FAILURES IN
REMOVABLE
PARTIAL
DENTURE
Contents
• Introduction
• Classification of failures in removable partial
dentures
• Failures in diagnosis and treatment planning
• Failures in mouth preparation
• Failures in framework design
• Failures in laboratory procedures
• Failure in support for denture bases
• Failures in occlusion
• Failure in patient-dentist relationship
• Conclusion
• Bibliography
Introduction
Failure?
. Classification
Mechanical failures
Failure of solder joints
Distortion
Occlusal wear
Changes in the abutment tooth
Periodontal disease
Problems with the pulp
Caries
Movement of the tooth
Design failures
Improper surveying
Improper component selection
Occlusal problems
Failure of removable partial dentures
is due to inadequate:
1. Diagnosis and treatment planning
2. Mouth preparation procedures
3. Design of framework
4. Laboratory procedures
5. Support for denture bases
6. Occlusion
7. Patient-dentist relationship
FAILURES IN DIAGNOSIS AND TREATMENT
PLANNING
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1) Improper diagnosis:
Not making set of diagnostic casts for
each patient
If discrepancy is seen between teeth and
the diagnostic casts and the definitive casts
Making RPD’s using a 2-appointment
system:
one for diagnosis, definitive
impressions, mouth preparation procedures
and second for insertion of partial denture.
Failing to remove debris and plaque from
the teeth before impression is made.
2) Surveying:
Failure to use a surveyor during treatment
planning
FAILURES IN MOUTH PREPARATION
PROCEDURES
1) Improper guide plane preparations:
2) To change height of contour:
Improper positioning of the retentive
clasp arm and reciprocal clasp arm
Retention and Stability of the prosthesis
affected.
Inlays, Onlays and crowns:
3) Inadequate mouth preparation:
Insufficient planning of the design of the
partial denture
Episodes of pain or discomfort during
treatment procedure due to caries or defective
restoration.
Failure to properly sequence mouth
preparation procedures
4) Rest and Rest Seat Preparation:
Movement of the abutment tooth or sliding
of the prosthesis
-The forces transmitted from the
prosthesis to abutment teeth would occur
against the inclined plane.
Occlusal rest Preparation in a multi-
surface Amalgam Restoration.
-Amalgam tends to flow when placed under
constant pressure or even excess preparation.
FAILURES IN DESIGN OF FRAMEWORK
1) Tripoding:
Metal frame work not fitting in the
patient.
-When technician not able to retripod
the master cast according to the desired tilt
of the dentist.
2) Design transfer to master cast:
Clasp tip not engaging the undercut
Abrasion of the master cast
3) Incorrectly located RPD components:
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Incorrectly located major connector
Incorrect use of clasp designs
Use of clasps that are too broad in tooth
coverage and have too little consideration for
esthetics
Flexible major connector
Flexible clasp designs
4) Beading of the cast:
Tissue blanching and inflammation or
ulceration seen when the beading on the cast
done too deep
5) Block out:
Improper seating of the framework:-
-Block out not done properly permitting
rigid part of the framework to be placed in
undercuts.
Framework that does not contact the tooth:-
Block out wax added above the height of
contour line or on the guiding planes and not
removed during shaping of wax.
6) Contouring of the block out wax:
If the undercuts recreated in an attempt
to set a smooth layer of wax, the block out wax
is flamed with torch and over flaming would
result in undercuts.
Framework is too retentive
- wax contouring is not correct, forming
a deep undercut.
Hydrocolloid mold is torn when master
cast is removed.
7) Relief:
Metal framework impinges on the soft
tissue.
-The thickness of the relief wax is too
thin
-The wax separated and lifted up from the
cast during duplication.
FAILURES IN LABORATORY PROCEDURES
1) Poor cast-forming procedures:
Cast is inaccurate: not a true
reproduction of the anatomy of the mouth.
2) Duplication:
Block out and relief wax melted by reversible
hydrocolloid.
