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1 Impression taking
2 Articulators & facebows
3 Occlusion
4 Removable partial dentures
5 Extensive partial dentures
6 Complete denture PBL 5.4
Retention, support, stability
Principles of retention
7 Denture maintenance (adjustment, reline, repair, remake, cleanser) PBL 5.4
8 Denture duplication PBL 5.4
9 RBB
10 Conventional bridge
11 General comments
12 Surveyed crown
13 Porcelain fracture
Impression taking
Alginate impression for study casts

- Tray size
o Smaller the no., larger the size
o Upper: 1-4
o Lower: 20-22
- Tray selection
o 3 mm clearance from teeth and deepest part of sulcus  sufficient thickness of alginate
o Correct extension: hamular notches for upper, retromolar pads for lower
o For upper, DO NOT wiggle the tray  patient discomfort
 Lower the tray anteriorly to check any clearance in posterior corridor
- Impression (apply to both upper & lower)
o Apply alginate adhesive
o Dry teeth with gauze
o Rub a small amount of alginate into embrasures & occlusal fissures
o Retract lips when seating the tray  allow alginate to flow into sulcus
o Handle should coincide with patient’s midline
o Avoid blocking perforations of tray with fingers
o After the tray is fully seated, DO NOT move the tray until alginate sets
o Tips for removing the tray
 Remove the tray from posterior first, can also try 左右反
 For upper, ask patient to blow form throat (好似咳痰咁) and 推高 sulcus at 1st molar region
o Rinse the impression under running water, shake off excess surface water, cover with dampened gauze
- Lower impression
o When seating the tray, ask patient to raise the tongue
o Once the tray is seated, ask patient to protrude the tongue
o Mylohyoid muscles is contracted  floor of mouth is raised  functional depth of sulcus
- Upper impression
o Add compound to palate & long edentulous spans
 Otherwise, alginate will be too thick  cannot withstand the weight of plaster/gypsum
 Make sure compound is locked in perforations of tray
 Make sure compound is soft enough but not too hot before putting into patient’s mouth
o When seating the tray, ask patient to lower their head and breathe deeply to reduce discomfort
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Working impression for bridge (PVS, putty and wash)
- Plastic tray (do not use rigid metal or acrylic custom trays as the material will get locked)
- Block out all deep undercuts or spaces to allow easy removal (with utility wax or cotton pellets)
- Retraction cord (for conventional bridge)
- Mix putty (polyphase), roll it into sausage and insert into the tray, up to the rim of the tray, cover with polyethylene sheet (to
avoid material sticking onto the teeth)
- Dry the teeth
- Insert, press hard until the tray is fully seated and all the teeth are covered by impression material
- Wiggle sideway a few times
- For lower impression, tell patient there will be a lot of pressure, support mandible when pressing
- Remove the tray, place monophase into the spaces created
- Reinsert the tray and press hard (less pressure than before) and stop when monophase material oozes out underneath the
putty (without wiggling)
- Wait until monophase sets and remove tray. Protect opposing teeth with your fingers when you remove the tray
Putty Wash
- More fill - Monophase
- Less flow - Better flow
- Less polymerization shrinkage - More accurate details
- More dimensionally stable
Checking impression
- Correct extension
- All teeth & sulcus have been recorded with no metal show-through
- The tray is fully seated
- The tray is centered in position
- No air bubbles and saliva bubbles
- For lower, should record retromylohyoid fossa
- Margins of preparations for crown & bridge work
Disinfection of impression
- Alginate and polyether
o Rinse under running water and shake off surface water
o Dip in 0.8% sodium hypochlorite for 1-2 seconds
o Dip again in sodium hypochlorite
o Cover with gauze dampened with sodium hypochlorite and leave for 10 min
o Cover with gauze dampened with water (not dripping wet)
o Place in polythene bag
- PVS
o Immerse in sodium hypochlorite for 3-5 min
o Rinse well again under running water
o Put n polythene bag
Articulators & facebow
Types of articulators
- Hinge
- Fixed condyle articulators
- Semi-adjustable
o Arcon (articulating condyle): Denar  condyle is in lower membrane
o Non-arcon: Dentatus  condyle is in upper membrane
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- Fully adjustable
- Fossa-moulded
Facebow
- Transfer relationship between maxilla & terminal hinge axis from patient to articulator
Dentatus facebow
- Reference points
o Centre of tragus & outer canthus of eye
o Mark a point 13 mm away from posterior edge of tragus along this line  arbitrary hinge axis
o Inferior border of left infraorbital notch
- Wax on bite fork
o Rod of bite fork is to the patient’s right
o 2 layers for upper, 1 layer for lower
o Cut off excess wax in palatal region and smoothen any sharp edges
- Record sharp (but not deep) indentations of cusp tips
- Average the readings of condylar rod on both sides
- Reposition the bite fork and ask patient to hold it with their thumbs
- Attach facebow to bite fork and tighten the locking clamp
- Position the orbital pin and tighten the locking clamp (ask patient to close their eyes)
- Make sure locking clamps are tightened and not upside-down (logos should be facing up)
Denar facebow
- Draw a reference point which is 43 mm from 12 on the side of the nose
- Bite fork
o The handle should be on patient’s right side
o Mold two layers of wax on upper and one layer of wax on lower
o Cut away excess and smoothen the sharp edges
o Warm the wax and locate bite fork in patient’s mouth; align the bite fork’s midline with patient’s dental midline
o Hold it steady until the wax hardens to ensure there is no extra space created
o There should be no perforations and three-point contact should be established
- Locate bite fork in patient’s mouth again and ask patient to hold the bite fork by himself/herself by putting thumb only on
posterior region
- Install the transfer jig; move the jig up and down until pointer is at 43 mm mark; facebow arm may not be parallel to inter-
pupillary line as the lobes may not entirely go into ear holes
- Tighten screw no. 1 first then no. 2
Occlusion
Occlusal components of teeth

- Cusp to fossa: like mortar and pestle
- Cusps
o Functional cusps: upper palatal & lower buccal
o Non-functional cusps: upper buccal & lower lingual
- Marginal ridges: deflect food away from interproximal contacts  avoid food trapping
- Grooves: exit channels for food during mastication
Dynamics of mandibular movement

- Posselt’s envelope of movement
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- Intercuspal position (ICP), centric occlusion (CO), maximal intercuspal position (MIP)
o Independent of condylar position
o Reproducible = can be duplicated on casts (hand articulate)
o Stable = patient bites at the same position every time
- Centric relation (CR)
o When condyle is in most superior & anterior position against posterior slope of articular eminence
o Musculoskeletally stable position for mandible
o Irrespective of teeth position
- Retruded contact position (RCP)
o First tooth contacts when mandible is closed in CR
o Only 10% of patients have MIP & RCP coincident; 90% slide forward from RCP to MIP
- Rest position
o Freeway space: 2-4 mm
- Lateral excursion
o Canine guidance (mutually protected occlusion): canines alone provide total disclusion of remaining teeth
o Group function: multiple teeth contacts (two or more teeth) on working side
- Protrusion
o Only anterior teeth should touch during protrusion, with disclusion of posterior teeth
o Usually incisor guidance
- Occlusal interferences
o Centric interferences
 Upper mesial-facing cusp inclines & lower distal-facing cusp inclines  deflect mandible anteriorly
o Non-working side interferences
 First tooth contacts on non-working side, preventing contacts on working side
o Non-working side contacts
 Tooth contacts occur at the same time on non-working side & working side (balancing contacts)
o Working side interferences
 Upper: palatal facing incline of palatal cusp
 Lower: buccal facing incline of lingual cusp
o Protrusive interferences
 Upper distal-facing cusp inclines & lower mesial-facing cusp inclines
- Bennett movement
o Working condyle moves laterally and forwards/backwards/upwards/downwards during lateral excursion
o May or not be present
o Patient with large Bennett movement  steep cuspal inclines of restorations will become interference
 Should match the steepness of cuspal inclines of restorations with adjacent & opposing teeth
- Bennett angle
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o Non-working condyle moves downwards, forwards & inwards during lateral excursion  creating an angle to sagittal
plane
o Always present
Thickness of articulating paper

- 1 micron = 1 x 10-6 m
- Shimstock: 8 microns
- Bausch articulating paper (PPDH): 40 microns
- Ash articulating paper: ?
Removable partial dentures
Clinical procedures
Clinic Lab
Patient assessment Pour study casts
Preliminary design Wax rims for jaw records (if needed)
Preliminary impressions
Jaw records (if needed) and facebow Mount study casts on an articulator
Fabricate custom trays for working impressions
Survey study casts Pour working models
Tooth preparation Wax rims for jaw records (if needed)
Working impression
Jaw records (if needed) and facebow Mount working models on an articulator
Finalize denture design on master casts Fabricate metal framework

Trial insertion of metal framework Wax up dentures and add acrylic teeth
Altered cast technique (if needed)
Trial insertion of waxed-up dentures Convert wax to acrylic; finishing and polishing
Denture delivery
Denture review and maintenance
Anatomy
- Soft tissues
o Philtrum
o Nasolabial angle
- Upper
o Incisive papilla: 10 mm to labial surfaces of incisors

o Rugae
o Torus palatini
o Median palatine raphe
o Vibrating line: junction between movable & immovable tissues of soft palate
o Fovea palatine: 2-3 mm posterior to vibrating line
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o Hamular notch: between maxillary tuberosity & pterygoid hamulus
- Lower
o Buccal shelf: between alveolar ridge & external oblique ridge

o Pear-shaped pad (anterior): attached keratinized mucosa, firm & fibrous
o Retromolar pad (posterior): non-keratinized, freely movable
o Mylohyoid ridge
o Retromylohyoid fossa
o Genial tubercle (mental spines): geniohyoid & genioglossus
o Torus mandibularis
- Others
o Sulcus: functional depth & width
o Frenum: labial & buccal (premolar region)
- Muscles
o Modiolus
o Buccinator
o Mentalis
Kennedy classification
- Class I: bilateral free-ends
- Class II: unilateral free-ends
- Class III: bounded saddles
- Class IV: anterior saddle (cross midline) with no other posterior saddles (no modifications)
- Modifications: no. of other bounded saddles
Major connectors
- Factors to consider
o Support, retention, cross-arch stability
o Rigidity, resistance to flexing
o Patient comfort, tolerance, interference with tongue movement, speech & mastication, hygiene
o Clearance from gingival margin
 Upper 6 mm, lower 3 mm
 If coverage of gingival margin is unavoidable
- Close contact between gingival margin & connector
- Gingival relief  gingival enlargement
- Upper
o Palatal strap
 AP dimension should not be less than 8 mm
 Should not cover rugae whenever possible
o Antero-posterior palatal strap
 For prominent torus palatini
 Contacts tongue frequently
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 Anterior palate is highly innervated  sensitivity
 Less support
o U-shaped / horseshoe
 Less resistance to flexing  tendency to deform
 No cross-arch stability
 Greater bulk in anterior  patient discomfort & affects speech
- Lower
o Sublingual bar: for shallower sulcus
o Lingual bar
 4 mm thick + require 3 mm clearance from gingival margin  require 7 mm sulcus depth
o Dental bar & Kennedy Bar
o Lingual plate
 Can stabilize teeth with reduced periodontal support
 Easy to add acrylic tooth  can prepare for tooth loss
 Plaque accumulation
o Labial bar: lingually tilted teeth
Principles of denture design
Support
- Prevents movement towards tissues (resistance to vertical forces towards mucosa)
- Tooth-borne, mucosa-borne, tooth/mucosa-borne
o Root area of abutment teeth
 Oblique fibres of PDL
 Tilting of abutments
o Extent of saddle
o Expected force on saddle
 Functional force created by acrylic teeth is less than natural teeth
- Rests
o Vertical force is directed down the long axis of tooth
o Other effects
 Maintain components in their correct position (clasps won’t sink)
 Indirect retention
 Prevent over-eruption (if no opposing)
 Close ID space to avoid food trap
- Overdentures
Retention
- Prevent movement away from tissues
- Achieved by
o Retentive arms of clasps engaging undercuts
o Muscular control by patient
o Border seal, close mucosal fit, etc. (complete denture)
- Clasps
o Occlusally or gingivally approaching
 Occlusally approaching
- Circumferential clasp (C-clasp) or ring clasp
- Terminal 1/3 is flexible & engages undercut (below survey line)
- 2/3 is rigid (above survey line)  bracing/reciprocation
 Gingivally approaching
- Only contacts tooth surface at its tip
- Rest is free of contact with sulcus and gingiva
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- Better aesthetics but need to consider soft tissues undercut
o Factors affecting retention of clasps
 Force required to flex the clasps over maximum bulbosities of crown > dislodging force = successful retention
 Tooth shape: depth & steepness of undercut
 Clasp design
- Flexibility
o Displacement can occur without permanent deformation of clasp arm
o Without putting strain on PDL fibres
- Cross section
o Round: flex in all directions
o Half round: flex more horizontally
- Length: longer retentive arm  more flexible
- Thickness: thickness/2 = flexibility*8
- Curvature: curved in two planes  more flexible
- Type of metal: modulus of elasticity of CoCr
o Undercut requirements
 CoCr: 0.25 mm
 SS: 0.5 mm
 Gold: 0.75 mm
o CoCr C-clasp should not be used in premolars
 Too rigid  premolars have weaker & shorter roots  easily distorted
 I-bar or wrought wire instead
Stability, bracing, reciprocation

