1. Although replacement of missing teeth by means of fixed partial dentures, either tooth - or implant supported is the method of choice.
There are many reasons why a removable partial denture is the better method of treatment for a specific patient.
DIFFERENTIAL DIAGNOSIS: FIXED OR REMOVABLE PARTIAL DENTURE
Ultimately the economic limitations and personal desires of the patient, is the choice of treatment

2. Although re placement of missing teeth by means of fixed partial dentures, either tooth - or implant-supported, is generally the method of choice, there are many reasons why a removable partial denture is the better method of treatment for a specific patient.
Ultimately, the choice of treatment must meet the economic limitations and personal desires of the patient.

3. . The exception to this guideline is the Class III arch with a modification space on the opposite side of the arch , which will provide better cross- arch stabilization and a simpler design for the removable partial denture.
unilateral tooth loss is sometimes inappropriately treated by removable partial denture
. This type of prosthesis docs not benefit from:
1-cross- arch stabilization
2-places excessive stress on abutment teeth.
3- Possibly more importantly, there is a Significant risk for aspiration if such a prosthesis is dislodged during use.

4. Modification Spaces
Design for removable restoration is greatl y simplified, resulting in significantly enhanced stability.

5. Indications for Use of Fixed Restorations:
1-Tooth-Bounded Edentulous Regions
any unilateral edentulous space bounded by teeth suitable for use as abutments should be restored with a fixed partial denture cemented to one or more abutment teeth at either end. The length of the span and the periodontal support of the abutment teeth will determine the required number of
abutments.

6. There are two specific contraindications for use of unilateral fixed restoration
One is a long, edentulous span with abutment teeth that would not be able to withstand the trauma of non axial occlusal forces. The other is abutment teeth that exhibit
reduced periodontal support because of periodontal
disease that would benefit from cross-arch stabilization.
In either situation a bilateral removable restoration
can be used more effectively.

7. Modification Spaces
Design for removable restoration is greatl y simplified, resulting in significantly enhanced stability.

8. by means of a fixed partial denture. This acts to stabilize
when a lone-standing, single-rooted abutment binds a modification space, it is better restored
by means of a fixed partial denture. This acts to stabilize
the at-risk tooth, and the denture is made less
complicated by not having to include other abutment
teeth for the support and retention of an additional
edentulous space
When an edentulous space that is a modification
of either a Class I or Class II arch exists anterior to a
lone-standing abutment tooth, this tooth is subjected
to trauma by the movements of a distal extension
removable partial denture far in excess of its
ability to withstand such stresses. The splinting of
the lone abutment to the nearest tooth is mandatory.

9. 2-Anterior Modification Spaces

10. Usually, any missing anterior teeth in a partially edentulous arch, are best replaced by means of a fixed restoration.There are exceptions:
.Kennedy Class IV arch , Sometimes a better esthetic result is obtainable when the anterior replacements are supplied by the removable partial denture.
. treatment is simplified by inclusion of an anterior modification space into the removable partial denture.
. excessive tissue and bone resorption necessitates the placement
of the pontics in a fixed partial denture too far palataly for good esthetics or for an acceptable relation with the opposing teeth.

12. 3-Replacement of Unilaterally Missing Molars (Shortened Dental Arch)
To restore the missing molars with a fixed partial denture would require a cantilever prosthesis or the use of dental implants. A cantilever fixed prosthesis is most applicable
if the second molar is to be ignored.

13. then only first molar occlusion need be supplied by using a cantilever-type fixed partial denture. The cantilevered pontic should be narrow buccolingually and need not occlude with more than one half to two thirds of the opposing tooth. Often, such a restoration is the preferred method of treatment. However, at least two abutments should be used to support a cantilevered molar opposed by a natural molar
Unilaterally missing molars. If the patient exhibits opposing contacts to the remaining 6 posterior teeth (bilateral premolars, right first and second molars), there may be minimal functional gain from replacing the left molars., By contrast, the functional gain from replacement of the posterior occlusion in this palient is likely significant.

14. To replace unilaterally missing molars with a removable partial denture necessitates use of a distal extension prosthesis. This involves the major connector joining the edentulous side to retentive and stabilizing components located on the non-edentulous side of the arch. Leverage factors are frequently unfavorable, and the retainers used on the Non-edentulous side are often unsatisfactory
factors important to consider in making the decision to provide a unilateral , distal extension removable partial denture include the opposing teeth and the future effect of the maxillary tuberosity

15. First the opposing teeth must be considered if it
is considered important to prevent extrusion and
migration. This influences the replacement of the
missing molars far more than any improvement in
masticating efficiency that might result
Second the future effect of a maxillary tuberosity
must be considered if concern exists for tuberosity
enlargement. Often when left uncovered, the
tuberosity increases in size, making future occlusal
treatment difficult. However, covering the tuberosity
with a removable partial denture base, in combination
with the stimulating effect of the intermittent
occlusion, helps maimain tubero sity size and position.
In such an instance, it may be better to make a
removable partial denture with cross-arch stabilization
and retention

16. Indications for Removable Partial Dentures
Although a removable partial denture should be considered only when a fixed restoration is contraindicated, there are several specific indications for the use of a removable restoration.
Length of span→
If many teeth missing →
Think removable
If one tooth or two teeth missing →
Think fixed

17. 1-Distal Extension Situations
Replacement of missing posterior teeth is often best accomplished with a removable partial denure), especially when implant treatment is not feasible for the patient.
The exception to this includes situations in which the replacement of missing second (and third) molars is either inadvisable or unnecessary or in which unilateral replacement of a missing first molar can be accomplished by means of a multiple -abutment cantilevered fixed restoration or an implant-supported prosthesis.