Mold damaged during removal of the master
cast.
3) Refractory cast:
Abraded refractory cast:-
Surface treatment of the cast not done
4) Waxing:
Space exists between the upper border of
the lingual plate and tooth:-
Block out wax placed too high.
Lingual or palatal plate connector too thin in
some areas.
Displacement of the pattern wax from the
cast.
5) Failure of technician to follow the design
and written instructions:
Improper seating of the framework.
6) Spruing
Small particles of investment in the casting:-
-Sprue leads joined to main sprue on wax
pattern improperly.
-Sprue hole was enlarged by cutting with
knife, leaving roughened surface for metal to
flow over.
Metal spilled when casting:-
-Sprue hole is too small for Bulk of metal.
-Sprue leads broken during investing
procedure
Plaster inclusion in metal framework:-
-Sharp edges remaining in the cast, broken
due to the force of molten metal casted into
the mold.
Internal mold deformations:-
-Constriction in the sprue lead
Porosity in casting:-
-Improper spruing procedure
Pattern failed to casting:-
-Pattern separated from crucible former
during investment
7) Investing:
If the cast is dried with teeth up, white
materials would be deposited around the
teeth. This is due to deposition of salts which
form a positive layer that cannot be removed
without scraping and damaging the cast.
Cracks in the cast
8) CASTING defects:-
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Pitted casting
If the design is placed on the refractory
cast with a graphite pencil….
Contaminates…..
Burn out temperature…..
Metal nodules and rough area on cast
framework
-Failing to use surface tension reducer
correctly on the waxed patterns would cause
air trap, when paint on investment flows
-If the surface tension, reducer is not
allowed to dry before applying the paint on
investment
• Incomplete casting and rough areas or fins in
casting
-W: P ratio….
-If paint on investment layer is too thin…
-If the paint on layer is too thick…..
Porous cast frame work
If the mold moves in the casting machine
as the casting arm starts to spin, molten
metal sometimes may miss the sprue hole and
spill outside the mold.
Incomplete casting
If the sprue hole faces upward during burn
out……
Casting temperature of metal….
Warpage of the Frame work
The air pressure of the nozzle of air
abrasion machine is about 100 psi…..
If sufficient time is not allowed for the
metal to cool to room temperature in the
investment (quenching the mold)…..
Nicks on the metal casting
Carelessly cutting off the sprue leads
Using the wrong mandrel in high spread
lathe…….
Framework is too loose
Carelessly grinding the inside of
clasps….
Fracture of the clasps
Removing too much metal from retentive
clasps ….
An improperly tapered clasp or one that
has thin places or nicks encourages breakage
by concentrating the strain….
Electro polishing for a longer time….
Warpage of the framework
Abrasive rubber wheels and points can
build up heat in the framework very quickly
Loose frame work
Polishing removes a definitive layer of
metal.
Distorted frame work
Clasps and other parts of the frame
work can easily catch in the polishing wheel.
If they catch the framework they would be
pulled from operator hands and thrown. The
force usually distorts the framework and
injures the operator.
Incomplete Casting of the Metal frame
work
-Metal too cold when cast…..
-Improper spruing ….
-Gas trapped in mold……
9) Mixing and packing acrylic resin:
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Incompletely processed denture-
10) Deflasking and polishing the removable
partial denture:
Distorted framework
Increase in the vertical dimension
Warpage of framework
Scratches on the final metal framework
Damaged denture teeth
Distorted clasps
-Using a cloth wheel that was not broken
properly would result in damaged removable
partial denture or injure the operator.
-A new cloth wheel has strings of
material protruding from it.
-The strings could tangle in the clasp or
other parts of removable partial denture and
snaps the removable partial denture from the
operator’s hands throwing it out with great
force.
Scratches on the denture
-Course pumice leaves scratches…..
-It would be difficult to adequately polish
around the necks of denture teeth with a
cloth wheel or a lathe mounted bristle brush
without damaging the contours of the teeth.
