Distal Extension Removable Partial Denture Prosthesis

1.
DISTAL EXTENSION REMOVABLE PARTIAL DENTURE

PROSTHESIS. www.indiandentalacademy.com
2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
www.indiandentalacademy.com www.indiandentalacademy.com
3. 3. CONTENTS: Introduction Movements of a distal extension Rpd
Nature of load acting in distal extension partial denture Treatment of
distal extension partial denture Altered cast impression procedure
Review of literature Summary and Conclusion References
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4. 4. INTRODUCTION A removable partial denture prosthesis as its name
implies is a prosthodontic restoration that supplies teeth and its associated
structures to a partial edentulous arch and can be removed and inserted by
the patient. Removable partial dentures can be classified according to the
support they derive from the remaining dentition and associated soft
tissues. www.indiandentalacademy.com
5. 5. Many RPD’s derive all their support from the remaining natural teeth
and are referred to as toothborne RPD’s. RPD’s that derive their support
from both the teeth and associated residual ridge tissues are termed as
tooth-tissue borne RPD’s or distal extension RPD’
6. 6. Movements of a Distal Extension RPD Rotation of the prosthesis
around a fulcrum line passing through the two principal occlusal rests of
the direct retainer or through the points where the minor connectors
adjacent to the edentulous area break contact with the tooth surface.
Rotation of the prosthesis around the longitudinal axis formed along the
crest of the residual ridge. Rotation of the prosthesis around an
imaginary perpendicular axis located along the center of the dental
www.indiandentalacademy.com arch.
7. 7. FORCES AROUND THE FULCRUM LINE
8. 8. www.indiandentalacademy.com
9. 9. FORCES AROUND THE LONGITUDINAL AXIS
10. 10. FORCES AROUND THE PERPENDICULAR AXIS
11. 11. NATURE OF LOAD ACTING IN DISTAL EXTENSION PARTIAL
DENTURE www.indiandentalacademy.com
12. 12. THE BILATERAL DISTAL EXTENSION PARTIAL DENTURES
The bilateral distal extension partial denture is the most common design
of partial denture and occurs more often in the mandible than the maxilla.
Before considering the design of such a denture it is necessary to
understand what happens to it during function and in particular under the
vertical, lateral and anterior-posterior loads to which it is subjected.
13. 13. VERTICAL LOAD The vertical load that may be exerted on a partial
denture can be divided into parafunctional load and functional load. In
additional an uncomplicated vertical load is likely to be applied
intermittently throughout the day in empty swallowing function. It has
been demonstrated that the degree of displacement of the tissues under
the saddle of the denture is greater than that of the tooth within its socket,
and that the displacement increases towards the retromolar area.
14. 14. When vertical load is applied to the saddle both the abutment teeth
and the soft tissue covering the saddle area are displaced with the alveolar
tissues being displaced to a greater content than the tooth. The result of
this is rotation of the free end saddle being displaced into the soft tissue
posteriorly and the clasp arm exerting leverage on the abutment tooth in a
distal direction. www.indiandentalacademy.com
16. 16. With a rigid connector present between the saddle, the same effect
will occur on the opposite side of the arch. This is such a design that
application of the vertical load will cause rotation of the free end saddles
into the tissues overlying the residual ridges and the line joining the
occlusal rest can be considered as the axis of rotation. At the same time as
rotation of the saddles into the supporting tissues occurs, so also is three
rotation in the opposite direction of the lingual bar connecting the
saddles. www.indiandentalacademy.com
17. 17. The amount of displacement of both the saddle and the connector is
however dependent upon the nature and amount of the fibrous submucosa
that covers that covers the residual alveolar ridge and this can be assessed
by palpation. Since increased vertical load causes increased bony
resorption it is wise to make the saddle cover as large an area as possible
in order to reduce the load per unit area and ensure that the residual ridge
is subjected to minimal stress. www.indiandentalacademy.com
18. 18. It has been generally accepted that when the saddle of a Kennedy
class I denture with occlusal rest placed distally on the abutment teeth is
loaded vertically, there is tendency to distal displacement of the abutment
tooth. This is not a bodily movement but rather one of the tilting due to
the arch of rotation of the saddle, which in the gingival area of the
abutment tooth is almost parallel to the mucosa, resulting in minimal or
no support from the mucosa near the tooth.
19. 19. This will result in distal bone loss, eventual tooth mobility and of
course denture movement, dependent upon the state of the inter dental
marginal ligament and its regenerative capacity. It has been shown that
bilateral loading of the denture saddles is more favorable to the abutment
teeth than unilateral loading and that loads applied to the saddles are
transmitted to the abutment teeth primarly through the occlusal rests
20. 20. The potential mobility of the abutment tooth will depend upon
Magnitude of the vertical load. The physical characteristic of the
overlying mucosa. Angulation of the residual ridge to the horizontal
plane. The periodontal status of the tooth itself.
