Removable Partial Dentures Flashcards
What is an RPD
- restores partial loss of natural teeth and supporting structures
- supported by natural teeth/ mucosa
- can be removed and replaced in the mouth by patient
What are the consequences of tooth loss?
- Reduced facial height
- Compromised aesthetics
- Partial or complete loss of function
- Extrusion can lead to ectopic caries
- Bone resorption leads to lose of lip support
- Costly and some can be challenging to replace
- Front teeth can flare if posterior bite collapses
- Collapse dental arch or occlusion
What are some of the rationale and indications for an RPD?
- Patient desire
- Cost of treatment
- Excessive alveolar bone loss
- No posterior abutment for fixed
- Immediate replacement of extracted teeth
- Lengthy edentulous span cant support fixed prosthesis
- reduced periodontal support of remaining teeth
- Cross-arch stabilization of teeth
What is the relevance of RPD’s?
- restores chewing and biting efficiency, restores 2/ preserves and improves appearance
- aids speech
- restores health comfort and quality of life
- provides splinting action to weakened teeth
- preserves remaining teeth and supporting structures
- restores integrity of dental arch
What is a kennedy Class I?
Bilateral edentulous areas located posterior to the remaining natural teeth
What is a kennedy Class II?
Unilateral edentulous area located posterior to remaining natural teeth
What is a kennedy Class III?
unilateral edentulous area with natural teeth remaining anterior and posterior to it
What is a kennedy Class IV?
Single but bilateral (crosses midline) edentulous area located anterior to remaining natural teeth
What is a surveyor used for?
Determining relative parallelism of two or more surfaces teeth or part of the cast
What is a tissue-supported rpd?
Tissue supported RPD’s are primarily supported by the tissues (mucosa overlying bone) of the denture foundation area
what is a tooth-supported rpd?
primarily supported by natural (abutment) teeth, denture retention is derived from direct retainers
what are some advantages of polymer based rpds?
- good aesthetics
- processing technique is simple
- reduced construction time
- popular and affordable
- PMMA van be easily repaired or relined
- restore the full contour of an edentulous ridge
what are some disadvantages of polymer based rpds?
- brittle and liable to fracture
- reported biological reactions to oral tissues
- rigid so can be difficult to insert in deep undercut is required for retention
- mainly tissue supported therefore wide and thick designs required for stability
- pressure is transmitted directly to mucosa and underlying tissues
- fitting surface can accumulate mucous deposits and food debris
what are some advantages of nylon-based rpds?
- easy undercut insertion
- allows movement and tissue simulation
- monomer free reduces tissue reaction
what are some disadvantages to nylon-based rpds?
- inferior to metal-base dentures
- high water absorption
- possible discolouration
what are some advantages to metal rpds?
- easy to clean
- mainly tooth or tooth and mucosa supported
- framework can be fabricated with CAD/CAM
- better durability and stability from direct and indirect retainers
what are some disadvantages of metal rpds?
- difficult to repair
- labour intensive construction
- reported patient allergies
- mechanical retention of denture can fail
what are interim rpds?
sometimes made prior to making a definitive one and is used to:
1. maintain or enhance appearance
2. maintenance of space
3. reestablishment of occlusal relationships
4. conditioning of teeth and residual ridges
5. interim restoration
6. conditioning the patient for wearing prosthesis
Why are rpds used to improve conditions before definitive dentures?
tissue conditioning:
- due to papillary hyperplasia (massage, brushing) or acute inflammation (increase tissue adaption and redistribute stress)
implant healing:
- may be necessary for aesthetics or function, a soft liner is placed so that the fixtures can heal
alteration of vertical dimension:
- important use to determine how a patient will react to changes
Surgical splint:
- after removal of palatal tori, etc.
what is required on a patient form?
patient name, record number, DOB, gender, clinical details, clinician name and contact details, type of restoration, shade, prescription date, due date (including next appointment), items included in prescription (impressions, models, bite registrations)
what is an articulator?
mechanical device that simulates the movements of the mandible in relation to maxillary arch
why use an articulator?
- maintain or re-establish healthy occlusion
- enhance efficiency and precision
- construction with articulator will suit better
- communication between dentist and technician
- minimize major occlusal adjustments
what is occlusion?
the static contact relationship between the incising or masticating surfaces of maxillary and mandibular teeth
what are the types of denture processing techniques?
- compression moulding
- injection moulding
- pouring (fluid resin)
- light activated
what are the components of an RPD?
- saddle
- major connectors
- minor connectors
- rests
- direct retainers
- stabilizing components
- indirect retainers
- denture base
what is the saddle?
a saddle is the part of the denture that replaces lost alveolar tissue and carries artificial teeth - bounded or free-end
what are major connectors?
join components on both sides of a dental arch together to effectively distribute forces throughout the arch and reduce the load
what are types of maxillary major connectors?
