SECTIONEDITORS

a abrication

** and George *, L.
Name, D.D.S., M.S.D.***
Virginia Commonwealth University, School of Dentistry, Richmond, Va.

In an effort to better ~~de~sta~~ and define the present sbandard of practice for
removable partial denture design and fabrication, a questionnaire was prepared
and distributed to prosthodontic ~~ecia~i$t~ and graduate students or residents
attending the American College of ~~ostbo~~~tist~ annual meeting in 1987. The
survey was designed to determine the philosophies and techniques used by
prosthodontic specialists in treatment involving the removable partial denture.
There were 195 questionnaires completed and used in determining the results. The
results indicate areas of general agreement. Comparison with other data shows
areas of controversy, but ~rost~odo~t~st$ tend to follow techniques and philoso-
phies similar to what is taught in most U.S. dental schools and what is recom-
mended by the Academy of Denture Prostbeties. (J PR~STNET DENT 1989;62:303-7.)

he concept of a universally agreed upon standard
of practice for removable partial denture design and fabri-
cation has been shown to be illusive.1-4 This is because the
body of information used to guide dentists on this subject
is largely empirical and not solidly based upon research-
generated data. Many concepts that were controversial
when first described decades ago for removable partial
denture design and fabrication have over time become es-
tablished as conventional ways of thinking. With this in
mind, it is easier to understand the confusion regarding
appropriate treatment procedures and philosophy.
Frantz’, 2 found a wide variation in removable partial den-
ture philosophy and interpretation of prosthodontic prin-
ciples among general practitioners. Taylor et a13z4 con-
cluded that the highly technical and frequently cumber-
some treatment of patients with prosthodontic restorations
lends itself to the search by many dentists for sometimes
inappropriate shortened techniques relative to those in-
cluded in the curriculum of most dental schools in this
country. Trainor et al.” concluded that the deficiency in
rationale for a removable partial denture design for a spe-
cific clinical situation was, in part, a function af dentists’
training.
In an effort to better understand what might be consid-
ered the present standard of practice for removable partial
denture design and fabrication, the following investigation
was undertaken to survey prosthodontic specialists and
prosthodontic graduate students to determine what gen-
eral philosophies and techniques they are using regarding
removable partial denture treatment. It was presumed that
trained specialists in prosthodontics as a group would be
familiar with the published and unwritten body of knowl-
edge, whether empirical or research-generated, wou
vide a wealth of clinical insight, and as a result cou
vide a valid interpretation of an appropriate standard of
practice for removable partial denture design and fabrica-
tion.
ETMOD
A questionnaire consisting of 27 questions with multiple
choice answers was constructed. Some questions elicited
more than one choice of response. Respondents were
requested to answer the questionnaire anonymously. The
questionnaires were distributed during the Friday, Qctober
20, 1987 scientific program of the American College of
Prosthodontists annual meeting in Williamsburg, Virginia.
Respondents were asked to complete the questionnaire
during the program for collection at the end of the session.
The results were normalized and computed as a percentage
of the number of respondents answering the questian. The
total of the percentages for all responses for some questions
may be greater than 100% if the question elicited more
than one response per individual.

ESLJLT
*Assistant Professor, Department of Removabie Prosthodontics.
“*Associate Professor, Department of Removable Prosthodontics. There were 195 questionnaires completed, returned, and
***Private practice, limited to prosthodontics, Richmond, Va. used in determining the results. Of these, 18 were cam-
1011/12263 pleted by prosthodontic graduate students or residents.

