1. Copyright 2003, Elsevier Science (USA). All rights reserved. Removable Prosthodontics Chapter 52 Copyright 2003, Elsevier Science (USA). All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher. PowerPoint ® presentation slides may be displayed and may be reproduced in print form for instructional purposes only, provided a proper copyright notice appears on the last page of each print-out. Produced in the United States of America ISBN 0-7216-9770-4

2. Copyright 2003, Elsevier Science (USA). All rights reserved. Introduction  Removable prosthodontics is the specialty of dentistry that replaces missing teeth with a removable prosthesis.  Removable partial denture, also referred to as a partial, replaces one or more teeth in the same arch.  Removable full denture, also referred to as a denture, replaces all of the teeth in one arch.  Removable prosthodontics is the specialty of dentistry that replaces missing teeth with a removable prosthesis.  Removable partial denture, also referred to as a partial, replaces one or more teeth in the same arch.  Removable full denture, also referred to as a denture, replaces all of the teeth in one arch.

3. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 52-1 Removable partial denture.

4. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 52-2 Full denture.

5. Copyright 2003, Elsevier Science (USA). All rights reserved. Extraoral Factors that Influence the Choice of a Removable Prosthesis  Physical health  Mental health  Motivation  Age  Dietary habits  Socioeconomic factors  Occupation  Physical health  Mental health  Motivation  Age  Dietary habits  Socioeconomic factors  Occupation

6. Copyright 2003, Elsevier Science (USA). All rights reserved.  Musculature  Salivary flow  Residual alveolar ridge  Oral mucosa  Oral habits  Tori  Musculature  Salivary flow  Residual alveolar ridge  Oral mucosa  Oral habits  Tori Intraoral Factors that Influence the Choice of a Removable Prosthesis

7. Copyright 2003, Elsevier Science (USA). All rights reserved. Indications for a Removable Partial Denture  To replace several teeth in the same quadrant or in both quadrants of the same arch.  As a temporary replacement for missing teeth in a child.  To replace missing teeth for patients who do not want a fixed bridge or implants.  For the patient who finds it easier to maintain good oral hygiene.  To serve as a splint to support periodontally involved teeth.  To replace several teeth in the same quadrant or in both quadrants of the same arch.  As a temporary replacement for missing teeth in a child.  To replace missing teeth for patients who do not want a fixed bridge or implants.  For the patient who finds it easier to maintain good oral hygiene.  To serve as a splint to support periodontally involved teeth.

8. Copyright 2003, Elsevier Science (USA). All rights reserved. Contraindications for a Removable Partial Denture  A lack of suitable teeth in the arch to support, stabilize, and retain the removable prosthesis.  Rampant caries or severe periodontal conditions that threaten the remaining teeth in the arch.  A lack of patient acceptance for esthetic reasons.  Chronic poor oral hygiene.  A lack of suitable teeth in the arch to support, stabilize, and retain the removable prosthesis.  Rampant caries or severe periodontal conditions that threaten the remaining teeth in the arch.  A lack of patient acceptance for esthetic reasons.  Chronic poor oral hygiene.

9. Copyright 2003, Elsevier Science (USA). All rights reserved. Components of a Partial Denture  Framework The cast metal skeleton that provides support for the remaining components of the prosthesis.  Connectors Join various parts of the partial together Major connector Minor connector  Framework The cast metal skeleton that provides support for the remaining components of the prosthesis.  Connectors Join various parts of the partial together Major connector Minor connector

10. Copyright 2003, Elsevier Science (USA). All rights reserved.  Retainer Known as a clasp, it supports and provides stability to the partial denture by partially circling an abutment tooth.  Rest A metal projection designed to control the seating of the prosthesis.  Artificial teeth Constructed from either acrylic or porcelain.  Retainer Known as a clasp, it supports and provides stability to the partial denture by partially circling an abutment tooth.  Rest A metal projection designed to control the seating of the prosthesis.  Artificial teeth Constructed from either acrylic or porcelain. Components of a Partial Denture- cont’d

11. Copyright 2003, Elsevier Science (USA). All rights reserved. Appointment Sequencing for a Partial Denture  Appointment 1: Records Updated health and dental history. Prophylaxis. Preliminary impressions. Radiographs. Photographs.  Appointment 1: Records Updated health and dental history. Prophylaxis. Preliminary impressions. Radiographs. Photographs.