- Prevents horizontal movement, anteroposterior displacement & rotations
- Provided by
o Reciprocal arm of clasp (above survey line)
o Plate
o Major connects & flange
Indirect retention
- Distal extension saddle  when eating stick food  displace saddle in an occlusal direction
o Pivoting about clasp tips
- Anterior saddle
- Lever
o Effect = displacing force e.g. sticky food

o Resistance = retention generated by clasp
o Fulcrum = indirect retainer
- Clasp axis
o Major = closer to the saddle
- Principle
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o Clasps as close to saddle as possible
o Indirect retainer as far away from saddle as possible
- Design
o Rest on surface at right angles to path of movement (not inclined surfaces)
Free-end saddle
- Indirect retention: clasp as close to the saddle as possible; indirect retainer as far away from the saddle as possible
- Downward movement
o Stress on mucosa/pain, ulcer, bone resorption
 (1) Wide base
 (2) Rest on tooth
 (3) Small occlusal table
o Stress on abutment
 (1) Altered cast impression
 (2) Mesial rest
 (3) RPI/RPA system
- RPI = mesial rest, distal proximal plate, i-bar

o No reciprocal arm for RPI system
o Mesial rest  avoid torquing & rotating abutment
o Proximal plate  don’t prepare long guide plane  need to preserve proximal undercut for
disengagement
o Allow slight disengagement of proximal plate (into proximal undercut) and clasp tip when saddle is
pressed onto mucosa  avoid torquing & traumatizing abutment
- For RPA, clasp is placed on the survey line
o RPA: use wrought wire, because SS clasp is too short and too rigid on premolar
- Distal movement: prevented by mesial rest and its minor connector
Anterior saddle
- Anterior teeth tend to rotate upwards & forwards when patient bites
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- Indirect retention
- Change DB to MB clasp  zero tilt  labial undercut
- Eliminate labial undercut  tilt the cast posteriorly  more DB undercut  need to place clasp pointing backwards
- Rotational pathway  survey twice  (1) zero tilt for posterior clasp  (2) posterior tilt for anterior saddle
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- OR posterior tilt w/ undercut build-up on MB using composite
Surveying
- Survey line on the abutment tooth
o If too low (too close to gingival margin)  no undercut
o If too high (too close to occlusal surface)
 Opposing teeth occlude on the clasp
 Occlusal interference
 Deformation of the clasp
 Deflect upwards when placing the clasp
 Requires tooth preparation to lower the survey line
- Information obtained from surveying a cast
o If too low (too close to gingival margin)  no undercut
o Undercut  locate area for retention (wanted undercuts & unwanted undercuts)
o Path of insertion & withdrawal
 Zero tilt: MB undercut on molars
 Posterior tilt (heels down) (molars tip distally): DB undercut on molars, eliminate labial soft tissue undercuts,
eliminate dead space in anterior interproximal spaces
 Anterior tilt (heels up) (molars tip mesially): more MB undercut
 Lateral tilting: won’t create any retentive undercuts
o Reference points
 Parallel lines x3 (on base of cast): transfer among articulators
 Tripod marking (on teeth surfaces): transfer among casts
- Guiding plane
- Dead space
- Tooth preparation
- Eliminate unfavorable undercuts
- Detect soft tissue & bony undercut (which is unavoidable)
 Affects (1) flange & (2) gingivally-approaching clasp (i-bar)
- Guiding plane
- A pair of parallel walls
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- Guide the path of insertion/withdrawal
- Minimize stress on the abutment
- Easier to wear and remove
- Determine retention, reciprocal, etc.
- Remove dead space
- More guiding planes  more frictional grip  better retention
- Steps
- Initial survey to determine path of insertion
- Mark upper & lower survey lines of teeth & soft tissues
- Mark retentive undercuts to be used (with a red dot / cross)
Denture design
- Drawing of RPD design
o Black: missing teeth
o Red: saddle
o Green: CoCr
o Blue: SS
o Yellow: gold
- RPI = mesial rest, proximal plate, i-bar
o No reciprocal for RPI system
o No guide plane on distal surface of the abutment  otherwise will distort the abutment
o RPI is not required for upper free-end saddle  enough support by palate  less chance of rotation
o Indirect retainer (= rest seat / lingual plate) on anterior teeth, preferably on the opposite side of the longer free-end
saddle
- Prevent movement
o Support
o Retention
o Antero-posteriorly
o Laterally
o Rotations
- Remember to also draw minor connectors
- No CoCr C-clasp on premolars; only i-bar is allowed (premolar has shorter & weaker root  easily distorted)
- If there are two rest seats on premolar, join them together (MOD rest seat instead of M+D rest seat)
- Clasp and rest seats can be placed on third molar if prognosis is good
- A maximum of two to three clasps are allowed in one denture
- Mesially approaching clasp (engaging MB undercut) is more preferred due to easier removal by patient and it’s more
aesthetic
- If there is severe occlusal tooth wear, still need to prepare rest seat for technician to recognize, but 1 mm clearance is not
required
- Connect rest seats of opposite sides to form a fulcrum line = axis of rotation
- If abutment is highly mobile  use SS clasp or wrought wire (not pre-formed clasp)
- If abutment is rotated  still prepare rest seat on anatomical landmarks (e.g. fossa)
- Don’t prepare rest seat on amalgam
- Upper unilateral saddle
o Problem: distal displacement  clasp distortion  need to add mesial rest seat
- Replace 7 or not?
o More teeth replaced  more rotation  less stable
o Opposing any 7? If no, there will be tendency of over-eruption, then may need to replace
Tooth preparation
Rest seat
- Should preserve enamel
o Dentine: low abrasion resistance, risk of caries
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- Vertical force should be directed along long axis of teeth
- Occlusal rest seat
o Clearance: ~1 mm (at least 0.5 mm)

o Slope towards centre of the tooth (positive rest seat)  explorer will not slip off if pulled proximally
o Round triangular shape (equilateral triangle)
o Width: 2/3 or marginal ridge and 1⁄2 of intercuspal distance (B&L cusp tip)
o Saucer shape
o Use diamond round bur
o Avoid preparing onto amalgam
 May weaken proximal margin
 Amalgam alloy tends to flow under constant pressure
 Poor tensile strength
 Risk of fracture of restoration and recurrent caries
 Most ideal: rest seat incorporated onto a cast restoration
 Alternative: replace with composite (higher flexural fatigue strength)
o Modifications
 More flared lingual line angle if adjacent tooth is present
 Embrasure widening to allow clearance for clasps and minor connector  flared more to facial & lingual line
angles
- Cingulum rest seat
o Use tapered cylindrical diamond bur

o Don’t use round bur  create unwanted undercut
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o Don’t create undercut
o Semi-lunar outline  rounded groove lowest at marginal ridge
o Just incisal to cingulum

o Open proximally
o Labial wall blended into original lingual slope
o Deeper towards the centre of the tooth

o Depth: ~0.5-1 mm (less than bur head)
o No premature contacts on metal framework by opposing tooth
o Composite build-up if cingulum is poorly developed
o Errors
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- Marginal ridge rest seats
o Notch-shaped
o 45° angle to proximal surface
o Slopes inwards
o Depth ~1mm
Other preparation
- Alter survey line
o Lower survey line: cylindrical bur
o Raise survey line: composite build-up
- Occlusal adjustment
- Embrasure widening
o Tapered cylindrical diamond bur

o To allow clearance for clasps and minor connectors
- Guide plane preparation
o Cylindrical diamond bur

o 2/3 in width (curved bucco-lingually), 1/2 in height (straight occluso-gingivally)
o Blend smoothly into buccal & lingual contours of crown
o Parallel to each other in a pair & parallel to POI
o Anterior teeth: preserve labial width for aesthetics
After tooth preparation

- Polish with white stone & Shofu
- Topical fluoride varnish
Framework try-in
- *For any try-in including wax rims, patient should be in a seating position, not lying down on dental chair
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- Use shimstock to detect natural tooth contact (these teeth should still have contact after seating the framework)
- Fit in the framework; check if rest seat and major connector closely adapts to tooth surface and the palate
- Check stability (horizontal movement)
- If cannot fit in, use Occlude to spray the suspected area of problems
o Spray even thickness of spray, better in the same direction
- After attempt to fit in, area of show-through can be observed
- If natural tooth contact is lost, use articulating paper to detect high spots
o Use different colors to mark ICP and lateral excursion
Denture teeth shade guide: Trubyte Bioform
Denture delivery
- Natural tooth contact should remain the same before and after seating of the denture
- Check saddle extension by PIP (pressure indicating paste)  check if saddle has impinged soft tissues
- Apply on denture base (saddle)
- If show-through / perforate  over-extension
- White color (Occlude is green in color)
- *Apply in the same direction  more uniform
- If still have problems after PIP & fix  may be due to occlusion
- Can also use fit checker or light body impression
- Occlude: for fitting surface of crown/post
- Post-op instructions
- Teach patient to wear and remove denture
- 返屋企試下戴, 唔好即刻食野 (as the denture may move and cause trauma)
- 戴到損左  can continue to wear if the patient can bear
- Denture review 1-2 weeks after delivery
- Review 前 1-2 日戴多 D  睇下邊度損左/紅左
- Also teach denture hygiene
 Use 洗手液/洗潔精 + 軟毛牙刷
 Don’t use toothpaste  abrasive
 Treat like 餐具
 浸水 / container with 濕氣  prevent acrylic from deformation (don’t use hot water)
- Modify patient expectations first (denture is not the same as real teeth)
Altered cast technique

- Mucostatic impression  difference in support between abutment (incompressible) & denture-bearing area (more
displaceable)  distal extension saddle sinks under occlusal load  pivots about the rest on abutment
- Altered cast technique  compressive impression which mimic functional loading  reduce such difference in support
- Use metal framework with acrylic resin added on posterior saddle as the tray
- Press only on rest seats and indirect retainers when seating the framework
- Border molding with greenstick compound
- Impression material: ZnO eugenol
- Wax rims could be incorporated for jaw records at the same visit
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Extensive partial dentures
- EPD: acrylic based
- In the past call “transitional partial denture” (to complete denture); now EPD can also be definitive
- Criteria for choosing EPD
o Any tripod support (tooth support); if no, need to depend on soft tissue support
 *Class I/II free-end actually is a combined tooth & soft-tissue support case
o Quality of remaining teeth (e.g. perio); if poor, cannot place rest
o Degree of tooth wear & loss of OVD  rest seat may not be possible
- Design: support, retention, stability
o Shade all missing teeth – don’t just cross out
o Undercuts – (1) map out all potential undercuts; (2) mark both MB & DB, esp. molar MB
o Saddle area (red=acrylic) – also shade
o Occlusal rests (may skip in EPD)
o Clasps – green for CoCr; blue for SS
o Bracing arms (usually no need for SS clasp)
o Major connector
o *A maximum of 2-3 clasps are allowed (as denture is also a plaque-retentive factors)
o *Bounded saddle  restricted path of insertion  good stability  so don’t need too many clasps
o Don’t open window for single tooth (don’t open window in any situations?)
o Palatal coverage of teeth: half of vertical dimensions
o Thickness of acrylic: 1.5-2 mm
- MB or DB undercuts
o DB undercut: (1) Tilting of last molar  D undercut may disengage + (2) less aesthetic + (3) more difficult for px to
take off
o So use MB undercut
- Survey
o Path of insertion + tripod marking
o Mark both U&L survey lines
o Mark undercuts in red
- Lower anterior acrylic design: if acrylic margins overlap gingival margins  become gum strippers or gum-stripping effect
 when occlusal force placed on gingival margin
- MD distance of edentulous ridge↓ guiding plane effect↑
- Composite build-up to alter survey line should still follow tooth contour
- Working models require another wax rim with permanent base
o For mounting
o For determining tooth positions
 Arch form, soft tissue support [lip support  nasolabial angle (~90°) + cheek buccal channel (dark corridor in
posterior region when px smile)], tongue space
 Labial contour of anterior teeth
 B/L width of posterior teeth: should try to limit to↑stability
o Level
o Lateral orientation
o Anterior-posterior orientation
 Mark centre + canine line
 Take into account remaining teeth if they’re in good condition  can also make adjustments on these tooth
 Spatula should only contact wax rim, don’t be interfered
- Jaw position = CO v.s. tooth contact = MIP/CIP
o PPDH follows Clark’s textbook: CO=ICP
o US: CO=/=ICP
- Balanced occlusion is used only in complete denture case
- Group function definition: refer to glossary
- Interference of anterior teeth
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o Grind lingual surface of upper teeth
o Don’t grind incisal edges of lower teeth  otherwise will have eruption
- Interference of posterior teeth (refer to occlusion manual)
o Working side: BULL (buccal cusps of upper teeth; lingual cusps of lower teeth)
o Non-working side: BULL (buccal facing inclines of upper lingual cusps; lingual facing inclines of lower buccal
cusps)
- Check jaw relationship
o Articulating paper  disclosure of occlusion
o U&L anterior teeth don’t occlude  will cause over-eruption  require ramps on lingual surface of upper teeth
o Halo spot  very high contact
o Lighten contact instead of removing contacts completely
- Keyskill
o Can use free-end cases
o Rest seat, widen embrasure, alter survey line (can add composite)
o Perio pockets (if 4-5mm persists, explain they are under monitor); compare risks & benefits
o Properly mounted models (check if mounting consistent with px occlusion)
o Understand denture design; able to explain every component
o Alter survey line: use a bur to survey clinically to check enough or not
o Occlusal indicator wax to check occlusal clearance: fold into 3 layers  then use caliber
o Px requiring both fixed & removable: have wax try-in for removable first before making fixed
Questions:
- Why shouldn’t use compound to extend tray extension? not tray-supported?
Extra notes on manual:

