RPD clinical sequence

Question 1

What are the important information points to get from the patient interview?

Answer 1

Presenting complain + history of PC

Med Hx

Dent Hx

Pt expectation

Question 2

What should be achieved from the complete oral exam?

Answer 2

TMJ + Occlusion

Vitality of critical teeth

Perio assessment of abutments

Assessment of soft tissues

Study models on articulator

Question 3

What are the steps to producing an RPD?

Answer 3

In the clinic the upper and lower preliminary impressions are taken.

In the lab the impressions are used to produce the upper and lower cast

RPD survey and design is conducted in lab. Identify which teeth need survey crowns

Mouth preparation for RPD is then conducted in the clinic

Another final impression is taken in clinic

Master model is produced to create the final denture.

Question 4

How should bite registration be achieved CR or MIP?

Answer 4

If the confirmative approach is used (for RPDs often the case) then in MIP

If the reorganizing approach is used (If increasing vertical dimension is needed) then in CR

Question 5

How is the anterior bite registration achieved?

Answer 5

Using a leaf gauge

Question 6

When is a leaf gauge best to use?

Answer 6

When the patient doesn’t have any tenderness in MoM or TMJ issues

Question 7

What is used when a leaf gauge is contraindicated?

Answer 7

An anterior jig + occlusal splint

Question 8

How is bite registration determined in patients with edentulous anterior teeth in one arch?

Answer 8

Base and rim as well as external soft tissue can be used to determine the bite registration.

Base of the nose to base of chin - freeway space

Question 9

What should be sent to the lab for production of an acrylic partial denture?

Answer 9

Master model

Lab prescription

Question 10

What should be sent to the lab for Co-Cr partial denture?

Answer 10

Master model

Study model with framework design

Lab prescription

Question 11

What is used for the final impression?

Answer 11

A special tray and an elastomeric impression material

Question 12

How is an acrylic partial denture made from the master model?

Answer 12

Mount models on articulator

Tooth setting

Denture try in

Processing

Insertion

Question 13

How is a CoCr partial denture made from the master model?

Answer 13

Duplicate master model

Survey blocks out the undercuts

Cast Co-Cr framework

Framework try in

Mounting of master model on the articulator

Tooth setting

Denture try in

Denture processing

Insertion

Question 14

How can final impression be used to create a denture?

Answer 14

It can be scanned directly (not at ohcwa) and then:

Digital designing of the acrylic denture -> Milling of the acrylic partial denture

Digital designing of the Co-Cr framework -> 3D printing of the bridgework (wax or castable resin)

Question 15

What can be scanned to produce a final denture?

Answer 15

Master model can be scanned directly

Impression can be scanned directly

Question 16

Why is the master model duplicated?

Answer 16

1 of them will be used for blocking out undercuts and designing the framework whereas the other one is used for processing the denture

Question 17

How is the frameowkr assessed outside of the model?

Answer 17

Assess cast framework outside of the model:

Check for defects on the tissue side of the framework

Check for abraded areas on the master cast

Assess smoothness of the framework

Check for adequate thickness

Question 18

How is the framework assessed on the master model?

Answer 18

Verify that the framework follows the design created

Check seating of the framework on the master model

Check for proper adaptation and placement of clasps

Check for ease of framework removal

Question 19

What are the steps to assessing framework for try in?

Answer 19

Assess cast framework outside of the model

Assess cast framework on the model

Assess framework in the mouth

Question 20

How can the framework be assessed in the mouth?

Answer 20

Seating the framework in the mouth: IT MUST BE PASSIVE SEATING

Fully seated on the rest seats with clasps in the correct position

Retention and stability (denture should not rock)

Relationship with soft tissue (ensure correct distance from framework to mouth)

Assess occlusion (use shim stock)

Question 21

How is framework adjusted during try in?

Answer 21

Dye is applied to the internal surface of the framework. Then framework is applied to the tooth, this then tells us where there is interference to be reduced using a cylindrical carbide bur

Question 22

What structure should never be reduced when trying in a framework?

Answer 22

Do not touch the terminal 1/3rd of the retention arm with the bur that point should always touch the teeth.

Question 23

How is occlusion assessed in class 1, 2s or extensive class 4s?

Answer 23

Use a base and rim with bite registration material on top

Question 24

What is the altered cast technique?

Answer 24

It is used for class 1 and 2s in the mandible (maxilla is supported by hard palate so no need).

After try in of framework, framework is then returned to the master cast and a baseplate is created which acts as a custom tray above the acrylic base, border molding around the free end saddle is conducted light body impression material is added.