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DIAGNOSIS, TREATMENT PLANNING,

DESIGN, TREATMENT SEQUENCING


AND MOUTH PREPARATION
! Study cast surveyor
! Diagnosis
! Guiding and verify the appropriate tooth preparation

! Mouth preparation goal


! Support
REMOVABLE PARTIAL ! Stabilization
DENTURE ! Retention
! Harmonious occlusion

CHATCHAI KUNAVISARUT
CHANITA SUPA-AMORNKUL

DIAGNOSIS, TREATMENT PLANNING, DIAGNOSIS, TREATMENT PLANNING,


DESIGN, TREATMENT SEQUENCING DESIGN, TREATMENT SEQUENCING
AND MOUTH PREPARATION AND MOUTH PREPARATION
! Mouth preparation sequence ! Take impression with alginate for ascertain the
! Proximal tooth surfaces contour of abutment
! Parallel to guiding plane ! Take another impression for master cast
! Occlusal rest seats ! Master cast
! Direct occlusal force along the long axis
! Survey
! Spoon shape
! Draw RPD framework design
! Retentive area
! Tripoding
! Resist dislodging force
! Reciprocal area

KENNEDY’S CLASSIFICATION

CLASSIFICATION OF
PARTIALLY EDENTULOUS
ARCHES
APPLEGATE’S RULE APPLYING THE
KENNEDY CLASSIFICATION

COMPONENT OF PARTIAL
DENTURE DESIGN

MAJOR CONNECTOR
! Join the components on one side of the arch with
those on the other side
! Rigidity " Distribution force

! Not impingement subgingival

MAJOR CONNECTOR

BORDER OF MAJOR CONNECTOR


! Design
! Symmetrical
! Cross midline at right angle
! Avoid torus
! Smooth and round contour
! Self cleansing
PALATAL BAR
MAXILLARY MAJOR CONNECTOR
! Palatal bar Narrow half oval with thickest point at the middle
! Palatal strap
Interim application
! Anteroposterior palatal bar

! Horseshoe Uncomfortable
! Anteroposterior palatal strap

! Complete palate Little vertical support

All support derive from remaining teeth

Short span class III

Should not place anterior to second molar

PALATAL STRAP ANTEROPOSTERIOR PALATAL BAR

Anterior bar = Palatal strap Posterior bar = Palatal bar

Wide – thin band of metal Join two bar with flat longitudinal element

At least 8 mm. wide Rigidity

Little interfere tongue Minimized soft tissue coverage

Patient accept Uncomfortable

Resistance to bending and twisting force Little support from palate

Distribute stress Not the first choice

Patient may complain of palatal coverage Support is not major consideration

Widely separate abutment

HORSESHOE CONNECTOR ANTEROPOSTERIOR PALATAL STRAP

Thin metal band running along the lingual surface of remaining teeth
and extending (6-8 mm.) on to the palatal tissue
Indicated when replace numerous teeth or present of palatine torus
Symmetry
Extensive length of border may irritation to tongue
Replaced several anterior teeth
Open area in palatal region at least 20x15 mm.
Prominent median palatal suture line
Good support from palate
Inoperable torus
Resistance to flexure
Tendency to flex or deform
Uncomfortable
Not good for cross arch stabilization

More rigid connector cannot be used


COMPLETE PALATE
INDICATION OF MAXILLARY MAJOR
Ultimate rigidity and support
CONNECTOR
Condition Major connector
Posterior border extend to hard and soft palate junction
Weak periodontal support of -Wide palatal strap
remaining teeth -Complete palate
Anterior border cover cingular of anterior teeth
Adequate periodontal support of -Palatal strap
Greatest amount of tissue coverage remaining teeth -Ant.-post. palatal bar
Long span distal extension -Ant.-post. palatal strap
Replaced all posterior teeth
-Complete palate
Replaced anterior teeth -Ant.-post. palatal strap
Periodontal compromised
-Complete palate
Distribution force to remaining teeth and tissue -Horseshoe

Stabilization

Extensive tissue coverage

MANDIBULAR MAJOR CONNECTOR


Condition Major connector ! Lingual bar
Torus present -Ant.-post. Palatal strap ! Lingual plate
-Ant. -post. Palatal bar
! Double lingual bar
-Horseshoe
! Labial bar

•Very sparing use horseshoe connector


•Palatal bar is rarely indicated

LINGUAL PLATE
LINGUAL BAR

Half pear shape and thin piece of metal

Indicate for all tooth support unless insufficient space Scallop appearance

At least 8 mm. between gin. margin and floor of mouth Always support by rests

Minimum contact with teeth and soft tissue Insufficient vertical space for lingual bar

