The document discusses the process of diagnosis and treatment planning for removable partial dentures. It involves a thorough patient interview and medical/dental history to understand the patient's needs and concerns. A comprehensive clinical examination including intraoral photos, diagnostic casts, and x-rays is then used to evaluate the oral health, identify treatment needs, and assess teeth for suitability as abutments. The findings are interpreted to formulate a treatment plan addressing disease management and prosthetic reconstruction.

1. DIAGNOSIS AND TREATMENT
PLANNING IN REMOVABLE PARTIAL
DENTURES
PRESENTED BY
DR KELLY NORTON
100
1

2. CONTENTS
• Introduction
• Diagnosis
• Patient interview and history taking
• Initial examination
• Diagnostic impressions and casts
• Jaw relations and mounting of the casts
• Radiographic interpretation
• Definitive oral examination
• Treatment planning
• Conclusion
100 2

3. Removable partial denture prosthesis
• Any prosthesis that replaces some teeth in a partially dentate
arch. It can be removed from the mouth and replaced at will
also called partial removable dental prosthesis – GPT8
100 3

4. 100 4
INTRODUCTION
• The purpose of dental treatment is to address
the needs :
• PERCEIVED BY THE PATIENT
• DEMONSTRATED BY THE CLINICIAN
• Each patient is unique
• The delineation of each patient’s uniqueness
occurs through the patient interview and
diagnostic clinical examination process.
• FOUR DISTINCT PROCESSES-
(1)CHIEF COMPLAINT – the desires/concerns plus history behind it
(2)DIAGNOSTIC CLINICAL EXAMINATION- to ascertain the ‘needs’
(3)TREATMENT PLANNING- that reflects the best management of desires
and needs
(4)Appropriately sequenced EXECUTION OF TREATMENT with planned
follow-up

5. • After evaluation the decision made by the clinician-
NO TREATMENT LIMITED TREATMENT EXTENSIVE TREATMENT
• THE ULTIMATE GOAL------- ‘SHARED DECISION MAKING’
• To achieve optimum results that addresses both ‘DESIRES’ AND ‘NEEDS’ in
the most appropriate manner
100 5

6. Diagnosis:
The determination of the nature
of a disease.
(GPT-8)
Treatment planning:
The sequence of procedures
planned for the treatment of a
patient after diagnosis.
(GPT-8)
6100

7. FIRST MEETING WITH THE PATIENT
MOST IMPORTANT PERIOD OF DENTIST PATIENT INTERACTION
• BEING A PATIENT LISTENER
• OPPORTUNITY TO GAIN TRUST DEVELOP RAPPORT—ESSENTIAL FOR
SUCCESS
• UNDERSTAND THE REASON BEHIND PRESENTATION TO YOUR OFFICE
• PREVIOUS DENTAL EXPERIENCE
• PATIENT’S EXPECTATIONS
• CONCERN AND EMPATHY
• CLEAR EXPLANATION
• SHARED DECISION MAKING
100 7
“ We should meet the mind of the patient before
we meet the mouth of the patient.” – De Van

8. PATIENT INTERVIEW AND HISTORY TAKING
The dentist should follow a sequence that includes:
1. Chief complaint and its history
a) Correction of an abnormality - most important aspect
b) Maintenance of optimum oral health - often missed
2. Medical history review
3. Dental history review, especially related to previous
prosthetic experience(s)
4. Patient expectations - do not execute a treatment plan
that is in opposition to the patients desires
• FAILURE TO UNDERSTAND ----UNHAPPY PATIENT -----
---FAILURE OF TREATMENT
• Should be the major component of ‘MANAGEMENT FOCUS’100 8

9. Evaluation of the patient ’s
psychological status
• Personal and psychological factors are significant to the success of
prosthodontic treatment
• House classification
- Philosophical
- Exacting
- Hysterical
- Indifferent
House classification revisited :
- Ideal= philosophical mind
- Submitter
- Reluctant
- Indifferent = indifferent mind
- Resistant = exacting mind
100 9

10. 100 10
M. M. House mental classification revisited: Intersection of particular patient types and
particular dentist’s needs. THE JOURNAL OF PROSTHETIC DENTISTRY, MARCH 2003

11. • OBJECTIVES OF PROSTHODONTIC TREATMENT
• Elimination of disease
• Preservation restoration and maintenance of remaining teeth and
oral tissues
• Selective replacement of lost teeth for the purpose of restoration
of function in a manner that ensures optimum stability and comfort
in an esthetically pleasing manner
• CLINICAL EXAMINATION
• Treatment plan should be formulated first
• Should precede all but emergency treatment
100 11

12. INITIAL ASSESSMENT AND EMERGENCY TREATMENT
DIAGNOSTIC CASTS
OVERALL EVALUATION AND ASSESSMENT OF FORCE FACTORS
DESIGN THE PROSTHESIS
DETAILED CHARTING OF ORAL CONDITIONS AND PROPOSED TREATMENT
PLAN
MASTER PLAN
EXECUTION IN A PLANNED SEQUENCE
FOLLOW UP
100 12

13. Clinical examination
• The process of clinical examination involves two stages :
- Medical examination
- Oral examination
A comprehensive medical history includes :
- systemic disorders (Chronic degenerative or dysfunctional diseases)
- Medication history
- Diet
- Habits
100 13

