Prosthodontics

3rd class
Lec.1 Dr. osama Alheeti

Introduction to Removable Partial Dentures

Partial Dentures
A removable partial denture or a fixed partial denture that restores a partially
edentulous arch

1.Removable partial denture (RPD): Is a prosthesis that replaces some

teeth in a partially dentate arch, and can be removed from the mouth and
replaced at will; it is either acrylic type or metallic type (cobalt/chrome)or
flexible type.

2.Fixed partial denture (FPD): A partial denture that is luted securely

retained to natural teeth, tooth roots, and /or dental implant that furnish the
primary support and retention for the prosthesis.
Removable prosthodontics:
The branch of prosthodontics concerned with the replacement of teeth and
contiguous structures for edentulous or partially edentulous patients by
artificial substitutes that are readily removable from the mouth by the
patient.

Why do we have to make a removable partial denture?

Objectives for RPD construction:
1. Restore esthetic (especially for anterior teeth).
2. Restore function (phonetic and mastication) for proper speech, proper
occlusion and proper food mastication.

3. To prevent apposing teeth extrusion or migration and tilting of adjacent

teeth.
4. To fill empty space or spaces.
5. Prevent disease atrophy by a form of stimulation to the underlying tissue
and ridge.
6. For proper muscular balance.
7. To restore the psychological status of the patient.

Indications of removable partial dentures:

1. Distal extension situations (free end situation).
2. Long span tooth-bounded edentulous area.
3. Need for cross-arch (bilateral) stabilization.
4. Excessive loss of the residual ridge.
5. Unusually sound abutment teeth.
6. If the prognosis of remaining teeth is questionable or reduced periodontal
support of remaining teeth (these teeth cannot support fixed prostheses).
7. After recent extraction (need immediate replacement of extracted teeth).
8. Patient younger than 18 years old.
9. Economic consideration.
Components of a typical removable partial denture:
1. Major connectors.
2. Minor connectors.
3. Rests.
4. Direct retainers.
5. Stabilizing or reciprocal components (as parts of a clasp assembly.
6. Indirect retainers (if the prosthesis has distal extension bases).
7. One or more dentures bases each support one to several replacement teeth

Definitions

Abutment: A tooth, a portion of a tooth, or that portion of a dental implant

that serves to support and/or retain a prosthesis.

Height of contour: A line encircling a tooth and designating its greatest

circumference at a selected axial position determined by a dental surveyor.
Undercut: The portion of the surface of an object that is below the height of
contour in relationship to the path of placement.

Guiding planes are two or more vertically parallel surfaces of abutment

teeth shaped to direct prosthesis during placement and removal.
Path of insertion (path of placement) is the specific direction in which
prosthesis is placed on the abutment teeth.

Bounded edentulous area: It is an edentulous area that is bounded and

supported by natural teeth at both ends.
Free-end edentulous area: It is an edentulous area that is bounded and
supported by natural teeth at one end.

Tooth supported: For partially edentulous patients the prosthetic options

available include natural tooth-supported fixed partial dentures, removable
partial dentures, and implant-supported fixed partial dentures.

Tooth and tissue supported: For removable partial dentures that do not
natural tooth support at each end of arch (the extension base removable
partial denture), it is necessary that the residual ridge be used to assist in the
functional stability of the prosthesis.

FINISHED
 Prosthodontics
Lec.2 Dr. osama Alheeti

Classification of Partially Edentulous Arches

A classification that is based on diagnostic criteria has been proposed recently for partial
edentulism. Several classifications of partially edentulous arches have been proposed and
are in use. This variety has led to some confusion and disagreement concerning which
classification best describes all possible configurations and should be adopted. The most
familiar classifications are those originally proposed by Kennedy, Cummer, and
Bailyn. Beckett, Godfrey, Swenson, Friedman, Wilson, Skinner, Applegate, Avant,
Miller, and others have also proposed classifications.

Need for classification:

1. To formulate a good treatment plan.

2. To anticipate the difficulties common to occur for that particular design.

3. To communicated with a professional about a case.

4. To design the denture according to the occlusal load usually expected for a particular
group.

Removable partial dentures may be classified according to the type of support into:

1. Tooth supported prosthesis: is a prosthesis or part of the prosthesis that depends

entirely on the natural teeth (abutments) for support.
For partially edentulous patients the prosthetic options available include:
- supported fixed partial dentures.
– supported removable partial dentures.
Implant - supported fixed partial dentures.
Retention is derived from direct retainers on the abutment teeth, tooth supported RPDs do
not move appreciably in function.
2. Tooth - tissue supported prosthesis: is a prosthesis or part of the prosthesis that
depends on the natural teeth (abutment) as well as the residual ridge and tissue for
support. Also called true partial denture, it includes a free end extension.

The tooth – tissue supported RPD supported at one end by natural teeth, which essentially
do not move, and at the other end by the denture bearing tissues (mucosa overlying bone)
which moves because of the resiliency of the mucosa.

3. Tissue supported prosthesis: is one which is supported entirely by mucosa and

underlying bone.

Tissue supported RPDs are primarily supported by tissues (mucosa overlying bone) of the
denture foundation area. Tissue supported RPDs usually have plastic major connectors
and are, therefore, usually interim RPDs. Tissue supported RPDs will move in function
because of the resiliency of the mucosa.

Retention for tissue supported RPDs is customarily provided by wrought wire retentive
clasp arms on selected natural teeth.

Removable partial dentures may be classified according to the type of material used
into:

1. Acrylic (Temporary RPDs): is the RPD made of acrylic and artificial teeth, retentive
wires (clasp) may be used for retention.

2. Cr/Co (Chrome/Cobalt)-metal RPDs (Definitive RPDs): is the RPD made of metal or

alloys and artificial teeth, acrylic may be used as a denture base.
Removable partial dentures may be classified according to the type of treatment:

1. Definitive RPDs:

Definitive RPDs are constructed after extensive diagnosis, treatment planning, and
through preparation of the teeth and tissue for the prosthesis. The length of service
of definitive RPDs is intended to be many years.

2. Interim RPDs:

Interim RPDs are usually constructed as part of the preparation of the mouth for
definitive RPD, FPD or implant treatment. The length of service of interim RPDs is
generally planned to be a year or less, they are frequently referred to as temporary
RPDs .

Classification based on arch configuration:

The most widely accepted system of classification of RPDs and partially edentulous
arches was proposed by Dr. Edward Kennedy in 1923.

Class I: Bilateral edentulous areas located posterior to the natural teeth.

Class II: Unilateral edentulous area located posterior to the remaining natural teeth.
Class III: Unilateral edentulous area with natural teeth remaining both anterior and
posterior to it.

Class IV: Single, but bilateral (crossing the midline), edentulous area located
anterior to the remaining natural teeth.

Edentulous areas other than those determining the basic classes were designated as
modification spaces and written as a number 1, 2, 3… depending on the number of the
extra edentulous spans. Example:

Class III, modification 2

Rules for Applying the Kennedy Classification

Rule 1: Classification should follow rather than precede extraction.

Rule 2: If the 3rd molar is missing and not to be replaced, it is not considered in the

classification.

Rule 3: If the 3rd molar is present and to be used as an abutment, it is considered in the

classification.

Rule 4: If the second molar is missing and not be replaced, it is not considered in the

classification.

Rule 5: The most posterior edentulous area determines the classification.

Rule 6: Edentulous areas other than those determining classification are called
modification spaces.

Rule 7: The extent of the modification is not considered, only the number.

Rule 8: There is no modification space in Class IV.

Examples of different partially edentulous arches cases

 Prosthodontics

Lec.3 Dr.Osama alheeti

Surveying
The ideal requirements for successful removable partial denture are:
1. Be easily inserted and removed by the patient.

2. Resist dislodging forces.

3. It should be aesthetically pleasing.

4. Avoid the creation of undesirable food traps.

5. Minimize plaque retention.

Surveying

It’s the determination of the relative parallism of two or more surfaces of the
teeth or other parts of the cast of the dental arch.

Survey

It’s the procedure of the locating and delineating the contour and position of
the abutment teeth and associated structures before designing a removable
partial denture.

Objective of surveying
In order to plane those modifications to fabricate a removable partial denture
thus can be easily inserted in the mouth and retained in place during
function.
Purposes of the Surveyor

Surveying the diagnostic cast.

Recontouring abutment teeth on the diagnostic cast.
Contouring wax patterns.
Measuring a specific depth of undercut.
Surveying ceramic veneer crowns.
Placing intracoronal retainers.
Placing internal rests.
Surveying and blocking out the master cast.

Guiding planes: two or more vertically parallel surfaces on abutment teeth

and/or fixed dental prostheses oriented so as to contribute to the direction of
the path of placement and removal of a removable partial denture,
maxillofacial prosthesis, and overdenture. They are:
A. Flat surfaces parallel to the path of insertion.
B. Represent the initial contact of the RPD.
C. Help to stabilize, control and limit the movement of the RPD.

Advantages of single path of placement (insertion):

A. Allows insertion and removal of prosthesis without interference.
B. Help to direct the force along the long axis of the tooth.
C. Provide frictional retention.
D. Minimize torque on the abutment teeth.
E. Cross arch stabilization.
F. Equalize retention.

Path of displacement: This is the direction in which the denture tends to be

displaced in function. The path is variable but is assumed for the purpose of
design to be at right angles to the occlusal plane.

Undercuts could be:

A. Desirable undercut: this is useful in to retain RPD against dislodging
forces.
B. Undesirable undercut: other than that used to retain the RPD; in most of
the case undesirable undercut interfere with placement and removal of the
prosthesis or produces damaging effects on the teeth and underlying
structures. Such type of undercut can be eliminated by:

RPD functions and requirements.

A-B, The path of placement is determined, and the base of the cast is scored
to record its relation to the surveyor for future repositioning. C, An alternate
method of recording the relation of the cast to the surveyor is known as
tripoding. A carbon marker is placed in the vertical arm of the surveyor, and
the arm is adjusted to the height by which the cast can be contacted in three
divergent locations. The vertical arm is locked in position, and the cast is
brought into contact with the tip of the carbon marker. Three resultant marks
are encircled with colored lead pencil for ease of identification.
Reorientation of the cast to the surveyor is accomplished by tilting the cast
until the plane created by three marks is at a right angle to the vertical arm of
the surveyor. D, Height of contour is then delineated by a carbon marker.

Three dots (tripoding) Parallel lines

Dental surveyor
It’s as an instrument used to determine the relative parallelism of two or
more surfaces of the teeth or other parts of the cast of a dental arch.
Types of dental surveyors
The most widely used surveyors are:
1. Ney surveyor with non-swiveling horizontal arm. The Ney surveyor
is widely used because of its simplicity and durability.
2. Jelenko surveyor with swiveling horizontal arm and has spring
mounted paralleling tool.
Parts of dental surveyor (Ney type surveyor):
A. Platform on which the base is moved.
B. Vertical arm or upright column that supports the superstructures.
C. Horizontal arm from which surveying tools suspends.
D. Survey arm.
E. Mandrel for holding special tools.
F. Tools which are used for surveying (in sequence) include: analyzing rod,
carbon marker, undercut gauges, wax trimmer.
G. Table to which the cast is attached.H. Base on which the table swivels.
Analyzing rod
A thin straight metal rod used to analyse contours and undercuts. This is the
principal tool used in surveying. This metal rod is placed against the teeth
and ridges during the initial analysis of the cast to identify undercut areas
and to determine the parallelism of surfaces without marking the cast.

Carbon marker
It’s used for the actual marking of the survey lines on the cast. A metal
shield is used to protect it from breakage.

Undercut gauge
Gauges are provided to measure the extent of horizontal undercut and are
available in the following sizes: 0.25 mm, 0.50 mm and 0.75 mm. By
adjusting the vertical position of the gauge until the shank and head contact
the cast simultaneously, the point at which a specific extent of horizontal
undercut occurs can be identified and marked.
Trimming knife
Before talking about trimming knife we have to mention about (Blocking
out the Master Cast procedure). After the path of placement and the
location of undercut areas have been established on the master cast, any
undercut areas that will be crossed by rigid parts of the denture (which is
every part of the denture framework but the retentive clasp terminals) must
be eliminated by blockout by wax.

Trimming knife: This instrument is used to eliminate unwanted undercuts

on the master cast. Wax is added to these unwanted undercut areas and then
the excess is removed with the trimmer so that the modified surfaces are
parallel to the chosen path of insertion.

Surveying procedure:
This may be divided into the following distinct phases:
Preliminary visual assessment of the study cast: This stage has been
described as ‘eyeballing’ the cast and is a use- ful preliminary to the
surveying procedure proper. The cast is held in the hand and inspected from
above.

Initial survey: The cast is positioned with the occlusal plane horizontal. The
teeth and ridges are then surveyed to identify undercut areas that might be
utilised to provide retention in relation to the most likely path of
displacement.

Analysis: An RPD can be designed on a cast which has been surveyed with
the occlusal plane horizontal (ie so that the path of insertion equals the path
of displacement). However, there are occasions when tilting of the cast is
indicated so that the paths of insertion and displacement differ.
Final survey: If it is decided that the cast should be tilted, the analysing rod
is exchanged for a marker different in colour from that used in the first
survey, and the final survey is carried out. It will then usually be found that
the teeth to be clasped have two separate survey lines which cross each
other. In order to obtain optimum retention it is necessary to understand how
to position the clasps correctly in relation to the two survey lines.
 Recording the orientation of a cast.
If the cast has been tilted for the final survey, the degree of tilt must be
recorded so that the position of the cast can be reproduced in the laboratory.
There are two methods of recording the degree of tilt.
1. Using the tripod method, the vertical arm of the surveyor is locked at
a height that allows the tip of the marker to contact the palatal surface
of the ridge in the molar and incisal regions. Three points are marked
with the graphite marker, one on each side posteriorly and one
anteriorly. The points will then be ringed with a pencil so that they are
clearly visible.

2. Alternatively, the analysing rod is placed against one side of the base of
the cast and a line drawn on the cast parallel to the rod. This is repeated on
the other side and at the back of the cast so that there are three widely spaced
lines parallel to the path of insertion.
 Prosthodontics

Lec.4 3rd class Dr.Osama alheeti

Principles of surveying
Surveying a tooth consist of locating accurately the height of its
maximum contour in relation to the plane in which the cast is positioned.
Modifying the proximal tooth surfaces so that the prosthesis goes
smooth in place without interferences.

The fact that the majority of the natural teeth crowns are bulbous in
shape (have a suprabulge region), where this suprabulge region could occur
anywhere between the occlusal surface and the gingival margin.

 When a tooth is tilted or rotated in relation to the analyzing rod, another

survey line will be traced, as a result, the extent of non-undercut area and the
undercut area are consequently changed. That means the survey line can
vary according to the angle formed by contact of the vertical analyzing rod
with the tooth surface.

Alteration of undercut area can be done by anterior or posterior tilting of

dental cast. So that the effect of tilting a cast on the surveyor will be:
1. Redistribution of undercuts to the desired areas.
2. Allow a more favorable path of insertion.
3. Allow the use of a desired type of clasp for better function and esthetics.
4. Allow the use of a design to minimize food impaction, food entrapment
and plaque accumulation.
Path of placement (Insertion)
The specific direction in which a prosthesis is placed on the residual alveolar
ridge, abutment teeth, dental implant abutment(s).
Factors that determine and affect the path of placement (insertion)
and removal of the RPD
1. Guiding Planes
Guiding planes are parallel surfaces of abutment teeth that direct the
insertion and removal of a partial denture. The path of insertion should be
parallel to guiding planes. Proximal tooth surfaces that bear a parallel
relationship to one another must either be found or be created to act as
guiding planes.
To do so this, proximal plates (part of the RPD contact guiding planes)
should, whenever possible, be the initial portions of the partial denture to
contact the abutments.

Function of guiding plane:

The denture can be easily placed and removed by the patient without
strain on the teeth contacted .
Can provide bracing or stabilization when placed in the axial tooth
surfaces.
Ensure clasp assembly function including retention and stabilization.
The friction forces of contact of prosthesis with the guiding planes wall
will contribute significantly to the retention of the RPD.

2. Retentive Areas
Retentive areas must exist for a given path of placement and must be
contacted by retentive clasp arms that are forced to flex over a convex
surface during placement and removal.
Fairly even retention may be obtained by one of two means:
Change the path of placement to increase or decrease the angle of
cervical (Gingival) convergence of opposing retentive surfaces of abutment
teeth.
Alter the flexibility of the clasp arm by changing its design, its size and
length, or the material of which it is made.
For a clasp to be retentive; its path of escapement must be other than
parallel to the path of removal of the denture itself; otherwise, it would not
be forced to flex and thereby generate the resistance known as retention.
Clasp retention therefore depends on the existence of a definite path of
placement and removal.

3. Interference
The prosthesis must be designed so that it may be placed and removed
without encountering tooth or soft tissue interference (areas of interference
like the proximal tooth undercut, maxillary or mandibular lingually or
labialy or buccally incline teeth, bony exesistosis and tissue undercuts).

A path of placement may be selected that encounters interference only if

the interference can be eliminated:
During mouth preparations.
On the master cast by a reasonable amount of blockout.

Interference may be eliminated during mouth preparations by:

Surgery.
Extraction of the tooth or teeth.
Modification of interfering tooth surfaces.
Or alteration of tooth contours with restorations
4. Esthetics
A path of insertion should be selected to provide the most esthetic placement
of artificial teeth and the least amount of visible metal on the abutment teeth.
Retentive areas must be selected to optimize retention purposes with esthetic
requirements.
Metal component must be concealed. Less metal will be displayed (most
esthetic location of clasps) if the retentive clasp is placed at a more
distogingival area of tooth surface made possible either by changing the
path of placement selected or by the contour of the restorations.

