advanced removable partial dentures (1st ed1999)

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This book describes the basic pricipios metal structures a removable prosthesis is recommended for all

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  • Advanced RemovablePartial Dentures

    James S. Brudvik, DDS, FACI'Professor Emeritus of Prosthodontics

    University of\VashingtonSchool of DentistrySeattle, \ Vashington

    Quintessence )lublishing Co, IncClJicago, Berl in. Loudon , Tokyo, Paris, Barcelona, Sao Pau lo,

    ~ toSC()W, Prague, and \ Varsaw

  • Il.ihntl)"of Con~n'~~ C;t lalogi ng-in-Puhlic:;tlion Data

    Bru(hik. [ nmes s.Advanced removahlc part ial dentures I [anu-s S. Brudvik.

    p. em.Includes index.IS BN O-1i67 15-.3.'31 -2 (hard cov r-r}L f'urnal dentuu-s, Homovable. I. Tltk-.Il ) XL.\l : I . Deutu n-, Partial. Hemovnhlr-. WU .515 USfiSa I!/!)!)]

    Il Km'5.R78 19!~Jfil i .(i'lJ2-

  • Introduction

    Contents

    IX

    Chapter 1 Pat ient Evaluation, Diagnosis, and Treatment Planning ]Initia l Examination Decision Making for RPD Treat ment Planning >Preliminary Impressions Preprosthet icTherapy

    Chapter 2 He~novahle Partial Denture DesignElements of Design Design Specifics: Class I-IV

    7

    Chapter 3 Mouth Preparation 37Surveying th e Diagnostic Cast Diagnostic Mo uth Preparatio n >Clinical Mouth Preparat ion

    Chapter 4 Final Impressions and Maste r Casts 55Altered Cast lmpressions > Jaw Relatio n Records

    Chapter 5 Laboratory C onstruction of the F ramework 63Design Transfer Bla ckout and Duplication >W axing Spruing,Invest ing, and Casting Met al Finishing A ddit ion of W ire ClaspsAddit ion of Alte red Cast Trays

    Chapter 6 Estahlishing the Tooth-Frame Relationship 7.5Tooth Contact Surfaces > Static Fit Functional Fit Poo r Cast ing Fit

    Chapter 7 Completion of the Partial D t::nture 79Jaw Relat ion Records Placement of Dent ure TeethFlaski ng,Tinting, and Packing lnsertion > Metal Occlusal Surfaces Long-Term Maintenance

  • Chapter 8 Repairs, Additions , and Relines 93Pick-up Impressio ns Res in Repairs Metal Repairs > Restorat ionsUnder Existing RPDs Crowns Under EXisti ng RPDs Relines andRebases

    Chapter f) Special Prostheses lO.5Splint ing with the RPD Hinged Major Connectors RotationalPart ial Dentures

    Chapter 10 Precision Attachments 11 ,5Common Clinical Procedu res Precision Attachment Systems

    Chapter 11 Implants and Removable Partial DenturesClass I and II Situ ations ' Class III and IV Sit uat ions

    Index

    I

    1.5:3

    160

  • T he removable partial den tu re In" a1-way~ 1)('('11 Ill)-' speci al challenge i lld en tistry. As a clinician , researcher; 1I('lIlallaboratory direct or, 'lect ure r, and IIIPHtor, Ihave s[X'llt almost 3-5 years Il")ing to cometo grips wi t II t lie co mplexit ies o r th is fo rm orprosthodoutt c treatment . r would estimatethat 2()1}t of parual W{'aTeTS are more th anjust a litt le dissatisfied " ; 11. the ir denture.Unlike \\il l. the fixed part ial denture. till'pa tient has the option of removing the p lUS-thesis at tile slightest hint of d iscomfo rt .physical or men tal. Civcu the act ual state ofpructice-c- thc dent ist docs only the occa-_..ional partial denture with almost tota! T('-Hance 011 t Il t ~ dcu tallallmlnty for desi gn aswe ll as const rucuon-c-I .nnmost pessimi sticus to the e f1i.d of this, or :I ll: ' oilie r text onthe subject .

    \Vhile there are a number of excellen tbaste texts Oil the rr-movuble pa rtial den-ture . they arc all direc ted toward tht, un-de rgraduate dental studen t. I han ! notfou nd anyt hing that I ca n m e as an ad-vanced text for th e graduate student andstudy club participant who wishes to pur-

    Preface

    Sill ' this form of therapy at the highestlevel . After years of be ing asked if I hadever conside red putting Illy lectu re mater-ial in written form and protesting tha t I didnot have the time. my partial ret ire men tfrom the University of \Va.~hillgtuTl Schoolof Dentist ty has made my excuses nolonger valid .

    T his work is not in ten ded to be a text-book ill th e classical sense. It is, rathe r. amonog raph on the rem ovable partial den-ture , writte n wi tl r the expec tat ion tha t thereader will already have covered the basicsof the part ial denture and is now ready totake a more sophi...t icatcd look at this tre at -mcut modali ty It dops not have a btbl iogru-phy, and the Illustrations consist o f draw-ings that I have placed 011 countlessblackboa rds over the years i ll all attempt 10make things clr-ar to m)' students. \ \ 1.:lt 1'01.lows an' my thoughts as they have evo lvedover these yea rs orpractice and teaclnug inth is f ascinating urea.