THEJOURNAL OFPROGTMGTPCDENTISTRY 303

 BURNS, WARD, AND NANCE

The statement for each question as it appeared on the Question 7. Are you Board certified?
questionnaire is presented in these results. If a question Responses
was answered by less than 195 individuals, the number of 45% (a) Yes
responses is presented in parentheses with the statement. 55% (b) No
The responses are presented after the statement along with Question 8. In making impressions for removable partial
percentage of response, in descending order when applica- denture master casts, do you use a. . .
ble. Responses (Some individuals answered more than once.)
Question 1. Please select your age group. 66% (a) Stock tray
Responses 43% (b) Custom tray
24% (a) <35 Question 9. What impression material do you usually use
47% (b) 36 - 45 in making the master cast for an RPD framework?
21% (c) 46 - 55 Responses (Some individuals answered more than once.)
8% (d) >55 66% (a) Irreversible hydrocolloid (alginate)
Question 2. How would you best describe the setting for 21% (b) Polysulfide rubber base
your training? 10% (c) Reversible hydrocolloid
Responses 5% (d) Polyvinyl siloxane silicone rubber base
42% (a) Military 3% (e) Polyether
38% (b) University or dental school 1% (0 Conventional silicone rubber base
17% (c) Veteran’s Administration 1% (g) Wax
3% (d) Civilian hospital or medical complex Question 10. In communicating with the dental labora-
Question 3. What was the primary emphasis of your tory do you. . .
training program? Responses (Some individuals answered more than once.)
Responses 92% (a) Survey and tripod the RPD master cast.
22% (a) Fixed 90% (b) Write a work authorization with a de-
27% (b) Removable tailed description of the RPD frame-
2% (c) Maxillofacial work.
49% (d) Equal emphasis 66% (c) Mark the retentive undercuts on the
Question 4. What is your current position in the field of master cast.
prosthodontics? 63% tdd) Submit a drawing of the RPD framework
Responses as part of the work authorization or as a
35% (a) Military separate diagram.
23% (b) Academic 62% (e) Outline the RPD framework on a diag-
21% (c) Private practice (full-time) nostic cast or duplicate master cast and
10% (d) Resident/graduate student submit it to the laboratory along with the
6% (e) Veteran’s Administration master cast.
2% (f) Institutional 40% 03 Outline the RPD framework on the mas-
1% cd Private practice (part-time) ter cast.
~1%’ (h) Research Question 11. Which alloy do you usually use for your
<l% (i) Administration RPD framework?
Cl% (j) Retired Responses (Some individuals answered more than once.)
Question 6. What percentage of your practice is devoted 64% (a) Ticonium
to fixed prosthodontics (whether full or part-time prac- 37% (b) Vitallium
tice)? (193) 6% (c) Type IV gold
Responses <l% (d) Nobilium
22% (a) <25% 4% (e) Durallium
30% (b) 25% - 50% <l% (f) Rexillium
30% (c) 50% - 75% -cl% (g) Jelenko LG
18% (d) 75% - 100% <l% (h) Generic CrCo
Question 6. What percentage of your practice is devoted Question 12. Do you routinely appoint patients for a
to removable prosthodontics? (193) separate framework try-in?
Responses Responses
30% (a) <25% 98% (a) Yes
41% (b) 25% - 50% 2% (b) No
14% (c) 50% -75% Question 13. How do you verify that the RPD framework
15% (d) 75% -100% is completely seated?

304 SEPTEMBER la69 VOLUME 62 NUMBER 3

RPD DESIGN AND FABRICATION SURVEY

Responses (Some individuals answered more than once.) Responses

80% (a) Visual inspection 5% (a) X25%
52% (b) Liquid disclosing medium (chloroform 5% (b) 25% - 50%
and rouge, Die-Mark, etc.) 5% fc) 50% - 75%
51% (ci Disclosing wax 85% (d) >75%
26% (d) Aerosol disclosing medium (Detex, Oc- Question 19. If you do not use extracoronal clasp assem-
clude, etc.) bles on mandibular distal-extension RPDs please spec-
7% fe) Pressure indicating paste ify what you do use.
4% (f) Impression material (Fit-checker, etc.) Responses
1% (g) Explorer The responses for this question included a wide and var-
<l% (h) Shim stock ied selection of specific attachments. No single attachment
<l% (i) Butterfly ribbon was ranked above the rest; however with few exceptions,
<l% (j) Duplicate cast nearly all were resilient in nature.
<l% (k) Anterior struts Question 20. What has been the most important influ-
<l% (1) Accufilm ence in determining your philosophy of clasp selection
<l% (m) Microscope X10 - x20 and rest placement?
Question 14. Which of the following procedure(s) do you Responses
do routinely for mandibular distal-extension RPDs? 84% (a) Graduate training
Responses (Some individuals answered more than once.) 16% (b) Continuing education
87% (a) Utilize the corrected or altered cast pro- 14% (c) Empirical experience
cedures. 5% td) Developed after training
21% (b) Reline the RPD at delivery. Question 21. Where do you place rests on the distal
16% (c) Make the master cast impression by us- abutment of mandibular distal-extension RPDs? (191)
ing a border molded custom tray with an Responses
elastomeric impression material. 60% (a) Always on the mesial
~1% (d) Stock tray impression using alginate. 19% (b) Varies depending upon the occlusion
Question 15. What impression material do you use for 9% (c) Always on the distal
corrected (altered) cast impressions if there are no bony 8% (d) Varies depending upon the type of clasp
undercuts? (192) 5% (e) Varies depending upon the location and
Responses (Some individuals answered more than once.) amount of undercut
64% (a) Rubber base <l% (f) Always on the mesial and distal
22% (b) ZOE Question 22. Which of the following statements best de-
12% (c) Wax scribes your philosophy of managing the distal-extension
12% (d) Silicone (polyvinyl siloxane) RPD? (192)
5% te) Silicone (conventional) Responses (Some individuals answered more than once.)
1% (f) Alginate 78% (a) Rigid framework, “stress-releasing”
1% (g) Tissue-conditioning materials 14% (b) clasp
1% (h) Polyether Denture base attached to rigid frame-
<l% (i) Adapt01 work so that under occlusal loading, re-
Question 16. What impression philosophy do you utilize tainer and base “bottom out” at same
for corrected cast impressions? (191) time
Responses (Some individuals answered more than once.) 14% (c) Rigid framework, rigid clasp
64% (a) Selected pressure 2% (d) Resilient attachment between major con-
23% (b) Functional nector and abutment tooth
18% (c) Mucostatic 2% (e) Stress-breaker between major connector
Question 17. What percentage of all the RPDs you con- and denture base
struct utilize extracoronal clasp assemblies? 1% (f) Stress-broken major connector
Responses Question 23. Which statement(s) beat describe(s) your
3% (a) <25% philosophy of extracoronal clasp assembly selection for
7% (b) 25% - 50% distal-extension RPDs? )192)
9% (c) 50% - 75% Responses (Some individuals answered more than once.)
81% (d) >75% 72% (a) Always use a “stress-releasing” clasp
Question 18. What percentage of the mandibular distal- such as the RPI, RPA, wrought-wire
extension RPDs you construct utilize extracoronal clasp combination, etc.
assemblies? (193) 48% (b) If a cast circumferential clasp with a dis-

