This document discusses the design of removable partial dentures. It begins by classifying partially edentulous jaws using Kennedy's classification system. It then covers the basic considerations in design such as biomechanics, types of supports, and biological factors. The key steps in design are surveyed, including marking the path of insertion, height of contour, and undercuts. It describes the components of partial dentures including major connectors, minor connectors, rests, retainers, and the denture base. Specific clasp and retainer designs are covered for different clinical situations.
This presentation specifically deals with the maxillary and mandibular Major connectors used in a cast partial denture. it also mentions the uses, advantages and disadvantages of each,
Bevels and flares are very important components of resin restoration procedure. This presentation focuses on bevels and flares in restorative procedure.
a detailed account of the principles of tooth preparation with main reference from Shillingburg
The presentation is available on request. Mail me at apurvathampi@gmail.com
This presentation specifically deals with the maxillary and mandibular Major connectors used in a cast partial denture. it also mentions the uses, advantages and disadvantages of each,
Bevels and flares are very important components of resin restoration procedure. This presentation focuses on bevels and flares in restorative procedure.
a detailed account of the principles of tooth preparation with main reference from Shillingburg
The presentation is available on request. Mail me at apurvathampi@gmail.com
Posterior tooth preparationscertified fixed orthodontic courses by Indian den...Indian dental academy
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The cast metal restoration is versatile and is especially applicable to Class II onlay preparations. The process has many steps, involves many dental materials, and requires meticulous attention to prepration.
Tooth treatment planned to be restored with an intracoronal restoration, but the decay or fracture is so extensive that a direct restoration, such as amalgam or composite, would not be able to sustain or bear forces.
Additionally, when decay or fracture incorporate areas of cusp or remaining tooth structure that undermines perimeter walls of a tooth, an onlay might be indicated.
partial denture must have major connectors
there is types of mandibular major connectors
and maxillary major connectors
functions :
Make RPD as a one unit
Equal stress distribution at the parts of RPPD
Cross arch stabilization
If it rested on hard tissue give support (unless if it rested on soft tissue , relief must be done
requierments
Rigid to give equal distribution of forces
should be comfort to patient
shouldn't interference with movable tissue
shouldn't impingement of gingival margins (maxilla at least 6mm from margins mandible at least 3-4 mm from gingiva)
shouldn't have sharp edges or margins
Should be perpendicular at minor connector but with gentle curve
Avoid food impaction
designed to be self cleansable area
and we discuss these types briefly
*mandibular major connectors
Lingual bar
Double lingual bar ( lingual bar with a continuous bar indirect retainer)
labial bar (plate)
cingulum bar
sublingual bar
*maxillary major connectors
Anterior palatal bar
Posterior palatal bar
Middle palatal bar
Anterio posterior palatal bar (ring design )
Anterior palatal strap
Middle palatal strap
Anterio posterior palatal strap (closed horse shoe )
Complete plate
principles of tooth preparation - ann george final.pptxDrHIMANSHUTIWARI1
No recent literature has reviewed the current scientific knowledge on complete coverage tooth preparations.Nine scientific principles have been developed that ensure mechanical, biologic, and esthetic success for tooth preparation of complete coverage restorations.
Contacts and Contours in Conservative DentistryAneetinder Kaur
A brief presentation on:
Form and Function
Fundamental Curvatures
Proximal Contact Area
Labial And Buccal Contours
Benefits of an Ideal Contact and Contour
Matrix
Classification of Matrixes
Universal Matrix (Tofflemire Matrix)
Matrix Bands
Ivory Matrix No.1
Ivory Matrix No. 8
Black’s Matrices
Copper Band Matrix / Soldered Band
Anatomical Matrix/ Compound Supported Matrix
Roll in Band Matrix (Automatrix)
S-shaped Matrix Band
T-shaped Matrix
Mylar Strips
Aluminium Foil Incisal Corner Matrix
Transparent Crown Form Matrix
Window Matrix
Preformed Transparent Cervical Matrix
Tooth Movement
Rapid/ Immediate Movement
Wedges
Slow/ Delayed Tooth Movement
Recent Advances
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Welcome to Indian Dental Academy
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Designing a Removable Partial Denture (Kennedy's Classification)
1. Design of a Removable Partial Denture
By Taseef Hasan Farook, BDS (final
year, University of Dhaka)
2. Denture Design: A planned visualization of the
form and extent of a dental prosthesis
arrived at after a study of all factors involved
- GPT
3. Kennedy’s Classification of partially
edentulous jaw
• Classification I- bilateral edentulous area situated
posterior to natural teeth
• Classification II- unilateral edentulous area situated
posterior to natural teeth
• Classification III- edentulous space bounded on both
side by natural teeth
• Classification IV- A single, but bilateral edentulous area
located anterior to the natural teeth
Applegate‘s 8 rules are used in diagnosing a case
according to Kennedy’s classification
4. Types of partially edentulous jaw According to the Classification
by Edward Kennedy in 1923:
5.
