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The Lower Free End Saddle
(distal extension saddle)
Free end saddle dentures move. Excessive movement of the denture can cause pain, tissue damage, and complaints of instability and looseness. Patients will complain immediately about pain and instability, but tissue damage tends to be long term and irreversible, painless until it is too late. You could try to prevent a free end saddle denture from moving by ensuring the saddle area is continually under maximum loading (which will cause ischaemia) and by gripping the abutment teeth with clasps and guide planes so tightly as to allow no freedom of movement (which will put unacceptable torquing forces on them). This will not earn you the admiration of your patients, colleagues, or examiners. The art of designing a free end saddle denture involves understanding all the movements that the denture can make, and designing them into the denture so that they are hardly noticed by the patient, and cause minimal damage to the mouth.
Downward Movement of the Saddle
The free end saddle will move forwards and downwards with occlusal load, as it rotates about the abutment rest seat.
Reducing Rotational Movement of the Saddle The largest downwards movement will be at the posterior end of the saddle, where the mucosa will be maximally compressed. As you get closer to the rest- seat axis, the movement will be more horizontal. If you are very close to the axis, the movement will be completely horizontal and the mucosa may get puckered up against the abutment. Ideally, the entire saddle bearing mucosa will be evenly compressed, spreading the load equally over its whole area. This ideal is not possible, but the further away the rest-seat axis is from the saddle, the closer to ideal you will get.
To reduce rotational movement of the saddle Put the abutment rest seat mesially, to keep it as far from the saddle as possible
2 Reducing Downwards Movement Of The Saddle Assuming an even mucosal loading. the mucosa will get compressed under the saddle and. and into the sulcus. With this technique. the leverage forces will be lighter. causing less pressure on the mucosa. the saddle will sink. If you keep occlusal forces near to the rest-seat axis. ) Reducing the Force To ensure minimum mucosal displacement. they will torque the teeth. pressure can be reduced by reducing the force. or increasing the area. Put a rest on a tooth close to the saddle (but keep it mesial!) Consider leaving off the second molars. the pressure on the mucosa must be reduced (no matter how ‘even’ it is). At a gross level. the more it will sink. too much mucosal displacement will cause pain or ridge resorbtion. Use Narrow Teeth. as tissue fluid is squeezed out. Consider the Altered Cast Technique to increase the effective area. Increasing the Effective Saddle Area . Thus the saddle will sink less. the denture rocking about the rest-seats. . . Small sharp teeth will cut into food with less force needed than broad ones. More subtly. the saddle is shaped to fit the mucosa when it is under load. Pressure = Force / Area So. The abutment will pick up the extra force. (Additionally. The greater the pressure. if clasps are positioned so that their tips rise during this movement. . as the saddles sink. the less the saddle will sink. The more evenly the force is spread. . . This rocking is very irritating if there are anterior components such as indirect retainers. Avoid the buccal fraenum. casing less saddle movement. and will lead to immediate complaints. Reduce the pressure by increasing the saddle area. ensuring an even spread offorce when it is most needed. and fully extended over the buccal shelf. Share the force with a tooth. the anterior part of the denture will rise. Ensure the saddle is extended distally to cover the pear-shaped pad (half way up the retromolar pad).
e. Put the clasp tip just fractionally under the survey line so it doesn't have to swing out much. the tooth is pulled out ofits socket. deep in an undercut). the clasp tips will sink. it will push the tooth lingually.R. by using a gingivally approaching clasp ). so the abutment teeth will get torqued. When the saddle sinks. Should the tip rise. or that extrusive forces are gentle over an acceptable range of upward movement • • Ensure the most common clasp tip movement is downwards by engaging undercuts distal to the rest seat.R. and unacceptably easy displacement.R. • Where no suitable rest exists for Indirect Retention. If a lot of clasp movement is likely because of a non-ideal tip position (i. Lateral tooth movements cannot be tolerated. the answer is to either arrange the denture so that upward clasp movement is minimal. Clearly. so this is prevented with a lingual bracing arm. then it will resist displacement. Upward Movement of the Clasp Tips When a denture is at rest. However. the I. If the ideal tooth for an indirect retainer is steeply sloped (as are most anterior teeth). the displacing forces have to be absorbed somewhere. component on the incisal edge. should be a last resort. the greater the upward leverage on the clasped tooth.Upward Movement of the Saddle Guide Planes Sticky foods will move the saddle upwards. use angled guide planes. The nearer the clasp is to the Indirect Retainer. but still pretty bad. .g. You can use a more flexible material (wrought stainless steel) or make the clasp arm longer ( e. use a wrought clasp or a longer clasp. If the denture is made so it can not be moved in this direction. • In deep undercuts. to reduce leverage on the clasped tooth. but this is unsightly. component may slide down the lingual face. We assume the path of displacement is at right angles to the occlusal plane. assuming an effective clasp. • To minimise upward displacement of the saddle. by using guide planes. You must find a balance between unacceptable torquing by guide planes. create one with adhesive and composite. You could put the I. 3 Indirect Retainers These help resist upwards movement of the saddle. you should increase the clasp flexibility. which is considered preferable. Drilling a seat for I. Let's assume a very stiff buccal clasp. • Put the Indirect Retainers as far anterior to the clasped tooth as possible. but keep them short to minimise abutment torquing. the clasp tips sit passively in their undercuts. Now if the clasp rises.
