1. Framework Adjustment

2. RPD Framework Fabrication Prepare Master Cast –Place blockout in undercuts -Below heights of contour -Minor connector & lingual plate embrasures -Soft tissue undercuts (if necessary) Prepare Master Cast –Place blockout in undercuts -Below heights of contour -Minor connector & lingual plate embrasures -Soft tissue undercuts (if necessary)

3. RPD Framework Fabrication Prepare Master Cast –Place relief -Under gridwork -Over FGM -Under mandibular major connector Prepare Master Cast –Place relief -Under gridwork -Over FGM -Under mandibular major connector

4. RPD Framework Fabrication Duplicate Master CastDuplicate Master Cast –Refractory material -Withstand casting temperature -Wax-up framework using design on secondary cast or paper equivalent -Prefabricated patterns Duplicate Master CastDuplicate Master Cast –Refractory material -Withstand casting temperature -Wax-up framework using design on secondary cast or paper equivalent -Prefabricated patterns

5. RPD Framework Fabrication Invest Refractory CastInvest Refractory Cast –Burnout wax –Cast in a chrome cobalt or other alloy –Finish & polish –Return to dentist Invest Refractory CastInvest Refractory Cast –Burnout wax –Cast in a chrome cobalt or other alloy –Finish & polish –Return to dentist

6. Partial Denture Framework Adjustment Rudd & KuebkerRudd & Kuebker –75% of frameworks don’t fit perfectly –Active - orthodontic movement –Adjust to make passive Rudd & KuebkerRudd & Kuebker –75% of frameworks don’t fit perfectly –Active - orthodontic movement –Adjust to make passive

7. Partial Denture Framework Adjustment Adjust without denture baseAdjust without denture base Adjust soon after fabricationAdjust soon after fabrication –Prevent tooth migration Adjust without denture baseAdjust without denture base Adjust soon after fabricationAdjust soon after fabrication –Prevent tooth migration

8. Preclinical Inspection Check accuracy of the framework as designedCheck accuracy of the framework as designed

9. Preclinical Inspection Framework should fit master castFramework should fit master cast –If it does not, probably will not fit intraorally Framework should fit master castFramework should fit master cast –If it does not, probably will not fit intraorally

10. Framework Evaluation Replace framework on master cast as little as possibleReplace framework on master cast as little as possible Prevent abrasion (in case of remake)Prevent abrasion (in case of remake) Replace framework on master cast as little as possibleReplace framework on master cast as little as possible Prevent abrasion (in case of remake)Prevent abrasion (in case of remake)

11. Pre-clinical Inspection Rest seats should be fully seated

12. Pre-clinical Inspection Contacting Cast: –Retentive –Reciprocal arms, –Proximal plates –Superior portion of lingual plates –All maxillary major connectors Contacting Cast: –Retentive –Reciprocal arms, –Proximal plates –Superior portion of lingual plates –All maxillary major connectors

13. Pre-clinical Inspection Framework Proportions Major & minor connectorsMajor & minor connectors –Adequate distance from abutments (hygiene) –Proper proportions (rigidity, hygiene) –Adjust or have lab adjust or remake framework Major & minor connectorsMajor & minor connectors –Adequate distance from abutments (hygiene) –Proper proportions (rigidity, hygiene) –Adjust or have lab adjust or remake framework

14. Pre-clinical Inspection Minor ConnectorsMinor Connectors –Butt joint junction slightly undercut for acrylic resin –1mm gridwork relief Minor ConnectorsMinor Connectors –Butt joint junction slightly undercut for acrylic resin –1mm gridwork relief

15. Direct Retainers Clasps have uniform taperClasps have uniform taper No Taper

16. Finish and Polish Highly polishedHighly polished No pits, nodules, scratchesNo pits, nodules, scratches No sharp edges - injure mucosaNo sharp edges - injure mucosa Highly polishedHighly polished No pits, nodules, scratchesNo pits, nodules, scratches No sharp edges - injure mucosaNo sharp edges - injure mucosa

17. Framework Adjustment ReductionReduction –Heatless Stones –Diamond burs –Brasseler E-Cutter burs –Coarse stones -Shofu coral stones -Carborundum disks ReductionReduction –Heatless Stones –Diamond burs –Brasseler E-Cutter burs –Coarse stones -Shofu coral stones -Carborundum disks

18. Framework Adjustment PolishPolish –Carborundum points & wheels –Final polish - Shofu brown & green points –Use care! PolishPolish –Carborundum points & wheels –Final polish - Shofu brown & green points –Use care!

