Prosthodontics

Lec.1 Anatomical Landmarks of Edentulous

Arches

Although a thorough knowledge of all anatomical landmarks of the edentulous mouth is

indispensable for the successful treatment of dental patients, certain structures are
especially important when fabricating complete dentures. These structures, which affect
the fabrication of complete dentures, and the structures that underlie those important
landmarks will be discussed in this chapter. Accurate impressions of the maxillary and
mandibular arches should reproduce the landmarks that do not change their position with
function (Ex: alveolar ridges and hard palate) and the landmarks that change their shape
with function (Ex: frenula, vibrating line between soft and hard palate).

Types of landmarks structures according to their function in denture

fabrication:

1. Limiting structures

 These are the sites that will guide us in having an optimal extension of the
denture so as to engage maximum surface area without engaging upon the
muscle action.
 Encroaching upon these areas will lead to dislodgement of the denture
and/or soreness of the area while failure to cover the areas up to the limiting
structure will decrease retention, stability and support of the denture.

2. Supporting structures

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 These are the load bearing areas. The denture should be designed such that
most of the load is concentrated on these areas.
 It can be divided into :

-Primary stress bearing area

- Secondary stress bearing area

3. Relief area

 Relief areas are areas in the denture bearing area which should be relieved
during construction of the denture.
 They are either resorbed under constant load, having fragile structures within
or covered by thin mucosa which can be easily traumatized.

Maxillary Arch
The incisive papilla is a small tubercle located on the palatal side between the two central
incisors. It overlies the incisive foramen, through which the incisive nerve and blood
vessels exit. Because of the sensitivity of this structure, care must be taken when inserting
the maxillary denture to relieve almost all pressure in this area. The incisal papilla is a
good landmark when contouring occlusion rims and positioning the dentures because
studies indicate that the facial surfaces of the natural central incisors, when present, were
approximately 8-10 mm anterior to the middle of the incisal papilla, and the tips of the
canines were approximately in line with the middle of the incisal papilla.

The palatine rugae are irregular mucous membranes that extend bilaterally from the
midline of the hard palate in relation to the upper six anterior and sometimes bicuspid

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teeth. Many years ago it was felt that these structures could potentially play a large role is
speech and in helping the patient position the tongue. Dentures were fabricated with
artificial rugae in an attempt to aid patients in these areas, however current studies do not
indicate that the rugae play a significant role in speech or tongue positioning, and they are
no longer considered important when fabricating maxillary dentures.

Torus palatinus (when present) is a bony prominence of variable size and shape, which is
located in the middle of the hard palate. Because the tissue overlying a palatal torus is
usually very thin, and the torus is very rigid, any pressure caused by a maxillary denture
during chewing and swallowing will often traumatize the tissue and lead to irritation and
ulceration. Care must be taken during insertion to relieve any pressure to the torus caused
by the denture. Additionally, an enlarged torus palatinus could act as a fulcrum that can
lead to instability of a denture. Generally, any torus that has lateral undercuts or extends
to the vibrating line should be considered for surgical removal.

The midpalatine raphé is a line in the middle of the mucosa of the hard palate that
overlies the mid-palatine bony suture. The tissue in this area is very thin, and any
pressure from a denture will not be tolerated in most patients. Care must be taken when
inserting the denture to provide necessary relief.

The fovea palatini are two depressions that lie bilateral to the midline of the palate, at the
approximate junction between the soft and hard palate. They denote the sites of opening
of ducts of small mucous glands of the palate. They are often useful in the identification
of the vibrating line because they generally occur within 2 mm of the vibrating line.

Lying between the maxillary tuberosity and the hamulus is a groove called the hamular
notch . This notch is a key clinical landmark in maxillary denture construction because
the maximum posterior extent of the denture is the vibrating line that runs bilaterally

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through the hamular notches. The hamulus can be palpated clinically and it can be a
possible site of irritation in denture wearing patients, if the denture touches this process

Inflammation and pain can result from mechanical irritation by unstable dentures.

The vibrating line is very important to locate for proper construction of the maxillary
complete denture . Although not precisely true, the vibrating line can be considered as the
junction between the hard and soft palates and is important because it is the maximum
posterior limit to the maxillary denture. This line runs from about 2 mm buccal to the
center of the hamular notch on one side of the arch, follows the junction of the hard and
soft palates across the palate, and ends about 2 mm buccal to the center of the opposite
hamular notch. Additionally the vibrating line is the distal extent of the posterior palatal
seal area.

The posterior palatal seal area is very important in maxillary complete denture fabrication
and must be identified and evaluated. It is the area of compressible tissue located anterior
to the vibrating line and lateral to the midline in the posterior third of the hard palate. The
distal extent of this area is the vibrating line,

The maxillary tuberosity is the most posterior part of the alveolar ridge; it lies distal to
the position of the last molar. It is a bulbous mass of mucous membrane that overlies a
bony tuberosity. The maxillary tuberosity is important from a denture standpoint because
it is considered a primary stress-bearing area and because surgery must be considered
when the tuberosity is extremely large and compromises the clearance necessary for
opposing dentures.

The canine eminence is a bony prominence in the maxilla that denotes the roots of the
canine teeth. The eminences of the upper jaw raise the upper lip; its loss leads to the
sagging of the lip associated with aging.

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Alveolar (Residual) Ridge
The roots of the teeth are supported by the alveolar process of the maxilla and the
mandible. Following full mouth extractions, the alveolar ridges undergo significant boney
changes, with the largest changes seen on the mandibular arch. It consists of two
parallel plates of cortical bone which unite behind the last molar to form the tuberosity.

The part of the alveolar process that remain after loss of teeth is called the residual
alveolar ridge. secondary stress bearing area. The slopes of the ridges do help in the
stability of the denture during function.

Palatine Process of Maxiilary Arch they arises as horizontal plates from the body of the
maxilla. The two plates unite in the mid line forming the mid palatine suture. Sometime
overgrowth of bone seen in this area called torus palatinus. The hard palate resist
resorption (primary stress bearing area). (mid palatal raphe) is covered by firmly adherent
mucous membrane (stress relief area)

Greater Palatine Foramen medial to the third molar at the junction of the ridge and
horizontal plates of palatine bone . Rarely would a relief be required in the denture base
over this area since the nerve and blood vessels are housed in a groove and covered by
thick soft tissue.

The upper medial labial frenum, or frenulum, is a fold of mucous membrane that overlies
dense connective tissue

. It does not contain muscle fibers, in contrast to the buccal frenula. It anchors the upper
lip to the gingiva. The frenum varies in size among individuals but it is usually more
developed than other frenula found in the vestibule. When it is abnormally large, it

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extends to the interdental papilla between the two central incisors. An enlarged upper
median labial frenum is frequently found in association with a diastema (large space
between the two central incisors). In many edentulous patients, resorption of the alveolar
bone brings the crest of the alveolar ridge closer to the frenum. Therefore, a normal
frenum may need surgical excision before successful denture construction can be
initiated. In all cases, the dentures should be relieved away from the frenula, to avoid
irritation of these folds and to prevent future instability of the dentures. The upper buccal
frenum is a mucous membrane fold that overlies dense fibrous connective tissue and
fibers of the caninus, or the levator anguli oris muscle (elevator of the angle of the
mouth). The latter is one of the muscles of facial expression.

Labial vestibule (sulcus): a space lined by a thin mucous membrane, extends on both
sides of the arch from the labial frenum to buccal frenum and bounded externally by
upper lip and internally by the teeth, gingiva and alveolar ridge in dentulous mouth or by
R.R in edentulous mouth. It is divided into two compartments by a labial frenum namely
the right and left.

