2. INTRODUCTIONINTRODUCTION
A meaningful treatment embodiesA meaningful treatment embodies
four different processes:four different processes:
1.1. Ascertaining a patient’s dentalAscertaining a patient’s dental
needs.needs.
2.2. Relating the patient’s desires orRelating the patient’s desires or
wants to needs.wants to needs.
3.3. Developing a treatment plan relevantDeveloping a treatment plan relevant
to these wants and needs, andto these wants and needs, and
4.4. Executing the treatment.Executing the treatment.
3. OBJECTIVES OF PROSTHODONTIC TREAMENTOBJECTIVES OF PROSTHODONTIC TREAMENT
1.1. Elimination of the disease.Elimination of the disease.
2.2. The preservation of the health and relationshipThe preservation of the health and relationship
of teeth and the health of the remaining oralof teeth and the health of the remaining oral
tissues, which will enhance the removabletissues, which will enhance the removable
partial denture design, andpartial denture design, and
3.3. The selected replacement of lost teeth and theThe selected replacement of lost teeth and the
restoration of function in an esthetically pleasingrestoration of function in an esthetically pleasing
manner.manner.
4. Diagnosis and Treatment Planning for oralDiagnosis and Treatment Planning for oral
rehabilitation must take into consideration somerehabilitation must take into consideration some
or all of the following procedures:or all of the following procedures:
1.1. The establishment of good periodontalThe establishment of good periodontal
health.health.
2.2. The restoration of individual teeth.The restoration of individual teeth.
3.3. The restoration of harmonius occlusalThe restoration of harmonius occlusal
relationships.relationships.
4.4. The replacement of missing teeth by fixedThe replacement of missing teeth by fixed
restorations.restorations.
5.5. The replacement of other missing teeth byThe replacement of other missing teeth by
means of removable partial dentures.means of removable partial dentures.
5. Treatment plan should precede earlier treatment soTreatment plan should precede earlier treatment so
that abutment teeth and other areas in the mouththat abutment teeth and other areas in the mouth
can be prepared to support and retain the partialcan be prepared to support and retain the partial
denture.denture.
Diagnostics casts for designing and planningDiagnostics casts for designing and planning
partial denture treatment must be made beforepartial denture treatment must be made before
definitive treatment is undertaken.definitive treatment is undertaken.
6. Diagnosis is the determination of the natureDiagnosis is the determination of the nature
of the disease.of the disease.
Diagnosis can be classified as:Diagnosis can be classified as:
A.A. Clinical diagnosisClinical diagnosis -- includes personalityincludes personality
evaluation ,clinical examination andevaluation ,clinical examination and
radiographic examinationradiographic examination..
B.B. Post –clinical or derived diagnosisPost –clinical or derived diagnosis -- dealsdeals
with the evaluation of patients conditionwith the evaluation of patients condition
using the diagnostic data collected duringusing the diagnostic data collected during
the clinical diagnosisthe clinical diagnosis
7. IMPORTANCE OF DIAGNOSTIC PHASE OFIMPORTANCE OF DIAGNOSTIC PHASE OF
TREATMENTTREATMENT
Failure in RPD treatment can be traced to inadequate diagnosisFailure in RPD treatment can be traced to inadequate diagnosis
and an incomplete treatment plan.and an incomplete treatment plan.
Essential diagnostic data are obtained from a patient’sEssential diagnostic data are obtained from a patient’s
interview , radiographs , mounted and surveyed diagnosticinterview , radiographs , mounted and surveyed diagnostic
casts, a definitive oral examination including periodontalcasts, a definitive oral examination including periodontal
probing, percussion , vitality tests and consultations withprobing, percussion , vitality tests and consultations with
medical and dental specialists when appropriate.medical and dental specialists when appropriate.
8. ORGANIZING THE EXAMINATIONORGANIZING THE EXAMINATION
A.A. Health questionnaire-to assess the patient’sHealth questionnaire-to assess the patient’s
general health.general health.
B.B. Patient’s interview –Patient’s interview –
i.i. Establishing a rapport.Establishing a rapport.
ii.ii. Gaining insight into psychological makeup of theGaining insight into psychological makeup of the
patient-patient- In 1950 Dr. M M House classified patientsIn 1950 Dr. M M House classified patients
into the following four psychological type :into the following four psychological type :
PhilosophicalPhilosophical
ExactingExacting
HystericalHysterical
IndifferentIndifferent
9. O’Shea et alO’Shea et al characterized ideal dental patient as :characterized ideal dental patient as :
compliant ,sophisticated and responsive.compliant ,sophisticated and responsive.
WinklerWinkler described traits that characterized the idealdescribed traits that characterized the ideal
patient’s response:patient’s response:
Realizes the need for the prosthetic treatment.Realizes the need for the prosthetic treatment.
Wants the prosthesis.Wants the prosthesis.
Accepts the prosthesis.Accepts the prosthesis.
Attempts to use the prosthesis.Attempts to use the prosthesis.
WHY THE HOUSE CLASSIFICATION REQUIRESWHY THE HOUSE CLASSIFICATION REQUIRES
REEVALUATION?REEVALUATION?
Terminology is antiquated, falling out of use, noTerminology is antiquated, falling out of use, no
longer carries the same meaning within psychiatry.longer carries the same meaning within psychiatry.
The classification pertains to the patients inThe classification pertains to the patients in
isolation.isolation.
10. PROPOSED CLASSIFICATIONPROPOSED CLASSIFICATION
INDIVIDUAL ADAPTATION TO THE ROLE OF PATIENTINDIVIDUAL ADAPTATION TO THE ROLE OF PATIENT
The proposed classification is based on 2 factors:The proposed classification is based on 2 factors:
1.1. The level and quality of the engagement orThe level and quality of the engagement or
involvement of the patient toward the dentistinvolvement of the patient toward the dentist
{including issues as domination, submission,{including issues as domination, submission,
idealization and devaluation of the dentist }idealization and devaluation of the dentist }
2.2. The level of willingness to submit (trust) to theThe level of willingness to submit (trust) to the
dentist.dentist.
Patient type:Patient type: IDEAL, SUBMITTER , RELUCTANT ,IDEAL, SUBMITTER , RELUCTANT ,
INDIFFERENT , RESISTANT.INDIFFERENT , RESISTANT.
11. IDEAL a patient who accepts whatever treatment isIDEAL a patient who accepts whatever treatment is
given to him by the dentist but after his query hasgiven to him by the dentist but after his query has
been answered. He is engaged in his treatment andbeen answered. He is engaged in his treatment and
trusts the dentist.trusts the dentist.
SUBMITTER a patient who submits to what theSUBMITTER a patient who submits to what the
dentist says without any questions asked.dentist says without any questions asked.
RELUCTANT a patient who feels that no person canRELUCTANT a patient who feels that no person can
help him and reluctantly follows instructions.help him and reluctantly follows instructions.
