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Chapter 52

Removable Prosthodontics
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Introduction
 Removable prosthodontics is the
specialty of dentistry that replaces missing teeth with a removable prosthesis.  Removable partial denture, also referred to as a partial, replaces one or more teeth in the same arch.  Removable full denture, also referred to as a denture, replaces all of the teeth in one arch.

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Fig. 52-1 Removable partial denture.

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Fig. 52-2 Full denture.

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Extraoral Factors that Influence the Choice of a Removable Prosthesis


      
Physical health Mental health Motivation Age Dietary habits Socioeconomic factors Occupation

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Intraoral Factors that Influence the Choice of a Removable Prosthesis


     
Musculature Salivary flow Residual alveolar ridge Oral mucosa Oral habits Tori

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Indications for a Removable Partial Denture


 To replace several teeth in the same quadrant or    
in both quadrants of the same arch. As a temporary replacement for missing teeth in a child. To replace missing teeth for patients who do not want a fixed bridge or implants. For the patient who finds it easier to maintain good oral hygiene. To serve as a splint to support periodontally involved teeth.

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Contraindications for a Removable Partial Denture


 A lack of suitable teeth in the arch to support,
stabilize, and retain the removable prosthesis.  Rampant caries or severe periodontal conditions that threaten the remaining teeth in the arch.  A lack of patient acceptance for esthetic reasons.  Chronic poor oral hygiene.

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Components of a Partial Denture


 Framework
The cast metal skeleton that provides support for the remaining components of the prosthesis.  Connectors Join various parts of the partial together Major connector Minor connector

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Components of a Partial Denturecontd


 Retainer
Known as a clasp, it supports and provides stability to the partial denture by partially circling an abutment tooth.  Rest A metal projection designed to control the seating of the prosthesis.  Artificial teeth Constructed from either acrylic or porcelain.

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Appointment Sequencing for a Partial Denture


 Appointment 1: Records
Updated health and dental history. Prophylaxis. Preliminary impressions. Radiographs. Photographs.

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Appointment Sequencing for a Partial Denture-contd


 Appointment 2: Preparation
Prepare the teeth. Take the final impression. Take the occlusal registration. Select the shade and mold of the teeth. Prepare the laboratory prescription.

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Appointment Sequencing for a Partial Denture-contd


 Appointment 3: Try-in
Evaluate the fit, comfort, and function of the appliance. Evaluate the shade, mold, and arrangement of the teeth. Take new occlusal registration. Note any changes on the laboratory prescription.

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Appointment Sequencing for a Partial Denture-contd


Appointment 4: Delivery  Have patient place partial.  Check occlusion.  Detect any pressure points.  Check retainers for tension on the natural abutment teeth.  Polish partial.  Give patient home instructions.

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Home Care Instructions for a Partial Denture


 Store prosthesis in water or a moist airtight
container when not wearing it.  After eating, remove from mouth and brush or rinse the retainers, rests, and complete partial.  Brush and floss abutment teeth and natural teeth to keep them free of food debris and plaque.  Advise patient not to adjust the partial denture.

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Appointment Sequencing for a Partial Denture-contd


 Appointment 5: Postdelivery check
Evaluate the fit. Check the mucosa for pressure areas and sore spots. Evaluate the function of the prosthesis.

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Indications for a Full Denture


 The patient is edentulous.  The remaining teeth cannot be saved.  The remaining teeth cannot support a
removable partial denture, and no acceptable alternatives are available.  The patient refuses alternative treatment recommendations.

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Contraindications for a Full Denture


 Another acceptable alternative is available.  Physical or mental illness affects the patient's
ability to cooperate during the fabrication of the denture and to accept or wear the denture.  The patient is hypersensitive to denture materials.  The patient is not interested in replacing missing teeth.

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Components of a Full Denture


 Base
Designed to fit over the residual alveolar ridge and surrounding gingival area.  Flange Part of the base that extends over the attached mucosa from the cervical margin of the teeth to the border of the denture.

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Components of a Full Denture-contd


 Post dam
Retention of a maxillary denture depends on the suction seal.  Artificial teeth Fabricated from acrylic or porcelain.

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Appointment Sequencing for a Full Denture


 Appointment 1: Records
Updated health and dental history. Preliminary impressions. Radiographs. Photographs.

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Appointment Sequencing for a Full Denture-contd


 Appointment 2: Final impression
Essentials of a final impression for dentures Landmarks of the dental arches are accurately reproduced. Maxillary should include the hamular notches, post dam, tuberosities, and frenum attachments. Mandibular should include the retromolar pads, oblique ridge, outline of the mylohyoid ridge and the genial tubercles, plus the lingual, labial, and buccal frena. Laboratory prescription

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Appointment Sequencing for a Full Denture-contd


 Appointment 3: Try-in of
baseplate-occlusal rim Occlusal rim records Vertical dimensions evaluated. Occlusal relationship. Smile line. Canine eminence. Select artificial teeth

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Appointment Sequencing for a Full Denture-contd


 Appointment 3: Try-in of
baseplate-occlusal rim-cont d Occlusal registration measurements Centric relation. Protrusion. Retrusion. Lateral excursion.

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Appointment Sequencing for a Full Denture-contd


 Appointment 4: Try-in
Denture is evaluated for fit, comfort, and stability. Appearance of the denture, including the shade, mold, and alignment of the teeth, is verified. Retention of the denture setup is checked as the patient verbalizes the f, v, s, and th sounds; swallows; and yawns. Occlusion of the denture is checked. Laboratory prescription for the completion of the denture is prepared.

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Appointment Sequencing for a Full Denture-contd


 Appointment 5: Delivery
New denture is inserted into the patient's mouth. Shade and mold of the artificial teeth are checked for natural appearance. Patient is requested to perform facial expressions and the actions of swallowing, chewing, and speaking, using s and th sounds. Occlusion is checked. Home instructions are given.

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Home Care Instructions for a Full Denture


 Thoroughly rinse the oral tissues at least once
daily.  All surfaces of the denture should be thoroughly cleaned with a denture brush and mild abrasive.  When dentures are not in the mouth, they must be stored in a moist, airtight container to prevent drying and warpage.

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Appointment Sequencing for a Full Denture-contd


 Appointment 6: Postdelivery of a full
denture Check the mucosa for pressure areas and sore spots. Schedule recall appointment.

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Immediate Dentures
 Type of denture that is placed immediately
after the extraction of a patient's remaining anterior teeth. This type of denture serves as a compress and bandage to protect the surgical site.

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Construction of an Immediate Denture


 Occlusal wax rims are completed with posterior
teeth and tried in before extraction of anterior teeth. The denture, complete with the anterior teeth, is constructed, sterilized, and ready for placement at the time of surgery.  Surgical template Clear plastic impression tray of the anterior area that the surgeon uses as a guide in properly contouring the remaining alveolar ridge.

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Denture Relining
 Relining is accomplished by placing a new
layer of denture resin over the tissue surface of the prosthesis. Impression is taken with the present denture used as the impression tray. Patient is instructed to close-in normal occlusion. Denture and written prescription are sent to the laboratory technician for relining.

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Denture Repairs
 Simple repairs can be handled in the dental
office laboratory by using cold-cured acrylics.  Complicated repairs, particularly those involving the replacement of teeth or the complex fracture of the denture, are usually sent to the dental laboratory technician.

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Fig 52-19 Broken denture.

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Denture Duplication
 Because dentures can break or require time
for relining, the patient should have a duplicate denture made.

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