classification and compontnts of removable partial · pdf file3 removable partial denture...

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CLASSIFICATION ANDCOMPONTNTS OF

REMOVABLE PARTIALDENTURES

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CLASSIFICATION OFREMOVABLE PARTIAL

DENTURES

PARTIAL DENTURE

Definition

A dental prosthesis that restores one or more but notall of the natural teeth and/or associated parts andthat is supported in part by natural teeth, dentalimplant supported crowns, abutments, or other fixedpartial dentures and /or the mucosa; usage: a partialdenture should be described as a fixed partial dentureor removable partial denture based on the patient’scapability to remove or not remove the prosthesis.

From The Academy of Prosthodontics (1999). Glossary ofProsthodontic Terms (7th ed). St. Louis: Mosby.

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REMOVABLE PARTIAL DENTURECLASSIFICATION

- KENNEDY CLASSIFICATION SYSTEM-

CLASS I - Bilateral Posterior Edentulous Areas

CLASS II - Unilateral Posterior Edentulous Area

CLASS III - Unilateral or Bilateral EdentulousArea(s) Bounded by RemainingTooth/Teeth

CLASS IV - Single Edentulous Area Anterior toRemaining Teeth and Crossing the Midline

Note: The U of M follows this classification system and uses therules proposed by Dr. O.C. Applegate for applying the system.

KENNEDY CLASSIFICATION SYSTEMRULES

(Proposed by Dr. O.C. Applegate)

1. Classification follows all mouth preparations including extractions

2. Edentulous areas with no teeth replacements are not considered

3. Third molars are not considered unless present or being replaced

4. Additional edentulous areas are “modification spaces”

a. Anterior space - A

b. Posterior space - P

5. Class I or II situations take precedence over IV situations

6. A Class III situation takes precedence over a Class IV situation

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KENNEDY CLASS I

CLASS I - Bilateral Posterior Edentulous Areas

Source: Jeff Shotwell, University of Michigan, 2008

KENNEDY CLASS II

CLASS II - Unilateral Posterior Edentulous Area


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CLASSIFICATION WITH MODIFICATION AREAS

CLASS II-P

CLASS II-A-2P


KENNEDY CLASS IIICLASS III - Unilateral or Bilateral Edentulous Area(s) bounded by Remaining Tooth/Teeth

UNILATERAL


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KENNEDY CLASS III

BILATERAL


KENNEDY CLASS IV


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KENNEDY-APPLEGATE CLASS VI


COMPONENTS OFREMOVABLE PARTIAL

DENTURES

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REMOVABLE PARTIAL DENTURE

COMPONENTS

- Major Connector

- Minor Connector

- Direct Retainer

- Base

- Replaced Teeth

- Indirect Retainer (Class I and II RPD’s only)

MAJOR CONNECTOR

Definition:

“The part of a removable partial denture that joins thecomponents on one side of the arch to those on theopposite side.” The Academy of Prosthodontics (1999). Glossary ofProsthodontic Terms (7th ed). St. Louis: Mosby.

MANDIBULARMAJOR CONNECTORS

- Lingual Bar- Labial Bar- Lingual Plate

MAXILLARYMAJOR CONNECTORS

- Complete (or modified) PalatalPlate- Anteroposterior Palatal Strap- Anterior Palatal Strap

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1. LINGUAL BAR - Six gaugehalf-pear shape approximately 4mm in height with superiorborder at least 3mm from fgm’s.

MANDIBULAR MAJOR CONNECTORS

7mm

The bar is pear shaped in crosssection with the thickest partalong the inferior border.

2. LINGUAL PLATE – Used whenfgm to floor of mouth is less than7mm, or when anteriors are mobileand their longevity is questionable.

30ga relief wax is used to ensure that bar or plate does not contact tissue.Source: Jeff Shotwell, University of Michigan, 2008

Superior border is placed atthe junction of incisal andmiddle thirds.

MAXILLARY MAJOR CONNECTORS

-Wide application to all classifications, but mostly to Cl I and II.

- Provides maximum support as plate rests on tissue (as do all maxillarymajor connectors.)

- Contraindicated where tori are present.Source: Jeff Shotwell, University of Michigan, 2008

COMPLETE PALATALPLATE

MODIFIED PALATALPLATE

Anterior border ends in valley ofrugae not less than 6mm from fgm

Posterior border must notimpinge upon movable tissue

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Used where torus precludes useof palatal plate, provided aminimum of 5mm exists betweenthe posterior aspect of thetorus and the vibrating line.

Minimum width of 4mm


(MID)PALATALSTRAP

Used mainly in Cl IIIsituations – width ofstrap varies to suitthe clinical situation.