Buccal vestibule: is a space lined by a thin mucous membrane, extends from the buccal
frenum to the hamular notch on both sides of the arch in edentulous mouth, it is bounded
externally by the cheek and internally by the R.R.

Relief areas

1. Incisive papillae

2. Median palatine raphe

3. Torous palatinus

4. Sharp spiny processes

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5. Cuspid eminence

6. Zygomatic process

Supporting structures

A.Primary stress bearing area

1. Hard palate

2. Posterio-lateral slopes of residual ridge

B. Secondary stress bearing area

1.Residual ridge

2.Rugae area

3.Maxillary tuberosity

Limiting structures:

1. Labial frenum

2. Buccal frenum

3. Labial vestibule

4. Buccal vestibule

5. Hamular notch

6. Vibrating line

7. Fovea palatine

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Anatomical Landmarks of the Mandibular Arch

Residual Ridge:

is the bony process that remains after teeth have been lost. the R.R may not be favorable
as a primary stress- bearing area because the underlying bone is often cancellous

Retromolar pad: a triangular area of thick mucosa is found distal to the last molar,
basically on the crest of the ridge, and is referred to as the.This pad is extremely

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important in denture construction from both a denture extension and plane of occlusion
standpoint. The retromolar pads should be covered by the denture, and the plane of
occlusion is generally located at the level of the middle to upper-third of this pad.

The buccal shelf Area: is located on the mandibular arch and is important to mandibular
denture fabrication because it is the primary stress-bearing area of the mandibular arch. It
is an area bounded on the medial side by the crest of the residual ridge, on the lateral side
by the external oblique ridge, in the mesial area by the buccal frenulum, and on the distal
side by the masseter muscle. The buccal shelf consists primarily of thick cortical bone, in
contrast to the crest of the ridge, which is fenestrated and consists of thin cortical bone
overlying more cancellous bone.

Some patients will exhibit bilateral bony prominences of the inner surface of the
mandible in the region of the premolar teeth called the torus mandibularis. These
prominences must usually be removed prior to denture fabrication.

In patients suffering from atrophied mandibles, the residual ridge resorbs to the level of
the genial tubercles, which can be easily palpated. These bony midline lingual projections
offer attachment to genioglossi and geniohyoid muscles. The dentures should be trimmed
around the genial tubercles in those cases.

Mental Foramen: located on the external surface of the body of mandible between 1st and
2nd premolar area. As a resorption progress, the mental foramina will become closer to
the R.R crest .

External Oblique Ridge: a ridge of dense bone extending from just above the mental
foramen in superior and distal direction to become continuous with the anterior region of
the ramus.

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Mylohyoid Ridge: it is an irregular bony ridge on the lingual surface of the mandible
from which the mylohyoid muscle arises to form the floor of the mouth. Anteriorly: lies
close to the inferior border of mandible. posteriorly: it lies flush with the residual ridge.
The area under the mylohyoid ridge is considered as an undercut.

Labial frenum: it is a fold of m.m . it is not as pronounced as the maxillary one. It may be
single or multiple

Labial vestibule: space extends from labial to buccal frenum Bounded internally by the
residual ridge and labially by lower lip.

Buccal Frenum: is a fold or folds of m.m extending from the buccal m.m reflection to the
R.R crest in the region just distal to the cuspid eminence.

Buccal Vestibule: space extends buccally from buccal frenum to the retromolar pad area

Lingual Frenum: is a fold of m.m observed when the tongue tip is elevated

Mandibular Stress Bearing Areas:

Primary:

buccal shelves

retromolar pads

Secondary : alveolar ridge ( if well developed)

Areas Requiring Relief in Impression

Mandibular tori

Retromylohyoid ridge

Undercuts or sharp boney prominence on ridges.

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Genial tubercules

Mental Foramen

The pattern of bone resorption:

The maxilla resorb upward and inward to become progressively smaller
(centripetal) .while the mandible resorb downward and incline outward to become
gradually wider (centrifugal). This progressive change of the mandible and maxillae
makes many edentulous patients appear to be prognathic.
The mean denture bearing area for edentulous maxillae are 23cm2 while for
mandible 12cm2 in contrast with 45cm2 area of PDL in each dental arch.
The masticatory loads recorded for the natural teeth are about 20 Kg while
maximum forces of 6 Kg during chewing have been recorded with complete
denture. In fact , maximal bite forces appear to be five to six times less for complete
denture wearer than person with natural teeth.

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Le2. Diagnosis and Treatment Planning for Partially Edentulous
Patients

Purpose and Uniqueness of Treatment:

The purpose of dental treatment is to respond to a patient’s needs, both the needs

perceived by the patient and those demonstrated through a clinical examination and
patient interview.

The delineation of each patient’s uniqueness occurs through the patient interview and

diagnostic clinical examination process. This includes four distinct processes:

1. Understanding the patient’s desires or chief concerns/complaints regarding his or her

condition (including its history) through a systematic interview process.

2. Ascertaining the patient’s dental needs through a diagnostic clinical examination.

3. developing a treatment plan that reflects the best management of desires and needs
(with influences unique to the medical condition or oral environment), and

4. Executing appropriately sequenced treatment with planned follow-up.

Patient Interview:

A fundamental objective of the patient interview, which accompanies the diagnostic

examination, is to gain a clear understanding of why the patient is presenting for

evaluation; this involves having the patient describe the history related to the chief
complaint. To ensure thoroughness the dentist should follow a sequence that includes:

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1. Chief complaint and its history.

2. Medical history review.

3. Dental history review, especially related to previous prosthetic experience(s).

4. Patient expectations.

Clinical Examination:

Objectives of Prosthodontic Treatment:

(1) The elimination of disease;

(2) The preservation, restoration, and maintenance of the health of the remaining teeth
and oral tissues (which will enhance the removable partial denture [RPD] design); and

(3) The selected replacement of lost teeth; for the purpose of restoration of function in a
manner that ensures optimum stability and comfort in an esthetically pleasing manner.

Oral Examination:

A complete oral examination should precede any treatment decisions. It should include

visual and digital examination of the teeth and surrounding tissues with a mouth mirror,

explorer, and periodontal probe, vitality tests of critical teeth, and examination of casts
correctly oriented on a suitable articulator. Clinical findings are augmented by and
correlated with a complete intraoral radiographic survey.

Sequence for Oral Examination:

1. Relief of pain and discomfort and caries control by placement of temporary

restorations.

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2. A thorough and complete oral prophylaxis. An adequate examination can be

accomplished best with the teeth free of accumulated calculus and debris.

3. Complete intraoral radiographic survey. The objectives of a radiographic examination

are

A. To locate areas of infection and other pathosis that may be present;

B. To reveal the presence of root fragments, foreign objects, bone spicules, and irregular

ridge formations;

C. To reveal the presence and extent of caries and the relation of carious lesions to the

pulp and periodontal attachment;

D. To permit evaluation of existing restorations as to evidence of recurrent caries,

marginal leakage, and overhanging gingival margins;

E. To reveal the presence of root canal fillings and to permit their evaluation as to future

prognosis;

F. To permit evaluation of periodontal conditions present and to establish the need and

possibilities for treatment; and

G. To evaluate the alveolar support of abutment teeth, their number, the supporting

length and morphology of their roots, the relative amount of alveolar bone loss

suffered through pathogenic processes, and the amount of alveolar support remaining.

4. Impressions for making accurate diagnostic casts to be mounted for occlusal

examination.

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5. Examination of teeth, investing structures, and residual ridges.

caries susceptibility is of primary importance. The number of restored teeth present, signs

of recurrent caries, and evidence of decalcification should be noted.

recession, and mucogingival relationships should be observed.

the edentulous areas, and the quality of

the residual ridge also should be considered during the examination procedure.