6. Basic Considerations
Biomechanics at play within the oral cavity must be
taken into consideration and the denture design
must be made in accordance, to counteract the
mechanical forces/stress acting within the oral
cavity.
Forces to consider: 1. Vertical – Displacing
- Dislodging forces
2. Horizontal forces
3. Torsion
7.
8. Biomechanics and Types of RPD
Most common mechanical forces at play:
1. Lever principle (all Kennedy Class I and II cases)
2. Inclined principle (all rest and retainers)
3. Wheel and axle principle (rotation)
the prosthesis constructed can either be:
1. Tooth supported- (all Kennedy Class III dentures)
2. Tissue supported (Kennedy Class I & II dentures)
9. Wheel & Axle Principle
Lever and Fulcrum Principle
Inclined plane principle
11. Biological factors to consider during
design
• Length of edentulous span
• Type of oral mucosa
• Quality of ridge support
• Clasp design – (type, length, flexibility,
material used)
• Occlusal harmony
12. Initial Step is Surveying of the cast
• To determine path of insertion
• To mark the height of contour
• Mark undercuts otherwise not visible to the
naked eye
Survey Lines: line produced on a cast of a tooth by
a surveyor or scriber marking the greatest
height of contour in relation to the chosen path
of insertion of a planned restoration- GPT
14. 1. Path of insertion
• Kennedy Class I case: may have multiple paths of
insertion. A single path obtained by additional
guiding planes on the lingual surface
• Kennedy Class II: Path of insertion depends on
the modification space and their guiding plane
• Kennedy Class III: Single path of insertion
depending on the proximal abutment teeth
• Kennedy Class IV: Single path of insertion
15. Factors influencing Path of insertion
• Retentive undercuts
• Interference
• Guiding plane
• Denture Base
Guiding plane: Two or more vertically parallel surfaces
of abutment teeth so oriented as to direct the path of
placement of removable partial denture- GPT
Use short guiding planes for Class I & II cases, use long
guiding planes for Class III and IV cases
16. 2. Height of Contour
Line encircling a tooth designating its greatest
circumference at a selected position – GPT
The area below the height of contour is a
potential undercut and if feasible, can be used
for designing the retentive components of an
RPD.
17. 3. Undercuts
The area enclosed by the vertical drop and
horizontal surface of any given structure.
Lingual
Undercut
18. After Surveying, the next step is to
DESIGN THE COMPONENTS of the RPD
Parts:
• Major connectors
• Minor Connectors
• Rests
• Retainers
• Denture base
Kennedy Class II modification I cast partial denture
19. Major connectors
Basic Design principles:
• The borders should be 6mm (maxillary) and 3mm
(mandibular) away from the marginal gingiva
• The borders should be parallel to the gingival
margin
• The metal framework should cross the gingival
margin only at 90 degree (right angle) and cross
the palate in a straight line
• Anterior border of maxillary major connectors
should not lie on the crest of the palatal rugae
20. Maxillary major connectors: (and their
uses)
• Single posterior palatal bar (Kennedy Class III)
• Palatal Strap (bilateral short span Class III)
• Palatal plate (Kennedy class I)
• Antero-posterior palatal bars ( Class II and IV)
• Horse shoe shaped plate ( Class I and II)
• Complete palate (Kennedy Class I)
22. Mandibular major connectors
• Lingual bar
• Lingual Plate
• Double lingual bar/ Kennedy bar
• Sublingual bar
• Mandibular cingulum bar
• Labial bar
24. Major Connectors of Choice
For maxillary arches: broad palatal plate connector
Modifications: 1. L-beam priniciple
2. Circular configuration
3. Strut configuration
For mandibular
arches, lingual
plate with
retainers can help
distribute stress.
Circular
configuration
25. Minor Connectors
These are the connecting links between the major
connector and clasps, retainers and rests.
Basic Design principles:
• Broad bucco-lingually, thin mesio-distally
• Triangular cross-section with thickest portion near the
lingual line angle
• If not placed on the abutment teeth, the connector
should be placed in the embrasure.