Rules of surveying
1. The undercut areas cannot be created or produced by tilting the cast.
2. All casts are originally surveyed with the occlusal plane is parallel to the
base of surveyor; this is what we called zero tilt, in which the retentive
undercut must be present on the abutment teeth.

Most patients will tend to seat the partial denture under the force of
occlusion.
If the path of insertion is other than vertical to the occlusal plane such
seating may deform the clasps. Also dislodging forces are always directed
perpendicular to the occlusal plane.
3. The retentive tip of the clasp must engage the undercut area, which are
present when the cast is surveyed in certain position.
4. Wherever possible, the undesirable undercut and area of interference are
removed during mouth preparation by recontouring teeth or making
necessary restoration.

5. Anteroposterior tilt: anterior tilt will increase the mesial undercut, while
the posterior tilt will increase the distal undercut. Such as in free end
extension partial denture tilting the cast anteriorly will decrease or eliminate
the distal undercut where the path of insertion will be changed, thus getting
rid of undesirable undercut located distally, therefore the tilting of the cast is
to minimize or equalize the undesirable undercut.

6. Lateral tilt: dealing with retentive undercut situated buccally or lingually

on posterior teeth.
Blocking out the master cast:

After the master cast has been surveyed and establishment of the path of placement and
the location of undercut areas on the master cast, any undercut areas that will be crossed
by rigid parts of the denture (which is every part of the denture framework except the
retentive clasp terminals) must be eliminated by blockout.

Blockout:- It is the elimination of the undercut areas that will be crossed by rigid parts of
the denture except the retentive clasp terminals; this step was done on the master cast
before duplication.

Deep areas in the palatal rugae and interdental spaces should also be blocked out. This
facilitates subsequent removal from the duplicate mould.

Types of blockout of master cast:

1- Parallel blockout: Parallel blockout is necessary for areas that are cervical to guiding
plane surfaces and over all undercut areas that will be crossed by major or minor
connectors. Hard inlay wax may be used satisfactorily as a blockout material. It is easily
applied and is easily trimmed with the surveyor knife. All guiding plane areas must be
parallel to path of placement, and all other areas that will be contacted by rigid parts of
denture framework must be made free of undercut by parallel blockout.
Sites of parallel blockout
Proximal tooth surfaces to be used as guiding planes.
Beneath all minor connectors.
Tissue undercuts to be crossed by rigid connectors.
Tissue undercuts to be crossed by origin of bar clasps.
Deep interproximal spaces to be covered by minor connectors or linguoplates.
Beneath bar clasp arms to gingival crevice.

2- Shaped blockout (Ledges for clasp arms):- For locating clasp patterns may or may
not be used. However, this should not be confused with the actual blocking out of
undercut areas that would offer interference to the placement of the denture framework.

Site :On buccal and lingual surfaces, to locate the wax patterns for clasp arms.

3. Arbitrary blockout: Such areas are the labial surfaces and labial undercuts not
involved in the denture design and the sublingual and distolingual areas beyond the limits
of the denture design. These are blocked out arbitrarily with hard baseplate wax, but
because they have no relation to the path of placement, they do not require the use of the
surveyor.

Arbitrary block out is done to:

1. Facilitate the removal of the cast from the impression during duplication.

2. Prevent distortion of duplicating mold when the master cast is removed.

Sites of arbitrary blockout

1. All gingival crevices.
2. Gross tissue undercuts situated below areas involved in design of denture framework.
3. Tissue undercuts distal to cast framework.
4. Labial and buccal tooth and tissue undercuts not involved in denture design.

Relieving the master cast:

It is the procedure of placing wax in certain areas on the master cast before duplication, to
create a raised area on the refractory cast.
Purpose of relief
1.To prevent tissue impingement resulting from rotation of the denture framework.
2.To prevent abrasion of the cast.
3.To create space for the acrylic resin (beneath the retentive ladder).
Sites
1.Beneath lingual bar connectors or the bar portion of the linguoplates concerning the relative
slope of the alveolar ridge.
2.Areas in which major connectors will contact thin tissue, such as hard areas so frequently
found on lingual or mandibular ridges and elevated palatal raphes and tori.
3.Beneath the ladder minor connectors for attachment of resin bases.

Duplication is the procedure of accurately reproducing a refractory cast.

Refractory cast: It is a cast made of material that will withstand high temperature without
disintegration when used in partial denture casting procedure; it has an expansion to
compensate for metal shrinkage. The refractory cast has been made of investment material.
The investment material is used for making the refractory cast; the type of investment
depends on the type of alloy used.
a- Gypsum bounded investment is used for low heat alloys as type IV gold alloy.
b- Phosphate bounded investment is used for high heat alloys as vitallium, palladium
and Co-Cr alloy.
Objectives of duplication
1.To preserve the original master cast.
2.On the duplicated cast the metal framework may be fitted without fracture or abrading
the original master cast.
 Prosthodontics
PREPARING MASTER CASTS FOR DUPLICATION

3rd class

Lec.4 Dr. osama Alheeti

During RPD metal fabrication it is necessary to have two identical casts. the first
(original) stone cast is used for acrylic partial denture fabrication and for producing the
second cast (Refractory cast) from the impression material like silicon or agar materials
that are used for modeling and making of metal partial denture frameworks.

Preparation of master model for duplication includes isolation of areas where saddles are
placed. This procedure is carried out with special wax for isolation . In edentulous area of
upper jaw the thickness of wax is 0,5 – 0,8 mm .In mandible master model when loss of
the distal teeth bilaterally presents the thickness of isolation wax in edentulous areas can
be up to 2 mm .

Fig. 1. Wax isolation of alveolar ridge (the position of the saddles) in upper jaw (1) and
lower jaw(2) and notch forming for transfer of clasps position on the refractory model (3)

Blocking out the master cast:

After the master cast has been surveyed and establishment of the path of placement and
the location of undercut areas on the master cast, any undercut areas that will be crossed
by rigid parts of the denture (which is every part of the denture framework except the
retentive clasp terminals) must be eliminated by blockout.

Blockout:- It is the elimination of the undercut areas that will be crossed by rigid parts of
the denture except the retentive clasp terminals; this step was done on the master cast
before duplication.
Deep areas in the palatal rugae and interdental spaces should also be blocked out. This
facilitates subsequent removal from the duplicate mould.

Types of blockout of master cast:

1- Parallel blockout: Parallel blockout is necessary for areas that are cervical to guiding
plane surfaces and over all undercut areas that will be crossed by major or minor
connectors. Hard inlay wax may be used satisfactorily as a blockout material. It is easily
applied and is easily trimmed with the surveyor knife. All guiding plane areas must be
parallel to path of placement, and all other areas that will be contacted by rigid parts of
denture framework must be made free of undercut by parallel blockout.

Sites of parallel blockout

Proximal tooth surfaces to be used as guiding planes.
Beneath all minor connectors.
Tissue undercuts to be crossed by rigid connectors.
Tissue undercuts to be crossed by origin of bar clasps.
Deep interproximal spaces to be covered by minor connectors or linguoplates.
Beneath bar clasp arms to gingival crevice.
2- Shaped blockout (Ledges for clasp arms):- For locating clasp patterns may or may
not be used. However, this should not be confused with the actual blocking out of
undercut areas that would offer interference to the placement of the denture framework.

Site :On buccal and lingual surfaces, to locate the wax patterns for clasp arms.

Wax ledge for reciprocal clasp arm as cervical as possible also ledge for location of
retentive clasp arm, ledge is applied below the survey line around the abutment teeth.
Wax ledges on buccal surfaces of premolar and molar abutments have been duplicated in
refractory the cast for exact placement of clasp molar pattern and the premolar wrought
wire clasp.

3. Arbitrary blockout: Such areas are the labial surfaces and labial undercuts not
involved in the denture design and the sublingual and distolingual areas beyond the limits
of the denture design. These are blocked out arbitrarily with hard baseplate wax, but
because they have no relation to the path of placement, they do not require the use of the
surveyor.

Arbitrary block out is done to:

1. Facilitate the removal of the cast from the impression during duplication.

2. Prevent distortion of duplicating mold when the master cast is removed.

Sites of arbitrary blockout

1. All gingival crevices.
2. Gross tissue undercuts situated below areas involved in design of denture framework.
3. Tissue undercuts distal to cast framework.
4. Labial and buccal tooth and tissue undercuts not involved in denture design.

Relieving the master cast:

It is the procedure of placing wax in certain areas on the master cast before duplication,
to create a raised area on the refractory cast.

Purpose of relief
1.To prevent tissue impingement resulting from rotation of the denture framework.
2.To prevent abrasion of the cast.
3.To create space for the acrylic resin (beneath the retentive ladder).

Sites
1.Beneath lingual bar connectors or the bar portion of the linguoplates concerning the
relative slope of the alveolar ridge.
2.Areas in which major connectors will contact thin tissue, such as hard areas so
frequently found on lingual or mandibular ridges and elevated palatal raphes and tori.
3.Beneath the ladder minor connectors for attachment of resin bases.

Tissue stops:- Tissue stops are represented as (2 mm x 2 mm) square cut in the relief
wax over the ridge in distal extension areas. Tissue stops are integral parts of minor
connectors designed for retention of acrylic resin bases. They provide stability to the
framework during the stages of transfer and processing.
Preparing the finishing margins (Beading):- The finishing margins of the transversal
connector marked on the model are ground to a maximum depth of 0.5 mm with a 1 mm
round bur. This increases the suction of the denture. The prepared finishing margins are
trimmed towards the plate to avoid any sharp edges or pressure points. Used only on
maxillary design.

Duplication is the procedure of accurately reproducing a refractory cast.

Refractory cast: It is a cast made of material that will withstand high temperature
without disintegration when used in partial denture casting procedure; it has an expansion
to compensate for metal shrinkage. The refractory cast has been made of investment
material.
The investment material is used for making the refractory cast; the type of investment
depends on the type of alloy used.
a- Gypsum bounded investment is used for low heat alloys as type IV gold alloy.
b- Phosphate bounded investment is used for high heat alloys as vitallium, palladium
and Co-Cr alloy.

Objectives of duplication
1.To preserve the original master cast.
2.On the duplicated cast the metal framework may be fitted without fracture or abrading
the original master cast.

Duplication procedure:-
1- Mount master cast to the middle of the flask base with sticky wax. Ensure that there is
a uniform gap (approx. 1 cm) between the model and the edge of the sleeve so that the
silicone mold has adequate stability. Seat body of flask.
2- Prepare silicone or agar we two types of duplication materials
a- For the duplicating silicone (irreversible material) is mixed bubble free in a vacuum
mixer according to the manufacturer‘s instructions for use.
b- or using agar ( reversible hydrocolloid that are capable of being reused up to four
times, they may be prepared and stored in an automatic duplicating machine. The clean
colloid can be used by cutting it into small pieces, reheated in this double boiler to a fluid
consistency, then tempered to a working temperature, it will be cooled enough to flow
easily without melting the blocked out wax (63°C).

3- Filling the flask with silicone or agar

4- After hardening remove the master cast from the agar mold. Ensure that no wax
sections are left in the duplicate mold.
5- Spray the duplicate mold with silicone wetting agent to avoid bubbles forming in the
investment model. The Cr-Co investment is mixed bubble free in a vacuum mixer
according to manufacturer‘s instructions.

6- Poured the investment slowly into the duplicate mold with the aid of a vibrator. It is
important to use the correct oscillation mode for the material at the optimum level of
vibration to ensure that the model is poured without bubbles. The model can be carefully
removed after the investment has set.

The end of the lecture

 Prosthodontics
3rd class Lec.5 Dr.osama Alheeti

Component Parts of a Removable Partial Denture

The removable partial denture consists of seven main components and these are
essential for the success of the treatment for the partially edentulous patient.

1. Major connectors

2. Minor connectors

3. Rests

4. Direct retainers

5. Reciprocal components

6. Indirect retainers

7. denture bases (each supporting one to several replacement teeth)

Figure 1: 1, lingual bar major connector;

2a, minor connector by which the resin
denture base will be attached; 2b, minor
connector, proximal plate, which is part
of clasp assembly; 2c, minor connector
used to connect rests to major
connectors; 3, occlusal rests; 4, direct
retainer arm, which is part of the total
clasp assembly; 5, stabilizing or
reciprocal components of clasp
assembly

Major connectors

A major connector is the component of the partial denture that connects the parts of
the prosthesis located on one side of the arch with those on the opposite side .
 Maxillary major connector

To function effectively and minimize potentially damaging

effects, all major connectors must:

1. Be rigid.
A flexible major connector may cause severe damage to the hard and soft tissues of
the oral cavity. Flexibility allows forces to be concentrated on individual teeth and
segments of the residual ridges. This may lead to tooth mobility or tooth loss. The
concentration of forces upon small segments of the residual ridges may cause
resorption of the hard and soft tissues. This may result in decreased ridge height and
decreased support for the associated denture bases.

2. Protect the associated soft tissues.

The Major connector must not permit impingement upon the free gingival margins
of the remaining teeth.

3. Provide a means for obtaining indirect retention where indicated.

Removable partial denture that is not supported at each end of an edentulous space
tends to rotate about a fulcrum line. The most common method for controlling this
movement is through the use of one or more indirect retainers. For practical
purposes, indirect retainers will always take the form of rests.
 4. Provide a means for placement of one or more denture bases.
Generally, the type of major connector will be dictated by the number and location
of edentulous areas.

5. Promote patient comfort.

slope of a
prominent iuga. (b) The anterior border of the major connector should be terminated on the
posterior slope.

The edges of a major connector should be contoured to blend with the oral tissues.
This is particularly true for major connectors that cross the anterior palate.

The major connector is a component part of the removable partial denture, as

mentioned earlier. The chief functions of a major connector are to

1) unify the major parts of the prosthesis.

2) distribute the occlusal force throughout the arch

3) cross-arch stabilization to minimize the torque to the teeth.

Major connectors should be designed with the following guidelines in

mind:

1. Major connectors should be free of movable tissue.

2. Impingement of gingival tissue should be avoided.

 4 mm

3. The borders of the major connector should run parallel to the gingival
margins of the remaining teeth .

Figure: The border s of the major

connector should run parallel to the
gingival margins of the remaining
teeth.

4. The major connector should be as a symmetrical as possible.

Figure: The borders of a maxillary major

connector should always cross the palatal
midline at 90 degrees.
5. Bony and soft tissue prominences should be avoided during placement and
removal .

Figure: Coverage of tori should be

avoided if possible. The tissues covering
tori are extremely thin and susceptible
to irritation.

6. The major connector should show smooth, rounded . Sharp angles and
comers may cause patient discomfort and produce areas of stress
concentration within a removable partial denture framework..

Figure : All major connectors should

exhibit smooth rounded
,

7. Relief should be provided beneath a major connector to prevent its settling

into areas of possible interference, such as an elevated median palatal suture.

8. Major connectors should be located and/or relieved to prevent impingement

of tissue that occws because the distal extension denture rotates in function
in the mandible.
 Maxillary Major Connectors
The four types of maxilla major connectors include the following:

1. Single palatal strap and Single palatal bar.

2. Combination anterior and posterior palatal strap (Anterior-posterior

palatal bars).

3. Palatal plate-type connector.

4. U-shaped palatal connector/ Horse-shoe.

1- Single palatal strap and Single palatal bar.

Indications

1- Posterior bilateral edentulous spaces of short span in a tooth-supported

restoration.

2- It may also be used in tooth-supported unilateral edentulous situations

with provision for cross-arch attachment by extracoronal retainers.

Contraindications

1- Tooth-tissue supported removable partial denture.

2- Presence of palatal tori.

3- Extremely long edentulous span. Anteroposterior major connector would

be better.
ADVANTAGES

1- Very simple design.

2- Very few metal-tissue edges.

DISADVANTAGES

It covers a considerable portion of the palate.

Characteristics and Location

(1) Anatomic replica form.

(2) Anterior border follows the valleys between rugae as nearly as possible
at right angles to median suture line.

(3) Posterior border is well anterior to the vibrating line, at right angle to
median suture line.

(4) Strap should be 8 mm wide or approximately as wide as the combined

width of a maxillary premolar and first molar.

(5) In sagittal section, midportion of major connector demonstrates slight

elevation to provide rigidity. Such thickness of major connector does not
appreciably alter palatal contours.

connector component of less than 8 mm in width is called palatal bar.

2- ANTERIO-POSTERIOR PALATAL STRAP

It is a rigid palatal major connector. The anterior and posterior palatal strap
combination may be used in almost any maxillary partial denture design.
The strength of this major connector design lies in the fact that the anterior
and posterior components are joined together by longitudinal connectors on
either side, forming a square or rectangular frame.

Indications

(1) In Class I and II arches in which excellent abutment and residual ridge
support exists, and direct retention can be made adequate without the need
for indirect retention from palate (palatal plate).

(2) Long edentulous spans in Class II mod. 1 arches.

(3) In Class IV arches in which anterior teeth must be replaced with a

removable partial denture.

(4) Inoperable palatal tori that do not extend posteriorly to the junction of the
hard and soft palates.

Contraindications

1- When can use simple major connector.

2- When there is large inoperable palatal torus that extends posteriorly to the
soft palate, so broad U- shaped major connector may be considered.

ADVANTAGES

The double-strap type of major connector provides the maximum rigidity

without bulk. It covers minimum of palatal tissues than full palatal coverage.
DISADVANTAGES

1- Very complex design.

2- A lot of metal-tissue edges.

3- The posterior palatal bar or strap frequently does not fit the palate closely.

4- The anterior border is frequently located in the rugae.

Characteristics and Location

(1) Parallelogram shaped and open in center portion.

(2) Relatively broad (8 to 10 mm) anterior and posterior palatal straps.

