INTRODUCTION TO REMOVABLE

PARTIAL DENTURE

Presented By: Asmita Adhikari, Pg Resident

Department Of Prosthodontics And Maxillofacial Prosthetics
Peoples’ Dental College And Hospital
08/08/2020 1
CONTENTS

• History
• Introduction
• Consequences of tooth loss
• Types of removable partial dentures
• Indications and contraindications
HISTORY
• There is historical evidence that man has been replacing
missing teeth since at least 2500 B.C.

• Tuscanny, Italy
• Beginning of the 17th century
• 5 mandibular incisor linked by golden band
and two small golden pins inserted to each
tooth to fix the teeth to internal gold band

Minozzi S, Panetta D, De Sanctis M, Giuffra V. A Dental Prosthesis from the Early Modern Age in Tuscany
(Italy). Clinical implant dentistry and related research. 2017 Apr;19(2):365-71.
 • Heister, described making a RPD by carving a block of bone
1711 to fit the mouth.
• These were focused primarily on the esthetic rather than
functional improvements offered by these prostheses.

1728 • Fauchard, described making a mandibular RPD by joining

two carved blocks of ivory together by metal labial and
lingual connectors to achieve rigidity in prosthesis.

1746 • Retentive clasps were first discussed by Mouton.

1810 • By the year 1810, Gardette of Philadelphia began using wide
wrought band clasps in an attempt to improve prosthesis
retention.
• The bands completely encircled the tooth and often
extended into the gingival sulcus.
• The destruction of the marginal gingiva and the tooth due to
constant vertical movement of the prosthesis
1810 • First description of an occlusal rest.
• Delabarre described “little spurs” and their prevention of
excessive vertical settling of the RPD and the resulting
gingival or wear issues.

• The high incidence of gross caries due to food impaction

1890 between the imprecisely fit bands and teeth was of
concern.
• Bonwill therefore advocated a change to a retentive arm
with much less vertical height instead of a band design.
• Such a dramatic reduction in clasp surface area was possible
due to Bonwill’s attention to fit, support, and stability of the
prosthesis.

• Bonwill recorded his techniques for clasping abutments with

individually contoured gold circumferential clasps that were
then soldered to "the plate" (major connector).
1913 • Roach presented a wrought wire circumferential clasp as an
improvement over the wide band clasp.

• Henrichsen mentioned the use of infrabulge clasp.

1914
INTRODUCTION
• Tooth loss is a permanent condition in that the natural order
has been disrupted, which is much like a chronic medical
condition(irreversible and requires management).

• Although Complete Edentulism has decreased, the number

of Partially edentulous individuals has increased, probably
because of increased average life span of the global
population and oral health-related prevention policies.
Source: Global Burden of Disease 2010
 Various causes attributed to tooth loss are:

Recurrent caries( 45.3%)

Periodontal diseases (6%)
Traumatic incident (10.2%)
Congenital anomalies(2.3%)
Endodontic complications

Pradhan D, Shrestha L, Dixit S, Shrestha A. Prevalence of Type of Partial Edentulousness among the Population of
Bhotenamlang, Sindhupalchowk, Nepal: An Observational Study.
• Some teeth are retained longer than others, the last
remaining teeth in the mouth are the mandibular
anterior teeth, especially the mandibular canines. Thus,
it is a common finding to see an edentulous maxilla
opposing mandibular anterior teeth.

• Interarch difference in tooth loss is seen, with maxillary

teeth demonstrating loss before mandibular teeth.

• Intra-arch difference has also been suggested, with

posterior teeth lost before anterior teeth.

Carr AB, Brown DT. McCracken's Removable Partial Prosthodontics-E-Book. Elsevier Health
Sciences; 2010 Jun 22.
Carr AB, Brown DT. McCracken's Removable Partial Prosthodontics-E-Book. Elsevier Health
Sciences; 2010 Jun 22.
Consequences of tooth loss
 Anatomical effect :

a) Residual ridge resorption :

When teeth are lost, the residual ridge lacks the functional
stimulus provided by the teeth.

Thus there is loss of ridge volume in both height and width.

The residual ridge resorption varies in different individual.

• Various results from studies have shown that horizontal
bone loss (average 3.87 mm) was more than vertical bone
loss (average 1.67 mm)

• Both horizontal and vertical bone loss have mainly been

observed at the buccal part of the residual ridge which
becomes narrower and shorter after the resorption process.
Therefore, the alveolar ridge is relocated in a more posterior
position.
• In general ,bone loss is greater in mandible than in the
maxilla and more pronounced posteriorly than
anteriorly.

