This lecture is something like a piece of cake and above it there is a layer of

.chocolate with pieces of fruits, and beside it there is a cup of tea, so enjoy eating it

I tried to be very specific in writing and transferring this lecture to you and I added
(anything in the slides not mentioned by doctor with small font (font 12

:Some infection control notes

Anyone who forgot to sign he is absent, it`s your responsibility•
.to sign your name
The doctor was very very upset regarding our infection control in the•
.clinic
Starting from the next semester the doctor will order the supporting•
staff to check our infection control policies , and if he see someone
touching something clean with his contaminated gloves he should fail
that stage , so if you are doing jaw registration you will get zero if
you get wax knife from other colleague , it`s your own wax knife that
has been disinfected before you use it on your patient , do not use wax
knifes or carvers from your other colleague , but if you forgot yours
and you want to use your colleague one, it has to be disinfected before
.you use it on your patient
Also handpieces and burs: don’t leave your clinic and go to other one•
and just grip the handpiece and start trimming, that patient in the
other clinic might have hepatitis B or hepatitis C and you are just
.transferring the disease to your patient
!!!!!!!Indelible pencils: four or five use the same indelible pencil•
Indelible pencil is touching mucosa and saliva so it should be also
.disinfected
If you go to the mini lap and you do trimming on the wheel, do not ever•
put your denture immediately on the wheel, there is a disinfecting
solution just beside the wheel where you leave your complete denture,
special trays, your record blocks, for four or five minutes then you
clean it under water and then you use the wheel, also don't take your
.dirty gloves from your clinic to the mini lap
The doctor said answering one of the students that he teaches us the•
correct things and he want us to do the correct things, and not to do
the mistakes that others are doing, he don’t want us to be careless as
others are, he want to raise our level so that to know how exactly how
.infection control policies are applied in prosthodontic clinics
 It`s not a good idea to be sewed in the court for transmitting hepatitis•
B or C to your patient, no one else will come to your clinic anymore, it
.did happen in Irbid and dentist did transfer hepatitis B to their patients
Do not wear gloves outside your clinic, if you want to go outside the•
clinic to grip something you should take your two gloves off, but as you
have an assistant you don’t need to go out and your colleague who did
not touch anything- only adjusting light or chair for you-should go and
. bring you what you want

.Now we will start our lecture today

"Acrylic partial dentures"

Some of you are doing acrylic partial dentures at the moment, it’s a
.little bit different from using cobalt chromium partial dentures

In between 2000-2001 the cost of metallic framework partial dentures

in England was about 13 million pounds, but for acrylic partial dentures
it`s about 41 million pounds, which means that in England they are
doing a lot more acrylic partial dentures, than cobalt chromium
.partial dentures

In our practice here in Jordan we are doing a lot more acrylic

.partial dentures

Now in the USA acrylic partial dentures are just interim for less than a
year, so the patient has to wear it for less than a year, however if the
patient is going to wear the acrylic denture for a longer period of time
-which actually shouldn’t be- the partial denture should not cause more
damage to the tissues than it would be if the patient is not wearing
.acrylic denture

There are several types of transitional partial dentures-the doctor thinks

:that doctor zead told us about them-and they are

Interim: it`s indicated when the age, health and time precludes a
more definitive treatment (cobalt chromium partial denture) so we
can`t make it because of the age of the patient, or we can`t give the
.patient a fixed prosthesis because of his age
for example: young patients with large pulps are missing central•
incisors, we can`t prepare the adjacent centrals and the laterals
 because the patient is young (just 15 years old) and the pulp
chamber is huge, so when you do the preparation you will end up
with pulp exposure, so we just give the patient an interim partial
denture so that it will support the patient for few years, it`s not only
for just a minimal time it's going to be a few years until the patient is
.old enough that we can start our treatment

or might give the patient an implant to replace the missing tooth, but
because the patient is growing we can`t put an implant in a growing
patient because the implant will stay in its place and the bone will
continue to grow, so if you place it here (in a place of central incisor for
ex.) and the patient continues growth we will find that the entire occlusal
plane has gone upward (dr said downward) and the implant stayed in its place,
.it will look really ugly as if it`s an infraoccluded deciduous tooth

The doctor answered one of the students that we start implants for
males at the age of 17 and at the age of 16 for females –this is the
.absolute minimum- but it`s preferred to wait until early twenties