-formed edentulous residual ridge;

however, palpation often indicates that supporting bone has been resorbed and has been
replaced by displaceable, fibrous connective tissue. When the mouth is prepared, this
tissue should be recontoured or removed surgically, unless otherwise contraindicated.

ed together with their relation to

framework design. Failure to palpate the tissue over the median palatine raphe to

ascertain the difference in its displaceability as compared with the displaceability of the

soft tissues covering the residual ridges can lead to a rocking, unstable, uncomfortable

denture and to a dissatisfied patient. Adequate relief of the palatal major connectors must

be planned, and the amount of relief required is directly proportionate to the difference in

displaceability of the tissues over the midline of the palate and the tissues covering the

residual ridges or selecting a different design for the major connector that avoid the

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presence of tori.

he

opposing arch must be considered separately; this is to evaluate the presence of a good

interocclusal distance to restore the missing teeth and the presence of extrusion or tilting

of the remaining teeth.

6. Vitality tests of remaining teeth.

7. Determination of the height of the floor of the mouth to locate inferior borders of
lingual mandibular major connectors. Two methods used in determining this distance:
direct method with the use of periodontal probe inside the patient’s mouth, and indirect
method through measuring the distance on the diagnostic cast.

Diagnostic Casts:

A diagnostic cast should be an accurate reproduction of all the potential features that aid

diagnosis. Additional information provided by appropriate cast mounting includes

occlusal plane orientation (using face-bow and semi-adjustable articulator).

The impression for the diagnostic cast is usually made with an irreversible hydrocolloid

(alginate) and usually they poured with dental stone.

Purposes of Diagnostic Casts:

1. Diagnostic casts are used to supplement the oral examination by permitting a view of
the occlusion from the lingual, as well as from the buccal, aspect.

2. Diagnostic casts are used to permit a topographic survey of the dental arch that is to be

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restored by means of a RPD.

3. Diagnostic casts are used to permit a logical and comprehensive presentation to the
patient of present and future restorative needs, as well as of the hazards of future neglect.

4. Individual impression trays may be fabricated on the diagnostic casts, or the diagnostic
cast may be used in selecting and fitting a stock impression tray for the final impression.

5. Diagnostic casts may be used as a constant reference as the work progresses.

6. Unaltered diagnostic casts should become a permanent part of the patient’s record.
Therefore diagnostic casts should be duplicated, with one cast serving as a permanent
record and the duplicate cast used in situations that may require alterations to it.

Differential diagnosis for fixed or removable partial dentures:

Although replacement of missing teeth by means of fixed partial dentures either tooth
orimplant supported is generally the method of choice, there are many reasons why a
RPD may be better method of choice for specific patient. For example (indications for
RPD):
1. Distal Extension Situations.

2. After Recent Extractions.

3. Long Span.

4. Need for Effect of Bilateral Stabilization.

5. Excessive Loss of Residual Bone.

6. Unusually Sound Abutment Teeth.

7. Abutments with Guarded Prognoses.

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8. Economic Considerations. Differential diagnosis for fixed or removable partial dentures: Although
replacement of missing teeth by means of fixed partial dentures either tooth or implant supported is generally
the method of choice, there are many reasons why a RPD may be better method of choice for specific patient.
For example (indications for RPD): 1. Distal Extension Situations. 2. After Recent Extractions. 3. Long Span. 4.
Need for Effect of Bilateral Stabilization. 5. Excessive Loss of Residual Bone. 6. Unusually Sound Abutment Teeth.
7. Abutments with Guarded Prognoses. 8. Economic Considerations.

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Lec.3 Mouth Preparation for Removable Partial Denture

Mouth preparation follows the preliminary diagnosis and the development of a tentative
treatment plan. In general, mouth preparation includes procedures in four categories: (1)
oral surgical preparation, (2) conditioning of abused and irritated tissues, (3) periodontal
preparation, (4) and preparation of abutment teeth. The objectives of the procedures
involved in all four areas are:

1. To return the mouth to optimum health.

2. To eliminate any condition that would be detrimental to the success of the RPD.

Naturally, mouth preparation must be accomplished before the impression procedures

are performed that will produce the master cast on which the RPD will be fabricated.

The longer the interval between the surgery and the impression procedure, the more
complete the healing and consequently the more stable the denture-bearing areas. If
possible, at least 6 weeks, and preferably 3 to 6 months, should be provided between
surgical and restorative dentistry procedures.

- Oral Surgical Preparation

A variety of oral surgical techniques can prove beneficial to the clinician in preparing the
patient for prosthetic replacements. The important consideration is that the patient should
not be deprived of any treatment that would enhance the success of the RPD.

1.Extractions: Extraction of nonstrategic teeth that would present complications or those

that may be detrimental to the design of the removable partial denture is a necessary part
of the overall treatment plan.

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2.Removal of residual roots: Generally, all retained roots or root fragments should be
removed. This is particularly true if they are in close proximity to the tissue surface, or if
associated pathologic findings are evident.

3.Impacted teeth: All impacted teeth, including those in edentulous areas, as well as those
adjacent to abutment teeth, should be considered for removal. Early elective removal of
impactions prevents later serious acute and chronic infection with extensive bone loss.

4.Malposed teeth: The loss of individual teeth or groups of teeth may lead to extrusion,
drifting, or combinations of malpositioning of remaining teeth. In most instances, the
alveolar bonesupporting extruded teeth will be carried occlusally as the teeth continue to
erupt. In such situations, individual teeth or groups of teeth and their supporting alveolar
bone can be surgically repositioned.

5.Cysts and odontogenic tumors: Panoramic radiographs of the jaws are recommended to
survey the jaws for unsuspected pathologic conditions. All radiolucencies or radiopacities
observed in the jaws should be investigated.

6.Exostoses and tori: The existence of abnormal bony enlargements should not be
allowed to compromise the design of the RPD. Although modification of denture design
can accommodate for exostoses, more frequently this results in additional stress to the
supporting elements and compromised function. The removal of exostosis and tori is not
a complex procedure, and the advantages to be realized from such removal are great in
contrast to the deleterious effects that their continued presence can create. RPD
components in proximity to this type of tissue may cause irritation and chronic ulceration.

7.Hyperplastic tissue: Hyperplastic tissues are seen in the form of fibrous tuberosities,
soft labby ridges, folds of redundant tissue in the vestibule or floor of the mouth, and
palatal

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8.Muscle attachments and frena: As a result of the loss of bone height, muscle
attachments may insert on or near the residual ridge crest.

9.Bony spines and knife-edge ridges: Sharp bony spicules should be removed and
knifelike crests gently rounded. These procedures should be carried out with minimum
bone loss. If, however, the correction of a knife edge alveolar crest results in insufficient
ridge support for the denture base, the dentist should restore the vestibular deepening.

10.Osseointegrated devices: A number of implant devices to support the replacement of

teeth have been introduced to the dental profession. These devices offer a significant
stabilizing effect on dental prostheses through a rigid connection to living bone

- Conditioning of Abused and Irritated Tissues

Many RPD patients require some conditioning of supporting tissues in edentulous areas
before the final impression phase of treatment begins. Patients who require conditioning
treatment often demonstrate the following symptoms:

1. Inflammation and irritation of the mucosa covering denture-bearing areas.

2. Distortion of normal anatomic structures, such as incisive papillae and rugae,

3. A burning sensation in residual ridge areas, the tongue, and the cheeks and lips.

-fitting or poorly occluded RPD. So

these conditions should be treated before relining or making a new RPD.

treatment procedure includes good, home care by:

1. Rinsing the mouth three times daily with prescribed saline solutions.

2. Massaging the residual ridge area, palate and tongue with a soft tooth brush.

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3. Removing the prosthesis at night.