21. 21. The effects of clasping are that The more rigid the clasp, the greater
the leverage on the tooth and the less the load on the alveolar ridge. The
more flexible the clasp arms the less leverage on the tooth and more load
on the ridge. www.indiandentalacademy.com
22. 22. THE LATERAL COMPONENT Lower distal extension saddles may
be displaced laterally as a result of the inclined plan action of the cusps of
the posterior teeth and the steeper the cusp inclines the greater will be the
load which acts laterally. Lateral load may also act on the saddle during
these tooth contacts that may take place at times other than during
mastication and like the vertical forces will be greater in magnitude.
24. 24. The efficiency depends up on the anatomy of the residual ridge and
the condition of the soft tissue of the working saddle. Flat ridge with a
marked fibrosis of the submucosa offers comparatively little resistances,
but if the ridge is well formed and shows a thinner submucosa, resistance
is increased. Lateral displacement have an adverse effect on the residual
alveolar ridge and in this respect the lateral component of load is
probably a major factors is ridge resorption than the vertical component.
25. 25. Stress Communicated by Resisting structure Working side saddle.
Buccal ridge plate on working side. Abutment tooth on working side.
Buccal arm of clasp on working side. Balancing side saddle. Lingual
arm of claps on balancing side. Continuous clasp (if included in
design). Lingual plate (if included in design. Lingual ridge plate on
balancing side. Abutment tooth on balancing side. Teeth on balancing
side. Lingual plate of ridge supporting teeth, and teeth themselves, on
balancing side. www.indiandentalacademy.com
27. 27. Lateral loads will also be exerted on the denture by the adjacent facial
and lingual musculature particularly during swallowing. These loads,
which act through out the day may total twice the load resulting from
masticatory function and their effects can be minimized by using marrow
posterior teeth and shaping the flanges so that they do not extend beyond
the zone of minimal conflict. In addition the flanges should be kept thin
in order to give steam lined appearance to the denture.
28. 28. ANTERO - POSTERIOR COMPONENT. Posterior displacement of
the mandible from the inter cuspal position takes place only during the
first power strokes which are used when a hard or tough bolus is being
masticated. Although the magnitude of the load involved in considerable
and an anterior displacing load on the lower denture results, it is generally
well resulted by the abutment teeth and those anterior in the arch.
29. 29. Although a masticatory performance a true protrusive movement of
the mandible is only used in incision, there is often a protrusive element
in grinding. The cusp of the lower teeth, instead of being accommodated
in the fossae of the upper teeth, make a contact on the slopes of the upper
cusps. This results in a inclined plane action which produces a distal force
on the lower denture, the magnitude of which will depend on the
musculature and the steepness of the cusp angles. This backward force is
in part resisted by the ridge when it slopes upwards into the ascending
ramus of the mandible, but the greater part of the resistance comes from
the clasped abutment tooth. www.indiandentalacademy.com
30. 30. The arms of the three arm clasp encompass the tooth almost
completely on its buccal and lingual surfaces, and the tips of the arm lie
on the mesial of the crown. Consequently the abutment tooth tends to be
pulled in a distal direction. The magnitude of the force applied will be
greater if the clasp arm are cast alloy than if they are wrought wire. A
greater problem arises if the abutment tooth is a canine. Due to the crown
morphology of this tooth it is difficult to design a claps that will
encompass the tooth and also be an aesthetically acceptable. In such a
situations the clasped tooth is unable to offer resistance to the distal
displacement of the saddle, which is borne entirely by the residual ridge.
31. 31. TREATMENT OF DISTAL EXTENSION PARTIAL DENTURE
32. 32. KENNEDY CLASS I The suggested methods of restoring the
bilateral free end saddle may be achieved by 1.Reducing the load
2.Distributing the load between teeth and residual ridges. i) By varying
the connector between clasp and saddle. a) Stress breaking. b) Combining
rigid connection and gingivally approaching clasp. c) Combining rigid
connection and occlusal approaching clasp
33. 33. ii) By anterior placement of the occlusal rest : a) The RPI system. b)
The balance of force system. iii) By mucocompression 3. Distributing the
load widely i) Over more than one abutment tooth on each side. ii) Over
the maximal area of edentulous ridge. www.indiandentalacademy.com
34. 34. Reducing the load The vertical load on the saddle in mastication may
be reduced by decreasing the size of the occlusal table and also by
ensuring as wide a coverage of the residual ridge area by the base of the
saddle as is compatible with function. Using canines and premolars
instead of premolars and Molars. Using narrow teeth or reducing the
width of selected teeth by removing the lingual cusp (s).
www.indiandentalacademy.com Leaving a tooth off a saddle.