INDIFFERENT a patient who is not engaged in theINDIFFERENT a patient who is not engaged in the
treatment and does not follow the dentist’streatment and does not follow the dentist’s
instructions.instructions.
RESISTANT a patient who challenges the dentistRESISTANT a patient who challenges the dentist
and feels that the dentist is incompetent and willand feels that the dentist is incompetent and will
cheat him.cheat him.
12. iii.iii. Evaluating effect of physical problems onEvaluating effect of physical problems on
treatmenttreatment––
Systemic disturbances can have significance:Systemic disturbances can have significance:
DiabetesDiabetes-- small oral abscesses and poor tissue tone.small oral abscesses and poor tissue tone.
- reduced salivary output which reduces the ability of- reduced salivary output which reduces the ability of
patient to wear prosthesis.patient to wear prosthesis.
ArthritisArthritis –– changes in the TMJ , jaw relation record can be difficult.changes in the TMJ , jaw relation record can be difficult.
Paget’s diseasePaget’s disease ––patient’s may have enlargement of maxillarypatient’s may have enlargement of maxillary
tuberosities.tuberosities.
AcromegalyAcromegaly-- patient’s may have enlargement of the mandiblepatient’s may have enlargement of the mandible..
13. Parkinson’s diseaseParkinson’s disease –– patient has severe rhythmic contractionspatient has severe rhythmic contractions
of the muscles which prevents the patient to insert andof the muscles which prevents the patient to insert and
remove RPD. Impressions are compromised due to excessiveremove RPD. Impressions are compromised due to excessive
amount of saliva.amount of saliva.
Pemphigus vulgarisPemphigus vulgaris –– disease begins with formation of bullae indisease begins with formation of bullae in
the oral cavity. Symptoms are painful oral cavity and dryness ofthe oral cavity. Symptoms are painful oral cavity and dryness of
the mouth.the mouth.
EpilepsyEpilepsy –– a grand mal seizure may result in the fracture anda grand mal seizure may result in the fracture and
aspiration of the prosthesis.If the patient is on Dilantin sodiumaspiration of the prosthesis.If the patient is on Dilantin sodium
then care should be taken that the RPD should not irritate thethen care should be taken that the RPD should not irritate the
gingival tissues.gingival tissues.
Cancer-Cancer- oral symptoms are effects of radiation and chemotherapyoral symptoms are effects of radiation and chemotherapy
which include mucosal irritations, xerostomia and bacterial andwhich include mucosal irritations, xerostomia and bacterial and
fungal infections which will complicate the construction andfungal infections which will complicate the construction and
wear of the prosthesis.wear of the prosthesis.
14. XerostomiaXerostomia –– patients susceptibility to mucosalpatients susceptibility to mucosal
ulcerations and fungal infections mayulcerations and fungal infections may
increase due to decreased salivary flow.increase due to decreased salivary flow.
iv.iv. Evaluating effects of drugs onEvaluating effects of drugs on
treatmenttreatment ––
IIncreasing age usually means an increase in:ncreasing age usually means an increase in:
The need for some type of prosthodonticThe need for some type of prosthodontic
treatment.treatment.
The use of prescribed and over the counterThe use of prescribed and over the counter
drugs.drugs.
15. Some of the frequently prescribed drugs that can affectSome of the frequently prescribed drugs that can affect
prosthodontic treatment are :prosthodontic treatment are :
1.1. AnticoagulantsAnticoagulants: post surgical bleeding could be a: post surgical bleeding could be a
problem for patients receiving anticoagulants whoproblem for patients receiving anticoagulants who
undergo extractions or soft tissue or osseousundergo extractions or soft tissue or osseous
surgery.surgery.
2.2. Antihypertensive drugsAntihypertensive drugs: side effect of: side effect of
antihypertensive drugs is postural or orthostaticantihypertensive drugs is postural or orthostatic
hypertension which may result in syncope whenhypertension which may result in syncope when
patient assumes an upright position. The treatmentpatient assumes an upright position. The treatment
for hypertension includes prescription of a diureticfor hypertension includes prescription of a diuretic
agent , which can contribute to a decrease inagent , which can contribute to a decrease in
saliva which is associated to dry mouth.saliva which is associated to dry mouth.
16. 3.3. Endocrine therapy :Endocrine therapy : patients may develop sorepatients may develop sore
mouth, they may blame the prosthesis for causingmouth, they may blame the prosthesis for causing
the discomfortthe discomfort..
4.4. Saliva-inhibiting drugs :Saliva-inhibiting drugs : methantheline bromide ,methantheline bromide ,
atropine are used to control excessive saliva toatropine are used to control excessive saliva to
make accurate impressions, these drugs shouldmake accurate impressions, these drugs should
not be used for patients with cardiacnot be used for patients with cardiac
diseases,prostatic hypertrophyand glaucoma.diseases,prostatic hypertrophyand glaucoma.
AIDS FOR SUCCESSFUL INTERVIEW :AIDS FOR SUCCESSFUL INTERVIEW :
a)a) Dentist’s attitude and behaviourDentist’s attitude and behaviour
b)b) Phrasing of questionsPhrasing of questions
c)c) Expectations of treatmentExpectations of treatment
d)d) Questions from patient.Questions from patient.
17. Dentist’s attitude and behaviorDentist’s attitude and behavior
a.a. Dentist should make eye contact with the patient ,Dentist should make eye contact with the patient ,
looking directly at the patient and displayinglooking directly at the patient and displaying
complete attention rather than studyingcomplete attention rather than studying
radiographs or writing.radiographs or writing.
b.b. He should maintain a relaxed and attentiveHe should maintain a relaxed and attentive
physical posture. The dentist should face thephysical posture. The dentist should face the
patient , preferably at the same level and shouldpatient , preferably at the same level and should
appear relaxed and unhurried.appear relaxed and unhurried.
c.c. Dentist should employ appropriate head nodding ,Dentist should employ appropriate head nodding ,
verbal following and verbal reflection.verbal following and verbal reflection.
18. STRUCTURE OF INTERVIEWSTRUCTURE OF INTERVIEW
i.i. DENTAL HISTORY:DENTAL HISTORY:
Reason as to why teeth have been lost , and careReason as to why teeth have been lost , and care
should be taken to preserve the remaining teeth byshould be taken to preserve the remaining teeth by
improving patient’s oral hygiene and dietaryimproving patient’s oral hygiene and dietary
intake.intake.
If teeth have been lost due to periodontal disease ,If teeth have been lost due to periodontal disease ,
effort must be made to discover and eliminate theeffort must be made to discover and eliminate the
cause.cause.
ii.ii. DIET:DIET:
Sugar and /or sugar containing products should beSugar and /or sugar containing products should be
controlled if taken continuously throughout thecontrolled if taken continuously throughout the
day as the prosthesis shields the microorganismsday as the prosthesis shields the microorganisms
from the cleansing and buffering action offrom the cleansing and buffering action of
patient’s saliva.patient’s saliva.
