2. RPD - DEFINITION
"A prosthesis (denture) that
replaces some teeth in a
partially dentate arch. It can be
removed from the mouth and
replaced at will"
6. DIAGNOSIS OF
REMOVABLE
PARTIAL DENTURE
• Patient evaluation
• Medical & clinical history
• Clinical examination of patient
(pemeriksaan klinis)
• Kennedy classification
7. PATIENT
EVALUATION
(EVALUASI PASIEN)
• People with neuromuscular disorders shows
different gait denture adaptation retention
& stabilization of denture (retensi & stabilisasi)
Gait (cara
jalan)
• Younger patient good healing
• Older patient compromised healing
Age
(usia)
• Male & female have different approach
Sex
7
8. PATIENT
EVALUATION
(EVALUASI PASIEN)
• Help determine the shade of teeth
Complexion
& personality
• Class I high cexpectation
• Class II moderate / normal expectation
• Class III low expectation and is difficult to
know if the patient is satisfied or not
Cosmetic
index
•Philosophical ideal and rational
•Exacting/critical high intelligent and difficult to satisfy
•Hysterical/antagonistic emotionally unstable and
negative attitude with unrealistic expectation
•Indifferent/passive unconcerned with appearance and
function
Mental
attitude
8
10. MEDICAL &
CLINICAL HISTORY
10
Pretreatment records
• Previous denture
• Current denture
• Pre-extraction record
Period of edentulousness
• Cause of tooth loss
• Teeth loss due to trauma have lesser impact in
resorption
• Teeth loss due to periodontal trauma are prone
to increased resorption than those which are
lost due to caries
12. The patient’s head and neck region should be examined in general for the
presence of any pathologic conditions.
It includes:
Facial Examination
Lip Examination
TMJ Examination
EXTRA ORAL
EXAMINATION
16. Health of the lips -Cracking, fissuring at corner &
ulceration: indicative of vitamin B-complex deficiency,
candida infection.
Lip support – adequately supported or
unsupported(collapsed or wrinkled appearance)
Lip thickness- thick lips require lesser support from
artificial teeth and labial flange.
Lip length- long , medium and short.
Lip mobility – normal (class I)
- reduced mobility (class II)
- paralysis (class III)
LIP EXAMINATION
17. Lip thickness – thick or thin
Thick – gives more freedom in teeth setting.
Thin – any change in labiolingual position can alter fullness, support or
drape of thin lip.
Lip length long or short.
Measured from - base of the nose to vermillion border of lip (ideal = 25
mm). or with index finger tip ,from incisive papilla to upper lip.
VERMILION BORDER
Long – will hide denture base & most of the tooth (maximum facial
expression is required for display of tooth).
Short – any expression will expose most of the tooth or even denture
base.
18. 1. Competent lips – lips are in slight contact
when the musculature is relaxed
2. Incompetent lips – morphologically short lips
which do not form a lip seal in a relaxed state
3. Potentially incompetent lips – normal lips ,
fail to form lip seal
4. Everted lips – hypertrophied lips with weak
muscular tonocity.
LIPS CAN BE CLASSIFIED
INTO 4 TYPES
19. • Clicking(disc displacement),crepitations(osteoarthrosis)
• Pain & tenderness on palpation
• Temporomandibular arthralgia
• Impaired mandibular mobility
• Irregularity or deviation on opening & closing of mandible
• Deflection.
• Locking of mandible.
TEMPOROMANDIBULAR JOINT
EXAMINATION
21. INTRA ORAL EXAMINATION
Remaining teeth Periodontal health Color of mucosa saliva
Ridge contour Ridge relation
Redundant and
hyperplastic tissue
Palatal throat form
Bony undercut and
torii
Muscle and frenum
attachment
Tongue Gag reflex
Note:
size = ukuran , form = bentuk. Arch = rahang
Muscle and frenum attachment = perlekatan otot dan frenulum
22. REMAINING TEETH
EXAMINATION
A thorough examination of the remaining teeth must be
performed
Caries, defective restoration must be corrected
Radiographic examination must be performed to check the
remaining teeth
Teeth with suspected pulpal involvement must be tested for
vitality
Percussion test must be performed to all teeth
22
23. PERIODONTAL
EXAMINATION
A complete periodontal examination should be
accomplished
Oral structure should be evaluated to
determine pocket depth, mobility, soft tissue
attachment, furcation involvement, etc
23
24. Ranges healthy pink to angry red.
Redness indicative of inflammation: related
to ill fitting denture, underlying infection,
systemic disease or chronic smoking.
