Final Flashcards
What is the path of insertion for most RPDs?
Straight
What are the indications for rotational path RPDs in the sagittal plane?
- Maxillary and mandibular class IVs without modification spaces where visible clasping isn’t an option (A-P path)
- Mandibular class IIIs with mesially tipped molar abutments and bilateral edentulous segments (P-A path)
What are the indications for path of insertion for the frontal plane?
- Maxillary and mandibular class IIs (lateral path)
- Class IIIs (unilateral) with no modification spaces (lateral)
Maxillary and mandibular class IIs as well as class IIIs with no modification spaces are best suited for what type of path of insertion?
Lateral path (frontal plane)
Maxillary and mandibular class IVs without modification spaces are suited for what path of insertion?
Anterior-posterior path
Mandibular class IIIs with mesially tipped molar abutments and bilateral edentulous segments and best suited for what path?
Posterior-anterior path
What are design considerations for rotational path RPDs?
- If there is no straight path of placement
- Eliminate unesthetic clasps (esp class IV)
- Clasps replaced by rigid retainers
- Rigid retainers (struts or plates) engage undercuts
- Little tolerance for error
Does changing the path of insertion increase or decrease the number of clasps?
decrease
Is there usually minimal or aggressive tooth preparation when preparing RPDs with another path of insertion?
Minimal; maximal in mesial tipped molars and maxillary canines in class IV
Are rotational path RPDs easier to clean?
Yes
Are rotational path RPDs more esthetic?
Yes
Can a rotational RPD be made if there is an absence of facial undercuts in a kennedy class IV?
Yes
Which are easily more distortable: clasps or rigid plates?
Clasps - thus since rotational RPDs use rigid plates there is less distortion of retentive components
Do rotational RPDs preserve the integrity of the arch more or less than traditional RPDs?
More arch preservation (for eg: no need for embrasure clasps)
What are some disadvantages of rotational RPDs?
- Adjustment of retentive components is difficult
- Less tolerance for error
- Requires well prepared rest seats
For what classes are lateral path of placement RPDs made for?
Class IIs and IIIs without modification spaces
The struts on a lateral path of placement RPD engage what undercuts?
Palatal or lingual plating engage undercuts on the fully dentate side
Is the occlusal rest connected or not connected in a lateral path of placement RPD?
Connected
Class I’s and II’s require passive rotational placement. Does a lateral path of placement RPD require a reciprocal element?
No
What part of the lateral path RPD engages the teeth first to stabilize it?
Rest
What part of the lateral path RPD engages second to rotate the RPD into the undercut without deformation or pressure on abutment teeth?
The retentive plate or strut
Is the lateral path RPD inserted from left to right or from right to left?
Left to right
How is the lateral path RPD removed?
Right to left
What class is indicated for the use of a P-A path of insertion?
Mandibular class III with mesially tipped molars
What is the primary retention of a P-A path RPD on the mandibular class III mesially tilted molar?
Mesial plate on a .01 undercut; no clasps
How are the occlusal rests on the molars prepared for a P-A RPD?
- Depth: 1.5-2mm
- Floor of the rest is perpendicular to the long axis of the tooth
- The length should extend more than the FL dimension of the abutment tooth
- Asymmetric outline
- Bilaterally parallel walls on the facial lingual
- Intimate contact of rest and minor connector
What is the depth of the extended occlusal rest for the mandibular molar abutments?
1.5-2mm
Which walls in the extended occlusal rest are bilaterally parallel? Facial and lingual or mesial and distal?
Facial and lingual
Is the extended occlusal rest symmetrical or asymmetrical?
Asymmetrical because it has to be more than the FL dimension of the tooth
Is the floor of the rest parallel or perpendicular to the long axis of the tooth?
Perpendicular
What engages first in a P-A path of placement RPD to initially stabalize the RPD?
The rest
What engages second in a P-A RPD that allows it to rotate into the undercut without deformation?
Retentive plate or strut
Is there any horizontal force on the P-A molar abutment tooth when placing the RPD?
No
Since there is no horizontal force of the abutment tooth in a P-A RPD, during placement, is there then a requirement for reciprocation?
