RPD Manual Full
RPD Manual Full
RPD Manual Full
REMOVABLE PARTIAL
PROSTHODONTIC DESIGN
Kenneth R. McHenry, D.D.S., M.S.
Terrence McLean, D.D.S.
Contributing Authors:
Robert E. Ogle, D.D.S.
Illustrations:
John A. Nyquist, M.S. CMI
TABLE OF CONTENTS
CHAPTER 1 - SURVEYING
Surveying............................................................. 1-2
Diagnostic Survey.................................................... 1-5
Tripoding.............................................................. 1-10
CHAPTER 2 - REFERENCE
Basic Components of a Partial Denture........................... 2-1
I. Methods of Partial Denture Retention..................... 2-1
II. Support Units - Rests......................................... 2-10
III. Major Connector.............................................. 2-12
- Types of Mandibular Major Connectors................. 2-19
IV. Minor Connectors............................................. 2-23
V. Indirect Retainers............................................ 2-25
VI. Lattice Work.................................................. 2-26
VII. Acrylic Base.................................................. 2-29
VIII. Teeth......................................................... 2-29
CHAPTER 3 - PRELIMINARY DESIGN
Procedure
1. resurvey........................................................ 3-2
2. marking the cast.............................................. 3-2
3. design........................................................... 3-5
CHAPTER 4 - TOOTH MODIFICATIONS
I. Tooth Modifications........................................... 4-1
Sequence of Abutment Modifications.................... 4-2
1. guiding planes............................................ 4-3
2. tooth surfaces to accomodate clasp form........... 4-5
3. interferences............................................. 4-8
4. esthetics................................................... 4-10
5. rests........................................................ 4-12
6. modification of rests for embrasure clasps........... 4-15
II. Criteria......................................................... 4-22
1. for tooth modification (maxillary)..................... 4-22
2. for tooth modification (mandibular)................... 4-23
3. for rests.................................................... 4-24
SURVEYING:
ITEMS NEEDED:
dental surveyor
assigned casts
red, blue and green pencils
correctable erasing pencil
PRINCIPLES:
INDICATIONS:
CHAPTER 1 - SURVEYING
1 -2
PROCEDURES:
DENTAL SURVEYOR:
B
Surveyor
A - friction knob to secure vertical arm
B - knob to secure stylus
C - moveable vertical arm
D - storage for stylii
E - platform for survey table
Surveying table
E
A
B
1
-3
1- 4
DIAGNOSTIC SURVEY:
OBJECTIVE:
To select the best possible path of placement and removal for the prosthesis. This path should
minimize interferences and identify the mouth preparation necessary to optimize guiding planes, retention,
and esthetics
Items Needed:
Dental Surveyor
Four Assigned Casts
Colored Pencils
Erasing Pencil
PROCEDURE:
1) Place analyzing rod in movable arm
2) Place the diagnostic cast on the survey table
a. Secure the cast on the surveying table using
knob A (Figure 1-3)
b. Set the initial position of the table approxi-
mately parallel to the occlusal plane and lock
it in place with knob B (Figure 1-3)
1-5
Guiding planes:
Ideal
Errors
1-6
Areas of retention:
Ideal
Non-ideal:
1-7
d. Interferences. The remainder of the cast is
checked and areas of interference to the
determined path of placement are noted. The
only undercuts desirable for a given path of
placement are those which will be utilized by
the terminal one third of the retentive clasp
arms. All other undercuts are neither
wanted nor needed. Some areas of the cast
will be undercut but they will not involve the
prosthesis, so these areas are not of concern.
Other areas which involve the prosthesis
may have slight amounts of undercut. How
ever, these can either be modified or blocked
out (the process of relieving the prosthesis of
intimate contact). It is only excessive under-
cut in the areas listed below that must be
recognized. If these undercuts cannot be
dealt with, we must modify the teeth to
accept the desired path of placement or alter
our path of insertion to eliminate them and
then retrace our steps to determine new
areas to be prepared as guiding planes and
retentive areas.
e. Esthetics. Check the esthetics of the survey.
The retentive areas should show as little as
possible; the placement of denture base and
teeth should be pleasing. These factors must
be considered in determining final survey.
1-8
Ideal
Error
1-9
TRIPODING
Record this position of the cast by tripoding the cast.
1. Tripod procedures
a. fix the analyzing rod in position with the
setscrew.
b. mark three widely divergent points on the cast
with a pencil without lifting analyzing rod to
maintain a plane (circle with a red pencil
for identification)
c. Alternate technique if desired, groove the tripod
points are located at the periphery of the cast
and marked as grooves for reproduction in the
refractory cast.
The resulting position is the most advantageous one
that demonstrates the best possible proximal surfaces to
be prepared to act as guiding planes and retentive areas
on the abutment teeth. Combining the information from
this diagnostic survey along with the results of the clinical and radiographic exam, a design with its required
tooth modifications can be determined.
