 687 Precision plastic base dentures 474
Overpostdamming 88 Pin facing 513 Precurrent side shift 115
Overwaxed margins 661 Pin modified three-quarter crowns 593 Pre-extraction records 133
Pin retention 554 Pre-fabricated pontic facings 512
P Pindex system 652, 654 Pre-fabricated technique 611
Pinholes 554, 596 Preformed occlusal rims 106
PMS (Pankey, Mann, Schuyler) system Pins 554 Pre-heating the crucible 665
532 Pivot 162 Preliminary impression 47
Paddle boxing 94 Placing internal rest seats 319 Preparation of retentive undercuts 400
Palatal incompetence 693 Plane of occlusion 194 Preparing the axial contours 656
Palatal insufficiency 693 Plaque 300 Preparing the occlusal contours 658
Palatal lift prosthesis 707 Plaster and pumice boxing 93 Pre-pour technique 652
Palatal obturator 706 Plaster impression 48 Preprosthetic mouth preparation 300
Palatal plate type major connector 330 Plastic materials 494, 521 Preprosthetic procedures 288
Palatal strap 330 Plastic patterns 432 Preservation of periodontium 574
Palatal throat form 26 Plastic teeth 378, 379 Preservation of remaining structures 65
Pantograph 538 Plasticized methyl methacrylate 714 Preservation of tooth structure 567
Pantographic tracing 149, 537 Plasticizer migration 714 Pressed-on acrylic 441
Para-functional movements 108, 118 Platinum salts 715 Pressure indicating paste 436
Parallel block out 427 Pleasure curve 195 Previous denture 18
Parallel pinholes 554
841
Pleasure’s concept 187 Primary impressions 47, 65
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Textbook of Prosthodontics
Primary rests 346 Reciprocal arm 353 Reverse pin facing 514
Primary retention 567 Reciprocation 357 Reverse three-quarter crown 589
primary stress-bearing area 53 Reconstruction of removable partial Reverse, circlet or reverse approach, clasp
Principle of indirect retainers 372 denture 482 360
Principles of a removable partial denture Record base 97 Reversible hydrocolloid impression 47
380 Recovery 436, 666 Rhabdomyosarcoma 689
Principles of clasp design 354 Re-established mandibular defects 705 Ribbond 611
Principles of design/or philosophy of Refractory cast 431 Ridge augmentation 495
design 392 Reinforced acrylic pontics (RAP) 379, 380 Ridge defects 495
Principles of impression making 59 Relief 428 Ridge lap pontics 510
Principles of tooth preparation 567 Relief wax 71 Ridge parallelism 24, 133
Processing 443 Relining 239, 479 Ridge relation 132
Profile silhouettes 133 Remounting plates 96 Rigid connectors 516
Progressive side shift 115 Remounting the dentures 541 Ring clasp 361
Prosthesis fracture 565 Removable bridge 605 Ripples 661
Prosthesis retaining screws 563 Removable die system 652 Roach clasp 359
Prosthetic dressings 685 Road traffic accidents 694
Removable partial overdenture 449, 451
Prosthetically maladaptive 229 Rochette bridge 613
Removable prosthodontics 266
Prothero 352 Rolled wax technique 105
Removable splinting 304
Protrusive incisal path inclination 194 Root configuration 523
Removal of edentulous cuff 631
Protrusive incisal path or incisal guidance Root extended pontic 511
Repair of major and minor connectors 485
194 Root support 523
Repairs of removable partial dentures
Protrusive jaw relation 122 Root tipped pontic 511
482 Rotary curettage 627
Protrusive movements 112 Replacement of denture teeth 483
Provision of support for weakened teeth Rotherman 367, 370
Reservoir 434 Round loop 629
304 Residual alveolar ridge 58
Proximal boxes 588 RPA (Rest, proximal plate and Aker’s
Residual ridge 53, 495 clasp) 461
Proximal contacts 676
Residual ridge resorption (RRR) 233 RPD with attachments 449
Proximal flare 587, 592, 596
Resin bonded fixed partial denture 493, RPI (Rest, proximal plate and I-bar) 460
Proximal grooves 586, 595
612 RPI system RPD 449
Proximal half crown 589
Resin denture teeth 440 RS-1 binangle chisel 580
Proximal plate 325, 456
Resin obturators 706 RTV-silicones 715
Proximal reduction 580, 582, 584, 592, 594
Resin pattern fabrication 559 Rubber dam 622
Proximal-half 552
Resin veneer 495, 521 Rubbery stage 214
Pterygomandibular raphe 58
Resin-bonded retainers 610 Rugae 54
Pumice wash 217
Resistance 567 Rugae support 376
Purse string 699
Rest 290, 345, 353, 392 Russel’s index 293
Purse string action 707
Push type retention 357 Rest area 345
Rest jaw relation 122 S
Putty elastomer 578
Putty wash technique 632 Rest seat 345
Saddle pontic 510
Rest seat preparation 403 Sagittal plane 530
Q Retainer 266, 490 Saliva 22
Retainer pontic component 517 Saliva ejector 622, 623
Quad 191 Retainer wax pattern 655
Quadrilateral configuration 387 Salivary gland tumours 689
Retainer wing component 517 Sand paper finishing 217
Qualities of a clasp 385 Retainers 503 Sanguinous 173
Retention 60, 354 Sanitary facings 513
R
Retention loops 702 Sanitary or hygienic pontics 511
Racemic epinephrine 625 Retentive arm 352 Saturation or chroma 176
Radial fissure 580 retentive finger 363 SC barnum 622
Radial shoulder 572 Retentive fulcrum line 372 Scar band 698
Radiation appliances 685, 710 Retentive pearls 670 Scissor bite 9
Radiation applicator 711 Retentive terminal 363 Sculpting 708