19. iii.iii. HABITS:HABITS:
1.1. Bruxism and clenchingBruxism and clenching
2.2. Tongue thrustingTongue thrusting
PATIENTS PHYSICAL CHARACTERISTICS:PATIENTS PHYSICAL CHARACTERISTICS:
If the patient has a speech problem , the problem should beIf the patient has a speech problem , the problem should be
corrected and recognized as these patients require a longercorrected and recognized as these patients require a longer
period to learn a good speech with new prosthesis.period to learn a good speech with new prosthesis.
Some patient’s may exhibit poor coordination hence it willSome patient’s may exhibit poor coordination hence it will
be difficult to maintain an adequate level of hygiene of thebe difficult to maintain an adequate level of hygiene of the
oral cavity and prosthesis.oral cavity and prosthesis.
Patients with short or highly mobile lips may be problematicPatients with short or highly mobile lips may be problematic
as esthetics will be compromised as most or all of the claspas esthetics will be compromised as most or all of the clasp
arms , denture borders , and other components will showarms , denture borders , and other components will show
when the patient speaks or smiles.when the patient speaks or smiles.
20.
21. Oral examination should precede anyOral examination should precede any
mouth rehabilitation procedures andmouth rehabilitation procedures and
should include :should include :
1.1. a visual and digital examination ofa visual and digital examination of
the teeth and the surroundingthe teeth and the surrounding
tissues with mouth mirror, explorer,tissues with mouth mirror, explorer,
periodontal probe,periodontal probe,
2.2. a complete intraoral radiographica complete intraoral radiographic
survey,survey,
3.3. vitality tests for critical teeth andvitality tests for critical teeth and
4.4. an examination of casts correctlyan examination of casts correctly
oriented on an adjustable articulator.oriented on an adjustable articulator.
22. During examination it is important toDuring examination it is important to
restore and maintain the remaining oralrestore and maintain the remaining oral
structures in a state of healthstructures in a state of health
The primary objectives are:The primary objectives are:
It should include the prevention ofIt should include the prevention of
tooth migration and the correction oftooth migration and the correction of
traumatic influences.traumatic influences.
Should consider the best method toShould consider the best method to
restore lost function within the limits ofrestore lost function within the limits of
tissue tolerance of the patient.tissue tolerance of the patient.
To maintain or improve the appearance ofTo maintain or improve the appearance of
the mouth.the mouth.
23. SEQUENCE OF ORAL EXAMINATIONSEQUENCE OF ORAL EXAMINATION
I.I. Visual examinationVisual examination includesincludes
looking for:looking for:
caries susceptibiltycaries susceptibilty
number of restored teethnumber of restored teeth
evidence of decalcificationevidence of decalcification
periodontal diseaseperiodontal disease
gingival inflammationgingival inflammation
gingival recessiongingival recession
II.II. Relief of pain and discomfortRelief of pain and discomfort
and placement of temporaryand placement of temporary
restorations.restorations.
24. III.III. Complete intraoral radiographic surveyComplete intraoral radiographic survey
Objectives of a radiographic examination are:Objectives of a radiographic examination are:
1.1. To locate areas of infection and other pathosisTo locate areas of infection and other pathosis
that may be present.that may be present.
2. To reveal the presence of root2. To reveal the presence of root
fragments,foreign objects, bone spicules andfragments,foreign objects, bone spicules and
irregular ridge formations.irregular ridge formations.
3. To reveal the presence and extent of caries and3. To reveal the presence and extent of caries and
the relation of carious lesions to the pulp.the relation of carious lesions to the pulp.
25. 4.4. To reveal the presence of root canalTo reveal the presence of root canal
fillings and to permit their evaluation as tofillings and to permit their evaluation as to
future prognosis.future prognosis.
5. To permit evaluation of existing5. To permit evaluation of existing
restoration as to evidence of recurrentrestoration as to evidence of recurrent
caries, marginal leakage and overhangingcaries, marginal leakage and overhanging
gingival margins.gingival margins.
26. 6.6. To permit evaluation of periodontalTo permit evaluation of periodontal
conditions present and to establish the needconditions present and to establish the need
and possibilities for treatment.and possibilities for treatment.
7. To evaluate the alveolar support of abutment7. To evaluate the alveolar support of abutment
tooth , their number , the supporting lengthtooth , their number , the supporting length
and morphology of their roots, the alveolarand morphology of their roots, the alveolar
support remaining.support remaining.
IV.IV. A thorough and complete oral prophylaxisA thorough and complete oral prophylaxis
27. V.V. The exploration of teeth and investing structuresThe exploration of teeth and investing structures
includes:includes:
Determination of tooth mobility andDetermination of tooth mobility and
Examination of occlusal relationships.Examination of occlusal relationships.
VI.VI. Vitality tests of remaining teethVitality tests of remaining teeth
VII.VII. Determination of height of the floor of the mouth to locateDetermination of height of the floor of the mouth to locate
inferior borders of the lingual mandibular majorinferior borders of the lingual mandibular major
connectorsconnectors
VIII.VIII. Impressions for making accurate diagnostic castsImpressions for making accurate diagnostic casts
28. DIAGNOSTIC CASTSDIAGNOSTIC CASTS
A Diagnostic cast should beA Diagnostic cast should be
an accurate reproduction ofan accurate reproduction of
the teeth and adjacentthe teeth and adjacent
tissues.tissues.
A diagnostic cast is made ofA diagnostic cast is made of
dental stone because of itsdental stone because of its
strength and it is lessstrength and it is less
abraded than dental plaster.abraded than dental plaster.
Impression is made withImpression is made with
irreversible hydrocolloidirreversible hydrocolloid
(alginate).(alginate).
29. PURPOSES OF DIAGNOSTIC CASTSPURPOSES OF DIAGNOSTIC CASTS
To supplement the oralTo supplement the oral
examination by permitting a viewexamination by permitting a view
of the occlusion from theof the occlusion from the
lingual ,as well as buccal aspect.lingual ,as well as buccal aspect.
Possibilities for improvementPossibilities for improvement
either by occlusal adjustmenteither by occlusal adjustment
and /or occlusal reconstructionand /or occlusal reconstruction
with the help of diagnosticwith the help of diagnostic
waxing which helps the dentistwaxing which helps the dentist
to plan ahead.to plan ahead.
To permit a topographic surveyTo permit a topographic survey
of the dental arch to be restoredof the dental arch to be restored
by a removable partial denture.by a removable partial denture.
30. A cast surveyor determines the parallelism of theA cast surveyor determines the parallelism of the
tooth surfaces and to establish the influence on thetooth surfaces and to establish the influence on the
design of the partial denture.design of the partial denture.