12. Copyright 2003, Elsevier Science (USA). All rights reserved.  Appointment 2: Preparation Prepare the teeth. Take the final impression. Take the occlusal registration. Select the shade and mold of the teeth. Prepare the laboratory prescription.  Appointment 2: Preparation Prepare the teeth. Take the final impression. Take the occlusal registration. Select the shade and mold of the teeth. Prepare the laboratory prescription. Appointment Sequencing for a Partial Denture-cont’d

13. Copyright 2003, Elsevier Science (USA). All rights reserved.  Appointment 3: Try-in Evaluate the fit, comfort, and function of the appliance. Evaluate the shade, mold, and arrangement of the teeth. Take new occlusal registration. Note any changes on the laboratory prescription.  Appointment 3: Try-in Evaluate the fit, comfort, and function of the appliance. Evaluate the shade, mold, and arrangement of the teeth. Take new occlusal registration. Note any changes on the laboratory prescription. Appointment Sequencing for a Partial Denture-cont’d

14. Copyright 2003, Elsevier Science (USA). All rights reserved. Appointment 4: Delivery  Have patient place partial.  Check occlusion.  Detect any pressure points.  Check retainers for tension on the natural abutment teeth.  Polish partial.  Give patient home instructions. Appointment 4: Delivery  Have patient place partial.  Check occlusion.  Detect any pressure points.  Check retainers for tension on the natural abutment teeth.  Polish partial.  Give patient home instructions. Appointment Sequencing for a Partial Denture-cont’d

15. Copyright 2003, Elsevier Science (USA). All rights reserved. Home Care Instructions for a Partial Denture  Store prosthesis in water or a moist airtight container when not wearing it.  After eating, remove from mouth and brush or rinse the retainers, rests, and complete partial.  Brush and floss abutment teeth and natural teeth to keep them free of food debris and plaque.  Advise patient not to adjust the partial denture.  Store prosthesis in water or a moist airtight container when not wearing it.  After eating, remove from mouth and brush or rinse the retainers, rests, and complete partial.  Brush and floss abutment teeth and natural teeth to keep them free of food debris and plaque.  Advise patient not to adjust the partial denture.

16. Copyright 2003, Elsevier Science (USA). All rights reserved.  Appointment 5: Postdelivery check Evaluate the fit. Check the mucosa for pressure areas and sore spots. Evaluate the function of the prosthesis.  Appointment 5: Postdelivery check Evaluate the fit. Check the mucosa for pressure areas and sore spots. Evaluate the function of the prosthesis. Appointment Sequencing for a Partial Denture-cont’d

17. Copyright 2003, Elsevier Science (USA). All rights reserved. Indications for a Full Denture  The patient is edentulous.  The remaining teeth cannot be saved.  The remaining teeth cannot support a removable partial denture, and no acceptable alternatives are available.  The patient refuses alternative treatment recommendations.  The patient is edentulous.  The remaining teeth cannot be saved.  The remaining teeth cannot support a removable partial denture, and no acceptable alternatives are available.  The patient refuses alternative treatment recommendations.

18. Copyright 2003, Elsevier Science (USA). All rights reserved. Contraindications for a Full Denture  Another acceptable alternative is available.  Physical or mental illness affects the patient's ability to cooperate during the fabrication of the denture and to accept or wear the denture.  The patient is hypersensitive to denture materials.  The patient is not interested in replacing missing teeth.  Another acceptable alternative is available.  Physical or mental illness affects the patient's ability to cooperate during the fabrication of the denture and to accept or wear the denture.  The patient is hypersensitive to denture materials.  The patient is not interested in replacing missing teeth.