ANTEROPOSTERIOR PALATALSTRAP


These designs arenot recommended –the ones on the leftlack rigidity andtherefore do notdistribute stressadequately.

The bars on theright are too high(thick) for comfort.

1.

2.

3.

4.

The anterior palatalstrap in design 1. isonly used where atorus extends towithin 5mm of thevibrating line.



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LABIAL BAR -

Form and Usage: Same as the lingual bar but placed buccally(labially) due to severe lingual inclination of the remainingteeth

Labial Bar Labial Bar


MINOR CONNECTOR

(Unification with Rigidity)

Definition:

“The connecting link between the major connector or base of a removablepartial denture and the other units of the prosthesis, such as the claspassembly, indirect retainers, occlusal rests, or cingulum rests.” The Academy ofProsthodontics (1999). Glossary of Prosthodontic Terms (7th ed). St. Louis: Mosby.

Requirements:

- must be rigid to distribute stress between linked components

- must not impinge on underlying mucosa; tissue relief (30 ga.) needed in the mandibular arch

- mucosal surface is highly polished to prevent plaque accumulation

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Usage:

- minor connector and restjunction must be at least 1.5mm thick

- try to place interproximally

- joins major connector at aright angle

- should be located at least 5mm from other verticalcomponents

MINOR CONNECTOR -


DIRECT RETAINER

Definition: “That component of a removable partialdenture used to retain and prevent dislodgment,consisting of a clasp assembly or precisionattachment.” The Academy of Prosthodontics (1999). Glossary ofProsthodontic Terms (7th ed). St. Louis: Mosby.

Parts:- Reciprocal Arm

-Occlusal Rest

- Retentive Arm


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An OCCLUSAL REST:

- Transfers stress to the abutment tooth- Resists movement of the prosthesis in a cervical direction

-Stabilizes the retentive arm in the proper position

Avoid placing the rest in Glass Ionomer – and choose composite overamalgam for Class II situations.

Less than 90degree angle tomake rest seat

“positive”

Marginal ridge loweredto allow sufficientthickness without

creating an occlusalinterference.

Deepest portion of restseat; deeper than

reduced marginal ridgearea

Source: Jeff Shotwell,

University of Michigan,

2008

OCCLUSAL RESTS - POSTERIOR

The image on the right shows a conventionalocclusal rest seat prepared in a gold inlay.

The images below show an elongated occlusalrest (left) and continuous occlusal rest(right). These are occasionally used todistribute the load more evenly over a molartooth, or to stabilize a lone-standing tooth(and prevent it from drifting).


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OCCLUSAL REST: ANTERIOR

Must be placed in a prepared recess orbe part of a material added to the lingualaspect of an anterior tooth to make therest “positive”

WRONG RIGHT

MANIBULAR ARCH MAXILLARY ARCH

- Raised Cingulum* - Cingulum Ball*- Cingulum Ledge* - Cingulum Ledge (Groove)*- Incisal Ledge (Notch) - Raised Cingulum- Cingulum Ball - Incisal Ledge (Notch)

Listed in decreasing order of frequency used.(* Most often used at U of M)


OCCLUSAL REST: ANTERIOR - Maxillary

Cingulum Ball -

A small round bur type rest seat placedin the mesial or distal lingual cingulumarea cervical to any opposing occlusalcontact.

When placing, care is taken not toundercut the axial wall area to the pathof placement of the rpd.

Cingulum Ledge (Groove) -

Rest seat needs to be deep enough toprovide a positive stop for the rest. Ifdentine is exposed and sensitive, place acomposite restoration.

Notice the positive seat created by restpreparation.


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OCCLUSAL REST: ANTERIOR - Mandibular

Raised Cingulum -

- A small, semilunar shaped addition to the lingual of the anterior tooththat is part of a crown or formed from composite restorative material.

- It is the best rest type for a mandibular anterior tooth that is thedirect retainer abutment since it can easily be made positive and alsoprovides better bracing potential than any other anterior rest seat.

Rest as part of acrown

Class I situation priorto rest seat addition in

composite

Composite added tocanine and incisor to

form rest seat


OCCLUSAL REST: ANTERIOR - Mandibular

Incisal Notch -

- Used infrequently because it is unesthetic and places the forceapplication to the tooth some distance from the alveolar bone level.

- Used only when a raised cingulum or ledge type rest are not feasible.

Incisal notch in distalincisal corner of canines;teeth rotated too muchto use a better type ofrest seat

Lingual plate majorconnector has rest seatcoverage as part of it


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RECIPROCAL ARM (Reciprocation)

Definition: “A component of the clasp assembly specificallydesigned to provide reciprocation by engaging a reciprocalguiding plane; it counteracts the action of the clasp duringremoval and insertion of the removable partial denture.”