If you then ease the denture occlusally so it is 'clear'.e. the pear shaped pad) will be squeezed flatter and flatter until they offer the same resistance as the stiff bits. The altered cast technique (supposedly) allows for the different compressibility of different parts of the mucosa. bruxing on the denture can cause mucosal pain. .4 Coping with the bruxist Loss of posterior teeth in a bruxist can cause occlusal problems. The denture framework must seat very positively for any hope of success -a minimum of three widely spaced rests are needed. but it could be due to rotational movement of the saddle (i. you should suspect parafunction. guess) needs to be made on how viscous the impression material should be. A clinical judgement (i. such as forward posturing and attrition of the front teeth. The cycle continues until you realise it is not the much blamed friable mucosa. but the fatty soft bits (e. .e occlusion). The stiff bits of mucosa (e. When the denture is made. if the back teeth are replaced with a denture. The technique takes no account of the different pressures applied to the mucosa as a result of saddle rotation: it assumes even force is applied along the length of the saddle. If the pain is localised.g. but more on the soft bits which can take it without suffering. . and can easily lead to too much or too little pressure. The technical procedures. it is usually the fitting surface. If a patient returns every few months for easing. over the ridge) will be hardly deformed at all. There are practical difficulties with the altered cast technique: . It is very difficult to tell whether pain is being caused by the fitting surface or the occlusion. are difficult to do well. and ensures that an even pressure is applied everywhere when force is applied. The amount of pressure exerted by the mucocompressive impression is not under measurable control to suit each patient's individual need. causing more collapse. . However. . the mucosa is permanently deformed by the denture -not much over the ridge. attrition will continue on the front teeth. The Altered Cast Technique An impression of the saddle area is taken while it is under light pressure. until the denture is 'back in the bite' and the saddle mucosa gets sore again. although easily understood. .g.
and impossible to reline. It disengages on functional load as the saddle sinks The RPI system is the logical result of considering how a free end saddle denture moves during function. It is best to reline with cold-cure acrylic at the chairside. do not let the cold-cure acrylic set in the undercuts! Off the ridge Retention If the metal substructure of the saddle rests on the ridge. to allow acrylic to flow under it when flasked. To aid trying-in. • The mesial rest is classical. To aid future relining. RPI The mesial REST is classical. The I-bar clasp is gingivally approaching. This relies on accurate positioning of the metal framework. Relining Laboratory relines of free end saddles usually disrupt the occlusion by being too thick.g.occlusal rests) the framework will rock while it is being positioned. The casting should sit lor 2mrn above the ridge. then stress breakers give the saddles a degree of I independent movement. design the framework to have a positive three-point contact with the teeth. .5 Stress Breakers . . This is useful if the abutments are poorly angled and would De torqued unacceptably by normal denture movement. • A mesial plate provides a guide plane. If there are only two good contacts (e. • A lingual clasp arm goes into the distal undercut. but is unsightly. If one prefers more force to be applied to the saddle mucosa than the abutments. While relining. Balance Of Forces . or if their periodontal support is weak. The distal PLATE provides a guide plane to resist displacement by sticky foods. ask the technician to leave a tag of metal ( called a foot ) dropped down from the mesh onto gum level. it is very difficult to ease.
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