1 - 10
B. COMPONENTS OF A CLASP
REFERENCE:
BASIC COMPONENTS OF A PARTIAL DENTURE
CLASP ASSEMBLY
LATTICE WORK
INDIRECT RETAINER
MAJOR CONNECTOR
ARTIFICIAL TEETH
MINOR CONNECTOR
REST
ACRYLIC BASE
TISSUE STOP
A - Rest
B - Retentive Arm
C - Reciprocal Arm
D - Minor Connector
E - Minor Connector, serving
as a proximal plate
1. CLASP ASSEMBLY
A. FUNCTION
To provide resistence to vertical forces of dislodgement, i.e. force of gravity, adhesiveness of food or
forces related to opening the jaws. This retention is
achieved by the resistance of metal (retentive arms) to
deformation.
2-1
CHAPTER 2 - REFERENCE
2-2
DIMENSIONS in mm
premolar
Body
Tip
molar
Body
Tip
Width
1.8 0.8
2.0 1.0
Thickness
1.0 0.5
1.8 0.8
Length
2-3
1. Suprabulge
a. Circumferential Arms originate at the minor
connector above the height of contour and contact
the tooth throughout the extent of the clasp. This
is the basic fundamental clasp of all tooth supported RPDs because of its retentive and stabilizing ability. This clasp utilizes an 0.01 inch
undercut away from the body of the clasp
2-4
Lingual
2. Infrabulge
a. Bar : Originates below the height of contour
extending from a major connector or denture base,
passing adjacent to the soft tissues and approaches
the tooth from a gingivo-occlusal direction. The undercut is usually the side of the tooth closest to the
extension base for the t or 1/2 t bar, or at the greatest mesiodistal contour of the tooth for the I bar. It
is seldom used on the lingual surface and can not
be used if there is a shallow vestibule (minimum
5 mm), severely tilted tooth, or excessive tissue
undercut (greater than 2 mm) present in the area
of the approach arm because of patient discomfort
and food entrapment. This clasp uses a undercut of
0.01 inch. Types are the t-bar, half
sqt-bar and I bar.
Buccal
2-5
I Bar
T Bar
1/2T Bar
2-6
b. RPI bar: This clasp utilizes a buccal undercut or an undercut on the side of the tooth
away from the edentulous area. The entire
clasp is composed of a rest (R), with its minor
connector, proximal plate (P), and an "I" bar
clasp. The "I" bar contacts the tooth anterior
to the greater buccal curvature of the tooth.
There are other components of this mode of
clasping that the student should understand
by referring to his or her lecture notes. Because of its unique requirements, this clasp is
best accomplished when the abutment tooth
is being crowned. This clasp is utillized on
distal extension bases but has the same limitations as any infrabulge clasp in its usage.
This clasp uses an undercut of 0.01 inch.
Mesial rest
Occlussal view
1mm
Buccal view
2-7
1.0mm overlap
of guide plane
2-3mm
PP
Distal view
2-8
3. Reciprocal arms
Except for the RPI bar clasp which develops reciprocation by utilizing vertical surfaces (lingual edge
of the minor connector which contacts the guiding
plane), all retentive clasp arms need a corresponding horizontal reciprocal component to brace the
tooth as the retentive clasp flexes over the height of
contour to enter the undercut zone. The reciprocal
clasp is at or above the height of contour, never in
an undercut and placed as low in the middle 1/3 of
the tooth as the survey line allows. While most all
retentive clasps need a reciprocal clasp, additional
reciprocal clasps may be placed (e.g., for horizontal
stabilization) without the placement of corresponding retentive clasp.
2-9
II. REST
A rigid extension of a removable partial denture
that prevents movement toward the mucosa and
transmits occlusal functional forces to the teeth
A. FUNCTION OF REST
Primary function is to provide vertical support for
the partial denture.
2 -10
C. TYPES OF RESTS
Rests are named for the surface of the tooth on
which they are prepared.
1. Occlusal rest: a rigid extension of a partial
denture that contacts the occlusal surface of a
tooth
2 - 11
In addition to its function of unification, the maxillary major connector also can contribute substantially
to the support and retention of the prosthesis. Support
comes from the fact that broad palatal coverage of some
maxillary major connectors greatly adds to the surface
area covered by a prosthesis and this broad coverage
contributes to adhesive, cohesive and surface tensional
retention of the prosthesis much as that of a complete
denture. Maxillary major connectors ordinarily require
no relief. The intimate contact between the connector and the tissue provides the support and retention
desired. Exceptions to this rule are maxillary tori and
a prominent median palatal suture line. The gingival
tissue of the remaining natural teeth shold never have
impingement. Therefore, the borders of the palatal connector should be placed a minimum of 6 mm. away
from gingival margins and should be located parallel to
their marginal tissue. The gingival tissue underlying
the minor connectors should be relieved. Anterior and
posterior borders of the major connector should be lightly beaded to insure intimate contact with the mucosa.
2 - 12
2 - 13
2. Broad Palatal :
This connector is similar to the previous type except
its width is extended to cover much more palatal
area. It is indicated in unilateral or bilateral edentulous arches having a large edentulous space or
distal extension base with good residual ridges that
can lend excellent support and/or strong abutment
teeth.
2 - 14
2 - 15
2 - 16
2 - 17
2 - 18
Mandibular Major Connectors: Mandibular major connectors have a limited capability for support, but
it may contribute to indirect retention, a function
which a maxillary connector does not ordinarily perform. The basic form of a mandibular major connector is the half-pear-shaped lingual bar. The inferior
border of the bar must be located so that it does
not impinge on the tissues in the floor of the mouth
as they change elevations during normal activity.
