Best Approach To RPD Design Best Approach To RPD Design

Successful Outcomes in
Contemporary Removable Prosthodontics: Successful Outcomes in

Clinical Removable Partial Dentures Clinical Removable Partial Dentures
Mark Dellinges, DDS, FACP, MA Clinical Aspects-

•!Introduction •! Appointment Sequence
6/19/2015
•!Design Philosophy •! Surveying
! •!Biomechanics •! Design Sequence
•!Simplified Component Selection •! Impressions “Trouble
•!Design Considerations Shooting”
•! Altered Cast vs. Reline
•! Implants & RPD’s
Best Approach to RPD Design Best Approach to RPD Design

“There are over 65,534 partially edentulous !!Identify biomechanical classification of
situations per arch meaning there are partially edentulous arch
literally tens of thousands of potential RPD !!Design should satisfy biomechanical
designs.” Beaumont, A. J. Micro-computer aided requirements of tooth borne vs. tooth &
removable partial denture design, the next evolution. tissue borne removable partial dentures
JPD 62:551-6, 1989 !!Utilize a small number of well designed
components whose selection is based on
sound biomechanical principles
RPD Design Philosophy Major Connector Selection

!!Minimal tooth and minimal gingival coverage !!mandibular arch: lingual vestibular depth
!!maxillary arch: requirement for support
!!Equitable distribution of functional forces !!need for contingency planning
Tooth Borne RPD Tooth & Tissue Borne RPD Tooth Borne RPD Tooth & Tissue Borne RPD
1
Primary Supporting Areas Clasp Selection
!!need for stress release anterior to the
fulcrum line axis
Tooth Borne RPD Tooth & Tissue Borne RPD
Tooth Borne RPDs Tooth & Tissue Borne RPDs
Tooth & Tissue Borne RPDs Tooth & Tissue Borne RPDs
RPI
RPC
Combo WW
2
Selection of Components and Design Considerations for Removable Partial Dentures
Tooth & Tissue Borne RPDs Design Criteria: Minimal Tooth and Tissue Coverage
Equitable Distribution of Forces

No Clasp (rest only)
Tooth Borne RPD’s Tooth & Tissue Borne RPD’s
CC (non-retentive)
Major Connectors: Maxillary RPD’s Mandibular RPD’s Maxillary RPD’s Mandibular RPD’s
Combo WW 1. Anterior Palatal Strap (Same as Mandibular 3. Anteroposterior Palatal 1. Lingual Bar
Tooth & Tissue Borne RPD’s) Strap
2. Posterior (mid-palatal) 4. Modified Palatal Plate 2. Sublingual Bar

Strap
5. Complete Palatal Plate 3. Lingual Plate
Clasp Assemblies: 1. Cast Circlet (Akers) 1. RPI
2. Combination Bar 2. RPC
3. Embrasure Clasp 3. Combination WW
Tooth Borne RPDs Design Criteria: Minimal Tooth and Tissue Coverage
1. Anterior Palatal Strap (Same as Mandibular 3. Anteroposterior Palatal 1. Lingual Bar

Strap
Tooth & Tissue Borne RPDs Design Criteria: Minimal Tooth and Tissue Coverage

Strap
3
Requirements of Major Connectors Design Criteria: Minimal Tooth and Tissue Coverage
•! Sufficiency Rigid Tooth Borne RPD’s Tooth & Tissue Borne RPD’s
•! Properly Located
•! Must Not Impinge on 1. Anterior Palatal Strap (Same as Mandibular
Tooth & Tissue Borne RPD’s)
3. Anteroposterior Palatal
Strap
1. Lingual Bar
the Gingiva 2. Posterior (mid-palatal) 4. Modified Palatal Plate 2. Sublingual Bar

Strap
Maxillary Major Connectors Design Criteria: Minimal Tooth and Tissue Coverage
1. Anterior Palatal Strap Equitable Distribution of Forces

Strap
2. Posterior (mid-palatal) Strap Equitable Distribution of Forces

Strap
4
3. Anteroposterior Palatal Strap Equitable Distribution of Forces

Strap
4. Modified Palatal Plate Equitable Distribution of Forces

Strap
5. Complete Palatal Plate Equitable Distribution of Forces

Strap
5
Mandibular Major Connectors
1. Lingual Bar
Design Criteria: Minimal Tooth and Tissue Coverage

