Introduction to Removable Partial Prosthodontics - PowerPoint PPT Presentation

Loading...

PPT – Introduction to Removable Partial Prosthodontics PowerPoint presentation | free to download - id: 4300dc-MDY5O



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Introduction to Removable Partial Prosthodontics

Description:

Introduction to Removable Partial Prosthodontics Rola M. Shadid, BDS, MSc Eliminate the technical difficulties of restoring multiple edentulous spaces in one quadrant. – PowerPoint PPT presentation

Number of Views:1300
Avg rating:3.0/5.0
Slides: 53
Provided by: Dr438
Learn more at: http://drrolashadid.weebly.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Introduction to Removable Partial Prosthodontics


1
Introduction to Removable Partial Prosthodontics
  • Rola M. Shadid, BDS, MSc

2
Partial Denture
  • A prosthesis that replaces one or more, but not
    all of the natural teeth and supporting
    structures. It is supported by the teeth and/or
    the mucosa. It may be fixed (i.e. a bridge) or
    removable.

3
Removable Partial Denture (RPD)
  • A partial denture that can be removed and
    replaced in the mouth by the patient.
  • Can be interim RPD (all-resin) or definitive cast
    framework RPD

4
Interim Rmovable Partial Denture (Provisional
Temporary)
  • A denture used for a short interval of time to
    provide
  • a. esthetics, mastication, occlusal support
    and convenience.
  • b. conditioning of the patient to accept the
    final prosthesis.

5
  • Retention
  • Resistance to removal from the tissues or teeth
  • Stability
  • Resistance to movement in a horizontal direction
    (anterior-posteriorly or medio-laterally
  • Support
  • Resistance to movement towards the tissues or
    teeth

6
  • Abutment A tooth that supports a partial
    denture.
  • Retainer A component of a partial denture that
    provides both retention and support for the
    partial denture

7
Classification of Partially Edentulous Arches
8
Major Categories of Partial Tooth Loss
  • Tooth- and tissue-supported space
  • Tooth-supported
  • space

9
Requirements of an Acceptable Classification..
  • should permit immediate visualization of the type
    of partially edentulous arch that is being
    considered.
  • should permit immediate differentiation between
    the tooth-supported and the tooth- and
    tissue-supported removable partial denture.
  • should be universally acceptable.

10
Classification of Partially Edentulous Arches
  • To assist our management of partially edentulous
    patients
  • Many classifications have been proposed but
    Kennedy classification is the most widely
    accepted
  • Class II RPD

11
Kennedy classification
  • Was proposed by Dr. Edward Kennedy in 1925
  • Like Bailyn Skinner classification, it
    classifies the partial edentulous arches in a
    manner that suggests principles of design for a
    given situation

12
Kennedy classification
  • He classified the partial edentulous arches into
    four basic classes
  • The other edentulous areas that donot determine
    the class are considered as modification spaces

13
Kennedy classification
  • Class I Bilateral edentulous areas located
    posterior to natural teeth
  • Class II A unilateral edentulous area located
    posterior to remaining natural teeth
  • Class III A unilateral edentulous area with
    natural teeth remaining anterior and posterior to
    it
  • Class IV A single, but bilateral (crossing the
    midline) edentulous area located anterior to
    remaining natural teeth

14
(No Transcript)
15
Applegates Rules for Applying the Kennedy
Classification
  • Rule 1 the classification should follow, not
    precede extractions.
  • Rule 2 if a 3rd molar is missing and not to
    be replaced, its not considered in the
    classification.
  • Rule 3 if a 3rd molar is present and to be
    used as an abutment, its considered in the
    classification.
  • Rule 4 if a 2nd molar is missing and not to
    be replaced, its not considered in the
    classification.

16
Rule 5 the most posterior area always determines
the classification. Rule 6 edentulous areas
other then those determining the classification
are referred to as modifications and are
designated by their numbers. Rule 7 the extent
of the modification is not considered, only the
number of additional edentulous areas. Rule 8
there are no modification areas in a K Class IV.
17
(No Transcript)
18
(No Transcript)
19
What are the Available Options to Manage This?
20
What are the Available Options to Manage This?
21
What are the Available Options to Manage This?
22
Missing Teeth May Be Replaced By One of Three
Prosthesis Types
  1. An implant-supported fixed partial denture
  2. A tooth-supported fixed partial denture (FPD)
  3. A removable partial denture (RPD)
  4. No replacement

23
Alternatives to RPD (Treatment Options)
  • 1. Implant-supported prosthesis most costly,
    closest replacement to natural dentition, less
    costly over long term
  • 2. Fixed partial denture requires abutments at
    opposite ends of edentulous space, more expensive
    than RPD, must grind down abutments, flexes and
    can fail if too long
  • 3. No treatment

24
No Treatment
  • If a patient presents with a long-standing
    edentulous space into which there has been little
    or no drifting or elongation of the adjacent or
    opposing teeth, the question of replacement
    should be left to the patient's wishes.
  • If the patient perceives no functional, occlusal,
    or esthetic impairment, it would be a dubious
    service to place a prosthesis.

25
No Treatment (Shortened Dental Arch)
  • Most patients can function with a shortened
    dental arch (SDA)
  • RPD doesnt usually improve function in shortened
    dental arch cases

26
Shortened Dental Arch
  • Requires anterior teeth 4 occlusal units
    (symmetric loss) or 6 occlusal units (asymmetric
    loss) for acceptable function-
  • Opposing PM 1 unit, opposing molars 2 units

27
Indications of RPD
  • A removable partial denture should be considered
    only when a fixed restoration (either
    tooth-supported or implant-supported) is
    contraindicated

28
Indications of RPD (Span Length)
  • Edentulous spaces greater than two posterior
    teeth, anterior spaces greater than four
    incisors, or spaces that include a canine and two
    other contiguous teeth i.e, central incisor,
    lateral incisor, and canine lateral incisor,
    canine, and first premolar or the canine and
    both premolars.

