Introduction to Removable Partial Dentures (RPD’s) Prosthodontics Definitions Treatment Options for Partially Edentulous Treatment Sequence for RPD’s RPD Classification Clinical Anatomy Tour

Prosthodontics Maxillofacial Removable Fixed Implants Restoration or replacement of missing teeth & contiguous tissues Maxillofacial Congenital Conditions Cleft palate Acquired Conditions - Injuries - Cancer Facial & Intraoral Prostheses Removable Complete Dentures Removable Partial Dentures - Conventional - Attachment Fixed Crowns, Onlays Fixed Partial Dentures (Bridges) Implants

Treatment Objectives Oral Health Preserve remaining teeth & tissues Restore/improve: Mastication Esthetics & Phonetics Health & comfort Quality of Life

Treatment Options Partial Edentulism No Replacement Fixed Partial Denture (FPD) Removable Partial Denture (RPD) Implant crowns/FPD Extractions & Complete Denture

Treatment Option: No Replacement Shortened Dental Arch (SDA) Patients can function with as few as 20 occluding teeth No significant difference in chewing discomfort JCDA Sept 07, 73:593-4

No Replacement Shortened Dental Arch (SDA) Require Anterior teeth + 4-6 occlusal units Opposing PM’s = 1 occlusal unit Opposing M’s = 2 occlusal units Symmetric loss need 4 units Assymetric loss need 6 units

Treatment Options Partial Dentures Prosthesis replacing one or more, but not all teeth Supported by teeth (abutments) and/or mucosa May be fixed or removable Fixed Partial Denture (FPD) Removable Partial Denture (RPD)

Treatment Option: FPD Patients prefer to RPD Porcelain ± Metal Cemented Need tooth (abutment) at either end

Treatment Option: FPD Must prepare (grind down abutments) If too long, flexes, loosens or breaks More expensive

Treatment Option: RPD Removed & replaced by patient Less expensive Won’t necessarily improve function if patient has ≥ 4 occlusal units

Indications for RPD's Edentulous area too long for fixed prosthesis Longer than 4 units is more complex

No posterior abutment for a fixed prosthesis Indications for RPD's No posterior abutment for a fixed prosthesis

Excessive alveolar bone loss (esthetic problem) Indications for RPD's Excessive alveolar bone loss (esthetic problem)

Poor prognosis for complete dentures due to residual ridge morphology Indications for RPD's Poor prognosis for complete dentures due to residual ridge morphology

Indications for RPD's Reduced periodontal support of remaining teeth Won't support a fixed prosthesis)

Other Indications for RPD's Need for immediate replacement of extracted teeth Cost/patient desire considerations Cross-arch stabilization of teeth needed

Treatment Option: Complete Dentures Remaining teeth are hopeless Other options are too complex/expensive

Treatment Option: Implant Prostheses Implant Crowns Implant Bridges Implant Dentures

Partially Edentulous Treatment Options?

Definitive (permanent?) Types of RPD’s Interim Definitive (permanent?)

Interim Denture (Provisional; Temporary) Used for short time to provide: Esthetics Mastication Occlusal support

Interim Denture Partial denture made while crowns are being fabricated for a definitive RPD)

Transitional Denture Prosthesis to which teeth will be added Replaced after post-extraction tissue changes Made with intention of subsequently altering it

Definitions Retention: Resistance to removal from the tissues or teeth Stability: Resistance to movement in a horizontal direction (anterior-posteriorly or medio-laterally Support: Resistance to movement towards the tissues or teet

Definitions Abutment: A tooth that supports a partial denture. Retainer: A component of a partial denture that provides both retention and support for the partial denture

Components of an RPD Major Connector Connects parts together Principal functions: Unification Rigidity

Components of a RPD Minor Connector Connects other components to the major connector Principle functions: Unification Rigidity

Components of an RPD Direct Retainer Provides retention against dislodging forces.

Components of an RPD Direct Retainer 'Clasp' or 'clasp unit' composed of: Rest Retentive arm Reciprocal arm Minor connector

Components of an RPD Denture Base Covers the residual ridges Supports the denture teeth

Treatment Sequence for RPD’s PLAN RPD BEFORE ANY OTHER TREATMENT BEGINS Dx & Trt Plan, mounted casts Draw design on surveyed cast, list abutment modifications Instructor Approval of design prior to any treatment, other than emergencies

Partially Edentulous Arch Classification May be over 65,000 possible combinations of teeth and edentulous spaces. Facilitates communication between dentists

Kennedy Classification Bilateral edentulous areas located posterior to all remaining teeth

Kennedy Classification Class II Unilateral edentulous area located posterior to all remaining teeth

Kennedy Classification Class III Unilateral edentulous area bounded by anterior & posterior natural teeth

Kennedy Classification Class IV Single, but bilateral (crossing the midline) edentulous area located anterior to remaining teeth

Applegate's Rules for the Kennedy Classification Classification should follow rather than precede extraction

Applegate's Rules for the Kennedy Classification If 3rd molar is missing & not to be replaced, it is not considered in the classification

Applegate's Rules for the Kennedy Classification If the 3rd molar is present and to be used as an abutment, it is considered in the classification

Applegate's Rules for the Kennedy Classification If the second molar is missing and not to be replaced, it is not considered in the classification

Applegate's Rules for the Kennedy Classification The most posterior edentulous area determines the classification

Applegate's Rules for the Kennedy Classification Edentulous areas other than those determining classification are called modification spaces

Applegate's Rules for the Kennedy Classification The extent of the modification is not considered, only the number

Applegate's Rules for the Kennedy Classification There is no modification space in Class IV

Classify the Following Arches