Half pear shape Splinting

Existing of mandibular tori


Simplicity
Exceptional rigidity
Decrease plaque accumulate
More comfortable than lingual bar
Need extreme care for design and construction
Extensive coverage
DOUBLE LINGUAL BAR

Characteristics of both lingual bar and plate

Join 2 bars with rigid minor connector

Contact with remaining anterior teeth indicated

Marginal gingival receives natural stimulation

Horizontal stabilization

Tendency to trap debris

Not comfortable

LABIAL BAR
MANDIBULAR MAJOR CONNECTOR
Run across the mucosa on facial surface Condition Mandibular major connector
Tooth support Lingual bar
Indicated in the presence of a gross uncorrectable interference
-Insufficient space Lingual plate
Half pear shape -Inoperative torus
-High lingual frenum attachment
Swing-lock -Reduced periodontal support in -Modified lingual plate
anterior teeth (step back design)
Tipped remaining mandibular teeth -Large interproximal space -Double lingual bar

Poor patient acceptance

Distort lower lip

Discomfort

Condition Mandibular major connector


Replace all posterior teeth Lingual plate

• Labial bar is rarely indicated


MINOR CONNECTOR
MINOR CONNECTOR TYPE OF MINOR CONNECTOR
! Join the remaining component of RPD to the ! Join clasp to major connector
major connector ! Join direct retainers or auxiliary rest to major
! Distribute force to supporting teeth and oral connector
tissues ! Join denture base to major connector
! Rigidity ! Serve as approach arms for bar- type clasp

JOIN INDIRECT RETAINERS OR AUXILIARY REST


JOIN CLASP TO MAJOR CONNECTOR TO MAJOR CONNECTOR

Right angle with the major connector


Rigid
Gently curve junction
Locate on proximal surface
Positioned in lingual embrassure
Broad buccolingually but thin mesiodistally

JOIN DENTURE BASE TO MAJOR CONNECTOR OPEN CONSTRUCTION FORM LADDER LIKE NETWORK

Strong enough to anchor denture base


Open construction form ladder like network
Distal extension

Mesh construction
In maxillary arch, extend as far posterior as practical

Bead, wire or nail head components on metal base


In mandibular arch, extend two thirds the length of edentulous ridge
SERVE AS APPROACH ARMS FOR BAR- TYPE CLASP

Not required to be rigid

Must not cross tissue undercut

RESTS AND REST SEAT

PRIMARY REST
! A rest that is part of a retentive clasp is referred ! Prevent vertical movement
to a primary rest ! Transmit force to supporting tissue
! Ball and socket joints
! A rest that is responsible for additional support
or indirect retention is called an auxiliary rest or
secondary rest

AUXILIARY REST MAJOR FORM OF REST


! Indirect retainer in extension base ! Occlusal rest
! Place anterior or posterior to the axis of rotation ! Lingual or cingulum rest
! Incisal rest
OCCLUSAL REST OCCLUSAL REST

Triangular Floor of rest seat slightly inclined toward the center of the teeth

Deepest portion located near the center


1/3 – 1/2 of mesiodistal diameter
At least 0.5 mm. thick at thinnest point
Approximate 1/2 of bucco lingual width
1.0-1.5 mm. thick at the marginal ridge

LINGUAL AND CINGULUM REST INCISAL REST

Primarily used on maxillary canine Frequently used in mandibular canine

V shape Small V shaped notch

Ball and socket assembly Located approximately 1.5 to 2.0 mm. from the proximal
incisal angle

DIRECT RETAINER
! Engage abutment and resist dislodging forces
! Two type
! Intracoronal direct retainer
! Precision attachment
! Semiprecision attachment

! Extracoronal direct retainer


! Retentive clasp
DIRECT RETAINER ! Suprabulge
! Infrabulge

! Attachment
RETENTIVE CLASP ASSEMBLIES RETENTION
! Structure of clasp assembly ! The quality of clasp that resists forces acting to
! Rest dislodge component from supporting tissue
! Retentive arm
! Reciprocal element ! Depend on
! Minor connector ! Type of clasp
! Flexibility
! Undercut

CLASP ARM FLEXIBILITY RECIPROCATION


! Depend on
! Length " increase
! Cross-sectional diameter "circular
! Longitudinal taper
! Clasp curvature " single plane
! Metallurgical properties of alloy "gold , wrought
wire

The quality of clasp that counteracts lateral


displacement of an abutment when retentive
clasp terminate

RECIPROCATION ELEMENT ENCIRCLEMENT


! Cast clasp ! The characteristic of clasp that prevent
! Lingual plate movement of abutment away from associated
! Combination of mesial and distal minor
clasp assembly
! Contact over at least 180°
connector