(3) Lateral palatal straps (7 to 9 mm) narrow and parallel to curve of arch;
minimum of 6 mm from gingival crevices of remaining teeth.

(4) Anterior palatal strap: anterior border not placed farther anteriorly than
anterior rests and never closer than 6 mm to lingual gingival crevices;
follows the valleys of the rugae at right angles to the median palatal suture.
Posterior border, if in rugae area, follows valleys of rugae at right angles to
the median palatal raphe.

(5) Posterior palatal connector: posterior border located at junction of hard

and soft palates and at right angles to median palatal raphe and extended to
hamular notch area(s) on distal extension side(s).

(6) Anatomic replica surface.

3- PALATAL PLATE MAJOR CONNECTOR

The words palatal plate are used to term any thin, broad, contoured palatal
coverage used as a maxillary major connector and covering one half or more
of the hard palate.

Indications of complete palatal coverage

(1) In Class II arch with large posterior modification space and some
missing anterior teeth.

(2) When relining is expected or cost is a factor.

(3) In the absence of a torus.

(4) In most situations in which only some or all anterior teeth remain.

(5) When the last remaining abutment tooth on either side of a Class I arch is
the canine or first premolar tooth, especially when the residual ridges have
undergone excessive vertical resorption.

A- One method is to use a complete cast plate that extends to the junction of
the hard and soft palates.

B- The other method is to use a cast major connector anteriorly with

retentive means posteriorly, for the attachment of an acrylic-resin denture
base that extends posteriorly to the posterior palatal seal area.
Contraindications

When less than complete palatal coverage is necessary and there are
sufficient remaining natural teeth to use a palatal plate or strap major
connector.

ADVANTAGES

1- Maximum support, retention, bracing, and direct-indirect retention from

the palate.

2- Fairly simple design.

3- Few metal teeth edges.

4- Easy to add new prosthetic teeth to framework.

5- Can be easily converted to an interim complete denture.

DISADVANTAGES

1- Covers more teeth and tissues surface than any major connector.

2- There are several design difficulties: A- The hamular notch, vibrating line
area must be included on a master cast.

B- Difficult to adjust the metal-tissue contact.

C- Difficult to reline the metal portion of palatal contact.

Characteristics and Location

(1) Anatomic replica form for full palatal metal casting supported anteriorly
by positive rest seats.

(2) Palatal linguoplate supported anteriorly and designed for the attachment
of acrylic resin extension posteriorly.

(3) Contacts all of the teeth remaining in the arch.

(4) Posterior border: terminates at the junction of the hard and soft palates;
extended to hamular notch area(s) on distal extension side(s); at a right angle
to median suture line.

4- U-SHAPED MAJOR CONNECTOR/ Horse-shoe

The U-shaped palatal major connector is the least favorable design of all
palatal major connectors.

Indications

1- A class IV partially edentulous arch.

2- A class III or class III mod.1 partially edentulous arch with anterior
edentulous spaces.

3- A partially edentulous arch with a palatal torus extends to the posterior

limit of the hard palate.

4- When several anterior teeth are to be replaced.

Contraindications

1- Where support, retention, bracing, and direct-indirect retention from the

palate is necessary.

ADVANTAGES

1- Minimal coverage of the palate.

2- Fairly simple design.

3- Fewer metal-tooth or -tissue edges than anteroposterior design.

DISADVANTAGES

1- It is not rigid as other maxillary major connectors; rigidity may be

increased by having the metal in the vertical and horizontal planes. Its lack
of rigidity (compared with other designs) can allow lateral flexure under
occlusal forces, which may induce torque or direct lateral force to abutment
teeth.

2- It covers the rugae, which are highly enervated, this make the patient
uncomfortable.

3- Impinging the gingival tissue, this leads to gingival irritation and

periodontal damage.

4- For gaining good support for U-shaped major connector, the occlusal rests
should be increase.

Characteristics and Location

Where it must be used, indirect retainers must support any portion of the
connector extending anteriorly from the principal occlusal rests. Anterior
border areas of this type of connector must be kept at least 6 mm away from
adjacent teeth. If for any reason the anterior border must contact the
remaining teeth, the connector must again be supported by rests placed in
properly prepared rest seats.

BEADING OF THE MAXILLARY CAST

It is the scribing of a shallow groove (not in excess of 0.5 mm in width or

depth) on the maxillary master cast outlining the palatal major connector
exclusive of rugae areas.

The purposes of beading are as follows:

1- To transfer the major connector design to the investment cast.

2- To provide a visible finishing line for the casting.

3- To ensure intimate tissue contact of the major connector with selected

palatal tissue.
4- Preventing food from easily dislodging the prosthesis.
 Prosthodontics
Major Connectors(2)

3rd class Dr. osama Alheeti

The major connector is the component of the partial denture that connects the parts of
the prosthesis located on one side of the arch with those on the opposite side.

Unlike maxillary major connectors, the mandibular major connectors often need relief
between the rigid metal surfaces and the underlying soft tissues. The Distal extension
removable partial denture tends to rotate during function so a moderate amount of relief
may be needed. Relief prevents the margins of the major connector from lacerating the
sensitive lingual mucosa as a result of this movement.

Bead lines are not used in combination with mandibular major connectors. Contact with
the mucosa of the mandibular arch may cause irritation, ulceration, and patient
discomfort.

Location of Major Connectors.

1. Major connectors should be free of movable tissue.
2. Impingement of gingival tissue should be avoided.
3. Bony and soft tissue prominences should be avoided during placement and removal.
5. Major connectors should be located and/or relieved to prevent impingement of tissue
that occurs because the distal extension denture rotates in function.
6. Margins of major connectors adjacent to gingival tissue should be located far enough
from the tissue to avoid any possible impingement, the superior border of a lingual bar
connector be located a minimum of 4 mm below the gingival margin.
Types of Mandibular major connectors
The following is a list of the different types of mandibular major connectors:
1 . Lingual bar
2. Lingual plate (Linguoplate)
3. Double lingual bar (Lingual bar with cingulum bar)
4. Labial bar

Of these, the lingual bar and lingual plate are used very frequently. The other mandibular
major connectors are seldom indicated, or are advocated by few practitioners.

1- Lingual Bar

The lingual bar is perhaps the most frequently used mandibular major connector .
Because of its simplicity in design and construction, a lingual bar should be used
unless one of the other connectors offers a definite advantage.

A lingual bar is indicated for all tooth-supported removable partial dentures unless
there is insufficient space between the marginal gingivae and the floor of the
mouth.

The superior border should be tapered toward the gingival tissue and the
greatest bulk should be at the inferior border which should be slightly
rounded, resulting in a contour that has a half-pear shape.
The inferior border of a lingual mandibular major connector must be
located free from the floor of the mouth.

ADVANTAGES
(1) Covers minimum surface area of teeth and tissue therefore potential for caries,
periodontal problems caused by plaque being held in contact with teeth and tissue is
minimal.
(2) It is relatively small, inconspicuously located and minimally interfere with functions,
so patient prefers lingual bar over linguplate.

Disadvantages:
1. Not as rigid as the lingual plate, sublingual bar or lingual bar with continuous
bar indirect retainer.
2. Difficult to add additional prosthetic teeth to framework.
3. Framework goes from thick (at the minor connectors) to thin (at the bar) to thick again
which is metallurgically and structurally complicated.

Indications
1- The lingual bar should be used for mandibular removable partial dentures where
sufficient space exists between the slightly elevated alveolar lingual sulcus and the
lingual gingival tissue (at least 8 mm).
2- Diastemas or open cervical embrasures of anterior teeth.
3- Overlapped anterior teeth.

Contraindications
1- When the lingual frenum is high or the space available for a lingual bar is limited (less
than 8 mm).
2- Lingually inclined teeth.
3- An undercut lingual alveolar ridge which would result in an excessive space between
the bar and the mucosa.
4- When the future replacement of one or more incisor teeth.
There are two clinically methods to determine the relative height of the floor
of the mouth to locate the inferior border of a lingual mandibular major
connector.
(1) Ask the patient to touch the vermilion border of upper lip with the tip of his tongue,
and measure the height of the floor of the mouth in relation to the lingual gingival
margins of adjacent teeth with a periodontal probe. Recording of these measurements
permits their transfer to both diagnostic and master casts.
(2) Use a special tray having its lingual borders 3 mm short of the elevated floor of the
mouth and then to use an impression material that will permit the impression to be
accurately molded as the patient licks the lips. The inferior border of the planned major
connector can then be located at the height of the lingual sulcus of the cast resulting from
such impression.

2- LINGUOPLATE
The inferior border of a lingual plate should be positioned as low in the floor of the
mouth as possible, but should not interfere with the functional movements of the tongue
and soft tissues.

The superior border of a lingual plate must be contoured to intimately contact the lingual
surfaces of the teeth above the cingula.

In addition. the lingual plate must completely close the interproximal spaces to the level
of the contact points. Sealing these spaces from the lingual aspect prevents food from
being packed into these areas. As a result of this contoming, the lingual plate should
display a scalloped appearance
Indications

1.Less than 8 mm between the marginal gingiva and the activated lingual frenum and
of the mouth.
2. Only a few remaining anterior teeth which must be contacted to provide a reference for
fitting the framework and indirect retention.
3. Undercut or parallel lingual alveolar ridge when the superior edge of a lingual bar can
not be located in close contact with the mucosa and still be at least 3 mm inferior to the
marginal gingiva.
4. Distal extension RPDs with parallel or sloped lingual alveolar ridges where a lingual
bar would rotate into the ridge when the base area rotates tissueward.
5. Mandibular tori or exostosis which must be covered by the RPD because they can not
be surgically removed or avoided in the RPD design. Relief is provided between the torus
or exostosis and the framework.

Contraindications:
1. A lingual bar may be used.
2. Overlapped anterior teeth where the undercuts in the area of the superior edge of
the plate can not be removed.
3. Lingually inclined teeth.
4. Diastemas, unless the lingual plate can have slots in it to avoid the display of metal.
5. Open cervical embrasures where the plate would be visible . A lingual bar with
continuous bar indirect retainer or a labial bar should be considered.

ADVANTAGES
1- More rigid than lingual bar.
2- Easy to add additional prosthetic teeth to framework.
DISADVANTAGES
1- Covers more teeth and tissue surface than lingual bar.
2- May be more noticeable to the patient than lingual bar.
3- May cause flaring of incisors if it contacts their cingula as the base area rotates tissue-
ward.

The linguoplate does not in itself serve as an indirect retainer. When indirect retention is
required, definite rests must be provided for this purpose. Both the linguoplate and the
cingulum bar ideally should have a terminal rest at each end, regardless of the need for
indirect retention. However, when indirect retainers are necessary, these rests may also
serve as terminal rests for the linguoplate.

The linguoplate can then be constructed so that the metal will not show through the
spaced anterior teeth. This is a modification of the linguoplate and is named "interrupted
linguoplate" or "step backs". To accomplish this, the superior border of a lingual plate
should cover the cingulum of the individual tooth. The border should extend toward the
contact area of the tooth and then turn apically, following the line angle to the level of the
gingiva. The rigidity of the major connector is not greatly altered. However, such a
design may be as much of a food trap as the continuous bar type of major connector

3. Double lingual bar (Lingual bar with cingulum bar or Kennedy bar).
The connector consists of a lingual bar plus a secondary bar resting above the cingula of
the anterior teeth. The upper and lower components of a double lingual bar are not joined
by a continuous sheet of metal. As a result, the lingual surfaces of the teeth and the
interproximal soft tissues are largely exposed .

The lower component of this major connector should display the same structural
characteristics as does a lingual bar. The upper bar should be half oval in cross section.
This bar should be 2 to 3 mm in height and I mm thick. The upper bar should not run
straight across the lingual surfaces of the teeth but should present a scalloped appearance.
The two bars should be joined by rigid minor connectors at each end. Rests should be
placed at each end of the upper bar and should be located no farther posterior than the
mesial fossae of the first premolars. Placement of these rests is intended to prevent the
bar from moving inferiorly and causing orthodontic movement of the remaining anterior
teeth.
The secondary bar supposedly acts as an indirect retainer and performs a role in the
horizontal stabilization of periodontally involved teeth. The performance of these
functions is questionable. Additionally, this major connector can create a food trap
between the two bars. The use of this type of connector is not encouraged.

Indications :
1. when a linguoplate is indicated but the axial alignment of anterior teeth is such that
excessive blackout of interproximal undercuts would be required.

2. When wide diastema exist between mandibular anterior teeth and a linguoplate would
objectionably display metal in a frontal view.

The disadvantage of this type of major connector is the tendency of the upper bar to trap
debris especially with crowding of the mandibular anterior teeth. This can be minimized
by accurate impressions and good adaptation of the upper bar to the anterior teeth. Also,
the double lingual bar may irritate the tongue and annoy the patient due to the multiple
borders and the thickness of the upper bar. Thus, a modified lingual plate major
connector may be preferred.

4. Labial Bar
As its name suggests, a labial bar runs across the mucosa on the facial surface of the
mandibular arch . Like other mandibular major connectors, a labial bar displays a half-
pear shape when viewed in cross section. But, because of its placement on the external
curvature of the mandible, a labial bar is longer than a corresponding lingual bar, double
lingual bar or lingual plate. To ensure rigidity, the height and thickness of a labial bar
must be greater than those described for a lingual bar.
In only few situations when the extreme lingual inclination of the remaining lower
premolar and incisor teeth prevent the use of a lingual bar major connector. With the use
of conservative mouth preparations in the form of recontouring and block out, a lingual
major connector can almost always be used. Lingually inclined teeth sometimes may
have to be reshaped by means of crowns. Although the use of a labial major connector
may be necessary in rare instances, this should be avoided by resorting to necessary
mouth preparations rather than by accepting a condition that is otherwise correctable.
The same applies to the use of a labial bar when a mandibular torus interferes with
placement of a lingual bar. Unless surgly is definitely contraindicated, interfering
mandibular tori should be removed so that the use of a labial bar connector may be
avoided.

Indications :
1. When lingual inclinations of remaining mandibular premolar and incisor teeth cannot
be co1Tected, preventing placement of a conventional lingual bar connector.
2. When severe lingual tori cannot be removed and prevent the use of a lingual bar or
lingual plate major connector.
3. When severe and abrupt lingual tissue undercuts make it impractical to use a lingual
bar or a lingual plate major connector.
Characteristics and Location:
1. Half-pear shaped with bulkiest portion inferiorly located on the labial and buccal
aspects of the mandible.
2. Superior border tapered to soft tissue.
3. Superior border located at least 4 mm inferior to labial and buccal gingival margins
and farther if possible.
4. Inferior border located in the labial-buccal vestibule at the junction of attached
(immobile) and unattached (mobile) mucosa.

A labial bar can be used in association with the linguoplate as a modification for the
linguoplate. This concept is incorporated in the Swing-Lock design, which consists of a
labial or buccal bar that is connected to the linguoplate major connector by a hinge at one
end and a latch at the other end.
Support is provided by multiple rests on the remaining natural teeth. Stabilization and
reciprocation are provided by a linguoplate that contacts the remaining teeth and are
supplemented by the labial bar with its retentive struts. Retention is provided by a bar
type of retentive clasp with arms projecting from the labial or buccal bar and contacting
the infra-bulge areas on the labial surfaces of the teeth.

Use of the Swing-Lock concept would seem primarily indicated when the following
conditions are present:
1) Missing key abutments
2) Unfavorable tooth contours
3) Unfavorable soft tissue contours
4) Teeth with questionable prognoses.
Contraindications to the use of this hinged labial bar concept are poor oral hygiene or
lack of motivation for plaque control by the patient, the presence of a shallow buccal or
labial vestibule, & a high frenal attachment.

FINISHED
 Prosthodontics
3rd class

Lec.7 Dr. osama Alheeti

MINOR CONNECTORS
Minor connectors: the connecting link between the major connector or
base of a removable partial denture and the other units of the prosthesis,
such as the clasp , indirect retainers or rests.

FUNCTIONS OF MINOR CONNECTORS

purposes.
1- To transfer functional stress to the abutment teeth. This is a (prosthesis-to-
abutment function) of the minor connector.
2- To transfer the effect of the retainers, rests, and stabilizing components
throughout the prosthesis. This is an (abutment-to-prosthesis function) of the
minor connector.
3- Provide unification and rigidity.
4- It might help in retention and stability of the prosthesis.
5- Through its connection to the guiding plane; it helps as a bracing element.
6- Share in the path of insertion and removal maintenance.
There are four types of minor connectors based on location and function:
1. Proximal minor connectors.
2. Embrasure minor connectors.
3. Surface minor connectors.
4. Denture base retention mechanism.

1. Proximal minor connectors

Proximal minor connectors contact an abutment tooth adjacent to an
edentulous space. Proximal minor connectors are usually term proximal
plates but are sometimes call guiding plates.

The functions of proximal plates are to:

(1) Connect rests and clasp arms to the major connector.
(2) Contact proximal guiding planes on the teeth thus helping to determine
the path of placement of the RPD.
(3) Prevent food impaction between the proximal surface of the tooth and
the RPD.
(4) Provide a definite finish line for the junction of the denture base and
major and minor connectors.
(5) Provide frictional retention by contact with guiding planes on the teeth.
(6) Help reciprocate the force of the direct retainer.
(8) Distribute forces (bracing).

2. Embrasure minor connectors

Embrasure minor connectors are located between two teeth. Their functions
are to:
a. Connect rests and clasp arms to the major connectors.
b. Contact interproximal guiding planes thus helping to determine the path
of placement of the RPD.
c. Provide frictional retention by contact with the guiding planes on the
teeth.
d. Help reciprocate the force of the direct retainer.
e. Unite the dental arch by substituting for lost proximal tooth contacts.
f. Distribute forces (bracing).
3- SURFACE MINOR CONNECTORS
Surface minor connectors are located on the lingual surface of incisors and
canines. They connect lingual rests to the major connector. Their junction
with the major connector is a rounded right angle and they taper toward the
occlusal (incisal). The lateral borders extend into the proximal embrasures to
hide these edges from the tongue.

