Mouth preparation for removable dental prosthesis, Non-prosthodontic preparation

1. Mouth Preparation For Removable Partial
Dentures
Presented by:
Dr. Mujtaba Ashraf
MDS II
Non-Prosthodontic Preparation
4/15/2017
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2. INTRODUCTION4/15/2017
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3. Mouth preparations for partial dentures follow in
logical sequence after oral diagnosis and treatment
planning. We might say that mouth preparation
begins where treatment planning leaves off.
-William L. McCracken
Mouth preparations for partial dentures; JPD;1958
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4. The problems of the dentist in making a removable
partial denture are similar to the problems of the
architect in designing a building. The architect must
interpret the effect conditions at the building site
will have on the building. He searches for defects
that need correction to assure success. The dentist
likewise directs his attention toward detecting,
correcting, and eliminating imperfections.
George Ward Glann;
Mouth preparation for RPD, JPD;1960
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5. Mouth preparations are identified as those procedures
that are accomplished to prepare the mouth for
reception of prosthesis.
Renner RP, Boucher LJ; 1987
Mouth preparation is a term intended to cover all
types of changes effected in the teeth, foundation
ridges or oral structures which may be deemed
necessary to accomplish a better partial denture result.
Applegate OC
Essentials of Removable Partial Denture Prostheses;1965
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6. More specifically they are the procedures that
change or modify existing oral structures of
conditions to
 Facilitate placement and removal of prosthesis
 Facilitate its efficient physiologic function
 Enhance its long term success
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7. Objectives In Planning Mouth Preparations
 To establish a state of health in the supporting and
contiguous tissues.
 To eliminate interferences or obstructions to the
placement, removal and function of prosthesis.
 To establish an acceptable occlusal scheme.
 To establish an acceptable occlusal plane.
 To alter natural tooth form to accommodate
requirements of form and function of prosthesis.
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8. Mouth preparation
Prosthodontic procedures
Procedures related to
Occlusion
•Restorative dentistry
(fixed partial dentures)
Non prosthodontic
procedures
•Oral surgery
•Orthodontics
•Periodontics
•Endodontics
Classification
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9. NON-PROSTHODONTIC
PREPARATION
 Relief of pain and infection
 Oral surgical preparation
 Tissue conditioning
 Periodontal preparation
 Endodontic and restorative treatment
 Orthodontic treatment
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10. Relief Of Pain And Infection
• Teeth that are causing pain or discomfort due to
caries or defective restoration and infection should
be treated to eliminate pain.
• Large carious lesion which is asymptomatic should
be restored with an intermediate restoration to
prevent possibility of any acute pain during
treatment.
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11. • Gingival tissues should also be treated early to
eliminate acute infections like abscesses.
• Scaling, root planing, and prophylaxis should be
performed, and a rigorous oral hygiene program
should be established and carefully monitored.
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12. Oral Surgical Preparation
• Should be completed as early as possible.
• Longer the interval between surgery & impression
procedure, more complete the healing & more
stable the denture bearing area.
• The important consideration is that the patient
should not be deprived of any treatment that
would enhance the success of the removable
partial denture.
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13. EXTRACTION
Planned extractions should occur
early in the treatment regimen but
not before a careful and thorough
evaluation of each remaining
tooth in the dental arch is
completed.
Extraction of nonstrategic teeth that would present
complications or those that may be detrimental to the design
of the removable partial denture is a necessary part of the
overall treatment plan.
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14. Removal Of Residual Roots
All retained roots or root
fragments should be removed
particularly if they are in close
proximity to the tissue surface or
if there is evidence of associated
pathologic finding.
Residual roots adjacent to
abutment teeth may contribute to
progression of periodontal
pockets.
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15. Impacted Teeth
All impacted teeth including those
in edentulous areas as well as those
adjacent to abutment teeth should
be removed.
Asymptomatic impacted teeth in
elderly that are covered with bone
with no evidence of pathologic
condition should be left to preserve
arch morphology
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16. If an impacted tooth is left, this should be recorded
in the patient’s record, and the patient should be
informed of its presence.
Roentgenograms should be taken at reasonable
intervals to ensure that no adverse changes occur.
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17. Malposed Teeth
The loss of individual teeth or groups of teeth may lead to
extrusion, drifting or combinations of malpositioning of the
remaining teeth.
The alveolar bone supporting the extruded teeth is also carried
occlusally in some instances.
In such situations individual tooth or groups of teeth and their
supporting alveolar bone can be surgically repositioned if
orthodontic treatment is not possible.
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18. Cysts And Odontogenic Tumors
Panoramic radiographs should be
taken for ruling out unsuspected
pathology.
Radiolucencies and radiopacities
noted in the radiograph should be
investigated, and the diagnosis
should be confirmed through
biopsy.
Surgical removal should be done.