- Can use Willis Bite Gauge to measure OVD
- Custom tray
o For alginate: spaced & perforated; 3mm; uniform thickness
o For silicone: non-perforated; 1.5mm
- Trial denture to raise OVD
o If raise too much, will have TMJ pain & difficulty in speech
o Use acrylic blocks instead of denture teeth for posterior
o r/v TMJ, chewing; wear for 1 month
o If posterior raise bite, there will be more overjet anteriorly (posterior 2mm = anterior 6mm)
- Cross-mounting technique for remounting another set of casts
- How to check whether desired occlusal adjustment is achieved?
o Make vacuum-formed matrix on cast A (not prep)
o Put the matrix on cast B (already prep) and trim to that prep level
o Put the trimmed matrix on px teeth and occlusal adjustment until reduce to same level
- Retromolar pad
o Anterior part is fibrous and relatively non-displaceable; RPD ends here
o Posterior part is mucous glands and displaceable; CDC ends here
- Camper’s line
o Use fork’s plane to measure
o Inferior border of nose ala to superior border of ear tragus
- If patient has many missing teeth, may have lateral spread of tongue  will bite on tongue if level set too low
- Old denture  wearing of artificial teeth  OVD drops  need to adjust
Why don’t use CoCr framework for extensive partial denture?

- Cannot be relined
- Only mechanical retention between mesh and relining material
Biometric guide
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- Level
o 0.5-1 mm below upper lip
o Angle of the mouth
o Lateral border of tongue (if occlusal plane too low  tongue biting; too high  food trapping in
sulcus)
o Retromolar pad
Occlusal plane
- Lateral orientation: interpupillary line
- AP orientation
o Camper’s line: lower border of ala of nose  upper border of tragus of ear
o Parallel/bisect ridges
o Lateral border to tongue
o Retromolar pad to corner of mouth
- Measurement (2-3 mm of FWS)
o Marked tape on nose tip + chin point
o At rest, ask patient to lick lips, then swallow saliva
o Confirm at least 2-3 times
- Aesthetics (facial proportion)
- Phonetics (presence of closest speaking space)  pronounce “s”, “m”, from “1-49” in Chinese 
OVD ~2mm space in premolar region
- Existing denture
- Parallel ridges
- Pre-extraction record
- Errors
o Too great: incompetent lips, muscle tiredness, ridge soreness, burning sensation, speech problem
o Too small: sunken face, masticatory problem, TMJ problem, cheek biting, angular cheilitis
- Aesthetics: nasolabial angle, philtrum, vermillion border, angle of mouth (dripping)
- Biometric guide: incisive papilla
- Functional: smile line, speech (“F”), neutral zone
- Existing records
- Anterior teeth
o Mould: square, square tapering, square ovoid, square tapering ovoid, tapering, tapering ovoid,
ovoid
Anterior teeth o Length of central without collar: height of central incisor
o Width of central: MD width of central incisor
o Width of 6 anteriors on curve: MD width from 3-3  add a bit from inter-alar distance
o Articulates with lower mould
- Selection of anterior teeth
o Size: inter-alar distance  cusp tips from 3-3
o Shade: skin color
o Mould: inverted face shape
Biometric guide for occlusal plane

- Level
o Lateral border of tongue (if occlusal plane too low  tongue biting; too high  food trapping in sulcus)
o Retromolar pad
- AP orientation
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Biometric guide for OVD

- Phonetics (presence of closest speaking space)  pronounce “s”, “m”, from “1-49” in Chinese  ~2mm space in premolar
region
- Existing denture
- Parallel ridges
- Errors
Biometric guide for anterior teeth

- Existing records
- Anterior teeth
o Mould: square, square tapering, square ovoid, square tapering ovoid, tapering, tapering ovoid, ovoid
o Length of central without collar: height of central incisor
o Shade: skin color
Fitting of EPD difficulty

- Depends on no. of guide planes
- Accuracy of impressions
o Must hold the impression perfectly still
Complete denture
Indications Contraindications
- Edentulous patient - Temporary factors
- Poor support from remaining teeth for RPD  Remaining roots or teeth
- Remaining teeth cannot be saved  Local pathology e.g. cyst
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 Lack of motivation/ability to maintain teeth  Overwhelming disease
 Gross caries or abscesses - Permanent C/I
 Extensive bone loss, periodontal disease  Epileptic patients / other psychological disorders
that prevent neuromuscular control over denture
 risk of suffocation
- Allergy to acrylic
- Severe gag reflex (desensitization?)
- Have other alternative tx
Retention
Important factors Not important factors
- Surface tension - Atmospheric pressure
 Thin saliva film  negative curvature (concave) - Vacuum
 retentive force - Adhesion & cohesion
- Viscosity of saliva - Wettability
- Time - Surface roughness
 Flow is time-dependent - Gravity
 Chewing  seating force is applied before
detachment  transitory displacement only
- Base adaptation
 Smaller gap  less flow
 Narrow gap  surface tension
- Border seal
 Smaller opening  allow less saliva to flow in
 Lowered pressure beneath denture  hold buccal
tissues in close approximation to acrylic
- Firm seating force  ensure thinnest film of saliva
- Soft tissues (patient manipulation)
- Border seal
 Achieved by slight displacement of tissue at sulcus reflexion and intimate contact with cheek mucosa
 Maxilla
 Palatal mucosa is mostly non-displaceable
 Extend to vibrating line to lie on displaceable tissues
 Mandible
 Floor of mouth moves with the tongue  displace the denture
 So need to record impression with tongue raised in a functional position
Support
- Types of alveolar ridges
Upper
Thick ridges Most favorable
Moderate palatal vault with flat centre
Wide sulcus
High V-shaped palate Difficult to make a close fitting base

Thick bulky ridges Difficult to achieve posterior border seal
Flat palate with small ridges Poor resistance to lateral displacement

Shallow sulcus
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Ridges with undercut Denture base cannot pass over undercut
No border seal
Need surgical improvement
Lower
Broad ridges Most favorable
Undercut Loss of border seal

Loss of support
Food-trapping
High but knife-edge ridges Pain during mastication
Flat ridges No resistance to lateral displacement
- Support areas
 Upper: hard palate (primary), alveolar ridge (secondary)
 Lower: buccal shelf & retromolar pad (primary), alveolar ridge (secondary)
- Displaceability of tissues
 Upper: vibrating line
 ~2mm posterior to fovea palatini
 Marks the junction of displaceable and non-displaceable tissues of soft palates
 Lower: retromolar pad
 Anterior 2/3: remnant of distal papilla of last molar tooth; fibrous; non-displaceable (RPD ends here)
 Posterior 1/3: contains mucous glands; displaceable (CD ends here)
- Impression technique
Mucostatic Muco-displacing Selective pressure
- Better distribution of occlusal force - Closed mouth impression technique - Only compress displaceable tissue on
throughout mucosa to underlying - Record mucosa under functional posterior part of palate and around
bone conditions sulcus reflexion
- Not compatible with border seal - Dentures only fit well when load is
applied
Stability
- Vertical height of residual ridge
- Shape of palatal vault
- Arch form (square arch  resist rotation)
- Quality of soft tissues covering ridge (flabby ridge)
- Mandibular lingual flange (retromylohyoid fossa)
- Occlusal plane (parallel to ridge)
- Teeth arrangement (balanced occlusion)
 Now only require group function on working side & no contact on non-working side
- Contour of polished surface (neutral zone)
- Orofacial musculature
Buccinator - Press the denture towards their support tissues
- Destabilizing if denture is over-extended
Orbicularis oris - Marginal parts: stabilizing when contracted
- Labial part: may reduce sulcus depth  dislodge denture
Mentalis - Mentalis eminence is covered by labial flange
- Lift soft tissues of chin  raise labial sulcus reflexion  displace denture
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Dislodging muscles - Levator anguli oris
- Depressor anguli oris
- Incisivus
- Mentalis
- Genioglossus
- Mylohyoid
Tongue - Rest on lingual flange & occlusal surface of lower teeth
- Occlusal plane too high  food trapping in buccal sulcus
- Occlusal plane too low  tongue biting
Modiolus - Orbicularis oris, buccinator, levator anguli oris, depressor anguli oris, etc.
- Tooth loss  modiolus displaced  sunken cheeks
- Buccal surface of lower denture at premolar region  if too thick  modiolus lift the denture
Patient assessment
- Existing dentures
- Patient expectations
- If poor retention, stability, support
 Ridge resorption
 Denture stomatitis
- Decently made dentures but still a lot of pain  high patient expectations  difficult case
- Palpate supporting mucosa to check for thickness  if too thin, easily cause pain
- Ridge configuration
 Knife edge margin  not favourable
 Amount of ridge resorption
 Mental foramen  may need relief
- Torus  compromise the seal
- Stability: press down the denture and twist it
- Support: press on occlusal surface  any see-saw movement?
- Retention: try to pull down the denture; and try to flip the denture to see any dislodge
- Seal: to see any pop sound when removing denture
- Seal =/= retention
- Flabby ridges  need open window technique
- Summary
 Patient expectations
 Existing dentures
 Oral conditions
- CD after Xn: ~3 months
 If not much remaining bone support  healing time could be shorter
- Denture delivery
 Warn patient of possible cheek biting initially  close mouth slowly
- Post-dam
 Peripheral seal
 Why need post dam? If patient has more displaceable tissues  muco-compressive impression technique may not be
able to displace fully
- Vibrating line
 Not anatomical landmark
 Palpation using ball-end instrument to compare movable and immovable tissues of soft palate
 2-3 mm posterior to fovea palatini  sometimes can see on the cast
Biometric guide
Occlusal plane - Level
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o Lateral border of tongue (if occlusal plane too low  tongue biting; too high  food trapping in
sulcus)
o Retromolar pad (2/3 of height)
- AP orientation
- Phonetics (presence of closest speaking space)  pronounce “s”, “m”, from “1-49” in Chinese 
OVD ~2mm space in premolar region
- Existing denture
- Parallel ridges
- Errors
- Existing records
- Anterior teeth
o Mould: square, square tapering, square ovoid, square tapering ovoid, tapering, tapering ovoid,
ovoid
Anterior teeth o Length of central without collar: height of central incisor
o Shade: skin color
Preliminary impression
- Tray selection
- Warm tray with torch, apply compound, make sure compound is not hot before placing in mouth
- Don’t use Stanley knife; soften the compound in water bath instead
- 1st attempt: just to try for alignment, make sure it’s midline, for rough positioning, not need too much
- 2nd attempt: same positioning as 1st but go deeper (but not to the deepest)
- 3rd attempt: repeat; should be able to hear pop sound when removing the tray, indicating good seal
- Apply adhesive on compound
- Take alginate wash  function to fill the void of compound
- Remind patient: alginate is very flowable, relax, breathe by nose
- For maxilla: need to capture frenum, hamular notch, fovea palatini
- Does not matter if compound has show-through
- Indelible pencil mark on alginate: identify 2 fovea palatini  vibrating line is 2-3 mm posterior to them
- No need cut excess alginate on clinic
- Send to lab for fabrication of custom tray (close-fitting non-perforated for ZnOE, with finger rests)
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Check record
- A check record is an interocclusal record that records the most retruded position of the mandible (centric relation), relative
to the maxilla.
- It is needed because we can then use this record to mount the upper and lower dentures on an articulator. The check record
is then removed, and upper and lower dentures are bought into contact to check for any occlusal errors.
- The check record can be a two-layer or three-layer thick wax that is placed on the lower molar and premolar regions on both
left and right sides. The teeth must not contact through the check record as any deflective contact may induce an error in the
record. However, the separation of the teeth must be kept to the minimum.
- 2nd check record
o A second check record is needed to verify the first check record for accuracy to ensure that the patient is biting into
centric relationship during record taking, and that the mounting is correct.
o If do not match  We will put the dentures with the second check record back into the patient’s mouth to check if CR
has been correctly recorded. If it is still correct, either the first check record was inaccurate or mounting was
incorrect. So we will remount the mandibular cast according to the second check record, and verify the new mounting
with a third check record.
Selective grinding
- Centric occlusion is adjusted when there is premature contact at one point, or when the cusp-fossae relationships of
opposing occlusal surfaces are disturbed, or both.
- Working side occlusion is adjusted to achieve proper alignment of the cusps and their opposing embrasures.
- Non-working side occlusion is adjusted if there is a premature contact when the lower buccal cusp moves up the disto-
palatal incline of the upper palatal cusp mesial to it.
- Protrusive occlusion is adjusted to ensure that there is a good contact between the incisors and that there is smooth path of
movement from the protrusive occlusion back to the centric occlusion.
- For the sequence, centric occlusion should be adjusted first to remove any uneven contacts. Then working side should be
adjusted to ensure precise, even interdigitation. Non-working side is adjusted if there is any interfering contacts preventing
smooth movement from lateral occlusion to centric occlusion. Protrusive occlusion is finally adjusted to provide a smooth
articulation.
- It is to be noted that the areas to be adjusted to correct errors on the path of closure, working and non-working occlusions do
not overlap, and therefore do not affect each other.
Hanau’s Quint
- Christensen’s phenomenon
 During protrusion, condyles move downwards & forwards  rims separated posteriorly
Factors under control Factors that cannot be changed
- Compensating curves - Condylar guidance (fixed for each individual)
- Incisal guidance (will affect aesthetics, speech, etc.)
- Orientation of occlusal plane (fixed according to ref
points e.g. corner of mouth, retromolar pad, etc.)
 Tend to displace upper base forwards & lower