35. 35. DISTRIBUTION OF THE LOAD BETWEEN TEETH AND
RIDGES i) By varying the connection between clasp and saddle. a. Stress
breaking The principle of stress breaking in partial denture design is the
provision of some degree of movement or flexibility between the clasp
unit and the distal extension saddle. The stress transmitted by the denture
to the tissues is distributed differently therefore and also reduced by the
energy absorbed in deformation than if the connection had been rigid.
Any device which allows movement between the saddle unit and the
retaining unit is known as a stress breaker.
36. 36. Stress Breakers can be divided into two groups.  Those having a
movable joint between the direct retainer and the saddle.  Those having
a flexible connection between the direct retainer and the saddle. The first
group is necessary when a precision attachment is used, but can also be
used when a claps is preferred. They vary in their range of movement,
some allowing only up and down and side to side movements, whereas
others also permit a vertical hinge action. www.indiandentalacademy.com
37. 37. Construction of a flexible or semi-flexible connector between the
direct retainer and tooth supported part of the denture and the mucosally
supported saddle is achieved with a distally extended flexible bar
connected to the rigid connector. The degree of flexibility will depend
upon in its length and cross sectional form. Where a lingual bar connector
has been used to join the two saddles it should be distally extended on
each side and then re-curved along the residual ridge to allow attachment
into the matrix resin of the saddle. www.indiandentalacademy.com
39. 39. Alternatively if a lingual plate connector is used a split of an
appropriate length can be made at its inferior border. The saddle is
attached to the more flexible bar while the clasp units are attached to the
rigid part of the framework. The use of such designs allows the mucosa
supported saddle a degree of movement which is independent of the rigid
tooth supported part of the denture and therefore lessens the stress of the
abutment teeth. www.indiandentalacademy.com
40. 40. When a vertical load is applied the saddle is displaced downward into
the soft tissue covering the ridge to a greater extend than where the
retainer and occlusal rest have direct connection with a saddle. This
means that the ridge bone has to withstand an increased vertical load
which is more evenly spread over the whole ridge rather than
concentrated at the free end of the saddle. Although not quite accurate it
may be assumed that the centre of saddle rotation is at the portion of the
connector lying anterior to it. www.indiandentalacademy.com
41. 41. The net result of the stress breaking action as far as the vertical
component is concerned is a greater assignment of load to the edentulous
ridge and less to the abutment tooth. The torque on the abutment is
reduced markedly in magnitude and is favorable in direction.
42. 42. When a lateral component acts on the stress broken saddle a greatly
increased lateral stress is placed on the alveolar bone. Less of the load
falls on the abutment teeth and consequently the magnitude of the
damaging lateral torque is reduced. If a continuous clasp or lingual plate
is included in the design it is incorporated in the retainer unit and thus
plays less part in the distribution of lateral load.
43. 43. Stress breaking has little effect on the anterior component of force
acting on the denture saddle during the power strokes ; uninterrupted
contact between tooth and retainer and retainer and saddle ensures no
saddle movement in an anterior direction and load distribution is
accordingly not altered. The dangerous horizontal torques acting on the
abutment teeth are reduced by stress breaking and that, in consequence,
their supporting structures are less liable to break down. However, the
edentulous ridge is called upon to accept more vertical and horizontal
stress and as a result tends to resorb more quickly.
44. 44. B. COMBINING RIGID CONNECTION AND GINGIVALLY
APPRAOCHING CLASPING When rigid connection between retainers
and saddles is used, with gingivally approaching clasps, a condition may
exist which is similar in principle to stress breaking. The portion of this
type of claps that is in contact with the abutment tooth is at the end of a
bar that is resilient to a degree which depends upon its length and cross
section and the alloy used. www.indiandentalacademy.com
45. 45. If the occlusal rest is allowed to move over the occlusal surfaces of
the tooth to a small degree in lateral and antero-posterior directions (and
this may occur when saucer-shaped rest seat preparation are used), the
action of the clasp bar resembles a stress breaker, since its resilience
reduces the horizontal forces on the abutment tooth. The effectiveness of
the stress breaking actions of these clasps may be increased by increasing
the resilience of the bar. www.indiandentalacademy.com
46. 46. C. COMBINING RIGID CONNECTION AND OCCLUSALLY
APPROAHING CLASPING. A combination of rigid connection and
occlusally approaching clasps is the opposite extreme to stress breaking.