    While I take complete rcsponstbtltty forthe content of thf.. work, r have l WC B aidedin tlll ~ writing hy Illy friend and coworke r,

    vii

  • Advanced Removable Part ial Dentures

    [uuiuc Nr-mcrevr-r Coal; \~ , who, as program coordi nator orthe (; radu alp Programin Prosthodontics, has long stood watchove-r Illy fau lty gram mar and sentencestruct ure. I han:' also had the ln-lp of DrAlex Shor, present ly in OIl f graduate pro-gram, who has rovh-wed the entire hook toprovide insight and guidalll'l' from the eyt'Sor the pote-ntial readership.

    viii

    This boo k is dt'dicakd to Illy grad llalesuu k-nts-c-past , pn-sent , and hopc-Inllv fll-tnfl"- --who provide. 0 11 a daily basis. the joyofsl"{'ing S( 1111{"O Il(' learn. It is also rk-dicatodto Illy longtime friend ami colleague, theeminent functional anat omist . ProfessorJ('an I~OI I 11' row~ki (If tilt) Unlversity of Part s.VII , who has h('('11 an inspiration in thismailer as i ll so mallYotln -r endeavors overthe H'aI~.

  • T he removable par tial denture bas lon g!JPCH considere d an in fer ior means ofreplaci ng missing ' teet h and assoc iatedstructures when compared 10 the fixed par-tial de ntu re. Some have even spoken of itas a stepping stone to a complete denture .The old rhyme, "Litt le HPD , don't yon C'Y.You'll be a CD by and by" may be st expressour feelings toward th is tre atment modal-ity. Many Slll\'CYS published over IIH~ yearsin our journals indicate that den tist ry docsa rathr-r pOOT job witlr th e HPJ) . These re-ports testify to the hid that most RPDs arccreated entirely bv the technician wtth a

    , ,

    mi nim um of Input from the clinicia n in thefo rm of mouth p reparat ion or de.sign.

    Dental schools make it serious effort toteac h th e subject, and excellent texts forthe undergraduate are available. None-theless, the state of removable partial den-turc s scou in the commercial laboratoriesand in the cross-sectional studies availableto IL~ indicates that , in general, pa rtials arepoorly de signe d and cons tructed andpoorl y maintained.

    Introduction

    Therefore , it is no wonder th at patientsdislike t hei r partials to tile point of notwearing them and, if they can afford alte r-native treatment , request it routi nely It hasbeen my experience that the pattent whostates , "1 had a partial once and couldn'twear it!" most likely hall a substandardprosthe sis; when t reated ,vith a sta te- of-the -art partial dent ure, the patient wou ldlikely find it tolera ble and easily accept thelimitations of this fonu of tooth awl tissuereplacement .

    Plainly stat ed. th ere ts a dramatic diffe r-ence bet ween the standard RPD and theone th at approaches the state of the art aswe know it today. It is in the attemplto cre -ate that qu ality rem ovable part ial denturethat this book is written . It is intended toserve as a KI dde to both gnHlwlfe studentsin prosth odont ics and conce rne d generalpractitione rs-to challenge the m to thinkof the removable app liance as they wouldthe fixed partial denture, with all th e sameconsiderations of soft tissue man agem ent ,cades control , periodontal supp ort, ortho-

    ix

  • Advanced Removable Partia l Dentures

    don tlc therapy. ami implant involveun-nt.In almost eH'ry clinical situ ation . the pa-tieut who requires a removable part ial den-turc will have a need for so me fonn of fixedprosthodontics as well, from a si mpl ebonded rest to the most complex precisionattachments extending from fixed unit s.

    Philosophy of Care

    \\"hat makes a SlIt'('('SSflll RPD? At tilt, riskofoversimplifi cat ion . on e co uld say that thesuccessful rem ovable appliance Ill't 'tl beonlv Ion I' things:

    , . , .

    I, Strong. in that it does not wear, break.distort , or COII\I' apart when worn.

    2. He/entire, so that it rem ains in positionin the patient's mouth duri ng usc andg1VtoS tho patlcut confide nce that it willcontinue to do so (JVP I" the life of tile par-tial.

    3. Est/wtie, to satisfy the patien ts cxpI'ela-tious without undue evidence of its pws-r-ncc.

    ,I. 1'(1; 11-/1'(.'(', lIw,lIling that it docs not ( .IlI\('discomfort when in the mou th for theshort term ami that it causes no 101lg-term damage to eit he r hard or soft tissueOW l" the life of tho parti al.If these four requirements can hl' met ,

    the partial stands a good chance of long-k r ill success. Unfort unately, the Sll l,(,(.'S.~ ofthe part ial in and of itself does 1I0t ~lIar.mh't' the long-tr-rm he-al th of the rr'mainingh 't,th ami soft tissues. Matntenancc . there-fore. becomes the primary factor ill thelong-term succe ss (If the treatment . Theprofession has usually subst ituted conce rnover the tn )e of clasp to be used for themore fundamental requirem en ts (If n'WI-

    x

    lady scheduled recall and app ropriatemamtcuancc. Preparing tile mouth to itsvery la-st state of hr-alth be fore startingprosthodontic procedures and then keep-ing the tissues in that state of hea lth overthe life of the pa rtial is f ar mon- importantthan .IIlY desigll considerat ions, It has he-come obvious to me that a part ial den turein a healthy mou th , assum ing that it meet sour four requirements. will he successfulregardless of its design. lk -st placementand clasp (I"sign, Intcrcst iug lLs Ilie}' may IK'to argile ove-

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