base backwards  pressure on supporting tissues
 Not enough space to set upper posterior teeth &
lower anterior teeth  Not aesthetic
 Not aesthetic  Upper base moves forwards & lower backwards
- Cusp angles
 Upper base moves forwards & lower backwards
Post dam
- = posterior palatal seal
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- Determine vibrating line & displaceable soft tissues
o Examine displaceability using a ball-ended instrument

o Mark front & back of post-dam area on primary casts
 Distance ranging from 2-6 mm
o Greatest dimension = mid-way between palatal vault & alveolar process
- Transfer marking from primary cast to secondary cast
o Cut into the cast to a depth of 1mm along posterior border of post dam; divide post dam area with contour lines
separated by 2mm at widest point (A)
o Shade the area between posterior border and its nearest contour line with lead pencil (B)
o Now scrape this shaded area, producing a slight bevel sloping backwards (C)
o Continue shading and scraping (D) until the line marking front of post-dam is reached (E)
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Flabby ridge
- Due to excessive resorption of alveolar bone and replacement with fibrous tissue
- Ridges become mobile and easily displaced -> reduced support and stability
- As a result of trauma from uneven occlusion (e.g. when complete denture is worn against natural teeth)
- Most commonly in anterior region of maxillary ridge and maxillary tuberosity
- Easily displaced during impression -> later recoil against denture base and displace it
- Impression technique
○ Custom tray: close-fitting over normal mucosa; window cut at flabby ridge area
○ ZOE impression for main part of impression
○ The past is cleaned from the window in the tray
○ Reseat the tray and impression plaster is gently applied to the flabby ridge without displacing it
Denture maintenance
Frequently fractured denture

- Denture factor: thickness of denture base
- Patient factor: handling by patient, occlusion, parafunctional habits, etc.
Adjusting CoCr clasp

- Only terminal 1/3 is engaging undercut
- So, hold the rigid part of the clasp, and bend clasp tip with plier
- Stop once you can see the clasp tip is moved
Denture maintenance
- Would you recommend toothpaste for cleaning the dentures? Why?
 No, as most toothpastes contain an abrasive material that will wear away the surface of acrylic resin.
- Would you recommend the dentures to be worn overnight? Why?
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 No, as the mucous membrane is not supposed to be covered. The continuous pressure of the dentures may adversely
affect capillary circulation. Also micro-organisms can be harboured in the space between the denture and the soft
tissue, which is isolated from the saliva by the denture, especially during sleep where saliva secretion is reduced.
- Would you recommend the dentures to be stored in dry condition? Why?
 No, because if the denture is stored dry, there will be loss of absorbed water from the acrylic, which may result in
dimension changes.
- Would you recommend to immerse the dentures in hot water? What is the critical temperature? Describe the
mechanism using glass transition temperature.
 No, as the acrylic may be heated up to above the glass transition temperature, which can vary from around 100°C to
130°C (for atactic PMMA it is 105°C). Polymer chains can now move around freely in long-range segmental motion,
making the acrylic soft and flexible, which may present as distortion of the denture.
Introduction
- Adhere a denture to the oral mucosa
- Increase retention and stability
 Related to residual ridge resorption, wear and tear of the denture, xerostomia
- Enhance comfort, improve function, provide psychological satisfaction
- Should not be used as a method to improve retention in an improperly fabricated ill-fitting denture
- New user
Composition
- Adhesive agents
 Karaya gum, tragacanth, acacia, pectin, methyl-cellulose, hydroxyl-methyl cellulose, sodium carboxy-methyl
cellulose and synthetic polymers
- Antimicrobial agents
 Sodium tetraborate, ethanol, hexachlorophene, sodium borate
- Other agents
 Plasticizers
 Flavouring agents e.g. peppermint oil, wintergreen oil
 Wetting agents
Mode of action
- Supplied as a paste, powder or cream
- Absorb water and swell up to obliterate voids and fill the space between oral mucosa and denture base
- Hydrated material formed by adhesives stick readily to the denture and the mucosa, and is more cohesive than saliva, which
can resist displacing pull
- Increase viscosity of saliva
Requirements
- Available as gels, creams, and powders
- Biocompatible, nontoxic, non-irritant
- Neutral odor and taste
- Easy application and removal from the tissue surface of the denture
- Discourage microbial growth
- Able to sustain for a suitable period of time
- Increase the comfort, retention and stability of the denture
- Not degrade the fitting surface of the denture base
- Not modify occlusion (thin film)
Mode of application
- Food debris on the tissue surface is wiped clean
- Small amounts of adhesive are applied to the tissue-bearing surface of the denture
 Upper: anterior alveolar ridge, center of the hard palate and posterior palatal seal region
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 Lower: along the sulcus of denture over the crest of the ridge extending from the anterior region to the distal extension
- Denture seated and held in place firmly by hand pressure for 5-10s
 Remove excess adhesive
 Close into centric occlusion several times to spread the adhesive as a thin even layer
- Remove denture by swishing mouth with warm water
 Upper: place thumbs against front teeth upward and outward
 Lower: pull gently with rocking motion
- Remove adhesive residue by brushing with a soft brush using denture cleanser or soap
Indications
- Stabilize trial bases
- Compromised denture bearing areas
- Loosened immediate denture due to tissue healing and resorption requiring relining, rebasing or a new denture fabrication,
aid the comfort and function during the interim period
- Xerostomia (either drug or radiotherapy induced)
- Secure an existing or interim denture in patients undergoing intraoral surgical procedures
Contraindications
- Allergies to any of its components
- Severely ill-fitting dentures
- Excessive bone resorption and soft tissue shrinkage leading to loss of vertical dimension
- Should not be used to retain fractured dentures or dentures with lost flanges
- Inability to maintain proper denture hygiene
- Absence of professional supervision
Denture cleaning
Mechanical cleaning
- Soft bristles are recommended and use of denture brush ideal
- Brushing with soap or non-abrasive toothpaste

Chemical cleaning used as adjunct to mechanical cleaning as insufficient to remove all deposits
- Alkaline peroxidase
 Most commonly used for overnight immersion
 Release oxygen bubbles which exert mechanical cleansing effect
 Does not affect the surface of acrylic but may cause bleaching
- Alkaline hypochlorites
 Chemical agents that remove stains and dissolve organic substances
 Used as overnight immersion but higher risk of bleaching so should only be used once a week
- Acids
 Effective in preventing calculus and stains on dentures
 Dilute acids like acetic acids can be used at weekly intervals
- Disinfecting agents
 Chlorhexidine gluconate if candidosis is present
 Unsuitable daily denture immersion because of staining on a regular basis;
 Sodium salicylate can have a similar beneficial effect as chlorhexidine
Denture Reline
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- The procedure used to resurface the tissue side of a denture with new base material to make it fit more
accurately/comfortably
- Used as denture liners for patients with irritation of denture bearing mucosa, areas of severe undercuts
- May have an inhibitory effect on oral bacteria
- Silicone-rubber resilient reliners are the most appropriate
- Soft lining will not relieve chronic soreness due to a problem with unstable occlusion and cannot eliminate tissue
trauma caused by inadequate tissue coverage
Soft relining materials can be conventional mouth cured or laboratory processed:

Mouth cured Laboratory processed
- Leach out significant amounts of alcohol - Used for those who experience chronic
and esters so hardens over time discomfort from occlusal/anatomical
- After several weeks they break down and challenges
debond from denture and become foul - They can last about 1 year, after which they
- 3 types of materials debond, become porous and foul smelling
o Addition silicone elastomers - Materials include
o Powder (PMMA and peroxide o Plasticized acrylics
initiator) and liquid (tertiary o Plasticized vinyl acrylics
amines, aromatic esters, ethanol) (e.g polyvinylchloride)
o Powder (PMMA, plasticizers, o Heat and cold cured silicones
peroxide initiator) and liquid o Hydrophilic acrylates
(MMA and tertiary amines) o Polyphophazine

Relining techniques
- Direct method
 Can be done directly in patient’s mouth using cold cure acrylic resin
 Lubricant (Vaseline) applied on denture occlusal surface to prevent it sticking onto the teeth
 Acrylic is lined on the tissue surface of denture and place in mouth
 Denture with the relining acrylic material is taken out before acrylic completely sets in order to prevent heating
damage to oral tissues; although this leads to distortion
 Relined denture is trimmed to removed excess and polished
- Indirect method
 Static impression technique
 Denture is kept out of mouth for 24 hours
 Denture flanges and tissue surface and reduced by 1-2mm and relief holes are made for the impression
material to flow
 Border moulding with compound, then impression material (either zinc oxide eugenol or rubber base
impression) is placed
 Cast is poured to allow wax up of relining; denture is processed
 Functional impression technique
 Denture flanges and tissue surface is reduced by 1-2mm; posterior palatal seal/ border moulding is done using
with compound
 If there is extensive ridge resorption and loss of OVD, compound stops may be placed on the impression surface
of denture to re-establish new OVD and proper occlusion
 Tissue conditioner materials are used and placed - this soft material allows for the forces causing
discomforting to be evened out and relieved
 Patient then wears denture for up to 5 days or so
 Afterwards the denture is used to pour a cast and relined; denture is processed
Unfit dentures leading to denture stomatitis

- Chairside hard reline material should be used; temporary soft lining materials will act as reservoirs for micro-organisms and
are difficult to disinfect
- Use of tissue conditioner
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- Or ask patient not to wear dentures for 1-2 weeks
Kooliner - Hard reline

- Semi-permanent  can last 1-2 months (but better send to lab for better reline)
- Cold-cure acrylic (v.s heat-cure?)
 Heat-cure: better textures, but may have some errors causing patient
discomfort
- Patient can chew on it and adapt before it sets  more comfortable
- Repair: heat-cure requires more than 12hrs  use cold-cure instead
Coe-soft - Soft reline
- May act as reservoirs for micro-organisms and are difficult to disinfect
Coe-comfort - Tissue conditioner
- Therapeutic effect on mucosa
- Last 1-2 weeks
Denture duplication
Definition
- To produce new denture or replacement denture similar to the present denture
- We do not really copy the denture but reproduce the old features that are satisfactory
From pt’s hx taking