At the same time, the bar should be located as far
inferiorly as possible to avoid interference to the
tongue and trapping of food particles. Additionally,
the more inferiorly a lingual bar can be located, the
farther the superior border of the bar can be placed
from the lingual gingival margins. The superior
border of the lingual bar should be at least 4 mm.
from the gingival margins.
Types of Mandibular Major Connectors
1.Lingual Bar:
This connector is utilized most of the time on man
dibular RPDs. It is half-pear shaped with the thicker
part making up the inferior border and the superior
border should be tapered to the soft tissue. It is
indicated for use when there is sufficient space be
tween the slightly elevated alveolar lingual sulcus
and the lingual gingival margins. The connector
should be placed no closer than 4mm. from the free
gingival margin. Relief is necessary along the
inferior edge on distal extension bases when the
most distal rests are located close to or on the
anterior teeth.
2 - 19
Lingual Bar
2 - 20
Lingual Bar
2 - 21
2. Linguoplate:
This mandibular major connector is half-pear
shaped with the thickest portion inferiorly located.
A thin metal apron extends superiorly to contact
cingula of anterior teeth and lingual surfaces of
involved posterior teeth at their height of contour
and interproximally to the height of the contact
points. The superior border is finished flush with
the teeth and the inferior border is at the height of
the alveolar lingual sulcus in function. All undercuts on involved teeth must be blocked out parallel
to to the path of insertion and all the underlying
gingival margins should be relieved. This connector
is indicated when there is insufficient space between
the gingival margin and the alveolar lingual sulcus
for the adequate width of a rigid lingual bar or when
the presence of an inoperable lingual torus makes
the placement of a lingual bar impossible. It is also
indicated where more resistance to horizontal movement of the framework is needed because of flat
resorbed alveolar ridges, or the teeth are to be used
in "group function" because of periodontal instabilaity to resist the horizontal rotation of a distal extension base. Still other indications are for an abnormally high lingual frenum making the placement
of a lingual bar impossible, the need for an indirect
retainer on a 6-tooth partial denture or when the
future replacement of one or more incisor teeth is
contemplated.
Note: The plate is supported by a rest where it
starts and finishes.
2 - 22
2 - 23
2 - 24
V. INDIRECT RETAINERS
Part of a removable partial denture that assists the
direct retainers in preventing the displacement of
distal extension denture bases away from the tissue
by functioning through lever action on the opposite
side the fulcrum line. This action depends on the
proper functioning of the direct retainers to work.
The indirect retainer is more effective the further it
is from the fulcrum line. However, as a single rest,
the indirect retainer should rest on an abutment
tooth that has the health and periodontal support
needed to withstand the load, or else the indirect
retainer may be fabricated as a continuous bar to
contact several teeth and distribute the load.
Factors influencing the effectiveness of Indirect
Retainers
1. Location
2. Distance from the fulcrum line
3. Length of the extension base
4. Rigidity of the connectors
2 - 25
smaller spaces and so it is this type that is recommended for routine use.
The partial denture framework retention latticework is that part of the casting that extends on to
the edentulous ridge and retains the replacement
teeth and acrylic base. This latticework is actually
a minor connector that connects the framework
to the acrylic resin denture base. In tooth bound
cases, its extension is arbitrary and does not have
a major supportive function, but one of the esthetics and convenience for the attachment of teeth. In
distal extenison bases, its function is expanded to
include support, stability and retention. The majority of its bulk is to the lingual aspect of the ridge
with a buccal extension just over the crest and
extending 1-2 mm. on the buccal side of the ridge.
This is so the metal framework will not interfere
with either tissue reflections or the esthetic setting
of replacement teeth. The length of the lattice in
relation to the ridge differs from maxillary to mandibular:
B. Placement
Mandibular Distal Extension
lattice extends two-thirds of the edentulous area;
Maxillary Distal Extension
lattice extends to the tuberosity.
The lattice is retentive to the processed resin by
virtue of the fact that there are large spaces placed
in it and it is cast with a slight relief from the ridge
enabling the resin to encircle the metal. Large
spaces in the latticework have been shown to be
more effective in retaining the resin than many
2 - 26
C. Finish lines
This is the junction of the major connector and the
retention latticework. Sharp, definite, butt-type
finish lines are incorporated into the metal
because it is here that the acrylic resin meets the
metal.
External finish lines (oral side) should be
formed in the wax pattern in a way that
provides ample thickness of both metal and
resin.
latticework
external finish line
D. Beading
Palatal major connectots should have a specially prepared seal along the border of the connector where it
contacts the soft tissues. This seal will form a beading at the border of the connector that will displace
the soft tissues very slightly, thus preventing food
from collection under the maxillary major connector.
This bead is made aproximately
1/2mm. deep and 1/2mm. wide. It follows the leading edge of the design of the maxillary major connector. The groove must fade out of at least 6mm. away
from the gingival tissues to prevent tissue displacement of the marginal gingiva. It also may fade out
major connector
2 - 27
A. FUNCTIONS
1. Provide support for artificial occlusal
surfaces (masticatory function).