4. Using a prescribed therapeutic multiple vitamins along with a prescribed high protein
low carbohydrate diet.

The tissue conditioning materials are elastopolymers that continue to flow for an
extended period, permitting distorted tissues to rebound and assume their normal form.
These soft materials apparently have a massaging effect on irritated mucosa, and because
they are soft, occlusal forces are probably more evenly distributed.

- Periodontal Preparation:

riodontal preparation of the moth usually follows any oral surgical procedure and is
performed simultaneously with tissue conditioning procedures. It is strongly
recommended that a gross debridement be performed before tooth extraction when
patients present with significant calculus accumulation. This helps limit the possibility of
accidentally dislodging a piece of calculus into the extraction socket, which could lead to
an infection.

any situation, periodontal therapy should be completed before restorative dentistry

procedures are begun for any dental patient. This is particularly true when a RPD is
contemplated because the ultimate success of this restoration depends directly on the
health and integrity of the supporting structures of the remaining teeth.

- Preparation of abutment teeth:

After surgery, periodontal treatment, endodontic treatment, and tissue conditioning of the
arch involved, the abutment teeth may be prepared to provide support, stabilization,
reciprocation, and retention for the RPD. Rarely, if ever, is the situation encountered in

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which alterations of the abutment are not indicated because teeth do not develop with
guiding planes, rests, and contours to accommodate clasp assemblies.

Classification of abutment teeth preparation:

1. Those abutment teeth that require only minor modification to their coronal portion and
they include:

A. Teeth with sound enamel.

B. Teeth with small restorations not involved in the RPD design.

C. Teeth with acceptable restorations that will be involved in the RPD design.

D. Teeth that have existing crown restorations requiring minor modification that will not
jeopardize the integrity of the crown. They may exist as an individual crown or as the
abutment of a fixed partial denture.

2. Those that are to have restoration other than crowns.

3. Those that are to have crowns (complete coverage).

Sequence of Abutment Preparations on Sound Enamel or Existing

Restorations:

It should be done in the following order:

1. Proximal surfaces parallel to the path of placement should be prepared to provide

guiding planes.

Guiding planes should be longer (occlusogingivally) for tooth supported than for
distal extension prostheses .Proximal guiding planes for all tooth-supported
prostheses should be approximately one half –two thirds the length of the

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occlusogingival dimension of the coronal enamel. The guiding plane should extend
from the marginal ridge cervically. Guiding planes on teeth that serve, as
abutments for distal extension prostheses should be one- third to one half the
occlusocervical dimension of the coronal dimension of the coronal enamel.

 From an occlusal view, guiding planes on proximal tooth surfaces may be slightly
curved buccolingually to more or less follow the natural tooth contour.
Buccolingually, guiding planes on proximal tooth surfaces should be about two-
thirds as wide as the distance between the buccal & lingual cusp tips.

2. Tooth contours should be modified, lowering the height of contour so that:

a. The origin of circumferential clasp arms may be placed well below the occlusal
surface, preferably at the junction of the middle and gingival thirds.

b. Retentive clasp terminals may be placed in the gingival third of the crown for better
esthetics and better mechanical advantage.

c. Reciprocal clasp arms may be placed on and above a height of contour that is no higher
than the cervical portion of the middle third of the crown of the abutment tooth.

Survey lines can be modified by

1.Changing the tilt of the diagnostic cast
2.Selectively grinding the tooth
3.Placing an appropriate cast restoration
4.Placing an enamel bonded resin veneer.

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When survey lines are modified by tilting the diagnostic cast ,the survey lines on all
abutment teeth are affected.One cannot alter the survey lines on one abutment tooth by
tilting the diagnostic cast without affecting the survey line on all other abutment teeth.
Tooth alterations by selective grinding are often necessary to achieve acceptable survey
lines for appropriate clasp placement.
Survey lines can be lowered but not raised by selective grinding. When survey lines are
extremely high & the degree of undercut is severe, teeth are often selectively ground to
lower the survey line,thus reducing the degree of undercut so that the retentive arm tip
can be placed more gingivally.

Selective grinding procedures to modify survey lines should be accomplished within the
thickness of the enamel.
It is not generally possible to raise a survey line on natural tooth structure by selective
grinding.The amount of enamel that would have to be removed to effectively raise a
survey line would undoubtedly expose the dentin.

 Changing survey lines by placing an appropriate cast restoration.

-When survey line on an abutment tooth needs to be changed significantly to meet
design requirements ,a cast restoration may be employed.
 Creating an acceptable undercut for clasp retention with an enamel bonded resin
veneer:

-When the enamel of an abutment tooth is sound but presents an inadequate survey
line relative to the chosen path of placement & removal ,the survey line may be
appropriately changed by veneering an enamel bonded resin to a portion of the enamel
surface.This technique of changing a survey line is generally employed to enhance an
inadequate undercut

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3. After alterations of axial contours are accomplished and before rest seat preparations
are instituted, an impression of the arch should be made in irreversible hydrocolloid and a
cast formed in a fast-setting stone. This cast can be returned to the surveyor to determine
the adequacy of axial alterations before proceeding with rest seat preparations. If axial
surfaces require additional axial recontouring, this can be performed during the same
appointment and without compromise.

4. Occlusal rest areas should be prepared that will direct occlusal forces along the long
axis of the abutment tooth. Mouth preparation should follow the RPD design that was
outlined on the diagnostic cast at the time the cast was surveyed and the treatment plan
confirmed. Proposed changes to abutment teeth should be made on the diagnostic cast
and outlined in colored pencil to indicate the area, amount, and angulation of the
modification to be done.

The procedure of rest seat preparation on sounds enamel surface:

1. Round bur No.8 used to lower the marginal ridge and establish the outline of the
rest seat.

2. Round bur No. 6 used to slightly deepen the floor of the rest seat, this provides for an
occlusal rest that satisfied the requirements (the rest placed so that any occlusal force will

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be directed axially and that there will be the least possible interference to occlusion with
the opposing teeth).

3. The floor of the rest seat should incline toward the center of the tooth so that the
occlusal, forces are centered over the root apex.

4. The marginal ridge must be lowered so that the angle formed by the occlusal rest with
the minor connector will be less than 90 ͦ , also sufficient bulk must be provided to
prevent a weakness in the occlusal rest at the marginal ridge, The marginal ridge must be
lowered and yet not be deepest part of the rest preparation.

Basic for Occlusal Rest Seat Preparation:

 Location: mesial or distal fossa of the occlusal surface of molars & premolars.

 Outline: spoon shaped.It also resembles a printed U that has been spread apart
slightly at its open end.

 Width: at the marginal ridge should be one half-two thirds the distance b/w the
tips of the buccal & lingual cusps.

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 The deepest portion of the rest seat is located in the fossa area away from the
marginal ridge.

 This concave area is called the positive seat.

 It should be 0.5-1.0mm deeper than the general base of the rest seat.

 The base of the rest seat should be at right angles to or should make an acute angle
with the long axis of the abutment tooth.

Assessment of the adequacy of occlusal rest seats:

The adequacy of occlusal rest seats can & should be checked before the impression for
the master cast is made.

 visual inspection

 direct tactile contact

 by making wax imprints or patterns

 by making an impression to create a diagnostic cast.

Incisal Rest Seat:

 Location: On the incisal edge of anterior teeth .

 Minimum depth - 1.5 mm, Width-2.5 mm

 Mesiodistally: rest should be Concave.

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 They may be used on any anterior tooth if they can be employed without
interfering with the existing occlusion.They may be safely employed on anterior
teeth that have adequate bony support.Major disadvantage –aesthetics

 An alternative to placing an incisal rest is the use of a resin bounded cast

restoration.

