Arabella Yelland Damage that may result from poor design Plaque accumulation decalcification periodontal issues Direct trauma from components abrasionfracture of teethrestorations inflammation of gingival tissues ID: 916021
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Slide1
Removeable partial denture design
Arabella
Yelland
Slide2Damage that may result from poor design
Plaque accumulation (decalcification, periodontal issues)
Direct trauma from components (abrasion/fracture of teeth/restorations; inflammation of gingival tissues)
Transmission of excessive
occlusal
forces (tooth mobility/aggravation of existing periodontal disease)
Occlusal
error (tooth mobility/aggravation of existing periodontal disease)
And inflammation to edentulous areas/
resorption
of bone
Slide3Assessment of existing teeth
Recent
periapical
view to assess bone levels and
periapical
status
Are teeth
restoreable
?
Patient medical history
Likelihood of losing more teeth
Periodontal condition
Slide4Kennedy classification
Slide5Slide6Slide7Slide8Slide9Modification of teeth?
Rest seats
Undercuts
Guide surfaces
Milled parallel surfaces
Slide10Rest seats
Slide11Guide surfaces
Slide12“Six core elements”
1. teeth to be replaced
2. support
3 rigid major connector
4. retention
5. anti-rotation/indirect retention
6. reciprocation/bracing
Slide13Teeth to be replaced
Do all missing teeth need to be replaced?
Slide14Support
From teeth
From soft tissues
Slide15Rigid major Connector
May also provide support
Must not flex
Incorporate hygienic design
Slide16Retention
Direct – usually clasps
Indirect – opposing rotation is obtained anterior to the rotational axis
Slide17Indirect retention
Slide18Davenport’s rules for clasps
A clasp should always be supported by a rest.
A molar ring clasp should have occlusal rests mesially and distally.
A molar ring clasp, which engages lingual undercut, should have a buccal strengthening arm.
Retentive clasps can be used to provide indirect support for a distal extension saddle by being placed on the opposite side of the support axis from the saddle.
A wrought wire clasp should be attached to a saddle, not to exposed parts of the metal framework.
An occlusally-approaching clasp should not approach closer than 1 mm to the gingival margin.
A retentive occlusally-approaching clasp should run from the side of the tooth with the least undercut to the side with the greatest undercut.
Slide19Occlusally-approaching retentive clasps should have the terminal third of the retentive arm entering the undercut.
A retentive clasp should engage 0.25 mm of undercut if it is constructed in cast cobalt-chromium alloy.
If an undercut on a tooth that needs to be clasped for retention is less than 0.25 mm, then composite resin should be added to the tooth to create at least this amount of undercut.
A retentive clasp should be at least 15 mm in length if it is constructed in cast cobalt-chromium alloy.
Occlusally-approaching retentive clasps should be restricted to molar teeth if constructed in cast cobalt chromium alloy.
A retentive clasp should engage 0.5 mm of undercut if it is constructed in wrought wire.
A retentive clasp should be at least 7 mm in length if it is constructed in wrought wire.
If an occlusally-approaching retentive clasp is used on a premolar or canine it should be constructed in wrought wire.
Slide20Retentive clasps should usually be placed buccally on upper teeth.
Retentive clasps should usually be placed lingually on lower molars.
Retentive clasps should usually be placed buccally on lower premolar or canine teeth.
Where there are clasps on opposite sides of the arch, the retentive arms are best placed on opposing tooth surfaces ie buccal/buccal or lingual/lingual.
Retentive and bracing/reciprocating elements of a clasp should encircle the tooth by more than 180 degrees.
Reciprocation should be provided on a clasped tooth diametrically opposite the retentive clasp tip.
If a reciprocating clasp, rather than a plate, is used it should be placed at the gingival end of a guide surface on the clasped tooth.
Where a plate connector is used, reciprocation can be obtained by a guide plate on the connector.
Slide21Gingivally-approaching clasps are contra-indicated if the buccal sulcus is less than 4 mm in depth.
Gingivally-approaching clasps are contra-indicated if there is a tissue undercut buccally on the alveolus more than 1mm in depth and within 3 mm of the gingival margin.
A gingivally-approaching clasp should be used if a retentive cast cobalt chromium clasp is required on a premolar or canine tooth, assuming that sulcus anatomy is favourable.
The RPI system (rest, plate, I-bar clasp) should be used on premolar abutment teeth for mandibular distal extension saddles if the tooth and buccal sulcus anatomy is favourable.
The RPI system (rest, plate, I-bar clasp) should be used on premolar abutment teeth for maxillary distal extension saddles if the tooth and buccal sulcus anatomy is favourable.
A distal extension saddle should have a retentive I-bar clasp whose tip contacts the most prominent part of the buccal surface of the abutment tooth mesio-distally.
If the retentive clasp for a distal extension saddle is on a premolar or canine abutment, it should be either a cast gingivally-approaching I-bar or a wrought wire occlusally-approaching clasp.
Slide22RPI system
Slide23A distal extension saddle should have a retentive clasp on the abutment tooth.
A unilateral distal extension saddle denture (Kennedy II) should have one clasp as close to the saddle as possible and the other as far posteriorly as possible on the other side of the arch.
Bounded saddles should have a clasp at least at one end.
A Kennedy III modification 1 denture should have 2 retentive clasps forming a diagonal clasp axis which bisects the denture.
A Kennedy IV denture should have retentive clasps on the first molars if there is suitable undercut present.
Slide24Reciprocation
Prevents tooth movement when clasps is activated
Slide25Bracing
Slide26Connectors
Plate
Horseshoe/anterior bar
Ring
Mid palatal bar
(posterior bar)
Slide27Lower connectors
Lingual bar – requires >7mm between
gingival margin
and functional
sulcus
depth
Sublingual bar
Plate
Dental bar/
kennedy
bar/continuous clasp (need crowns at least 12mm in height)
(labial bar)
Slide28References
BDJ JC Davenport series 2000-2001 (also available as BDJ Clinical Guide
to Removable
Partial
Denture Design)
Revisiting the principles of partial denture design, C. Stilwell, Dental Update 2010, 682-690
Successful removable partial dentures, C. Lynch, Dental Update 2012, 118-126