• These anatomic changes can present challenges to

fabrication of prostheses.
b) Alteration of oral mucosa :
• The attached gingiva of the alveolar bone is replaced with
less keratinized oral mucosa which is more readily
traumatized.

c) Migration of teeth :
• This can be seen in form of tipping, extrusion, and rotation
& especially after the first year of the extraction.
• It has been demonstrated that supraeruption occurred in
most of the unopposed teeth, usually resulting in
periodontal attachment reduction, and is mostly observed
in the upper arch.
Active Supraeruption Supraeruption of the teeth
occurs accompanied by the
growth of the periodontal
tissues and alveolar bone
• The teeth adjacent to the extraction site have a tendency to
tip towards this side.

• While rotation of teeth mesial to the edentulous site has

been more observed in the mandible, rotation of teeth
distal to the edentulous ridge is greater in the maxilla.

• This shift may continue until the tooth encounters an

obstacle (such as other teeth or the residual ridge) and a
new occlusal balance may develop.
• After the migration of the teeth, premature contacts and
interferences may occur. Thus, pseudoprognathism and
retruded contact position interferences may develop.

• These could lead to traumatic occlusion, root and furcation

exposure, soft tissue trauma, plaque retention, and loss of
proximal contacts resulting in food impaction.
d) Enlargement of tuberosities:

• When mandibular molars are lost, maxillary teeth may

extrude together with the alveolar process, and as a
consequence, excessive fibrous connective tissue may occur.

• If this tissue cannot be reduced surgically in the post-

extraction phase, it may result in contact with the
retromolar pad, inappropriate occlusal plane, and/or lack of
space for denture material.
e) Loss or decrease of occlusal vertical dimension:

• Alterations of occlusal vertical dimension may occur due to

loss of tooth contacts, displacement of the teeth, and
uncompensated tooth wear.
 Effect on masticatory function :

 Oral sensory feedback guides movement of the mandible in

chewing by forming a basic pattern of movement that comes
comes from a variety of sources.

 The most refined and precisely controlled movement, comes

from periodontal mechanoreceptors (PMRs), with additional
input coming from the gingiva, mucosa, periosteum/ bone, and
temporomandibular joint (TMJ) complex.
This patterned movement is moderated on the basis of food
and task needs by oral sensory input from various sources.

With loss of the finely tuned contribution from periodontal

mechanoreceptors , the resulting peripheral receptor
influence is less precise in muscular guidance, producing
more variable masticatory function.
• The gaps that arise through the loss of posterior teeth
reduce the efficiency of mastication as the bolus of food is
allowed to slip into the edentulous areas and thus escape
the crushing and shearing action of the remaining teeth.
• The first step of digestion starts in the oral cavity by amylase
and lipase.

• On the other hand, lysozymes of oral cavity disinfect the

contaminated food moderately.

• If someone eats fast and swallow the food, the salivary glands
do not have enough time to secrete these beneficial enzymes
and the morsel falls down in the stomach without suitable
preparation.

• In long time, it weakens the stomach and decreases the quality

of absorbed materials from the small intestine
• As patients with impaired dentition tend to eat soft food
and avoid vegetables or fruit which are hard may encounter
nutritional problems which may lead to systemic disorders
and have a higher risk of obesity.

• This may result in increased gastrointestinal disorders, high

cholesterol levels, cardiovascular diseases, and noninsulin-
dependent diabetes mellitus.

• A recent study also showed that the number of natural

teeth is inversely associated to the presence of metabolic
syndrome in adults.
• In free-end saddle partially edentulous cases ,Masticatory
function may be impaired and as a result unilateral or
anterior chewing may occur.

• In large or bilaterally tooth-bound edentulous areas,

masticatory function may also be disturbed. Although these
cases may be able to chew with most of the remaining
occlusal contacts, they may need longer chewing time and
swallow larger particles, which may lead to digestive
problems, and this may cause them to prefer easy-to-chew
food items.
Effect on esthetics and speech

• In the absence of anterior teeth and maxillary premolars,

esthetics , speech, and facial features are affected.

• If an incisor is not replaced soon after extraction, successful

treatment at a later date may be compromised.
The adjacent teeth have drifted into the
unrestored space.

Reduced space does not allow for an

artificial tooth of a realistic size to be
used on a denture

If a reasonable aesthetic result is to be

obtained the space must be reestablished
• Loss of anterior teeth allows the lip to fall back and affect
the appearance of the patient and when lips are parted
there is socially unacceptable gap on view.