19. Clinical Adjustment Incomplete seatingIncomplete seating Usually binding on abutmentsUsually binding on abutments Use an indicating mediumUse an indicating medium Incomplete seatingIncomplete seating Usually binding on abutmentsUsually binding on abutments Use an indicating mediumUse an indicating medium

20. Indicating Medium Aerosol Sprays (Occlude)Aerosol Sprays (Occlude) Disclosing WaxDisclosing Wax SiliconeSilicone Aerosol Sprays (Occlude)Aerosol Sprays (Occlude) Disclosing WaxDisclosing Wax SiliconeSilicone

21. Two Dimensional Indicating Medium OccludeOcclude –Thin & accurate –Not easily displaced –Can dissolve in saliva –Difficult to remove –Can’t tell how far from seating OccludeOcclude –Thin & accurate –Not easily displaced –Can dissolve in saliva –Difficult to remove –Can’t tell how far from seating

22. Three Dimensional Indicating Medium Disclosing WaxDisclosing Wax –Sets immediately –Inexpensive –Shows how far from seating –Can stick to teeth –Can be distorted Disclosing WaxDisclosing Wax –Sets immediately –Inexpensive –Shows how far from seating –Can stick to teeth –Can be distorted

23. Adjustment with Disclosing Wax Adjust areas of significant burn-throughAdjust areas of significant burn-through Completely remove wax with metal particlesCompletely remove wax with metal particles Repeat until full seatingRepeat until full seating Adjust areas of significant burn-throughAdjust areas of significant burn-through Completely remove wax with metal particlesCompletely remove wax with metal particles Repeat until full seatingRepeat until full seating

24. Adjustment with Silicone Indicating Medium Three dimensionalThree dimensional Minimal distortionMinimal distortion More expensiveMore expensive Sets relatively slowly (~ 2 min)Sets relatively slowly (~ 2 min) Can tear or pull off the frameworkCan tear or pull off the framework Three dimensionalThree dimensional Minimal distortionMinimal distortion More expensiveMore expensive Sets relatively slowly (~ 2 min)Sets relatively slowly (~ 2 min) Can tear or pull off the frameworkCan tear or pull off the framework

25. Adjustment with Silicone Medium –Use minimal amount (expense) –Cover all components contacting the abutments –Mark contacts with dampened red pencil –Remove silicone material –Adjust marked areas –Use minimal amount (expense) –Cover all components contacting the abutments –Mark contacts with dampened red pencil –Remove silicone material –Adjust marked areas

26. Framework Adjustment Initial AssessmentInitial Assessment ‘How does the framework feel?’‘How does the framework feel?’ No pulling or wedgingNo pulling or wedging –Active engagement of abutment teeth Overall comfort of the frameworkOverall comfort of the framework Initial AssessmentInitial Assessment ‘How does the framework feel?’‘How does the framework feel?’ No pulling or wedgingNo pulling or wedging –Active engagement of abutment teeth Overall comfort of the frameworkOverall comfort of the framework

27. Framework Adjustment Place indicating medium –Align the framework –Place pressure over rests –No pressure over gridworks –Check for ‘burn-through’ –Repeat Place indicating medium –Align the framework –Place pressure over rests –No pressure over gridworks –Check for ‘burn-through’ –Repeat x x x x

28. Framework Adjustment Areas of abrasion on master cast may indicate areas of bindingAreas of abrasion on master cast may indicate areas of binding

29. Cautious Adjustment Differentiate between normal & abnormal contactsDifferentiate between normal & abnormal contacts Guiding planesGuiding planes –normal: long vertical areas of contact –broad areas of severe burn- through may indicate binding Differentiate between normal & abnormal contactsDifferentiate between normal & abnormal contacts Guiding planesGuiding planes –normal: long vertical areas of contact –broad areas of severe burn- through may indicate binding

30. Cautious Adjustment Avoid excessive force - bendingAvoid excessive force - bending Heat generation could melt the acrylicHeat generation could melt the acrylic Retentive tip of direct retainersRetentive tip of direct retainers –normal: burn-through –eliminate active clasp retention Avoid excessive force - bendingAvoid excessive force - bending Heat generation could melt the acrylicHeat generation could melt the acrylic Retentive tip of direct retainersRetentive tip of direct retainers –normal: burn-through –eliminate active clasp retention

31. Ensure complete seating Most common interferences: –Under rests –Rigid portions of direct retainers –Interproximal portions of lingual plates –Interproximal minor connectors –Shoulder areas of embrasure clasps Most common interferences: –Under rests –Rigid portions of direct retainers –Interproximal portions of lingual plates –Interproximal minor connectors –Shoulder areas of embrasure clasps

32. Finalizing the adjustment Medium - thin even layerMedium - thin even layer Greyish hue from underlying metalGreyish hue from underlying metal SeatingSeating –No grating or snapping –Gliding sensation Approximately 20 minutesApproximately 20 minutes Medium - thin even layerMedium - thin even layer Greyish hue from underlying metalGreyish hue from underlying metal SeatingSeating –No grating or snapping –Gliding sensation Approximately 20 minutesApproximately 20 minutes