To permit a logical and comprehensiveTo permit a logical and comprehensive
presentation to the patient of present and futurepresentation to the patient of present and future
restorative needs as well as of the hazards ofrestorative needs as well as of the hazards of
further neglect.further neglect.
31. Occluded and individualOccluded and individual
diagnostic casts can bediagnostic casts can be
used to point out to theused to point out to the
patient:patient:
a.a. Evidence of toothEvidence of tooth
migration and the result ofmigration and the result of
the same.the same.
b.b. Effects of further toothEffects of further tooth
migration.migration.
c.c. Loss of occlusal supportLoss of occlusal support
and its consequences.and its consequences.
d.d. Hazards of traumaticHazards of traumatic
occlusal contacts.occlusal contacts.
e.e. Cariogenic and periodontalCariogenic and periodontal
implications of furtherimplications of further
neglect.neglect.
32. Individual impression trays can beIndividual impression trays can be
fabricated. For wax blockouts duplicatefabricated. For wax blockouts duplicate
diagnostic casts can be used.diagnostic casts can be used.
Diagnostic casts may be used as a constantDiagnostic casts may be used as a constant
reference as the work progresses.reference as the work progresses.
Unaltered diagnostic casts should become aUnaltered diagnostic casts should become a
permanent part of the patient’s records ofpermanent part of the patient’s records of
conditions existing before treatment.conditions existing before treatment.
33. MOUNTING DIAGNOSTIC CASTSMOUNTING DIAGNOSTIC CASTS
Diagnostic casts may be occluded by hand ,butDiagnostic casts may be occluded by hand ,but
occlusal analysis is better accomplished by using anocclusal analysis is better accomplished by using an
adjustable articulator.adjustable articulator.
Casts if mounted in relation to the axis-orbital planeCasts if mounted in relation to the axis-orbital plane
permit better interpretation of the plane of occlusionpermit better interpretation of the plane of occlusion
in relation to the horizontal plane.in relation to the horizontal plane.
The objective of diagnostic mounting is to positionThe objective of diagnostic mounting is to position
the casts of the dental arches on an articulator sothe casts of the dental arches on an articulator so
that the casts have the same relationship as do thethat the casts have the same relationship as do the
mandible and maxilla in the patient’s skull.mandible and maxilla in the patient’s skull.
34. There are three distinct phases to this procedure:There are three distinct phases to this procedure:
1.1. Orientation of the maxillary cast to the condylar elements ofOrientation of the maxillary cast to the condylar elements of
the articulator by means of a face bow transfer.the articulator by means of a face bow transfer.
2. Orientation of the mandibular cast to the maxillary cast at2. Orientation of the mandibular cast to the maxillary cast at
the patient’s centric jaw relation by means of an accuratethe patient’s centric jaw relation by means of an accurate
centric jaw relation record.centric jaw relation record.
3. Verification of these relationships by means of an additional3. Verification of these relationships by means of an additional
centric jaw relation records and comparison of occlusalcentric jaw relation records and comparison of occlusal
contacts on the articulator with those in the mouth.contacts on the articulator with those in the mouth.
35. ARBITRARY HINGE AXISARBITRARY HINGE AXIS
The selection depends on the type of face-bow such as theThe selection depends on the type of face-bow such as the
whip-Mix and Hanau Spring-Bow placed into each externalwhip-Mix and Hanau Spring-Bow placed into each external
auditory meatus.auditory meatus.
A convenient point to use isA convenient point to use is Beyron's pointBeyron's point, located 13 mm, located 13 mm
anterior to the posterior margin of the tragus of the ear on aanterior to the posterior margin of the tragus of the ear on a
line to the outer canthus of the eye.line to the outer canthus of the eye.
36. Anterior Point of ReferenceAnterior Point of Reference
The infraorbital notch is selected when aThe infraorbital notch is selected when a
Hanau face-bow is used with the Hanau WideHanau face-bow is used with the Hanau Wide
Vue articulator.Vue articulator.
The plane contacting the anterior referenceThe plane contacting the anterior reference
point and the two external auditory meatus ispoint and the two external auditory meatus is
parallel with the Frankfort horizontal plane ofparallel with the Frankfort horizontal plane of
the maxillary cast to the condylar elements ofthe maxillary cast to the condylar elements of
the articulator.the articulator.
37. Technique:Technique:
1.1. Preparation of bite fork.Preparation of bite fork.
2.2. Orientation of face-bow to bite fork andOrientation of face-bow to bite fork and
reference points.reference points.
3.3. Orientation of face-bow to articulator.Orientation of face-bow to articulator.
4.4. Attachment of maxillary cast toAttachment of maxillary cast to
articulator.articulator.
38. Preparation of Bite forkPreparation of Bite fork
One sheet of baseplate wax is thoroughly softened over theOne sheet of baseplate wax is thoroughly softened over the
Bunsen burner, formed into a cylinder, and adapted aroundBunsen burner, formed into a cylinder, and adapted around
both sides of the bite fork.both sides of the bite fork.
A cake of red modeling compound softened in a water bath isA cake of red modeling compound softened in a water bath is
equally effective. While the compound is still soft, the bite forkequally effective. While the compound is still soft, the bite fork
is positioned in the mouth with the projecting attachment armis positioned in the mouth with the projecting attachment arm
to the left side of the patient, and the midline of the patient.to the left side of the patient, and the midline of the patient.
Imprints of the maxillary teeth are accurately recorded.Imprints of the maxillary teeth are accurately recorded.
The mandibular teeth are allowed to close lightly into the softThe mandibular teeth are allowed to close lightly into the soft
compound to stabilize the face-bow.compound to stabilize the face-bow.
The compound is allowed to cool in the mouth, removed andThe compound is allowed to cool in the mouth, removed and
chilled with cold water. Then the face-bow record is trimmed sochilled with cold water. Then the face-bow record is trimmed so
that only indentations of the maxillary cusp tips remain and allthat only indentations of the maxillary cusp tips remain and all
soft tissue contacts are removed.soft tissue contacts are removed.
39. Orientation of the Face-bow to Bite fork and ReferenceOrientation of the Face-bow to Bite fork and Reference
PointsPoints
The bite fork with its record in position is seated inThe bite fork with its record in position is seated in
the maxillary teeth and supported by the mandibularthe maxillary teeth and supported by the mandibular
teeth.teeth.
A convenient point to use has been described byA convenient point to use has been described by
Beyron. Beyron's point is located 13 mm anterior toBeyron. Beyron's point is located 13 mm anterior to
the posterior margin of the center of the tragus ofthe posterior margin of the center of the tragus of
the ear on a line to the outer acanthus of the eye. Athe ear on a line to the outer acanthus of the eye. A
line running through these marks is theline running through these marks is the arbitraryarbitrary
hinge axis.hinge axis.