2. Sublingual Bar

Strap

Equitable Distribution of Forces 3. Lingual Plate

Strap
6

Requirements of a Clasp Assembly

!!Retention
!!Stability
1. Anterior Palatal Strap (Same as Mandibular
Strap
1. Lingual Bar
!!Support
2. Posterior (mid-palatal)
Strap
4. Modified Palatal Plate 2. Sublingual Bar !!Reciprocation
!!Adequate Encirclement
!!Passivity
Requirements of a Clasp Assembly Requirements of a Clasp Assembly

!!Retention !!Retention
!!Stability !!Stability
!!Support !!Support
!!Reciprocation !!Reciprocation
!!Adequate Encirclement !!Adequate Encirclement
!!Passivity !!Passivity
Requirements of a Clasp Assembly Requirements of a Clasp Assembly

!!Retention !!Retention
!!Stability !!Stability
!!Support !!Support
!!Reciprocation !!Reciprocation
!!Adequate Encirclement !!Adequate Encirclement
!!Passivity !!Passivity
7
Requirements of a Clasp Assembly Design Criteria: Minimal Tooth and Tissue Coverage
!!Retention Tooth Borne RPD’s Tooth & Tissue Borne RPD’s

!!Stability
!!Support 1. Anterior Palatal Strap (Same as Mandibular
Strap
1. Lingual Bar
!!Reciprocation 2. Posterior (mid-palatal)

Strap
4. Modified Palatal Plate 2. Sublingual Bar
!!Adequate Encirclement 5. Complete Palatal Plate 3. Lingual Plate
!!Passivity
Clasp Assemblies - Tooth Borne Design Criteria: Minimal Tooth and Tissue Coverage
1. Cast Circlet (Akers) Clasp Equitable Distribution of Forces

Strap
Clasp Assemblies – Tooth Borne Design Criteria: Minimal Tooth and Tissue Coverage
2. Combination Bar Equitable Distribution of Forces

Strap
8
Clasp Assemblies – Tooth Borne Design Criteria: Minimal Tooth and Tissue Coverage
3. Embrasure Clasp Equitable Distribution of Forces

Strap
Clasp Assemblies – Tooth & Tissue Borne

1. RPI Clasp
RPI Clasp
Functional Movement of the Design Criteria: Minimal Tooth and Tissue Coverage
RPI Clasp Equitable Distribution of Forces

Strap
9
2. RPC Clasp
RPC Clasp

3. Combination Wrought Wire Clasp

Strap
Combination WW Clasp Design Criteria: Minimal Tooth and Tissue Coverage

Strap
10
Review of Clinical Removable Clinical and Laboratory
Partial Denture Prosthodontics Procedures for RPD Fabrication
Introduction Introduction
!! Intake Interview & Clinical Assessment !! Intake Interview & Clinical Assessment
!! PARP Form !! PARP Form
!! Treatment Planning & Clinic Forms !! Treatment Planning & Clinic Forms
!! Treatment Sequence for RPDs !! Treatment Sequence for RPDs
- tooth borne RPDs - tooth borne RPDs
- tooth mucosa borne RPDs - tooth mucosa borne RPDs
- combination C/D & RPD - combination C/D & RPD
Introduction
!! Intake Interview & Clinical Assessment

!! PARP Form
!! Treatment Planning & Clinic Forms
!! Treatment Sequence for RPDs
- tooth borne RPDs
- tooth mucosa borne RPDs
- combination C/D & RPD
11
Introduction

!! PARP Form
- tooth borne RPDs
Introduction

!! PARP Form
- tooth borne RPDs
Introduction

!! PARP Form
- tooth borne RPDs
12
Introduction

!! PARP Form
- tooth borne RPDs
Introduction

!! PARP Form
- tooth borne RPDs
1st Clinical Appointment 1st Clinical Appointment

-Evaluation for RPDs -Evaluation for RPDs
!!Clinical Assessment !!Clinical Assessment
!!Making Diagnostic !!Making Diagnostic

Cast Impressions Cast Impressions
13
-Getting Casts Ready for Mounting
!!Making Record Bases
!!Placing Wax Rims
-Getting Casts Ready for Mounting