In this condition more load is placed on the abutment tooth and ridge is
capable of variation and depends on the ridge. When the arm is resilient,
a certain amount of movement of the clasp over the surface of the tooth is
permitted. At one extreme a wrought gold wire clasp allows most
movement of the clasp over the enamel. Whereas a cast cobalt chromium
clasp permits least movement. www.indiandentalacademy.com
47. 47. The extent of these clasp movements is small but they may, however,
be sufficient to reduce the torque acting on the abutment and keep them
within the physiologic limit. If the mucosal tissues covering the ridge
areas are highly displaceable and mobile, then there may be an indication
for some type of movable or flexible connection between the saddles and
the retainer units. www.indiandentalacademy.com
48. 48. d. THE DISJUNCT DENTURE In the older patient it is not
uncommon to find a situation, particularly in the lower jaw, where the
few remaining teeth are anterior teeth with considerable gingival
recession and a generally poor periodontal condition. It has been
suggested that such a problems may be overcome by the construction of a
two part denture, composed separately of tooth borne and mucosa borne
sections each acting independently of each other on its supporting tissues.
49. 49. The tooth borne part comprises a lingual plate which acts to protect
the teeth and the gingivae from the connector of the mucosa borne part,
and which also carries retention elements. In addition, it is constructed
with distally extending buccal bars which are designed to engage a slot in
the saddle of the mucosa borne part. These are known as disjunct bars as
they are not attached directly and rigidly to the mucosa borne saddle but
allow some movement. They are however, necessary for its retention.
51. 51. The mucosa borne section of the denture are essentially separate,
there is no transfer of the vertical masticatory load from the mucosa borne
saddle to the tooth borne section. In addition because of the absence of a
rigid connection between the two separate parts there is little transfer of
load by means of the disjunct bars. The mucosa borne part can therefore
move independently according to the compressibility of the mucosa.
52. 52. This technique has been suggested as particularly useful in the
treatment of the bilateral free end saddle, where the support contribution
of the remaining standing teeth is poor and their periodontal health also
might be further compromised by a totally mucosally borne designed
denture. The disadvantage of the denture is that is technically difficult to
construct and also that patients occasionally complain it ‘rattling’ during
function which is of course due to the principles inherent in its design.
53. 53. II. BY ANTERIOR PLACEMENT OF THE OCCLUSAL REST The
distribution of load between the abutment teeth and residual ridge can
sometimes be altered favorably by anterior placement of the occlusal rest.
This has the effect of altering stresses on the saddle from a Class I lever
situation where the resistance to the applied load lies on the opposite side
of the fulcrum, to a Class II lever where the resistance lies between the
applied load and the fulcrum. This permits more even distribution of load
and less stress on the abutment teeth www.indiandentalacademy.com
55. 55. a. THE RPI SYSTEM This system of partial denture design involving
a clasp unit comprised of a rest, proximal plate and “I” bar retainer An
important consideration of this system is the positioning of the occlusal
rest to provide the element of tooth support. If the rest is placed distally
on the abutment tooth and applied to the saddle, it has been demonstrated
that the arc of movement of the denture base tends to the mainly
perpendicular to the residual ridge in the posterior region.
56. 56. On moving anteriorly, however, the region near the abutment tooth
the saddle movement is almost parallel to the ridge in an anterior
direction. It is clear that in this situations the mucosa adjacent to the tooth
can offer little resistance to the applied load, it and the gingival margin
being likely to be traumatized by the horizontal movement of the denture
against the abutment tooth. This area, where tooth support ends and
mucosa support begins, should therefore be protected.
57. 57. If the occlusal rest is placed mesially on the abutment teeth, it has
been shown that the arc of movement of the saddle under applied load
will alter and be more perpendicular to the mucosa throughout its length,
due to the presence of a mesial rather than a distal fulcrum. This will
increase the support provided by the mucosa whilst reducing the anterior
movement of the saddle under applied www.indiandentalacademy.com
load.
58. 58. If the rest is placed distally then the tooth will tend to tilt distally,
where it has little support. If it is placed mesially however, although there
will be a tendency of mesial tilting of the abutment tooth, this will be
resisted by other teeth in the arch anterior to it. Potential damage to the
gingival tissues distal to the abutment tooth can be lessened if the distal
surface of the tooth is covered by a thin plate of cast metal (the proximal
plate) which extends on to the soft tissues. This is relieved at the gingival
margin. www.indiandentalacademy.com
59. 59. Wear and damage will also be limited and the metal will maintain a
close adaptation so protecting the tissues from food packing and
preventing gingival hypertrophy. In addition the plate should extend
lingually on the proximal surfaces of the tooth in order to provide some
reciprocation for the “I” bar clasp. It has been argued that by constructing
a conventional occlusally approaching clasp the external contour of the
tooth is altered adversely, particularly in relation to natural stimulation of
the gingivae and in food shedding. www.indiandentalacademy.com
61. 61. If its tip is placed towards the mesial portion of the tooth it also serves
to bring the proximal plate into tight contact with the distal surface. As
the denture is depressed on to its basal seat the clasp will move towards
and downwards and out of contact with the tooth so removing any
possibility of leverage. The mesial rest is linked to a minor connector
which also provides some reciprocation and is placed in the mesio lingual
embrasure but free of the adjacent tooth anterior to it. With applied load
to the saddle the rest acts as a fulcrum point, ensuring mesial rather than
distal loading of the abutment tooth. www.indiandentalacademy.com
62. 62. Under load it will be depressed tissue wards further into the undercut
area without exerting torque or leverage on the abutment tooth. The “I”
bar crosses the gingival margin at right angles and contacts the tooth in its
gingival third and at the greatest mesiodistal prominence of the tooth, its
precise position of contact immediately below and above the survey line.
