Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
Fixed prosthodontic treatment can offer exceptional satisfaction for both patient and the dentist. Fixed Prosthodontics can transform an unhealthy, unattractive dentition with poor function into a comfortable, healthy occlusion capable of giving years of further service while greatly enhancing esthetics.
Nothing is more important in the construction of fixed partial dentures than an adequate diagnosis and a well-devised treatment plan. Although these two subjects are usually considered together. Astute dentists must recognize their subtle differences. Diagnosis is an evaluation of the condition of the patient when he presents for treatment. Treatment planning concerns the treatment procedures by which the dentist will restore the patient to an optimum state of dental health.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
Fixed prosthodontic treatment can offer exceptional satisfaction for both patient and the dentist. Fixed Prosthodontics can transform an unhealthy, unattractive dentition with poor function into a comfortable, healthy occlusion capable of giving years of further service while greatly enhancing esthetics.
Nothing is more important in the construction of fixed partial dentures than an adequate diagnosis and a well-devised treatment plan. Although these two subjects are usually considered together. Astute dentists must recognize their subtle differences. Diagnosis is an evaluation of the condition of the patient when he presents for treatment. Treatment planning concerns the treatment procedures by which the dentist will restore the patient to an optimum state of dental health.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Design of a fixed Partial Denture (with Abutment Tooth Preparation)Taseef Hasan Farook
A simplified take on the steps to designing a Fixed partial denture. This presentation also includes an overview of abutment preparation, associated finishes and methods of impression taking prior to the designing of the prosthesis itself
The patient who requires a single denture opposing a natural or restored dentition challenges the clinician even more than the completely edentulous patient does. This is due to the biomechanical differences in the supporting tissues of the opposing arches. So a proper evaluation, correction of the existing factors and proper sequence of denture construction is necessary to give a more stable prosthesis.
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
Design of a fixed Partial Denture (with Abutment Tooth Preparation)Taseef Hasan Farook
A simplified take on the steps to designing a Fixed partial denture. This presentation also includes an overview of abutment preparation, associated finishes and methods of impression taking prior to the designing of the prosthesis itself
The patient who requires a single denture opposing a natural or restored dentition challenges the clinician even more than the completely edentulous patient does. This is due to the biomechanical differences in the supporting tissues of the opposing arches. So a proper evaluation, correction of the existing factors and proper sequence of denture construction is necessary to give a more stable prosthesis.
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
About failures of root canal treatment and retreatment. This presentation describes about various techniques for gutta percha removal, posts removal, pastes removal, and removal of separated instrument
DIAGNOSTIC SETUP FOR REMOVABLE PARTIAL DENTURE /prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Mouth preparation refers to procedures that must be accomplished before fixed prosthodontic treatment can be properly performed.
Rarely are crowns or fixed prosthodontic treatment provided without initial therapy because what causes the need for the fixed prosthesis also promote other pathological processes (caries and periodontal disease are the most common).
Failure of fixed prosthesis often results from inadequate or incomplete mouth preparation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
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
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
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
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
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
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
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. WROUGHT WIRE: SELECTION AND QUALITY CONTROL
• Wrought-wire direct retainer arms may be attached to the restoration
• by embedding a portion of the wire in a resin denture base
• by soldering to the fabricated framework
• by casting the framework to a wire embedded in the wax pattern
Craig* has suggested that
• the tensile strength of the wrought structure is approximately 25% greater than that
of the cast alloy from which it was made
• a minimum yield strength of 60, 000 psi is required for the retentive element of a
direct retainer.
• A percentage elongation of less than 6% is indicative that a wrought wire may not be
amenable to contouring without attendant undesirable changes in microstructure.
106 97
98. • A retainer arm is in essence a cantilever and can be made more serviceable
and efficient by tapering.
• Tapering to 0. 8 mm permits more uniform distribution of service stresses
throughout the length of the arm, being readily demonstrated by
photoelastic stress analysis.
106 98
99. • 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 99
• 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
100. • 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.
100 100
• 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.
101. • 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
100 101
102. 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
100 102
103. • 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
100 103
The interview, an opportunity to develop rapport with the patient, involves listening to and understanding the patient’s chief complaint or concern about his or her oral health. A fundamental objective of the patient interview, which accompanies the diagnostic examination, is to gain a clear understanding of why the patient is presenting for evaluation;this involves having the patient describe the history related to the chief complaint.
The proposed classification is based on 2 factors: (1) the level and quality of the engagement or involvement of the patient toward the dentist (including such issues as domination, submission, and idealization and devaluation of the dentist) and (2) the level of willingness to submit (trust) to the dentist.
radiographic changes are not observed until approximately 25% of the mineral content has been depleted.
The lamina dura on the side to which the tooth is sloping becomes uniformly heavier, which is nature’s reinforcement against abnormal stresses.
when anatomic limitations to implant placement exist and surgical measures cannot be taken to correct this, the removable partial denture is the only option.
Valplasts do not have vertical displacement components(metal rests) and must rely on the soft tissue for support.
Combination improves the esthetics of a traditional RPD but also ensures the rigidity of the major connector and provides vertical support with metal occlusal rests
composite resin - to avoid using unesthetic distoincisal metal rests for vertical support of the metal framework
rotational path RPD or overlay RPD- significant loss of anterior residual ridge support for a conventional RPD or a heavily worn dentition with loss of significant vertical of dimension
distal region renders the denture tooth-implant-supported instead of toothmucosa-supported, promoting greater retention, stability and comfort.
the advantages of CAD/CAM designs for RPDs seem to be improved fit, decreased time for fabrication, less labor required, and fewer sources of error