No
What class is more readily indicated for an A-P path of placement?
Maxillary and mandibular class IV
Why is an A-P path of placement better suited for a class IV case?
Because anterior clasping is eliminated so it is more esthetic
Which teeth are used as anterior abutments for A-P path of placement RPDs?
Canines and 1st/2nd bicuspids with .01” mesial undercuts
Are the undercuts on the canines and 1st/2nd bicuspids for the A-P RPD on the mesial or distal?
Mesial
What rests are made on the canines for an A-P RPD?
Cingulum rest
What rests can be made on the occlusal surface of the bicuspids for an A-P RPD?
Mesio-occlusal of abutment teeth (1st/2nd) bi’s
Mesio-occlusal of 2nd bicuspids with 1st bicuspid abutments
What is the rest preparation depth for the cingulum rest on MX canines for an A-P RPD?
1.5mm
What is the shape of the strut made for the MX canine’s cingulum rest?
Chevron shaped
What engages first when a A-P RPD is inserted into the mouth?
The retentive plate and rest engage simultaneously
When the A-P RPD is first inserted what is the initial path of insertion?
Straight
Does an A-P RPD need reciprocation?
No
What are the posterior abutment teeth for an A-P RPD?
1st or 2nd molars
Are the rests on the mesial or distal for the posterior abutment teeth (1st and 2nd molars) for a A-P RPD?
They can be mesial or distal but have to be bilateral
What clasps are used in the posterior abutment teeth for a A-P RPD?
C clasps
What major connector is used for a maxillary A-P RPD?
Horseshoe strap
What major connector is used for a mandibular A-P RPD?
Lingual bar
Which type of attachments are usually a prefabricated key or keyway with parallel walls, within the contours of the restoration?
Intracoronal
Intracoronal attachments produce (mechanical or frictional) resistance against RPD displacement?
Frictional
Which attachments create mechanical resistance to displacement through components attached to the external surface of an abutment tooth?
Extracoronal
Do extracoronal attachments create (mechanical or frictional) resistance in order to resist RPD displacement?
Mechanical
What are the advantages of extracoronal attachments?
Esthetics and mechanical resistance (functional loads are more apically directed and there is improved cross-arch load transfer and prosthesis stabilization)
What are the disadvantages of extracoronal attachments?
- Demanding crown prep (space for attachment)
- Vertical height (4-6 mm)
- Laboratory technique (path of insertion)
- Cost
- Wear of components/ maintenance
What contraindications are considered when deciding whether or not to place an extracoronal attachment?
- Poor periodontal health
- Poor crown to root ratio
- Compromised endo or restorative conditions
- Compromised manual dexterity
- Inadequate oral hygiene
Are the ERA male attachments located inside the RPD or inside the patient’s mouth?
Inside the RPD
Are the female ERA attachments located in the RPD or in the patient’s mouth?
Inside the patient’s mouth
What is the main reason considered for choosing a type extracoronal attachment?
Vertical height requirement
What are the three types of extracoronal attachments that are considered reasonable choices and are widely used?
ERA, SA Swiss anchor/CEKA, Allergro DE
What reasons considered when choosing a type of extracoronal attachment?
- Cost
- Simplicity
- Vertical height requirement
- Easy to use
- Easy to adjust or change out parts
What is the first step taken when deciding to make an RPD?
Design the framework on a cast
What is the second step when making an RPD framework (after designing it on a cast?)
Crown preparation, impression and jaw relation record
Why are crowns normally prepped for an RPD?
To create extra space for an occlusal rest
After making a provisional for the prepped crown, what is done next?
VPS impression and then jaw relation record
What is the 3rd step when making an RPD?
Laboratory prescription; write every feature of the survey crown on the lab slip!
What features are described in the prescription?
Rests: location and type
Guide planes: location
Clasp type: retention/ reciprocation
Retentive undercut: location and amount
In the 4th step, what should be done before seating the crown in the patient’s mouth?
Evaluate the survey crown on the master cast! Does it match? Is it in the right plane? Is the undercut in the right place? survey line? cingulum rest? Remember to add undercuts before seating the crown!