4. Denture base retention mechanism

The denture base retention minor connector is the means by which the
plastic denture base is mechanically attached to the framework. There are
several types of denture base retention minor connectors:
a. Retentive mesh.
b. Retentive lattice.
c. Retentive loops.
d. Retentive bead.
e. Retentive posts.
Forms and location of minor connector
1. All types of minor connector must have sufficient bulk to be rigid;
otherwise the transfer of functional stresses to the supporting teeth and tissue
will not be effective.
2. Minor connectors placed into embrasures between two adjacent teeth
should not be located on a convex surface. Instead it should be located in an
embrasure where it will be least noticeable to the tongue.

3. Minor connector that contacts the guiding plane surface of the abutment
teeth adjacent to an edentulous space. Here the minor connector must be
broad buccolingually to use the guiding plane to the fullest advantage, and
thin mesiodistally to place a prosthetic tooth in a natural position.
4. When an artificial tooth will be placed against a proximal minor
connector, the minor connector's greatest bulk should be toward the lingual
aspect of the abutment tooth. This way sufficient bulk is ensured with the
least interference to placement of the artificial tooth.

5. It should passing vertically from the major connector and covers as little
of the gingival tissue as possible.
6. The minor connector cross the free gingival area must be relieved in order
not to impinge the tissue.
7. The deepest part of the interdental embrasure should have been blocked
out to avoid interference during placement and removal, and to avoid any
wedging effect on the contacted teeth.
8. Minor connector that covers the edentulous area to join denture base to
major connector should be completely embedded within the denture base.
9. The junctions of these mandibular minor connectors with the major
connectors should be strong butt-type joints; angles formed at the junctions
of the connectors should not be greater than 90°, thus ensuring the most
advantageous and strongest mechanical connection between the acrylic resin
denture base and the major connector.

10. Minor connector for mandibular distal extension base should extend
posteriorly about two thirds the length of the edentulous ridge. Such design
will not only add strength to the denture base but also may minimize
distortion of cured base from its inherent strains caused by processing.
11. Minor connectors for maxillary distal extension denture base should
extend entire length of the residual ridge and should be of a ladder-like or
mesh-like.

12. Minor connector for vertical projection of bar type clasp approaches the
tooth from an apical direction rather than from an occlusal direction, the
approach arm should display a smooth, even taper from its origin to its
terminus.
13. Minor connector for vertical projection of bar type clasp must not cross a
soft tissue undercut (need parallel block out).

FINISHED LECTURE
 Prosthodontics

3rd class Dr. osama Alheeti

Rest and Rest seat

Rest: - Is any rigid part of an RPD framework which contacts a properly
prepared surface of a tooth.
A rest that is part of a retentive clasp assembly is referred to as a
primary rest. The main purpose of a primary rest is to prevent vertical
movement of a prosthesis toward the tissues and also helps transmit forces
to the supporting teeth. A rest that is responsible for additional support or
indirect retention is called an auxiliary rest or secondary rest.

Rest seat: The prepared surface of an abutment to receive the rest.

Functions of the Rests:

1.Provide vertical support for the partial denture.

2.Maintains components in their planned positions.
3.Maintains established occlusal relationships by preventing settling of the
denture.
4.Prevents impingement of soft tissue.
5.Directs and distributes occlusal loads to abutment teeth.

Types of rest:
1.Occlusal rest: - A rest placed on the occlusal surface of a bicuspid or
molar.
2. Lingual (Cingulum) rest: - A rest placed on the cingulum of an anterior
tooth (usually the canine). Rests may also be placed on the lingual of
posterior teeth by creating a ledge of the tooth surface (prescribed for
surveyed crowns).
3.Incisal rest: - A rest placed on an anterior tooth at the incisal edge.

Requirements of Rests:
1. Should have sufficient thickness to avoid fracture.
2. Should be able to direct forces along the long axis of tooth.
3. Extend properly close to the center of the tooth as possible.
4. Placed in rest seats properly.
5. Must not raise the vertical dimension of occlusion.
6. In bounded partial denture: placed in the near zone of the occlusal surface
to edentulous area.
7. In free end partial dentures: placed in the far zone of the occlusal surface
to decrease torque action on abutment tooth.
8. The use of amalgam restoration to support an occlusal rest is not
recommended due to amalgam’s tendency to creep and flow under pressure.

Form or preparation of the rest and rest seat

1- Occlusal rest
1- The outline form of an occlusal rest seat should be a rounded triangular
shape with the apex toward the center of the occlusal surface.

2- The base of the triangular shape is at the marginal ridge and should be
approximately one third the bucco-lingual width of the tooth.

3- The marginal ridge must be lowered and rounded to permit a sufficient

bulk of metal to prevent fracture of the rest from the minor connector (1 to
1.5 mm).

4- The floor of the occlusal rest seat should be apical to the marginal ridge
and the occlusal surface and should be concave, or spoon shaped.
5- The floor of the rest seat should be inclined towards the centre of the
tooth, so that the angle formed by the rest and the minor connector should be
less than 90°. This helps to direct the occlusal forces along the long axis of
the tooth.
A clinician can test to see if a rest seat is ‘positive’ (i.e. <90°) by trying to
slide an explorer tip off the rest seat. An angle of more than 90° fails to
transmit the occlusal forces along the long axis of the tooth and permits
movement of the clasp assembly away from the abutment and orthodontic
movement of the tooth.

A clinician can test to see if a rest seat is ‘positive’ (i.e. <90°) by trying to
slide an explorer tip off the rest seat. An angle of more than 90° fails to
transmit the occlusal forces along the long axis of the tooth and permits
movement of the clasp assembly away from the abutment and orthodontic
movement of the tooth.
2. Extended O.R.: This rest should extend more than one-half the
mesiodistal width of the tooth, should be approximately one-third the
buccolingual width of the tooth, usually used mesially tipped molars.
This rest should extend more than one-half the mesio-distal width of the
tooth, should be approximately one-third the bucco-lingual width of
the tooth.

3- Interproximal Occlusal Rest Seats

The design of a direct retainer assembly may require the use of
interproximal occlusal rests.
These rest seats are prepared as individual occlusal rest seats. The lingual
interproximal area requires only minor preparation. Creation of a vertical
groove must be avoided to prevent a torqueing effect on the abutments by
the minor connector. This is especially true for RPDs with distal extension
bases.

The advantages of such occlusal rests are:

1) Prevent interproximal wedging by the framework.

2) The joined rests shunt food from contact points

 Internal Occlusal Rests:
They are used for a partial denture that is totally tooth supported for both
occlusal support and horizontal stabilization . They must be used in
association with a crown on the abutment tooth. An internal occlusal rest
should not be confused with an internal attachment.
The main advantages of the internal rest are:
1) The clasp arm buccally is not visible. Retention is provided by a
lingual clasp arm.
2) Permits the location of the rest seat in a more favorable position
in relation to the tipping axis (horizontal) of the abutment.

Occlusal Rests on Amalgam Restorations

It is always better to place an occlusal rest on sound enamel or cast
restoration. Sometimes a conservative amalgam restoration may be used
to support removable partial denture, but advantages and
disadvantages of such treatment should be carefully considered.
As for a large ama1gam restoration, it is easier to place an occlusal
rest on a large amalgam restoration because an amalgam restoration costs
less than a crown. However, the disadvantages are greater than the benefits
so this is not advisable.
The flow characteristics and poor tensile characteristics of amalgam
increase the possibility of restoration failure. Amalgam alloys tend to
deform when a sustained load is applied and this may result in fracture of
the material and failure of the restoration.
Occlusal Rest on Crowns
All-ceramic restorations should not be used to support removable partial
dentures, via rests, because of the undesirable physical characteristics of
ceramics. Ceramic materials are relatively strong in compression, but Weak
 in tension and any wedging or elongation of a ceramic surface often lead to
fracture.
Metal -ceramic restorations can be used but it is recommended that rest
seats be constructed entirely in metal. The metal borders should extend at
least 1 mm beyond the borders of the rest (in all directions).

4- Lingual Rests on Canines and Incisor Teeth

If an anterior tooth is sound and the lingual slope is gradual rather than
perpendicular, a lingual rest sometimes may be placed in an enamel seat at
the cingulum or just incisally to the cingulum. This type of lingual rest is
usually confined to maxillary canines that have a gradual lingual incline and
a prominent cingulum.
A slightly rounded V is prepared on the lingual surface at the junction of the
gingival and the middle one third of the tooth. The apex of the V is directed
incisally. The proximal view demonstrates the correct angulation of the floor
of the rest seat (< 90°).

The most satisfactory lingual rest from the standpoint of support is one that
is placed on a prepared rest seat in a cast restoration.
 The preparation of an anterior tooth to receive a lingual rest is
accomplished in two ways:
First method: A slightly rounded V-shape prepared on the lingual surface
at the junction of the gingival and the middle one third of the tooth The
apex of the V is directed incisally. The mesio-distal length of the
preparation should be a minimum of 2.5 to 3 mm, labia-lingual width
about 2 mm, and incisal-apical depth a minimum of 1.5 mm. This
preparation of the tooth starts with an inverted cone shapedbur .

Second method: A ball type of rest may be used in a prepared seat .Round
rest seats are occasionally prepared on the mesial side of the canine when
the use of a typical cingulum rest is contraindicated (i.e. large
restoration, lack of clearance with the opposing teeth, poorly developed
cingulum ). The seats of these rests are prepared in the same manner as
that of the occlusal rest seats.

5- Incisal Rests and Rest Seats

Incisal rests are placed at the incisal angles of anterior teeth and on prepared
rest seats.
Although this is the least desirable placement of a rest seat for reasons
previously mentioned. Therefore incisal rests generally are placed on
enamel. Incisal rests are used predominantly as auxiliary rests or as indirect
retainers. It is more applicable to the mandibular canine.
 An incisal rest seat is prepared in the form of a rounded notch at the incisal
angle of a canine or on the incisal edge of an incisor, with the deepest
portion of the preparation apical to the incisal edge

A. Implants as a Rest

Implants can serve as a rest, since they resist tissue-ward movement

and are useful for retentive needs as well. Their use allows a low
profile connection (i.e., close to the ridge), and less torque to the
implant.
 Prosthodontics

3rd class Dr. osama Alheeti

DIRECT RETAINERS
which are clasp assemblies or attachments applied to an abutment tooth to retain an RPD
in position. A CLASP ASSEMBLY is the part of an RPD that acts as a direct retainer for
the prosthesis by partially contacting an abutment tooth. The CLASP is the component of
the clasp assembly that engages a portion of the tooth surface and either enters an
undercut for retention or remains entirely above the height of contour to act as a
reciprocating element.

Requirements of a Direct Retainer:

1. Retention
Retention is provided by the retentive arm which prevents the partial denture
from displacement away from the tissues toward the occlusal.

2. Support
Resistance to gingival displacement (occlusal rests). Support in a clasp is
generally provided by the rest.

3. Stability
Resistance to lateral movement (reciprocal arms, minor connectors). When
the direct retainer comes into contact with the tooth, the framework must be
stabilized against horizontal movement for the required clasp deformation to
occur.

4. Reciprocation
Resistance to orthodontic movement of teeth using reciprocal arms or
elements placed against guiding planes (PP).

5. Fixation
Prevents the prosthesis from moving away from the tooth. Fixation of a
clasp assembly is provided by having the components of the clasp assembly
encircle at least 180 degrees of the abutment tooth's circumference. Fixation
of a clasp assembly is frequently calling ENCIRCLEMENT.

6. Passivity
Direct retainers should not exert forces on the abutment teeth when the RPD
is seated. They should be PASSIVE when the RPD is seated. Forces should
occur only when the denture is being seated or removed.

They are of two types:-

1. Clasps designed without movement accommodation.
2. Clasps designed to accommodate distal extension functional movement

Clasps designed without movement accommodation: (Supra bulge

clasps) or occlusally approach clasp since the clasp approaches the retentive
undercut from the occlusal direction.
Clasps for tooth-borne partial dentures (Class III, IV) have one function – to
prevent dislodgment of the prosthesis without damage to the abutment teeth.
These clasps can also be used in modification spaces for tooth and tissue
supported removable partial dentures (Class I, II).

1.Circumferential (Circle or Akers) clasp:

It is the most logical clasp to use with a tooth-supported partial denture.
The circumferential clasp will be considered first as an all-cast clasp and it
is the simplest one.
 The basic form of the circumferential clasp is a buccal and lingual arm
originating from a common body (principle occlusal rest and minor
connector).
The circumferential clasp has only one retentive clasp arm, opposed by a
nonretentive reciprocal arm on the opposite side.

Indications:
1.It is a most logical clasp to use with all tooth-supported partial dentures
because of its retentive and stabilizing ability.
2.On free end extension when minimal undercut is utilized.

Contraindication:
1.When the retentive undercut may be approached better with a bar clasp
arm.
2.When esthetics will be enhanced by using bar clasp arm.
Advantages:
1.Excellent bracing qualities.
2.Easy to design and construct.
3.Less potential for food accumulation below the clasp compared to bar
clasps.
Disadvantages:
1.More tooth surface is covered than with a bar clasp arm because of its
occlusal origin.
2.In the mandibular arch, more metal may be displayed than with the bar
clasp arm.
3.Its half-round form prevents adjustment to increase or decrease retention.
True adjustment is impossible with most cast clasps.

2. Ring clasp
a. Encircles nearly the entire abutment tooth.
b. Usually used with mesially and lingually tilted mandibular molars (with a
M-L undercut) or mesially and buccally tilted maxillary molars (with a M-B
undercut).
c. Should always be used with a supporting strut on the non-retentive side
with an auxiliary occlusal rest on the opposite side.

Advantages:
a. Excellent bracing (with supporting strut).
b. Allows use of an available undercut adjacent to edentulous area.
Disadvantages:
a. Covers a large area of tooth surface, therefore requiring meticulous
hygiene.
b. Very difficult to adjust due to the extreme rigidity of the reciprocal arms.

Contraindications: excessive tissue undercuts prevent the use of a

supporting strut.

3. Embrasure (double Akers) clasp:

The embrasure clasp always should be used with double occlusal rests,
even when definite proximal shoulders can be established. This is done to
avoid interproximal wedging by the prosthesis, which could cause separation
of the abutment teeth and result in food impaction and clasp displacement.
In addition to providing support, occlusal rests also serve to shunt food
away from contact areas.

Advantages:
a. Allows placement of direct retainer where none could otherwise be placed
(especially contralateral to the edentulous span on a Class II case).
Disadvantages:
a. Extensive interproximal reduction is usually required.
b. Covers large area of tooth surface - hygiene considerations.

Other less commonly used modifications of the cast circumferential clasp

are:

a.Reverse-action clasp (Hairpin):

Ring clasp or bar clasp originating on the opposite side of the tooth can be
used with the same result getting from reverse- action clasp.

Advantage:
Clasp arm is designed to permit engaging a proximal undercut (undercut
adjacent to edentulous space) from an occlusal approach.

Disadvantages:
1.Esthetically objectionable when using an anterior abutment.
2.The clasp covers a considerable tooth surface and may trap debris.
3.Almost impossible to adjust.
4. Difficult to fabricate.
5.Insufficient flexibility on short crowns due to insufficient clasp arm length.

Indications:
1. When a proximal undercut must be used on a posterior abutment and
when tissue undercuts, tilted teeth or high tissue attachments prevent the use
of a bar clasp arm.
2.When lingual undercuts may prevent the placement of a supporting strut
(of ring clasp) without tongue interference.
b. Back action clasp:
o The back-action clasp is a modification of the ring clasp.
o It is used on premolar abutment anterior to edentulous space

c. Multiple clasps:
The multiple clasps are simply two opposing circumferential clasps joined at
the terminal end of the two reciprocal arms.

Indications:
o It is used when additional retention and stabilization are needed, usually
on tooth-supported partial dentures.
o It may be used for multiple clasping in instances in which the partial
denture replaces an entire half of the dental arch.
o It may be used rather than an embrasure clasp when the only available
retentive areas are adjacent to each other.
Disadvantage:
o Its disadvantage is that two embrasure approaches are necessary rather
than a single common embrasure for both clasps.

d. 3. Half-and-half Clasp:
o It is consists of a circumferential retentive arm arising from one direction
and a reciprocal arm arising from another.
o The second arm must arise from a second minor connector, and this arm
is used with or without an auxiliary occlusal rest.
o Its design was originally intended to provide dual retention, a principle
that should be applied only to unilateral partial denture design

o Reciprocation arising from a second minor connector usually can be

accomplished with a short bar or with an auxiliary occlusal rest, thereby
avoiding so much tooth coverage.
o There is little justification for the use of the half-and-half clasp in
bilateral extension base partial dentures.

2.Clasps designed to accommodate distal extension functional

movement(Tooth and Tissue Borne RPD's)
Tooth and tissue borne situations (Class I & II) require special attention in
direct retainer selection, due to stresses created by rotational movements of
the prostheses. Stress releasing clasp assemblies include:

1. The bar clasp with mesial rest (e.g. RPI clasp).

2. The RPA clasp.
3. The combination clasp.

Mesial rest concept clasps assemblies (RPI, RPA, and Bar clasp): These
are proposed to accomplish movement accommodation by changing the
fulcrum location to prevent harmful tipping or torquing of the abutment
tooth and prevent more denture base movement. This is concept includes
RPI and RPA clasps.