Besides being retentive, it will move mesio gingivally away from the
tooth under applied load. www.indiandentalacademy.com
63. 63. The RPI system will result in a denture with  Enhanced mucosal
support due to loading. perpendicular Reinforcement against mesial
tilting of the abutment tooth. Adequate retention with minimal effect on
natural tooth contour. No adverse stress on the abutment tooth during
masticatory loading. Protection of the transitional region between the
tooth and the mucosal areawww.indiandentalacademy.com saddle. of the
edentulous
64. 64. b. Balance of force system The balance of force system, canbe
considered as a further refinement of the RPI system being based on the
mechanical principles of a class II lever. As the magnitude of masticatory
loads on the abutment teeth are much greater than those of the forces of
displacement and as the tooth is less able to withstand this, the design has
been developed to ensure that loads during masticatory performance are
directed vertically along the long axis of the tooth so avoiding torque and
leverage. www.indiandentalacademy.com
65. 65. A rest seat must be provided on the part of the occlusal surface of the
abutment tooth that is distant from the saddle. This will act as the fulcrum
point and ensure vertical loading on the tooth during function. In distal
extension partial dentures this would be a mesially placed support unit. In
addition to rest seat preparation an interproximal access area of about 1
mm must be created between the abutment tooth and the anterior tooth
adjacent. It is in this area that reciprocation for the clasp arm will be
positioned together with the minor connector.
67. 67. The clasp unit is designed so that retentive tip of the claps arm is
positioned on the interproximal surface of the abutment tooth adjacent to
the edentulous saddle. It should lie below the maximum convexity of this
surface engaging a degree of undercut according to the physical
properties of the material. The reciprocation for the retentive force of the
clasp arm in resisting displacement is provided by a vertical plate in the
prepared access area on the abutment tooth above its maximum
convexity. The vertical plate is joined to the major connector.
68. 68. The unit should be so designed that the flexible tip of the clasp arm,
the occlusal rest and the contact surface of the vertical reciprocating plate
are in line with the crest of the edentulous ridge. Retention is therefore
achieved mesiodistally as opposed to bucco-lingually and the design
ensures that the greatest loads on the tooth are applied mesio-distally
where it is well supported. www.indiandentalacademy.com
69. 69. When masticatory load is applied to the distal extension saddle its
downward movement towards the underlying tissue is accompanied by a
similar movement of the retentive tip of the clasp arm. This allows the
clasp to disengage the tooth as it moves into an area of increased
undercut, this eliminating horizontal tooth loading. The mesial occlusal
rests will direct loads vertically along the long axis of the tooth hence it is
better able to withstand them. www.indiandentalacademy.com
70. 70. If a displacing force is applied to the denture, the saddle and clasp tip
once again move in the same direction occlusally. The clasp tip will now
engage the proximal surface of the tooth below its maximum convexity
thus providing resistance to further displacement. Reciprocation during
this action is provided by the vertical interproximal plate on the opposite
side of the tooth. www.indiandentalacademy.com
71. 71. III. BY MUCOCOMPRESSION Mucostasis Mucocompression.
The greater the amount of displacement the less is the magnitude of the
torque and load on the abutment, when a vertical load is placed on the
saddle. Different impression materials give varying degrees of mucosal
displacement The saddle base fitted accurately against the mucosa from
which tissue fluid has already been displaced sinks less under the
masticatory load than if fitted against an undisturbed mucosa.
72. 72. The amount of displacement affects the distribution of load between
abutment and ridge bone. The greater the displacement the more evenly is
the stress distributed between the abutment and the edentulous ridge.