If the third point of reference is desired the orbitalIf the third point of reference is desired the orbital
pointer is released and rotated toward the patient sopointer is released and rotated toward the patient so
that the tip approximates the infraorbital notchthat the tip approximates the infraorbital notch
below the patient's right eye. This anterior referencebelow the patient's right eye. This anterior reference
completes thecompletes the Frankfort horizontal plane.Frankfort horizontal plane.
40. Jaw Relationship Records for Diagnostic CastsJaw Relationship Records for Diagnostic Casts
The maxillary cast is correctly oriented to theThe maxillary cast is correctly oriented to the
opening axis of the articulator by means of face bowopening axis of the articulator by means of face bow
transfer and becomes spatially related to the uppertransfer and becomes spatially related to the upper
member of the articulator in the same relationshipmember of the articulator in the same relationship
that the maxilla are related to the hinge axis and thethat the maxilla are related to the hinge axis and the
Frankfort plane.Frankfort plane.
When a centric relation record is made at anWhen a centric relation record is made at an
established vertical dimension, the mandible is in itsestablished vertical dimension, the mandible is in its
most retruded relation to the maxilla.most retruded relation to the maxilla.
When the maxillary cast is correctly oriented to theWhen the maxillary cast is correctly oriented to the
axis of the articulator, the mandibular cast becomesaxis of the articulator, the mandibular cast becomes
correctly oriented to the opening axis, whencorrectly oriented to the opening axis, when
attached to and mounted with an accurate centricattached to and mounted with an accurate centric
relation record.relation record.
43. Roentgenographic interpretation:Roentgenographic interpretation:
• The quality of the alveolarThe quality of the alveolar
support of an abutment toothsupport of an abutment tooth
is important because theis important because the
tooth will withstand greatertooth will withstand greater
stress loads in supporting astress loads in supporting a
dental prosthesis.dental prosthesis.
• Abutment teeth adjacent toAbutment teeth adjacent to
distal extension bases aredistal extension bases are
subjected not only to verticalsubjected not only to vertical
and horizontal forces, but toand horizontal forces, but to
torque as well because of thetorque as well because of the
movement of the tissuemovement of the tissue
supported base.supported base.
44. Value of Interpreting bone density:Value of Interpreting bone density:
Abnormal stresses, may create a reduction inAbnormal stresses, may create a reduction in
the size of the trabecular pattern, particularlythe size of the trabecular pattern, particularly
in that area of bone directly adjacent to thein that area of bone directly adjacent to the
lamina dura of the effected tooth.lamina dura of the effected tooth.
Such bone changes usually indicatesSuch bone changes usually indicates
stresses that should be relieved because ifstresses that should be relieved because if
the resistance of the patient decreases, thethe resistance of the patient decreases, the
bone may exhibit a progressively lessbone may exhibit a progressively less
favorable response in future radiographs.favorable response in future radiographs.
45. Index Areas:Index Areas:
Index areas are those areas of alveolar supportIndex areas are those areas of alveolar support
that disclose the reaction of bone to additionalthat disclose the reaction of bone to additional
stress.stress.
The reaction of the bone to additional stressesThe reaction of the bone to additional stresses
in these areas may be either positive bonein these areas may be either positive bone
factor with evidence of a supporting trabecularfactor with evidence of a supporting trabecular
pattern, a heavy cortical layer, and a densepattern, a heavy cortical layer, and a dense
lamina dura, or the reverse response orlamina dura, or the reverse response or
negative bone factor with a poor prognosisnegative bone factor with a poor prognosis
because the additional stresses caused by thebecause the additional stresses caused by the
RPD may hasten destructive processes andRPD may hasten destructive processes and
cause failure of the abutment teeth.cause failure of the abutment teeth.
Other index areas are those around teeth thatOther index areas are those around teeth that
have been subjected to abnormal occlusalhave been subjected to abnormal occlusal
loading, that have been subjected to diagonalloading, that have been subjected to diagonal
occlusal loading caused by tooth migration,occlusal loading caused by tooth migration,
and that have reacted to additional loading,and that have reacted to additional loading,
such as around existing FPD abutments.such as around existing FPD abutments.
Positive response
Negative response
46. Alveolar Lamina Dura:Alveolar Lamina Dura:
The lamina dura is a thin layer of hard corticalThe lamina dura is a thin layer of hard cortical
bone that normally lines the sockets of allbone that normally lines the sockets of all
teeth.teeth.
When a tooth is in the process of being tipped,When a tooth is in the process of being tipped,
the centre of rotation is not at the apex of thethe centre of rotation is not at the apex of the
root but in the apical third.root but in the apical third.
Resorption of bone occurs where there isResorption of bone occurs where there is
pressure, and apposition occurs where there ispressure, and apposition occurs where there is
tension. Therefore during the active tippingtension. Therefore during the active tipping
process the lamina dura is uneven, withprocess the lamina dura is uneven, with
evidence of both pressure and tension on theevidence of both pressure and tension on the
same side of the root.same side of the root.
When systemic disease is associated withWhen systemic disease is associated with
faulty protein metabolism and when the abilityfaulty protein metabolism and when the ability
to repair is diminished, bone is resorbed andto repair is diminished, bone is resorbed and
the lamina dura is disturbed.the lamina dura is disturbed.
47. Third MolarsThird Molars::
Unerupted third molars should be considered asUnerupted third molars should be considered as
prospective future abutments to eliminate the need forprospective future abutments to eliminate the need for
a distal extension RPD.a distal extension RPD.
Root Length, size, and FormRoot Length, size, and Form
Teeth with large or long roots are more favorableTeeth with large or long roots are more favorable
abutment teeth because of the greater potential areaabutment teeth because of the greater potential area
for periodontal ligament support.for periodontal ligament support.
Tapered or conical roots are unfavorable becauseTapered or conical roots are unfavorable because
even a small loss of bone height can greatlyeven a small loss of bone height can greatly
diminish the attachment area.diminish the attachment area.
Multi- rooted teeth whose roots are divergent orMulti- rooted teeth whose roots are divergent or
curved are stronger abutment teeth .curved are stronger abutment teeth .
48. The position of roots of adjacent teeth is alsoThe position of roots of adjacent teeth is also
important. If the roots of the approximating teeth areimportant. If the roots of the approximating teeth are
close together with little interproximal boneclose together with little interproximal bone
separating them, even moderate irritation or forceseparating them, even moderate irritation or force
may be destructive.may be destructive.
Crown /Root RatioCrown /Root Ratio
It can be defined as "the physical relationship betweenIt can be defined as "the physical relationship between
the portion of the tooth with in the alveolar bonethe portion of the tooth with in the alveolar bone
compared with the portion not with in the alveolarcompared with the portion not with in the alveolar
bone, as determined radiographically".bone, as determined radiographically".