1.RPI clasp:
RPI clasps are referring to the: R = Rest always mesial, P = Proximal plate,
and I = I-bar. These are component parts of the clasp assembly.

a) The bar clasp is a cast clasp that approaches the retentive undercut from
gingival direction (as opposed to a circumferential clasp that approaches the
undercut from the occlusal direction).

b) Retentive clasps are identified by shape of retentive terminal, i.e. T, Y, L,

I, U, and S. The bar clasp arm has been classified by the shape of the
retentive terminal. Thus it has been identified as T, Y, L, I, U and S. I shape
bar is preferred than other shapes because this shape being biologically and
mechanically sound

c) T-and Y-shaped terminal ends are the most misused clasps.

d) L-shaped clasp is same as I clasp with a longer horizontal component.
e) The S-shaped terminal end is used to avoid a mesial soft tissue undercut.

Contraindications:
a) Deep cervical undercuts.
b) Severe soft tissue or bony undercuts.

2.Bar Clasp
This clasp assembly is similar to the RPI design except a wrought wire
circumferential clasp (Akers) is used instead of the I-bar. This clasp arises
from the proximal plate and terminates in the mesio-buccal undercut. It is
used when there is insufficient vestibule depth or when a severe tissue
undercut exists.

3. Combination Clasp
The combination clasp is similar to the cast circumferential clasp with the
exception that the retentive arm is fabricated from a round wrought wire
(platinum-gold-palladium alloy or chrome-cobalt alloy).

Advantages:
o The flexibility.
o The adjustability
o The esthetic appearance of the wrought-wire retentive arm over other
retentive circumferential clasp arms).
o Minimum of tooth surface covered because of its line contact with the
tooth, rather than having the surface contact of a cast clasp arm.
o A less likely occurrence of fatigue failures.
Disadvantages:
o It involves extra steps in fabrication, particularly when high-fusing
chromium alloys are used.
o It may be distorted by careless handling on the part of the patient.
o Because it is bent by hand, it may be less accurately adapted to the tooth
and therefore provide less stabilization in the suprabulge portion.
o It may distort with function and not engage the tooth.
Indications:
o When maximum flexibility is desirable, such as on an abutment tooth
adjacent to a distal extension base where only a mesial undercut exists on the
abutment or a weak abutment or where a large tissue undercut,
contraindicates a bar- type direct retainer.
o It may be used for its adjustability when precise retentive requirements
are unpredictable and later adjustment to increase or decrease retention may
be necessary.
o When esthetic required overcast clasps, because wrought -wire is round,
light is reflected in such a manner that the display of metal is less noticeable
than with the broader surfaces of a cast clasp.
Clasp selection:
Successful clasp selection depends upon many factors. The practitioner
should select a direct retainer that will control tipping and torquing forces on
the abutment teeth, provide adequate retention against normal dislodging
forces, and be compatible with the tooth and tissue contours, and satisfy the
patients esthetic and functional requirements. The most important factor is
the location of the retentive areas and placement of the survey line. The
clasp selection will depend upon where the retentive undercut is located and
how much undercut is available. If the existing undercut area is undesirable,
then the contour of the abutment tooth must be changed. The alteration in
the height of contour is accomplished through the use of fixed restorations or
enamel recontouring. These procedures will allow the clinician to ideally
place the survey line in a more desirable and functional position.
Accurate diagnostic casts are a requirement if an accurate diagnosis is to be
made regarding clasp selection. The amount of soft tissue undercut can be
determined, if present, to evaluate the possibility of using a bar clasp. The
height of the contour must be accurately marked to evaluate the survey line
and amount of retentive undercut available. This accumulation of
information will guide the practitioner in an intelligent and informed
selection of the proper clasp design.
 Prosthodontics
3rd class
Lec.11 Dr. osama Alheeti

Denture Base in RPD

Denture base: The part of a denture that rests on the foundation tissues and
to which teeth are attached.

The primary function of denture base:

1. Masticatory function as the denture base transfers the occlusal stresses to
the underlying supporting oral structures.
2. Esthetic or cosmetic function: this is related to reproduction of natural
looking contours.
3. Stimulation of the underlying tissue by massaging action during vertical
movement of the denture base under functional stresses, as this will maintain
the form and health of underlying tissue.

Types of denture base according to support:

1. Tooth supported partial denture base.
2. Tooth tissue borne partial denture base.
1- Tooth-supported Partial Denture Base
In a tooth-supported prosthesis, the denture base is primarily a span between
two abutments supporting artificial teeth. Thus occlusal forces are
transferred directly to the abutments through rests. Also, the denture base
and the supplied teeth serve to prevent horizontal migration of all of the
abutment teeth in the partially edentulous arch and vertical migration of
teeth in the opposing arch. When anterior teeth are replaced, esthetics may
be of primary importance. Future relining or rebasing may not be necessary
to reestablish support.

2.Tooth tissue borne partial denture base.

In a distal extension partial denture, the denture bases must contribute to the
support of the denture and improving prosthesis stability.
Maximum support from the residual ridge may be obtained by using broad,
accurate denture bases, which spread the occlusal load equitably over the
entire area available for such support (snowshoe principle). Therefore
support should be the primary consideration in selecting, designing, and
fabricating a distal extension partial denture base.

The edentulous area close to the terminal abutments is supported primarily

by the occlusal rest on the abutment teeth however; farther from the
abutment the support from the underlying ridges tissue becomes increasingly
important.

Maximum support from the residual ridge may be obtained by:

1. Using broad denture base.
2. Using accurate denture base.
Management of distal extension cases:
1- Using mesial rest on the last abutments.
2- Using indirect retainers.
3- Using special type of direct retainers, the first choice is R.P.I system,
second choice is I bar, and the third choice is combination clasp.
4- Relining the finished free end extension partial denture before insertion
inside patient mouth.
5- Using special kind of impression technique called altered cast technique.
6- Using implant to support the denture base.

Types of the denture base according to materials:

1. Resin type (acrylic denture base).
2. Metal type denture base.
1. Resin type (acrylic denture base):
Its most widely used type of denture base because of easy of fabrication and
easy of attachment to metal framework. The resin denture base attached to
metal framework by mechanical mean (throughout the hole present in
meshes or ladder area) in addition, the resin denture base having the
advantage of future relining or rebasing
ADVANTAGES
1- Can be easily relined.
2- Easy to fabricate, adjust, finish, polish, and repair.
3- Resin is more esthetic than metal.

DISADVANTAGES
1- More porous than metal and therefore more difficult to clean.
2- Requires more bulk for rigidity than metal.
3- Easily abraded.
4- Easily fractured.
5- Plastic is a poor thermal conductor.
6- Has the potential to be dimensionally unstable.
2. Metal type denture base:
It’s made of either:
a. Gold and platinum but these materials are so expensive.
b. Stainless steel or chrome cobalt that are more being in use now day.
c. Recently, the titanium being used as a denture base and in oral implant
because of its excellent properties
The metal type denture base has the ability to stimulate the underlying
tissues that will maintain the integrity of the bone by preventing osseous
tissue resorption, but it principle disadvantage its difficulty to reline in
future, therefore the metal type denture base will be indicated in:
a. Short span (tooth borne removable partial denture).
b.When there is no enough space for artificial teeth (inadequate
intermaxillary space) because of over eruption of opposing teeth.
Advantages of metal denture base:
1.Accuracy and permanency of form
2. Comparative tissue response
3.Thermal conductivity
4.Weight and bulk
Disadvantages of metal denture base:
1. Difficult to reline and rebase.
2. Expensive.
3. The error that occur in posterior palatal seal area (post dam) can’t be
corrected with metal denture base, while if same error occurred in resin
denture base repostdaming is the choice for this problem.

Types of artificial teeth:

1. Acrylic teeth: Artificial teeth that have been made of acrylic resin, it has
the ability to be attached chemically to denture base.
2. Porcelain teeth: Is made of feildspathic porcelain material, its attached to
denture base by mechanical mean, either by pin that will be processed in
denture base and a hole is presenting the base of the tooth allowing its
attachment by cementation.

3. Metal teeth: Some cases the anterior or posterior teeth may be processed
as part of the denture base by casting procedure this is indicated in cases of
limited intermaxillary spaces.
Modified poly-ether-ether-ketone (PEEK):
A new material in prosthodontics. Comparing to the metals used in dentistry.
1. An alternative material for the fabrication of distal extension removable
dental prosthesis (RDP) frameworks.
2. This material can be used for patients allergic to metals, or who dislike the
metallic taste, the weight, and the unpleasant metal display of the denture
framework and retentive clasps.
3. A biocompatible, nonallergic, rigid material, with flexibility comparable
to bone, high polishing and low absorption properties, lowplaque affinity,
and good wear resistance.
4. Can be constructed either via CAD/CAM manufacturing or via the
conventional lost wax technique.
 Prosthodontics
3rd class Dr. Osama Alheeti

Indirect Retainers
Partial denture movement can exist in three planes; horizontal, frontal, and
sagittal. Tooth-supported partial dentures use teeth to control movement
away from the tissues. Tooth-tissue-supported partial dentures have at least
one end of the prosthesis free to move away from the tissue.

A fulcrum line is a theoretical line around which a removable dental

prosthesis tends to rotate when subjected to forces towards or away from the
residual ridge.

This movement away from the residual ridge around the fulcrum line can be
prevented by the action of an indirect retainer. Therefore, the main function
of the indirect retainer is to prevent movement of a distal extension base
away from the tissues.

An indirect retainer consists of one or more rests and the supporting minor
connectors and should be placed as far from the distal extension base as
possible in a prepared rest seat on a tooth capable of supporting its function.

Action of the indirect retainer where E:

Effort (e.g. sticky food), F: fulcrum line,
& R: Resistance (indirect retention).

The most effective location of an indirect retainer is in the area of an incisor

tooth, but this tooth may not be strong enough may have steep inclines that
cannot support a rest. Thus, the nearest canine or the mesio-occlusal surface
of the first premolar may be the best location for the indirect retention and
on both sides of the arch closer to the fulcrum line are used to compensate
for the compromise in distance.
In the absence of indirect retainers for distal end extension dentures
subjected to posterior dislodging forces, two undesirable events may take
place:

(1) the denture base moves away from the supporting tissues.

(2) the anterior segment of the major connector impinges upon the
underlying soft tissues .This results m transmission of destructive forces to
the hard and soft tissues of the dental arch.

When an indirect retention is included in distal extension dentures:

(1) forces acting to dislodge the distal extension bases are neutralized.

(2) the rotational axis shifts from the abutment teeth to the indirect retainers
and as long as the clasp assemblies resist the vertical dislodging forces, the
prosthesis remains in place.

Movement of a distal extension denture in the absence (a) and presence (b) of an
indirect retainer.

The following are the main factors influencing the effectiveness of an

indirect retainer:

1. The principal occlusal rests on the primary abutment teeth must be held in
their seats by the retentive arms of the direct retainers. If rests are held in
their seats, rotation about an axis should occur, which subsequently would
activate the indirect retainers. If total displacement of the rests occurs, no
rotation about the fulcrum would occur, and the indirect retainers would not
be activated.
2. Distance from the fulcrum line. The following three areas must be
considered:

a. Length of the distal extension base.

b. Location of the fulcrum line.

c. How far beyond the fulcrum line the indirect retainer is placed.

3. Rigidity of the connectors supporting the indirect retainer. All connectors

must be rigid if the indirect retainer is to function as intended.

4. Effectiveness of the supporting tooth surface. Tooth inclines and weak

teeth should never be used to support indirect retainers.

Forms of Indirect Retainers:

1. Auxiliary Occlusal Rest

The most commonly used indirect retainer is an auxiliary occlusal rest

located on an occlusal surface and as far away from the distal extension base
as possible. As mentioned earlier, this is the best form of indirect retention.

In a Class I arch this location is usually on the mesial marginal ridge of the
first premolar on each side of the arch. The ideal position for the indirect
retainer perpendicular to the fulcrum line would be in the area of the central
incisors, which are too weak and have steep lingual surfaces. Bilateral rests
on the first premolars are quite effective, even though they are located closer
to the axis of rotation . This is advantageous because

1) not only are they effective without jeopardizing the weaker single-rooted
teeth.

2) interference with the tongue is far less when the minor connector can be
placed in the embrasure between canine and premolar rather than anterior to
the canine teeth.

Indirect retainers for Class II partial dentures are usually placed on the
marginal ridge of the first premolar tooth on the opposite side of the arch
from the distal extension base .

2. Lingual rest

A cingulum rest also can be used as an effective indirect retainer. A

cingulum rest on the adjacent canine tooth may be used when the mesial
marginal ridge of the first premolar is too close to the fulcrum line or when
the teeth are overlapped. Modifications of the lingual rest can be applied for
anterior teeth when the conventional c:ingulum rest is inapplicable.

3. Incisal rest

An incisal rest also may provide indirect retention where other rests are
contraindicated. This is particularly true for maxillary and mandibular
incisors, as well as mandibular canines. Because of the unfavorable lingual
anatomy of these teeth, incisal rests may be the only acceptable option.
Unfortunately, incisal rests are esthetically objectionable and exhibit long
approach arms that may transfer harmful tipping forces to abutments. A
better solution would be to use one of the modifications for a lingual rest on
these teeth.

4. Canine Extensions from Occlusal Rests

A finger extension from a premolar rest is placed on the prepared lingual

slope of the adjacent canine tooth when the first premolar must serve as a
primary abutment

5. Cingulum Bars (Continuous Bars) and Linguoplates:

In Class I & II partial dentures, a cingulum bar or linguoplate may act as an

indirect retainer. Technically, cingulum bars ( continuous bars) and
linguoplates are not indirect retainers because they rest on unprepared
lingual inclines of anterior teeth.

6. Modification Areas

The occlusal rest on a secondary abutment in a Class II partial denture may

serve as an indirect retainer. A secondary abutment is an abutment adjacent
to a bounded edentulous span other than the free end extension.

7.Rugae Support

The rugae area of the maxillary arch can be used as a means of indirect
retention because the rugae area is firm and usually well situated to provide
indirect retention for a Class I removable partial denture. Although this is
true, rugae coverage is undesirable and should be avoided if possible.

The use of rugae support for indirect retention is usually part of a U shaped
maxillary major connector (palatal horseshoe design). Posterior retention is
inadequate due to absence of posterior palatal seal and the requirements for
indirect retention are greater than avoiding rugae coverage.

In a maxillary arch, where only anterior teeth remain, full palatal coverage is
usually necessary. In fact, with any Class I maxillary removable partial
denture that extends distally from the first premolar teeth, except when a
maxillary torus prevents its use, palatal coverage may be used to advantage.
 Prosthodontics
3rd class Dr. osama Alheeti

Stress Breaker and internal attachments

A stress breaker is defined as, “A device which relieves the abutment
teeth of all or part of the occlusal forces.
OR
STRESS BREAKER:-It is a device that permits some hinge or rotational
movement between the denture base or its supporting framework and the
direct retainers (whether they are intra coronal or extracoronal retainer)

Dentures with a stress breaker are also called as a broken stress partial
dentures or articulated prostheses. We know that the soft tissues are
more compressible than the abutment teeth. In a tooth-tissue supported
partial denture, when an occlusal load is applied, the denture tends to rock
due to the difference in the compressibility of the abutment teeth and the
soft tissues. As the tissues are more compressible, the amount of stress
acting on the abutments is increased. This can produce harmful effects on
the abutment teeth.
In order to protect the abutment from such conditions, stress breakers are
added to the denture.

Types of stress breaker

1-Type 1 : RPD having a movable joint between the direct retainer and
the denture base include hinge , sleeve , and cylinder, ball and socket
device.
These types have a movable joint between the direct retainer and the
denture base and permit vertical movement and hinge action of the distal
extension denture base.
 2.Type 2
It has a flexible connection between the direct retainer and the denture
base. It can be a wrought wire connector, divided or split major connector
or a movable joint between two major connectors.
The major connector is split by an incomplete cut parallel to the occlusal
surface of the teeth into two units namely the upper unit (more near to the
tooth) and the lower unit. The denture base is connected to the lower unit
and the rests and direct retainers are connected to the upper unit.

1- Divided major connector (split bar): by using this type of stress

breakers, the vertical forces applied on distal extension base must pass
anteriorly along the lower bar and then back along more rigid upper bar
to reach abutment tooth therefore the tipping forces that would otherwise
be transmitted directly to abutment teeth are dissipated by flexibility of
lower bar and distance traveled.

2- wrought wire soldered to major connector

3- 3-clasps having stress breaking effect:

a-RPI system

R=rest mesially located ,P=proximal plate on abutment distally, I=I bar

b-Reverse Aker clasp
c-RPA system
R=rest mesially located P=proximal plate, A= Aker clasp

Advantages:
1. The alveolar support of the abutment teeth is preserved as the stress
acting on the abutment teeth are reduced.
2. The stress on the residual ridge and the abutment teeth are balanced.
3. Weak abutment teeth are well splinted even during the movement of
the denture base.
4. Abutment teeth are not damaged even if relining is not done
appropriately (after the denture wears out).
5. Minimal requirement of direct retention.
6. Movement of the denture base produces a massaging effect on the soft
tissues.
7. This avoids the frequent need for relining and rebasing.

Disadvantages
1. Design is complicated and expensive.
2.The assembly is very weak and tends to fracture easily. Distorts to
rough handling.
3. It is difficult to repair.
4.It can be used only to counter the vertical forces on the denture.Inability
to counteract lateral stress acting on the ridge leads to ridge resorption.
5. Reduced stability against horizontal forces.
6. Both vertical and horizontal forces are concentrated on the ridge
leading to resorption.
7. Inappropriate relining leads to excessive ridge resorption.
8. Reduced indirect retention.
 Internal and precision attachment of RPD
The precision attachment denture has long been considered advantageous
in dentistry as it combines fixed and removable prosthodontics in such a
way as to create the most esthetic partial denture possible.