14. DIABETES MELLITUS
• Multiple small oral abscesses and
poor tissue tone.
• Decreased resistance to infection
• Reduced salivary output
• Discomfort while wearing
prosthesis.
• increased occurrence of caries.
• The disease should be brought
under control before
Prosthodontic treatment is
accomplished.
100 14

15. The patients physician should be consulted
and written approval should be obtained
before any dental treatment is initiated.
• Antihypertensive drugs are often associated
with xerostomia, gingival hyperplasia and
lichenoid reactions
• Calcium-channel blockers can also
encourage interdental gingival hyperplasia.
All these can complicate restorative care
and require careful management
• Cardiac transplant patients are often on
immunosuppressive therapy, which can
induce gingival enlargement
Gingival hyperplasia
associated with calcium
channel blockers
• CARDIOVASCULAR DISEASE
100 15

16. • ARTHRITIS
• Arthritic changes in TMJ may produce changes in
occlusion.
• Difficulty in determining and recording jaw
relations.
• PAGET’S DISEASE, ACROMEGALY
• Paget’s disease- enlargement of maxillary tuberosities
• Acromegaly- enlargement of the mandible.
• Change in fit and occlusion of the prosthesis
• Requires frequent replacement of prosthesis.
100 16

17. • Site – usually under CD & RPD
• Appearance patchy distribution often associated with speckled
curd like white lesion
• Symptoms  soreness & dryness of mouth
• Signs  palatal tissue  bright red, edematous & granular
Candida associated lesion
[denture stomatitis]
[chronic atrophic candidiasis]
100 17

18. EPILEPSY
• Teeth and prosthesis may be subject to trauma during seizures
• Restorative treatment should be carried out when the patient
is well controlled and radio-opaque materials used to aid
localization of lost objects.
• Removable dentures may be contraindicated if they are small
and seizures are frequent and severe: choking
• If patient takes phenytoin make sure that RPD does not
irritate gingival tissues
100 18
• PARKINSON’S DISEASE
• Oral hygiene and handling of dentures
will be impaired
• Difficult impressions due to excessive
quantities of saliva
• Difficulty in recording jaw relations due
to impaired neuromuscular coordination

19. • TRANSMISSIBLE DISEASES
• HEPATITIS, TUBERCULOSIS, HIV/AIDS,
INFLUENZA
• All universal precautions should be followed
• Special protection against aerosols
• Impressions should be thoroughly disinfected
• Reduced bone density
• Osteoporosis
• Response of bone to increased stress should be
evaluated
• POST MENOPAUSAL WOMEN
100 19

20. • EFFECTS OF DRUGS ON TREATMENT
• ANTICOAGULANTS
post-surgical bleeding
• ANTIHYPERTENSIVE AGENTS
orthostatic hypotension
xerostomia, gingival hyperplasia, lichenoid reactions
• ENDOCRINE THERAPY
xerostomia
• IMMUNOSUPRESSIVE DRUGS
Gingival hyperplasia
100 20

21. • HABIT HISTORY
• Parafunction needs to be evaluated
• BRUXISM AND CLENCHING
• TONGUE THURSTING
• NAIL BITING
100 21

22. ORAL EXAMINATION:-
EXTRA ORAL EXAMINATION:-
• General Appearance
• Facial Appearance and Asymmetry
• Soft tissues
• Lymph Nodes
• Temporo-mandibular Joint
Clicking?
Crepitus?
Pain?

23. PATIENT’S PHYSICAL CHARACTERISTICS:-
• Speech problems should be recognized before the construction of
the prosthesis.
• Poor neuromuscular control leads to difficulty in adapting to the
new prosthesis and maintenance of oral hygiene.
• A short or highly mobile lips leads to compromise in the esthetics
because most or all of the clasp arms, denture borders, and other
components will show when patient smiles or speaks.

24. • Aim – restoration and maintenance of the remaining teeth and oral tissues
for the longest period of time
• SEQUENCE OF ORAL EXAMINATION
1. Relief of pain and discomfort and caries control by placement of temporary
restorations
2. A thorough and complete oral prophylaxis.
3. Complete intraoral radiographic survey
4. Impressions for making accurate diagnostic casts to be mounted for
occlusal examination
5. Examination of teeth, investing structures, and residual ridges
6. Vitality tests of remaining teeth
7. Determination of the height of the floor of the mouth to locate inferior
borders of lingual mandibular major connectors.
• INTRAORAL EXAMINATION
100 24

25. • RELIEF OF PAIN AND PLACEMENT OF TEMPORARY
RESTORATIONS
• Management of acute needs
• Caries assessment and measures to arrest
• Temporization --- clean accurate diagnostic impression
• ORAL PROPHYLAXIS
100 25

26. • Complete intraoral radiographic survey of remaining teeth and adjacent
edentulous areas reveals much information vital to effective diagnosis and
treatment planning.
• The response of bone to previous stress is of particular value in
establishing the prognosis of teeth that are to be used as abutments.
100 26
• COMPLETE INTRAORAL RADIOGRAPHIC SURVEY