However, the mucosa cannot be continuously subjected to such heavy
pressure since this will result in decreased blood supply to, and drainage
from, the soft tissues. Coupled with the fact that the tissue fluid is also
reduced, this may result in a tropic disturbance
73. 73. The natural tendency of the displaced tissue is to recoil in a visco-
elastic manner. In assuming that the saddle is maintained in the closest
approximation with the displaced mucosa, the presence of some force to
hold it in this position is also assumed. This force can only come from
rigid clasping of the abutment tooth and results in a continuous force
acting on the abutment. It is thus seen that the use of rigid connection and
clasping together with mixture displacement leads to an unacceptable
situation in respect of potential damage to the abutment and covering
mucosa. www.indiandentalacademy.com
74. 74. If maximum displacement is to be used, arrangement must be made to
allow some recoil of the mucosal tissues. This can be achieved either by
very light clasping, generally wrought gold wires of thin gauge, or by a
stress breaker giving flexible connection between the saddles and retainer
units. www.indiandentalacademy.com
75. 75. The method of maximum displacement coupled with light clasping
directly attached to the saddles is not used  Retention of such a denture
is inadequate because of the light clasping and poor adhesion, the latter
being due to the uneven thickness of saliva film between the mucosa and
the fitting surface of the denture after recoil of the tissues.  Lateral
stresses are resisted largely by the edentulous ridge, which is, therefore,
liable to resorb. www.indiandentalacademy.com
76. 76. With mucostasis, even when cast clasps are directly attached to the
saddles, no forces act either on the ridge or abutment when the saddle is
not under load. In the resting stage, too, adhesion is maximal. With this
type of impression too, the bone is not evently stressed, the areas
underlying thinner mucosa receiving an increased share of the load. With
such a technique and where rigid clasping directly attached to the saddle
is used, maximal leverage and torque is placed on the abutment teeth,
which are, therefore, predisposed to periodontal breakdown.
77. 77. With this type of impression too, the bone is not evenly stressed, the
areas underlying thinner mucosa receiving an increased share of the load.
There is however, a condition intermediate between maximum
displacement and mucostasis that has considerable advantages Thus a
compromise between stasis and maximum displacement seems to give a
result with the advantages of each present to some degree.
78. 78. 3. WIDE DISTRIBUTION OF LOAD I)WIDE DISTRIBUTION OF
LOAD OVER THE TEETH When clinically circumstances permit, the
procedure is to move the occlusal rest anteriorly so that it lies not on the
tooth that immediately bound the saddle, but on the occlusal surface of
the tooth that lies immediately anterior. If a rest is placed on this tooth
some of the vertical load is placed upon it and its marginal ridge becomes
the fulcrum point. www.indiandentalacademy.com
79. 79. If two flexible arms now arise from this and its encompass the buccal
and lingual surfaces of the posterior tooth and if these arms lie above the
survey lines then some of the vertical load is dispersed. Part is dissipated
in opening the clasp arms and part is directed down the long axis of the
tooth. The retaining clasp is on the rested tooth. Which accepts vertical
load through the occlusal rest. Lateral www.indiandentalacademy.com
load is distributed to the two teeth by the clasp arms.
81. 81. II.) WIDE DISTRIBUTION OF LOAD OVER THE RIDGE The
saddles of the denture should always cover the largest possible area, so
that the pressure falling on any unit area of the edentulous ridge is
reduced under vertical and horizontal loading. While full coverage over
the retromolar area and the buttress bone both buccally and lingually is
desirable for load distribution it may not www.indiandentalacademy.com
always be acceptable to the patient.
82. 82. Modification of the bilateral free end saddle lower denture
83. 83. Modification of the bilateral free end saddle lower denture 1) An
anterior saddle present in addition to 2 free end saddle 2) Long free end
saddle interrupted by a single standing www.indiandentalacademy.com
84. 84. An anterior saddle present in addition to 2 free end saddle The stress
on the abutment tooth depends on • saddle length and shape
•Displaceability of mucosa A rigid construction is advisable By clasping
the 4 abutment teeth , vertical and horizontal forces are resisted by 2 teeth
on each side . This facilitates wide distribution of load
85. 85. a)If only 2 premolars remain bilaterally • Lingual bars and continuous
clasps The clasps are constructed in wrought wire but if ridges are well
formed they may be constructed in cast metal b)if premolars are severely
inclined lingually • Buccal bar • Back action clasp c)Only 2 canine
remain •Simple acrylic resin mucosa supported denture
89. 89. 2)Long free end saddle interrupted by a single standing a) Extract
b)Retain if healthy . This reduces length of saddle thereby reduces
leverage Wide distribution of load since clasping on 2 teeth c)when molar
is single long standing tooth it is sensible to dispense with the small free
end saddle www.indiandentalacademy.com
92. 92. Bilateral free end saddle upper denture The basic problem
encountered with Bilateral free end saddle upper denture is similar to
those found with lower denture Indirect retention is more necessary with
the upper than with the lower Indirect retention is obtainable in these
cases by. • Continuous clasp •Cummer arms •Anterior extension of
palatal bar www.indiandentalacademy.com •Extension of any palatal
plate to cover the rugae
93. 93. Modifications of the Bilateral free end saddle upper denture a)Long
free end saddle interrupted by a single standing b)Anterior natural teeth
missing c)Series of single tooth saddles separated by single teeth standing
If no teeth are to be extracted a horse shaped metal base covering hard
palate is often the treatment of choice www.indiandentalacademy.com
94. 94. ALTERED CAST PROCEDURE The purpose of altered cast
procedure is to obtain the maximum support from the edentulous area of
the extension partial denture. This procedure applies the principal of
recording the edentulous tissue in a form that provides the proper denture
base extension without distortion or displacement of the tissues. The
objective is to ensure the best possible relationship between the casting
framework, properly fitted on the teeth and the denture base thereby
deriving the greatest support potential from both teeth and edentulous
www.indiandentalacademy.com areas.