Pigmented spots or lesions.
White patches keratotic areas caused by
denture irritation.
COLOUR OF MUCOSA
25. Flow – regular or irregular.
Quality – thin serous, mucinous, mixed.
Quantity – normal, excessive, scanty.
Deficient saliva: retention of denture will be affected.
Excess of saliva: complicates impression making.
Thick mucous saliva makes dentures more difficult to wear. It will
push out denture by accumulating beneath the denture.
Mixture of both Thin serous & Thick mucous saliva is the best to
work with.
SALIVA
27. The positional relation of the mandibular ridge &
maxillary ridge.
Angle classified ridge relationship as:
CLASS I: Normal
CLASS II: Retrognathic
CLASS III: Prognathic
RIDGE
RELATIONSHIP
28. Both the maxilla and mandible should be
examined for redundant tissue.
An excessive amount of flabby tissue will cause
the denture base to shift and move as force is
applied .
In such cases , surgical excision of the movable
tissue will improve the condition.
REDUNDANT TISSUE
29. Often hyperplastic tissue is present under an ill-
fitting denture which may be an epulis fissuratum
related to a denture border, papillary hyperplasia
under the denture base.
Rest to the tissue, proper oral hygiene, tissue
massage will improve the condition.
If not, surgical correction is needed for the
foundation of new denture.
HYPERPLASTIC TISSUE
30. U-shaped palatal vault: most favourable for retention & lateral stability.
V-shaped vault: less favourable for retention.
Flat palatal vault: also unfavourable.
HARD PALATE
31. Classified according to configurations based on the degree of
flexure the soft palate makes with the hard palate and the width of
the seal area.
Class I: Horizontal & demonstrating little muscular movement. Most
favourable condition as it allows for more tissue coverage for
posterior palatal seal. Forms a 10 degree angle.
Class II: Turns downward forming a 45degree angle to hard palate.
Potential tissue coverage is less than for classI.
Class III: Turns downward sharply at 70 degree angle just
posterior to hard palate. Least favourable soft tissue form.
SOFT PALATE
32. V- shaped vault: associated with Class III soft palate
Flat palatal vault: usually associated with Class I or Class II soft palate.
33. Bony undercuts are frequently found on
maxillary and mandibular ridges.
The rule should be always selective relief of the
denture rather than surgical excision.
If the undercuts are severe and previous
denture attempts have failed , surgery should
be considered.
On mandibular ridge, the only undercut that
can pose a real problem is a prominent sharp
mylohyoid ridge.
BONY UNDERCUTS
35. Torus palatinus & lingual tori frequently
present.
Torus palatinus: range from a small
prominence in the midline to one that covers
the entire hard palate.
Adequate relief must be planned.
Lingual tori: interfere with denture
construction & unless very small should be
surgically removed
TORI
36. Class I - Tori absent or minimal in size. Do not interfere with
denture construction.
Class II – Moderate size. Mild difficulties in denture
construction and use. Surgery not required.
Class III – Large in size. Compromise fabrication & function of
dentures. Requires surgical recontouring and removal.
TORII
CLASSIFICATION
37. BORDER ATTACHMENTS (HOUSE) :
Class I – Attachments are away from the crest of ridge (0.5 inches or
more between level of attachment and crest of ridge)
Class II – Attachments height is 0.25 to 0.50 inches.
Class III - < 0.25 inches from ridge crest.
FRENUM ATTACHMENTS (HOUSE):-same as border
attachments
Class I – frenum located away from crest of ridge.
Class II – nearer to the crest of ridge.
Class III – freni encroach on the crest of the ridge and may interfere
with denture seal. Surgical correction may be required (frenotomy or
frenectomy)
38. Normal defense mechanism developed by the
body to prevent foreign bodies from entering the
trachea.
Can be caused by:
Systemic disorders,
Psychological factors,
Extraoral & intraoral physiological factors
Iatrogenic factors.
Controlled by glossopharyngeal nerve
GAG REFLEX
39. • Clinical techniques, pharmacological
measures, psychological intervention.
• Identify the existence of gag reflex with
thorough conversation with the patient.
• Careful handling of impression
procedure and constant reassurance of
the patient will suffice.