• Psychosocial problems (such as loss of self esteem and self-

confidence) and disorders may develop.

• Loss of posterior teeth can in some cases lead to sunken

appearance of the cheeks.
• The loss of maxillary anterior teeth may prevent the clear
reproduction of certain sounds, particularly the ‘F’ and ‘V’
which are made by the lower lip contacting the edges of the
maxillary incisors and also affects the siblilant sounds’S’ and
‘Sh’.

• Absence of anterior teeth in addition to esthetic and

phonetic handicap will affect the anterior guidance of the
patients.
• The lingual surfaces of the maxillary anterior teeth act as
proprioceptive guides to bring the teeth together in centric
occlusion so that closing forces will be vertically directed
onto the posterior teeth.

• Without the anterior teeth the mandible could close in

positions that would direct forces horizontally on the
posterior teeth.
Prosthetic options for Partial Edentulism

• Removable partial dentures (RPDs)

• Tooth supported fixed partial dentures (FPDs)
• Implant supported partial dentures
Removable Prosthodontics :

The branch of prosthodontics concerned with the replacement of

teeth and contiguous structures for edentulous or partially
edentulous patients by artificial substitutes that are readily
removable from the mouth by the patient -GPT 9
Removable Partial Denture :
A removable denture that replaces some teeth in a partially
edentulous arch; the removable partial denture can be readily
inserted and removed from the mouth by the patient
- GPT 9
INDICATIONS
1. Long-span edentulous area :

• Support for removable partial denture:

 Teeth adjacent to a long-span edentulous area.
 The tissues of the residual ridge and from the
abutment teeth on the opposite side of the arch.
 These allows for the distribution of forces, so the
leverage and torque reduced on the abutment teeth.
2. No abutment tooth posterior to the edentulous
space

Cantilevered fixed partial dentures produce harmful

torquing forces.
These forces often produce bone resorption, tooth
mobility, and restoration failure.
3. Reduced periodontal support for remaining teeth :

When remaining teeth are periodontally compromised,

the abutments may be unable to support fixed
prostheses.
Removable partial dentures can derive appreciable
support from the remaining teeth and residual ridges
and so
This reduces total support that must be provided by the
abutment teeth.
 4.Need for cross-arch stabilization :

• After treatment of advanced periodontal disease the

remaining teeth need to counteract mediolateral and
anteroposterior forces.

FPD RPD

Excellent anteroposterior cross-arch

stabilization limited stabilization
mediolateral stabilization.
5. Excessive bone loss within the residual ridge:

• Trauma, surgery, or abnormal resorptive patterns may cause

excessive bone loss which might require replacement of ridge
contours with regenerative procedure(eg; bone graft)

• For patients in whom regenerative therapy is not a viable

option denture bases can be used to restore missing portions
of the dental arches.

• Properly contoured denture bases may be used to support

the lips and cheeks, and to reestablish desirable facial
contours
6. Minimize Patient-dentist contact time :

• Patients with physical or emotional problems, lengthy

preparation and construction procedures for fixed
partial dentures can be tiring.

• Treatment should be designed to prevent further oral

deterioration and continued until the underlying
physical or emotional problems are resolved or
appropriately managed.
7. Esthetics of primary concern :

• Pleasing appearance can be achieved by using one or

more denture teeth on a denture base.
• When appearance of diastema, dental crowding, dental
rotation, or extreme changes in the soft tissue
architecture (eg: recreation of papillae).
8. Immediate need to replace extracted teeth :

• The replacement of teeth immediately following

extraction is most readily accomplished using a
removable prosthesis.
• Unlike fixed restorations, properly designed removable
partial dentures may be altered easily as Acrylic resin
denture bases may be relined as ridge resorption occurs
9. Patient desires :

• Patients may insist on getting removable prosthesis

over fixed prosthesis :
To avoid operative procedures on sound, healthy teeth
To avoid the placement of one or more implants
For economic reasons.
10. Unfavorable maxillomandibular relationships :

Unfavorable relationships or disharmonies in arch size,

shape, and position may cause difficult treatment situations.
eg: In patient with few serviceable teeth and a moderate to
severe Class 2 skeletal relationship.
Contraindications

• A lack of suitable teeth in the arch to support, stabilize, and

retain the removable prosthesis.
• Patients who lack manual dexterity to insert prosthesis.
• Patients who do not care to maintain oral hygiene
• Epileptic patient where there is a danger of swallowing
the denture during an attack
• A lack of patient acceptance for esthetic reasons
Metal denture bases :