100. 100. Impression procedure www.indiandentalacademy.com
102. 102. Cast alteration www.indiandentalacademy.com
105. 105. THE LOADED IMPRESSION TECHNIQUE FOR THE
DISTAL EXTENSION REMOVABLE PARTIAL DENTURE In order
to obtain an optimum impression of an arch that will receive a Kennedy
class I or II RPD, a dual impression technique must be employed. The
final impression combine an elastomer to register the anatomic form of
the teeth and surface detail of the residual ridge and a more viscous
material to load the residual ridge. www.indiandentalacademy.com
110. 110. Review of Literature www.indiandentalacademy.com
111. 111. Stress analysis is distal extension partial dentures. George W.
Hindels J. Prosthet Dent. 7; 197 – 205, 1952. He described the load
distribution in extension saddle partial dentures. He said that the method
used to make impression of the supporting and retaining anatomic status
of the mouth is of basic importance for obtaining optimum distribution of
the masticatory load in the construction of remarkable partial denture,
especially those of the lower extension saddle type. His opinion is that
there are three definite requirement that must be fulfilled to assure proper
load distribution in extension saddle partial denture.
112. 112. They are The tissue surface of the saddle should be negative
reproduction of the anatomic, undisturbed surface of the alveolar mucosa.
The masticatory load should be distributed between the ridge and the
abutment teeth during function and cannot be left to be carried by
alveolar ridge alone. The denture saddle should be related to the metal
frame work in such a way as to be similar to the relationship existing
between the supporting teeth and the supporting mucosa when latter is a
masticatory load. www.indiandentalacademy.com
113. 113. The Bilateral free end saddle lower denture. Lamme G.A. and
John Osborne J. Prosthet Dent 4 : 640 – 652, 1954. They stated that the
bilateral free end saddle lower denture (class I lower denture of the
kennedy’s classification) always presents a treatment problem. A free end
saddle can have tooth support at only one extremity and this at least part
of lead falling upon it must be resisted by the edentulous alveolar bone.
This is in contra distinction to the bounded saddle, which has anteriorly
and posteriorly placed abutment teeth. in this he given following methods
for the treatment of the free and saddle. The following method of
attempting to control the vertical load are designed to give the optimal
reaction in both www.indiandentalacademy.com
114. 114. 1.Reducing the load directly. 2.Distributing the load between
teeth and alveolar i) By varying the nature of the connection between
clasp and saddle. a)Stress breaking b)Combining rigid connection and
gingivally approaching clasping. c)Combining rigid connection and
occlusal approaching clasping. ii) By anterior placement of the occlusal
rest. iii) By mucocompression. 3. Distributing the load widely i) Over
more than one abutment tooth on each side.
www.indiandentalacademy.com ii) Over the maximal area of edentulous
alveolar
115. 115. Stress analysis is distal extension partial dentures. George W.
Hindels J. Prosthet Dent. 7; 197 – 205, 1957. He did a stress analysis in
distal extension partial dentures, he said that masticatory stresses exerted
on the base of a distal extension partial denture are transmitted to the
supporting anatomic structures through contacting parts of the appliance.
If the parts are incorrectly designed or constructed, they will alter the
direction and force of these masticatory stresses and may create stresses
which are not within the physiologic limits of tissue tolerance. The partial
denture should be constructed. www.indiandentalacademy.com So this
movement is vertical is relation to the supporting bone.
116. 116. Clasp and rest should be designed to allow for this vertical
movement of the denture base. Stress other than those vertical to the
abutment teeth should be reciprocated. Reciprocation is best obtained by
contact of rigid parts of the partial denture with modified axial surface of
the abutment teeth which are made parallel to each other and the path of
insertion www.indiandentalacademy.com
117. 117. A study of partial denture design and masticatory pressure in
the mandibular bilateral distal extension case. Anthony K. Karies : J.
Prosthet dent. 8: 340-350, 1958 In a study of masticatory performance, he
found out that the followings;  The reduction of the size of the occlusal
table reduces the forces acting on the partial denture and lessens the
stresses on the abutment teeth and supporting tissues.  The effect of the
partial denture on masticatory performance did not reveal any significant
relationship.  The rigid design of the partial denture were more
desirable than the flexible are specifically the rigid lingual bar is more
desirable than a flexible bar in withstanding horizontal stresses.
