1. The document discusses considerations for managing partial tooth loss through removable partial dentures (RPDs). It covers topics like different types of RPDs, reasons for failure, and the six phases of RPD service. 2. Key types discussed are tooth-supported, tooth and tissue-supported, and distal extension RPDs. The six phases of service include patient education, diagnosis and treatment planning, establishing occlusion, placement, and periodic recalls. 3. While RPDs have limitations like dependence on patient cooperation, the document notes they can provide long-term function when made properly and with patient maintenance, while also being an economical option.

1. Mc Cracken’s
Removable Partial Prosthodontics
Edition - XII
Seminar Created By
Dr. Joel Koshy Joseph MDS

2. Consideration for Managing Partial
Tooth Loss
Chapter 2

3. Contents
1. Points of View
1. Tooth replacements from the patient's
perspective
2. Shared decision making
2. Tooth Supported Prostheses
3. Tissue and tooth supported Prosthesis
4. Six Phases of Partial Denture Service
5. Reasons for Failure of Clasp Retained Partial
dentures.

4. Points of View
Tooth Replacements from the patient’s
Perspective
Like any other medical Condition, ‘Tooth loss’ also required adequate medical assistance

5. How can tooth loss effect a patient?
Pain Social Anxiety Nutritional
Deficiency
The above reasons can compel patients to sort for
medical/ dental advice.

6. Shared Decision making
TRUSTPatient Dentist

7. Health Advices
Best possible
treatment
Pros of Treatment Cons of Treatment
Deliverance
of skill
Future care
Trust on Dentist Time with
Patience
Shared Decision making

8. Types of Removable Partial
Prosthesis
Tooth Supported Prosthesis Tooth and tissue Supported
Prosthesis

9. For Distal Extension Cases
Tooth and tissue supported
RPD
Implant supported RPD

10. Tooth Bonded RPDs
Tooth Bonded RPDs Fixed Partial Denture~
Vertical Support = Rest
seats
Vertical Support = Occlusal part
of Crowns on abutment

11. Tooth Bonded RPDs Fixed Partial Denture~
Horizontal Support = Rest
seats + Guiding plane+ parts
of clasp+ Parts of major and
minor connector etc
Horizontal Support = Lateral
Surfaces of Crown
In RPD, a portion of abutment tooth is taken as support. In FPD, the
whole clinical crown is taken as support.
In FPD, the prosthesis is cemented on to the abutment tooth, in
RPD it is just clamped to the abutment tooth.

12. Tooth and Tissue Supported
Prostheses
Here, along with the tooth, tissue support is also
taken for horizontal and vertical support

13. NOTE!!
During mastication, residual ridge mucosa movement from
1 to 3mm should be expected which is not seen in tooth
bonded RPDs.

15. Clasp retained RPDs
Extra Coronal Direct Retainers Intra Coronal Direct Retainers

16. Extra Coronal Direct Retainers
 Strain on Abutment teeth
 Clasp are unaesthetic
 Caries may develop
 Can be used when cross
arch stabilization is desired
 Can be used when wider
distribution of forces to
support teeth and tissue is
desired.
Intra Coronal Direct Retainers
 Higher cost
 Difficult procedure
 Sufficient clinical crown
length is required
 Pulp morphology should
be conducive.
 Excess torsional load on
abutment in D.Ext. RPDs.
 Aesthetic

17. Six Phases of Partial Denture Service
I - Education of Patient
Why?!

18. Because….
• Patient can better understand the benefits of
removable partial denture
• Patient would avoid misuse
• Patient can provide the required oral care and
maintenance procedures
• Patient follows his/her recall appointments
• Without patient’s cooperation, success of any
treatment is dicey.

19. When and how to educate?
• Education should begin at the initial contact
with the patient and should continue
throughout the treatment.
• Treatment plan and prognosis should be
thoroughly discussed with the patient.
• Oral instruction, written suggestion, visual aid
(models/ chards/ videos) to be used.

20. II- Diagnosis, Treatment Planning, Design,
Treatment Sequencing and Mouth Preparation
Detailed Case History
This should include through medical and dental histories
Clinical and Radiographic interpretation
Occlusal plan evaluation, arch form, occlusal relation of remaining teeth through
Diagnostic mounting and surveying records
Treatment plan sequenced
Mouth preparation done form the information obtained through diagnostic records
and surveying records .

21. III- Support for Distal Extension Denture Bases
• It does not apply to tooth supported
removable partial dentures.

22. • Soft tissue in the primary supporting area
should be recorded under some loading so
that it is made to fit the form of the ridge
when under function.
• Hence, Dual impressions are necessary

23. ALTERED CAST IS
FABRICATED

24. IV- Establishment and Verification of Occlusal
Relations and Tooth Arrangements
Establishment and verification of occlusal
relation= Jaw relation
Distal Extension cases=
Tooth Supported RPDs=
Following this teeth arrangement is
done

25. V- Initial Placement Procedures
• The patient is given possession of the
removable prosthesis.
• Minute changes in the planned occlusal
relationships do occur during processing
• These corrections are done here.
• Patient is given instructions about the use and
recall appointments.

26. VI- Periodic Recall
• This is critical for early recognition of changes in
oral structures and allow steps to be taken to
maintain oral health.
1. First recall- Immediately (To correct occlusal
disharmony and to check for immediate tissue
reaction)
2. Second recall- after one week (to check for tissue
reaction, comfort and other problems)
3. Third recall – after every 3-6 months (tissue reaction
and amount of resorption)
4. Fourth recall- Yearly (for relining or rebasing)

27. Reasons for failure of Clasp Retained
Partial Dentures
This can occur during different stages of
treatment

33. Million Dollar Question….
If a treatment (Removable partial denture) is
susceptible for more failure and totally depends
on patients’ cooperation and use, then why
advice this treatment option at all??
….. Study also suggests that, RPD gives a very
minimal benefit over no prosthesis……

34. However, the merit of this type of restoration
lies in the knowledge that:
1. Its economical
2. They are comfortable and efficient for a long
period of time
3. It can provide for healthy abutments, free of
caries and periodontal disease
4. It can provide continued health of restored.
Healthy tissue of the basal seats
5. Its makes possible a partial denture service
that is definitive and not merely an interim
treatment.

35. References:
1. Mc Cracken’s Removable Partial
Prosthodontics. Edition 12
2. Pics: Google image search