• The metal denture base has metal in contact with the

edentulous ridge. Prosthetic teeth are attached to the
metal base with a plastic base.
Advantages of partial dentures made of cast framework

1. Very rigid and stable form

2. Patient Comfort :
• Partial dentures constructed with Cr-Co are thin, thus
reducing the thickness required for resistance in resin base
materials.
• The reduced thickness provides more sensation.
3. Durability:
• These cast frameworks are durable to compressive and
bending forces and do not deteriorate chemically when they
come in contact with the liquids or bacteria and the
chemical environment of the mouth.

4. Stress-breaking function:
• The metal absorbs the shock exerted by the chewing forces.
Thus, the forces exerted on the edentulous ridge and the
supporting teeth are substantially reduced.
5. High thermal conductivity. Thermal conductivity may
be decreased if acrylic is processed onto the metal base.
6. High abrasion resistance.
7. Less porous than plastic and therefore are easier to clean.
8. Greater longevity
9. Enhanced Stability
Disadvantage of metal denture base :

• 1. More difficult to adjust tissue surface than acrylic

base.
• 2. More difficult to reline the metal tissue surface.
• 3. Metal does not provide esthetic.
Acrylic denture base :

• The acrylic denture base has acrylic in contact with the

edentulous ridge and is used more frequently than the
metal base.
Advantages of acrylic deture base :

1. Economical and material easily available.

2. Easy to fabricate, adjust, finish and polish, and
repair.
3. Can be easily relined
3. Acrylic is more esthetic than metal.
 Disadvantages of acrylic base :

1. More porous than metal and therefore has an

increased area for plaque accumulation and so is
more difficult to clean.
2. Acrylic is a non rigid material so it has low strength.
This problem is usually compensated by increasing
the bulk of the material which has the potential of
traumatizing the soft tissues as well as periodontal
tissue breakdown with subsequent tooth loss.
3. Acrylic is a poor thermal conductor. It has low thermal
conductivity (5.7×10-4oc/cm2), which is three times
lower than that of metals and thus leads to patient
dissatisfaction .

Hamedi-Rad F, Ghaffari T, Rezaii F, Ramazani A. Effect of nanosilver on thermal and mechanical

properties of acrylic base complete dentures. Journal of Dentistry (Tehran, Iran). 2014 Sep;11(5):495.
According to indication for use:

a. Interim partial denture:

Removable dental prosthesis designed to enhance

esthetics, stabilization, and/or function for a limited
period of time, after which it is to be replaced by a
definitive dental or maxillofacial prosthesis.
GPT -9
 Indications

• Young patients who have lost one or more teeth as a

result of trauma. In these patients, the large pulp
chambers of adjacent teeth are not ideal for fixed
prosthesis. Thus, an interim prosthesis solves space
maintenance while restoring adequate function.

• Elderly patients whose health contraindicate lengthy

and physically tiring appointments with fixed
prosthesis.
• Patients who seek treatment following unexpected
tooth loss and have certain urgent ceremonies in near
future. The time available does not permit a definitive
treatment.
• Patients with financial crisis.
b. Transitional partial denture :
A removable partial denture serving as an interim
prosthesis to which artificial teeth will be added as
natural teeth are lost and that will be replaced after post-
extraction tissue changes have occurred.
GPT-9
Indications:

• In elderly patient or patient suffering chronic

debilitating disease where multiple extractions could
exacerbate the basic illness, this treatment plan can be
used effectively.

• In patients who are psychologically unable to accept

the loss of teeth. When the loss of teeth is inevitable, the
treatment should be carried out over as long a period as
possible. During treatment, the patient should be reassured
as to the success of treatmet and mentally prepared to
accept the unavoidable result.
c. Treatment partial denture :

A removable denture used for the purpose of treating or

conditioning the tissues that are called on to support and
retain.
GPT-9
 Indications:

• As a vechicle for tissue conditioner:

When temporary partial dentures are used for too
long, marginal gingivitis can be seen. Inflammatory
hyperplasia may also occur due to ill fitting
prosthesis,due to poor oral hygiene, patient wearing
the prosthesis continuously, without giving the tissues
a chance to recover.

Epulis fissuratum is a hyperplastic response to the

overextended border of a denture base.
• Tissue conditioner being a soft resilient material
provides a combination of improved force distribution
and a short-term cushioning effect thus treating the
abused tissues.