THE JOURNAL OF PROSTHETIC DENTISTRY

305
 BURNS, WARD, AND NANCE

(4 Location of available undercut

47%-a-31%-5-13%-c-3%-
d-2%-e-4%
(4 Depth of available undercut
28% -a-26% -b-30% -c-8% -
d-3% -e-5%
(4 Height of muscle attachments
31% -a-30% -b-23% -c-8% -
d-3% -e-5%
(0 Bony facial undercuts
31%-a-32%-b-22%-c-6%-
d-4% -e-5%
k) Type and location of edentulous space
Fig. 1. (As used in questionnaire.)
restored
58%-a-20%-b-14%-c-3%-
tal rest and mesial retentive undercut is d-2% -e-3%
used, tissueward movement of the base Question 26. Do you feel retentive clasps should be
will place deleterious forces on the abut- placed anterior to the fulcrum line in mandibular
ment. Kennedy class II cases? (Fig. 1) (193)
10% (c) A cast circumferential clasp with a distal Responses
rest and me&al retentive undercut may 56% (a) Yes
be used if a “stress-releasing” device 41% (b) No
such as a hinge, split major connector, 2% (c) Sometimes
etc. is used. 1% (d) Only if necessary
5% (d) A cast circumferential clasp with a distal Question 27. If you do place retentive clasps anterior to
rest and mesial retentive undercut causes the fulcrum line in mandibular Kennedy class II RPDs,
no deleterious forces on the abutment which type do you prefer? (176) (Many answered No. 27
tooth. although they answered No in No. 26.)
5% (e) Clasp assembly design is not important Responses (Some individuals answered more than once.)
to long-term effect of the RPD on the 63% (a) Wrought wire
health of the abutment tooth and tissues. 25% (b) Bar type
Question 24. What is the clasp assembly of choice for a 15% (c) Cast circumferential
distal-extension RPD? (193) 4% (d) Cast round
Responses (Some individuals answered more than once.)
67% (a) RPI DISCUSSION
20% (b) Wrought-cast combination with distal The demographic results of the sample population rep-
8% (c) rest resent a varied cross section of prosthodontic specialty
8% (d) RPA training, background, and age groups. Nearly half (45% ) of
Cast bar with distal rest and distal un- the respondents were Board certified. Most (84%) indi-
5% (e) dercut cated that graduate training had the greatest amount of
Wrought-cast combination with mesial influence in determining their philosophy of RPD design
5% 09 rest and fabrication.
Cast circumferential with mesial rest Responses to questions 8 through 10 indicate that most
and distal undercut prosthodontists (66 % ) use a stock tray when making the
3% M Cast circumferential with distal rest and impression for a RPD master cast. Irreversible hydrocol-
mesial undercut loid was the most frequently used impression material
Question 26. Rate the following factors as to importance (66% ), with rubber base (21% ) and reversible hydrocolloid
in determining retentive clasp selection as a important (10 % ) used much less frequently.
to e not important. When communicating with the dental laboratory for
Responses framework construction, almost all respondents (92 % )
(a) Type of support for RPD surveyed and tripod the master cast and write a work au-
60%-a-21%-5-9%-c-2%-d thorization with a detailed description of the RPD frame-
-3% -e-5% work design (90%). Fewer respondents mark the retentive
(b) Survey lines undercuts on the master cast (66% ), submit a drawing of
49%-a-26% -b-15% -c-3% - the RPD framework design on the work authorization or a
d-2%-e-5% separate sheet, and/or outline the framework design on a

