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Preparation of Mouth for Removable Partial Dentures

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Preparation of Mouth of Removable Partial Dentures, RPD Basics, Undergraduate Prosthodontics Lectures, McCracken's 12th Edition – PowerPoint PPT presentation

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Title: Preparation of Mouth for Removable Partial Dentures


1
Preparation of the Mouth for Removable Partial
Dentures
  • Dr. Shujah A Khan
  • MDS Resident,
  • Department of Prosthodontics
  • DIKIOHS, DUHS

2
  • Mouth preparation follows the preliminary
    diagnosis and the development of a tentative
    treatment plan.
  • In general, mouth preparation includes
    procedures in four categories
  • Oral surgical preparation,
  • Conditioning of abused and irritated
    tissues,
  • Periodontal preparation, and
  • preparation of abutment teeth.

3
Oral surgical preparation
4
Oral Surgical Preparation
  • Pre-prosthetic surgical treatment for the
    removable partial denture patient should be
    completed as early as possible.
  • Necessary endodontic surgery, periodontal
    surgery, and oral surgery should be planned, so
    that they can be completed during the same
    time frame.
  • The longer the interval between the surgery and
    the impression procedure, the more complete the
    healing and consequently the more stable the
    denture-bearing areas.

5
Oral Surgical Preparation
  • Extractions
  • Removal of residual roots
  • Impacted teeth
  • Malposed teeth
  • Cysts and Odontogenic Tumors
  • Exostoses and Tori
  • Hyperplastic Tissue
  • Muscle attachments and Frena
  • Bony spines and knife-edge ridges
  • Polyps, Papillomas and traumatic hemangiomas
  • Hyperkeratoses, Erythroplasia and Ulcerations

6
  • Dentofacial Abnormality
  • Osseointegrated devices
  • Augmentation of Alveolar Bone

7
Extractions
  • Planned extractions should occur early in the
    treatment regimen.
  • Each tooth must be evaluated for its strategic
    importance and its potential contribution to the
    success or RPD
  • Heroic attempts to salvage seriously involved
    teeth or those of doubtful prognosis for which
    retention would contribute little if anything are
    contraindicated

8
Removal of Retained Roots
  • Generally all retained roots or root fragments
    should be removed.
  • Close approximation to tissue surface or if
    associated pathologic findings are evident
  • Roots adjacent to abutment teeth contribute to
    progression of periodontal pockets

9
Impacted Teeth
  • All impacted teeth, including those in the
    edentulous area, as well as those adjacent to
    abutment teeth should be considered for removal.
  • Asymptomatic impacted teeth in the elderly that
    are covered with bone, with no evidence of
    a pathologic condition, should be left to
    preserve the arch morphology

10
Malposed Teeh
  • The loss of individual teeth or groups of teeth
    may lead to extrusion, drifting, or
    combinations of malpositioning of remaining
    teeth
  • Orthodontics may be useful in correcting many
    occlusal discrepancies, but for some
    patients, such treatment may not be practical
    because of lack of teeth for anchorage of the
    orthodontic appliances or for other reasons

11
Cysts and Odontogenic Tumors
  • Panoramic roentgenograms of the jaws are
    recommended to survey the jaws for
    unsuspected pathologic conditions.
  • All radiolucencies or radiopacities observed
    in the jaws should be investigated
  • Patient should be informed of the diagnosis and
    provided with various options for resolution of
    the abnormality as confirmed by the
    pathologists report.

12
Exostoses and Tori
  • The existence of abnormal bony enlargements
    should not be allowed to compromise the design of
    the removable partial denture
  • The removal of exostoses and tori is not a
    complex procedure, and the advantages to be
    realized from such removal are great in contrast
    to the deleterious effects that their continued
    presence can create.

13
Hyperplastic Tissue
  • Hyperplastic tissues are seen in the form of
    fibrous tuberosities, soft flabby ridges, folds
    of redundant tissue in the vestibule or floor
    of the mouth, and palatal papillomatosis.
  • All these forms of excess tissue should be
    removed to provide a firm base for the denture.

14
Muscle Attachments and Frena
  • As a result of the loss of bone height,
    muscle attachments may insert on or near the
    residual ridge crest.
  • The mylohyoid, buccinator, mentalis, and
    genioglossus muscles are most likely to
    introduce problems of this nature.
  • The mentalis and genioglossus muscles
    occasionally produce bony protuberances at their
    attachments that may also interfere with
    removable partial denture design.

15
  • The maxillary labial and mandibular lingual frena
    are the most common sources of frenum
    interference with denture design.
  • Under no circumstances should a frenum be
    allowed to compromise the design or comfort of a
    removable partial denture.

16
Bony Spines and Knife-Edge Ridges
  • Sharp bony spicules should be removed and
    knifelike crests gently rounded
  • These procedures should be carried out with
    minimum bone loss

17
Hyperkeratoses, Erythroplasia and Ulcerations
  • All abnormal white, red or ulcerative lesions
    should be investigated, regardless of their
    relationship to the proposed denture base or
    framework
  • The lesions should be removed and healing
    accomplished before the removable partial denture
    is fabricated

18
Dentofacial Deformity
  • Patients with such problems often have multiple
    missing teeth as part of their problem.
  • Correction of the jaw deformity can simplify the
    dental rehabilitation
  • Several dental professionals may play a role in
    the patients treatment
  • Replacement of missing teeth and development of a
    harmonious occlusion are almost major problems

19
Osseointegrated Devices
  • These devices offer a significant stabilizing
    effect on dental prostheses through a rigid
    connection to living bone.
  • Long term research has demonstrated good results
    for the treatment of complete and partially
    edentulous patients using dental implants

20
Augmentation of Alveolar Bone
  • Careful clinical judgment with sound surgical and
    prosthetic principles must be excercised.
  • Ridge augmentation with the use of alloplastic
    and autogenous materials is gaining popularity
    especially in conjunction with dental implants.