Dull appearance of the denture
Detergent alone would not adequately
remove polishing compound from the
removable partial denture.
The remaining residue would prevent the
removable partial denture from achieving the
luster.
11) Fitting the framework to the cast and
mouth:
Framework too retentive on the
definitive cast.
Frame Work not fitting exactly in the
mouth.
12) Finishing and polishing of framework:
Polished surface is dull with fine
scratches
-Sequence of finishing steps not followed
Major and minor connector over thinned
and flexible.
-Framework over thinned with abrasive
stones during finishing
Clasps is nicked or notched
Framework distorted
-Frame work caught in lathe during
finishing.
13) Fitting and adjusting the removable
partial denture to mouth :
Failing to evaluate the denture borders
when placed intra-orally.
Loss of retention and support.
Soreness or Ulceration of soft tissue in
the patient’s mouth
Increase in the vertical dimension of
occlusion
Warpage of the RPD
-If the patient does not seat the
removable partial denture correctly, they may
warp the removable partial denture or be
injured by it.
-Warn the patient’s about the destruction
that would result if they bite on removable
partial denture to seat it.
FAILURE IN SUPPORT OF DENTURE BASE
Inadequate coverage of basal seat
tissues
Failure to record basal seat tissues in
supporting form
FAILURES IN OCCLUSION
1) Articulation:
Error in articulation of the cast
2) Face bow transfer:
Alteration in the jaw relation
-Positioning the face bow on patient’s
face.
-Placement of the fork
-Rocking of the record
-Trimming of the record or metal
showing through the record.
-Face bow transfer not done.
3) Correction of occlusal plane:
Sensitivity of teeth or incipient caries-
after enameloplasty
4) Selecting and arranging teeth:
Unable to interdigitate artificial teeth with
opposing natural dentition
Insufficient space to set posterior tooth
replacement
Anterior replacement teeth too short for
satisfactory esthetics
Dentists failing to select type, shade and
mold of the denture teeth to be used
resulting in unaesthetic prosthesis not
accepted by patient.
FAILURE IN PATIENT-DENTIST RELATIONSHIP
Failing to make a follow up appointment for
the patient
Failure of dentist to provide adequate
dental health care information, including care
and use of prosthesis
CONCLUSION
“Good technique pays off” – these words are
not merely a motto to hang on the wall in the
laboratory but words that are to be followed.
Shortcuts are risky attempts to save time by
modifying a proven procedure. They would
increase the chair time work required for
adjusting misfit dentures, dissatisfaction and
pain experienced by patients.
• To paraphrase an old saying, “the most
important step in making a removable partial
denture is the step being done correctly at
any given moment”.
• As someone well said, it is not how much
success we obtain, but how best we tackle
complex situations and failures, that
determine the skill of a clinician. No doubt,
failures are stepping stones to success but
not until their etiologies are established and
their occurrence is prevented.
After all, as correctly said by Henry Ford,
“Failure is the opportunity to begin again,
more intelligently”
BIBLIOGRAPHY
• Rudd W.R, Rudd D.K. Review of 243 errors possible
during the fabrication of removable partial denture:
Partial denture: I, II, III. J Prostet Dent 2001; 86:
251 -287.
• McCracken’s: Removable partial Prosthodontics.
Eleventh edition 2005
• Stewart’s Clinical Removable Partial Prosthodontics.
fourth edition
• A clinical overview of removable prostheses:3.
principles of design for removable partial denture
dent update 2002
• Internal porosity of cast titanium removable partial
dentures: influence of sprue direction on porosity in
circumferential clasps of clinical framework design
j prosthet dent 2002
• Pattern waxes and inaccuracies in fixed and
removable partial denture design
j prosthet dent 1997
• Surveying the removable partial denture : the
importance of guiding planes path of insertion for
stability
j prosthet dent 1997
WE SHOULD MEET THE MIND OF THE PATIENT
BEFORE WE MEET
THE MOUTH OF THE PATIENT