 From an incisal view the axial wall should flare lingually. This will provide an
extra bulk of metal for strength without increasing the display of metal from labial
view.

Incisal Hook Rest Seat:

 Prepared as a modification of incisal rest seat.Most often used on

mandibular canines.their preparation extends 1.5 –2.0 mm onto the
labial surface of the tooth as a concave depression.

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 It provides greatest stability than the incisal rest.Disadvantage-Greater metal

display.The incisal rest seat and the incisal hook rest seat are very similar when
viewed from the labial and incisal aspects.The only difference is that the incisal
hook rest seats extend on to the labial surface for an additional 1.5 –2.0 mm as a
concave depression.

Proximal incisal rest seat on maxillary canines

Usually employed when the anterior teeth have a deep vertical overlap and
canine is located adjacent to an edentulous space

Cingulum Rest Seat:

Should follow general contour of the cingulum. No.2 or 4 round diamond

instruments. The base of the rest seat should be placed about 1mm cervical to
the height of the cingulum. The preparation can be finished with a rounded
point cylindric diamond instrument.

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From the lingual view the cingulum rest seat should follow the natural
contour of the cingulum & slope cervically as the preparation approaches the
mesial and distal line angles of the tooth.
From the proximal view the base of the rest seat is concave or U shaped. Care
must be exercised so that there are no undercuts on the lingual axial wall. The
rest seat should be 1.0-1.5 mm deep.

Lingual Ledge Rest Seat:

Usually employed on anterior teeth without a cingulum or on anterior teeth
with a cingulum that is not sufficiently prominent to accommodate the
cingulum rest preparation. The most satisfactory lingual rest seats are placed
on cast restoration,where the ledge can be made wider and the rest can be
located more cervically to avoid occlusal interferences

Width 1-1.5mm at the central portion of the lingual surface & tapers to
blend with mesial and distal line angles of the tooth.

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- Lingual ledge rest seats are prepared with a cylindric,wheel shaped,or
inverted-cone carborandum stone or diamond instruments.

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Lec:5 Impression materials and techniques for RPD
Making the master impression for fabrication of a removable partial denture (RPD)
prosthesis is accomplished once the remaining teeth in the partially edentulous arch have
been modified. The modifications, including intracoronal and extracoronal restorations
and/or enameloplasty to enhance extracoronal contours, should follow the treatment plan
derived after careful analysis, design, and prescription for the prosthesis.
Classification of impression technique

1. PRIMARY IMPRESSION

An impression made for the purpose of diagnosis or for the construction of a tray.

2. Secondary or definitive impression

An imprint that record the entire functional denture bearing area to ensure maximum
support, retention and stability for the denture during use.Primary purpose to record
accurately the tissues of the denture bearing areas,in addition to recording functional
width and depth of the sulci.

Secondary impression CLASSIFIED INTO:-

1. Conventional techniques

2. Selective pressure techniques

3. Functional techniques

4. Reline and rebases techniques

Conventional technique also known as Anatomical or Mucostatic

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impression techniques:-the surface contour of the ridge is recorded at itsresting form (no
occlusal load) (soft or less viscous alginate impression material)

Disadvantages: In free end saddle dentures, distal end will show tissue ward movement
under occlusal recommended for tooth supported partial dentures Kennedy class III and
IV these are bounded saddles.

Selective pressure technique

Techniques to achieve selective pressure impression Kennedy Class I. Altered cast

technique

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Functional dual impression technique or Applegate

Selection of impression material

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It is important to make an accurate impression in order to ensure the accuracy of the
resulting master cast. The elastomeric impression materials available for use for the final
impression include a range of materials from irreversible hydrocolloid (alginate) to
vinylpolysiloxane or polyether impression materials. The range of choices varies
according to the preference of the clinician.

Impression material

1. Rigid Impression material

a. Plaster of Paris

Now elastic materials have completely replaced the impression plaster, Modified
impression plasters are used by many dentists to record maxillomandibular relationships.
Also used for recording impression of edentulous area without under cut.

b. Metallic Oxide Paste

They are not used as primary impression materials and should never be used for
impressions that include remaining natural teeth. They are also not to be used in stock
impression trays.Metallic oxide pastes, being rigid substances, can be used as secondary
impression materials for complete dentures and for extension base edentulous with
custom acrylic impression tray which has being properly designed and attached to the
partial denture framework.

Metallic oxide pastes can also be used as an impression material for relining distal
extension denture base
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2. Thermo-plastic impression material

It cannot record minute details accurately because they undergo permanent distortion
during with drawl from undercut

Modeling Plastic

This material is most often used for border correction (border molding) of custom
impression trays for Kennedy Class I and II removable partial denture bases.

Modeling plastic is manufactured in two different colors the red (red-brown) material in
cake form record impression for edentulous area & green modeling plastics are
obtainable in stick form for use in border molding an impression

Impression Waxes and Natural Resins

use in recording the functional or supporting form of an edentulous ridge. The impression
waxes also may be used to correct the borders of impressions made of more rigid
materials

3. Elastomeric impression Materials include the following

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1. Polysulphide

2. Polyether

3. Silicone

a. Additional polymerizing silicone

b. Condensation polymerizing silicone.

polysulphide Impression Material used for removable partial denture impressions and
especially for secondary corrected or altered cast impression

Reversible Hydrocolloids (agar-agar):-

1. It is used primarily as impression materials for fixed restorations. They

demonstrate acceptable accuracy when properly use

2. Fluid at high temp and gel on reduction temperature

3. Acceptable accuracy when properly used.

4. border control of impressions made with these materials is difficult

Main use is in fabrication of refractory cast in duplication procedure.

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It required special equipment (cooling tray) if being used as an intra-oral impression
material.

Irreversible hydrocolloid

1. Irreversible hydrocolloids are used for making diagnostic casts, orthodontic treatment
casts, and master casts for removable partial denture.

2. Dimensionally unstable, it can be used in presence of moisture are hydrophilic;

3. A pleasant taste and odor; and are nontoxic, no staining.

4. These material have allow strength provide less surface details than other material

Differences between reversible and irreversible hydrocolloid

The principal differences between reversible and irreversible hydrocolloids are as

follows:

1. Reversible hydrocolloid converts from the gel form to a sol by the application of heat.
It may be reverted to gel form by a reduction in temperature. This physical change is
reversible.

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2. Irreversible hydrocolloid becomes a gel via a chemical reaction as a result of mixing
alginate powder with water. This physical change is irreversible.

use of irreversible hydrocolloid material — alginate — has been advocated based on

multiple factors such as: the material is used widely in most dental practices, there is ease
of handling and manipulation by support personnel, and it is relatively inexpensive and
does not require special equipment in the office in most instances.

The key disadvantage in use of this material relates to the handling characteristics, in that
there is a relatively short time period in which the material is accurate. The short period
of time for predictable accuracy of alginate is based on the physical properties such as
syneresis; the loss of fluid occurs in a short period of time and can affect the accuracy of
the master cast. If managed properly, alginate impression material is cost ‐ effective when
pouring the master cast can be accomplished immediately after the impression is removed
and disinfected. This implies the master cast is poured in the office in a timely fashion —
less than 12 – 14 minutes from removal — rather than shipping the impression to an off ‐
site dental laboratory for fabrication of the master cast at a later time.

The vinylpolysiloxane or polyether impression materials may be the impression material

of choice since under the right conditions, either maintains accuracy for a longer period
of time when compared to alginate impression material. The ultimate goal is to obtain an
accurate cast for fabrication of a removable partial denture prosthesis.