What should be done before the final crowns are cemented in the patient’s mouth?
Check guide planes and retentive undercuts
What is the 5th step (after you have inspected the crown sent back from the lab?)
Seat the crown
After the crown is seated the clinican should do what on natural tooth abutments?
Prepare any rests, guide planes, tooth modifications
After the rests are made on the natural teeth what is the last step before the RPD framework is made?
Framework impression
What type of RPD is indicated for young patients who suffered from post traumatic tooth loss, rapid caries and partial anodontia as well as older patients with compromised medical conditions?
Interim RPD
How long should it take for an interim RPD to be completed?
As soon as possible
What are some uses for an interim RPD?
- Maintain space
- Re-establish occlusion
- Replace visible missing teeth
- Service during periodontal or implant therapy
- Condition the patient to an RPD
Do interim RPDs come in various sizes?
Yes
What specific design principles give the interim RPD its retention?
Wrought/ortho wire, ball claspsi; interproximal acrylic struts; surface tension and adhesives
What design principles allow for hard tissue support?
Cingulum and occlusal rests, wrought or orth wire rests, ball clasps
How far should an interim RPD extend for soft tissue support?
To the pterygomaxillary notch and to the retromolar pad and tuberosity
Interim RPDs are an (immediate or not immediate) replacement for teeth removed during a surgical appointment
Immediate
How often should the stability and retention of the interim RPD be checked?
Every 3-6 months
What materials are used to compensate for tissue changes as a result of post surgical healing of the interim RPD?
Soft tissue conditioners or hard chairside reline materials
What types of RPDs are used to aid a patient in making the transition to complete dentures?
Transitional RPDs
What type of RPD is made for a patient so that immediate extractions are avoided when some or all of the teeth are hopeless but the patient is not physiologically or psychologically ready for CDs?
Transitional
What is a quality that the transitional RPD has that is unique?
Teeth can be added as they are lost and relining is performed as needed.
When does a transitional RPD need to be replaced?
This is no absolute time restriction on the use of this prosthesis
What type of RPD is used as a vehicle for tissue conditioning?
Treatment
Which type of RPD is used to establish a new VDO or act as an occlusal guard to correct or control undesirable oral habits?
Treatment
What technique is used in order to repair an RPD? (change a clasp, repair a broken clasp, add teeth, extend a saddle etc)
Make a pick up alginate impression and pour a cast with the RPD in the impression- the RPD is then removed from the cast to make the necessary repairs.
Which kennedy classes saddles are treated as altered cast impression trays where a wash impression is made and the rests/clasps are engaged?
Class I and II
What is performed in order for occlusion to be finalized?
Clinical remount
What are some examples of critical data that is required in order to make an RPD?
- Medical history
- Dental history
- Radiographs
- Exam and charting
- Pre-pros perio, endo, restorative
- Design casts
- Intraoral photos
- Specialty consults
If a patient is on a significant number of medications what could be a clinical side effect?
Xerostomia
What type of radiograph should be taken if a patient is receiving an RPD?
Full mouth xray (FMX) to see if there are any perio, endo, or restorative issues. A Panorex can also be taken to see if there is any pathology
Should the patient have a perio charting prior to the consult?
Yes; to measure attachment loss and pocketing, bleeding, horizontal bone loss, mobility, and vertical defects
What considerations should be thought of when evaluating teeth for an abutment?
Periodontal health, endo health, occlusal health and restorative health
Can roots be clasped in an RPD?
No
If the teeth are mobile then it will be a problem when taking the alginate imression. How is the tooth position maintained in a stable position during this time?
Temporary splint or you can bond composite
Should the teeth be tested for any endo problems prior to making the prosthesis?
Yes
What type of abutments may require a post and core as well as a survey crown because they require special attention due to the torquing nature of the saddle?
Class I distal abutments
Should rests be placed on occlusal contacts?
No; always check occlusion before preparing the rests
If there is occlusal trauma or perio mobility on all teeth then what can be done?