306 SEPTEMBER 1989 VOLUME 82 NUMBER 2

RPD DESIGN AND FABRICATION SURVEY
diagnostic cast or duplicate master cast (62%). Only 40%
of the respondents outline the framework design directly
onto the master cast. It appears that nearly all respondents
assume the duty of designing the RPD, which is in agree-
ment with the principles, concepts, and practices recom-
mended by the Academy of Denture Prosthetics.6 In con-
trast to this, Taylor et aL3~4 reported that contrary to what
is taught in most dental schools, nearly 80% of the remov-
able partial denture frameworks made by their sampling of
dental laboratories were partially or fully designed by the
laboratory technician and not the dentist.
Ticonium (64% ) and Vitallium (37 % ) alloys are the most
frequently used RPD framework alloys. Gold is rarely used
(6% ). Nearly all respondents (98%) fit the framework to
the mouth in a separate appointment.
Most of the respondents (87 % ) use the corrected (al-
tered) cast technique on a regular basis for their mandib-
ular distal-extension RPDs. In addition, most of those who
do not use this technique either reline the RPD after pro-
cessing (21% ) or use a border molded custom tray with
elastomeric impression material (16%). Again, this ap-
proach is in agreement with that recommended by the
Academy of Denture Prosthetics.6 Contrasting this data,
Taylor et a1.3reported from their sampling of dental lab-
oratories that more than 90% of the laboratories indicated
that the corrected (altered) cast technique was infre-
quently or never used by the dentists for whom they
worked. It was also stated that most dental schools in this
country include the corrected (altered) cast technique in
their curriculum.4
As a rule, respondents indicated that they usually use a
conventional extracoronal clasp assembly. However, 10%
indicated that they use some other type of direct retainer,
such as an attachment, in greater than half of the remov-
able partial dentures they design.
When designing the mandibular distal-extension remov-
able partial denture, it appears from questions 21 through
24, that most respondents (60 % ) always place a rest on the
THE JOURNAL OF PROSTHRTIC DENTISTRY
me&al surface of the most distal abutment tooth. Fewer
respondents (19 % ) indicated that rest placement will vary,
depending on the occlusion. Most individuals (72% ) use a
“stress-releasing” clasp such as the RPI, RPA, or wrought-
wire combination and a rigid framework. Few respondents
(3 % ) would choose a cast circumferential clasp with a dis-
tal rest and mesial undercut on the most distal abutment
tooth.
From question 25, the respondents consider the type of
support for an RPD, survey lines, location of available un-
dercut, and type and location of the edentulous space to be
restored to be important in determining retentive clasp se-
lection. The depth of available undercut, height of muscle
attachments, and the presence of bone facial undercuts
were rated much less important.
The decision to place retentive clasps anterior to the ful-
crum line in a mandibular Kennedy class II RPD appears
controversial. If a clasp is used, however, the wrought wire
or bar type clasp are the clasps of choice.
REFERENCES
1. Frank WR. Variability in dentists’ designs of a removable maxillary
partial denture. J PRLXTHEX DENT 19X&29:172-82.
2. Frantz WR. Variation in a maxillary partial denture design by dentists.
J PROSTHET DENT 1975;34:625-33.
3. Taylor TD, Matthews AC, Aquilino SA, Logan NS. Prosthodontic sur-
vey. Part I: removable prosthodontic laboratory survey. J PROSTHET
DENT 19&1;52:598-601.
4. Taylor TD, Aquilino SA, Matthews AC, Logan NS. Prosthodontic sur-
vey. Part II: removable prosthodontic curriculum survey. J PWSTHET
DENT 19&L;52:747-9.
5. Trainor JE, Elliott RW, Bartlett SO. Removable partial dentures
designed by dentists before and after graduate level inat.ruction: a com-
parative study. J PFUBTHETDENT 1972;27:509-14.
6. Academy of Denture Prosthetics. Principles, concepts, and practices in
prosthodontics-1982. J PROSTHET DENT 1982;&467-84.
Reprintrequeststo:
DR. DAVID R. BURNS
VIRGINIA COMMONWRALTH UNIVERsITY
SCHOLL OF DENTISTRY
P.O. Box 566
RICHMONL-I, VA 23298
307