• Should NEVER be placed on the convex lingual surface
• The area to hold the connector should be devoid of
undercuts and parallel to path of insertion
• Mandibular distal extension should cover 2/3rd the
length of the edentulous ridge
26. Types of minor connectors
• Lattice work
• Meshwork
• Bead, wire or nail head
LATTICE WORK MESHWORK NAIL HEAD TYPE
27. Finish Line
The term denotes the junction between the acrylic denture base
and the major connector.
Types:
• Internal finish line: metal to tissue surface
• External finish line: acrylic to metal surface
Internal finish line
External Finish line
28. Finish Line Design
• Acrylic around lattice or meshwork minor
connectors should be smooth and present
with internal and external finish lines
• Bead type minor connectors require only
external finish line
29. Rests
Rest: rigid stabilizing extension of a partial denture
which contacts a remaining tooth/teeth to
dissipate vertical and horizontal forces
Types:
1. External 2. Internal
– Occlusal rest
– Incisal rest
– Cingulum rest
– Lingual rest
30. Rest seat
That portion of natural tooth or a cast
restoration of a tooth selected or prepared to
receive an occlusal, incisal, lingual, internal
or semiprecision rest - GPT
31. Design of an occlusal rest seat
• Triangular shape with apex at the centre of the
tooth and base at the marginal ridge
• ½ buccolingual width
• 1/3 mesiodistal width
• Angle between floor of the prosthesis and
proximal surface of tooth <90 degree
• 0.5mm thick at thinnest point and 1-1.5 mm
thick at margin.
32. Design of lingual and cingulum rest
• 2.5-3mm mesiodistal length
• 2mm labiolingual width
• 1.5mm deep
• V-shaped notch- labial inclination parallel to labial
surface, lingual inclination perpendicular to the labial
incline
• Apex of the V directed incisally
33. Direct retainer
• Component of a removable partial denture
that is used to retain and prevent
dislodgement consisting of a clasp, assembly
or precision attachment – GPT
Types:
Extra-coronal Intra-coronal
Occlusal Approach Internal Attachment
- Aker’s Clasp External Attachment
Gingival Approach Stud attachment
- Bar Clasp Bar attachment
Special attachment
34.
35. Design of a clasp
• The retentive arm terminal 1/3rd should be
flexible to engage undercuts
• The proximal 1/3rd of the retentive arm to be
placed above the height of contour
• The rigid components are to be placed in the
non retentive areas of the tooth
• The retentive part must make use of the
retentive undercuts present on the tooth
36. Design of clasp
Selection of clasp material according to the
buccolingual width of the undercut: (more
flexible material is required to facilitate insertion
of the RPD into deeper undercuts)
• 0.010 inch undercut- cast chrome alloy
• 0.015 inch undercut- gold and its alloys
• 0.020 inch undercut- wrought wire
-The longer the clasp arm, greater the flexibility.
-The clasp arm should be tapered towards the tip
37. Types of Clasp
• Circumferential Clasp/ Aker’s Clasp
– Simple circlet (NOT used for distal extension cases)
– Reverse circlet (used in distal extension cases)
– Multiple circlet (used for abutment with weak
periodontal support)
– Modified crib clasp (used in Kennedy Class II and III
without any modifications)
– Ring clasp (used in distolingual undercuts and
lingually tipped molars)
38. Other types of circumferential clasps
• Fish hook clasp (used when undercut is adjacent
to an edentulous area)
• Onlay clasp (used when abutment teeth are
below occlusal level. Thus the onlay restores
occlusal harmony while the clasp provides
retention)
• Combination clasp (wrought wire retentive arm
and cast wire bracing arm)
• Vertical reciprocal, horizontal retentive arm clasp
VRHR-(Used in posterior teeth with high survey
lines)
39. Bar clasps
• T-clasp (used in distal extension cases. Should
NOT be used in terminal abutments with
undercuts facing away from the edentulous
space)
• Modified T clasp (used in canine and
premolars for better aesthetics)
• Y-clasp (used for high heights of contour)
• I-clasp- (used on distobuccal surface of canine
with only tip in contact with the tooth
41. Clasp design configuration
Quadrilateral Configuration: Usually
seen in Kennedy Class III with a
modification on the opposite side of
the arch
Tripod Configuration: Usually seen in
Kennedy Class II arches
46. Modifications in the RPI system
• RPA system- When the i-bar is replaced by an
Aker’s clasp.