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19. Exostoses And Tori
The existence of abnormal
bony enlargements should
not be allowed to
compromise the design of
the removable partial
denture.
Mucosa covering these bony
protuberances is usually thin
and liable to ulcerate.
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20. Exostoses approximating gingival margins may
complicate the maintenance of periodontal health and
may lead to the loss of abutment teeth.
Denture design may be modified to accommodate the
exostosis but could result in additional stress to the
supporting elements and compromised function.
If so surgical removal of exostosis and tori is done.
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21. Hyperplastic Tissue
Hyperplastic tissues are seen in the form of fibrous
tuberosities, soft flabby ridges, folds of redundant tissue
in the vestibule or floor of the mouth, and palatal
papillomatosis.
All these forms of excess
tissue should be removed
to provide a firm base for
the denture.
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22. This removal will produce a more stable denture,
will reduce stress and strain on the supporting
teeth and tissues, and in many instances will
provide a more favorable orientation of the
occlusal plane and arch form for the arrangement
of the artificial teeth.
Hyperplastic tissue can be removed with any
preferred combination of scalpel, curette,
electrosurgery, or laser.
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23. Bony Spines And Knife Edge Ridges
Sharp bony spicules
should be removed and
knife like crests gently
rounded.
If, however, correction of a
knife-edge residual crest
results in insufficient ridge
support for the denture
base, the dentist should
resort to vestibular
deepening.
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24. An easy bidigital pressure after
tooth extraction, which could be
considered as the simplest
alveoloplasty procedure, may
prevent most of alveoloplasties.
The only exception for the need of
bidigital pressure after tooth
extraction would be a planned
future implantation at the same site.
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25. Alveolar Bone Augmentation
Ridge augmentation is done for atrophic ridges, flat
palatal vault and mild to moderate anteroposterior
ridge relation discrepancy.
It is done with synthetic graft materials like
hydroxyapatite and autogenous bone grafts.
It enhances the support and stability of the denture.
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26. Conditioning Of Abused And
Irritated Tissues
Many removable partial denture patients require some
conditioning of supporting tissues in edentulous areas before
the final impression phase of treatment begins.
Conditioning of the tissue is required if:
 Denture-bearing mucosa is irritated or inflamed.
 Anatomical structures like rugae, incisive papilla and
retromolar pad are distorted.
 Burning sensation in tongue, ridge area, cheeks and
lips.
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27. These conditions are usually associated with ill-fitting
or poorly occluding removable partial dentures,
nutritional deficiencies, endocrine imbalances,
diabetes, blood dyscrasias and bruxism
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28. • If denture is the problem, patient is advised against
wearing them till the tissues return to normal.
• If this is not possible, tissue conditioner are used to
provide a soothing and cushioning effect on the irritated
mucosa till mucosa becomes normal.
• Recommended home care during this period would
include patients rinsing with saline solution three times
in a day.
• Massaging the soft tissues,
• Using multivitamins and high protein, low carbohydrate
diet.
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29. Inflamed and distorted denture
bearing mucosa due to an ill-fitting
prosthesis that is worn 24 hours a
day.
After the tissue abuse is treated via
modification of the denture base
with a tissue conditioning resilient
liner material, the prosthesis is
removed for portions of the day,
and the abused tissue is massaged,
the denture bearing foundation is
healthy again. 4/15/2017
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30. PERIODONTAL PREPARATION
Periodontal preparation usually follows or is performed
simultaneously with oral surgical procedures and is
completed before restorative procedure.
The success of the prosthesis depends directly on the
health and integrity of the supporting structures of the
remaining teeth.
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31. Objectives Of Periodontal Therapy
1. Removal and control
of all etiologic factors
contributing to
periodontal disease along
with reduction or
elimination of bleeding
on probing.
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32. 2. Elimination of, or reduction in, the pocket depth
of all pockets with the establishment of healthy
gingival sulci whenever possible.
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33. 3. Establishment of functional atraumatic
occlusal relationships and tooth stability.
4. Development of a personalized plaque
control program and a definitive maintenance
schedule.
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34. TREATMENT PLANNING
There are three phases
Phase 1: Initial disease control therapy
Phase 2: Definitive periodontal surgery
Phase 3: Recall maintenance
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35. Initial Disease Control Therapy
• Oral hygiene instructions.
• Scaling and root planing is done for removal of
calculus and plaque deposits from coronal and root
surfaces of teeth.
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36. • Elimination of local irritating factors other than calculus
like overhanging margins of amalgam alloy and inlay
restorations, overhanging crown margins, open contacts
leading to food impaction.
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37. • Elimination of gross occlusal interferences
• Temporary splinting of mobile teeth to allow any
periodontal procedures to be performed.
• Use of night guard as a temporary splint and to
stimulate any unopposed teeth.