!!Making Record Bases
!!Placing Wax Rims
2nd Clinical Appointment

-Recording Maxillomandibular Relations
!!Interocclusal Record
!!Facebow Transfer
14
2nd Clinical Appointment
-Recording Maxillomandibular Relations
!!Interocclusal Record
!!Facebow Transfer
-Cast Mounting & Framework Design -Cast Mounting & Framework Design
!!Mount Maxillary !!Mount Maxillary
Cast Cast
!!Mount Mandibular !!Mount Mandibular
Cast Cast
!!Design RPD’s !!Design RPD’s
!!Record Design !!Record Design
The Survey & Design Sequence

-Cast Mounting & Framework Design
for RPDs
!!Mount Maxillary !!Survey Cast
Cast !!Rests & Minor Con.
!!Mount Mandibular !!Major Connector
Cast !!Clasp Arms
!!Design RPD’s !!Retentive Network
!!Record Design !!Ext. Finish Lines
!!Int. Finish Lines
!!Fill Out Forms
15
Definitions: The Survey Process:
!! Secure cast to neutral tilt
Dental Surveyor – A Paralleling
instrument used in the fabrication !! Identify guiding planes
!! Adjust anteroposterior tilt
of a Removable Partial Denture.
!! Identify potential undercuts
!! Adjust mediolateral tilt
Surveying – The procedure of
!! Index the cast
analyzing and delineating the
contours of the abutment teeth !! Draw survey lines
!! Mark depth of undercuts
and associated structures before
!! Indicate modification areas
designing a Removable Partial
!! Draw design
Denture.
The Survey & Design Sequence

-Cast Mounting & Framework Design
for RPDs
!!Survey Cast !!Mount Maxillary
!!Rests & Minor Con. Cast
!!Major Connector !!Mount Mandibular
!!Clasp Arms Cast
!!Retentive Network !!Design RPD’s
!!Ext. Finish Lines !!Record Design
!!Int. Finish Lines
!!Fill Out Forms
3rd Clinical Appointment

-Rest Seat Prep. & Master Impressions
!!Rest Seat
Preparation
!!Master Impressions
16
Modifications of Tooth Contour
Mouth Preparation for RPDs
Sequence of Treatment
!!Diamonds !!Guiding Planes

!!Burs !!Height of Contour
!!Polishing !!Retentive Grooves
Instruments !!Rest Seats
Review of Mouth Preparation

Problem:
with Patient
!!Patient’s Study !!Lack of Proper

Cast with Design Mouth Preparation
!!Models
Solutions: Final Impressions for RPDs

1.! Mouth preparation
check list
2.! Verify tooth
modifications before
final impressions
!! Alginate Impressions
!! Quick Set Stone
17
Trouble Shooting
Removable Partial Denture Framework Does Not Fit Cast
Framework Misfits
!!Casting Inaccuracies
!!Damage During
!! FrameworkDoes Not Fit Cast Finishing
!! Framework Does Not Fit Mouth
Framework Does Not Fit Mouth Framework Does Not Fit Mouth
!! Impression Errors !! Impression Errors
1.! Improper Tray 1.! Improper Tray
Selection Selection
2.! Impression Materials/ 2.! Impression Materials/
Technique Error Technique Error
!! Distorted Cast !! Distorted Cast
!! Tooth Movement !! Tooth Movement
Alginate Impressions Tray Selection for

Alginate Impressions
Alginate Trays 1.! Rigid Tray (metal or plastic)
!!Stock or Custom 2.! Perforated for Alginate Retention
!!Plastic or Metal 3.! 4 – 8 mm of Relief (space)
!!Rimlock or Notes:
Perforated a.! Rimlock type trays require use of an adhesive
b.! Maxillary trays may require modification of
palatal vault
c. Use an alginate adhesive on any tray where
alginate retention is questionable
d. Custom trays usually provide more even relief
18
Intraoral Technique:
1.! Block out large interproximal spaces (undercuts)
2.! Wipe alginate onto critical areas (e.g. rest seats,
palatal vault and areas of framework contact)
3.! Seat tray accurately in mouth
4.! Hold tray in position for several minutes after
initial set
5.! Remove tray quickly with a “snap”
6.! Inspect impression for desired detail/artifacts
7.! Apply disinfection spray
19
Alginate Manipulation
1.! Follow manufacturer’s recommendations
for
a. Water : Powder Ratio
b. Spatulation Times
Notes:
1. Slight variations in water : powder ratio
are permissible
2. Mechanical mixers may produce more
consistent mixes
Laboratory
1.! Pour impression as soon as possible
2.! Stare in atmosphere of 100% humidity until poured
3.! Pour with vacuum mixed die stone
4.! Do not invert impression after pouring with stone
5.! Avoid pressure on alginate (“cut off heels”)
Notes:
a.! Liquids to improve surface hardness may be used
b.! Match stone with alginate for compatibility
-Master Cast, Framework & Custom Trays