2. Esthetics
4. Oral cleanliness
B. CONSIDERATIONS
- Residual ridge
- Buccal shelf
- Palate
- Pear-shaped pad
VIII. TEETH
May be made of porcelain, resin or metal.
1. Denture teeth
2. Facings
3. Metal teeth
2 - 28
PRELIMINARY DESIGN:
OBJECTIVE: to
PRINCIPLES: the
PROCEDURE:
For purposes of this exercise, the student may assume that all
emergency conditions have been treated, all endodontic and
periodontal therapies have been completed.
3-1
Resurvey the diagnostic cast considering the tentative design and choose the best PI & R (path of
insertion and removal).
1. Select guiding planes and outline the areas
for modification in blue
Note:
a.In making a choice between having a good guide plane
on one tooth and none on another as against having to
contour both teeth, the latter is preferred because the
goal is to provide the greatest area of parallel proximal
surfaces possible that may act as guiding planes.
b.In making a choice between having the guide plane
contact only the cervical area or the marginal ridge
area the latter is preferred because the guide plane can
be achieved with only recontouring where the former
requires a casting to achieve a guide plane
3-2
4. Place the 0.020" undercut gauge in the surveyor and note the contacts this gauge makes
with the buccal surfaces of all the abutment teeth.
This amount of retention is usually reserved for
wrought wire clasps. Use this information to
make the same type of determinations as in step
#3.
3-3
3-4
3-5
9. Select the major connector design most appropriate for the situation
10. Draw the design for your future partial denture on your work sheet
11. Reconfirm the areas needing mouth modifications to achieve the determined design and mark
them on the surveyed cast as follows:
a. Indicate necessary guiding plane modifications areas in blue
b. Indicate necessary tooth preparation by
selective grinding in red
c. Indicate necessary rest preparation areas in
green
3-6
TOOTH MODIFICATIONS:
INSTRUMENTATION:
PROCEDURE:
4-1
CHAPTER 4 - TOOTH MODIFICATIONS
In creating guiding planes on interproximal tooth surfaces, no distinction should be made between a tooth
supported and a distal extension base RPD. The
guiding plane should extend approximately two thirds
the length of the interproximal surface for both a tooth
supported or a distal extension base RPD. The difference is in the minor connector acting against the In
creating guiding planes on interproximal tooth surfaces, no distinction should be made between a tooth
supported and a distal extension base RPD. The
guiding plane should extend approximately two thirds
the length of the interproximal surface for both a tooth
supported or a distal extension base RPD. The difference is in the minor connector acting against the
guiding plane. In a distal extension partial denture,
the minor connector should extend one half the length
of the interproximal surface on the distal abutment
tooth. This is done to minimize the leverage induced
stress created by the rotational movement of the distal
extension base in function. The tooth supported RPD
the minor connector extends the whole length of the
guiding plane. The RPI clasp is the only exception in
that the guiding plane is prepared one half the length
of the interproximal surface.
DIMENSIONS OF GUIDING PLANES
WIDTH
LENGTH
4-2
A. Start
B. Prepared guiding plane
ERROR
CORRECTION
4-3
4-4
Ideal
Common Modifications
4-5
4-6
B. Reciprocal Surfaces
Ideal
Reciprocal
arm
Reciprocal
arm
Common Modifications
Retentive
arm
Lowered height
of contour
4-7
Interferences can be located on different tooth surfaces for many different partial denture
components.
3. INTERFERENCES:
Ideal
Common Modifications
Rigid Components
4-8
4-9
2. The bell shaped crowns of the canines are causing excessive gingival embrasures and space problems which result in poor esthetics.
4 - 11
RESTS
Sequence of Modification of Tooth Surfaces to Accommodate Clasp Design
1.
Retentive Surfaces
2.
Reciprocal Surfaces
3.
Interferences
4. Esthetics
5. Rests
PROCEDURE
4 - 12
REST PREPARATION:
A. Occlusal Rest: This is most common type of rest
made on the occlusal surface of a bicuspid or molar. The rest is triangular or spoon shaped with the
point of the spoon facing the center of the occulsal of
the tooth.
REST DIMENSIONS
WIDTH:
one-half the distance between the tips of the buccal and lingual cusps
LENGTH:
A = 1/2 B
4 - 13
fig. 5
DEPTH:
SHAPE:
INSTRUMENTS:
Molar
Body of rest 36006-137 round ended diamond
Floor of rest 36006-136 round ended diamond
Premolar
Body of rest 36006-136 round ended diamond
Floor of rest 36006-135 round ended diamond
Polish using fine diamonds, finishing carbide
burs, stones, blue and green points
4 - 14
SHAPE:
INSTRUMENTS:
marginal ridge-36006-137
Polish fine diamonds, finishing carbide burs, stones,
blue and green points
4 - 15
B. Lingual Rest: Prepared on canines and incisors, preferably on canines since these are stronger abutments by
virtue of their alveolar support. If the slope of a canine
is gradual rather than more parallel to a vertical minor
connector, a lingual rest may be placed in enamel at or
just incisally to the cingulum. This type of rest is usually confined to the maxillary canine. The lingual slope
of the mandibular canine is too steep for an adequate
lingual rest preparation to be place in enamel i.e., one
in which the forces are directed parallel to the long axis
of the tooth. In order for a lingual rest to be used on a
mandibular canine, usually some form of restoration
must be place in the tooth for the rest to be made. Lingual rest preparations may be made in three ways on
maxillary canines.
