AssisProfRadhwan Himmadi Hasan 1 Reasons for tooth loss Traumatic injuries Caries Periodontal diseases Cysts malignancies and tumors Radiation therapy for tumors Grossly malaligned teeth ID: 1046769
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1. INTRODUCTION & CLASSIFICATION OF REMOVABLE PARTIAL DENTURE Assis.Prof.Radhwan Himmadi Hasan1
2. Reasons for tooth lossTraumatic injuriesCariesPeriodontal diseasesCysts, malignancies and tumorsRadiation therapy for tumorsGrossly malaligned teethIatrogenic extractionCongenitally missing teethFailure to erupt (impacted teeth)2
3. Sequelae of tooth lossResorption: The socket gradually remodels until it assumes the shape of the rounded edentulous ridge.TiltingDriftingOcclusal disharmony leads to discomfort, pain, or damage to temporomandibular joints.3
4. Partial DentureA 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.4
5. 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 RPD5
6. 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.6
7. TERMENOLOGY:Retention: Resistance to removal from the tissues or teethStability: Resistance to movement in a horizontal direction (anterior-posteriorly or medio-laterallySupport: Resistance to movement towards the tissues or teeth7
8. Abutment: A tooth that supports a partial denture.Retainer: A component of a partial denture that provides both retention and support for the partial denture8
9. Indications for RPDLength of edentulous: RPD preferred for longer edentulous arches. Abutment tooth: When there is no tooth posterior to the edentulous space to act as an abutment, a RPD is preferred.9
10. Periodontal support of remaining teeth: When it is poor, RPD is preferred because it requires less support from the abutment teeth.Cross arch stabilization: When a remaining teeth have to be stabilized against lateral and anterior-posterior forces, a RPD is indicated.10
11. Excessive bone loss: In RPD, the artificial tooth can be positioned as per the operators preferences and the denture base can be fabricated to provide required support and aesthetics.Aesthetics: RPD provide better aesthetics because the denture base gives the appearance of a natural tooth arising from the gingiva.11
12. Immediate tooth replacement after extractionEmotional problems: The appointment for removable partial denture is shorter and less demanding to patient.Patient desires: Patient insist on RPD over FPD for the following reasons:To avoid operative procedures on normal tooth.For economic reasons.12
13. RPD is generally preferred in the following conditions:When more than 2 posterior teeth or 4 anterior teeth are missing.If the canine & two of its adjacent teeth are missing.When there is no distaal abutment tooth.Presence of multiple edentulous spaces.If the teeth adjacent to edentulous spaces are tipped ,they cannot be used as an abutment for a fixed prosthesis.If periodontally weakened teeth are present near the edentulous spaces.13
14. Teeth with short clinical crowns.Insufficient number of abutmentsSevere loss of tissue on the edentulous space.Old patientsAssis.Prof.Radhwan Himmadi Hasan14
15. Requirements of an acceptable method of classification .It should permit immediate visualization of the type of partially edentulous arch that is being considered.It should permit immediate differentiation b/w the tooth supported & the tooth and tissue supported RPD.It should be universally acceptable.15
16. Kennedy’s classification Class I: bilateral edentulous areas located posterior to the remaining natural teeth. 16Class II: unilateral edentulous areas located posterior to the remaining natural teeth.
17. Class III: unilateral edentulous area with natural teeth anterior and posterior to it, i.e. this indicates a single edentulous area which doesn’t cross the midline of the arch, with teeth present on both sides of it.17
18. Class IV: single, bilateral edentulous area located anterior to the remaining natural teeth. This is a single edent. area, which crosses the midline of the arch, with remaining teeth present only posterior to it.18
19. Applegate’s rulesRule 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 is not to be replaced, it is not considered in the classification. 19
20. Rule 5: the most posterior edentulous area or areas always determine the classification.Rule 6: edentulous areas other than those, which determine the classification, are referred to as modification spaces and are designated by their no:Rule 7: the extend of the modification is not considered, only the no: of edentulous areas, i.e. the no: of teeth missing in the modification spaces is not considered only the no: of additional edentulous spaces are considered. Rule 8: there can be no modification areas in class IV. Because any additional edentulous space will definitely be posterior to it and will determine the classification.20
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23. Missing Teeth May Be Replaced By One of Three Prosthesis Types: *An implant-supported fixed partial dentureA tooth-supported fixed partial denture (FPD) A removable partial denture (RPD)No replacement23
24. Alternatives to RPD (Treatment Options)Implant-supported prosthesis – most costly, closest replacement to natural dentition, less costly over long term2. 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 long3. No treatment24
25. No Treatment (Shortened Dental Arch)Most patients can function with a shortened dental arch (SDA)RPD doesn’t usually improve function in shortened dental arch cases25
26. Shortened Dental ArchRequires anterior teeth + 4 occlusal units (symmetric loss) or (asymmetric loss) for acceptable function-26
27. 27This type of prosthesis does not benefit from cross-arch stabilization and places excessive stress on abutment teeth.
28. 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 .* 28This is done to simplify the RPD design . There are exceptions. Sometimes a better esthetic result is obtainable when the anterior replacements are supplied by the removable partial denture when excessive tissue and bone resorption exists
29. Components of a Typical RPDMajor connectors Minor connectorsDirect retainersIndirect retainers (if the prosthesis has distal extension bases)One or more bases, each supporting one to several replacement teeth 29