!!Bead, Box & Pour
Master Cast
!!Design Master Cast
!!Send to Laboratory
!!Examine Framework
& Make Custom Tray
for Altered Cast
20
-Master Cast, Framework & Custom Trays -Master Cast, Framework & Custom Trays
!!Bead, Box & Pour !!Bead, Box & Pour
Master Cast Master Cast
!!Design Master Cast !!Design Master Cast
!!Send to Laboratory !!Send to Laboratory
!!Examine Framework !!Examine Framework
& Make Custom Tray & Make Custom Tray
for Altered Cast for Altered Cast
!!Bead, Box & Pour

Master Cast
Tx. Plan Form & Work Auth. Form !!Examine Framework
& Make Custom Tray
for Altered Cast
21
!!Bead, Box & Pour
Master Cast
!!Examine Framework
& Make Custom Tray
for Altered Cast
4th Clinical Appointment 4th Clinical Appointment

-Frame Try-in & Altered Cast Impression -Frame Try-in & Altered Cast Impression
!!Framework Try-in !!Framework Try-in
!!Making Altered Cast !!Making Altered Cast

Impression Impression
-Making the Altered Cast and Record Bases

!!Making the Altered
Cast
!!Making the Record

Bases
22
-Making the Altered Cast and Record Bases
!!Making the Altered
Cast
!!Making the Record

Bases
5th Clinical Appointment

-JRR, Facebow & Shade Selection
!!Maxillomandibular
Relationship
Records
!!Facebow Transfer
!!Tooth Shade
Selection

!!Maxillomandibular
Relationship
Records
!!Facebow Transfer
!!Tooth Shade
Selection
23
-Mounting Casts, Tooth Selection & Set-up
!!Maxillomandibular !!Mounting the
Relationship Master Casts
Records
!!Selecting Teeth
!!Facebow Transfer
!!Setting Teeth
!!Tooth Shade
Selection
-Mounting Casts, Tooth Selection & Set-up -Mounting Casts, Tooth Selection & Set-up
!!Mounting the !!Mounting the
Master Casts Master Casts
!!Selecting Teeth !!Selecting Teeth
!!Setting Teeth !!Setting Teeth
6th Clinical Appointment 6th Clinical Appointment

-The Complete Wax Try-in -The Complete Wax Try-in
!!Try-in Set-Up !!Try-in Set-Up
!!Verify JRR !!Verify JRR
!!Selection Resin !!Selection Resin

Shade Shade
24
-The Complete Wax Try-in
!!Try-in Set-Up
!!Verify JRR
!!Selection Resin
Shade
-Processing RPDs Before Delivery -Processing RPDs Before Delivery

!!Prepare RPD’s for !!Prepare RPD’s for
Processing Processing
!!Laboratory Remount !!Laboratory Remount
!!Finishing & Polishing !!Finishing & Polishing
-Processing RPDs Before Delivery

!!Prepare RPD’s for
Processing
!!Laboratory Remount
!!Finishing & Polishing
25
7th Clinical Appointment 7th clinical Appointment
-Delivery & Clinical Remount of RPDs -Delivery & Clinical Remount of RPDs
!!Try-in !!Try-in
!!Clinical Remount !!Clinical Remount
!!Delivery !!Delivery

-Delivery & Clinical Remount of RPDs
!!Try-in
!!Clinical Remount
!!Delivery
26
8th-10th Clinical Appointments
-Post Delivery Adjustments of the RPD
!!24, 72 Hour & One
Week Adjustments
Implant Borne Supported

Removable Partial Dentures
Removable Partial Dentures !! Need to Replace Hard and Soft Tissue
!! Limited Number/Location of Implants
!! Enhanced Support, Stability & Retention
!! Eliminate the Extension Base
!! Reduce/Eliminate Visible Clasp Arms
27
28
29
30
31
32
33
Removable Partial Dentures
!! Increased expenses: Surgical & prosthetic