Occlusal and periodontal splinting with RPD framework
What type of tray should be used for a maxillary complete denture final impression?
Custom triad tray
What type of material and tray should be used for a mandibular RPD final impression?
alginate with metal tray
Where is the relief wax placed when waxing up the framework?
Under the saddles
In the first clinic appointment, of fabricating an RPD, what is accomplished?
Rest preparations, tooth modifications and final impressions
In the second clinic appointment, when fabricating an RPD, what is accomplished?
Mandibular framework try in and altered cast
In the third clinic appointment, when fabricating an RPD, what is accomplished?
Jaw relations- wax rims, VDO/VDR, facebow, CR, MI, select teeth
In the fourth clinic appointment what occurs when making an RPD?
verify articulator mounting, esthetics, phonetics, posterior palatal seal, patient acceptance form
After the denture is processed, what occurs?
Delivery of mandibular RPD- fit the RPD and verify occlusion; remount it clinically
How many times is the RPD adjusted after it is delivered and what days?
24hrs, 48 hrs, 1 week, 1 month
What are some solutions posed to control rotation in Kennedy class I and II RPDs?
Indirect retention, clasps with M rests and saddle extension and fit to soft tissues
What is the purpose of the dual impression technique?
Equalize support derived from the edentulous ridge and abutment teeth
When is the dual impression technique used?
When there are two unequal support systems which require equalization
Is soft tissue (like gingiva and mucosa) displaceable?
Yes
Is hard tissue (like enamel) displaceable?
No
The broader the coverage of the endentulous ridge the (greater or less) distribution of occlusal load
Greater
Should the maximum amount of surface area of the distal extention edentulous ridge be covered in an RPD?
Yes
What is the single most important factor in minimizing abutment tooth movement?
Fit of the base
Should the tissue be distorted under the fit of the denture base?
No
What kennedy classes are indicated for distal extension base stabilization?
- All mandibular distal extensions (class I, II)
- Some long span maxillary distal extensions
- Some long span anterior edentulous ridges (class IV) where the ridge supports the RPD
Should depressible, displaceable soft tissue (eg: flabby ridge) have distal extension base stabilization?
Yes
How far should a mandibular RPD extend in order to be stable and have retention?
Retromolar pad, buccal shelf and extend fully into the vestibules
How far should a maxillary RPD extend in order to be stable and have retention?
Cover the tuberosity, extend into the pterygomaxillary notch and buccal vestibule
What comprises the selected pressure technique?
The vestibular border has active tissue contact and the support area is impressed at rest
What is fabricated for the selected pressure technique and how far does this extend?
A light cured composite resin tray from triad is fixed to the framework and extended to within 2mm of the normal CD base
Which part, the (active or inactive), component of the impression is border molded?
Active- the periphery is border molded
The intaglio surface of the tray is relieved to provide space for impression material. This is the _______ component of the impression
static
What is the impression material of choice used for the selected pressure technique?
Light or medium bodied VPS
Should the framework be fully seated with the selected pressure technique?
Yes- rests have to be fully engaged under finger pressure
Should the saddle area be depressed when the impression is setting?
NEVER
Where should the pressure be kept if the saddle is never touched when the impression is setting?
Rests and clasp assemblies and border mold
The saddle is not depressed while the impression is setting. This ensures that the tissue is recorded in the (active or static) state
Static
The altered cast final impression is made with what type of impression material?
ethyl/ isobutyl metacrylate
Is the post root canal amputated tooth kept in a removable partial overdenture?
Yes
Are the retained teeth attached to the RPD saddle?
No
What materials are used to restore the RCT treatment access of the teeth used in a removable partial overdenture?
Amalgam, gold coping and glass ionomer
Root canal teeth beneath RPD saddles have several benefits. What are these benefits?
Proprioception, bone preservation (stability and retention)
The teeth underneath the RPD saddle of a removable partial overdenture is not connected to the saddle. What components are?
ERA, O-ring or Ball, Zest/ ZAAG or locator abutments
Are ERA’s easy to change in the office?
Yes
What is the wear, in months, of an ERA attachment?