27. PANORAMIC RADIOGRAPHS(ADJUNCT)
100 27

28. • IMPRESSION FOR DIAGNOSTIC CASTS
• EXAMINATION OF TEETH, PERIODONTIUM AND RESIDUAL
RIDGES
• EXPLORATION PLUS VISUAL EXAMINATION
• CARIES SUSCEPTIBILITY
• Restorations present, recurrent caries, decalcifications
• Risk assessment as a candidate for removable partial denture
• COMPLETE PERIODONTAL CHARTING
• REMAINING TEETH, LOCATION OF EDENTULOUS AREAS AND QUALITY OF
RESIDUAL RIDGES
100 28

29. • PALPATION
• Tissue contours, quality of residual ridges
• Flabby or hyperplastic tissues----eliminate
• Tori, exostoses, mid palatine raphe-----
difference in displaceability of tissues---rocking
• A small but stable ridge is preferred over a large
unstable one
• OCCLUSION
• Vertical and horizontal relationship of teeth
• Extrusions, rotations, tipping
• Deflective occlusal contacts
100 29

30. • VITALITY TESTS
• Prospective abutment teeth and those with deep restorations
• DETERMINATION OF DEPTH OF THE FLOOR OF THE MOUTH
• For choice of mandibular major connector
100 30

31. DIAGNOSTIC FINDINGS
• INTERPRETATION OF EXAMINATION DATA
• Integration of diagnoses through a culmination of patient interview and
examination findings
• FOCUS ON DISEASE MANAGEMENT + RECONSTRUCTION
• PLAN FOR PROSTHESIS SUPPORT AND OPTIMUM DESIGN
100 31

32. EVALUATION OF CARIES AND EXISTING
RESTORATIONS
– A simple two surface intra coronal restoration may be adequate for
restoring a carious tooth.
– If the tooth is extruded above the occlusal plane because of lack of
an antagonist – extra coronal restoration to improve the occlusal
plane .
– If a tooth is not possessing adequate contours for clasping – full
coverage restoration
– The selection of teeth to rest seats must be made before restorative
procedures begun.
100 32

33. EVALUATION OF TOOTH MOBILITY
• trauma from occlusion`- fremitus test
• inflammatory changes in periodontal ligament
• loss of osseous support
• Splinting in case of compromised periodontal support
100 33

34. IF CROWN –ROOT RATIO > 1 : 1
EXTRACT THAT TOOTH
AND USE ADJACENT
TOOTH AS ABUTMENT
IF EXTRACTION RESULTS
IN LARGE EDENTULOUS AREA
RETAIN THE ROOT
OVERDENTURE ABUTMENT
100 34

35. EVALUATION OF PERIODONTIUM
100
• Pocket depth in excess of 3mm
• Furcation involvement
• Deviation from normal color and contour of gingiva
• Marginal exudate
• Abutment teeth have less than 2mm of attached gingiva
Treatment
– Root scaling and planning
– Gingivectomy
– Periodontal flap procedures
– Free gingival grafts

36. • EVALUATION OF SPACE FOR MAJOR CONNECTOR
– The width of lingual bar – 5 mm
– The superior border – should be located 3 mm below the free
gingival margins of the mandibular teeth to avoid damage to the
gingival tissues.
– When the space is less than 8 mm- lingual plate is indicated.
100 36

37. EVALUATION OF PROSTHESIS FOUNDATION
• Achieve an appropriately stable
foundation
• SURGICAL PREPARATION
• Need for pre prosthetic surgery or
extractions
• Elimination of grossly displaceable
tissues from basal seat areas
• Elimination of tori that interfere
with path of insertion or removal
• Bone augmentation
• Implants
100 37

38. UNDERCUTS
MOST COMMON SITES
MAXILLARY TUBEROSITIES
DISTOLINGUAL AREAS IN
MANDIBULAR ARCH
RECENT EXTRACTION SITES
WHAT IS THE SOLUTION ?
CHANGE THE PATH
OF INSERTION
OF RPD
RELIEVE THE DENTURE
BASE OR REDUCE THE
LENGTH OF DENTURE
BORDER
SURGICAL
CORRECTION
100 38

39. CAN RADIOGRAPHIC INTERPRETATION PROVIDE CLUES TO
PREDICTING THE RESPONSE OF ABUTMENT TEETH TO
INCREASED OCCLUSAL LOADING?
1.BONE DENSITY
• Quality and quantity of bone
• Degree of trabeculation
Abnormal stresses on bone-----reduction in trabecular pattern
Bone condensation(immediately adjacent to lamina dura)
Favourable response stresses that should be relieved
Shows positive adaptive capacity of alveolar bone
• Increased PDL space-------tooth mobility
• Irregular crestal bone surface----active periodontal disease100 39

40. 2. BONE INDEX AREAS
• Areas of bone around the teeth that have been subjected to unusual
lateral or occlusal stresses and disclose the response to additional
stresses
• A tried an tested tooth is a more favorable prospective abutment
Increased trabeculation Translucent and sparse trabeculae
Dense lamina dura Thin lamina dura
Heavy cortical layer Thin cortical layer
• Favourable sign
• Positive bone factor
• Bad prognosis
• Negative bone factor
100 40

41. 3. ALVEOLAR LAMINA DURA and PDL SPACE
• Socket lining----attachment to PDL fibres, withstands mechanical strain
• Thickening of lamina dura AND widening of PDL space – mobile teeth,
occlusal trauma or under heavy function.
• If teeth not mobile- favourable response to increased occlusal forces
100 41