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38. The removable acrylic
resin splint with a flat
occlusal plane can be
used effectively as a
form of temporary
stabilization and as a
means of eliminating
excessive lateral forces
created by clenching and
grinding habits.
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39. Definitive Periodontal Surgery
Gingivectomy
Periodontal Flap
Mucogingival surgical procedures
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40. Parts Of Gingiva 4/15/2017 40

41. Gingivectomy: It is indicated to eliminate supra bony
pockets.
Pocket depth confined to band of attached gingiva.
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42. Periodontal flaps:They may be used to perform osseous
recontouring
Osseous recontouring may be indicated for pocket elimination,
when crown lengthening is needed.
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43. Guided tissue regeneration: (GTR) has been defined as
those procedures that attempt regeneration of lost
periodontal structures through differing tissue responses.
The GTR procedure commonly involves the use of an
osseous graft along with a resorbable membrane.
This technique has the potential to lead to substantial
improvement of the periodontal condition when used
around carefully selected two- and three-walled osseous
defects and mandibular furcation involvements.
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44. Tooth presented with a grade 2
furcation involvement with the
probe entering 3 mm in a
horizontal direction. A GTR
procedure using a combination of
a bone graft and a nonresorbable
membrane was planned.
Following hand and ultrasonic
instrumentation, decalcified
freeze-dried bone allograft was
grafted around the furcation.
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45. A nonresorbable membrane
was placed over the bone
graft.
The flap was then sutured
with a nonresorbable
expanded polytetraethylene
suture.
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46. Two months following
surgery, the membrane was
removed.
The presence of red
rubbery tissue filling the
previously exposed
furcation site.
This tissue has the potential
to form osseous tissue and
close the access to the
furcation entrance.
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47. Periodontal Plastic Surgery:
Earlier known as Mucogingival surgical procedures :
applied to those procedures used to resolve problems
involving the interrelationship between the gingiva and the
alveolar mucosa.
They are considered when an abutment tooth for a
removable partial denture lacks adequate attached
keratinized gingiva and requires root coverage to facilitate
partial denture construction and maintenance
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48. The objectives of periodontal plastic surgery are:
• elimination of pockets that transverse the
mucogingival junction,
• creation of an adequate zone of attached gingiva,
• correction of gingival recession by root coverage
techniques,
• relief of the pull of frena and muscle attachments on
the gingival margin
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49. Recall Maintenance
• This is very important in maintaining periodontal
health.
• It includes reinforcement of oral hygiene measures
and thorough scaling and root planing.
• Frequency of recall appointments depends on
susceptibility and severity of periodontal disease.
• Patients with previous moderate to severe
periodontitis should be placed on 3 to 4 months
recall system
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50. Advantages Of Periodontal Therapy
• Elimination of periodontal disease removes primary
etiologic factor in tooth loss
• Periodontium free of disease presents a much better
environment for restorative correction
• Response of teeth to periodontal therapy provides an
important opportunity for reevaluating their
prognosis before final decision is made to include or
exclude them in partial denture design
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51. Orthodontic Considerations
Orthodontic preparation is carried out to achieve the
following:
. Reduce the need for prosthetic teeth as much as
possible.
. Position the teeth to allow the most natural prosthetic
replacement
of teeth.
. Create sufficient vertical height to allow room for
placement of artificial teeth.
. Allow sufficient occlusal guidance on natural teeth.
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52. Unfortunately in many patients a large number of
teeth are missing so there may not be enough
remaining teeth to serve as an anchor from where
the moving force can be applied.
Orthodontic movement of malpositioned teeth
should be the first option.
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53. Endodontic And Restorative Treatment
Teeth with pulpal involvement and root end pathology
are candidates for endodontic therapy. Restorative
therapy like - crowns, inlays, onlays, restoration of
carious lesions and replacement of defective
restorations should be integrated with endodontic
treatment.
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54. Use of pulpless teeth as an abutment
It is considered when pulpless teeth that has
been treated endodontically is presented as a
potential abutment in mouth of patient for whom
a removable partial denture is to be made.
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55. CONCLUSION
The success or failure of a removable partial denture depends
on how well the mouth preparations were accomplished. It is
only through intelligent planning and competent execution of
mouth preparations that the denture can satisfactorily restore
lost dental functions and contribute to the health of the
remaining oral tissues.
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56. REFERENCES
• Stewart’s clinical removable partial prosthodontics, 3rd ed
• McCrackens removable partial prosthodontics, 12th ed
• Removable partial dentures-A Practitioners’ Manual, Olcay Şakar
• McCracken, W. L:Mouth Preparations for Partial Dentures, J. Pros. Den.
6:39-52, 1956
• Mills M. Mouth preparation for removable partial dentures. J Am Dent
Assoc 1960;60:154-159
• Glann G.W, Ralph C. Mouth preparation for removable partial dentures.
J. Pros Den 1950:10:698-706
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