Elderly whose health contraindicates lengthy appointments: patients•

who can`t come for a long appointment we should consider them
acrylic partial dentures because it needs minimal time and numbers
.of appointments
Transitional partial dentures: what do we mean by transition
is something that will transfer us from one stage to another stage,
the patient is (‫ )أمر حتمي‬when the loss of additional teeth is inevitable
going to lose his remaining teeth, but the prosthesis is needed for an
extended period of time until the patient loses his teeth, so every time
he loses a tooth we add a tooth to the partial denture and this is what
.we call transitional partial denture
Elderly patients suffering from debilitating disease who can`t•
undergo multiple extractions in one go which can affect their
health, then we might give them a transitional partial denture to
cover every tooth that we extract so if we extract a tooth we will
.have a tooth in its place
Or a patients who psychologically can`t accept losing their teeth at•
one go and they don’t won`t to be edentulous from the first, and
they want to go gradually to the edentulous state, we give them a
.transitional partial denture
 Treatment transitional partial dentures: they carry a
treatment material, for example: soft tissue or conditioner soft liners,
tissue conditioners, matrix for soft tissue healing, until we enhance the
health of the underlying mucosa in order to fabricate a new partial
.denture or complete denture

The general indications for acrylic partial

:dentures
If there is a time after extraction where bone resorption is going to
be rapid and the patient wants to have something immediately we
give them acrylic partial denture that we can reline easily and
adjust easily and once the resorption has happened we can move in
to a more permanent solution for example immediate denture replacing
.anterior teeth
When the remaining teeth have a poor prognosis and their extraction
and subsequent addition is anticipated this is when we can also use
acrylic partial dentures, a transitional denture maybe fitted under such
circumstances so that the few remaining teeth can stabilize the prosthesis for a
limited period while the patient develops the neuromuscular skills to successfully
.control a replacement complete denture

When we want to use them as a diagnostic procedure (or interim): we

want to increase the vertical dimension using the acrylic partial
denture to check the current vertical dimension if it`s acceptable to
the patient or that we need to increase or decrease it for the patient or
the patient can adapt to the new vertical dimension that we have
.changed to him
Finally when the denture must be provided for young patients whose
jaws are still growing, and the development of the dentition is
.proceeding

The advantages and disadvantages of acrylic partial

:dentures
acrylic partial dentures are cheap, easy to construct and easy to
modify (relining, adding teeth ….so it`s easy to add acrylic to acrylic) -in
the slides it`s written relatively easy to construct- even if clasp fractured it`s
not a big deal you can solve that by putting the acrylic partial denture in
the patient mouth and taking the impression on top of it, send it to the
 lap and the lap will just remove the broken clasp and will add a new one
.easily

:But the disadvantages are

Weak material: it can break easily and if the patient drops them on
.the ground it can fracture easily
It`s non- rigid: it deforms under occlusal load, and if a material
deforms under occlusal load this means that the load is not transmitted
evenly to the entire surface area underneath the partial denture,
because it`s flexing in one area so the load will be more on one area
than other areas, not like cobalt chromium which is rigid and the load
.is transmitted to the entire base
Must be bulky to be strong: if it`s not bulky it won't be strong and if
it`s bulky the patient will be annoyed because the patients don’t like
.bulky things in their mouths
High potential of damage to soft tissues: with the increased
potential of plaque accumulation and periodontal breakdown, because
it`s acrylic it`s porous so increases the chances of accumulation of
plaque, bacteria, candida, therefore what will happen is that we will
end up with more pathogens present near the gingival crevice and
gingival sulcus that can lead to periodontal pocketing and periodontal
break down and gingival recession -remember acrylic partial dentures
have a very nice name which is gingival gum strippers- and the
.doctor will show us a case later on

Now the others are related to the partial dentures in

:general
Damage to the mouths from the removable partial dentures in
.(general (cobalt chromium and acrylic