33. Soft Tissue Impingements Pressure-indicating pastePressure-indicating paste –Thin layer with streaks –Place with moderate pressure Pressure-indicating pastePressure-indicating paste –Thin layer with streaks –Place with moderate pressure

34. Soft Tissue Impingements Pressure-indicating pastePressure-indicating paste –Relieve areas of burn- through –Remaining streaks indicates no contact –Maxillary major connectors - broad even palatal contact Pressure-indicating pastePressure-indicating paste –Relieve areas of burn- through –Remaining streaks indicates no contact –Maxillary major connectors - broad even palatal contact

35. Remake Poor Castings Determine if casting fits similarly on the cast and intraorallyDetermine if casting fits similarly on the cast and intraorally If not, final impression inaccurateIf not, final impression inaccurate Make new impressionMake new impression Determine if casting fits similarly on the cast and intraorallyDetermine if casting fits similarly on the cast and intraorally If not, final impression inaccurateIf not, final impression inaccurate Make new impressionMake new impression

36. Framework Occlusal Adjustments Fabricated on unmounted castsFabricated on unmounted casts Occlusal interferences usually presentOcclusal interferences usually present Occlusal vertical dimension should be unchangedOcclusal vertical dimension should be unchanged Centric and eccentric contacts should be identical with or without the frameworkCentric and eccentric contacts should be identical with or without the framework Fabricated on unmounted castsFabricated on unmounted casts Occlusal interferences usually presentOcclusal interferences usually present Occlusal vertical dimension should be unchangedOcclusal vertical dimension should be unchanged Centric and eccentric contacts should be identical with or without the frameworkCentric and eccentric contacts should be identical with or without the framework

37. Framework Occlusal Adjustments Highly polished metalHighly polished metal –Articulating paper marks poorly –Check opposing occlusal contacts –Slightly roughen framework with air abrasive or rubber impregnated abrasive Highly polished metalHighly polished metal –Articulating paper marks poorly –Check opposing occlusal contacts –Slightly roughen framework with air abrasive or rubber impregnated abrasive

38. Opposing Frameworks Adjust individuallyAdjust individually Then adjust togetherThen adjust together Eliminate interferences between the frameworksEliminate interferences between the frameworks Adjust individuallyAdjust individually Then adjust togetherThen adjust together Eliminate interferences between the frameworksEliminate interferences between the frameworks

39. Occlusal Rest Thickness If ≤ 1.5 mm after adjustmentIf ≤ 1.5 mm after adjustment –Subject to fatigue –Possible fracture May require additional tooth preparation and remakeMay require additional tooth preparation and remake Last resort - occlusal reduction of opposing teethLast resort - occlusal reduction of opposing teeth If ≤ 1.5 mm after adjustmentIf ≤ 1.5 mm after adjustment –Subject to fatigue –Possible fracture May require additional tooth preparation and remakeMay require additional tooth preparation and remake Last resort - occlusal reduction of opposing teethLast resort - occlusal reduction of opposing teeth

40. Interferences on Retentive Arms Minor interferenceMinor interference –Reduce opposing cusp - last resort Heavy contactHeavy contact –Lower height of contour, remake Don’t relieveDon’t relieve –Alters flexibility and fracture resistance Minor interferenceMinor interference –Reduce opposing cusp - last resort Heavy contactHeavy contact –Lower height of contour, remake Don’t relieveDon’t relieve –Alters flexibility and fracture resistance

41. Physiologic Relief Class I & II w. long g.pClass I & II w. long g.p Normally shorter guiding planesNormally shorter guiding planes –Triangular space below height of contour –Allow for release Tipped teeth may only provide for long guiding planes (low h of c)Tipped teeth may only provide for long guiding planes (low h of c) Class I & II w. long g.pClass I & II w. long g.p Normally shorter guiding planesNormally shorter guiding planes –Triangular space below height of contour –Allow for release Tipped teeth may only provide for long guiding planes (low h of c)Tipped teeth may only provide for long guiding planes (low h of c)

42. Physiologic Relief Distal Extension CasesDistal Extension Cases –Guiding planes, minor connectors & lingual plates coated with rouge –Framework is placed under hyperfunction by pressing over the gridwork Distal Extension CasesDistal Extension Cases –Guiding planes, minor connectors & lingual plates coated with rouge –Framework is placed under hyperfunction by pressing over the gridwork

43. Physiologic Relief Relieve burn-throughRelieve burn-through –Until burn-through occurs only on the occlusal one third of the guiding planes Relieve burn-throughRelieve burn-through –Until burn-through occurs only on the occlusal one third of the guiding planes

44. Physiologic Relief Alternative Prescribe 1° reliefPrescribe 1° reliefOR Use physiologic relief, not bothUse physiologic relief, not both Prescribe 1° reliefPrescribe 1° reliefOR Use physiologic relief, not bothUse physiologic relief, not both