4 - 16
1 mm
1.5 mm
SHAPE:
the ledge preparation inclines slightly downward toward the center of the tooth and continues mesially and distally to include the
marginal ridges. This rest type usually does
not have a reciprocal arm; reciprocation is
gained from a parallel lingual surface above
the rest preparation so the rest serves both as
rest and reciprocal arm.
INSTRUMENTS:
4 - 17
occlusal rest. It is made just laterally to the midpoint of the lingual surface at or above the level
of the cingulum. This rest generally cannot act as
a reciprocal arm. This rest is intended for use on
Maxillary Canines.
REST DIMENSIONS
WIDTH:
4 - 18
there is a prominent cingulum. The rest preparation is made incisal to the cingulum. The ledge has
a mesial and distal slope and the floor of the ledge
is inclined apically or toward the center of the tooth
to a slight degree. This rest may
or may not act as a reciprocal arm.
1 mm
1.5 mm
REST DIMENSIONS
WIDTH:
LENGTH:
2.5 - 3 mm
SHAPE:
INSTRUMENTS:
4 - 19
4 - 20
WIDTH:
LENGTH:
SHAPE:
4 - 21
Tooth Modifications
Maxillary
CRITERIA:
ACCEPTABLE
TEST
EXCELLENT (E)
1. Guiding Planes
Orientation
-parallel to path insertion and other OP
Contour
-cylindrical B-L
-smooth
GOOD (S)
Orientation
- convergent within 3' of the
P.O.!. apically
Contour
-slight irregularities
-slight roughness
Dimension
-width B-L 2/3 distance between
summit cusps
-extends from marginal ridge
to junction of middle and gingival 1/3
Dimension
size 8-L 1/2 to 113 width cusps
0-0 1/2 to2/3 length crown
UNACCEPTABLE
CRITERIA NOT MET (N)
COMMENTS
Orientation
- varies> 6'from the determined P.O.I
Contour
-no guiding surbce
-flat or spherical 00
- created sharp B or L line angles
-rough. pitted, or scratched
Dimension
- size B-L < 112 or> 2/3 width cusps
- size 0-0 < 1/2 length crown or on the
root surface
Retentive area
-gingival 1/3
-2 mm. above free gingival (CEJ)
-0.01" or 0.02"depth depending
on clasp design
Retenti ve area
-slight malposition coronall
gingival MID
-undercut slightly extensivel insutticient
Retentive area
-insufficient retention < 0.0 I"
-too great an undercut> 0.0 I"
-placed above gingival 113
-excessive tooth modification
Reciprocal area
Reciprocal area
-parallel to OP
-extends to junco of middle& gingival 1/3
-follow natural contour of tooth M-D
3. Rests
Shape
- correct shape and smooth throughout
-angle of floor of rest and
guiding plane < 90
-wider and rounded at marginal ridge
Oeeulsal
-B-L 2.5mm or 1/2 dist. summit cusps
-M-D I14molar, I13premolar length of crow
-1.0 mm deep at M.R
Lingual spoon
-2mm wide
-I n1l11 deep
0
Inverted V
-I mm width LL
- 2.5mm MD follows cingulum
Ledge
-I.mm LL midpoint,
-1.5mm deep 00
4. Cast
-slight divergence
Shape
-correct shape with minimal roughness
-angular at marginal ridge
-1-1.5mm width LL
2-2.5mm MD follows
cingulum
Ledge
Reciprocal area
-placed above or below middle 1/3
-not present
-excessive tooth modification
Shape
-sharp edges internally or at marginal ridge
-same depth throughout
-rough, uneven and/or undercut
-angle is> 90
-does not follow anatomy
Oewlsal
-B-L <2mm or> 2.5 mm
-M-D < or >1/4molaL1/3 premolar
-depth at M.R.< I or >1.5 mm
-wider at midpoint than at marginal
0
ridge
Lingual spoon
-< 1.5mm or 2mm LL <lor> I.Smm deep
Inverted V
-<I mm or >I.Smm BL
- <2mm or >2.5m111 deep
Cingulum
-tedge -<I nlln or >1.5mm LL midpoint
4 - 22
Tooth Modifications
Mandibular
CRITERIA:
TEST
ACCEPTABLE
UNACCEPTABLE
EXCELLENT (E)
1. Guiding Planes
GOOD (S)
COMMENTS
Orientation
- cOl1\'ergent Within 3'- of lhe
POI. apically
Contour
Contour
-cvlllldncal B-1.
surface
-tlat~)r spl;;"rlcal OG
- created sbarp H or L line angl~,:.)