21
Conditioning abused and irritated tissues
22
Conditioning of Abused and Irritated Tissues
  • Patients who require conditioning treatment often
    demonstrate the following symptoms
  • Inflammation and irritation of the mucosa
    covering denture bearing areas
  • Distortion of normal anatomic structures, such as
    incisive papillae, rugae and retromolar pads
  • Burning sensation in residual ridge areas, the
    tongue and the cheeks and lips

23
  • These conditions are usually associated with
    ill-fitting or poorly occluding removable
    partial dentures.
  • However, nutritional deficiencies, endocrine
    imbalances, severe health problems (diabetes or
    blood dyscrasias), and bruxism must be considered
    in a differential diagnosis.

24
Use of Tissue Conditioning Materials
  • The tissue conditioning materials are
    elastopolymers that continue to flow for an
    extended period, permitting distorted tissues
    to rebound and assume their normal form.

25
  • Maximum benefit from using tissue conditioning
    materials may be obtained by
  • Eliminating deflective or interfering occlusal
    contacts of old dentures (by remounting in an
    articulator if necessary)
  • Extending denture bases to proper form to
    enhance support, retention, and stability
  • Relieving the tissue side of denture bases
    sufficiently (2 mm) to provide space for even
    thickness and distribution of conditioning
    material
  • Applying the material in amounts sufficient to
    provide support and a cushioning effect
  • Following the manufacturers instructions

26
  • Many dentists find that intervals of 4 to 7 days
    between changes of the conditioning material are
    clinically acceptable

27
Periodontal preparation
28
Periodontal Preparation
  • Periodontal preparation of the mouth usually
    follows any oral surgical procedure and is
    performed simultaneously with tissue
    conditioning procedures.

29
Objectives of Periodontal Therapy
  • The basic objective is the return to health of
    supporting structures of the teeth, creating an
    environment in which the periodontium may be
    maintained.
  • The specific criteria for satisfying this
    objective are as follows
  • ?

30
  1. Removal and control of all etiologic factors
    contributing to periodontal disease along with
    reduction or elimination of bleeding on probing
  2. Elimination of, or reduction in, the pocket
    depth of all pockets with the establishment
    of healthy gingival sulci whenever possible
  3. Establishment of functional atraumatic occlusal
    relationships and tooth stability
  4. Development of a personalized plaque control
    program and a definitive maintenance schedule

31
Periodontal Diagnosis and treatment Planning
  • The diagnosis of periodontal diseases is based on
    a systematic and carefully accomplished
    examination of the periodontium.
  • It follows the procurement of the health history
    of the patient and is performed with direct
    vision, palpation, a periodontal probe, a
    mouth mirror, and other auxiliary aids, such
    as curved explorers, furcation probes, diagnostic
    casts, and appropriate radiographs.
  • Dental Radiographs should be used to supplement
    the clinical examination but should never be used
    as a substitute

32
  • A critical evaluation of the following factors
    should be made
  • Type, location, and severity of bone loss
  • Location, severity, and distribution of
    furcation involvements
  • Alterations of the periodontal ligament space
  • Alterations of the lamina dura
  • The presence of calcified deposits

33
  • The location and conformity of restorative
    margins
  • Evaluation of crown and root morphologies
  • Root proximity
  • Caries and
  • Evaluation of other associated anatomic features,
    such as the mandibular canal or sinus
    proximity.

34
Treatment Planning
  • Periodontal treatment planning can be divided
    into three phases
  • First Disease control or Initial Therapy
  • Eliminate or reduce local causative factors
    before any surgical procedures are accomplished

35
  • Second Surgery phase
  • Periodontal surgery, free gingival grafts,
    osseous grafts, or pocket reduction is
    accomplished
  • Third or last Recall and maintenance
  • 3 4 month intervals

36
Initial Disease Control Therapy (Phase 1)
  • Oral Hygiene Instructions
  • Scaling Root Planing
  • Elimination of Local Irritating Factors other
    than Calculus
  • Elimination of Gross Occlusal Intereferences
  • Temporary Spliniting
  • Use of a Nightguard
  • Minor Tooth Movement

37
Definitive Periodontal Surgery (Phase 2)
  • Periodontal Surgery
  • Periodontal Flaps
  • GTR (Guided Tissue Regeneration)
  • Periodontal Plastic Surgery
  • Mucogingival Surgery

38
Recall Maintenance (Phase 3)
  • 3 4 month recall to maintain the results
    achieved by non surgical and surgical therapy

39
Advantages of Periodontal Therapy
  1. Elimination of periodontal disease removes a
    primary causative factor in Tooth Loss
  2. Better environment for restorative correction
  3. Response of strategic but questionable teeth to
    periodontal therapy provides an important
    opportunity for reevaluating their prognosis
  4. Reaction of patient to perio procedures and
    degree of cooperation

40
Abutment teeth preparation
41
Abutment Teeth Preparation
  • Abutment Restorations
  • Contouring Wax Patterns
  • Rest Seats

42
Thank You
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