Classification
• Based on their method of fabrication and the tolerance of fit between the
components.
I. Precision attachment (prefabricated types)
components with precisely manufactured metal to metal .
II. Semi precision attachment (laboratory made or custom made types)
components usually originate as prefabricated (made of plastic, nylon or
wax) or Hand waxed.

According to their relationship to the abutment teeth.

1) Intracoronal / internal attachment
If the attachment resides within the body / normal contours of the
abutment teeth.
2) Extracoronal / external attachment
If the attachment resides outside the normal clinical contours of the
abutment crown / teeth.

Advantages of precision attachments

1.Improved esthetics and elevated psychological acceptance
2. Compared to conventional clasp retained partial denture they give better
retention and stability, less liable to fracture than clasp, less bulky.
3. Lateral forces in the abutment during the insertion and removal are
eliminated and more axial force during functions are achieved.
Disadvantages
1. Complexity of design, complex principles and procedures for fabrication
and clinical treatment.
2. Expensive – increased overall cost of the treatment. .
3. Requires high technical expertise for successful fabrication experience
and knowledge on the part of dentist and laboratory technician are essential.
4. Increased demand on oral hygiene performance

Intracoronal precision attachment – prefabricated type: It comes as two

component matrix and patrix. Matrix (female) is waxed into the crown or
bonded into a preparation in the tooth. Patrix (male) is attached to the
framework usually by soldering. Type of retention is either friction or
mechanical.

Advantages
1) Improved esthetics (particularly important in anterior part of mouth)
2) Natural self cleansing contours of teeth can be maintained.

Disadvantages
1) Requires adequate faciolingual width / cervicoocclusal height to provide
as large as frictional area as possible between the slot and flange.
2) Requires extensive preparation of the abutment teeth to obtain space for
the keyway mechanism.

2. Semiprecision Attachment: There is a type of attachment usually referred

to as a semiprecision rest attachment that utilizes an intracoronal rest seat
and resilient lingual arm.
Advantages
1. Laboratory fabricated precision attachment offers far greater adaptability
to a wide variety of clinical situations compared to prefabricated precision
attachments.
2. Versatility for many clinical variation
3. Variation in tooth size and shapes are most easily accommodated.

Disadvantages
1. Long term wear is more
2. Lack of interchangeability of male and female attachment as there is no
standardization of sizing as been in prefabricated parts.
3. Repair and replacement of custom attachments are more difficult as
composed to prefabricated parts.

Extracoronal attachments

Classified by (Boitel 1978)

1.Rigid attachment
2.Resilient attachment
3.Bar attachment

Advantages
1. It does not alter the normal contour of the abutment, crown being entirely
outside the tooth contour.
2. Easy insertion and greater freedom in design.
3. Do not require space within the contours of the abutment tooth hence can
be used when there is insufficient buccolingual width to accommodate the
intraoral attachment.
Disadvantages
1. Lack of occlusal stability
2. Improper control of force distribution between dentulous and edentulous
area
3. Maintenance problems
4. Bulky, break or wear
5. Rebasing problem.

4. Magnets as Attachment: Use of magnets started gaining popularity since

1960 – when magnets based on rare earth element was developed. These
magnets were of small size having high strength. In recent years, there has
been an increased interest in the use of magnets, the modern alloy are
powerful and retain their magnetism for a long time.
 Prosthodontics

CLINICAL AND LABORATORIES STEPS

FOR CONSTRUCTION OF CHROM COBALT
PROSTHESIS

3rd class Dr. Osama Alheeti

Knowledge of the laboratory phase of partial denture construction is

essential for the clinician, who must assume total responsibility for the
design and the quality control of all aspects of this construction.
1. Primary impression making at 1st clinical appointment for patient
seeking for removable partial denture. A diagnostic cast with a neat and
specific design carefully drawn on it.(clinical work).
-Marking the height of contour
-Measuring the undercut
-Drawing the clasps ,rest and drawing the connectors.
2-mouth preparation inside the patient mouth (clinical work).
3-final impression and master cast production(clinical work).
4-After recording the master impression, the framework is fabricated for
a cast partial denture.(Laboratory work).
• The framework is essential for other procedures like preparing occlusal
rims, jaw relation, etc.
• Framework fabrication involves the following steps:-
1. Wax-up
2. Duplication and preparation of refractory casts
3. Waxing
4. Investing
5. Burn out
6. Casting
7. Finishing and polishing.
The first step in framework construction is the transfer of the design to
the master cast by the dental technician
The tripoded master cast is placed on the surveyor and the height of
contour marked according to the pre-selected path of insertion and
removal. The technician then carefully transfers the design on the
diagnostic cast to the master cast.
The elimination of undesirable undercuts on the master cast with wax is
referred to a s blockout. This will help insure the finished casting will go
to place with minimal engagement of these undercuts. Certain areas under
the RPD framework are deliberately relieved, using various thickness of
wax sheets. Relief is usually associated with the denture base and
mandibular major connectors.
Blockout is classified as paralleled, shaped or arbitrary. Parallel blockout
used in proximal surfaces, and lingual surfaces where reciprocation by
plate, shaped blockout used wherever clasp arm is used facially and
lingually, arbitrary blockout used to blockout undercuts out the design to
protect the mold from distortion when lifting the master cast from
duplicating material.
Relief done on the saddle, beneath the lingual bar and bar clasp, on any
bony projection and torous.

The elimination of undesirable undercuts on the master cast with wax is

referred to a s block out. This will help insure the finished casting will go
to place with minimal engagement of these undercuts. Certain areas under
the RPD framework are deliberately relieved, using various thickness of
wax sheets.
Relief is usually associated with the denture base and mandibular major
connectors
Blockout is classified as paralleled, shaped or arbitrary. Parallel blockout
used in proximal surfaces, and lingual surfaces where reciprocation by
plate
Shaped blockout :ledges on which clasp patterns are to be placed

arbitrary blockout: used to blockout undercuts out the design to protect

the mold from distortion when lifting the master cast from duplicating
material.

When the technician has completed the blockout and relief, the master
cast is then duplicated, usually using reversible hydrocolloid(Agar) or
thin viscosities of silicone in a duplicating flask.
The reversible hydrocolloid impression is poured in refractory material,
either gypsum, phosphate or silicate bonded, depending on the metal used
in the casting, and allowed to set. The technician then has a duplicate of
the master blocked out cast, in an investment material on which the RPD
framework will be directly waxed.
Also the design must once again be transferred to the refractory cast so
that the technician can accurately place the component parts of the
framework
ADVANTAGES OF DUPLICATION:
1-preserve the original cast
2- eliminating the danger of fracture or abrading the surface of the
original master cast
3- forming the wax or plastic pattern
4-the metal framework is cast against the surface of refractory cast
Before waxing, the refractory cast is dried and dipped into hot beeswax to
insure a smooth, dense surface. Also, the design must once again be
transferred to the refractory cast so that the technician can accurately
place the component parts of the framework .

Most components of an RPD framework are manufactured, flexible,

plastic patterns that are modified by the technician to fit the existing
requirements. The plastic patterns are placed onto the refractory cast with
adhesive so they will not lift off. Some freehand waxing must be done to
connect all the components together into a rigid, smooth pattern.
The waxed framework is sprued directly on the refractory cast and
invested with refractory material in a casting ring. The wax pattern is not
removed from the cast.
After the investment sets, the ring is placed in a burnout oven for a
prescribed time and temperature. Casting and burnout procedures differ,
depending on the type of metal being used. The Chromium-cobalt and
Nicle-chromium alloys usually require a high heat burnout and usually
induction casting (2500 F), as compared to torch casting. When the
casting is complete, the mold is removed from the machine and allowed
to cool according to the manufacturer's direction. The casting is removed
from the investing material and cleaned with a sand blaster
The sprue removal and finishing is done with high-speed lathe, large
abrasive discs, polishing compounds and wheels. The final finishing
procedures are similar to those used for gold alloy but the Chromium-
cobalt and Nicle-chromium alloys is much harder. The major difference
is that the Chromium-cobalt and Nicle-chromium alloys is also
electropolished, in addition to the usual mechanical lathe polishing, to
produce a smooth surface. This is necessary due to the hardness of the
metal and complexity of the design for hand polishing. The unfinished
RPD framework should not be tried on the master cast, as it will abrade
the surface of the gypsum. Many laboratory technicians used a duplicate
master cast for fitting the framework, and only place the framework on
the original master cast when the framework is completely finished and
polished. This is an excellent practice to follow.
The framework should be returned from the laboratory on an unabraded,
unbroken master cast, clean and properly fabricated and polished. There
should be no rocking of the framework on the master cast and all of the
rests should be seated accurately with the rest seat preparations and the
clasp arms contacting the desired locations of the abutment teeth. The
design should be exactly as you have drawn it on the diagnostic cast and
on the laboratory work authorization.

Laying Sheet Wax

A piece of 0.4mm sheet casting wax is lightly warmed and laid it down
over at least half the palate. (This wax is textured or stippled on one side
to simulate the texture of the soft tissues of the mouth. The stippled side
is always laid uppermost). The wax must not be unduly stretched, which
will result in thinning leading to a possible miscast and loss of surface
detail, while at the same time pressed firmly but gently to ensure it
contacts all of the refractory cast.

Retention Wax
Retention profile wax in the form of mesh or loops, provides the
mechanical retention which holds the acrylic resin on to the metal
framework. Without suitable retention the acrylic quickly becomes
detached from the casting, requiring a new framework to be made. The
retention wax is placed onto the saddle areas, extending just over the crest
of the ridge and abutting with the palatal sheet wax.
 Prosthodontics
3th class Dr.Osama Alheeti

Principles of removable partial denture design

The forces occurring through the removable partial denture can be widely
distributed, directed, and minimized by the selection, the design and the
location of components of removable partial denture and by developing a
harmonious occlusion.
Types of partial dentures
1. Removable partial denture, which includes the cobalt chromium and
acrylic removable partial denture.
2. Fixed partial denture.
3. Implant supported partial denture, this could be fixed (implant retained
partial denture) or removable (implant support partial denture).
General principle
1. Utilize what is present.
2. Minimize the framework elements.
3. Plan for future.
4. Consider caries susceptibility.
5. Avoid placing rest seats or guiding planes on direct restorations such as
amalgam.
6. Never design any removable partial denture without surveying.

Factors influencing the design of removable partial denture:

1. Which arch, is needed to be restored: because each arch may have certain
criteria indicates specific design, and if both arches are needed to be
restored, the relationship between maxillary and mandibular arches in
removable partial denture designing and construction may consider:

Inter-ridge space as well as space available for missing teeth restoration.
Orientation of occlusal plane.
Occlusal relationship of remaining teeth.
Arch integrity.
Tooth morphology.
2. Type of support: cases supported entirely by teeth are differ than cases
with tooth-tissue support, if one or more distal extension bases are involved,
the following must be considered:
Type of secondary impression material and technique.
Clasp design that will best minimize the forces applied to the abutment
teeth during function.
Need for indirect retention.
Need for later relining or rebasing, which influence the type of base
material used.

3. Abutment teeth: selection and modifications required (simple grinding to

more complicated restorations or splinting). This may affect the clasp design
and type.

In evaluating support that an abutment tooth can provide, consideration

should be given to
Tooth number and location in the arch relative to edentulous spaces.
Periodontal health.
Crown and root morphology.
Crown to root ratio.
Bone support (tooth response to stress (index area)).
Opposing dentition .

In evaluating support available from edentulous ridge areas,

consideration must be given to:
(1) the quality of the residual ridge.
(2) the extent to which the residual ridge will be covered by the denture base
(3) the type and accuracy of the impression
(4) the accuracy of the denture base.
(5) the occlusal load.

4. Type of major connector indicated.

5. Materials to be used for the framework and for the bases.
6. Type of artificial teeth to be used,
In general, removable partial dentures opposing natural teeth will require
greater support and stabilization over time because of the greater functional
load demands.
7. Patient past dental history and his experience with removable partial
denture and the reasons for making a new one, e.g. if patient was
objectionable for an anterior palatal bar because bulky, location or tissue
irritation, another major connector could be used and located more
posteriorly.
8. Using of other types of treatment modalities to restore missing tooth as
replacing of single missed anterior teeth by fixed restoration or benefits from
implant to simplify the removable partial denture design.
9. Response of oral structures to previous stress.

Different between the removable partial denture and fixed partial

denture:
1. Fixed partial denture does not move in function, this mean not supported
by clasp as in removable partial denture that the patient can easily insert and
remove the removable partial denture in mouth.
2. Occlusal forces are usually directed down the long axes of the teeth in
fixed partial denture so it considered to as a part of the natural tooth.

Differentiation between two main types of removable partial denture

(tooth supported and tooth - tissue supported removable partial
denture):
1. Differences in the manner in which each is supported.
The Class I type and the distal extension side of the Class II type derive their
primary support from the tissue underlying the base and secondary support
from the abutment teeth.

2. Differences in the method of impression registration and jaw record

require.
An impression registration for the fabrication of a partial denture must fulfill
the following two requirements:
The anatomic form and the relationship of the remaining teeth in the
dental arch and the surrounding soft tissue must be recorded accurately so
that the denture will not exert pressure on those structures beyond their
physiological limits.
The supporting form of the soft tissue underlying the distal extension base
of the partial denture should be recorded so that firm areas are used as
primary stress-bearing areas and readily displaceable tissues are not
overloaded.

3. Differences in the need for indirect retention exist in the distal

extension type of partial denture.
4. Differences in the type of the base material that can be relined to
compensate for tissue changes.
5. Differences in Clasp Design
The tooth-supported partial denture is retained and stabilized by a clasp at
each end of each edentulous space. Cast retentive arms are generally used
for this purpose. These may be either circumferential or bar clasp.
In the tooth-tissue supported removable partial dentures, because of the
anticipated functional movement of the distal extension base, the direct
retainer adjacent to the distal extension base must be able to flex sufficiently
to dissipate stresses that otherwise would be transmitted directly to the
abutment tooth as leverage, in addition to that of resisting vertical
displacement. A retentive clasp arm made of wrought wire can flex more
readily in all directions than can the cast half-round clasp arm.
The key to selecting a successful clasp design for any given situation is to
choose one that will:
Avoid direct transmission of tipping or torqueing forces to the abutment.
A clasp design with correctly positioned component parts on abutment
tooth surfaces.
Provide retention against dislodging forces.
Compatible tissue contour and esthetic desires of the patient.
Location of the undercut is the most important single factor in selection of
a clasp.
What is Biomechanics in Prosthodontics?
Application of mechanical principles on biological tissues while
studying the biology from a functional viewpoint and then using these
principles to design a stable prosthesis.
 Biomechanical considerations:
The RPD and their associated structures are subjected to various forms of
stress. Their ability to resist them dependon:
Direction, Duration, Magnitude and frequency of the Stress (Force) being
applied onto the denture and denture bearing areas
Capacity of these areas to resist these forces/stress
Changes due to resistance over time
The type of Resistance Generated: 1.Tooth based
2.Tooth and Tissue
 Types of Stress (Force) acting on an RPD
within the oral cavity:
These stresses can be classifiedinto:
- Vertical
Displacing Force
Dislodging Force
Horizontal
Torsion

Resistance to stress can be dividedinto:

Tooth based resistance contributes mainly to resisting Horizontal Stress
(direct retainers)
Tooth-Tissue based resistance contributes to resisting Vertical Stress and
Torsion (major connectors and indirectretainers)
Factors contributing to the amount of Stress on the RPD:

The length of edentulous span (example: Kennedy Classification III

usually exhibit no lever action)
Quality of Ridge Support (example: Wider ridges disperse more stress •
due to the Snow Shoe Principle)
Quality of Oral Mucosa (example: Healthy mucosa are able to •
withstand much greater force than weak flabby mucosa)
Clasp Design (flexibility, length and material used) •
Occlusal Harmony •
Principles of Mechanical forces (According toMcCraken):
 Mechanical Force Principles to be considered within the oral cavity:

Lever Principle (Further divided into Orders I, II and III)

Inclined Plane Principle
Wheel and Axle (Rotation)

INCLINED PLANE PRINCIPLE

LEVER PRINCIPLE
WHEEL AND AXLE (along Saggital Axis)

WHEEL AND AXLE PRINCIPLE (along horizontal axis)

 Types of lever Action:
There are 3 types of
mechanical lever action
based on:
1. the position of the fulcrum
2. The location of the load
along the fulcrum line.
3.The area from which
theeffort to displace is
exerted
First Order Lever Action (Class I):
Example of 1st Order Lever Action
In cantilever type of
Removable Partial Denture
where There is Distal
Extension. If there is bone
Resorption of the residual
alveolar ridge under the
distal extension, it will result
in an effort leading to first
order lever movement along
the fulcrum line.
Second Order Lever Action (Class II)
Third Order Lever Action (Class III)
Example of third order Leveraction:
Usually seen in the tooth supported RPD. Upon consuming sticky food,
the food exerts pulling effort on the prosthetic teeth while the natural
teeth and retainers exert counteracting forces from both sides.
Biomechanics of Inclined Planes:

However, flattening the rest seat

will aid in the retention of the
direct retainer on the tooth
surface and resist horizontal
forces
Wheel and Axle
Principle: (Rotation)
The Partial denture can
rotate along one of 3 planes:
The saggital plane .A
The frontal plane .B
The horizontal Plane .C

And along one of 3 axes:

Saggital axis
Vertical axis
Horizontal axis.
Rotation of Frontal Plane along Rotation of Horizontal Plane along Vertical
Saggital Axis Axis
Saggital Plane and Horizontal Axis Rotation
Frontal Plane Rotation Along the saggital Axis
Snow Shoe Principle
The basis of the principle is to
distribute stress/forces onto as
large an area as possible in
order to counteract the stresses
applied to a partial denture.
Snow Shoe Principle
In order to overcome the forces acting against the RPD, the prosthesis
must take full advantage of all the primary and secondary stress
bearing areas.
Ex. Buccal shelf area are the primary stress bearing areas in the
mandible because of their position on the occlusal plane. Not
extending the denture to the shelf area will result in displacing forces
and horizontal forces during mastication.
References:
McCraken’s Removable Partial Prosthodontics , 11th and 12th editions •
Stewart’s Clinical Removable Prosthodontics, 3rd edition •
Basic Principles of removable partial denture, Abbasi Begum,online •
journal, slideshare.net, 06-06-2016
RPD biomechanics, Foundation for Oral Facial Rehabilitation,online •
journal, ffofr.org
Biomechanics of removable partial denture, Dr Ann Winchy, Dept.of •
Oral Health and rehabilitation, University of Louisville,17-05-2014.
 Prosthodontics
3rd class Dr.Osama Alheeti

Jaw Relation in Removable Partial Denture and

arrangement of teeth
Record bases:
The ideal jaw relation record base is one that is processed (acrylic resin
bases) or cast (cast metal bases) to the form of the master cast, becoming the
permanent base of the completed prosthesis.
Bases for jaw relation records must have maximum contact with the
supporting tissue. Those areas are most often undercut and require blockout
of the distolingual and retromylohyoid areas of the mandibular cast, the
distobuccal and labial aspects of the maxillary cast, and, frequently, small
multiple undercuts in the palatal rugae.