-mugho pittE'cL or scratched
-lhllZUiding
-S(1100t!1
C(liltour
-,;light irregularities
-."light roughness
Dimensi{lIl
-width BL 2/.1 dis)allce belween
-overreducl'd
\urnnn[' cusps
I)illlellsioll
In
size B-L
o-c
Retentive area
-im~ival l/:i
-2 n~ll. aho\\' free
Retentive area
-slight malpllsitioll coronali
"in"ival MID
-~mkrcut slightly (:\["'::11:-.1\('1 i!lc'uflicit'1l1
(CLI)
-0.01' [11
nil cla:-.p design
Reciprocal area
-parallel to GP
-~xte!lds tu jUlie (11 Illicldlc& gingival l/3
-follow natural (nil/our ur tooth 1\.11-0
3. Rest.s
Reciprocal area
-slight diven-..'cnce
-co~tour cO';lpromiscd
-slight malposition
M-D
Oeculsal .
Oemlsal
:~UIlHljll
,:usps
length l)f lTOWI
Distal Incisal
-1-1.5111l1ldecp
-same \-\ idth buccal JS lillQULll
-axial tlllor HL is 8S to '9-" 10 POI
Shape
Shape
-slight change ill depth al
center
~l[ld
Reciprocal area
-placed abm'e or below rlllddlc
-!lot present
-excessive t(){Jlh !llOdificatlCln
Oeeulsal
-8-1. <21ll111 or > 2':;; Illill
-l\'l-D < PI' >rcljuircd length
\)1' cmWll
-depth at \1.1'.< I or> I 5 nlill
-\vider at midpoint lilall at nwrgilwJ
ridge
~-.~--.--.-.--
DistallJl('isal
-II
Shape
-"l1mp edgl',":' illkrually or
-same depth throughout
ull11~lr~1l1,d rld~e
Clnd 1I!l1'\\~1l
-rest Ulltk'rcut
-mlgle i.\> yO
-Sl1ll1(11il
----------~~---
Retentive ,u'ca
-illSullicicnt retentiun < (J.() )"
-too great all undercut> OJ) I'
-placed ubovc gillgi\-~d )I?,
-excessive [(10th lllodii'icatloll
llistallncisal
-1!.1~m.lj'llllldcq)
- conte! ,;jwpc'
of flour or rc"t
pl~!lk: < Ijii
-wider at 11l'-lr~inal
-rounded ,it
Dimension
- s1I.e 8-L < 112 or > ~/J width cu~p)
- size O-Ci < 112 length crown (l]" IJll the
root <.;urrace
.. --~--
----'-------~~---.----.--~-.
------'-------------- ---------------'----------------------------j
4 - 23
Tooth Modifications
Rests
Occlusal Rests
UNACCEPTABLE
ACCEPTABLE
EXCELLENT (E)
CRITERIA:
Shape
- eorreel shape and snlOolh IhroughoLiI
Ilf liullr of IN und
plolle < 90
-wider and rounded almarglnal ndgc
Oemlsal
-B-L 2.511l1ll or !/~. di'iL ~llJ11lllil
-\I-IlI/~nl\1laL 1/_'prell1o!c,r length
-J.(llliln deep al M.I<
GOOD (S)
COMMENTS
Shape
-correct ,,>hape with minil1l;li rOllghnc:)s
al
Shape
-incurrec!
-;.;klrp edge;.;
ur at marginal Jid2t?
throl.l~llUllt
''uneven and/Ill unc!elcul
-same' depth
-2-1.5lllf1l \\idc'.
1-1.5 111m delTal \LR
lllill
-+-------------1--------------+--------Embrasul'c
Sluieeway~
:ll1ll1(1
embrasures
il1rcbsp
<I
III In 111-
~j.s
Illlll
-110 llildelnll,~
undL'ITuh
-undc>rculs
~-------4---------------4_-----------4_----------------_+---------Lingual SpOOll
I.ingual SP!)()J1
Can inc Rests
Lingua!
-1-1.5111111 L.L, I.~ 111111 d\:'c'jI
-<1.5111111 or 2III 111 LL <I.;,) > l.~miil deep
"2Jll III
-I I11Ill dLcn
Inverted \"
Imerted \
-1-1)111111 \lldlll 1.1
-<lllllll (Ir >1.5111111 Bl
Inverted \
-\11)
:-hnn
('II
\11\
i}jJllIll
- Mil ,"It'lI(ls llilllU,h \IR
-lm!l1 \\,idth U"
-OG
(II
thicKIlC-":"
l-I]'
cinglllulll
-!
:11
III
~ tll(J high 1)1' [(I ]\m 1.111 i.:i!'l~u!UIll
- "II) (".Ieller, IU" nlill \JR
-fullo\\.') L'iil~Lllliill
-()(j al
1IIIdl1l',~:-l\f l'ill~uluIll
l.edgt.'
- ((,1 ill\.\. \ lin.~LI!ltlll
-<lllllll m >1.5llilllj,] lllllirlUI!l1
L.L
I,edge
m:\.i!)11111\
-1_1;IIIlLI
-! .~illill
Distal Indsul
-< I/.\\IIJ ur > f, ;,\111
DiltalIn('ilui
lli\tullnci,al
-1-i.5il1llllk\:j'
[() POI
L _____________________ ----
el5
iillgU:-I!