Reciprocation: “The mechanism by which lateral forcesgenerated by a retentive clasp passing over a height ofcontour are counterbalanced by a reciprocal clasp passingalong a reciprocal guiding plane.”

Guiding Plane: “A vertical parallel surface on an abutmenttooth oriented so as to contribute to the direction of thepath of placement and removal of a removable partialdenture.”

All definitions from The Academy of Prosthodontics (1999). Glossary ofProsthodontic Terms (7th ed). St. Louis: Mosby.

RECIPROCAL ARM - Functions:

- Resists lateral movement of the prosthesis

- Resists potential orthodontic movement of the abutmenttooth generated by the retentive arm during placement andremoval of the rpd

Types: Horizontal

Horizontal arm on molar- it is rigid, non-flexible,and placed in a non-retentive area

Horizontal arm ona premolar

Horizontal arm isincorporated intothe lingual platemajor connectorSource: Jeff Shotwell, University of Michigan, 2008

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RECIPROCAL ARM - Types: R.P.I. System

- A clasp assembly system that achieves reciprocation using two of itsthree components

- This system lacks bracing and lateral stress control that is found with ahorizontal reciprocal arm

Proximal plate and mesialminor connector combineto provide reciprocation

Proximal plate extendsonto the lingual surfacewith mesial connectorcontacting tooth at “c”

RPD framework oncast showing thelingual components ofthe R.P.I. system

This image removed

for copyright

reasons

This image removed

for copyright

reasons


RETENTIVE ARM (CLASP)-

Defintion: 1. “A clasp specifically designed to provide retention byengaging an undercut.” 2. “A flexible segment of a removable partialdenture that engages an undercut on an abutment and that is designed toretain the prosthesis.” The Academy of Prosthodontics (1999). Glossary ofProsthodontic Terms (7th ed). St. Louis: Mosby.

Function - provides resistance to vertical displacement of the rpd.

Types of clasps: (material) Types of Clasps:(approach toundercut)

1. Cast 1. Suprabulge (occlusal approach)

- circumferential - cast

- bar (infrabulge) - wrought

2. Wrought 2. Infrabulge (gingival approach)

- circumferential - cast

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RETENTIVE ARM (CLASP) -

Retentive Surface Material:

Acceptable: enamel, gold, porcelain, composite

Not acceptable: amalgam, glass ionomer

Types of Clasps: (material)

Cast half-roundcircumferential clasp

on a molar

Cast I-bar claspon a canine

Wrought wire (19 ga.)clasp soldered toframework on a premolar

Remotesolderedor laserwelded


DENTURE BASE

Definition: “The part of a denture (rpd) that rests on thefoundation tissue and to which teeth are attached.” The Academy ofProsthodontics (1999). Glossary of Prosthodontic Terms (7th ed). St. Louis: Mosby.

Attributes of a tooth-tissue supported (class I or II) rpd base:

- contacts edentulous ridge in a way that provides support

- acrylic base mandatory in mandibular arch; metal possible in maxillary

- Modified (loaded) anatomic form captured during impression procedure

-maximum area of coverage needed for stress distribution

Attributes of a tooth supported (class III or IV & modifications) rpdbase

- only need contact with edentulous ridge

- metal or acrylic base is possible

- only need anatomic (unloaded) form of the ridge during impression procedure

- convenience coverage of the edentulous area only

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DENTURE BASE - ACRYLIC

Usage:

- can be used in all rpd maxillary and mandibular classifications

- it can be relined if the edentulous ridge area changes

- attached to the rpd framework via meshwork

Meshwork wax-up onmand. Rpd. It isrelieved off the ridgeby using 24 ga. waxduring block-out ofthe cast prior toduplication andwaxing

Meshworkafter castingfor a class Imand.case

Cast meshwork foran anteriormodification space

Acrylic baseattached tomeshwork -note grayshadowingofmeshwork


DENTURE BASE - METAL

Usage:

- Can be used in mandibular class III or IV rpd’s, maxillary class I-IVrpd’s as well as all modification areas

- Cannot be used in mandibular class I or II rpd’s since it can not berelined

- The acrylic material associated with the base is attached using smallplastic beads at the time of base wax-up

Plastic beads Beads cast onmodification base

Acrylic attachedto metal base -

note acrylic flange


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DENTURE BASE - FINISH LINES

Definition: “The planned junction of different materials.” TheAcademy of Prosthodontics (1999). Glossary of Prosthodontic Terms (7th ed). St. Louis: Mosby.