For permanent denture base: When undercut are present, the master cast
will be destroyed during removal of the base, then existing undercuts must
be blocked out inside the denture base before dental stone is poured into it to
make a cast for articulator mounting.

For temporary denture base: These undercut areas and any others are
blocked out with a minimum of clay or wax, to obliterate as little of the
surface of the cast as possible. A close-fitting base may then be made that
will have the necessary accuracy and stability and yet may be lifted from and
returned to the master cast without abrading it.

Types of record bases according to materials constructed from it:

1. Visible light- cured bases (VLC).
2. Autopolymerizing acrylic resin bases.
3. Cast metal bases.
4. Compression molded or processed acrylic resin bases.

Occlusion rims:
Occlusion rims are added to allow recording of jaw relation records.
Placement of wax record is dictated by the opposing tooth position and the
supporting ridge character. When possible, the occlusion rim should allow
recording of the jaw position within the primary bearing area of the ridge.
Occlusion rims for static jaw relation records:
The materials of occlusion rims that are used to establish static occlusal
relationships include:
1. Hard baseplate wax: most commonly used to establish static occlusal
relationship.
2. Wax occlusion rim: registration made on wax occlusion rims using a wax
registration material .
3. Modeling plastic (compound): has several advantages and may be used
rather than wax for occlusion rims.
Occlusion rims for static jaw relation records should be so shaped that they
represent the lost teeth and their supporting structures.
An occlusion rim that is too broad and is extended beyond where prosthetic
teeth will be located will lead to:
1. Alter the shape of the palatal vault.
2. Alter arch form of the mandibular arch.
3. Crowd the patient’s tongue.

4. Have an unwelcome effect on the patient.

5. Offer more resistance to jaw relation recording media than will a correctly
shaped occlusion rim.

Occlusion rims for recording functional or dynamic jaw relationship

record:
It used for this purpose:
1. Because they can be carved by the opposing dentition.
2. Because most of them are hard enough to support occlusion over a period
of hours or days.
The construction of this type of occlusion rim consider as chair side
procedure rather than a laboratory procedure because it corrected at clinic.
Purpose of Recording the Jaw Relations in removable partial denture;

1. To establish and maintain a harmonious relationship

2. To ensure that all the effects of occlusal loading be distributed

3. To best control the undesirable effects of rotational or torquing forces on

the prosthesis.

4.To prevent any deflective contacts of the teeth during centric or eccentric
closures

Methods of recording jaw relation in removable partial denture:.

1-Direct apposition of casts: This should not influence the path of closure of
mandible

The first method is used when sufficient opposing teeth remain in contact to
make the existing jaw relationship obvious, or when only a few teeth are to
be replaced on short denture bases and no evidence of occlusal abnormalities
is found. With this method, opposing casts may be occluded by hand. The
occluded casts should be held in apposition with
rigid supports attached with sticky wax to the bases of the casts until they
are securely mounted in the articulator.

2-Interocclusal records with posterior teeth remaining:-

A second method, which is a modification of the first, is used when
sufficient natural teeth remain to support the removable partial denture
(Kennedy Class III or IV) but the relation of opposing natural teeth does not
permit the occluding of casts by hand. In such situations, jaw relations must
be established as for fixed restorations with some type of interocclusal
record like using metallic oxide paste,interocclusal wax record
The least accurate of these methods is the interocclusal wax record . The
bulk, consistency, and accuracy of the wax will influence the successful
chilling. Excess wax that contacts the mucosal surfaces may distort soft
tissue, thereby preventing accurate seating of the wax record onto the stone
casts. Distortion of wax during or after removal from the mouth may also
interfere with accurate seating.

3-Occlusal relations using occlusion rims on record base:

1-one or more distal extension areas are present
2- a tooth supported edentulous space is large
3-when opposing teeth do not meet.

A third method is used when one or more distal extension areas are present,
when a tooth-supported edentulous space is large, or when opposing teeth do
not meet

In any of these situations, jaw relation records are made entirely on

occlusion rims. The occlusion rims must be supported by accurate jaw
relation record bases. Here, the choice of method for recording jaw relations
is much the same as that for complete dentures, so jaw relation will be done
as following:
Jaw relation for R.P.D. (third method):
1-orientation jaw relation(by using ( face bow).

2-vertical jaw relation: it is measured between two arbitrary point marked on

the face one above the mouth and one below the mouth.
1- At rest
also called physiological rest position is determined when the patient is in an
upright position and is completely at rest. The mandibular position is
produced by a muscular balance between the muscles of mastication ,the
postcervical muscle group,and the suprahyoid muscle group.
At this position maxillary and mandibular teeth should not be touching. The
space between the maxillary and mandibular teeth is referred to as (the
interocclusal rest space).
2- At occlusion:
is determined by measuring the vertical dimension while the patient, s teeth
are in maximal intercuspal position.
The physiological rest dimension will always be greater than the occlusal
vertical dimension.
FREE way space=rest _OVD=(2-4)mm
3-horizontal jaw relation: it is determined after a correct vertical
dimension of occlusion is established. There are two horizontal relationship
that are of importance in developing occlusion .
a-centric jaw relation
b-eccentric jaw relation(protrusive and right –left movement).

Altering the existing vertical dimension of occlusion

Normally the VDO(vertical dimension of occlusion) for a partially
edentulous patient is provided by the opposing natural teeth contact if they
have normal shape, size and position and it should not be changed
unless:
Symptoms of diminished OVD exist such as :
1-tired aching muscles,
2-unexplained pain in the head and neck region,
3- shortened nose-chin distance (appearance of premature aging).
4-Excessive Free way Space or ‘over-closure’ of the jaws.
5-Confirmation of decrease in VD can be seen with severe tooth wear,
intrusion and greater than 4 mm free way. Temporary removable device in
form of acrylic resin overlay
This device must be worn for 24 hrs. If the patient can tolerate this fo 3- 4
months then definitive correction should be instituted.

Mounting casts on the articulator:

Mounting the maxillary and mandibular casts on adjustable articulator in
same relationship as they are on the patient by using a face-bow transfer .

Arrangement of artificial teeth

Principles that should be taken during arrangement of artificial
teeth:
1. In general, the same rules which apply to complete dentures also apply to
partial dentures in regard to the arrangement of posterior artificial teeth,
however, since the occlusal surfaces of most natural teeth have been altered
by wear, artificial teeth should be altered with suitable stones and acrylic
burs so that they will properly intercuspate with the natural teeth. So it was
preferring to use resin teeth since they are more easily modified and
reshaped.
2. The teeth are usually arranged for intercuspation with the opposing teeth
in a normal cuspal relationship.
3. Artificial posterior tooth forms should be selected to restore the space and
fulfill the esthetic demands of the missing dentition.
4. The artificial teeth must contact all opposing natural teeth to prevent their
extrusion.
5. There is broad agreement that selection posterior teeth with narrow
(reduced buccolingual) occlusal surfaces form are desirable.
they are placed relative to the primary support (buccal shelf) to distribute
the functional load to the most anatomically favorable location in a manner
that reduces leverage effects.

6. Sometimes a second and /or third molar will be extracted in an arch

opposing a removable partial denture to help decrease the length of the
occlusal table and thus reduce stress on a free – end extension abutment.
7. Artificial posterior teeth should not be arranged farther distally than the
beginning of a sharp upward incline of the mandibular residual ridge or over
the retromolar pad.

To do so would have the effect of shunting the denture anteriorly.

Mandibular posterior teeth should not be arranged distal to the upward
incline (ascending ramus) of residual ridge. The molar tooth has been placed
just anterior to a mark on the cast land area designating the beginning
incline.
8. Sometime it may be necessary to select teeth other than those lost by the
patient. For example, an artificial second premolar and first molar may be
indicated for a space occupied by two molars (first and second molars).
Fewer or smaller teeth are often necessary in a tooth – bounded edentulous
space because the abutments may have drifted toward one another.
9. Esthetic is often a factor in the selection of teeth for partial dentures. The
artificial teeth must be at least as long occlusogingivally as the abutment
teeth .
10. Anterior teeth on removable partial dentures are concerned primarily
with esthetics and the function of incising.
11. Anterior artificial teeth should be matched as closely as possible to the
adjacent natural teeth or fixed restorations. The matching process should be
accomplished using natural light and should be completed as quickly as
possible to prevent eye fatigue.
12. The selection of teeth for partial dentures replacing anterior teeth is
essentially the same as anterior tooth selection for complete dentures.
13. As a general rule, the most difficult part of arranging anterior denture
teeth is directly related to a loss of restorative space. Unless anterior teeth
are replaced immediately following their extraction, the natural teeth
adjacent to the space will either drift or tilt into the space.

During the mouth preparation appointment, an attempt should have been

made to regain the original width of the space by reshaping the proximal
surfaces of the adjacent teeth. If the entire width cannot be recovered,
consideration should be given to overlapping the artificial teeth so that a
normal-sized tooth may be used to harmonize with the patient’s face and
remaining teeth.

(a) When an anterior tooth is lost, adjacent teeth often drift or tip into the space. (b)
This produces a noticeable decrease in restorative space and forces the selection of a
replacement that is too narrow.

(a) When space has been lost, reshaping of adjacent teeth is indicated. (b)This
permits the practitioner to achieve an improved esthetic result.

14. If the maxillary central incisors are missing, it is essential that these teeth
be set first.
Lec.18 Prosthodontics ‫م فائزة محمد حسين‬.‫ا‬
Record Bases, Occlusion Rims, Mounting
and Arrangement of Teeth
Record bases:
Bases for jaw relation records should be made either of materials possessing
accuracy or those that can be relined to provide such accuracy. The ideal jaw
relation record base is one that is processed (acrylic resin bases) or cast (cast metal
bases) to the form of the master cast, becoming the permanent base of the
completed prosthesis.
Bases for jaw relation records must have maximum contact with the supporting
tissue. The accuracy of the base will proportionate to the contact provided to the
total area of intimate tissue. Those areas are most often undercut and require
blockout of the distolingual and retromylohyoid areas of the mandibular cast, the
distobuccal and labial aspects of the maxillary cast, and, frequently, small
multiple undercuts in the palatal rugae.
For permanent denture base: When undercut are present, the master cast will
be destroyed during removal of the base, then existing undercuts must be blocked
out inside the denture base before dental stone is poured into it to make a cast for
articulator mounting. A second cast, which includes the undercuts, must be poured
against the entire base to support it when processing the overlying acrylic resin that
supports the teeth and establishes facial contours.
For temporary denture base: These undercut areas and any others are blocked
out with a minimum of clay or wax, to obliterate as little of the surface of the cast
as possible. A close-fitting base may then be made that will have the necessary
accuracy and stability and yet may be lifted from and returned to the master cast
without abrading it. Then the cast and the blockout or reliefs are coated with a
separating medium before making the record base.
Types of record bases according to materials constructed from it:
1. Visible light- cured bases (VLC).
2. Autopolymerizing acrylic resin bases (using sprinkled acrylic resin technique).
3. Cast metal bases.
4. Compression molded or processed acrylic resin bases.
3rd
year / College of Dentistry/University of Baghdad (2019-2020) Page 1
Occlusion rims:
Occlusion rims are added to allow recording of jaw relation records. Placement
of wax record is dictated by the opposing tooth position and the supporting ridge
character. When possible, the occlusion rim should allow recording of the jaw
position within the primary bearing area of the ridge.

Occlusion rims may be made of several materials according to method used for
recording jaw relation.

Occlusion rims for static jaw relation records:

The materials of occlusion rims that are used to establish static occlusal
relationships include:
1. Hard baseplate wax: most commonly used to establish static occlusal
relationship.
2. Wax occlusion rim: registration made on wax occlusion rims using a wax
registration material must be handled carefully and mounted immediately on the
articulator. As with wax rims, an adjustable frame also may be used to support
the final record.
3. Modeling plastic (compound): has several advantages and may be used rather
than wax for occlusion rims.

Occlusion rims for static jaw relation records should be so shaped that they
represent the lost teeth and their supporting structures. An occlusion rim that is too
broad and is extended beyond where prosthetic teeth will be located will lead to:

1. Alter the shape of the palatal vault.

2. Alter arch form of the mandibular arch.
3. Crowd the patient’s tongue.

3rd
year / College of Dentistry/University of Baghdad (2019-2020) Page 2
4. Have an unwelcome effect on the patient.
5. Offer more resistance to jaw relation recording media than will a correctly
shaped occlusion rim.

Occlusion rims for recording functional or dynamic jaw relationship

record:
Occlusion rims must be made of a hard wax like inlay waxes. It used for this
purpose:
1. Because they can be carved by the opposing dentition.
2. Because most of them are hard enough to support occlusion over a period of
hours or days.

The construction of this type of occlusion rim consider as chair side procedure
rather than a laboratory procedure because it corrected at clinic.

Mounting casts on the articulator:

Mounting the maxillary and mandibular casts on adjustable articulator in same
relationship as they are on the patient by using a face-bow transfer and an accurate
centric occlusal relationship record on accurate record bases at establish correct
vertical dimension of occlusion.

Arrangement of artificial teeth to the opposing cast:

Before arrangement of teeth, the denture base on which the jaw relation
record has been made must first be removed and discarded (by heating the acrylic
resin over a properly adjusted burner and using a pliers to remove the softened
material away from the metal framework) unless metal bases are part of denture
framework, or heat- polymerized acrylic resin bases were used.
Principles that should be taken during arrangement of artificial teeth:
1. In general, the same rules which apply to complete dentures also apply to partial
dentures in regard to the arrangement of posterior artificial teeth, however, since
the occlusal surfaces of most natural teeth have been altered by wear, artificial
teeth should be altered with suitable stones and acrylic burs so that they will
properly intercuspate with the natural teeth. So it was preferring to use resin
teeth since they are more easily modified and reshaped.
2. The teeth are usually arranged for intercuspation with the opposing teeth in a
normal cuspal relationship. Whenever possible, the mesiobuccal cusp of the
maxillary first molar should be located in relation to the buccal groove of the
3rd
year / College of Dentistry/University of Baghdad (2019-2020) Page 3
 mandibular first molar and all other teeth arranged accordingly. However, this
classic relationship is not essential to good function and, of course, cannot be
achieved in many instances.
3. Artificial posterior tooth forms should be selected to restore the space and fulfill
the esthetic demands of the missing dentition. Manufactured tooth forms usually
required modification to satisfactorily articulate with an opposing dentition. The
original occlusal form, therefore, is of little importance in forming the posterior
occlusion for the removable partial denture.
4. The artificial teeth must contact all opposing natural teeth to prevent their
extrusion.
5. There is broad agreement that selection posterior teeth with narrow (reduced
buccolingual) occlusal surfaces form are desirable.

The posterior teeth in this distal extension have been selected with a narrower
buccal-lingual width than the original teeth, and they are placed relative to the
primary support (buccal shelf) to distribute the functional load to the most
anatomically favorable location in a manner that reduces leverage effects.
6. Sometimes a second and /or third molar will be extracted in an arch opposing a
removable partial denture to help decrease the length of the occlusal table and
thus reduce stress on a free – end extension abutment.
7. Artificial posterior teeth should not be arranged farther distally than the
beginning of a sharp upward incline of the mandibular residual ridge or over the
retromolar pad. To do so would have the effect of shunting the denture
anteriorly.