Important Precautions to Be Observed in the Handling of Hydrocolloid Impressions

1. Impression should not be exposed to air because some dehydration will inevitably
occur and result in shrinkage.

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2. Impression should not be immersed in water or disinfectants, because some imbibition
will inevitably result, with an accompanying expansion

3. Impression should be protected from dehydration by placing it in a humid atmosphere

or wrapping it in a damp paper towel until a cast can be poured.

To prevent volume change, this should be done within 15 minutes after removal of the
impression from the mouth

4. Exudates from hydrocolloid have a retarding effect on the chemical reaction of gypsum
products and results in a chalky cast surface. This can be prevented by pouring the cast
immediately or by first immersing the impression in a solution of accelerator, if an
accelerator is not included in the formula.

STEPS IN IMPRESSION MAKING

a. Position of patient & dentist (Dentist should stand & patient should sit upright)

b. Tray selection

c. Mixing the material & loading into the tray

d. Impression making & removal

e. Inspecting, cleaning & disinfecting the impression

Occlusal plane should be parallel to the floor

MAXILLARY IMPRESSION- dentist should stand at the right rear of the patient.

MANDIBULAR IMPRESSION- dentist should stand at the right front of the patient.

Tray selection

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The choice of an impression tray can include stock impression trays both made of metal
or the more rigid plastics available. The use of rigid plastic impression trays can be
advantageous since most are intended to be disposable and do not require additional
dental assistant time for cleaning after use. Stock impression trays are available as rim ‐
lock or other mechanical retention design such as perforated trays, and both can be
modified for use intraorally to meet the anatomical features of the patient.

The prime consideration in tray selection is to choose one with the absolute rigidity that
must be afforded by the tray material.

The step-by-step procedure and important points to observe in the making of a

hydrocolloid impression are as follows:

1. Select a suitable, sterilized, perforated or rim-lock impression tray that is large enough
to provide a 2- 4 to -mm thickness of the impression material between the teeth and
tissues and the tray.

2. Build up the palatal portion of the maxillary impression tray with wax or modeling
plastic to ensure even distribution of the impression material and to prevent the material
from slumping away from the palatal surface. At this time, it is also helpful to pack the
palate with gauze that has been sprayed with a topical anesthetic. This will serve to
anesthetize the minor salivary glands and mucous glands of the palate and thus prevent
secretions as a response to smell or taste or to the physical presence of the impression

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material. If gelation occurs next to the tissues while the deeper portion is still fluid, a
distorted impression of the palate may result, which cannot be detected in the finished
impression. This may result in the major connector of the finished casting not being in
contact with the underlying tissues. The maxillary tray frequently has to be extended
posteriorly to include the tuberosities and the vibrating line region of the palate. Such an
extension also aids in correctly orienting the tray in the patient’s mouth when the
impression is made.

3. The lingual flange of the mandibular tray may need to be lengthened with wax in the
retromylohyoid area or to be extended posteriorly, but it rarely ever needs to be
lengthened elsewhere. Wax may need to be added inside the distolingual flange to
prevent the tissues of the floor of the mouth from rising inside the tray.

4. Place the patient in an upright position, with the arch to be impressed nearly parallel to
the floor.

5. When irreversible hydrocolloid is used, place the measured amount of water (at 70°F)
in a clean, dry, rubber mixing bowl (600-mL capacity). Add the correct measure of
powder. Spatula move rapidly against the side of the bowl with a short, stiff spatula. This
should be accomplished in less than 1 minute. The patient should rinse his or her mouth
with cool water to eliminate excess saliva while the impression material is being mixed
and the tray is being loaded.

6. In placing the material in the tray, avoid entrapping air. Have the first layer of material
lock through the perforations of the tray or rim-lock to prevent any possible dislodgment
after gelation.

7. After loading the tray, remove the gauze with the topical anesthetic and quickly place
(rub) some of the impression material on any critical areas using your finger (areas such

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as rest preparations and abutment teeth). If a maxillary impression is being made, place
the material in the highest aspect of the palate and over the rugae.

8. Use a mouth mirror or index finger to retract the cheek on the side away from you as
the tray is rotated into the mouth from the near side.

9. Seat the tray first on the side away from you, next on the anterior area, while reflecting
the lip, and then on the near side, with the mouth mirror or finger for cheek retraction.
Finally, make sure that the lip is draping naturally over the tray.

10. Be careful not to seat the tray too deeply, leaving room for a thickness of material
over the occlusal and incisal surfaces.

11. Hold the tray immobile for 3 minutes with light finger pressure over the left and right
premolar areas. To avoid internal stresses in the finished impression, do not allow the tray
to move during gelation. Any movement of the tray during gelation will produce an
inaccurate impression.If, for example, you allow the patient or the assistant to hold the
tray in position at any time during the impression procedure, some movement of the tray
will be inevitable during the transfer and the impression will probably be inaccurate.

Do not remove the impression from the mouth until the impression material has
completely set.

12. After releasing the surface tension, remove the impression quickly in line with the
long axis of the teeth to avoid tearing or other distortion.

13. Rinse the impression free of saliva with slurry water, or dust it with plaster, and rinse
gently; then examine it critically. Spray the impression thoroughly

with a suitable disinfectant and cover it immediately with a damp paper towel. A cast
should be poured immediately into a disinfected hydrocolloid impression to avoid

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dimensional changes and syneresis. Circumstances often necessitate some delay, but this
time lapse should be kept to a minimum. A delay of 15minutes will satisfy the
disinfection requirements and should not be deleterious if the impression is kept in a
humid atmosphere

Step-by-Step Procedure for Making a Stone Cast from a Hydrocolloid

Impression The step-by-step procedure for making a stone cast from the impression is as
follows:

1. A more abrasive-resistant type IV stone should be used to form removable partial

denture casts. Have the measured dental stone at hand, along with the designated quantity
of room temperature water, as recommended by the manufacturer. A clean 600-mL
rubber mixing bowl, a stiff spatula, and a vibrator complete the preparations. A No. 7
spatula also should be within reach.

2. First, pour the measure of water into the mixing bowl and then add the measure of
stone. Spatulate thoroughly for 1 minute, remembering that a weak and porous stone cast
may result from insufficient spatulation. Mechanical spatulation under vacuum is
preferred. After any spatulation other than in a vacuum, place the mixing bowl on the
vibrator and knead the material to permit the escape of any trapped air.

3. After removing the impression from the damp towel, gently shake out surplus moisture
and hold the impression over the vibrator, impression side up, with only the handle of the
tray contacting the vibrator. The impression material must not be placed in contact with
the vibrator because of possible distortion of the impression.

4. With a small spatula, add the first cast material to the distal area away from you. Allow
this first material to be vibrated around the arch from tooth to tooth toward the anterior

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part of the impression. Continue to add small increments of material at this same distal
area, with each portion of added stone pushing the mass ahead of it. This avoids the
entrapment of air. The weight of the material causes any excess water to be pushed
around the arch and to be expelled ultimately at the opposite end of the impression.
Discard this fluid material. When the impressions of all teeth have been filled, continue to
add artificial stone in larger portions until the impression is completely filled.

5. The filled impression should be placed so that its weight does not distort the
hydocolloid impression material. The base of the cast can be completed with the same
mix of stone. The base of the cast should be 16 to 18 mm (23 to34 inch) at its thinnest
portion and should be extended beyond the borders of the impression so that buccal,
labial, and lingual borders will be recorded correctly in the finished cast. A distorted cast
may result from an inverted impression.

6. As soon as the cast material has developed sufficient body, trim the excess from the
sides of the cast. Wrap the impression and cast in a wet paper towel, or place it in a
humidor, until the initial set of the stone has taken place. The impression is thus
prevented from losing water by evaporation, which might deprive the cast material of
sufficient water for crystallization. Chalky cast surfaces around the teeth are often the
result of the hydrocolloid’s acting as a sponge and robbing the cast material of its
necessary water for crystallization.