Plaque and oral hygiene are going to be influenced by the presence

of the partial dentures (doctor mentioned cobalt chromium here) so there
.will be six times more plaque accumulation than fixed prosthesis
 Coverage of the marginal gingiva by parts of the removable
partial dentures: whenever you cover the marginal gingiva you will
always have an increased chance for gingival inflammation and
.damage to the gingival margins
Occlusal forces that are transmitted to the remaining teeth
and their periodontal tissues by the prosthesis: there will be an
increased load on the abutment teeth definitely when we use
.removable partial dentures
However a four year longitudinal study of dentogingivally supported
dentures (dentaly and gingivally) indicated that plaque control
was the most important factor that reduces the occurrence of
periodontal breakdown, so if we control plaque there is a high
chance that the denture will not cause as much damage (remember
that whenever a periodontal disease has started, occusal forces and
other modification factors might induce more damage, they might
not initiate perio problems but they are the propagating
.(factors

So initiation is always bacteria, that’s the initiating factor but they can
be the propagating factors from the acrylic or cobalt chromium partial
.dentures

:Potential causes of damage by acrylic dentures

:Potential damage by acrylic dentures could happen by

Physical stripping of the gingiva: physical stripping, occlusal forces

on the gingival margin adjacent to a tooth where there is no rest so
.there will be continuous pressure

Look to the gum in the picture -page 4 upper slide, I (muntaser) know that
you can`t see anything - where these are the teeth and that’s the partial
denture and you can see what happened is that the gum strippers just
strips and removes or terminates the gingiva and moves it apically from
.the tooth and this is why we call them gum strippers

Damage from lateral forces: we don’t have a very good stabilization

and reciprocation and bracing from acrylic partial dentures if they do
 not engage on the ligual side, plus because they are not rigid
.enough to distribute the load for a large number of teeth
Interdental wedges: if we have an acrylic partial denture that goes
in to the interdental area, it can wedge the food particles between the
teeth and keep it there and can lead to impaction and when lateral
movements happen it can act like a wedge between the teeth and
.increase the damage

The doctor answered one of the students that in addition to the gum
stripping and resection under heavy occlusal areas there will be
resorption of the underlying bone, and if we identify the problem
.early we can modify the prosthesis

Plaque accumulation and formation on teeth is also increased

.when we use acrylic partial dentures

Now let's have a look at design principles for good

:acrylic partial dentures
The same principles that applied for cobalt chromium we will try to
apply them for acrylic partial dentures, so that you will understand the
:idea of how to make a partial denture that act really good

.(All casts should be surveyed (will be discussed after a while

the first thing to talk about is the saddle areas: when we make an
acrylic partial denture, if we have a free end saddle we should have
maximum coverage of the distal extension because it's extremely
important in acrylic partial dentures that we cover as much as we
can from the palate and as much as we can from the distal extension
sites because this will distribute the forces to a large surface area
and reduce concentration of forces and reduce the possibility of bone
.resorption

Bounded saddle areas on the other hands, we might not even

use a flange, we just use the denture tooth we call it a gum fit
denture tooth rather than having a flange on the labial surface, if we
have a flange there is always a higher chance of inducing bone resorption
.of the buccal or labial plate especially in the anterior region

If you have a missing one tooth and there is no bone loss if you follow
the gum level between the central, lateral and you have a missing upper
central for example and the gum level of the missing upper central on the
 other side (existing central) is at the same level of the ridge then do not
?put a flange and just use a gum fit acrylic partial denture, why

Because this will reduce the chances of resorbing the labial alveolar
.plate

:Support
extend the acrylic above the survey line: which means that•
every single time we want to do an acrylic partial denture we
should survey the cast as if we are doing that for cobalt
chromium partial denture, and why is that? Because if it`s below
the survey line we will end up with slight support from the
.teeth
Relieve by blocking out of the dentogingival junction: we •
should always relief them although this is controversial, it
has been found that deterioration of the gingival margin will happen
regardless if we have a relief or not because the small amount of
relief that we put on the gingival margin will create a space on the
final denture, so the gingival margin will enlarge to fill the space –
soft tissues always enlarge to fill small spaces – and once they
enlarge you will establish again contact between the gingival margin
.and the partial denture

So it's controversial but we prefer to relief it just for that to feel a

.lot safer when we relief the gingival margin

The doctor answered one of the students that, when we relief for
cobalt chromium it's not only to protect the gingival margin but also
because we don’t won`t to go in to undercuts, because if we go in to an
undercut we won`t be able to fit the cobalt chromium partial denture
.((sorry the question not clear and I couldn`t anticipate it