19. Copyright 2003, Elsevier Science (USA). All rights reserved. Components of a Full Denture  Base Designed to fit over the residual alveolar ridge and surrounding gingival area.  Flange Part of the base that extends over the attached mucosa from the cervical margin of the teeth to the border of the denture.  Base Designed to fit over the residual alveolar ridge and surrounding gingival area.  Flange Part of the base that extends over the attached mucosa from the cervical margin of the teeth to the border of the denture.

20. Copyright 2003, Elsevier Science (USA). All rights reserved.  Post dam Retention of a maxillary denture depends on the suction seal.  Artificial teeth Fabricated from acrylic or porcelain.  Post dam Retention of a maxillary denture depends on the suction seal.  Artificial teeth Fabricated from acrylic or porcelain. Components of a Full Denture-cont’d

21. Copyright 2003, Elsevier Science (USA). All rights reserved. Appointment Sequencing for a Full Denture  Appointment 1: Records Updated health and dental history. Preliminary impressions. Radiographs. Photographs.  Appointment 1: Records Updated health and dental history. Preliminary impressions. Radiographs. Photographs.

22. Copyright 2003, Elsevier Science (USA). All rights reserved.  Appointment 2: Final impression Essentials of a final impression for dentures Landmarks of the dental arches are accurately reproduced. Maxillary should include the hamular notches, post dam, tuberosities, and frenum attachments. Mandibular should include the retromolar pads, oblique ridge, outline of the mylohyoid ridge and the genial tubercles, plus the lingual, labial, and buccal frena. Laboratory prescription  Appointment 2: Final impression Essentials of a final impression for dentures Landmarks of the dental arches are accurately reproduced. Maxillary should include the hamular notches, post dam, tuberosities, and frenum attachments. Mandibular should include the retromolar pads, oblique ridge, outline of the mylohyoid ridge and the genial tubercles, plus the lingual, labial, and buccal frena. Laboratory prescription Appointment Sequencing for a Full Denture-cont’d

23. Copyright 2003, Elsevier Science (USA). All rights reserved.  Appointment 3: Try ‑ in of baseplate ‑ occlusal rim Occlusal rim records Vertical dimensions evaluated. Occlusal relationship. Smile line. Canine eminence. Select artificial teeth  Appointment 3: Try ‑ in of baseplate ‑ occlusal rim Occlusal rim records Vertical dimensions evaluated. Occlusal relationship. Smile line. Canine eminence. Select artificial teeth Appointment Sequencing for a Full Denture-cont’d

24. Copyright 2003, Elsevier Science (USA). All rights reserved.  Appointment 3: Try ‑ in of baseplate ‑ occlusal rim-cont’d Occlusal registration measurements Centric relation. Protrusion. Retrusion. Lateral excursion.  Appointment 3: Try ‑ in of baseplate ‑ occlusal rim-cont’d Occlusal registration measurements Centric relation. Protrusion. Retrusion. Lateral excursion. Appointment Sequencing for a Full Denture-cont’d

25. Copyright 2003, Elsevier Science (USA). All rights reserved.  Appointment 4: Try-in Denture is evaluated for fit, comfort, and stability. Appearance of the denture, including the shade, mold, and alignment of the teeth, is verified. Retention of the denture setup is checked as the patient verbalizes the f, v, s, and th sounds; swallows; and yawns. Occlusion of the denture is checked. Laboratory prescription for the completion of the denture is prepared.  Appointment 4: Try-in Denture is evaluated for fit, comfort, and stability. Appearance of the denture, including the shade, mold, and alignment of the teeth, is verified. Retention of the denture setup is checked as the patient verbalizes the f, v, s, and th sounds; swallows; and yawns. Occlusion of the denture is checked. Laboratory prescription for the completion of the denture is prepared. Appointment Sequencing for a Full Denture-cont’d