• In severe cases, a specialist maybe
needed to treat the problem at a
psychological level.
MANAGEMENT OF
GAG REFLEX
41. COMPONENTS OF
REMOVABLE
PARTIAL DENTURE
1. Denture Base ( Saddle)
2. Supporting Elements( Rests &
Embrasure Hock & Onlay )
3. Retentive Elements ( Direct {clasp
& attachments} & Indirect )
4. Connectors ( Major & Minor )
42. "That part of the denture
that rests on the oral
mucosa and carry the
artificial teeth"
or alternatively "The space(s) to be filled by the
denture“
Classification of Saddles
• Bounded Saddles
• (teeth present at both ends of
the saddle area)
• Free-end saddles
• (teeth present at only the
anterior end of the saddle)
DENTURE BASE
(SADDLE)
43. SUPPORT
"The resistance to a
vertical displacing force
directed towards the
mucosa“
1. Tooth support
2. Mucosa support
3. Tooth and Mucosa support
Others i.e. implants, overdenture (tooth)- support
Classification of Support
44. RETENTION
"That quality inherent in a prosthesis acting
to resist movement or displacement away
from the mucosa”
Achieved in RPD prosthodontics by the use of clasps mechanical retention
45. MAJOR CONNECTOR
That component of a denture
which unites saddles of a denture
• • Cast metal (Co-Cr), Gold, Nickel chrome or titanium
• • Acrylic resin
46. CLASSIFICATION OF RPD
REQUIREMENTS OF AN ACCEPTABLE
METHOD OF CLASSIFICATION
1. It should be permit immediate visualization of the
type of partially edentulous arch being considered.
2. It should permit immediate differentiation between
the tooth- support and the tooth and tissue-
supported RPD.
3. Serve as a guide to the type of design to be used.
4. It should be universally acceptable.
The most familiar classifications are those originally proposed by Kennedy,
Cummer, and Bailyn. Classifications have also been proposed by Beckett,
Godfrey, Swenson, Friedman, Wilson, Skinner, Appligate, Avent, Miller, and
others.
47. CLASSIFICATION OF RPD
Classifications in current use are of
two types - those which classify the
partial denture and those which
classify the partially edentulous
arch.
A classification which describes
partial dentures is based on the
nature of the support utilized by a
partial denture. Support can be
gained from:
1. Teeth-support (born),
2. Mucosa-support,
3. Teeth and mucosa-support.
49. KENNEDY’S
CLASSIFICATION
Kennedy divided all partially edentulous arches into
4 clases based on the location of the
edentulous area/s as follows:
1. Class I: Bilateral edentulous areas located
posterior to the remaining natural teeth.
2. Class II: A unilateral edentulous area located
posterior to the remaining natural teeth.
3. Class III: A unilateral edentulous area located
between the remaining natural teeth.
4. Class IV: A single, but Bilateral (crossing the
midline), edentulous area located anterior to the
remaining natural teeth.
By Dr.Edward Kennedy,(1925)
53. KENNEDY’S CLASSIFICATION
APPLEGATE RULES
Applegate (1960) provided the following 8 rules to governed the application of
the Kennedy classification:
Rule 1. Classification should follow rather than precede extractions that might
alter the original classification.
Rule 2. If the third molar is missing and not to be replaced, it is not considered
in the classification
Rule 3. If the third molar is present and is to be used as an abutment, it is
considered in the classification
Rule 4. If the second molar is missing and not to be replaced, it is not
considered in the classification
Rule 5. The most posterior edentulous area/s determine the classification.
Rule 6. The edentulous areas other than those determine the classification
are referred to as modification spaces and are designated by their
number.
Rule 7. The extent of the modification is not considered, only the no. of
additional edentulous areas.
Rule 8. There can be no modification areas in Class IV arches.
57. ACRYLIC REMOVABLE PARTIAL
DENTURE(RPD)
Acrylic removable partial denture a dental prosthesis which artificially
supplies teeth and associated structure in a partially edentulous arch ,
made from acrylic resin and can be inserted and removed at will.
An acrylic RPD consist of an acrylic resin denture base , artificial teeth,
and wrought wire clasp (cangkolan 1 jari , cangkolan 3 jari) or even cast
clasps.
Various several type are considered as acrylic partial denture, all of
which are of temporary type.
they are designed to be used for a short interval of time and are usually
constructed as a part of the total prosthodontic treatment, they usually
need supportive care.