29
Indications of RPD (Distal Extension Situations)
  • An edentulous space with no distal abutment will
    usually require an RPD, especially when implant
    treatment is not feasible for the patient.

30
Distal Extension Situations
  • To minimize the leverage effect, the pontic
    should be kept as small as possible, more nearly
    representing a premolar than a molar .
  • There should be light occlusal contact with
    absolutely no contact in any excursion.
  • The pontic should possess maximum occlusogingival
    height to ensure a rigid prosthesis.

31
Indications of RPD (After Recent Extractions)
  • Replacement of teeth after recent extractions
    often cannot be accomplished satisfactorily with
    a fixed restoration. When relining will be
    required later or when a fixed restoration using
    natural teeth or implants will be constructed
    later, a temporary RPD can be used.

32
Indications of RPD (Abutment Alignment)
  • Tipped teeth adjoining edentulous spaces and
    prospective abutments with divergent alignments
    may lend themselves more readily to utilization
    as RPD rather than FPD abutments, if implant
    therapy is not amenable.

33
(No Transcript)
34
Indications of RPD (Need for Effect of Bilateral
Stabilization)
  • Periodontally weakened primary abutments may
    serve better in retaining a well designed
    removable partial denture than in bearing the
    load of a fixed partial denture.

35
Avoid Unilateral RPD
36
Indications of RPD (Abutment condition)
  • Teeth with short clinical crowns or teeth that
    are just generally short usually will not be good
    FPD abutments.
  • Unusually sound abutment teeth

37
Indications of RPD (Abutment Condition)
  • An insufficient number of abutments may also be a
    reason for selecting a removable rather than FPD,
    if implant therapy is not amenable.

38
Indications of RPD (Excessive Loss of Residual
Bone)
  • If there has been a severe loss of tissue in the
    edentulous ridge, an RPD can more easily be used
    to restore the space both functionally and
    esthetically.

39
Gingival Reconstruction with FPD
40
Indications of RPD ( Economic Considerations)
  • Economics should not be the sole criterion in
    arriving at a method of treatment.
  • When for economic reasons, complete treatment is
    out of the question and yet replacement of
    missing teeth is indicated, the restorative
    procedures dictated by these considerations must
    be described clearly to the patient as a
    compromise and not representative of the best
    that modern dentistry has to offer.

41
Combination of RPD and FPD
  • Usually, any missing anterior teeth in a
    partially edentulous arch are best replaced by
    means of a fixed restoration. Then, the
    replacement of missing posterior teeth is made
    with an RPD .

42
Combination of RPD and FPD
  • When an edentulous space that is a modification
    of either a Class I or Class II arch exists
    anterior to a lone-standing abutment tooth, the
    splinting of this abutment to the nearest tooth
    by FPD is mandatory.

43
Combination of RPD and FPD
  • Eliminate all but one posterior edentulous space
    per quadrant by using an FPD to simplify the RPD
    design.

44
Removable Partial Denture
  • Dry mouth poor RPD risk
  • Limited patient finances
  • Acceptable oral hygiene
  • Reliable recall candidate
  • Treatment simplification
  • Advanced age
  • Systemic health problems
  • More adaptable to dentition in transition to
    edentulous state

45
Conventional Tooth-Supported FPD
  • Unfavorable attitude toward RPD
  • Patient can't cope with aging, tooth loss
  • Favorable opposing occlusion
  • Periodontally weakened natural dentition may
    permit FPD in less than optimal situations
  • Dry mouth high caries risk
  • Muscular discoordination
  • Mandibular tori
  • Palatal soft tissue lesions
  • Large tongue
  • Exaggerated gag reflex

46
Components of a Typical RPD
  • Major connectors
  • Minor connectors
  • Direct retainers
  • Indirect retainers (if the prosthesis has distal
    extension bases)
  • One or more bases, each supporting one to several
    replacement teeth

47
  • (a) Major Connector The unit of an RPD that
    connects the parts of one side of the dental arch
    to those of the other side.
  • Its principal functions are to provide
    unification and rigidity to the denture.

48
  • (b) Minor Connector
  • A unit of a partial denture that connects other
    components (i.e. direct retainer, indirect
    retainer, denture base, etc.) to the major
    connector.
  • The principle functions of minor connectors are
    to provide unification and rigidity to the
    denture.

49
  • (c) Direct Retainer
  • A unit of a partial denture that provides
    retention against dislodging forces.
  • A direct retainer is commonly called a 'clasp'
    or 'clasp unit' and is composed of
  • four elements, a rest, a retentive arm, a
    reciprocal arm and a minor connector.

50
  • (d) Indirect Retainer
  • A unit of a Class I or II partial denture that
    prevents or resists movement or rotation of the
    base(s) away from the residual ridge.
  • The indirect retainer
  • is usually composed of one component, a rest.

51
  • (e) Denture Base
  • The unit of a partial denture that covers the
    residual ridges and supports the denture teeth.

52
References
  • McCrackens Removable Prosthodontics, 11th
    Edition 2005 by McGivney GP, Carr AB. Chapter 2
    and 3
  • McCrackens Removable Prosthodontics, 11th
    Edition 2005 by McGivney GP, Carr AB. Chapter 12
    Diagnosis and Treatment Planning P 215-220
About PowerShow.com