42. 4. ROOT MORPHOLOGY
• Multiple+ divergent roots favorable
• Fused conical roots ----not ideal
• resultant forces are distributed through
a greater number of periodontal fibers
5. THIRD MOLARS
• Unerupted third molars if not impacted
should always be considered as
prospective abutments especially if a
class I or class II scenario can be
converted into a class III
100 42

43. DIAGNOSTIC CASTS
100 43
Diagnostic casts are used to supplement the oral
examination by permitting a view of the occlusion from
the lingual, as well as from the buccal, aspect

44. • OCCLUSAL ANALYSIS – diagnostic wax up is valuable diagnostic tool
• PRESENTATION OF PROPOSED TREATMENT TO THE PATIENT
• Better comprehension
• Understanding of current and future treatment needs
• Demonstration of hazards of neglect
• Helps to make financial agreements
100 44

45. • Fabrication of custom trays
• Mock preparations
• Constant reference for work
progress
• Permanent record for the
clinician
• Transfer of records to
another clinician
100 45

46. Surveying of the cast
• verification of appropriate mouth modifications
• To determine the most desirable path of placement
that will eliminate or minimize interference to
placement and removal
• To locate and measure areas of the teeth that may
be used for retention
• To determine whether tooth and bony areas of
interference will need to be eliminated surgically
or by selecting a different path of placement
• To determine the most suitable path of placement
that will permit locating retainers and artificial
teeth to the best esthetic advantage.
• To permit an accurate charting of the mouth
preparation to be made including the preparation
of proximal tooth surfaces to provide guiding

47. • DESIGNING OF THE CAST PARTIAL
DENTURE FRAMEWORK AND
COMPONENTS
100 47

48. TO SIMULATE THE PATIENT’S MOUTH
CORRECT RELATION OF
MAXILLA TO MANDIBLE
MOVEMENT OF MANDIBULAR CAST IN
SAME ARCH AS MADE BY MANDIBLE
ORIENTATION OF MAXILLARY CAST
TO THE CONDYLAR ELEMENTS
BY FACE BOW TRANSFER
MOUNTING OF THE CASTS
100 48
BY CENTRIC RELATION RECORD

49. IN WHICH RELATION SHOULD
WE MOUNT THE CASTS ???
CENTRIC RELATION MAXIMUM INTERCUSPATION
100 49

50. 90 % OF PATIENTS
CENTRIC RELATION AND MAXIMUM
INTERCUSPATION -----DONOT COINCIDE
CASTS ARE MOUNTED IN CENTRIC RELATION
100 50

51. DIGNOSTIC CASTS SHOULD BE MOUNTED
AT CENTRIC RELATION
MUSCLES ARE RELAXED CR CAN BE REPEATEDLY
ACHIEVED
DECISION WHETHER TO CONSTRUCT THE PROSTHESES AT
CENTRIC RELATION OR MAXIMUM INTERCUSPATION
MADE AFTER COLLECTION OF ALL DIAGNOSTIC DATA
100 51

52. THE CRITICAL DECISION
• IF MOST POSTERIOR TEETH REMAIN
• NO EVIDENCE OF TMJ DISTURBANCE
• NO NEUROMUSCULAR DYSFUNCTION
• PERIODONTAL PROBLEMS ARE ABSENT
• OCCLUSAL PROBLEMS ABSENT
• WHEN MOST CENTRIC STOPS ARE MISSING
• NON RESTORED POSTERIOR EDENTULOUS
SPACES WITH
• TIPPING, DRIFTING OR EXTRUSIONS
MAXIMUM
INTERCUSPATION
CENTRIC
RELATION
100 52

53. MATERIAL SELECTED FOR RECORDING CENTRIC RELATION
DEPENDS ON NUMBER AND LOCATION
OF REMAINING TEETH
RECORDING MATERIAL • ALU WAX
• HARD BASE PLATE WAX
• ZINC OXIDE EUGENOL
• ELASTOMERS
• POLYETHER
• POLYSILOXANE
• IMPRESSION PLASTER
100 53

54. OCCLUSAL VERTICAL DIMENSION
PHYSIOLOGICAL REST POSITION
PHONETICS
SUFFICIENT POSTERIOR
CONTACTS
NO POSTERIOR CONTACTS
100 54

55. OCCLUSAL CONTACTS AT OVERCLOSURE OF
MANDIBLE ( DEEP BITE )
DETERMINE NEW VDO
MOUNT THE CASTS IN THAT VDO
THE CPD SHOULDN’T BE CONSTRUCTED WITHOUT CHECKING
THE TOLERANCE OF PATIENT TO NEW VDO
CONSTRUCTION OF DIAGNOSTIC SPLINTS AT THE INCREASED VD
100 55

56. • PROTRUSIVE RECORD to determine horizontal condylar
guidance(H)
• LATERAL CONDYLAR GUIDANCE adjusted according to
hanau’s formula
• L= H/8 + 12
• If mounting is to be done in maximum intercuspation by hand
articulation
• Minimum of 3 preferably 4 positive contacts should exist on
posterior teeth
• With widespread contact on molars on each side of the arch
100 56