If the crown/root ratio is greater than 1:1 or ifIf the crown/root ratio is greater than 1:1 or if
furcation involvement of a multirooted tooth isfurcation involvement of a multirooted tooth is
present, the tooth has a poor prognosis as anpresent, the tooth has a poor prognosis as an
abutment tooth.abutment tooth.
49. Periodontal Ligament SpacePeriodontal Ligament Space
A widening of the periodontal ligament space with aA widening of the periodontal ligament space with a
thickening of the lamina dura indicates mobility,thickening of the lamina dura indicates mobility,
occlusal trauma, and heavy function.occlusal trauma, and heavy function.
Evaluation of PeriodontiumEvaluation of Periodontium
Examination findings that indicate possible need forExamination findings that indicate possible need for
periodontal treatment include the following :periodontal treatment include the following :
Pocket depth in excess of 3 mm.Pocket depth in excess of 3 mm.
Function involvement.Function involvement.
Marginal exudates.Marginal exudates.
50. Deviations from normal color and contour inDeviations from normal color and contour in
gingival, indicating gingivitis.gingival, indicating gingivitis.
Potential abutment teeth with less than 2 mm ofPotential abutment teeth with less than 2 mm of
attached gingival.attached gingival.
Pulling of muscle or frena on attached gingiva.Pulling of muscle or frena on attached gingiva.
The wear of an ill-fitting prosthesis or continuousThe wear of an ill-fitting prosthesis or continuous
wear of a removable partial denture coupled with in-wear of a removable partial denture coupled with in-
adequate oral hygiene frequently contributes toadequate oral hygiene frequently contributes to
accumulation of redundant tissue on the proximalaccumulation of redundant tissue on the proximal
surfaces of the abutment teeth.surfaces of the abutment teeth.
The initiation of good oral hygiene measures andThe initiation of good oral hygiene measures and
tissue rest 6 to 8 hours per day (preferably at night)tissue rest 6 to 8 hours per day (preferably at night)
will usually allow some resolution of the redundantwill usually allow some resolution of the redundant
tissuetissue..
51. Evaluation of Oral Mucosa: PathologicEvaluation of Oral Mucosa: Pathologic
ChangesChanges
Any ulceration, swelling, or color change thatAny ulceration, swelling, or color change that
might indicate malignant or premalignantmight indicate malignant or premalignant
changes should be recognized and properlychanges should be recognized and properly
evaluated through biopsy or referral. Heavyevaluated through biopsy or referral. Heavy
smokers and drinkers (the oral cancer high-smokers and drinkers (the oral cancer high-
risk group) are particularly vulnerable torisk group) are particularly vulnerable to
these tissue changesthese tissue changes..
52. Evaluation of Caries and Existing RestorationsEvaluation of Caries and Existing Restorations
The simple two-surface intracoronal restoration mayThe simple two-surface intracoronal restoration may
be adequate for restoring a carious tooth.be adequate for restoring a carious tooth.
If the tooth has extruded above the occlusal planeIf the tooth has extruded above the occlusal plane
because of the lack of an antagonist, the choice maybecause of the lack of an antagonist, the choice may
be an extra coronal restoration to improve thebe an extra coronal restoration to improve the
occlusal plane.occlusal plane.
If a tooth that does not possess adequate contoursIf a tooth that does not possess adequate contours
for clasping is to serve as an abutment, a fullfor clasping is to serve as an abutment, a full
coverage restoration may be necessary.coverage restoration may be necessary.
If the tooth requires a restoration, the choice ofIf the tooth requires a restoration, the choice of
restorative material is a metallic casting.restorative material is a metallic casting.
53. Evaluation of Sensitivity to PercussionEvaluation of Sensitivity to Percussion
The following conditions can contribute to the irritationThe following conditions can contribute to the irritation
of the periodontal ligament fibers, making the toothof the periodontal ligament fibers, making the tooth
sensitive to percussion testing:sensitive to percussion testing:
Tooth movement caused by prosthesis or theTooth movement caused by prosthesis or the
occlusionocclusion
A tooth or restoration in traumatic occlusionA tooth or restoration in traumatic occlusion
Periapical or pulpal abscessPeriapical or pulpal abscess
Acute pulpitisAcute pulpitis
Gingivitis or preiodontitisGingivitis or preiodontitis
Cracked tooth syndromeCracked tooth syndrome
A removable partial denture should not beA removable partial denture should not be
constructed until the cause is discovered and theconstructed until the cause is discovered and the
sensitivity is eliminatedsensitivity is eliminated
54. Evaluation of Hard Tissue abnormalitiesEvaluation of Hard Tissue abnormalities
Torus PalatinusTorus Palatinus
Torus palatinus is a benign, slowly growingTorus palatinus is a benign, slowly growing
protuberance of the palatine processes of the maxilla.protuberance of the palatine processes of the maxilla.
Removal of a torus palatinus is not necessary unless itRemoval of a torus palatinus is not necessary unless it
is so large that it interferes with the design andis so large that it interferes with the design and
construction of the prosthesis.construction of the prosthesis.
Usually a major connector can be selected andUsually a major connector can be selected and
designed to circumvent the torus.designed to circumvent the torus.
If removal of the torus is deemed necessary, an acrylicIf removal of the torus is deemed necessary, an acrylic
resin surgical splint should be constructedresin surgical splint should be constructed
preoperatively.preoperatively.
TORUS PALATINUS
55. Torus MandibularisTorus Mandibularis --
The torus mandibularis usually occursThe torus mandibularis usually occurs
bilaterally, on the lingual surface of the bodybilaterally, on the lingual surface of the body
of the mandible. Mandibular tori should beof the mandible. Mandibular tori should be
removed if the patient is to wear a removableremoved if the patient is to wear a removable
partial denture with any degree of comfort .partial denture with any degree of comfort .
TORUS MANDIBULARIS
56. Exostoses and UndercutsExostoses and Undercuts
Undercut areas may be minimized by a change in the path ofUndercut areas may be minimized by a change in the path of
insertion of a removable partial denture. Surgical correctioninsertion of a removable partial denture. Surgical correction
of undercuts should be accomplished if relieving the dentureof undercuts should be accomplished if relieving the denture
base or reducing the length of the denture border would:base or reducing the length of the denture border would:
o Significantly reduce the support for and stability of theSignificantly reduce the support for and stability of the
prosthesis.prosthesis.
o Create a bothersome food impaction area, orCreate a bothersome food impaction area, or
o Cause a denture border to be so far away from theCause a denture border to be so far away from the
underlying tissue that it may affect function, compromiseunderlying tissue that it may affect function, compromise
esthetics, or cause discomfort for the patient.esthetics, or cause discomfort for the patient.
EXOSTOSES
57. Evaluation of Quantity and Quality of SalivaEvaluation of Quantity and Quality of Saliva
If the mouth is dry, the patient will probably beIf the mouth is dry, the patient will probably be
uncomfortable wearing a removable partial denture.uncomfortable wearing a removable partial denture.