Types: Internal (Acrylic bases only)

- Associated with the junction between the metal of the rpd frameworkand the acrylic base material

- Formed by the 24 ga. relief wax used to provide space for the dentureacrylic

24 ga. wax ~ 3mmdistal to tooth

24 ga. wax forming theinternal finish line

24 ga. wax forming theinternal finish line for a

modification space



Types: Internal (Acrylic bases only)

Internal finish line in cast framework -note definite edge for acrylicmaterial junction

Acrylic base-frameworkjunction on finished rpd - itshould be a smooth transitionbetween the two


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Types: External (Acrylic and Metal bases)

External finish onmandibular framework

External finish line on maxillaryframework

Note- Externaland internalfinish lineswhen presentare not placedopposite eachother topreventpotentialfracturing ofthe base

External finish line junction between acrylic and metal on a mandibular extensionbase, a mandibular modification base, and a maxillary extension base - again there isa smooth transition between the two. Source: Jeff Shotwell, University of Michigan, 2008

REPLACED TEETH

Functions:

- Prevent migration of the remaining teeth

- Restore masticatory efficiency

- Retain proper interarch space

- Maintain esthetics of a normal facial contour

- Achieve distinct enunciation

Types of Material:

- Acrylic

- Porcelain

- Metal: gold and chrome

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REPLACED TEETH - POSTERIOR

- Material:

Acrylic posteriordenture teeth -standard tooth usedon rpd’s and cd’s.Much easier to setand adjust thanporcelain. Clinicalwear helps dissipateocclusal forces.

Gold occlusalsurfaces added toacrylic denture teethopposite fixed partialdenture gold occlusalsurfaces to even outwear potential

Occlusal chromesurfaces on thismaxillary class IIIRPD are anextension of theframework. Acrylicfacings are placedon the buccal foresthetics.

Note- Not usedvery often clinically


REPLACED TEETH - ANTERIOR

Material:

Porcelain Acrylic

Acrylic dentureteeth on classs IVRPD. The standarddenture tooth typeused for rpd’s andcd’s at the U. Of M.

Porcelain denture teethare rarely used sincethey are difficult toset. Porcelain facings asshown on left were usedfor many years but notnow. The backing of thefacing is frameworkmetal with the facingadjusted to fit thebuccal mucosa so noacrylic is associatedwith this area. Thefacings can come offduring ultrasoniccleaning so beware.

Source: Jeff Shotwell,

University of Michigan, 2008

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INDIRECT RETAINER

(Class I and II RPD’s only)

Definition: “The component of a removablepartial denture that assists the directretainer(s) in preventing displacement of thedistal extension denture base by functioningthrough lever action on the side opposite of thefulcrum line when the denture base moves awayfrom the tissues in pure rotation around thefulcrum line.” The Academy of Prosthodontics (1999).Glossary of Prosthodontic Terms (7th ed). St. Louis: Mosby.

FULCRUM LINES

• Page 96 of your text (you need to know this material – all three columns,especially fulcrum and retentive fulcrum axes.)

• Definition: FULCRUM LINE AXIS (sometimes referred to just asFULCRUM LINE) An imaginary line, connecting the most distal occlusalrests, around which a removable partial denture tends to rotateTOWARDS the tissue under masticatory forces.

• Definition: RETENTIVE FULCRUM LINE AXIS – Movement of the baseAWAY from the ridge around an imaginary line connecting the retentiveclasp tips. (This is the axis relevant to indirect retention.)

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INDIRECT RETAINER -

Effectiveness and Placement:

- Usually it is a rest seat placed anterior the the fulcrum line on theside opposite the extension base. Theoretically, the further anteriorthe rest seat is placed the more effective it is. The rest seat is usuallylocated on a canine or first premolar mesial fossae.

The RPD base as shown by arrows canrotate away from the ridge around thefulcrum pt. “F” if foods stick to the baseduring function. This would cause themajor connector to rotate into theunderlying mucosa and produce soreness.

Note the placement of a rest seat in themesial fossae of the first premolar thatprevents tissue-ward movement of themajor connector. It is attached to themajor connector by a minor connector.This image removed

for copyright

reasons

INDIRECT RETAINER - Class I RPD Usage:

Primary fulcrumline through mostdistal rest seats

Ideally , a class I rpd hastwo indirect retainers asshown above; one for eachextension base

Practically, only oneindirect retainer isneeded for a class Irpd as shown on theright two pictures.Usually, the sitefurthest from thefulcrum line ischosen.

Indirectretainers


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INDIRECT RETAINER -

Class II RPD Usage:

Indirect retainerrest seat; only oneand on the sideopposite theextension base

Primary fulcrumline through mostdistal rest seats

Indirect retainerrest seat

Indirect retainer rest ontooth #28; only a secondaryrest seat on the mesial oftooth #21 to support thelingual plate major connector


QUESTIONS?????????

classification and compontnts of removable partial · pdf file3 removable partial denture...

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