57. ANALYSIS OF OCCLUSAL FACTORS
• The occlusion should be carefully evaluated using articulated study
casts and any working and nonworking interference’s carefully
assessed.
100 57
OCCLUSAL EQUILIBRATION
SHOULD BE DONE BEFORE
THE INITIATION OF ANY RESTORATIVE
PROCEDURE
FIRST DONE ON ACCURATELY MOUNTED
DIAGNOSTIC CASTS
SERVES AS BLUEPRINT FOR INTRAORAL ADJUSTMENTS

58. 100 58
•IRREGULAR OCCLUSAL PLANE
Treatment
Moderately extrude tooth
If the extrusion is greater than 2 mm
If clinical crown length is inadequate Severely extruded teeth
Enameloplasty.
crown placement
endodontic therapy
crown lengthning Extraction and alveoloplasty

59. FIXED RESTORATIONS
• There may be a need to restore modification
spaces with fixed restorations rather than include
them in the removable partial denture, especially
when dealing with isolated abutment teeth.
• The advantage of splinting must be weighed
against the total cost.
• One of the least successful removable partial
denture designs is where multiple toothbounded
areas are replaced with the removable partial
dentures in conjunction with isolated abutment
teeth and distal extension bases.
• Biomechanical considerations and the future
health of the remaining teeth should be given
preference over economic considerations when
such a choice is possible. 100 59

60. ORTHODONTIC TREATMENT
• Orthodontic movement of malposed teeth followed by retention
through the use of fixed partial dentures makes it possible for a better
removable partial denture design mechanically and esthetically than
could otherwise be used.
• Adequate anchorage for tooth movement can be a major limitation in
partially edentulous arches
100 60

61. 100 61
Removable partial denture with molar uprighting spring: An
innovative hybrid appliance
Jitendra Rao MDSa, *, Gulshan Kumar Singh MDSb , Habib Ahmed Alvi MDSa , Lakshya
Kumar MDSa , Kaushal Kishor Agrawal MDSa
Journal of Prosthodontic Research Volume 57, Issue 1, January 2013, Pages 57–61
A 45-year-old female patient with need of fixed replacement of her
missing teeth which were lost long time before.
Posterior teeth were severally tipped bilaterally in the edentulous
space.
Hybrid removable partial denture with molar uprighting spring was
fabricated for molar uprighting on both side tilted molars.
After 3 month and 15 days of treatment with hybrid appliance the
molar abutment were uprighted for fabrication of fixed partial
dentures

62. 100 62

63. Prosthodontic Diagnostic Index
( PDI )
• Based on diagnostic findings, The American College of
Prosthodontists (ACP) has developed a classification
system for partial edentulism
• Criteria 1: Location and extent of the edentulous area(s)
• Criteria 2: Abutment conditions
• Criteria 3: Occlusion
• Criteria 4: Residual ridge
100 63

64. Diagnostic criteria for the PDI
Criteria 1 : Location and extent of the
edentulous area(s)
Class I
– Ideal or minimally compromised
edentulous area – single arch and one
of the following:
• Any anterior maxillary edentulous
area – not exceed 2 incisors
• Any anterior mandibular
edentulous area – not exceed 4
incisors
• Any posterior maxillary or
mandibular edentulous area – not
exceed 2 PM or 1 PM and 1 molar100 64

65. Class II
– Moderately compromised edentulous area – edentulous
areas in both arches and one of the following:
• Any anterior maxillary edentulous area – not exceed 2
incisors
• Any anterior mandibular edentulous area – not exceed 4
incisors
• Any posterior maxillary or mandibular edentulous area –
not exceed 2 PM or 1 PM and 1 molar
• A missing maxillary or mandibular canine
100 65

66. Class III
– Substantially compromised
edentulous area
• Any posterior maxillary or mandibular
edentulous area greater than 3 teeth or 2
molars
• Any edentulous areas including anterior
and posterior areas of 3 or more teeth
Class IV
– Severely compromised edentulous
area
• Any edentulous area or combination of
edentulous areas requiring a high level
of patient compliance
• Congenital or acquired maxillofacial
defects 100 66

67. Criteria 2 : Abutment conditions
Class I
– Ideal or minimally compromised
abutment conditions
• No preprosthetic therapy indicated
Class II
– Moderately compromised abutment
condition
• Abutments in 1 or 2 sextants have
insufficient tooth structure to retain or
support intracoronal restorations
• Abutments in 1 or 2 sextants require
localized adjunctive therapy
(periodontal, endodontic, or
orthodontic procedures)
100 67

68. Class III
– Substantially compromised abutment condition
• Abutments in 3 sextants – insufficient tooth
structure to retain or support intracoronal or
extracoronal restorations
• Abutments in 3 sextants – require more
substantial localized adjunctive therapy
Class IV
– Severely compromised abutment condition
• Abutments in 4 or more sextants –
insufficient tooth structure to retain or
support intracoronal or extracoronal
restorations
• Abutments in 4 or more sextants – require
extensive adjunctive therapy100 68

69. Criteria 3 : Occlusion
Class I
– Ideal or minimally compromised occlusal
characteristics
• No preprosthetic therapy required
• Class 1 molar and jaw relationships are seen
Class II
– Moderately compromised occlusal characteristics
• Occlusion requires localized adjunctive therapy
(enameloplasty or premature occlusal contacts)
• Class 1 molar and jaw relationships are seen
100 69