118. 118. Preparation of abutment teeth for removable partial dentures.
Holmes J.B. J. Prosthet Dent. 20: 396 – 406, 1968. He mentioned about
the preparation of abutment teeth for dentures, he says that the
preparation of spoon shaped or rounded rest seat areas that direct forces
towards the long axes at abutment teeth provides positive support for the
partial denture. The location of rest areas affects the movements of
abutment teeth by changing the direction of force applied to the
www.indiandentalacademy.com teeth and to the denture base.
119. 119. Metal guiding planes that contact the proximal surface of the
abutment teeth and extend 1 to 2 mm onto the residual ridge lessen the
possibility that debris will collected around the denture the residual ridge
and the abutment. The development of adequate support for partial
denture without applying under torquing force to the abutment and the
maintenance of the health of the periodontal supporting structure pre vital
to the success of partial denture treatment.
120. 120. Clasp design for extension base removable partial dentures.
Arthur J. Krol J. Prosthet Dent. 29:408-416, 1973. He mentioned that
clasp design for extension base partial dentures is one of the more
fascinating and thought provoking subject in dentistry. Many types of
clasp for unilateral and bilateral distal extension base partial dentures are
consult being and by dentist and dental laboratories throughout the work
in an attempt to prolong the life of the remaining teeth. The clasp returd
to as an R.P.I. clasp is introduced which minimizes tooth coverage and
reduces stress on the abutment www.indiandentalacademy.com
121. 121. RICHARD P. FRANK in 1986 in his clinical observation
indicated that the wrought wire clasp assembly. The I-bar clasp assembly
and the L-bar clasp assembly yield similar results. Several thousand
observations have been made by the faculty and no special trend of
problems has been noted that would cause one clasp assembly to be
favoured over another. These three types of clasp assemblies work
satisfactorily when properly chosen and carefully applied.
122. 122. RONALD E. MYERS in 1986 in his photoelastic study of
rests found out that with a distal extension removable partial denture,
maximum use of existing oral structure can aid in the total support of the
prostheses and reduce the force on the solitary abutment. Four rests with
relieved and unrelieved guide plates were evaluated for optimum stress
distribution around the root of a solitary premolar abutment. The rest
were the mesial, the distal. The mesial and distal and the continuous rest.
123. 123. The findings demonstrated that : 1.The continuous rest had the
most favourable stress concentrations. 2.All other rest design
demonstrated more lateral stress than the continuous rest. 3.Relieved
guide planes demonstrated 58% less maximum shear stress in the apical
portion than unrelieved guide planes. www.indiandentalacademy.com
124. 124. An analysis of rotational movements of asymmetrical destal
extension removable partial dentures. Aviv I. Et al J. Prosthet Dent 61;
211 - 214, 1989. He states that an axis of rotation is created through the
most distally placed occlusal rest. When a distal extension removable
partial denture is loaded. If the residual ridges are of unequal length, the
axis of rotation may not be perpendicular to the residual ridge.
Movements of I bar retainers loaded on the mesiobuccal aspect of
asymmetrical abutment teeth may torque the abutment teeth as the
denture base moves tissues wards. Use of L shaped direct retainer on the
distobuccal surveyed undercut will create a more favourable class II
lesser effect on the abutment tooth www.indiandentalacademy.com
125. 125. Comparison of vertical movements occurring during loading
of distal extension RPD bases made by three impression techniques.
Richard J Leupold, Robert J Flinton, David L Pfiefer JPD 1992;68:290-
293 The study clinically compared the vertical displacement of the distal
extension RPD made from altered cast impression, an impression from
border molded custom tray. Stock tray irreversible hydrocolloid was used
as a control. Although statistically significant 0.19mm difference between
impression techniques may or may www.indiandentalacademy.com not
be clinically significant.
126. 126. Sectional impression for mandibular distal extension RPD
Hanaa Al Shiekh, Adel M Abdul Hakim JPD1998;80:216-219 The final
impressions made in border molded full arch custom tray clinically
comparable to sectional impression for distal extension mandibular RPD.
Sectional impressions demonstrated significant reduction in vertical
movement when analyzed statistically. However this finding maybe
clinically insignificant. www.indiandentalacademy.com
127. 127. Clinical outcome of altered cast impression procedures
compared with the use of a one piece cast. Richard P Frank , James S
Brudvik, Karleen G Noonan JPD 2004;91:468-476 The altered cast
impression procedure does not have significant advantages over the one
piece cast provided standards in this study are met. These include
completely extended impression, use of a magnification to ensure
complete seating of the frame work and coverage of the retromolar pad
and buccal shelf by the base

Distal Extension Removable Partial Denture Prosthesis

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DISTAL EXTENSION REMOVABLE PARTIAL DENTURE

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