- Elderly pt presenting with satisfactory complete denture
- Worn occlusal surfaces, indicating long-term acceptability
- Deterioration of denture base materials
- Good fit at initial insertion and gradually become loose.
Indications
- Request for duplicate or spare.
- Satisfactory of position of teeth in the neutral zone and good polished surface.
- Loss of retention in favorable denture that require replacement due to bone resorption.
- Elderly patient neuromuscular control require longer time.
- Wear of the occlusal surfaces
- Replacement of immediate dentures
Contraindications
- When the patient dislikes the appearance of his/her current dentures.
- When there is denture instability due to incorrect setting of teeth.
- When the status of the underlying tissues merits one of the special impression techniques. Ex: flabby ridge
Advantages
- Easy adaption to the new denture.
- No alteration of existing denture
- Short/less clinical appointment
- MMR stage become easy and simple due to presence of teeth.
- Simple duplication procedure, less time than conventional technique.
- No special tray or record blocks required
Disadvantages
- Major mistake of the old denture is difficult to overcome with this techniques
- Clinician and technician may not familiar with this technique.
- Not all patient suitable for this denture construction.
- Crucial assessment of existing denture.
Clinical and laboratory procedure
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Denture flask technique
1. Denture is submerged in alginate
2. When alginate is set, any flask of material on the base is trimmed with a sharp knife
3. The flask is then filled with a new mix of alginate  avoid any air entrapment and the lid is closed
4. Alginate halves are separated and the denture is removed. It is returned to the patient
5. Spur holes are cut into posterior border of alginate mold
6. The impression is reassembled and held together with adhesive tape. Auto-polymerizing resin (cold-cure) is the run into one
of the spur holes until it rises from the other
7. Lastly, the duplicate monochrome denture is removed from the flask and mounted on a suitable articulator. Then the pink
colored teeth are replaced by the selected mold of the teeth (= template dentures)
8. Modifications of template dentures (OVD, extension, etc.)  register jaw relationships and jaw records
9. Record shade of existing dentures  return original dentures to patients
10. Using the new jaw relationship, mount the replica dentures on articulators with jaw record
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11. Remove acrylic resin and replace with a tooth, one tooth at a time (better alternating tooth than neighboring tooth)
12. Second visit  try-in and functional reline impressions with ZnOE  investing of denture in flasks, de-waxing, packing the
mould with resin and curing of dentures in lab
13. Third visit  deliver dentures
Soap dish technique

1. Soap container
2. Denture borders are modified with green stick compound, then submerged in soap container
3. Denture invested in lower part of container
4. Second pour of alginate to complete the investment procedure  the soap container should be pressed from the sides to avoid
its distortion
5. Two halves are then opened and the spur holes are cut with a sharp knife; the halves are then resembled and can be held
together with elastic bands
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6. Replication of teeth in wax
7. Wax horse shoe representing teeth
8. Two halves together  self-cure (cold-cure) resin is being poured down one of the holes with light vibrations; while air
escapes from the other; place the container with the spur holes upright
9. The waxed or auto-polymerized duplicate dentures are then recovered from the molds
10. Wax teeth in one of the dentures are replaced with identical moulds of the acrylic teeth; the opposing denture guides the set
up in identical position to the original denture
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RBB
Important questions to ask patients who ask for replacement of missing teeth
- Why replace?
o Different reasons e.g. aesthetics, speech, chewing function will affect choice & design of prosthesis
- Do you have any denture experience?
o Old dentures can provide information which aids in setting up of artificial teeth, occlusal vertical dimension,
occlusal plane, etc.
o We can also ask what patient likes and doesn’t like about his old denture
- What was the reason for tooth loss?
o It may give hints to patient’s underlying problems e.g. high caries risk, tooth wear, periodontal disease which need to
be managed before proceeding to rehabilitation phase
- How long has the tooth been lost?
o If the tooth has been lost for a long time before patient asks for replacement, it may imply that the missing tooth
didn’t actually bother patient that much, which prompts us to think about whether it is really necessary to replace it
Contra-indications of RBB
- Hairline crack
- Heavily restored (>1/3 of crown)
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- Short clinical crown height (< 3 mm)
- Root-treated (weakened tooth structure, not suitable for major retainer, but OK if crowned for hybrid bridge)
- High aesthetic need
Clinical assessment of abutments

- Remaining tooth structure (crown height, caries, tooth wear, enamel available, any cracking)
o If have extensive caries & loss of marginal ridge, can consider onlay instead of full-coverage crown to be more
conservative
- Existing restoration (extent, overhang, margin, recurrent caries)
- Perio (active disease, mobility, remaining bone, crown-root ratio, root morphology)
- Pulpal status (root treatment, pulp vitality, pulpal disease, periapical pathology, restorability)
- Occlusion (occlusal clearance, over-eruption)
- Angulation (any tilting)
- Adjacent teeth: interproximal contact
- Span length
Design principles
- Maximize surface area for bonding
o Choose abutments with greater surface area (molar > premolar) and more remaining enamel
o Path of insertion (usually from palatal & from pontic side)
o Tooth prep to lower survey line (only if necessary)
o Increase wrap-around in posterior (at least 200; at least 270º in  2 pontics long-span RBB)
- Resistance form of abutment & retainer
o Grooves
 When short clinical crown height/too taper
 Placed in directions opposite to dislodging force (e.g. BL too taper  place MD grooves)
 MD grooves: placed in a more buccal position to increase wrap-around; buccal flaring to follow enamel rod
direction
 No grooves in incisors
 Required in long-span RBB (FM4+) for both minor & major retainers
o Increase wrap-around in posterior
o Occlusal bar
 No need prep if have enough clearance
o Lingual cusp coverage
 Open windows for upper premolar palatal cusp (fx cusp) to prevent occlusal interference
 Can cover whole lingual cusps for lower premolars
o Occlusal slots (on minor retainers): ~1.5 mm in depth
o Framework: use rigid material (Ni-Cr; zirconia if allergy); increase thickness (if too thin, may flex & debond)
o For CL using upper canine as abutment to replace upper 1st premolar, use canine form pontic with no palatal cusp (fx
cusp), as resistance form of canine abutment is poor; just for aesthetics
o For CL, pontic size should be always less than abutment
 Molar-sized pontic of 8-9 mm is acceptable for molar-molar CL
 Premolar-sized pontic is ~6-7 mm
- Reduce interabutment stresses
o Control MIP occlusal contacts on framework on major retainer in FM to prevent bite-out effect (occlusal bars instead
of rest seats)
o No interabutment stresses in CL, so CLx2 is preferred to FM unless span is too long
 For CL, pontic size should be always less than abutment
 Molar-sized pontic of 8-9 mm
 Premolar-sized pontic is ~6-7 mm
o FM: movable joints to allow independent movement between major and minor retainer; major retainer can be re-
cemented if debond
- Maintenance
o 1 mm away from gingival margin
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o Modified ridge lap pontic design
o Ensure can be accessed by ID brush

- Occlusal clearance
o 0.8 mm for metal framework
o Check by occlusal indicator wax (folded 3 times) or protemp
o Occlusal clearance in anteriors
 If prep upper palatal/lower incisal edges, may lead to occlusal instability and overeruption
 Can consider framework high in occlusion to intrude opposing teeth
- Existing restoration
o Replace amalgam with composite/RMGI
o Restorations should not extend beyond framework
Summary of RBB design features

CL2 FM3 FM4+ Remarks
Wraparound 180° ✘Anterior ✘ ✘ Short crown height: consider
200°+ ✓Posterior ✓ ✘ gingivectomy/crown
270° (no distal ✓ ✓ lengthening
tooth)
270° (break Break contact if 8-9mm span or ✓ Break contact: orthodontic
contact) short crown height separator for 1-2mo, use blue
360° Possible Possible To be considered comp to stabilize contact
point after tooth prep
Grooves Lower incisors ✘ N/A N/A No FM4 for anterior  do
Upper incisors CLx2 instead
PM (minor N/A Possible but Yes and/or
retainer) occlusal slot occlusal slot
preferred
Molar (major Not usually
retainer)
Occlusal slot Minor retainer N/A Depends ✓ Diverging towards occlusal
(short crown (more resistance Depth: 1.5-2.0mm
height or form) Must coincide with POI
lower PM)
Major retainer Not usually
Control MIP on Minor retainer No bite-out effect ✘ To minimize bite-out effect
framework Major retainer on CL ✓
retainer
Lingual/palatal Minor retainer ✓ ✓
cusp coverage (if have occlusal (Lower PM)
Major retainer clearance) ✓
(if have occlusal clearance)
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POI 2-surface wraparound (mesial + palatal)
- Slightly from palatal  lower survey line on palatal
- Slightly from pontic space (mesial)  lower survey
line on interproximal surface
3-surface wraparound
- Slightly from palatal & along long axis
If denture teeth against RBB abutments

- Only minimal prep for occlusal bar is suffice
- Can reduction on denture teeth
Tooth prep
- 170L tapered T.C. fissure bur for most prep
- Diamond round bur for occlusal bar (should not create any undercut)
- Multi-fluted finishing bur to remove composite if replacement is needed
- Break contact: either bur, or orthodontic separator for 1-2 months & apply blue composite after prep to maintain contact
o Blue composite: only acid-etch the abutment with no bonding; don’t etch neighbouring teeth to prevent composite
sticking and risk of destroying contact
- Assessment of tooth prep
o Take alginate impression & pour snap stone; draw framework extension & survey
o Taper
o Amount of reduction
o Height of contour
Debond & rebond