Retention: we can use wrought wire clasps, to have a C clasp for

example, or there are what we call ball clasps-have you ever seen it?-
they are really nice and the doctor like them, they are just a wire
with a ball at the end, so just you put them between the teeth if you
don’t have undercuts on the buccal surface so you just go and engage
the embrasure area, because it’s a ball it will engage in to the buccal
.side, so these are the easy and simple clasps
 If you go and do them they don’t need a good manual dexterity, you
just only need to be able to bend them to go in to the undercut from the
.buccal side

The doctor doesn't know if they are present in Jordan but he used
.them in Australia

Bracing and reciprocation: we should also add bracing and

reciprocation, so we should cover the ridge as much as we can, vertical
components and extend as much on the lingual side of the teeth to
.prevent lateral displacement of the prosthesis
Connecter should be rigid enough, wide enough and thick enough to
.avoid being deformed under occlusal load

Indirect retention: a sort of indirect retention not a true indirect

retention, we should look for that in free end saddle cases and make
sure that we have a clasp between the free end saddle and the
anterior component of your partial denture, so the part that is
extending anterior to the clasp will act as an indirect retainer, for
example in the maxilla if you have a clasp on an upper fours and a free
end saddle posteriorly, the acrylic component that extends anterior to
the clasp and touches the rouge area or goes on to the anterior teeth
.(will act as an indirect retainer (sort of indirect retainer
.Then you should review the entire complete design
.Wherever possible avoid covering the gingival margins
If you have acrylic try to cover above the survey line to get more
.support from the underlying teeth
Oral hygiene is really really important, for example: this is a
partial denture if you want to make it healthier to the remaining
dentition we should clear the gingival margin by about 3-4 mm from
the remaining teeth that we do not engage, like it engages here (I(mun)
think on the abutment but as you see the pictures are not clear (page 5 upper slide)) but it
leaves these teeth away (I(mun) think the other teeth which are not engaged) so that
.we do not cause any damage to the gingival margin

Some of the most common problems that you encounter in the clinic -
and the doctor have seen it with a lot of students before us- so we should
:know these things and tell our technicians not to do them
 Block all undercuts that are below the survey line and that
are not going to be used for retention of your clasps (pleaaaase
block them) and do not allow the acrylic to go to in that place, and if it
goes there you will have to trim it and once you start trimming you will
not be able to till when to stop because you are doing it haphazardly and
you can`t tell if it's enough or too much.(if I were the dr I will put the title of this lecture block out
(the undercuts because he mentioned that thousands of times

So block all these undercuts existed, proximally plus buccally and

ligually, buccally we need them for the retention of the clasps, ligually we
need to block them to prevent the acrylic from engaging there and
making it difficult to insert, however sometimes we try to utilize
those lingual undercuts plus the embrasure areas for the
mechanical retention from acrylic, for example: if we don’t won`t to put a
clasp on the anterior region we will decide to engage some of these
undercuts, and if you decide to engage these undercuts make sure that
it's not more than 0.25mm, so that you only engage about 0.25mm
and it depends on the flexibility of the acrylic to go in to these
.undercuts

For example in the picture on (page 5 lower slide) in this case the
technician forgot to block all these areas and what we ended up with is a
partial denture that will never go in its place because all what we need to
do is just to cut the lateral incisors from the cervical areas, cut the clasp
.because the clasp connecting arm is always go in to the contact area

Always adhere to the following points whenever making

:a wrought wire clasp
Whenever making a wrought wire clasp, it's important to memorize
:when you see the wire work of your technician

.Use a gauge 20 about 0.8mm wire

Clasp tip should always be directed occlusaly and not gingivally so
.that it doesn’t damage the gingival margin
?It should be away 1mm from the gingival margin but, why

A: because the gingiva is compressible and we use basically tissue

supported prosthesis, and if I place the clasp very close to the gingival
.margin, under occlusal load it will be digging in to the gingival margin
 Always start from the tip to adapt the clasp on the tooth
surface, and to adapt the clasp on the tooth surface use the least
number of bends as possible because the more bends you make the
.less flexible the clasp becomes
Make the clasp adapt to the tooth surface without creating a
.space
Whenever crossing the proximal surface adjacent to a saddle area the
clasp should not cross in the undercuts or be located at the
:contact area close to the marginal ridge

So if the clasp arm goes in to the proximal side, do not put the clasp
.in to the undercut

Lower slide page number 6: these are the three different forms of
clasps, this is the correct shape (left one), and this is a space that is
present because the clasp is either going in to the undercut from the
starting point, or you did not have good adaptation, so this will lead to
food accumulation (middle one), and this clasp (right one) is not even
.engaging the undercut so it's useless