III
-<I.Ol1liTIIJr">2rnlll dC'll'
111:11l
-a\i:rllloorMD is
I'll I
__________________________ -.-J._ _ _ _ __
4 - 24
5-1
nectors:
a. The gingiva must be either completely covered by a adequately relieved component of the
RPD or the components must be placed at least
4mm (mandibular) or 6mm (maxillary) away
from the gingival margins
b. All crossings of the gingival margin must be
made at 90 degree angle
c. Try to finish the borders of the connector in
low areas of the tissues rather than on a prominence
d. Mandibular major connectors:
- Lingual bar- superior border no less than
4mm inferior to gingival margins, inferior
border at the height of the alveolar lingual
sulcus when the tongue is elevated.
- Linguoplate-superior border follows the
cingulum of the teeth rising to the contact
points, inferior border is the same as the
lingual bar
e. Maxillary major connectors:
- rugae area - follow the valleys as much as
possible, when crossing rugae do so at 90
degree angles to the crests
- lateral borders - follow parallel to gingival
margin at least 6mm away
- medially - parallel to the junction of vertical
and horizontal parts of the palate
- posterior border - straps and bars traverse
palate just anterior to vibrating line
- placement of straps - place strap so it covers
area where it is in two planes giving it more
rigidity
5-2
Minor connectors: Join the direct and indirect retainers to the major connector. They should be approximately 2mm wide except those which are acting
as proximal plates which should be two thirds the
width of the summit of the cusps of the abutment
tooth. They should be placed whenever possible in
a interproximal space and fill the space as much as
possible for patient comfort. Remember they must
cross the gingival margin at 90 degrees and should
not join the major connector with sharp angles.
Adjacent connectors must be at least 5mm apart for
oral health.
Retentive mesh: The minor connector which retains
the acrylic base and artifical teeth. It should always extend over the crest of the ridge to prevent
fractures. Adequate bulk and strength in the metal
at the junction of the grid and the major connector
is necessary. The mesh should extend extend to just
anterior to the retromolar pad on the mandibular
and over the tuberosity on the maxillary. It should
not interfere with tooth placement.
5-3
Lastly any additional notations such as different
types of teeth, areas to be relieved, areas of beading,
finish lines, and any areas of notation that further
clarify the design are made.
Remember that the drawing is not rough sketch; it is
a precise line drawing of the partial framework placing the various components exactly where intended.
The quality of the work you provide the technician is
directly proportional to the quality of the work you
will receive in return. If the width of the clasp arms
are excessively thick or thin or poorly shaped, don't be
suprised if the final casting is the same; if the major
connector is drawn too close to the marginal gingiva
expect the same in casting; if one forgets to draw a
clasp arm or rest expect the same in the casting unless
you are employing a technician more astute or conscientious than yourself.
5-4
1. BLACK LEAD
Contour Lines
Tripod Marks
2. RED
Retentive Clasp Arms
Finish Lines
Circle Around Tripod Mark
3. BLUE
Major Connector
Minor Connectors
Reciprocal Arms
5-5
WORK AUTHORIZATION:
OBJECTIVE: To familiarize the student with the written
procedures necessary for communication with the laboratory technician
PROCEDURE: The Work Authorization is a written direction for laboratory procedures to be performed in the
fabrication of dental restorations by a laboratory technician. The purpose of this document is to provide the
laboratory with clear, concise understandable instructions concerning work to be done and to protect the
patient from the illegal practice of dentistry.
The dentist has a further responsibility to closely supervise the work of all auxiliary personnel. The dentist who does not honor these legal, ethical and moral
commitments by assuming his full responsibilities is
betraying his personal integrity. If such irresponsibility becomes widespread, the general public will seek
to change the laws so that certain phases of dental
practice can be performed by others less trained and
qualified. There are people ready to assume this
role and we as dentists will have no one to blame but
ourselves. The dentist is responsible for all phases of
a removable partial denture service. He may request
a dental technician to engage in certain mechanical
phases but the technician is responsible to the dentist
and never to the patient. The dentist who relegates
the survey and design of a partial denture to a technician is committing a grave injustice to the trust the
patient has placed in him.
6 - 1
Typodont No.
REMOVABLE PROSTHODONTICS
LABORATORY WORK AUTHORIZATION
To: Date:
Address:
Student: Instructor:
Patient: S.S. # :
General Request:
Date & Time Req.:
Specific Instructions:
UPPER
RIGHT
RIGHT
LEFT
LOWER
LEFT
Student Dentist's Sig.
Instructor Sig.
Lic. # :
6-2
Then list:
1. Rests - the type of rest and where on the tooth it
is located, e.g. spoon rest on mesial occlusal surface.
2. Retention - type of clasp and the retentive area,
e.g., mesial buccal undercut.
3. Reciprocution - type and location, e.g., cast arm
on the lingual surface.
l special instructions, this will vary with the individual case and may include such things as type of
retention latticework to use, the placement of special
types of replacement teeth, the mode of tripoding used,
special waxing specifications, special finishing procedures.
6-3
The importance of establishing a good working relationship between the dentist and technician cannot be
overemphasized. It is based on a common understanding of the overall objectives, an awareness of each
persons role and an appreciation of the problems that
each person might encounter. Within this framework,
legal and ethical considerations can be established
along with the basis for sound business management.