- CL: 90-96% success rate; 95% retention rate over 2 years
- RBBs generally last 5-10 years
- How to check for partial debond
o Spray water on margin
o Use perio probe to gently lift up the bridge and release
o Bridges move/bubbles appear  partial debond
- To rebond or not?
o Check framework (fracture, flexure, fit)
o Check abutment
o Check design
o If rebond, sandblast the fitting surface to remove residual cements
Occlusion
- Pontic should be in light contact in MIP to control axial position of opposing tooth, but not involved in guidance; if
unavoidable, then share guidance with natural teeth, esp. for CL
- ICP contact should be kept away from margin of retainer
Clinical steps
- Choose shade (see Oper crown notes)
- Plan POI & tooth prep
- Snapstone
- Working impression
o Plastic disposable stock tray
 Don’t use metal/acrylic trays for putty & wash as they are too rigid  may get locked in mouth
o One set, two stage putty & wash
o Should no need retraction cord?
- Check finished prosthesis
o Framework: extension, thickness, fitting, overhang, polishing, sandblasted fitting surface
o Pontic: design, interproximal cleansibility
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- Surface staining
- Cementation
o Pumice
o Framework try-in w/o rubber dam; tie with floss or gauze in patient mouth
o Check contacts; if tight, apply fit checker (white) or occlude spray (green) or simply articulating paper; adjust tight
spots (shiny spots)
o Any soft tissue pressure and blanching
o Occlusal adjustments can usually only be done after cementation of prosthesis
 Usually not possible to try-out the prosthesis to assess aesthetic, functional or periodontal reasons
 However, if necessary use temporary cement
 Dycal
 Panavia Opaque
 Panavia B paste
 Avoid material with eugenol which may affect polymerisation
 Removed with sharp excavator, moist cotton wool and irrigation
 Air abrade the retainer again; if not available, clean thoroughly and acid-etch to remove surface
contaminants followed by a thorough rinse
o After adjustment
 Gold: polish with rubber points, bristle brushes, polishing compound
 Porcelain (minor adjustment): soflex discs or diamond polishing paste
 Porcelain (significant amount of adjustment): send to lab for reglazing and polishing
o Apply rubber dam
o Adhesive cements – Panavia/RelyX Ultimate with 10-MDP (See DMS)
- Remove incisal hook with a ruby shaped diamond bur
- But occlusal adjustment is recommended not on the same visit (vibration and heat of bur will weaken the cement); better one
week later
RBB try-in
- Check fitting, extent, aesthetic, hygiene, thickness, sandblasted fitting surface, polished polishing surface
o Also check gingival margin (any overhang, any gap between retainer and tooth surface)
- For anterior RBB, can also try occlusion before cementation
o First put gauze in patient’s mouth but place it as posteriorly as possible (to make sure the teeth don’t bite on the
gauze)
o Hold the RBB when asking patient to bite down
- First, use shimstock to check for natural teeth contact w/o RBB
- Then, place RBB and use articulating paper to check for any high spots
o If very heavy occlusion, the RBB may even rock when patient is grinding the paper
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- With RBB, use shimstock to check for natural teeth contact
- Adjust accordingly
o Use a measuring gauging to check the thickness of framework from time to time to make sure it is not too thin!
- If framework is already very thin but still high in occlusion, consider remake or opposing teeth reduction
- Send to lab for sandblast, final glazing, adding surface stain, polishing
Importance of sandblasting
- Sandblast with alumina particles
- To remove surface contaminants
- To ensure adequate thickness of oxide layer on roughened surface of the alloy
- To improve bonding to resin cements
Jaw records
- Purpose: to record U&L jaw relationships (vertical, lateral, AP) for mounting U&L casts
- When need?
o No need: patient can bite into same MIP position every time (good interdigitation)
o Need: no posterior teeth or edge-to-edge
- Materials: wax, Protemp, Duralay, PVS
- How to obtain good jaw records
o Ideal impressions (pre-load alginate on occlusal fissures to prevent voids on impressions and bubbles on casts)
o Make sure have show-through at areas of occlusal contacts
o Sectional/localized jaw record, verified with shimstock
o Trim back excess on buccal side for visualization of cusp positions
Biomechanics
- Pier abutment: seesaw effect  heavy occlusal loads on one end will cause debond on the other side
o Solution: use non-rigid connector at pivot
o E.g. 5-unit FM bridge (minor retainer [APA]-[movable joint]-[PA] major retainer)
- Occlusal loads on pontics will result in rotational force at connectors  metal flexure & porcelain fracture
o Solution: increase thickness of connectors
- +1 pontic  stress will be doubled  greater flexing  porcelain fracture
o Solution: use thicker metal and thinner ceramics
- CL will NOT cause tipping of abutments as:
o Require at least 10-12 hrs of constant force for long periods to produce orthodontic tipping (normally only ~15-20
mins/day)
o Multiple simultaneous tooth contacts also prevent tipping
Course notes
- Resistance = resist displacement in any direction; retention = against path of insertion
- Path of insertion  position of survey line  amount of undercut  how much tooth prep needed
- Identify the contact point
o For anterior, don’t remove contact  if contact point is removed, may make the tooth look narrower  aesthetic
issue
o For molars, long-span >10mm should break contact; short-span depends on whether have enough wrap-around
- Hand surveying: don’t move the pen, tilt the cast instead (in opposite direction of the tilting of the pen), no finger rest
o Try to look from path of insertion and see whether can see the framework margin, if yes there is no undercut
- Usually approach from (1) palatally, and (2) shifted towards missing tooth
o To lower survey line  less undercut and less tooth prep  maximize surface area for bonding  increased
retention
o However, palatal tiling is limited by cow horn extension, mesial tilting is limited by another abutment
- Framework always check whether have enough wrap-around
- Framework always stays 1 mm away from gingival margin, as GCF from gingival sulcus may cause debond during
cementation
- During tooth prep, the bur is held at path of insertion
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o For lowering survey line, usually use high-speed T.C. 170L tapered fissure bur
o For occlusal bar and channel, use round bur
o Knife edge margin, don’t create any chamfer of shoulder  use the side but not the tip of the bur to prep
- Case 1: upper incisor as abutment
o Framework: (1) up to incisal edge; (2) pontic side can pass through most bulbous part of (or half into) contact area;
gingival part can pass beyond contact point; (3) mesio-palatal path of insertion
- Case 2: upper molar as abutment
o Cow horn: may require prep, depending on survey line
 Don’t use mesial cow horns for lower first premolars for aesthetic reasons
o Side with neighbouring tooth: may need to prep occlusal-palatal channel (elbow) to join occlusal bar and palatal
framework
o Occlusal bar: <1/3 of width of occlusal table
o Framework: palatal coverage or not?
 Upper palatal cusps = fx cusps  may have occlusal interference if framework is placed  open windows
 Lower lingual cusps of premolars  coverage to prevent “bite-out” effect and debond
 Lower premolars can have full palatal cusp coverage also because out of occlusion  enough occlusal
clearance ┗ So, no need to prep occlusal bar for lower premolars
- Incisal hook (no need prep)  to guide position of framework during cementation  trim afterwards
- Don’t place grooves for lower incisors (too destructive)
- Missing upper 24  23-24 cantilever RBB  use canine pontic  mainly for aesthetic but not function
o Palatal surface of canine abutment has no good resistance form
o Palatal cusp of premolar pontic = fx cusp  may induce RBB shear and failure
- Fixed-movable
o Use 170L non-end cutting tapered bur to prep 1-1.5 mm occlusal channel for long-span RBB  resistance form
o Held along path of insertion
o Don’t use diamond bur as it will create a rough surface
- Now, can do molar pontic (8-9 mm) for posterior cantilever
- Make sure there is enough embrasure space for ID brush cleaning
- No occlusal bar needed if the abutment has ring shape framework  enough rigidity  won’t flex
- Hybrid bridge = convention crown with movable joint + pontic + fixed RBB abutment  must be fixed-movable
o Advantage: can be re-cemented if the fixed part is dislodged
Key features for long span RBB

- Maximize surface area for bonding
- Increasing wrap-around/groove placement to increase resistance
- Movable joints to allow independent movement between major and minor retainer
- Abutment for major retainer is chosen with greater resistance form and/or bone support
- Other design features
o Pontic size
o Major/minor retainer
o Abutment: clinical crown height, surface area for bonding, existing restoration coverage, periodontal conditions
o Wrap around
o Occlusal bar 0.8mm thick
o Occlusal coverage
o Groove/slot
o Ni-Cr framework
o Embrasure large enough for ID cleaning
o Framework 1mm supra-gingivally
o Modified ridge lap pontic design to enhance cleaning and hygiene
Fixed-fixed v.s fixed-movable

FF FM
Advantages - Load more widely distributed - Compensates for some abutment mal-alignment
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o Rigid and fixed on both ends o When abutments have different POIs
o FM: major retainer takes more loading o Requires less tooth prep to eliminate undercut
- Less tooth preparation? - Permits reduced occlusal coverage of minor
o Compared to if FM abutment is matrix  abutment
require intracoronal tooth prep o FF: may have bite-out effect if MIP contact not
o But if FM extracoronal movable joint  no on minor retainer framework; FM: movable
need extra tooth prep joint  allows depression of minor abutment
- More aesthetic o Hybrid bridges must be made FM
o FM: metal movable joints  but can hide by o FM more successful than FF for long span
matrix on pontic and patrix on minor retainer RBBs as no interabutment stress
- Splinting o FM not recommend for long span conventional
bridges  concentration of load on one
abutment
- Elimination of adverse leverage forces on a pier
abutment
- Allows units to be cemented as individual sections
- Reduces cementation problems with abutments of
different mobility (full seating is possible)
- May permit future modification
o If distal abutment fails, movable joint or matrix
on minor abutment can be used for future
denture or longer span FPDs
- Long span FM RBB FPDs
Disadvantag - Pivoting - Metal showing on occlusal surface at the site of

e o Pier abutment: the middle abutment when movable joint
having three abutments in a 5-unit FPD
o Loading  pivoting at pier abutment 
uncementing forces on both ends 
cementation failure
- Requires preparations which are not undercut
relative to one another
o May need more taper
o Or need opposing grooves if excessive tapering
is anticipated
- Alters resistance requirements
o Higher requirements than single crown esp.
long-span / onlay / short crown height
- Abutments of different mobility
o High hydrostatic pressure of cement  depress
highly mobile teeth from the retainers during
cementation  retainer is not fully seated with
a wide cement gap
- No provision for future modification
- In PPDH: FM for 3 unit or more RBBs; FF for conventional FPDs
Conventional bridge
14/1/19 (Walter Lam)

- Conventional cantilever is also possible
- Anterior CMC bridge
o Reduction requirement
 Incisal: 1.5-2.0 mm
 Labial: 1.2-1.5 mm (shoulder margin)
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 Palatal: 0.8-1.0 mm (chamfer margin)
o Need to average POI of two abutments
o Wing preparation provides better resistance form
o Problems encountered
 Margin is too narrow, not clearly visible  apply greater pressure to cut labially, but just use gentle
pressure for palatal
 Mesio-distal undercut/too parallel  use tapered diamond bur and it should be parallel to long axis of the
tooth, then taper will be created naturally
 Wrong angulation of bur, didn’t have two-plane reduction  bucco-lingual wall becomes too thin and pulp
is probably exposed
 Incisal edges and corners should be rounded
o Depth orientation grooves are important to guiding the amount of reduction
- Burs
o Chamfer (small) bur for breaking contacts initially
o Chamfer (medium) bur for depth orientation grooves, reduction, and creating chamfer margin
o Tapered diamond bur (longer and slimmer one) for creating shoulder margin initially, and breaking contacts
completely
 When breaking contacts, try to lower down the bur gradually rather than dropping whole length of the bur
at once
o Tapered diamond bur (shorter and thicker one) for creating final shoulder margin
o Ruby bur for palatal reduction
o Latch-grip stainless steel bur for smoothening margin

- Use single eye vision to check whether you can see the margins of both abutments at the same time, if not it means there is
undercut, then modify the tooth with less prep
- Undercuts may be present not only mesio-distally, but also labial-palatally
o Intra-abutment undercut
o Inter-abutment undercut (occurs when the preps are too parallel), causing the temporary bridges to be locked and
cannot be taken out
- Can use measuring gauge to measure width of the bur so as to prevent under-reduction or over-reduction of the margin
- Crescent margin with uneven width is a common problem
- If sharp incisal corners are present, stress will be concentrated
- Prevent undercut/too parallel/over-taper
o Make sure you don’t change your posture and chair position during crown preparation
o Lock your wrist like a surveyor when running the bur
o Depth orientation grooves are important in guiding the correct path of insertion
o Look at the preparation from different angles to check for undercut
o Use a tapered diamond bur and angle it parallel to long axis of tooth to prevent undercut
- If over-taper occurs, to increase the resistance and retention, can place grooves
o If the tooth is over-tapered bucco-lingually, place grooves mesio-distally, vice versa
o Avoid putting grooves on lower incisors
- How to detect undercut
o Single eye vision from occlusal, use a perio probe to run along the margin, if the tip of the probe disappears, then
there is an undercut
o Use a parallel bur and move around the tooth like a surveyor
o Take a snapstone and survey the abutment
- Use measuring gauge to check thickness of temporary bridge to accurately measure the amount of reduction
- If there is enough occlusal clearance (due to tilted tooth, existing restoration, short crown height, no opposing), may not need
that much occlusal reduction esp. for RBB
- Occlusal clearance can be measured by: making a temp crown  adjust occlusion  measure the thickness with measuring
gauge
- Always make temp bridge before taking working impression to measure whether there is enough occlusal clearance
- Temporary bridge
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o Trim
 Complete setting – 7 min 30 s
 Mouth removal time (2 min)
 Fast setting, non-irritating PEMA
 After 2 min  insert & remove
 Remove at snappy stage (?); don’t remove too late when it’s completely hard
 Always trim margins from occlusal view
o Protemp 2
 Bis-acrylic composite
 New: Protemp 4
 Humidity 50%, 23°C – 30 s (loading)  1 min (?)
 Working time  2 min
 Setting time  2 min setting
 Total: 4 min

- Initial margin preparation should be 1 mm always from gingiva, so that the final margin, after modification, would be equal
gingival or slightly sub-gingival
- When lowering the margin towards the gingival margin, the width of the margin will get narrow due to the tapering of the
tapered diamond bur
- Initial shoulder preparation width should be 0.7 mm and final should be 1.0 mm
- Use tapered diamond bur for initial labial reduction, width of the bur’s tip is 0.7 mm
- Cavit is placed on adjacent teeth before temporization to block out the undercut below contact point
- Advantages or disadvantages of Trim compared to Protemp
o (+): can reline; less brittle and less easy to fracture (Protemp can repair with composite)
o (–): shrinkage
- Can blow air on the creamy mix of Trim to make it set fast if you mix it too thin
- Stages of mixing Trim: sandy  stringy  rubbery  snappy (remove at this stage)
- Do not let temporary set off the abutments to prevent shrinkage; try to move the bridge up and down when it is setting
- Allow better control of trimming by (1) marking the margin with pencil; (2) use loupes when trimming margin; (3) use palm
grip
- Avoid trimming the connector on palatal side which is originally thin to prevent fracture; trim buccal to give better aesthetics
- Polish the temporary on the abutments rather than on your hands for more controlled motion and it is easier to apply force;
polish by pumice on bristle/rubber cup
- No need to use Vaseline on real patients as their saliva is already the vaseline; only put a little vaseline on the margins of the
temporary bridges to prevent excess Temp-bond
- If the temporary bridge is locked on the abutments (Protemp is usually more slippery than Trim due to the oxygen inhibition
layer), first consider if the Cavit in the undercut is causing the locking; don’t use straight probe or excavator to remove the
bridge; use artery forceps and apply it on the pontic, then wiggle bucco-lingually
- When trimming the connector, the bridge should be held from occlusal view, the rough side of the polishing disc should
always face towards the pontic, and the connector should be trimmed until (1) the embrasure is created and is aesthetic; (2)
patient is able to clean with ID brush
Comparison of FPD choices