- single palatal strap
- anterior-posterior palatal strap
- palatal plate
- u-shaped palatal
- single palatal bar
- anterio-posterior palatal bar
what is a single palatal strap?
bilateral bounded saddles for kennedy class II and III cases
what class is a anterior-posterior palatal strap type used for?
ideal for all classes (mostly II and IV)
Why are single palatal bar and antero-posterior palatal bars used?
for cross-arch distribution of stress
what is a palatal plate-type connector?
a full palatal plate that is indicated when maximum tissue support is required. ideal for long distal extension cases when theres 6 or less anterior teeth remaining
what is a u-shaped palatal connector?
least favourable design due to lack of rigidity, and only used in situations when inoperable tori extends to the posterior limit of the hard palate
what are the types of mandibular major connectors?
- lingual bar
- linguoplate
- sublingual bar
- lingual bar with cingulum bar
- cingulum bar
- labial bar
what is a lingual bar?
used when enough space (>8mm) exists between the slightly elevated alveolar lingual sulcus and gingival tissue
what is a sublingual bar?
used when the height of the floor of the mouth in relation to free gingiva margins are <6mm.
what is a lingual plate?
used when there is insufficient space for a lingual bar, class I arches with highly resorbed residual ridges, for splinting
what is a labial bar?
when severe lingual tori cant be removed and prevents the use of a lingual bar or plate
what are the functions of a minor connector?
- connects major connector to other components (such as clasps, rests or indirect retainers)
- transfers functional stress to abutment teeth
- transfers the effect of retainers, rests and stabilising components through prosthesis
what are important things to consider with minor connectors?
- have adequate relief
- at a right angle to the major connector
- should not be located on a convex surface
- should be least noticeable
- tapered, no sharp edges or spaces for food debris
what are direct retainers - precision attachments?
direct retainers engage the vertical walls built into or around the crown of the abutment tooth to create frictional resistance for removal
what are direct retainers - clasps?
engage the external surface of abutment teeth in natural undercut or prepared depression and are either occlusally approaching or gingivally approaching.
what is the undercut for a g-clasp?
0.25 - 0.35mm
what is the undercut for a e-clasp?
0.20 - 0.35mm
what is the undercut for a ring clasp?
0.30 - 0.50mm
what is the undercut for a bonwill clasp?
0.20 - 0.35mm
what is an e-clasp?
on a bounded saddle (class II, III and IV (sometimes))
advantages of a e-clasp (akers)?
- has 1 or 2 retentive clasp arms
- path of insertion easy to define
- reliable retention close to saddle
- excellent bracing qualities
- less potential for food accumulation
- easy to design, construct and activate
disadvantages of e-clasp (akers)?
- more tooth coverage
- more metal is displayed
- adjustments are difficult or impossible
- low undercut depth
what class is a g-type clasp used for?
kennedy class I, II and III
what are some advantages for a g-clasp?
- mesial rest support acts indirectly to elongate the saddle
- minor connector is away from saddle (periodontally hygienic)
- passible clasp arm leads and stabilises denture
what are disadvantages of a g-clasp?
- extensive tooth coverage
- rest being distant to saddle
what class are back-action clasps used for?
ALL - kennedy class I, II, III and IV
what are some advantages of a back-action clasp?
- large retention field due to long retentive arm
- minor connector stabilises support
- aesthetically favourable
what are some disadvantages of a back-action clasp?
- space between minor connector and saddle
- extensive tooth coverage
what class are ring clasps used for?
only lingually shifted molars in kennedy II, III and IV
what are some advantages of a ring clasp?
- retention adjacent to saddle prevents displacement
- protection against distal drifting
- long retentive arm implies high ability of retention
- allows for use of available undercut adjacent to edentulous area
what are some disadvantages of a ring clasp?
- extensive tooth coverage
- long clasp arm can deform
- covered distal area of posterior teeth
- very difficult to adjust
- lower bracing arm should be at least 1mm from free gingival margin to prevent impingement of gingival tissues
what class is a bonwill (double akers) clasp used for?
kennedy II, III and IV
what are some advantages of a bonwill clasp?
- allows placement of direct retainer where none can be placed
- maximised retention
- retentive forces distributed
- provides splinting effect
what are some disadvantages of a bonwill (double akers) clasp?
- extensive tooth coverage
- bulky minor connector
- clasp arm can impede occlusion
- extensive interproximal reduction required
what are some advantages to a bar (or roach) clasp?
- easy insertion
- extreme undercut depth
- minimum tooth coverage
what are some disadvantages of a bar (roach) clasp?
- often unstable
- risk of labial tooth tilting
- hygienically unfavourable
what are the contraindications of a bar (roach) clasp?
- deep cervical undercuts (food trap)
- severe soft tissue or bony undercuts (food trap)
what are wrought circumferential clasps?
wrought wire clasps are fabricated by using metal that is made from a wire