The denture bases will drag across the tissuesThe denture bases will drag across the tissues
during placement and removal if the lubricatingduring placement and removal if the lubricating
effect of the saliva is not present.effect of the saliva is not present.
Nervousness, age drugs, systemic disturbances, andNervousness, age drugs, systemic disturbances, and
radiation can markedly reduce the salivary output.radiation can markedly reduce the salivary output.
A lubricating saliva substitute can help make theA lubricating saliva substitute can help make the
prosthesis more tolerable for the patient. Thick andprosthesis more tolerable for the patient. Thick and
ropy saliva or copious amounts of serous salivaropy saliva or copious amounts of serous saliva
present problems in the impression procedure.present problems in the impression procedure.
58. Evaluation of space for Mandibular Major connectorEvaluation of space for Mandibular Major connector
A properly constructed lingual bar major connector isA properly constructed lingual bar major connector is
approximately 5 mm wide from its inferior to its superior border.approximately 5 mm wide from its inferior to its superior border.
The superior margin of the connector should be located 3 mmThe superior margin of the connector should be located 3 mm
below the free gingival margins of the mandibular teeth to avoidbelow the free gingival margins of the mandibular teeth to avoid
damage to the gingival tissues. The inferior border of thedamage to the gingival tissues. The inferior border of the
connector should be positioned at or slightly above the positionconnector should be positioned at or slightly above the position
of the active floor of the mouth to prevent interference with theof the active floor of the mouth to prevent interference with the
functional movements of the floor of the mouth and to helpfunctional movements of the floor of the mouth and to help
avoid the packing of food under the major connector. Thereforeavoid the packing of food under the major connector. Therefore
a minimum of 7 to 8 mm of space should be available, a linguala minimum of 7 to 8 mm of space should be available, a lingual
plate major connector should be used if less than 7 mm ofplate major connector should be used if less than 7 mm of
space is available.space is available.
Mandibular lingual bar major connector
59. Evaluation of Mounted Diagnostic CastsEvaluation of Mounted Diagnostic Casts
Inter arch Distance:Inter arch Distance:
Lack of sufficient interarch distance is a commonLack of sufficient interarch distance is a common
finding for the placement of artificial teeth.finding for the placement of artificial teeth.
The problem is caused by a maxillary tuberosity thatThe problem is caused by a maxillary tuberosity that
is too large in vertical height or too bulbous. Theis too large in vertical height or too bulbous. The
surgical reduction of the vertical height of thesurgical reduction of the vertical height of the
tuberosity and at times the adjacent residual ridge istuberosity and at times the adjacent residual ridge is
necessary if satisfactory replacement of the missingnecessary if satisfactory replacement of the missing
teeth is to be accomplishedteeth is to be accomplished..
60. Irregular Occlusal PlaneIrregular Occlusal Plane
Enameloplasty can effectively reduce a moderatelyEnameloplasty can effectively reduce a moderately
extruded tooth. At times the reduction of a singleextruded tooth. At times the reduction of a single
cusp improves the occlusal plane.cusp improves the occlusal plane.
If the extrusion is greater than 1 or 2 mm or if theIf the extrusion is greater than 1 or 2 mm or if the
tooth does not lend itself to enameloplasty, thetooth does not lend itself to enameloplasty, the
placement of an extracoronal cast metallicplacement of an extracoronal cast metallic
restoration is indicated.restoration is indicated.
Traumatic Vertical OverlapTraumatic Vertical Overlap
Clinical symptoms of traumatic vertical overlapClinical symptoms of traumatic vertical overlap
include abrasion, mobility, and migration of theinclude abrasion, mobility, and migration of the
teeth, as well as inflammation and ulceration of theteeth, as well as inflammation and ulceration of the
gingival and palatal mucosa.gingival and palatal mucosa.
61. Akerly (1977) has classified traumatic verticalAkerly (1977) has classified traumatic vertical
overlap into four basic types:overlap into four basic types:
Type 1Type 1 – the mandibular incisors extrude and impinge– the mandibular incisors extrude and impinge
into the palate.into the palate.
Type 2Type 2 – the mandibular incisors impinge into the– the mandibular incisors impinge into the
gingival sulci of the maxillary incisors.gingival sulci of the maxillary incisors.
Type 3Type 3 – both maxillary and mandibular incisors incline– both maxillary and mandibular incisors incline
lingually with impingement of the gingival tissues oflingually with impingement of the gingival tissues of
each arch.each arch.
Type 4Type 4 - the mandibular incisors move or extrude into- the mandibular incisors move or extrude into
the abraded lingual surfaces of the maxillary anteriorthe abraded lingual surfaces of the maxillary anterior
teeth.teeth.
62. o A treatment prosthesis that plates the lingualA treatment prosthesis that plates the lingual
surfaces of the maxillary anterior teeth can be usedsurfaces of the maxillary anterior teeth can be used
to prevent further extrusion of the mandibularto prevent further extrusion of the mandibular
incisors.incisors.
o If a maxillary removable partial denture is indicated,If a maxillary removable partial denture is indicated,
the major connector can be extended onto thethe major connector can be extended onto the
lingual surfaces of the anterior teeth with a thin platelingual surfaces of the anterior teeth with a thin plate
of metal. This will provide a vertical stop to preventof metal. This will provide a vertical stop to prevent
further eruption of the mandibular anterior teeth.further eruption of the mandibular anterior teeth.
o The plating should cover the cingula of the teethThe plating should cover the cingula of the teeth
with projections extending to the contact points.with projections extending to the contact points.
o If only a mandibular removable partial denture isIf only a mandibular removable partial denture is
required for replacement of teeth, a lingual platerequired for replacement of teeth, a lingual plate
major connector can be designed to preventmajor connector can be designed to prevent
continued eruption of the anterior teeth.continued eruption of the anterior teeth.
63. Tipped or Malposed TeethTipped or Malposed Teeth
A posterior tooth tends to drift forward into theA posterior tooth tends to drift forward into the
space created by the removal of the tooth mesial tospace created by the removal of the tooth mesial to
it.it.
Limited orthodontic procedures for minor toothLimited orthodontic procedures for minor tooth
movement can be used to upright the tipped tooth tomovement can be used to upright the tipped tooth to
allow the placement of an artificial tooth of moreallow the placement of an artificial tooth of more
normal size.normal size.
OcclusionOcclusion
Partially edentulous patients have an even greaterPartially edentulous patients have an even greater
probability of having premature occlusal contactsprobability of having premature occlusal contacts
because of the drifting and migration of teeth thatbecause of the drifting and migration of teeth that
usually accompany the loss of continuity of theusually accompany the loss of continuity of the
dental archdental arch ..