!! Adequate interarch distance!!!
!! Attachment height requirements vary
!! Limited path of placement
!! Maintenance considerations
34

Best Approach To RPD Design Best Approach To RPD Design

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Successful Outcomes in

Contemporary Removable Prosthodontics: Successful Outcomes in

Mark Dellinges, DDS, FACP, MA Clinical Aspects-

Best Approach to RPD Design Best Approach to RPD Design

RPD Design Philosophy Major Connector Selection

Tooth Borne RPD Tooth & Tissue Borne RPD

Tooth Borne RPDs Tooth & Tissue Borne RPDs

Equitable Distribution of Forces

2. Posterior (mid-palatal) 4. Modified Palatal Plate 2. Sublingual Bar

5. Complete Palatal Plate 3. Lingual Plate

Clasp Assemblies: 1. Cast Circlet (Akers) 1. RPI

2. Combination Bar 2. RPC

3. Embrasure Clasp 3. Combination WW

Selection of Components and Design Considerations for Removable Partial Dentures

Equitable Distribution of Forces

Tooth Borne RPD’s Tooth & Tissue Borne RPD’s

2. Posterior (mid-palatal) 4. Modified Palatal Plate 2. Sublingual Bar

5. Complete Palatal Plate 3. Lingual Plate

Clasp Assemblies: 1. Cast Circlet (Akers) 1. RPI

2. Combination Bar 2. RPC

3. Embrasure Clasp 3. Combination WW

Selection of Components and Design Considerations for Removable Partial Dentures

Equitable Distribution of Forces

Tooth Borne RPD’s Tooth & Tissue Borne RPD’s

2. Posterior (mid-palatal) 4. Modified Palatal Plate 2. Sublingual Bar

5. Complete Palatal Plate 3. Lingual Plate

Clasp Assemblies: 1. Cast Circlet (Akers) 1. RPI

2. Combination Bar 2. RPC

3. Embrasure Clasp 3. Combination WW

Equitable Distribution of Forces

the Gingiva 2. Posterior (mid-palatal) 4. Modified Palatal Plate 2. Sublingual Bar

5. Complete Palatal Plate 3. Lingual Plate

Clasp Assemblies: 1. Cast Circlet (Akers) 1. RPI

2. Combination Bar 2. RPC

3. Embrasure Clasp 3. Combination WW

Selection of Components and Design Considerations for Removable Partial Dentures

1. Anterior Palatal Strap Equitable Distribution of Forces

Tooth Borne RPD’s Tooth & Tissue Borne RPD’s

2. Posterior (mid-palatal) 4. Modified Palatal Plate 2. Sublingual Bar

5. Complete Palatal Plate 3. Lingual Plate

Clasp Assemblies: 1. Cast Circlet (Akers) 1. RPI

2. Combination Bar 2. RPC

3. Embrasure Clasp 3. Combination WW

Selection of Components and Design Considerations for Removable Partial Dentures

2. Posterior (mid-palatal) Strap Equitable Distribution of Forces

Tooth Borne RPD’s Tooth & Tissue Borne RPD’s

2. Posterior (mid-palatal) 4. Modified Palatal Plate 2. Sublingual Bar

5. Complete Palatal Plate 3. Lingual Plate

Clasp Assemblies: 1. Cast Circlet (Akers) 1. RPI

2. Combination Bar 2. RPC

3. Embrasure Clasp 3. Combination WW

3. Anteroposterior Palatal Strap Equitable Distribution of Forces

Tooth Borne RPD’s Tooth & Tissue Borne RPD’s

2. Posterior (mid-palatal) 4. Modified Palatal Plate 2. Sublingual Bar

5. Complete Palatal Plate 3. Lingual Plate

Clasp Assemblies: 1. Cast Circlet (Akers) 1. RPI

2. Combination Bar 2. RPC

3. Embrasure Clasp 3. Combination WW

Selection of Components and Design Considerations for Removable Partial Dentures

4. Modified Palatal Plate Equitable Distribution of Forces

Tooth Borne RPD’s Tooth & Tissue Borne RPD’s

2. Posterior (mid-palatal) 4. Modified Palatal Plate 2. Sublingual Bar

5. Complete Palatal Plate 3. Lingual Plate