CL2 FM4 Conventional Implant/implant- RPD
supported FPD
Good - Simple design - Less tooth prep than - Most aesthetic - Good support - Low cost
- No bite-out effect conventional - Even distribution of - Don’t need to - Replace
- One debond, will not - Useful when space load across prepare other multiple saddle
affect the other too large, can’t do abutments teeth - Free-end
- High success rate two CL2 saddle
- Can be used for non- - Removable for
parallel abutments cleaning
- Addition of
tooth is
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possible
Bad - Wrap-around metal - Metal framework not - More destructive - Need adequate - Not ideal for
showing, not aesthetic - Inter-abutment bone level young patient
aesthetic - More wrap around stress - Possible injury - May
- Need careful and resistance - Parallelism of to ID nerve compromise
cementation feature needed, more abutment is required - Surgery and health of
- Difficult to establish complicated design healing period gingiva/teeth if
contact between - Intra-abutment stress needed oral health/diet
pontics - Bite-out effect  - Cost not ideal
control occlusion on
major retainer
- If minor retainer
debond, needs to
remove whole bridge
FF FM
Advantages - Load more widely distributed - Compensates for some abutment mal-alignment
o Rigid and fixed on both ends o When abutments have different POIs
o FM: major retainer takes more loading o Requires less tooth prep to eliminate undercut
- Less tooth preparation? - Permits reduced occlusal coverage of minor
o Compared to if FM abutment is matrix  abutment
require intracoronal tooth prep o FF: may have bite-out effect if MIP contact not
o But if FM extracoronal movable joint  no on minor retainer framework; FM: movable
need extra tooth prep joint  allows depression of minor abutment
- More aesthetic o Hybrid bridges must be made FM
o FM: metal movable joints  but can hide by o FM more successful than FF for long span
matrix on pontic and patrix on minor retainer RBBs as no interabutment stress
- Splinting o FM not recommend for long span conventional
bridges  concentration of load on one
abutment
- Elimination of adverse leverage forces on a pier
abutment
- Allows units to be cemented as individual sections
- Reduces cementation problems with abutments of
different mobility (full seating is possible)
- May permit future modification
o If distal abutment fails, movable joint or matrix
on minor abutment can be used for future
denture or longer span FPDs
- Long span FM RBB FPDs
Disadvantag - Pivoting - Metal showing on occlusal surface at the site of

e o Pier abutment: the middle abutment when movable joint
having three abutments in a 5-unit FPD
o Loading  pivoting at pier abutment 
uncementing forces on both ends 
cementation failure
- Requires preparations which are not undercut
relative to one another
o May need more taper
o Or need opposing grooves if excessive tapering
is anticipated
- Alters resistance requirements
o Higher requirements than single crown esp.
long-span / onlay / short crown height
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- Abutments of different mobility
o High hydrostatic pressure of cement  depress
highly mobile teeth from the retainers during
cementation  retainer is not fully seated with
a wide cement gap
- No provision for future modification
Clinical assessment of existing bridge

- Any partial debond on the abutment, spray water on margin, use probe to lift the bridge and release, see if any bubbles appear
on the margin
- Use a probe to run the margin to feel if any click (gap)
- Overhang
- Mobility
- Percussion test
- Caries
- Cleansibility (embrasure space, pontic design)
- Aesthetic
- Proximal contacts
- Occlusion
Clinical assessment for abutments

- Caries
- Existing restoration (overhang, recurrent caries, margin)
- Perio (bone support, root morphology, crown-root ratio)
- Remaining coronal tissue (crown height, presence of wear facets, enamel available)
- Angulation
- Endodontic condition
- Presence of hair-line crack
- No pathology
Assessment of anterior occlusion

- Centric occlusion, centric relation
- Protrusion, lateral excursion (canine guidance, group function, working side/non-working side interference)
- Overbite, overjet
- Dental midline v.s. facial midline
- BSI classification
- Crossbite, open bite
- Malocclusion (migrate/displace/rotate/tilt)
General comments
- Better to let patient get involved in decision making
o For prosthetic work, esp. involving aesthetics, better to provide pre-op wax-up to let patient visualise what will the
future appearance looks like
- Can try to set a time limit for any try in and adjustment of prosthesis
o E.g. if predict that cannot adjust within 30min, then better to redo the prosthesis
- Remaining amount of enamel is an important factor to consider when doing occlusal adjustment
o Resin bonding, post-op sensitivity, pulp exposure, etc.
Surveyed crown
What is a surveyed crown

Why are surveyed crowns used in clinical dentistry
What are the major clinical indications for placing a cast restoration on an abutment tooth prior to fabricating a removable
partial denture?
Describe the main methods available to construct a surveyed crown
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- Before a removable partial denture is made
- After a removable partial denture has been made
Describe a method of making a temporary crown for an abutment tooth that ensures that the removable partial denture still fits
Definition
- A surveyed crown is a full or partial coverage retainer (crown) designed and planned to retain and/or support a future
RPD or removable overdenture
Indications
- Large carious lesion
- Recurrent caries/endodontic involvement of abutment teeth
- Weakened due to the presence of large restoration
- Inadequate contours for clasping and the required recontouring will exposed the dentine
- Correct the occlusal plane when the abutment teeth are in infra- or supra-occlusion
- Teeth that are improperly positioned in either a faciolingual or mesiodistal direction
Advantages
- Greater accuracy
o It is generally impossible to make several proximal surfaces parallel to one another when preparing them
intraorally
o Easier to achieve ideal retentive contours, definite guiding planes and optimum occlusal rest support on the
surveyor
- Crown ledge or shoulder can be made
o Provides effective stabilization and reciprocation
Types
- Complete coverage crown
o Ideal crown restoration for RPD abutment
o Can be carved, cast and finished to ideally satisfy all requirements for support, stability, and retention, without
compromise for cosmetic reasons
- Three-quarter crown
o Indicated when the buccal/labial surfaces are sound and their retentive areas are acceptable or can be made by
slight modification of tooth surfaces
o Advantage: conservative
o Disadvantages: does not permit creation of retentive areas as does the complete coverage crown
Treatment planning
- Examined for caries, pocket depth, attachment loss, mobility and occlusal interferences
- Radiographs are used to confirm and expand on clinical findings
- Mounted diagnostic casts
o Assessment of both the interarch distance and the plane of occlusion, individual tooth position and occlusal
contacts between teeth
o Placed in the surveyor so that the path of insertion and removal for the RPD can be determined in relation to the
teeth
o Assessment of the height of contour and the amount and location of the available undercut
- RPD design
Procedures
- Study impression
- Preliminary RPD design
- Survey
- Finalize RPD design
- Trial preparation and fabricate wax pattern of the crowns
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o Survey again after wax-up, then carve out rest seat, guide planes, etc.
- Crown preparation
- Working impression
- Crown fabrication
- Crown cementation
Design of the surveyed crown on the wax pattern

- Guiding planes:
o Carved parallel to the POI with a surveyor blade
o Extended from the marginal ridge to the junction of the middle and gingival thirds of the tooth surface involved
o Not to extend to the gingival margin
 Because the minor connector must be relieved when it crosses the gingivae
 Including the occlusal 2/3 or 1/3 of the proximal area is usually adequate
o Features: follow normal tooth preparation of RPD
- Occlusal rest seats:
o Appropriate depth
 Should alter the axial contours of the tooth to ideal before preparing the tooth and creating a depression
in the prepared tooth at the occlusal rest area
 Difficult to adjust the depth of the rest seat after the fabrication of crown/ on the existing crown
because its thickness is not known
o Features: follow normal tooth preparation of RPD
- Crown ledge/shoulder:
o True reciprocation is only possible when the path of
placement of the reciprocal clasp arm is parallel to guiding
planes
 Inferior border of the reciprocal arm makes
contact with the guiding surface before the
retentive clasp on the other side begins to flex
 Reciprocation therefore exists during the entire
path of placement and removal
o Functions:
 Acts as a terminal stop for the reciprocal clasp
arm
 Augments the occlusal rest
 Provides indirect retention for a distal extension
RPD
 Inlayed into the crown and reproduces more
normal crown contours
 The patient’s tongue can contact a
continuously convex surface rather than
the projection of a clasp arm
o Same concept can hardly be applied on natural teeth
 Enamel is not thick enough nor the tooth so shaped that an effective ledge can be created
 Narrow enamel shoulders sometimes can be prepared on unrestored anterior tooth if the enamel is thick
enough
 But these do not provide the parallelism that is essential to reciprocation during replacement
and removal
o Can be used on any complete or three-quarter crown restored surface that is opposite the retentive side of an
abutment tooth
 Used most frequently on premolar and molars, or sometimes in canines
 Not ordinarily used on buccal surfaces for reciprocation against lingual retention because of the
excessive display of metal, but it may be used on posterior abutments when aesthetics is not a factor
o Points to note during tooth preparation
 Ensure sufficient removal of tooth structure in that area
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 Shoulder or ledge is not included in the preparation itself
o Requirements:
 Ledge is made sufficiently wide
 The surface above ledge should be made parallel to the POI
 Placed at the junction of the gingival and middle 1/3 of the tooth
 Curve slightly to follow the curvature of the gingival tissues
 Must be kept low enough to allow the origin of the clasp arm to be wide enough for sufficient strength
and rigidity
 Usually located on the lingual surface
o Preparation on the wax pattern:
 Wax pattern is completed – proximal guiding planes, the occlusal rest seats and retentive contours are
formed
 Carved with the surveyors blade so that the surface above is parallel to the POI
 A continuous guiding plane surface will exist from the proximal surface around the lingual surface
o Refinement after casting
 Machine the casting parallel to the path of placement with a handpiece holder in the surveyor or some
other suitable machining device
For PFM crown:

- Should be fabricated slightly over-contoured and then shaped to
provide the desired undercut for the location of the retentive clasp
arm
o Shaping of the crown must precede final glazing
- Glazed porcelain should be used to ensure the future retentiveness of
the veneered surface
o Prevent abrasion which results from the trapping and
holding of food debris against the tooth surface as the
clasp moves during function
For all-ceramic crown:

- Can be fabricated by CAD/CAM
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EPOW:
- Remember to survey surveyed crown before crown delivery
- Digital method: scan preoperative cast/wax up  temporary/definitive can follow original contour
- In making overdenture  diagnostic study impression to see if there is enough space
- Crown and bridge opposing denture
o Need waxing of denture teeth in working models
o Crown and bridge should be custom made for the denture teeth, as denture teeth have good incline and
morphology already
Construction of a surveyed crown before RPD is made

1. Tooth preparation
- Occlusal rest seat
o Need to provide the appropriate depth
o Create a depression in that area
- The lateral walls of the preparation must be in line with the POI as much as possible
- More tooth removal is usually required than for a routine preparation so the ideal position of the
survey lines and crown contours may be obtained
- Should include the removal of enough tooth structure to accommodate the rest seat
- If possible, tipped molars should be prepared to align the axial surfaces with the POI
2. Working impression, interocclusal record, facebow record
- Elastomeric impression of the entire arch
- Alginate impression of opposing arch
3. Fabrication of temporary crown (refer to below)
4. Wax pattern fabrication
- When multiple crowns are to be restored as RPD abutment, it is best that all wax patterns be made at
the same time
- Cast is placed on the surveyor at appropriate POI
o Wax cutters are available for use in handpieces and milling devices in varying sizes with
taper from 0 to 4 degrees
- Wax patterns are preliminarily carved for occlusion and contact
- Proximal surfaces are then carved parallel to the POI with a surveyor blade
- At last occlusal rest seats are carved in the wax pattern (ch.6)
5. Sprue, invest, cast, recover, finish and polish the castings
- Avoid damage by careless spruing or polishing
- Wax pattern should be sprued to preserve paralleled surfaces and rest areas
- Rest seat areas should need only refining with round finishing burs
- If spruing causes interference, the casting must be returned to the surveyor for proximal surface
refinement by a handpiece holder attached to the vertical spindle of the surveyor
6. Porcelain veneer (if needed)
- Contour the veneered surface on the surveyor before the final glaze
- To make sure the retentive contours are not excessive or inadequate
7. Perfecting the casting on the surveyor
- Both the wax crown and the casting can be machined with a handpiece and a bur or a stone by using
a handpiece holder attached to the surveyor, or self-contained milling devices
- Precise guide planes can be perfected by this procedure
- Milled surfaces must be repolished before cementation
8. Verify the casting
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- Verify the contours, guiding planes, and the retentive undercuts
of the cast restoration on the definitive cast mounted in a
surveyor
- Surveyor should be at the tilt used for the design of the RPD
- Ensure that the desired contours and undercuts have not been
lost in the finishing and polishing of the cast restoration
Construction of a surveyed crown after RPD is made