64. Role of Occlusal EquilibrationRole of Occlusal Equilibration
• Occlusal equilibrations is the selective grinding or coronalOcclusal equilibrations is the selective grinding or coronal
reshaping of teeth with the intent of equalizing occlusal stress,reshaping of teeth with the intent of equalizing occlusal stress,
producing simultaneous occlusal contacts, or harmonizingproducing simultaneous occlusal contacts, or harmonizing
cuspal relations.cuspal relations.
• Extensive occlusal equilibration should never be initiated on aExtensive occlusal equilibration should never be initiated on a
patient with acute temperomandibular joint dysfunction.patient with acute temperomandibular joint dysfunction.
• Balancing side or non chewing side interferences, which areBalancing side or non chewing side interferences, which are
usually the most destructive eccentric interferences, shouldusually the most destructive eccentric interferences, should
always be eliminatedalways be eliminated..
65. TREAT AT CENTRIC JAW RELATION OR CENTRICTREAT AT CENTRIC JAW RELATION OR CENTRIC
OCCLUSIONOCCLUSION
The following clinical situations indicate constructionThe following clinical situations indicate construction
of the prosthesis at centric jaw relation:of the prosthesis at centric jaw relation:
Coincidence of centric jaw relation and centricCoincidence of centric jaw relation and centric
occlusion.occlusion.
Absence of posterior tooth contacts because theAbsence of posterior tooth contacts because the
opposing arch is completely edentulous ofopposing arch is completely edentulous of
because of the pattern of the missing teeth.because of the pattern of the missing teeth.
Situation in which all posterior tooth contacts areSituation in which all posterior tooth contacts are
to be restored with cast restorations.to be restored with cast restorations.
Only a few remaining posterior contacts.Only a few remaining posterior contacts.
66. 5.5. Minimum alveolar support for all the teeth that canMinimum alveolar support for all the teeth that can
be made acceptable with minimum occlusalbe made acceptable with minimum occlusal
equilibration.equilibration.
6.6. Anterior slide from centric jaw relation andAnterior slide from centric jaw relation and
symptoms of traumatic occlusion of the anteriorsymptoms of traumatic occlusion of the anterior
teeth.teeth.
7.7. Clinical symptoms of occlusal trauma.Clinical symptoms of occlusal trauma.
In the absence of these indications , the removableIn the absence of these indications , the removable
partial denture should be constructed at centricpartial denture should be constructed at centric
occlusion.occlusion.
67. Indications for RPD:Indications for RPD:
o Distal extension situationsDistal extension situations
o After Recent ExtractionsAfter Recent Extractions
o Long SpanLong Span
o Need for Bilateral StabilizationNeed for Bilateral Stabilization
o Excessive Loss of Residual BoneExcessive Loss of Residual Bone
o Unusually Sound Abutment TeethUnusually Sound Abutment Teeth
o Abutments with Guarded PrognosisAbutments with Guarded Prognosis
o Economic ConsiderationsEconomic Considerations
68. Treatment Planning: -Treatment Planning: -
Phase IPhase I
a.a. Collection and evaluation of the diagnosticCollection and evaluation of the diagnostic
data, including a diagnostic mounting and thedata, including a diagnostic mounting and the
analysis and design of diagnostic casts.analysis and design of diagnostic casts.
b.b. Immediate treatment to control pain or infection.Immediate treatment to control pain or infection.
c.c. Biopsy of referral of patient.Biopsy of referral of patient.
d.d. Development of a treatment plan.Development of a treatment plan.
e.e. Initiation of education and motivation of patient.Initiation of education and motivation of patient.
69. Phase IIPhase II
a.a. Removal of deep caries and placement of temporaryRemoval of deep caries and placement of temporary
restorations.restorations.
b.b. Extirpation of inflamed or necrotic pulp tissues.Extirpation of inflamed or necrotic pulp tissues.
c.c. Removal of non retainable teeth.Removal of non retainable teeth.
d.d. Periodontal treatment.Periodontal treatment.
e.e. Construction of interim prosthesis for function orConstruction of interim prosthesis for function or
esthetics.esthetics.
f.f. Occlusal equilibration.Occlusal equilibration.
g.g. Reinforcement of education and motivation of patientReinforcement of education and motivation of patient
70. Phase IIIPhase III
a.a. Preprosthetic surgical procedures.Preprosthetic surgical procedures.
b.b. Definitive endodontic procedures.Definitive endodontic procedures.
c.c. Definitive restoration of teeth, includingDefinitive restoration of teeth, including
placement of cast metallic restorations.placement of cast metallic restorations.
d.d. Fixed partial denture construction.Fixed partial denture construction.
e.e. Reinforcement of education andReinforcement of education and
motivation of patient.motivation of patient.
71. Phase IVPhase IV
a.a. Construction of removable partial denture.Construction of removable partial denture.
b.b. Reinforcement of education andReinforcement of education and
motivation of patient.motivation of patient.
Phase VPhase V
a.a. Post insertion carePost insertion care
b.b. Periodic recallPeriodic recall
c.c. Reinforcement of education andReinforcement of education and
motivation of patientmotivation of patient
72. BIBLIOGRAPHYBIBLIOGRAPHY
Benedict Rich :New paradigms in prosthodontic Treatment planning :Benedict Rich :New paradigms in prosthodontic Treatment planning :
The Journal of Prosthetic Dentistry, volume 88 number 2,(208-212);The Journal of Prosthetic Dentistry, volume 88 number 2,(208-212);
August 2002.August 2002.
Kenneth L.Stewart: Clinical Removable Partial Prosthodontics:2ndKenneth L.Stewart: Clinical Removable Partial Prosthodontics:2nd
edition,(117-221):Ishiyaku euroamerica,inc,publishersedition,(117-221):Ishiyaku euroamerica,inc,publishers..
McCracken’s Removable Partial Prosthodontics:9McCracken’s Removable Partial Prosthodontics:9thth
edition, (213-edition, (213-
259):Harcourt brace and company asia pte ltd.259):Harcourt brace and company asia pte ltd.
Simon Gamer : M M House Mental classification: The Journal ofSimon Gamer : M M House Mental classification: The Journal of
Prosthetic Dentistry, volume 89 number 3,(297-300); March 2003.Prosthetic Dentistry, volume 89 number 3,(297-300); March 2003.
Susan K Hummel:Quality of removable partial dentures worn by theSusan K Hummel:Quality of removable partial dentures worn by the
adult U.S population :The Journal of Prosthetic Dentistry, volume 88adult U.S population :The Journal of Prosthetic Dentistry, volume 88
number 1,(37-43); July 2002number 1,(37-43); July 2002
Yoav Grossman : The prosthodontic concept of crown to rootYoav Grossman : The prosthodontic concept of crown to root
ratio:The journal of prosthetic dentistry, August 2006.ratio:The journal of prosthetic dentistry, August 2006.