70. Class III
– Substantially compromised occlusal
characteristics
• Entire occlusion must be reestablished, but
without any change in the occlusal vertical
dimension
• Class II molar and jaw relationships are seen
Class IV
– Severely compromised occlusal
characteristics
– Entire occlusion must be reestablished,
including changes in the occlusal vertical
dimension
• Class II, division 2 and Class III molar and jaw
relationships are seen 100 70

71. Criteria 4 : Residual ridge characteristics
– Radiographic height of the residual mandibular alveolar bone
–
• Class I – bone height ≥ 21 mm – measured at the most
reduced vertical dimension of the mandible on panoramic
radiograph
• Class II 16-20 mm bone height
• Class III 11-15 mm bone height
• Class IV ≤ 10 mm of mandibular radiographic bone height
100 71

72. Worksheet used to determine classification
• Individual diagnostic criteria are evaluated and the
appropriate box is checked. The most advanced finding
determines the final classification
Classification System for Partial Edentulism, Journal of Prosthodontics Vol. 11, no. 3,
2002: 181 – 193.100 72

73. 100 73
Guidelines for use of the worksheet:
1. Any single criterion of a more complex class, places the patient
into more complex class.
2. Consideration of future treatment procedures must not influence
the diagnostic level.
3. Initial preprosthetic treatment and/or adjunctive therapy can
change the initial classification level.
4. If there is an esthetic concern/challenge, the classification is
increased in complexity by one level.
5. In the presence of TMD symptoms, the classification is increased
in complexity by one or more levels.
6. In the situation where the patient presents with an edentulous
maxilla opposing a partially edentulous mandible, each arch is
diagnosed with the appropriate classification system.

74. Various Classifications:
• Cummer’s system – 1921
• The Kennedy System – 1923
• The Applegate – Kennedy system
• Fiset-Applegate-Kennedy
classification
• Bailyn’s system – 1928
• Neurohr’s System – 1939
• Mauk’s system – 1941
• Godfrey’s system – 1951
• Beckett’s system – 1953
• Friedman’s system – 1953
• Craddock’s system- 1954
• Watt’s system - 1958
• The Austin Ledge – 1956
• The Skinner’s system – 1957
• Wild’s system
• Swenson’s System – 1960
• Avant’s System – 1966
• Osborne and Lammie’s system
• McDermott’s system
• American college of prosthodontics
system
• Costa’s system
• Classification for implant dentistry

75. KENNEDY’S CLASSIFICATION
Proposed by Dr.Edward Kennedy in 1925.
In 1954, Dr. O.C. Applegate provided rules to govern the application of the system

76. 100 76
How to develop a
Treatment Plan????

77. CAST PARTIAL DENTURE VS IMPLANT SUPPORTED
PROSTHESIS ?
1. SHORT MODIFICATION SPACES-- < OR = 3 MISSING TEETH
• natural tooth, implant-supported fixed prostheses, and removable partial
dentures can generally be considered.
• Implant placement considerations- bone volume adequate or can be
provided with minimal morbidity, to adequately house sufficient implants
to support prosthetic teeth.
• Advantage of not requiring the use of teeth for support, stability, and
retention requirements, and consequently do not increase the functional
burden on the natural dentition
• provide replacement teeth without involving adjacent teeth in the
reconstruction.
• Therefore, when the adjacent teeth are in need of restoration, a
conventional prosthesis should be considered.100 77

78. 2. LONG MODIFICATION SPACES > OR = 4 MISSING TEETH
• Consider a CAST PARTIAL DENTURE-
--optimum
• IMPLANT SUPPORTED PROSTHESIS
• Bone volume requirements
• Need for bone augmentation
• More number of implants required
• Substantial increase in treatment cost
• FIXED PARTIAL DENTURE
• Not ideal
• Greater stress on abutment teeth
• Risk of failure
100 78

79. 3. DISTAL EXTENSION SPACES
• Without tooth support at each end of the missing
teeth, the REMOVABLE PARTIAL DENTURE
AND IMPLANT- SUPPORTED PROSTHESIS
are the primary treatment considerations.
• Weigh cost effectiveness against residual ridge
resorption to choose between a CPD or placement
of implants
4. ENDODONTIC TREATMENT
• Not a contraindication to use as abutment.
• abutment for a distal extension that is endodontically treated carries a
greater risk for complications than a similar tooth not involved in
removable partial denture function.
• Because tooth support helps control prosthesis movement, the need for
endodontic treatment should include assessment of Overdenture
abutments for removable partial dentures, especially to control movement
of distal extensions.
100 79

80. 100 80
A retrospective comparative ten-year study of cumulative survival rates of
remaining teeth in large edentulism treated with implant-supported fixed
partial dentures or removable partial dentures
Seiya Yamazaki et al, Journal of Prosthodontic Research
Volume 57, Issue 3, July 2013, Pages 156–16
This study aimed to compare the survival rates of remaining teeth between
implant-supported fixed dentures (IFDs) and removable partial dentures (RPDs) in
patients with large edentulous cases.
The second goal was to assess the risk factors for remaining tooth loss.
Twenty-one patients were included in the IFD group and 82 patients were included
in the RPD group. Survival rates of remaining teeth were calculated in three
subcategories:
1) whole remaining teeth
2) adjacent teeth to intended edentulous space
3) opposing teeth to intended edentulous space.