- Ideally, all abutment teeth would best be protected with complete crowns before the RPD is fabricated
- Except for the possibility of recurrent caries caused by defective crown margins or gingival recession
- It is necessary that the dentist be able to treat abutment teeth that later become defective so that their service as abutments
may be restored and the serviceability of the RPD maintained
Direct technique
1. Fabrication of acrylic resin shell

- Make an impression of the abutment tooth on the definitive cast using laboratory putty
- After separation, coat the inner occlusal and axial surfaces of the impression of the abutment tooth
with autopolymerizing acrylic resin (Pattern Resin; GC Corp, Tokyo, Japan) to fabricate a thin
acrylic resin shell, which is a template of the original tooth
2. Prepare the tooth for a complete coverage metal crown with a chamfer margin
3. Reline and trim the shell
- Flow a thin mix of autopolymerizing acrylic resin (Jet acrylic; Lang Dental, Wheeling Ill) into the
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template
- Place it on the prepared tooth
- Ensure that the template has intimate contact with the rest, clasp, and reciprocal arm of the RPD in
the same manner as for the original tooth
- Following polymerization, separate the relined template from the tooth
- Trim the template with an acrylic bur to ensure that the preparation margins are clearly exposed and
beyond the template extensions
4. Impression and pouring of working cast
- Make an impression with the template in place on the prepared tooth
- Separate the impression and pour it in type IV dental stone
- After separating the impression, ensure that the template is oriented correctly on the cast
5. Adjustment and finishing
- Wax the margins, invest the pattern, and cast in a high noble alloy or other suitable material
- Evaluate the crown intraorally and assess for contour, fit, and occlusion
Direct-indirect technique
1. Tooth preparation on the abutment

- If there are several abutment teeth to be restored, it is usually necessary that each temporary
restoration be completed before the next one is begun
o To make sure the original support and occlusal relationship of the RPD can be maintained
as each new temporary crown is being made
- During the preparation of the abutment tooth, the existing RPD is replaced frequently to ascertain
that sufficient tooth structure has been removed to allow for the thickness of the casting
2. Working impression of the entire arch, jaw relation records, and interocclusal record
3. Fabrication of resin coping (indirect)
- The stone model is trimmed to the finishing line of the
preparation, which is then delineated with a pencil
- The die is painted with a tinfoil substitute, which is a
separating material to form a thin film on a cold, dry
surface
- A resin coping is fabricated with brush technique by
autoplymerizing resin (Duralay)
o Uniform thickness
o Should extend not quite to the pencil line
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representing the limit of the crown preparation
- After hardening, the resin coping may be removed, inspected and trimmed if necessary
4. Fabrication of wax pattern (functional chew-in technique) (direct)
- Establish correct occlusion
o Ask the patient to close into ICP, followed by
excursive movements
o The wax pattern is returned to the cast, and additions
are made to dull areas as required
o Repeat the process until a smooth occlusal
registration has been obtained
- Establish proximal contacts
o Add sufficient wax to establish proximal contacts
with adjacent teeth
o Marginal ridges should be established
- Establish buccal and lingual surfaces
o The clasp arms should contact the crown
o Should not have any retentive undercut on the wax
pattern because it is impossible to withdraw a clasp
from it
- Refine contact with the clasp arm and occlusal relation
o Reseat the wax pattern in the mouth
o The clasp arms, minor connectors, and occlusal rests
involved in the RPD are carefully warmed with a
needlepoint flame
o Carefully avoid any adjacent acrylic resin
o The RPD is positioned in the mouth and onto the wax
pattern
o Several attempts may be necessary until the RPD
is fully seated and the components of the clasp are
clearly recorded in the wax pattern
o Each time the RPD is removed, the pattern will
draw with it and must be teased out of the clasp
o Adjust the wax pattern until the occlusal relation
and the contact with the clasp arms are satisfactory
5. Cement temporary crown and dismiss patient

6. Final adjustment of the crown pattern on die (indirect)
- Narrow the occlusal surface bucco-lingually
- Add tooth morphological features: grooves and spillways (embrasures)
- Refine margins
- Any wax ledge remaining below the reciprocal clasp arm may be left to provide some of the
advantages of a crown ledge
- Excess wax remaining below the retentive clasp arm must be removed to permit the adding of a
retentive undercut later
- For PFM crown:
o The veneer space is carved in the wax pattern
o The contour of the veneer may be recorded by making a stone matrix of the buccal surface,
which can be repositioned on the completed casting to ensure the proper contouring of the
composite veneer
7. Sprue, invest, cast, recover, finish and polish the castings
- Minimal polishing should be done to maintain the exact form of the axial and occlusal surfaces
8. Crown try-in and adjustment
- Proximal contacts, margin, occlusion, fitting, aesthetics
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- The RPD should be fitted in place
- Building clasp retention:
o The location of the retentive clasp terminal is
identified by scoring the crown with a sharp
instrument
o The crown may be ground and polished slightly in
this area to create a retentive undercut
o The clasp terminal then may be carefully adapted
into this undercut, thereby creating clasp retention
on the new crown
Indirect technique
- Use mounted casts with the RPD adapted to the working cast to develop occlusal surfaces for the involved crowns
- Traditional indirect method:
o Technique:
 Transferring the RPD to the working cast and availing the laboratory use of the prosthesis
 All types of crowns can be formed by transferring the RPD to the working cast for use by the laboratory.
 A combined impression of the RPD and abutment is created.
o Disadvantages
 Combined impression
o Complicates the impression process
o May distort the impression on removal from the mouth,
o May damage the die on the separation of the impression, RPD, and working cast.
 Retaining the RPD
o Often unacceptable to the patient when function or esthetics are substantially compromised despite
may facilitate the procedures
o Require routinely provided the patient with an interim partial denture.
- Index method:
o Indications
 When the contours of the abutment and the fit, function, and design of the existing clasp are acceptable
o Techniques
 Confirm or restore proper contours to the unprepared abutment
 Record the tooth form of unprepared tooth for later use in duplicating the contours in the new crown
 A mold or record consist of plaster or stone, resin, vacuum-formed shell, or impression material is indexed to
the working cast.
o Advantages:
 Enables the indirect fabrication of the crown
 Allows the patient to retain the RPD while using the resources of the dental laboratory.
o Limitations/ disadvantages:
 Limited to those abutments that have (or permit prior restoration of) acceptable contours.
 Does not provide the laboratory with any record of the clasp  may limit the technician when decisions in
design are required.
- Analog method
o Technique
 Making an impression of the RPD or clasp
 Generating a clasp replica (analog)and is transferred to the working cast
o Advantages
 Allow the patient to retain the RPD at the same time that the laboratory is provided with the components to
formulate most types of crowns.
o Procedures:
 Increased the thickness of the clasp with sticky wax and made a combined impression of the RPD and
abutment.
 RPD was carefully removed from the impression
 Impression was boxed to isolate the adjacent tooth and clasp.
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 Formation of clasp using low fusing metal to pour into the clasp arms
 Base of the clasp portion was tapered to orient the replica as a removable component of the working cast.
 The abutment was poured in the traditional manner before separating the clasp from the impression.
 The removable low fusing metal clasp was used to form the crown.
o Disadvantages:
 May include the same potential for distortion of the impression and damage to the die as in the indirect
technique.
 Thickening of the clasp with sticky wax
 Necessary for the flow of the metal
 Resulted in a broader clasp
Fabrication of temporary crown

1. Impression with elastic impression material of entire arch
- With the existing RPD in place before tooth preparation
- RPD should remain in the impression when it is removed from the mouth
- If it remains in the mouth, it must be removed and inserted into the impression in its designated
position
- Impression disinfected and wrapped in wet paper towel (for irreversible hydrocolloid) or placed in
plastic bag
- The impression is trimmed to eliminate any excess, undercuts and interproximal projections that
would interfere with the replacement of the impression in the mouth
2. The prepared teeth are dried and lubricated
3. Fabrication of temporary crown
- Fabricate temporary crown with materials e.g. MMA acylic-resins, composites, copolymers and
fiber-reinforced resins according to manufacturer’s instructions
- A small amount of the mixed material should be injected over and around the margins of the
prepared teeth; while the rest should be injected into the impression of the prepared teeth
- The impression is seated into the mouth, and held in place until initial setting
- Remove the impression and the temporary crown
- Remove all the excess
- Reseat the crown on the prepared abutment
- Remove the RPD from the impression and reseated in the mouth onto the temporary crowns (which
should be in a stiff-rubbery state)
- Ask the patient to bite down to re-establish the former position and occlusal relationship of the
existing RPD
- After the crown is completely set, the RPD is removed. The crown is then careful removed and
contoured to accommodate OH access, trimmed, polished and temporarily cemented
4. Cementation of temporary crown
- May require slight relief of the internal surface of the crowns to accommodate the temporary cement
and to facilitate removal
- Temporary cement should be thin and applied only to the inside gingival margin of the crowns to
ensure complete seating
- Occlusion checked and adjusted
- Excess cement removed
Porcelain fracture
- Reasons
o Absence of oxide layer for bonding metal to porcelain
o Sharp angles in metal framework
o Uneven thickness of porcelain
o Fast cooling during sintering cause cracks
o Mismatch of coefficient of thermal expansion between core and veneer
o Air entrapment during ceramic build up and firing
o Porcelain too thick, unsupported by metal substructure
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o Occlusion on metal-porcelain junction
o Excessive occlusal loading
o Premature contacts
o Trauma
o Increased overbite
o Parafunctional habits
o Acidic beverages
o Injudicious use (crack hard nuts, bite harder foods)
o Insufficent tooth reduction
o Knife-edge margins
o Fatigue failure
- Management options
o Adjustment and polishing
o Porcelain repair
o Replacement of restoration
o Factors related to patient/clinician/material/lab fabrication
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Alginate impression for study casts

Articulators & facebow

Occlusal components of teeth

Dynamics of mandibular movement

Thickness of articulating paper

Removable partial dentures

Finalize denture design on master casts Fabricate metal framework

Denture review and maintenance

o Incisive papilla: 10 mm to labial surfaces of incisors

o Buccal shelf: between alveolar ridge & external oblique ridge

Principles of denture design

Stability, bracing, reciprocation

o Effect = displacing force e.g. sticky food

- RPI = mesial rest, distal proximal plate, i-bar

- Change DB to MB clasp  zero tilt  labial undercut

o Clearance: ~1 mm (at least 0.5 mm)

- Cingulum rest seat

o Use tapered cylindrical diamond bur

o Just incisal to cingulum

o Deeper towards the centre of the tooth

o Composite build-up if cingulum is poorly developed

o Tapered cylindrical diamond bur

o Cylindrical diamond bur

After tooth preparation

Denture teeth shade guide: Trubyte Bioform

Altered cast technique

Extra notes on manual:

Why don’t use CoCr framework for extensive partial denture?

Biometric guide for occlusal plane

Biometric guide for OVD

Biometric guide for anterior teeth

Fitting of EPD difficulty

High V-shaped palate Difficult to make a close fitting base

Flat palate with small ridges Poor resistance to lateral displacement

Undercut Loss of border seal

High but knife-edge ridges Pain during mastication

Flat ridges No resistance to lateral displacement

 Tend to displace upper base forwards & lower

 Upper base moves forwards & lower backwards

o Examine displaceability using a ball-ended instrument

Frequently fractured denture

Adjusting CoCr clasp

Soft relining materials can be conventional mouth cured or laboratory processed:

Unfit dentures leading to denture stomatitis

Kooliner - Hard reline

From pt’s hx taking

Clinical and laboratory procedure

5. Spur holes are cut into posterior border of alginate mold

Soap dish technique

3. Denture invested in lower part of container

7. Wax horse shoe representing teeth

Clinical assessment of abutments

o Ensure can be accessed by ID brush

Summary of RBB design features

If denture teeth against RBB abutments

Debond & rebond

Key features for long span RBB

Fixed-fixed v.s fixed-movable

Disadvantag - Pivoting - Metal showing on occlusal surface at the site of

14/1/19 (Walter Lam)

21/1/19 (Walter Lam)