! Prepared parallel to path of insertion


LOCATION OF RETENTIVE CLASP
PASSIVITY TERMINUS
! Quality of clasp that prevent the transmission of ! Mesial or distal line angle
the adverse forces to the associated abutment ! Facial surface better than lingual surface
! Length " Flexibility
! Contraindicated in premolar

SIMPLE CIRCLET DESIGN (Aker’s clasp) REVERSE AKER DESIGN

Widely used
Undercut located adjacent to edentulous area
Tooth support RPD
Infrabulge clasp is contraindicated
Engage undercut remote from edentulous area
Kennedy class I ,II
Half round cross sectional
Disadvantage
Disadvantages - Reduced strength
- Increase circumference clinical crown - Lack of rest adjacent to edentulous area
- Increase tooth coverage - Poor esthetic

MULTIPLE CIRCLET DESIGN EMBRASURE CLASP

2 simple circlet joined at bodies


2 simple circlet clasp joined at the terminal aspect of their reciprocal
elements Used on no edentulous area side

Principle abutment is periodontal compromised Insufficient tooth preparation results in

Disadvantage Inadequate cross sectional dimension


- The same as simple circlet and reverse circlet
Compromised clasp strength
RING CLASP DESIGN

Indicated on tipped mandibular molar

Engage mesiolingual or mesiobuccal undercut

Auxiliary bracing arm

Distal and mesial –occlusal rest

Disadvantage
- Tooth coverage
- Difficult correction

Lingual Buccal
Contraindication
- Limit vestibular depth
- Soft tissue undercut

C-CLASP DESIGN (Back action clasp) WROUGHT WIRE CIRCUMFERENTIAL CLASP

Combination clasp
- Occlusal rest
- Cast metal reciprocal arm
“Fishhook” or “Hairpin” clasp - Wrought wire retentive arm

Simple circlet clasp with loop back retentive arm Circular cross sectional

Sufficient crown height Kennedy class I and II

Disadvantage Mesiobuccal undercut


- Insufficient flexibility
- Tooth coverage Minimal tooth coverage
- Esthetic compromised
Disadvantage
-Breakage
-Minimal stabilizing

COMBINATION CLASP IN
INFRABULGE CLASP
! Bar type
! Flexibility
! Length
! Taper
! More esthetics
! T-clasp, modified T clasp, Y clasp and I bar
DESIGN RULES
! Disadvantage ! Approach arm
! Food accumulate ! must not impinge soft tissue
! Flexibility ! " Horizontal stability " ! cross perpendicular to free gingival margin

! Uniformly tapered " Flexibility


! Terminate clasp positioned " Apically on the abutment
! Rigid minor connector " Bracing and Stabilization

T-CLASP DESIGN
I-CLASP OR I BAR

Kennedy class I and II Contact area

Undercut locate adjacent edentulous area 2-3 mm. in height

O.01’’ undercut 1.5-2 mm. in width

Contraindication Mesial rest


- Severe soft tissue undercut
- High of contour locate near occlusal surface Kennedy class I and II

A = Approach arm RPI


B= Vertical projection of approach arm - Mesial rest
C= Location where B cross perpendicular to free gingival - Proximal plate
D=Point of first tooth contact
E=Terminus of the retentive clasp
- I bar
F= Encirclement portion

MODIFIED T-CLASP Y-CLASP DESIGN

Equivalent to T-clasp
No retentive horizontal projection
Mesial and distal projection terminate near occlusal surface
Kennedy class I and II

Undercut locate near adjacent edentulous area

Canine and premolar

Advantage
- Improve esthetic compare with conventional T clasp
INDIRECT RETAINER

INDIRECT RETAINER
! Framework component that resists rotational
displacement of an extension base from the
supporting tissue
! Require for Kennedy class I, II and IV

EFFECT OF ROTATIONAL
MOVEMENT

! Occlusal dislodging forces


! Denture base move away from supporting tissue
! Anterior segment of major connector impinge upon
underlining tissue
FACTOR DETERMINE INDIRECT
RETAINER FORM OF INDIRECT RETAINER
! Position on the opposite site of fulcrum line ! Auxiliary occlusal rest
! Perpendicular and far from fulcrum line ! Cingulum rest
! Canine and premolar ! Incisal rest

! Rest at each end of lingual plate

Distal Extension RPD


! Direct retainer design

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Indirect retainer

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SUPPORT FOR DISTAL
EXTENSION DENTURE BASE Impression technique
! Maximum border extension ! Final impression with custom tray and
! Accurate border detail elastomeric impression material
! Primary supporting area ! Altered-cast technique

! Form of the ridge under function

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Miscellaneous
“Being excited about being wrong because
! Retentive arms should be on the same side that means you’ve discovered something new”
! Dimpling

! Treatment denture

! RPD drawing
- in paper
- on the cast

THANK YOU

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