81. 100 81
Results
• The ten-year cumulative survival rate of the whole remaining teeth
was significantly higher in the IFD group (40.0%) than in the RPD
group (24.4%).
• there was no significant difference between two groups in the
survival rate of teeth adjacent or opposing to intended edentulous
space.
• A Cox proportional hazard analysis revealed that RPD restoration
and gender (male) were the significant risk factors for remaining
tooth loss (whole remaining teeth).
Conclusions
• These results suggest that IFD treatment can reduce the
incidence of remaining tooth loss in large edentulous cases.

82. • FIXED OR REMOVABLE PARTIAL DENTURES ???
• INDICATIONS FOR FIXED RESTORATIONS
1. TOOTH BOUNDED EDENTULOUS REGIONS
• any unilateral tooth bound edentulous space.
• Contraindications ---
• long, edentulous span with abutment teeth that would not be able to
withstand the trauma of nonaxial occlusal forces.
• abutment teeth that exhibit reduced periodontal support because of
periodontal disease that would benefit from cross-arch stabilization.
100 82
2. MODIFICATION SPACES
• when a lone-standing, single-rooted
abutment binds a modification
space, it is better to splint it to the
nearest tooth by means of a fixed
partial denture.

83. 3.ANTERIOR MODIFICATION SPACES
• any missing anterior teeth in a partially
edentulous arch, except in a Kennedy Class
IV arch in which only anterior teeth are
missing, are best replaced by means of a fixed
restoration due to better biomechanics
• Excessive ridge defect or resorption- consider
cast partial denture
4. REPLACEMENT OF UNILATERALLY MISSING MOLARS
(SHORTENED DENTAL ARCH)
• Cantilever-fixed prosthesis - if the second
molar is to be ignored, then only first molar
occlusion need be supplied with double
abutments
• With RPD, Leverage factors are frequently
unfavorable, and the retainers used on the
nonedentulous side are often unsatisfactory
100 83

84. INDICATIONS FOR REMOVABLE PARTIAL DENTURE
• DISTAL EXTENSION SITUATION
• If implant placement is not feasible
• Exception---If 2nd and 3rd molar
replacement doesn’t provide significant
gain in function---use a cantilevered fpd
• AFTER RECENT EXTRACTIONS
• Use temporary partial dentures with
subsequent restoration with fpd and
implants
• LONG SPAN EDENTULOUS
REGIONS
• NEED FOR CROSS ARCH
STABILIZATION
100 84

85. 100 85
• EXCESSIVE RIDGE
RESORPTION
• ABUTMENTS WITH
GUARDED
PROGNOSIS
• ACQUIRED DEFECTS
• ECONOMIC
CONSIDERATIONS

86. 100 86
Maxillary Rehabilitation Using a Removable Partial Denture with Attachments
in a Cleft Lip and Palate Patient: A Clinical Report
D Yu, G Xing, P Nie, X Zhang, GS Shen - The Journal of prosthetic dentistry, 2016

87. CHOICE BETWEEN COMPLETE DENTURES AND
REMOVABLE PARTIAL DENTURES ????
• TOOTH RELATED FACTORS
• FUNCTIONAL REQUIREMENTS
• PATIENT EXPECTATIONS AND DESIRES
• TRANSITION FROM PARTIAL TO A FULLY EDENTULOUS STATE
• Tooth tissue borne to completely tissue borne
• The psychology , fears, difficulty in adjustment
• CHOICE OF RETAINING A TOOTH BASED ON 5YEAR PROGNOSIS
• Added functional demand imposed by prosthesis
• Risk assessment for recurrence of future disease
• Support , stability and retention
100 87

88. • LOCATION OF REMAINING TEETH
• PATIENT FACTOR
• Psychology
• Desires
• Fear of wearing a lower complete denture
• Desire to maintain even if complete denture is an inevitable
conclusion
• Use of transitional partial dentures is beneficial
• If the expected prognosis for a given tooth is questionable, the costs
associated with restoration high, and the added benefit to the
prosthesis low, the tooth should likely not be maintained unless the
patient strongly desires to maintain all teeth.
100 88

89. Valplast RPDs with anterior flexible
nylon clasps.
Cast metal framework with
conventional metal clasps in the
posterior and flexible nylon polyamide
retentive clasps in the anterior
100 89
Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am 2014; 58: 69–89
Prosthodontic Treatment Choices In Rpds

90. 100 90
Composite resin added to mid-facial
of abutment tooth to provide .01 in.
undercut for I-bar retentive clasp
Composite resin cingulum rest seats
added to lingual of mandibular
canines for metal framework support
Maxillary rotational path RPD framework with runner bar cast to framework
Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am 2014; 58: 69–89

91. Mandibular overlay unilateral distal
extension RPD with tooth-colored
acrylic resin processed to the metal
framework to restore lost vertical
dimension of occlusion
Mandibular overlay RPD metal
framework with bead retentive
elements
Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am 2014; 58:
69–89
100 91