6-9 months
What is the vertical height requirement for an ERA attachment?
4.85 mm
To what degree of angle width can be used to correct for path of insertion in an ERA?
0, 5, 11, 17
Which attachment requires 6.4mm in vertical height (which is alot)
O-ring/ Ball
Are O-rings easy to remove and replace?
Yes; the patient can do it
Which attachment is least desirable due to its short wear factor?
Ball/O-ring
Does an O-ring/ Ball attachment need a parallel path of insertion?
Yes; 10 degrees because they deform at a larger angle
Which attachment for implant retained RPD saddles is the most user friendly?
Locator
What is the most common RPD?
Kennedy class I
What are the three basic components of an RPD?
Metal framework, acryllic saddle and prosthetic teeth
Why does a patient usually opt for the use of an RPD?
- Replace missing teeth (esthetics)
- Increase function (mastication)
- Maintain teeth alignment and arch integrity
- Splint periodontally involved teeth
- Transition to a complete denture
- Lower cost alternative!
Bilateral edentulous areas located posterior to the natural teeth is known as what kennedy class?
Kennedy class I
A unilateral edentulous area located posterior to the remaining teeth is known as what kennedy class?
Class II
A unilateral edentulous area with natural teeth remaining both anterior and posterior to it is known as what kennedy class?
Class III
A single bilateral edentulous area located anterior to the remaining teeth is known as what kennedy class?
Class IV
What determines the path of insertion for an RPD?
The abutment teeth- the external surfaces of the teeth and their relationship (parallelism) defines the path the RPD framework and acryllic follows
What is considered the height of contour of a tooth? What is drawn at this area?
The HOC designates the greatest circumference of the teeth. Drawn here is the survey line
Is the portion of the tooth apical to or gingival to the survey line retentive or resistant?
Retentive
Is the portion of the tooth ,apical to the height of contour, suprabulge or infrabulge?
Infrabulge
Does a retentive arm at the infrabulge undercut help with horizontal displacement or vertical displacement?
Vertical displacement
Is the portion of the tooth coronal, incisal or occlusal to the survey line known as suprabulge or infrabulge?
Suprabulge
Does suprabulge arm placement help with vertical displacement or horizontal displacement (bracing)?
Bracing- resists unwanted lateral stress
Is the suprabulge arm conceptually for retention or reciprocation?
Reciprocation
What is retention?
Friction and resistance of vertical displacement
Which features of an RPD add to its retention?
Clasps and guide planes
What is reciprocation?
Bracing an abutment tooth to protect it from lateral stress during the placement and removable of an RPD
What part of the RPD aids in providing reciprocation?
Reciprocal clasp arm
Which is the most stress relieving because all the forces are supported by the abutment teeth? Quadrilateral, tripod or bilateral?
Quadrilateral clasp placement
Which kennedy classes allow for quadrilateral clasp placement?
Kennedy class III and IV
Where should the clasps on the dentate side of a Kennedy class II be placed?
As far from each other as possible
How many clasps are used in a Kennedy class II?
3; tripod
Which is the worst stress reducer? Quadrilateral, tripod or bilateral?
Bilateral
What kennedy class uses bilateral clasp placement?
Kennedy class I
What feature will significantly reduce the rotational stresses imparted to the abutment teeth?
Proper clasp design
What areas are most important for the support of the RPD?
Soft tissue (absolute distal extension) and teeth rests
Occlusal, cingulum and incisal rests help with support because they direct the force down the ____________
long axis of the tooth
What feature is most important for the stability of the RPD?
Passive fit of the metal framework
What determines the occlusion of the RPD?
The opposing occlusion (canine guided, group fxn or bilaterally balanced)
How should the surveyor table be placed when surveying the diagnostic cast?
Horizontal or parallel to the horizon because that is how the RPD is inserted into the patient’s mouth
What is first determined when surveying the dental cast to design an RPD framework?
Path of placement
Are all proximal surfaces adjacent to edentulous spaces involved in the path of placement?
Yes
How is an undercut found on the diagnostic cast?
The horizontal disc should meet the tooth surface and the barrel is tangent to the survey line