The purpose of all this is to best utilize the expertise
of two trained people to deliver to a patient the maximum in health care in the most efficient manner. To
do this so it is profitable to all; patient, technician and
dentist, the dentist must be the one to assume the initiative, ultimate leadership and delegation of responsibilities.
Technician's Responsibility
The technician is responsible for fabrication of the
prosthesis with the materials prescribed in accordance
with the directions received on the work authorization
form.
6-4
OBJECTIVE:
PRINCIPLES:
ADVANTAGES:
1. Increased cost
2. Increased complexity of the procedures both
clinical and technical
Never should you design a cast restoration in a semi
edentulous situation before first determining the
design of any RPD that may be necessary even if the
RPD is not being fabricated at that time. The same
holds true about fabricating a RPD before evaluating
the abutments for cast restorations and completing the
ones indicated.
PROCEDURES:
7-1
CUSTOM MATRIX:
OBJECTIVE: To provide a easy method of relating the postion of teeth to the residual ridge for purpose of locating portions of the framework particularly retentive
loops or posts.
INSTRUMENTATION REQUIRED:
Cast
Denture teeth
#7 Wax spatula
Bunsen burner
Baseplate wax
Hollenbeck carver
Alcohol torch
Handpiece and burs
PROCEDURES:
8-1
CHAPTER 8 - CUSTOM MATRIX
8-2
10-3, 10-6
10-9
10-2
10-9
10-4
10-2
10-5
10-4
10-5
8-3
8-4
8-5
9-1
TECHNIQUE:
When using a parallel blockout wax technique, considerable care must be exercised in placing the wax.
If the wax is not trimmed sufficiently to expose guide
planes after applying it with a hot spatula, then the
casting will be relieved away from the tooth and will
not contact the tooth and so we lose the function of
that guide plane. If too much wax is placed or not
trimmed sufficiently after it has been placed in a
deep interproximal space beneath a minor connector
or linguoplate, then this part of the casting will have
needless space between it and the tooth and serve as
an unnecessary food trap. If on the other hand, we
are over zealous in trimming back the wax, it is easy
to scuff or abrade the stone tooth surface. This would
lead to a casting that fits the model but would strike
prematurely in the mouth and not go to place.
In applying the blockout wax, the Ney high fusing
undercut wax supplied in the student kit should be
used. A high fusing wax such as this (actually a waxclay mixture) is necessary to withstand distortion from
the heat of the duplicating material which is poured at
about 120. The blockout wax is applied to the teeth
with a #7 wax spatula or large P.K. Thomas waxing
instrument. The spatula must be hot enough to cause
the melted wax to satisfactorily stick to the tooth or
it will be pulled off when an attempt is made to carve
it with the surveyor blade. At the same time the wax
should not be so hot to be drawn into unwanted areas
by capillary attraction. The student should experiment on a few trial teeth before attempting anything
on his working cast to get the feel of handling this
material.
9-2
9-3
PROCEDURE:
Pre-insertion Evaluation
Framework on the cast
10 - 1
Major Connectors:
Three main criteria must be evaluated:
design
shape and size
position
A mandibular lingual bar connector should be halfpear shaped with the thickest part placed inferiorly.
It should be no narrower than 4 mm incisal-gingivally
and 1/2 the thickness of a #6 gauge sprue inferiorly.
Placement is as close to the reflection of the floor of the
mouth as possible inferiorly and at least 4 mm from
the gingival margin superiorly.
A mandibular linguoplate is used when there is insufficient room for the lingual bar. It is the same size
and shape inferiorly as the bar but it extends over the
lingual surface of the teeth to cover the contact point
and cingulum superiority.
10 - 2
10 - 3
Minor Connectors:
size
location
shape
10 - 4
10 - 5
Minor Connector
Ideal
Common Errors
Joins major connector with sharp angles
10 - 6
10 - 7
Ideal
Errors
Joins major connector at sharp angles
No taper
10 - 8
10 - 9
Ideal
Errors
Joins minor connector with sharp angles
Too thin
10 - 10
11 - 11
11 - 12
11 - 1
11 - 2
The relief wax is 26 gauge sheet wax and it is applied in the area of the lingual bar. The superior
portion is feathered and blended into the tissue,
below the height of the contact of the superior
edge of the lingual bar so that the top of the
lingual bar will contact the tissue where possible.
This is necessary to prevent food impaction, and
the superior edge does not need relief because it
does not move toward the tissue when in function. The inferior edge of the relief wax is extended all the way to the tissue reflection and kept at
its full thickness. It is extended the full length
to the lingual sulcular depth so to not limit the
position of the inferior portion of the lingual bar.
If the rotation is farther posterior, the arc of
rotation of the lingual bar changes to more of an
upward movement and so does not impinge the
tissue. If the lingual alveolar mucosa in the area
of the lingual bar is undercut, then the undercut
must have parallel blockout so the framework
will seat without tissue irritation. In addition the
area also needs relief because of the upward rotation that will impinge the tissue.
4. The area under the retention latticework
needs relief for the attachment of the resin base.
One thickness of 26 gauge wax is applied to the
ridge beyond the involved area so to not limit
the placement of the latticework. The relief wax
ends abruptly at a right angle at the finish line
to create the internal finish line.
11 -3