18. The most common partially edentulous situations are the Kennedy Class I and Class II. With the latter, an edentulous space on the opposite side of the arch is often conveniently present to aid in the required retention and stabilization of the removable partial denture.

19. 2-After Recent Extractions
Tissue changes are inevitable following extractions.
The replacement of teeth after recent extractions often cannot be accomplished satisfactorily with a fixed restoration. When relining will be required later or when a fixed restoration using natural teeth
or implants will be constructed later, a temporary removable partial denture can be used .

20. Tooth-bounded edentulous areas (as a result of extractions) are best initially restored with removable partial dentures. Relining of a tooth-supported resin denture base is then possible. It is usually done to improve esthetics, oral cleanliness, or patient comfort. Support for such a restoration is supplied by occlusal rests on the abutment teeth at each end of the edentulous space.

21. 3- Long Span
A long span may be totally tooth supported if the abutments and the means of transferring the support to the denture are adequate, and if the denture framework is rigid.
in the absence of cross-arch stabilization, the torque and leverage would be excessive on the two abutment teeth.
Instead, a removable denture that derives retention, support, and stabilization from abutment teeth on the opposite side of the arch is indicated as the logical means of replacing the missing teeth.

22. 4- Excessive Loss of Residual Bone
A removable partial denture will permit the location of the replaced teeth in a favorable relation to the lip and opposing dentition regardless of the
shape of the residual ridge. When such a removable prosthesis is made, however, positive support must be obtained from the adjacent abutments.

23. The pontic of a fixed partial denture must be correctly related to the residual ridge and in such a manner that the contact with the mucosa is minimal.
Whenever excessive resorption has occurred, teeth supported by a denture base may be arranged in a more acceptable buccolingual position than is possible with a fixed partial denture.
Unlike a fixed partial denture, the artificial teeth supported by a denture base can be located without regard to the crest of the residual ridge and more nearly in the position of the natural dentition for normal tongue and cheek contacts. This is particularly true of a maxillary denture

24. 5-Need for Effect of Bilateral Stabilization
In a mouth weakened by periodontal disease, a fixed restoration may jeopardize the future of the involved abutment teeth unless the multiple-abutment splinting effect is used.
The removable partial denture, on the other hand, may act as a periodontal splint through its effective cross-arch stabilizing of teeth weakened by periodontal disease.
When abutment teeth throughout the arch are properly prepared and restored, the beneficial effect of a removable partial denture can be far greater than that of a unilateral fixed partial denture.

25. Removable is usually required if :
There is a significant loss of bone.
There is a free-end saddle.
Large edentulous space.

26. 6- Unusually Sound Abutment Teeth
Sometimes the reasoning for making a removable restoration is the desire to see sound teeth preserved in their natural state and not prepared for restorations.
the dentist should not hesitate to reshape and modify existing enamel surfaces to provide optimum retentive areas, and surfaces on which non retentive stabilizing components may be placed proximal guiding planes, occlusal rest areas,

27. 7- Abutments With Guarded Prognoses If the prognosis of an abutment tooth is questionable, or if it becomes unfavorable during treatment, it might be possible to compensate for its impending loss by a change in denture design. The questionable or condemned tooth or teeth may then be included in the original design, and if subsequently lost, the removable partial denture can be modified or emade .
every diagnostic aid should be used to determine its prognosis as a prospective abutment.It is usually not as difficult to add a tooth or teeth to a removable partial denture as it is to add a retaining unit when the original abutment is lost and the next adjacent tooth must be used for that purpose.

28. 7-Economic Considerations
When for economic reasons, complete treatment is out of the questioand yet replacement of missing teeth is indicated, the restorative procedures dictated by these considerations must be described clearly to the patient as a compromise and not representative of the best that modern dentistry has to offer. Aprosthesis that is made to satisfy economic considerations alone may provide only limited success and result in more costly treatment in the future.

29. CHOICE BETWEEN COMPLETE DENTURES AND REMOVABLE PARTIAL DENTURES
1- If the expected prognosis for a given tooth is questionable,
2- the costs associated with restoration high,
3- the added benefit to the prosthesis low, the tooth should likely not be maintained unless the patient strongly desires to maintain all teeth.
4-If the expectation is that an edentulous arch would have unfavorable physical features (poor ridge form, poor arch configuration, displaceable Mucosa, high frena attachments, minimal denture-bearing area,
5- an unfavorable jaw relationship) then retention of teeth is likely to provide amore significant benefit.
6- The remaining tooth location and distribution can also impact the decision to maintain teeth. It makes a difference if the remaining teeth are located only on one side of the arch.
An additional factor to consider when deciding between a complete denture and a removable partial denture is whether there is strong patient desire to maintain teeth. As mentioned previously, because the change to a complete denture is a significant transformation, there must be sufficient discussion before making this decision. The dentist must be very clear that the patient understands the functional difference between a mucosal-borne prosthesis for all aspects of function (i.e., chewing, talking, etc.) compared with the natural dentition or a removable partial denture.

30. Indications for a complete Denture
1. Extensive bone loss and advanced periodontal disease
excessive mobility, reduced alveolar bone level
transitional denture  final denture
2. uncontrolled rampant caries decay or abscesses
3. Lack of motivation or ability to maintain teeth
4. Patient refused partial dentures
5. Lack of financial resources for alternative treatments

31. Contraindications for a complete Denture
1.Physical or mental illness affects the patient's ability to cooperate during the fabrication of the denture and to accept or wear the denture.
2.The patient is hypersensitive to denture materials.
3.The patient is not interested in replacing missing teeth.

32. Thank You!