7. After the cast and impression have been in the humid atmosphere for 30 minutes,
separate the impression from the cast. Thirty minutes is sufficient for initial setting. Any
stone that interferes with separation from the tray must be trimmed away with a knife.

8. Clean the impression tray immediately while the used impression material is still
elastic.

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9. Trimming of the cast should be deferred until final setting has occurred. The sides of
the cast then may be trimmed to be parallel, and any blebs or defects resulting from air
bubbles in the impression may be removed. Master casts and other working casts are
ordinarily trimmed only to remove excess stone.

Possible Causes of an Inaccurate and/or a Weak Cast of a Dental Arch

The possible causes of an inaccurate cast are as follows:

1. Distortion of the hydrocolloid impression (a) by use of an impression tray that is not
rigid; (b) by partial dislodgment from the tray; (c) by shrinkage caused by
dehydration;(d) by expansion caused by imbibition (this will be toward the teeth and will
result in an undersized rather than oversized cast); and (e) by attempting to pour the cast
with stone that has already begun to set.

2. A ratio of water to powder that is too high. Although this may not cause volumetric
changes in the size of the cast, it will result in a weak cast.

3. Improper mixing. This also results in a weak cast or one with a chalky surface.

4. Trapping of air, either in the mix or in pouring, because of insufficient vibration.

5. Soft or chalky cast surface that results from the retarding action of the hydrocolloid or
the absorption of necessary water for crystallization by the dehydrating hydrocolloid.

6. Premature separation of the cast from the impression.

7. Failure to separate the cast from the impression for an extended period.

SPECIAL IMPRESSION PROCEDURES

a.Anatomic form:- The anatomic form is the surface contour of the ridge when it is not
supporting an occlusal load

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b. Functional Form of Ridge:- The functional form of the residual ridge is the surface
contour of the ridge when it is supporting a functional load

Procedure

A custom impression tray is constructed over a preliminary cast

Functional impression of distal extension ridge is made. Patient applies some biting force
with occlusion rims Then an Alginate impression is made with the 1st impression held in
its functional position with finger pressure

Mc LEAN’S PHYSIOLOGIC IMPRESSION

HINDEL’S MODIFICATION

Main difference of this with Mc Lean’s is that

o impression of edentulous ridge is not made under pressure but is an anatomic

impression made at rest with ZOE paste.

o As the hydrocolloid impression was being made finger pressure was applied through
holes in the tray to the anatomic impression.

Disadvantages of these methods

Constantly compressed residual ridge is prone to excessive bone resorption.

If the clasp do not hold the partial denture, the denture will be pushed slightly
occlusally by the tissue causing premature contacts (TISSUE REBOUND)

Polyether Impression Materials:

1. hydrophilic, which produces good wetability for easy cast forming.

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2. They have low to moderate tear strength and much shorter working and setting
times, which can limit the usefulness of the material.

3. The flow characteristics and flexibility are the lowest of any of the elastic
materials.

4. They are thixotropic, which provides good surface detail and makes them useful as
a border molding material.

5. The stiffness of the material can result in cast breakage

Silicone Impression Materials

• more accurate and easier to use than the other elastic impression materials.

• condensation silicone and addition silicone.

A.Condensation Silicone

• moderate (5 to 7 minutes) working time

• pleasant odor.
• moderately high tear strength, and excellent recovery from deformation.
• can be used with a compatible putty material to form fit a custom tray.

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• hydrophobic,
• can be disinfected in any of the disinfecting solutions
• Ideally, these materials should be poured within 1 hour.
• Byproduct Water

B. Addition Silicone

• are the most accurate of the elastic impression materials.

• less polymerization shrinkage.
• Low distortion.
• Fast recovery from deformation.
• Moderately high tear strength.
• working time of 3 to 5 minutes.
• available in both hydrophilic and hydrophobic forms.
• Have no smell or taste, and also come in putty form.
• expensive than the other elastic impression materials.

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The Recommended Infection Control Practices for Dental

Treatment

1. Gloves should be worn in treating all patients.

2. Masks should be worn to protect oral and nasal mucosa from splatter of blood and
saliva.

3. Eyes should be protected with some type of covering to protect from splatter of blood
and saliva

4. Sterilization methods known to kill all life forms should be used on dental instruments.
Sterilization equipment includes steam autoclave, dry heat oven, chemical vapor
sterilizers, and chemical sterilants.

5. Attention should be given to cleanup of instruments and surfaces in the operatory. This
includes scrubbing with detergent solutions and wiping down surfaces with iodine or
chlorine (diluted household bleach solutions).

6. Contaminated disposable materials should be handled carefully and discarded in plastic

bags to minimize human contact. Sharp items, such as needles and scalpel blades, should
be contained in puncture-resistant containers before disposal in the plastic bags.

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Lec.6 Metal Try In and Occlusal Records for RPD

Fitting the RPD framework:

After finishing of the laboratory steps for Chrome cobalt (Cr/Co) framework, it is tried in
the patient’s mouth. The fit of the framework is tried first on the master cast and then
inside the patient’s mouth. The framework should sit passively on the master cast without
wedging or impingement on the abutment teeth.

A. Laboratory inspection
The Cr/ Co framework must be checked on the master cast for the following:

1. The framework must confirm the original design.

2. Rests must be completely seated in the corresponding rest seat.

3. Lingual plate should be closely adapted to the surface of the cast.

4. The tissue surface of the framework should exhibit a fine matt texture. This surface
should not be highly polished.

5. The external surface of the framework should be extremely smooth and should be
polished to a high shine.

6. All surfaces should be checked for nodules, which may produce discomfort and
prevent complete seating of the framework.

7. Internal finish lines should be sharply defined.

8. External finished lines should be sharply defined and with slight undercut to permit
improved retention of acrylic resin denture base.

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9. Finger pressure should be applied to both side of the framework simultaneously.

The framework should be rigid enough to resist flexure. If not fully seated, the internal
surface of the framework should be painted with a disclosing medium such as disclosing
wax, fit checking spray or pressure indicating paste. The framework should then be
seated on the master cast using firm pressure. After removing the framework from the
cast, it should be inspected under magnification for indication of internal high spots or
frictional discrepancies as detailed by the disclosing medium. Adjustments are
accomplished as needed until the metal casting is completely seated.

B.Clinical procedures

Once the framework is fitted to the master cast, the casting or framework is ready for
clinical try-in which involves the following steps:

1. Don’t use excessive force to seat the framework immediately. Gradual seating of the
framework to check interference. The framework must go into place in a smooth
manner without binding or catching the abutment teeth.
 A framework that fits the master cast but not the mouth indicates that the
master cast is inaccurate and a new impression should be made to initiate the
remake of the framework.

2. Interference could be indicated by using pressure indicating paste or disclosing wax.

3. Remove internal interferences use a multifluted finishing bur in a high speed handpiece
until the framework is fully seated into the rest preparations.

4. Once seated, it should be inspected for complete stability. The casting or framework
should fit passively without rocking. All components should be checked with
magnification for close adaptation to the teeth and tissues.

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5. Use articulating paper to check if there are premature contacts (high spots) on
occlusion which should be adjusted when needed.