92. 100 92
The Andrews fixed
dental prosthesis was first
introduced in 1976 by
James Andrews,
Consisted of a bar
soldered to retainers at
each end onto which a
denture is clipped.
FIXED-REMOVABLE
PARTIAL DENTURE
Cu – Sil Partial Denture
Cu-Sil is a tissue-bearing appliance
featuring a soft elastomeric gasket

93. 100 93
Implant-supported removable partial denture
RGO - Rev Gaúcha Odontol., Porto Alegre, v.61, n.1, p. 127-132, jan./mar., 2013

94. 100 94Mohamed K, Mani U, Saravanakumar P, et al. (June 09, 2016) Split Hollow Bulb Obturator to
RehabilitateMaxillary Defect: A Case Report. Cureus 8(6): e635
Split Hollow Bulb Obturator attached to a cast partial framework

95. 100 95
1. Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am 2014; 58: 69–89
Computer-designed
metal RPD framework
PEEK
Framework
2. Zoidis P, Papathanasiou I, Polyzois G. The Use of a Modified Poly-Ether-Ether-Ketone (PEEK) as an Alternative Framework
Material for Removable Dental Prostheses. A Clinical Report. Journal of Prosthodontics. 2015;25(7):580-584.

96. Comparative clinical evaluation of removable partial dentures
made of two different materials in Kennedy Applegate class II
partially edentulous situation
• AIM: To compare the clinical efficacy and use of RPDs made of the nylon
based super polyamide with those made of the age old Cast Cr-Co alloy
(employing the circumferential clasp design with distal occlusal rests), in
Kennedy Applegate class II partially edentulous situations
• Method: The study was carried out on 30 patients presenting with a
Kennedy Applegate class II partially edentulous situation who were
divided into two equal groups and clinically assessed.
• Result: Flexible RPDs had better aesthetics, overall patient satisfaction,
ease in fabrication and lesser frequency of fracture of the prosthesis during
usage. The clinical parameters of ‘oral soft tissue tolerance’, ‘gingival
health’, ‘periodontal health’ and ‘adaptability in areas with undercut’ were
statistically at par for all the 30 patients thus suggesting the comparable
biocompatibility of the two materials.100 96
Hundal M, Madan R, Medical Journal Armed Forces India (2012)

97. • Phase I
1. Collection and evaluation of dianosis data
2. Immediate treatment to control pain or infection.
3. Biopsy
4. Development of treatment plan
5. Education and motivation of patient.
• .
TREATMENT PLAN - BLUEPRINT
100 97
• Phase II
1. Removal of deep caries and placement of temporary
restoration.
2. Extirpation of pulp
3. Removal of non retainable teeth
4. Periodontal treatment
5. Interim prosthesis
6. Occlusal equilibration
7. Education and motivation of patient

98. • Phase III
1. Pre prosthetic surgical procedure.
2. Definitive endodontic procedures.
3. Restoration of teeth – Cast metallic restoration
4. Fixed partial dentures
5. Education and motivation of patient.
100 98
• Phase IV
1. Construction of removable partial denture
2. Education and motivation of patient.
• Phase V
1. Post insertion care
2. Periodic recall
3. Education and motivation of patient.

99. • The diagnosis and treatment planning for removable partial dentures is a
sequential methodological process
• The responsibility of decision still rests with the dentist, who must
evaluate all factors in relation to the desired results
• When a decision of using a cast partial denture is made it must be
remembered that fundamentals do not change.
• It is only methods, procedures, and substances—by which the dentist
effects the best possible end result—that change.
• The dentist must weigh the problems involved, compare and evaluate the
characteristics of different potential materials, and then make a decision
that leads to the greatest possible service to the patient.
CONCLUSION
100 99

100. REFERENCES
• Rodney D. Phoenix, David R. Cagna, Charles F. DeFreest; Stewart’s
Clinical removable partial prosthodontics - 4th edition
• 2.Carr, Mcgivney, Brown; McCracken’s Removable Partial
Prosthodontics ; 12th ed
• Jitendra Rao MDSa, Gulshan Kumar Singh MDSb , Habib Ahmed
Alvi MDSa , Lakshya Kumar MDSa , Kaushal Kishor Agrawal
MDSa Removable partial denture with molar uprighting spring: An
innovative hybrid appliance Journal of Prosthodontic Research
Volume 57, Issue 1, January 2013, Pages 57–61
• Classification System for Partial Edentulism, Journal of
Prosthodontics Vol. 11, no. 3, 2002: 181 – 193.
• Bohnenkamp DM Removable Partial Dentures : Clinical Concepts,
Dent Clin N Am 2014; 58: 69–89
100 100

101. • Seiya Yamazaki et al, A retrospective comparative ten-year study of
cumulative survival rates of remaining teeth in large edentulism
treated with implant-supported fixed partial dentures or removable
partial dentures Journal of Prosthodontic Research Volume 57, Issue
3, July 2013, Pages 156–16
• Hundal M, Madan R, Comparative clinical evaluation of removable
partial dentures made of two different materials in Kennedy
Applegate class II partially edentulous situation, Medical Journal
Armed Forces India (2012)
• D Yu, G Xing, P Nie, X Zhang, GS Shen, Maxillary Rehabilitation
Using a Removable Partial Denture with Attachments in a Cleft Lip
and Palate Patient: A Clinical Report The Journal of prosthetic
dentistry, 2016
100 101

102. 100 102