Upper slide page number 7: this is the correct C shape clasp

(upper left) directed occlusaly and the height is below the contact
point, and beside it is the correct shape of the half T wrought wire clasp,
then the lower left picture here it's too close to the gingival margin, and
.the picture next to it the clasp arm is too high proximally

Lower slide page 7: if we take a cross section and we look at the

connecter arm of the clasp, once it leaves the labial surface and goes in
to the proximal side, the clasp should not be in the undercut, because if
it's in the undercut there (proximally) when you try to insert the partial
denture what will happen is that it will not go in, so you will get your bur
trying to remove from the proximal side of the denture to seat it, you will
trim and trim until you will find that you no longer have acrylic and what
you will end up with is your clasp, and you will continue trimming until
you cut the clasp, then the whole clasp that you were aiming on for
retention is going to be cut away because it was in the undercut and they
did not block it out before, so you need to block out then put your
clasp away from the block out area so that it is (the clasp) is
 surrounded by acrylic, and that’s why it's here (in this slide labeled
.correct) is correct, or a little bit more toward the tooth will be acceptable

Do not put it on the contact point between the artificial and

.natural tooth, so it should be below the contact point

Khaseb asked: can we place the clasp inside the proximal undercut and
?change the path of insertion

Dr: no, if you changed the path of insertion, you will need to block it out
.and duplicate the cast

Khaseb: what about inserting it from the side that have undercut and the
?other side will enter passively

Dr: no, you need to plan the path of insertion, and to be able to do that
you need to have a path of insertion, if it's not in the path of insertion if
it's an undercut in the path of insertion you will need to cut it so be
.careful

:Every design
There is a design called every design, it has been reported in the
literature, it’s a nice design although the bracing component is
not that good with this design, it depends on having at least 3mm
.space from the gingival margins
There should be a point contact between the artificial teeth and
abutment teeth to reduce the lateral stresses to the teeth to the
.minimum
It has posterior wire stops -in the picture upper slide page 8- to prevent the
posterior teeth from posterior (distal) drifting with consequent opening of
.the contact points, but they can be for additional retention postriorly
Flanges are included to assist the bracing of the denture, but these
are minimal flanges and lateral stresses are reduced by achieving as
much balanced occlusion or articulation as possible, or by relying
on guidance from the remaining natural teeth to disclude the
teeth on excursion, so basically put them out of lateral excursion
forces, so no lateral excursion forces and no contact on lateral
excursion forces, just slight centric stops with no contacts on lateral
excursion, but if it's going to be a large number of teeth then you
.will use a balanced occlusion procedure

:Spoon shape partial dentures

 It’s a design that you might utilize to restore only one or two missing
.anterior teeth
Look at this design –page 8 lower slide-: they have just extended the
acrylic on the palatal surface of the premolar and the central incisor to
engage like a rest to prevent stripping of the gum on the mesial side of
.the natural tooth of the central incisor and the canine
There should be a beading line to depend on adhesion and
cohesion forces; however you might need to modify such designs in
.order to gain more retention
The problem with spoon shape partial dentures is that if it's not very
retentive the patient might swallow it, and if they swallow it you will
.not be able to find it because the acrylic is radiolucent
The doctor don’t like them because he think that they are not very
retentive, so he always like to extend the spoon shape to get some
retention from the teeth, like in -lower slide page 8 right picture- are
engaging the lingual side of posterior teeth so by that we get more
.retention from adjacent teeth
I might change the shape to be adjacent to the premolar area; I don’t
.need to go all the way back, that is also another possibility
.Spoon shape dentures don’t have clasps

This is the last figure I want to show you today, whenever you do your
.trimming try to avoid your clasp

If you tried to adjust the occlusion with your bur, at the clasp area you
will end up of damaging the clasp and it will break, the patient might
swallow this wire and this is too dangerous, because it is sharp and can
.perforate the jejunum or ileum or whatever

The end
Very special thanks for every single one in this dofa`a, especially for those who
sacrifice their time trying to make the study easier for us and we always wait for more
and Very special thanks to abu 3oday for printing the last 1/4 of the last page of this
. lecture

Do not ever forget about our brothers in ghazza may god bless them all

Done by: muntaser ghassan toffaha