Occlusal evaluation

The framework should then be evaluated for clearance during patient articulation.
Initially, remove the framework from the patient’s mouth and ask him or her to occlude.
Analyze the bite closely, and observe whether opposing cusps fit into wear facets or if
opposing canines fully articulate together. If open spaces are observed, the framework is
elevated in occlusion and must be adjusted. When both maxillary and mandibular
frameworks are being tried, they should be done individually before they are done
together. Common areas of occlusal interferences are on rest seats, clasp shoulders, and
minor connectors. Thin articulating marking paper, or disclosing wax can be used to
discern high spots on the metal frame. Often it is difficult to mark and visualize highly
polished areas, so a matte finish with micro - abrasion may be desired in these occluding
areas. Disclosing wax can also be easily visualized when used to check occlusion

 Metal calipers should be used routinely after adjustments to ensure at least 1.5 mm
thickness of metal remains along rest seat, clasps, and minor connectors. Metal
less than 1.5 mm in thickness will likely fracture or deform under function and the
framework must be remade or repeated.
 When there are maxillary and mandibular frameworks are to be tried-in, each one
should be tried-in alone and any interference or high spot should be removed then
the two are checked together inside patient’s mouth.
 After try-in, the framework is forwarded to the laboratory for the fabrication of
the special tray for altered cast technique (in case of class I or II Kennedy) or for
the fabrication of the record base and occlusion rim.

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Occlusion and occlusal relationships in RPD:
The fourth phase in the treatment of patients with removable partial dentures is the
establishment of a functional and harmonious occlusion. Occlusal harmony between
the RPD and the remaining natural teeth is a major factor in the preservation of the
health of the oral structures and that the remaining natural teeth have the main
influence on the arrangement of artificial teeth; this means that in establishing
occlusion on RPD, the artificial teeth must be made to follow an already established
occlusal pattern in patient’s mouth (occlusion of the natural teeth).

One of the most important criteria of the successful RPD is a stable denture which
will cause fewer undesirable changes in its supporting structures. Occlusion is one of
the most important factors in developing a stable RPD.

To establish a satisfactory occlusion for RPD, the following should be made (criteria
for occlusal relationship in RPD):

1. Analysis of the existing occlusion.

2. Correction of the existing occlusal disharmony.

3. Recording of the centric relation.

4. Recording of the eccentric jaw relation (protrusive and laterotrusion- right and left
lateral movement-)

5. Correction of occlusal discrepancies created by the fit of the framework and during
processing of the denture.

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Desirable occlusal contact relationship for various RPDs:

1. Simultaneous bilateral contacts of opposing posterior teeth must occur in centric

occlusion.

2. Occlusion for tooth supported RPD may be arranged similar to the occlusion seen
in harmonious natural dentition, since stability of such RPDs results from the effect
of the direct retainers at both ends of the denture base.

3. Bilateral balanced occlusion in eccentric positions should be formulated when a

maxillary complete denture opposes the removable partial denture. This is
accomplished primarily to promote the stability of the complete denture.

4. Working side contacts should be obtained for the mandibular distal extension
denture. These contacts should occur simultaneously with working side contacts of
the natural teeth to distribute the stress over the greatest possible area. Masticatory
function of the denture is improved by such an arrangement.

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5. Simultaneous working and balancing contacts should be formulated for the
maxillary bilateral distal extension RPD (Kennedy Class I) whenever possible.

6. Only working contacts need to be formulated for the maxillary or mandibular

unilateral distal extension removable partial denture (Kennedy Class II). Balancing
side contacts would not enhance the stability of the denture because it is entirely tooth
supported by the framework on the balancing side.

7. In the Kennedy Class IV RPD, contact of opposing anterior teeth in the planned
intercuspal position is desired to prevent continuous eruption of the opposing natural
incisors, unless they are otherwise prevented from extrusion by means of a lingual
plate or auxiliary bar, or by splinting.

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8. Artificial posterior teeth should not be arranged farther distally than the beginning
of a sharp upward incline of the mandibular residual ridge or over the retromolar pad.
To do so would have the effect of shunting the denture anteriorly.

9. Artificial posterior teeth should be smaller buccolingually than the natural teeth.

Summary of occlusal relationships for different scenarios of RPD cases:

Recording jaw relationships for RPD:

For the purpose of registration of jaw relationships, partially edentulous patients can
be divided into two categories:

 Patients without any occlusal stop to indicate the correct intercuspal position or
vertical dimension of occlusion.

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 Patients with occlusal contact in the intercuspal position or vertical dimension
of occlusion.

Methods for establishing jaw relations for removable partial denture (RPD):

1. Direct apposition of the cast (hand articulation): Casts are held in maximum
intercuspation position. It is indicated when there are sufficient opposing teeth
and few occlusal abnormalities. This is done by occluding the opposing casts by
hand and held in position by using wax to make sure the casts are secured in their
relationship before mounting them on articulator.

2. Interocclusal records with posterior teeth remaining: Indicated when there are
sufficient natural teeth remaining to support the RPD (Kennedy Class III or IV), but
the relation of the opposing teeth doesn’t permit the recording of the cast by hand
articulation. In such situation, jaw relation must be established as for fixed
restorations using some kind of interocclusal record (bite registration materials).

 These may include: interocclusal wax; quick setting impression plaster;

metallic oxide bite registration pastes; and elastomeric materials.

A uniformly softened metal reinforced wafer of base plate wax or Aluwax is placed
between the teeth and the patient is guided to close in centric relation. Then the wax is
removed and chilled immediately to room temperature and then placed again in the

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patient’s mouth to correct the distortion from chilling, any excess wax is removed and
then place the interocclusal record on the casts to gain the same occlusal relationship.
Positioned wax record should not contact the mucosa and is further corrected by free
flowing metal oxide paste.

3. Occlusal relations using occlusion rims on record base: indications:

 When there is unilateral or bilateral distal extension areas.

 When a tooth-supported edentulous space is large (long bounded spans).
 When opposing teeth don’t meet.

In these cases occlusion rims on accurate bases are used. Place a layer of modeling
wax of about 2mm depth on the occlusal surface of the rim opposes the standing teeth
and the wax is thoroughly softened then the rim is seated in the mouth and the
mandible guided carefully into closure until maximal intercuspal contact for natural
teeth occurs.

4. Jaw relation records made entirely on occlusal rims: indicated in case of:

 Maxillary complete denture opposing mandibular RPD.

 When there are few remaining teeth which don’t occlude with each other.
 Only anterior teeth present in both arches.

Here the method for recording jaw relation is the same as that for complete dentures. We
can use the metal framework as a base plate on which the occlusal bite rims are

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constructed. The use of face bow, the type of articulator and eccentric records are
optional according to the training ability of the dentist and his/her desire (their use is
essential in case of bilateral balance occlusion).

5. Establishing occlusion by the recording of occlusal pathway: In this method the

framework (after checking it inside patient’s mouth) is used to register occlusal pathway.
In this way a hard inlay wax is placed over the denture base and the patient is asked to
keep his metal framework with the wax in his mouth for more than 24 hours to register
all jaw movements during this time. The patient should wear it even at night and remove
it from his mouth during meals. \

Note1: We need three widely separated tripod points of occlusal contact to relate the two
casts accurately. These contact points may be tooth to tooth or tooth to interocclusal
recording material.

Note2: a stable orientation of the opposing casts may exist if sufficient teeth remain and
in those patients no need for interocclusal relation recording (direct cast positioning is
done).

Materials used as interocclusal records are: (1) ZnO Eugenol imp material. (2) Plaster
impression material. (3) Molding compounds. (4) Polyether. (5) Polyvinyl siloxane. (6)
Wax; wax records made in edentulous areas with or without the support of record bases
may not be sufficiently stable to be acceptable.

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The interocclusal recording is most often made after fabrication of the RPD framework.
Following the fitting of the framework and making of a corrected cast impression (if
indicated), the record base is fabricated on the edentulous areas. Occlusion rims are
added, and an occlusal recording material is used to record the jaw relation using the
technique that is suitable to the patient’s situation. The casts will be mounted on the
dental articulator, and desired denture teeth are selected. Then, the patient will be prepare
for the next visit which will be try in of RPD.

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