RPD INSERTION ,INSTRUCTIONS

AND RECALL

Dr. . Mustafaf Zenelabidin

 Patients should not be given possession of RPD until:
1.Denture bases have been initially adjusted as required
2.Occlusal discrepancies have been eliminated.
3.The patient educational procedures have been continued.
The term adjustment has two connotations, each of which must
consider separately.
First:
The adjustments to the bearing surfaces of the denture and the
occlusion made by the dentist
at the time of initial placement.
Second:
is the adjustment or accommodation by the patient,
psychologically and biologically to the presence of a foreign
body, which is to serve as a prosthetic restoration of some
missing part or parts of the body.
procedures necessary to produce a biological acceptable
prosthetic restoration are:

1.Adjustment of bearing surfaces of denture base to be in

harmony with the supporting soft tissue.

2.The adjustment of occlusion to accommodate the occlusal rests

and other metal parts of the denture
3.The final adjustment of occlusion of artificial teeth to
harmonize with natural occlusion in all mandibular positions.
 The insertion visit is include :
1. Final inspection of the prosthesis before insertion.
2. Verifying the RPD framework fit.
3. Assessment of acrylic resin denture base adaptation.
4. Assessment of peripheral extension of the denture base.
5. Evaluating occlusion.
6. Adjusting retentive clasp assembly.
7. Providing instructions for the patient in the use &care of the
prosthesis.
 Final inspection of the prosthesis

Prior to the insertion appointment, the dentist should check &adjust

the following:
1. Nodules of acrylic resin on the tissue surface of the prosthesis:
the simplest way to locate these nodule is to run a finger over the
intagllio surface(tissue surface) of the prosthesis. Once identified
&marked, the nodules can then be removed with a small, acrylic bur
mounted in a slow-speed hand piece. When the nodule removed do
not polished the tissue surface.
2. Examine surface and internal porosity in the acrylic resin
reduces both the quality &ultimate strength of the completed RPD. A porous
surface will be difficult to keep free of dental plague. A rebase of the RPD is
recommended.
3. inspect the finish and polish of the RPD.
The polished surface contours should have a smooth, high-luster appearance
without surface blemishes.
Store the RPD until the insertion appointment in a plastic bag partly filled with
mouth wash. This will keep the prosthesis moist to prevent dehydration &possible
distortion of the acrylic resin base until the prosthesis is inserted.

.
Adjustment of occlusal interference from denture

framework
• The denture framework should have been tried in the
mouth before a final jaw relation is established, and any
such interference should have been detected and
eliminated.
 Seating of the RPD framework
• It is highly recommended to fit the cast metal framework intra-orally
before the insertion appointment.
• If there is considerable resistance to seating, stop &check for the
following problems:
1. Clasp or other components of the framework may have been bent or distorted.

2. A layer of acrylic resin flash may be covering part of the metal casting.

Remove the acrylic resin before seating the RPD .

There should be intimate fit between the teeth &retentive clasp assembly.

3. Acrylic resin may have been cured into undercuts adjacent to the abutment teeth,
preventing the uniform seating of the prosthesis.

• If the occlusal rests on the prosthesis do not seat completely in their respective rest seat
preparations, a minor discrepancy in the cast metal framework can be identified &corrected.
 Evaluation of the denture base adaptation
When the cast metal framework has been fully seated, fit the
acrylic resin portions of the prosthesis.
Excessive pressure may lead to discomfort, pain, &soft tissue
damage.
A common contributor to excessive pressure is the dimensional
changes that occur in the acrylic resin denture base during
processing.
• adjusting the bearing surfaces to perfect the fit of the denture to
the supporting tissues should be accomplished by the use of
some indicator paste.

• the paste must be one that will be readily displaced

by positive tissue contact and will not adhere to the
tissues of the mouth
The paste should be applied in a thin layer over
the bearing surfaces and then both occlusal and
digital pressure should be applied to the denture.
The denture is then removed and inspected , any areas where the
pressure has been heavy enough to displace a thin film of
indicator paste should be relieved and the procedure repeated
with a new film until excessive pressure areas have been
eliminated.
• Pressure areas most frequently encountered
as follows in mandibular arch:
1. The lingual slope of the mandibular ridge in the premolar area.
2. The mylohyoid ridge.
3. The border extension into Retromylohyoid space.
4. The distobuccal border (in the vicinity of the ascending ramus
and the external oblique ridge).
Pressure areas in maxillary arch:
1. The inside of the buccal flange of denture over the tuberosities.
2. The border of the denture lying at the malar prominence.
3. At the pterygomaxillary notch where the denture may impinge on the
pterygomandibular raphe or the
pterygoid hamulus itself.
Adjustment are made until displacement of PIP
appears only in the primary stress-bearing areas.
There should be little or no paste distortion in
areas that required relief or is not stress bearing
(incisive papilla, tori, mylohyiod ridge, crest of
the mandibular residual ridge, median
raphe,..etc.)
 Assessment of denture base peripheral extensions:

the peripheral borders of the denture base have a direct bearing on

retention, stability, &patient comfort .
Overextension of the prosthesis denture borders may cause the
followings:
1. The muscles &frena will tend to dislodge the RPD during
function.

2. The resultant dislodging force may be transferred to the abutment

teeth by the retentive clasp assemblies.

• These forces may be especially destructive when the denture base

borders of a bilateral distal extension RPD are overextended.
3.Denture base overextension may cause ulceration, pain,
&swelling of the vestibular tissues.

If this is not corrected, over an extended period of time, redundant

tissue may form in the vestibular as a response to chronic irritation.

4.Impingement on the muscles of mastication may interfere with

muscle function during mastication &speech.

5.Denture border extensions of modification spaces may

interfere with the complete seating of the RPD.
 • Under extension of the prosthesis denture borders may
cause the followings:
1. Inadequate distribution of the masticatory force. The denture base should cover the
retromolar pads &buccal shelf area to the external oblique ridges to obtain maximal
support for the RPD.

2. Food may collect under tissue surface of an RPD &be an annoyance and/or an
irritation.
 

3. The prosthesis may lack stability. Under-extended denture borders will not
satisfactorily resist lateral or horizontal stresses.
• observe border extensions by applying PIP or disclosing wax
to the RPD border

• The prosthesis is then placed in the mouth, several drops of

water are placed on the patient's tongue, and the patient is
asked to swallow.

• Any areas of over extension will be visible where the wax or

paste has been flattened or displaced by muscle action.
The use of disclosing wax or PIP is especially effective on the
distobuccal border of a mandibular RPD, which is controlled by
the masseter muscle. The most common areas of over-extension
of a maxillary RPD are the tissue side of the distobuccal flange
&continuing through the pterygomaxillary notch area.
THANKS