Radiation carrier 711 Retentive undercuts 322, 355 Sears’s concept 187
Radiation shields 711 Retraction cords 624 Seating groove 577
Radiogherapy prosthesis 711 Retromolar pad 57, 704 Second factor of occlusion 193
Radiographic examination 493 Retromolar papilla 57 Second rotational fulcrum line 383
Radium carrier 711 Retro-mylohyoid fossa 57 Secondary impressions 47, 80
Realiff factor 149 Retruding the mandible 140 Secondary rests 346
Rebasing 248 Reverse action 361 Secondary retention 567
Rebasing of removable partial dentures Reverse curve 195 Secondary stress-bearing area 53
842 481 Reverse lateral curve 197 Sectional border moulding 83
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Index
Seibert’s onlay graft 495 SPA factor 174 Support 65, 357
Selecting the mould of anterior teeth 440 Spark gap generator 628 Suprahyoid muscles 530
Selective grinding 541 Special attachment 368 Surgery 304
Selective occlusal grinding 221 Special complete dentures 250 Surgical crown lengthening 630
Selective pressure functional dual special tray 70 Surgical diathermy 628
impression technique 419 Speech 21, 118, 220 Surgical electrode 629
Selective pressure technique 46 Speech aids 684 Surgical guide template 563
Semi-adjustable articulators 157 Sphenomandibular ligament 529 Surgical obturators 685, 706
Semi-anatomic teeth 8, 180 Spherical concept of occlusion 182 Surgical splints 685
Sensation and mobility of the tongue 695 Spherical theory articulators 155 Survey 307
Separate die system 652 Spheroidal pontic 511 Survey lines 310
Separating medium 72, 213 Splint 304, 611, 685 Surveying 38, 307
Sequelae of wearing complete dentures Splinting 389, 609 Surveying arm 309
229 Split major connector 394 Surveying ceramic veneer crowns 320
Servo anchor (SA) 370 Split pontic connectors 517, 605 Surveying the diagnostic cast 298
Set up for surveying 312 Spoon dentures 473 Surveying the master cast 320
Shade selection 440 Spray-ons 715 Surveying the soft tissue contour 316
Shallow bevels 571 Spring cantilever fixed partial dentures Surveying the teeth 314
Shaped block out 428 603 Surveying tools 309
Shellac base plate 100 Spring-wire lock system 368 Surveyor 307
Sheppard’s statement 196 Sprinkle on technique 75 Svedopter 622, 623
Shield tracing 117 Sprue button 663 Swallowing 118
Shielding 711 Sprue design 663 Swallowing threshold 137
Shields 685 Sprue diameter 663 Swaping or stretching blocks 641
Short margins 661 Sprue former 434, 663 Swenson technique 251
Short span bridges 608 Sprue hole 434 Swenson’s classification 286
Short-term temporary restorations 641 Sprue leads 435 Swing lock RPD 449
Shoulder 572 Sprue pin 663 Swinglock removable partial dentures 461
Shoulder with a bevel 572 Sprues 663
Shoulderless 573 Spruing 434, 663 T
Siebert 495 Squint test 177
Silanation 380 Stability 64, 676 “T” burnisher 85
Silica 673, 714 Stabilization of shellac base plates 102 T clasp 364
Silicon 714 Stabilizing clasps 455 Tactile sense or neuromuscular perception
Silicone impression 48 Stabilizing fulcrum line 372 138
Silicone mould 247 Stannic oxide 674 Taper 567
Silicone obturators 706 Stannous fluoride 674 Tartaric acid 675
Silicone putty 578 Stannous octate 715 Tatooed 537
Silverman’s closest speaking space 136 Static or pressureless method 142 Teardrop tracing 118
Simple circlet clasp 359 Stefan’s law 62 Teeth selection 169, 439
Simultaneous border moulding 81 Stein 658 Telescopic crown 553
Single broad palatal major connector 330 Steins concept 173 Telescopic retainers 504
Single complete dentures 250 Stents 685 Temperamental theory 173
Single missing canine 525 Stern goldsmith attachment 366 Temporalis 529
Single missing molar 525 Stiff stage 214 Temporary base 97
Single mix putty wash technique 633 Stone-Mould Dough technique 98 Temporary denture base 97, 437
Single posterior palatal bar 329 Stopper 72 Temporary immediate partial denture 472
Single spruing 434 Straight dowel pin systems 652 Temporary partial dentures 464
Single stage surgery 564 Stress breaker 393, 551 Temporary removable partial denture 266
Skinner’s classification 281 Stress directing concept 393 Temporary restraining force 62
Slidematic type (Denar) 125 Stress equalization 393 Temporary splints 610
Small loop 629 Structural durability 569 Temporomandibular joint 108, 528
Small straight probe 629 Structure and function of Tenon 516
Smooth beak pliers 437 the temporomandibular joint 108 Tenon mortise connectors 516, 605
Sodium alginate solution 213 Strut configuration 392 Tensofriction 567
Sodium perborate 222 Stuart instrument gnathoscope 157 Terkla and Laney’s modification (1963)
Soft palate and palatal throat form 26 Stud attachment 367 273
Soft tissue 622 Stylomandibular ligament 529 Terminal jaw relation record 122
Soft tissue injuries 695 Sublingual bar 339 THA 540
Soldering 666 Sub-mucous cleft palate 687 The “F” or “V” and “S” speaking anterior
Soldering investment 667 Suction devices 622 tooth rel 136
The pressed-on or post tooth 440
843
Solid plastic sprues 663 Superior head of lateral pterygoid 529
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