26. Copyright 2003, Elsevier Science (USA). All rights reserved.  Appointment 5: Delivery New denture is inserted into the patient's mouth. Shade and mold of the artificial teeth are checked for natural appearance. Patient is requested to perform facial expressions and the actions of swallowing, chewing, and speaking, using s and th sounds. Occlusion is checked. Home instructions are given.  Appointment 5: Delivery New denture is inserted into the patient's mouth. Shade and mold of the artificial teeth are checked for natural appearance. Patient is requested to perform facial expressions and the actions of swallowing, chewing, and speaking, using s and th sounds. Occlusion is checked. Home instructions are given. Appointment Sequencing for a Full Denture-cont’d

27. Copyright 2003, Elsevier Science (USA). All rights reserved.  Thoroughly rinse the oral tissues at least once daily.  All surfaces of the denture should be thoroughly cleaned with a denture brush and mild abrasive.  When dentures are not in the mouth, they must be stored in a moist, airtight container to prevent drying and warpage.  Thoroughly rinse the oral tissues at least once daily.  All surfaces of the denture should be thoroughly cleaned with a denture brush and mild abrasive.  When dentures are not in the mouth, they must be stored in a moist, airtight container to prevent drying and warpage. Home Care Instructions for a Full Denture

28. Copyright 2003, Elsevier Science (USA). All rights reserved.  Appointment 6: Postdelivery of a full denture Check the mucosa for pressure areas and sore spots. Schedule recall appointment.  Appointment 6: Postdelivery of a full denture Check the mucosa for pressure areas and sore spots. Schedule recall appointment. Appointment Sequencing for a Full Denture-cont’d

29. Copyright 2003, Elsevier Science (USA). All rights reserved. Immediate Dentures  Type of denture that is placed immediately after the extraction of a patient's remaining anterior teeth. This type of denture serves as a compress and bandage to protect the surgical site.

30. Copyright 2003, Elsevier Science (USA). All rights reserved. Construction of an Immediate Denture  Occlusal wax rims are completed with posterior teeth and tried in before extraction of anterior teeth. The denture, complete with the anterior teeth, is constructed, sterilized, and ready for placement at the time of surgery.  Surgical template Clear plastic impression tray of the anterior area that the surgeon uses as a guide in properly contouring the remaining alveolar ridge.  Occlusal wax rims are completed with posterior teeth and tried in before extraction of anterior teeth. The denture, complete with the anterior teeth, is constructed, sterilized, and ready for placement at the time of surgery.  Surgical template Clear plastic impression tray of the anterior area that the surgeon uses as a guide in properly contouring the remaining alveolar ridge.

31. Copyright 2003, Elsevier Science (USA). All rights reserved. Denture Relining  Relining is accomplished by placing a new layer of denture resin over the tissue surface of the prosthesis. Impression is taken with the present denture used as the impression tray. Patient is instructed to close-in normal occlusion. Denture and written prescription are sent to the laboratory technician for relining.  Relining is accomplished by placing a new layer of denture resin over the tissue surface of the prosthesis. Impression is taken with the present denture used as the impression tray. Patient is instructed to close-in normal occlusion. Denture and written prescription are sent to the laboratory technician for relining.

32. Copyright 2003, Elsevier Science (USA). All rights reserved. Denture Repairs  Simple repairs can be handled in the dental office laboratory by using cold ‑ cured acrylics.  Complicated repairs, particularly those involving the replacement of teeth or the complex fracture of the denture, are usually sent to the dental laboratory technician.  Simple repairs can be handled in the dental office laboratory by using cold ‑ cured acrylics.  Complicated repairs, particularly those involving the replacement of teeth or the complex fracture of the denture, are usually sent to the dental laboratory technician.

33. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig 52-19 Broken denture.

34. Copyright 2003, Elsevier Science (USA). All rights reserved. Denture Duplication  Because dentures can break or require time for relining, the patient should have a duplicate denture made.