• Mesial rest modification
• Proximal modification
– Design modification I, II, III
Mod. I Mod. II Mod. III
47. Fulcrum Line
• An imaginary line around which a partial
denture tends to rotate- GPT
• This is a line joining the two posterior most
rests
48. Indirect retainer
• Part of a removable partial denture which assists
the direct retainers in preventing displacement of
the distal extension denture bases by functioning
through lever action on the opposite side of the
fulcrum- GPT
49. Design of Indirect retainer
• Ideally, the indirect retainer should be located
at a point perpendicular to the midpoint of
the fulcrum line
• Should be placed as far away from the
fulcrum line as possible
• Should generally be made of rigid material.
(Flexibility loses efficacy)
• Inclined or weak abutment teeth should NOT
be used.
50. The indirect retainer should be
perpendicular to the fulcrum
line
The indirect retainer should be as
far away from the fulcrum line as
possible
51. Types of indirect retainer
1. Auxiliary occlusal rest –
-Used on 1st premolars bilaterally for
Kennedy Class I cases
-Used on 1st premolar of opposite side for
Kennedy Class II cases
2. Canine Extension- When premolars must act
as a primary abutment
3. Canine rest
52. Types of indirect retainer
4. Continuous lingual bar/plate retainers –
Used for Kennedy Class I and II cases. The bar
should be placed above the middle 1/3rd of
the tooth to prevent unwanted tooth
movement
5. Rugae support
6. Direct-indirect retention (from the
reciprocating arm anterior to fulcrum line)
7. Indirect retention from the major connectors
53. When to use indirect retainer?
• Kennedy Class I: indirect retainers are
necessary and should be placed as far away
from fulcrum line as possible
• Kennedy Class II: indirect retainer on both
sides of the arch
• Kennedy Class III: indirect retainer is NOT
required
55. Design of denture base
• Should have long flanges to resist horizontal
forces
• Distal extension should extend onto the
retromolar pad or cover the entire tuberosity
• Since metallic dentures can be made rigid in thin
sections, mandibular dentures benefit greatly by
the thin rigid plate.
• Maxillary dentures benefit from non metallic
denture materials due to the aesthetic form
factor although lack the good thermal
conductivity that metallic dentures offer.
56. Tooth selection for the denture
(According to Deepak Nallaswamy)
• Anterior teeth replacement
– Acrylic teeth
– Porcelain teeth
– Metal teeth with facing
– Tube teeth
– Reinforced acrylic pontic
Posterior teeth replacement
-porcelain teeth
- metal teeth
- acrylic teeth
- metal teeth with acrylic window
57. In summary
• Design consideration depends on a variety of
factors.
• Design of a removable partial denture changes
with respect to some form of edentulous
classification. We prefer to follow the
classification proposed by Edward Kennedy.
58. Kennedy Classification I
• Direct retainer: essential. The position of the
undercut determines the type of retainer (i.e
gingival/occlusal approach)
• Clasp: 2 clasps on terminal abutments
bilaterally. This follows bilateral configuration
• Rest: to be prepared on tooth with maximum
support
• Indirect retainer: 2 retainers are needed
• Major connector: Palatal Plate, complete palate,
horse shoe palates, lingual plate, cingulum plate.
61. Kennedy Classification II
• Direct retainer: essential. The position of the undercut
determines the type of retainer (i.e gingival/occlusal
approach)
• Clasp: 3 retentive clasps are required, 1 clasp on the
edentulous side and 2 on the dentulous side. Should
follow Tripod configuration
• Rest should be placed on tooth with maximum support
• Indirect retainer: 1 retainer on the dentulous side is
sufficient
• Major connector: horse shoe shaped palatal connector,
antero-posterior palatal bar, lingual bar,
64. Kennedy Classification III
• Direct retainer: position of undercut is NOT
critical in designing the prosthesis since
damage to abutment is minimal
• Clasp: 4 clasps should be placed for
quadrilateral design in case of modification of
class III.
• Indirect retainer: not needed
• Major connector: single posterior palatal bar,
palatal strap, lingual bar
67. Kennedy Classification IV
• In case of short edentulous spans, the need
for retainers and clasps are very limited.
• In case of long span edentulous areas,
– 4 clasps can be placed for quadrilateral
configuration
– Indirect retainer to be placed posterior to the
fulcrum line
69. Reference
• A textbook of prosthodontics, Deepak Nallaswamy,
reprint 2005.
• McCracken’s removable partial Prosthodontics, 11th
edition.
• Principles of designing in Removable partial denture,
Shebin Abraham, online presentation, uploaded on
11/2/2016, slideshare.net.
• Designing removable partial dentures, Dr Ting Ling
Chang, UCLA, online presentation, ffofr.org.
• Presentations by Indian dental academy
• Pictures from the internet