3rd
year / College of Dentistry/University of Baghdad (2019-2020) Page 4
 Mandibular posterior teeth should not be arranged distal to the upward incline
(ascending ramus) of residual ridge. The molar tooth has been placed just
anterior to a mark on the cast land area designating the beginning incline.
8. Sometime it may be necessary to select teeth other than those lost by the patient.
For example, an artificial second premolar and first molar may be indicated for a
space occupied by two molars (first and second molars). Fewer or smaller teeth
are often necessary in a tooth – bounded edentulous space because the
abutments may have drifted toward one another.
9. Esthetic is often a factor in the selection of teeth for partial dentures. The
artificial teeth must be at least as long occlusogingivally as the abutment teeth to
prevent unwanted display of denture base material. This is particularly important
on maxillary partial dentures.
10. Anterior teeth on removable partial dentures are concerned primarily with
esthetics and the function of incising. These are best arranged when the patient
is present because an added appointment for try-in would be necessary any way.
11. Anterior artificial teeth should be matched as closely as possible to the adjacent
natural teeth or fixed restorations. The matching process should be accomplished
using natural light and should be completed as quickly as possible to prevent eye
fatigue.
12. The selection of teeth for partial dentures replacing anterior teeth is essentially
the same as anterior tooth selection for complete dentures. The shade and mold
are selected to match the remaining teeth and /or compliment the patient feature.
Arrangement of anterior teeth for partial dentures follows the same principles as
for arrangement anterior teeth for complete dentures.
13. As a general rule, the most difficult part of arranging anterior denture teeth is
directly related to a loss of restorative space. Unless anterior teeth are replaced
immediately following their extraction, the natural teeth adjacent to the space
will either drift or tilt into the space. The drifting or tilting produces a noticeable
decrease in the restorative space and forces the selection of one or more
prosthetic teeth that are narrower than their natural counterparts.
During the mouth preparation appointment, an attempt should have been
made to regain the original width of the space by reshaping the proximal
surfaces of the adjacent teeth. If the entire width cannot be recovered,
consideration should be given to overlapping the artificial teeth so that a
normal-sized tooth may be used to harmonize with the patient’s face and
remaining teeth.
3rd
year / College of Dentistry/University of Baghdad (2019-2020) Page 5
(a) When an anterior tooth is lost, adjacent teeth often drift or tip into the space. (b) This
produces a noticeable decrease in restorative space and forces the selection of a replacement
that is too narrow.

(a) When space has been lost, reshaping of adjacent teeth is indicated. (b)This permits the
practitioner to achieve an improved esthetic result.

14. If the maxillary central incisors are missing, it is essential that these teeth be set
first. This allows the practitioner to reestablish the maxillary midline in the
center of the face.

Laboratory procedure of arrangement teeth:

Example: arrangement of artificial teeth for chrome cobalt removable
partial denture in case of class II (missing first and second molars):
 The teeth are selected for the mandibular partial denture to fill the existing
space.
 The partial denture framework is placed on cast and stabilized by wax while the
teeth are being set.
 Drop the incisal pin 1mm. This will open the articulator 1mm at the incisal table.

3rd
year / College of Dentistry/University of Baghdad (2019-2020) Page 6
 The first molar is set into position. The gingival side of the tooth may need to be
reduced but should be “hollow-ground” to preserve the facial surface.
 Adapt by grinding the mesial surfaces of the first molar so that they fit around
the distal of the minor connector; a piece of articulating paper is inserted
between the tooth and minor connector and the tooth is wiggled slightly. The
marks on the tooth are then reduced. This procedure is repeated untilled the
tooth is adapted to the minor connector.
 The buccal cusp tips of the mandibular first molar are set in the central groove of
the opposing tooth. Check to make sure the lingual cusps are in tight contact.
 After the tooth has been properly positioned, the incisal pin should be returned
to its original position and the occlusal surface of the artificial tooth altered with
suitable stones and acrylic burs until the incisal pin touches the incisal table (the
occlusal surface is altered by reducing the area marked by the articulating
paper).
 Then second molar is set in similar fashion. The second molar is checked for
occlusion. Note that the occlusal alteration is done tooth by tooth.
 Spaces between the mandibular posterior artificial teeth may result during their
anteroposterior placement. These spaces are usually dictated by the maxillary
natural teeth and are not to be considered undesirable unless they interfere
unreasonably with esthetics. Then a compromise position must be selected.

3rd
year / College of Dentistry/University of Baghdad (2019-2020) Page 7
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

‫ميحرلا نمحرلا هللا‬ ‫بسم‬

University of Anbar
Dental Faculty
Prosthodontics Unit
Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD)
3th Grad / Lec.18th
2019-2020

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / Lec. 18th
2019-2020
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

Repairs and Additions to Removable Partial Dentures

The need for repairing or adding to a removable partial denture will occasionally arise.
However, the frequency of this occurrence should be held to a minimum by careful
diagnosis, intelligent treatment planning, adequate mouth preparations, and the carrying
out of an effective removable partial denture design with proper fabrication of all
component parts.

Broken Clasp Arms:

Reasons for breakage of clasp arms:

1- Breakage may result from repeated flexure into and out of too severe an undercut.
If the periodontal support is greater than the fatigue limit of the clasp arm, failure
of the metal occurs first. Otherwise the abutment tooth is loosened and eventually
is lost because of the persistent strain that is placed on it. Locating clasp arms
only where an acceptable minimum of retention exists, as determined by an
accurate survey of the master cast, can prevent this type of breakage.

2- Breakage may occur as a result of structural failure of the clasp arm itself. A cast
clasp arm that is not properly formed or is subject to careless finishing and
polishing eventually will break at its weakest point. This can be prevented by
providing the appropriate taper to flexible retentive clasp arms and uniform bulk
to all rigid non retentive clasp arms.

Wrought-wire clasp arms may eventually fail because of repeated flexure at the
region where it exits from the resin base (Figure 22-1), or at a point at which a
nick or constriction occurred as a result of careless use of contouring pliers. They
also may break at the point of origin from the casting as a result of excessive
manipulation during initial adaptation to the tooth or subsequent readaptation.
Clasp breakage can best be prevented by cautioning the patient against removing
the removable partial denture by sliding the clasp arm away from the tooth with
the fingernails. A wrought-wire clasp arm can normally be adjusted several times
over a period of years without failure. It is only when the number of adjustments
is excessive that breakage is likely to occur. Wrought-wire clasp arms also may
break at the point of origin because of recrystallization of the metal. This can be
prevented by proper selection of wrought wire, avoidance of burnout temperatures
exceeding 1300°F, and avoidance of excessive casting temperatures when a cast-
to method is used. When wrought wire is attached to the framework by soldering,

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / Lec. 18th
2019-2020
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

the soldering technique must avoid recrystallization of the wire. For this reason, it
is best that soldering be done electrically to prevent the wrought wire from
overheating.

3- Breakage may occur because of careless handling by the patient.

Fractured Occlusal Rests:

Breakage of an occlusal rest almost always occurs where it crosses the marginal
ridge. Improperly prepared occlusal rest seats are the usual cause of such weakness: an
occlusal rest that crosses a marginal ridge that was not lowered sufficiently during mouth
preparations may be made too thin or may be thinned by adjustment in the mouth to
prevent occlusal interference. Failure of an occlusal rest rarely results from a structural
defect in the metal and rarely if ever is caused by accidental distortion. Soldering may
repair broken occlusal rests.

In preparation for the repair, it may be necessary to alter the rest seat of the
broken rest or to relieve occlusal interferences. With the removable partial denture in its
terminal position, an impression is made in irreversible hydrocolloid and then is removed,
with the removable partial denture remaining in the impression. The dental stone is
poured into the impression and is allowed to set. The removable partial denture is
removed from the cast, and platinum foil is adapted to the rest seat and the marginal ridge
and overlaps the guiding plane. The removable partial denture is returned to the cast and,
with a fluoride flux, gold solder is electrically fused to the platinum foil and the minor
connector in sufficient bulk to form an occlusal rest.

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / Lec. 18th
2019-2020
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

Distortion or breakage of other components—Major and Minor

connectors:
Distortion usually occurs from abuse by the patient . Major and Minor Connectors
should be designed and fabricated with sufficient bulk to ensure their rigidity and
permanence of form under normal circumstances. Major and minor connectors
occasionally become weakened by adjustment to prevent or eliminate tissue
impingement. Such adjustment at the time of initial placement may result from
inadequate survey of the master cast or from faulty design or fabrication of the casting.
Such a restoration should be remade instead of further weakening the restoration by
attempting to compensate for its inadequacies by relieving the metal. Similarly, tissue
impingement that arises from inadequately relieved components results from faulty
planning, and the casting should be remade with enough relief to prevent impingement.
repeated adjustment to a major or minor connector results in loss of rigidity to the point
that the connector can no longer function effectively. In such situations, a new restoration
must be made, or that part must be replaced by casting a new section and then
reassembling the denture by soldering. This occasionally requires disassembly of denture
bases and artificial teeth. The cost and probable success must then be weighed against the
cost of a new restoration. Generally the new restoration is advisable.

Loss of a Tooth or Teeth not involved in Support or Retention of

the Restoration:
Additions to a removable partial denture are usually simply made when the bases are
made of resin. The addition of teeth to metal bases is more complex and necessitates
casting a new component and attaching it by soldering or creating retentive elements for
the attachment of resin extension. In most instances when a distal extension denture base
is extended, the need should be considered for subsequent relining of the entire base.
After the denture base has been extended, a relining procedure for both the new and the
old base should be carried out to provide optimum tissue support for the restoration.

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / Lec. 18th
2019-2020
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

Loss of an Abutment Tooth Necessitating its Replacement and

Making a New Direct Retainer:
If an abutment tooth is lost the next adjacent tooth is usually selected as a retaining
abutment, and it generally will require modification or a restoration. Any new restoration
should be made to conform to the original path of placement, with proximal guiding
plane, rest seat, and suitable retentive area. Otherwise, modifications to the existing tooth
should be done the same as during any other mouth preparations, with proximal re-
contouring, preparation of an adequate occlusal rest seat, and any reduction in tooth
contours necessary to accommodate retentive and stabilizing components. A new clasp
assembly may be cast for this tooth and the denture reassembled with the new
replacement tooth added.

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / Lec. 18th
2019-2020
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

Other Types of Repairs

Other types of repairs may include the replacement of a broken or lost prosthetic tooth,
the repair of a broken resin base, or the reattachment of a loosened resin base to the metal
framework. Breakage is sometimes the result of poor design, faulty fabrication, or use of
the wrong material for a given situation. Other times, it results from an accident that will
not necessarily repeat itself. If the latter occurs, repair or replacement usually suffices. On
the other hand, if fracture has occurred because of structural defects, or if it occurs a
second time after the denture has been repaired once before, then some change in the
design by modification of the original denture or with a new denture may be necessary.

Repair by Soldering
Approximately 80% of all soldering in dentistry can be done electrically. Electric
soldering permits soldering close to a resin base without removing that base because of
rapid localization of heat at the electrode. The resin base needs only to be protected with
a wet casting ring liner during soldering.

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / Lec. 18th
2019-2020
Lec.20 Prosthodontics ‫ فائزة محمد حسين‬.‫م‬.‫ا‬

Clinical Phases of Removable Partial

Denture Construction
1st Phase: Education of patient
Is the process of informing a patient about a health matter to secure informed
consent, patient cooperation, and a high level of patient compliance.
1. The dentist and the patient share responsibility for the ultimate success of a
removable partial denture.
2. Motivation and instruction to the patient for proper oral hygienase measure, the
patient should understand that removable partial denture cause periodontal
problem, caries and bad oral hygiene that is why partial denture is not supply to
a patient unless the oral hygiene is satisfactory.
3. Patient education should begin at the initial contact with the patient and
continue throughout treatment. This educational procedure is especially
important when the treatment plan and prognosis is discussed with the patient.
4. A patient will not usually retain all the information presented in the oral
educational instructions for this reason; patients should be given written
suggestions to reinforce the oral presentations.

2nd Phase: Diagnosis, Treatment Planning, Design,

Treatment Sequencing, and Mouth Preparation
Treatment planning and design begin with thorough medical and dental
histories. The complete oral examination must include:
A. Clinical and radiographic interpretations of: -
1. Caries.
2. The condition of existing restorations.
3. Periodontal conditions.
4. Responses of teeth (especially abutment teeth) and residual ridges to
previous stress.
5. The vitality of remaining teeth.
B. Evaluation of the occlusal plane.
C. Evaluation of arch form.
D. Evaluation of occlusal relations of the remaining teeth by clinical visual
evaluation and diagnostic mounting of diagnostic casts.

[3rd year / College of Dentistry/University of Baghdad (2019-2020)] Page 1

 After a complete diagnostic examination has been accomplished and
removable partial denture has been selected as treatment of choice, a treatment
plan is sequenced and a partial denture design is developed based on the support
available. For distal extension situations in which no posterior abutments remain
and in which extension bases must derive their principle support from the
underlying residual ridge require an entirely different partial denture design than
does one in which total abutment support is available.
Sufficient differences exist between the tooth-supported and the tooth and
tissue- supported removable restorations to justify a distinction between them.
Principles of design and techniques employed in construction may be
completely dissimilar. The points of difference are as follows: -
1. Manner in which the prosthesis is supported.
2. Impression methods required for each.
3. Types of direct retainers’ best suited for each.
4. Denture base material best suited for each.
5. Need for indirect retention.
The dental cast surveyor is an absolute necessity in which patients are being
treated with removable partial dentures. The surveyor is instrumental in
diagnosing and guiding the appropriate tooth preparation and verifying that the
mouth preparation has been performed correctly.
After treatment planning, a predetermined sequence of mouth preparations
can be performed. Mouth preparations, in the appropriate sequence, should be
oriented toward the goal of providing: -
1. Adequate support, stability and retention for partial denture.
2. A harmonious occlusion for the partial denture.
Through the aid of diagnostic casts on which the tentative design of the
partial denture has been outlined and the mouth preparations have been
indicated in colored pencil, occlusal adjustments, abutment restorations and
abutment modifications can be accomplished. Then the final form of the denture
framework should be drawn accurately on the master cast after surveying so that
the technician can clearly see and understand the exact design of the partial
denture framework that is to be fabricated.

3rd Phase: Support for Distal Extension Denture Bases

It does not apply to tooth-supported removable partial dentures because
support comes entirely from the abutment teeth through the use of rests.
For the distal extension partial denture (FEE), however, a base made to fit the
anatomic ridge form does not provide adequate support under occlusal loading;

[3rd year / College of Dentistry/University of Baghdad (2019-2020)] Page 2

 therefore, special impression technique is needed to satisfy the requirements for
support of any distal extension partial denture base.
Certain soft tissue in the primary supporting area should be recorded or
related under some loading so that the base may be made to fit the form of the
ridge when under function. This provides support and ensures the maintenance
of that support for the longest possible time. This requirement makes the distal
extension partial denture unique in that the support from the tissue underlying
the distal extension base must be made as equal to and compatible with the tooth
support as possible.

4th Phase: Establishment and Verification of Occlusal

Relations an Tooth Arrangements
Whether the partial denture is tooth supported or has one or more distal
extension bases, the recording and verification of occlusal relationships and
tooth arrangement are important steps in the construction of a partial denture.
For the tooth-supported partial denture, ridge form is of less significance than it
is for the tooth- and tissue-supported prosthesis, because the ridge is not called
on to support the prosthesis. For the distal extension base, however, jaw relation
records should be made only after obtaining the best possible support for the
denture base. This necessitates the making of a base or bases that will provide
the same support as the finished denture. Therefore, the final jaw relations
should not be recorded until after the denture framework has been returned to
the dentist, the fit of the framework to the abutment teeth and opposing
occlusion has been verified and corrected, and a corrected impression has been
made. Then either a new resin base or a corrected base must be used to record
jaw relations.

5th Phase: Initial Placement Procedures.

This phase begins when the patient is given removable partial denture. It
seems that minute changes in the planned occlusal relationships occur during
processing of dentures. Not only must occlusal harmony be ensured before the
patient is given the dentures, but also the processed bases must be reasonably
perfected to fit the basal seats.
The patient must be understanding the suggestions and recommendation
given by the dentist for care of the dentures and oral structures and understands
about expectations in the adjustment phases and use of the restorations.

[3rd year / College of Dentistry/University of Baghdad (2019-2020)] Page 3

6th phase: Periodic Recall
Periodic reevaluation of the patient is critical for early recognition of changes in
the oral structures to allow steps to be taken to maintain oral health. These
examinations must monitor: -
1. The condition of the oral tissue.
2. The response to the tooth restorations.
3. The prosthesis (removable partial denture).
4. The patient’s acceptance.
5. The patient’s commitment to maintain oral hygiene.
Although a 6- month recall period is adequate for most patients, a more
frequent evaluation may be required for some.

[3rd year / College of Dentistry/University of Baghdad (2019-2020)] Page 4

Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

‫ميحرلا نمحرلا هللا‬ ‫بسم‬

University of Anbar
Dental Faculty
Prosthodontics Unit
Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD)
3th Grad / 18th Lec.
2019-2020

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / 9th Lec.
2019-2020
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

Computer‑Aided Design/Computer‑Aided Manufacture

(CAD/CAM) Techniques For Removable Denture Fabrication

INTRODUCTION

With continuous developments over several years, present‑day technological

advancements allow the use of different systems with computer‑aided
design/computer‑aided manufacture (CAD/CAM) technology for the fabrication of
removable dentures, including milling and rapid prototyping (RP). CAD/CAM
technology refers to digital design and manufacture. CAD software recognizes
thegeometry of an object while CAM software is used for the manufacture. The
CAD/CAM manufacturing process can either include additive (RP) or subtractive
manufacturing (computer numerical control [CNC] machining; milling). RP has been
used for industrial purposes and was developed from CAD/CAM technology. It is used to
create automatically physical models from computerized three‑dimensional (3D) data.
RP, also known as solid freeform fabrication or layered manufacturing, has been used for
creating 3D complex models in the field of medicine since the 1990s and has recently
become popular for the fabrication of removable dental prostheses. CAD/CAM and RP
have been used for several years for the fabrication of inlays, onlays, crowns, fixed
partial dentures, implant abutments/prostheses, and maxillofacial prostheses.[6]
Currently, not only fixed restorations but also removable dentures are manufactured using
CAD/CAM and RP. However, few studies have reported on the use and effectiveness of
RP for removable denture fabrication. Subtractive manufacturing technique is based on
milling the product from a block by a CNC machine. The CAM software automatically
transfers the CAD model into tool path for the CNC machine. This involves computation
that points the CNC milling, including sequencing, milling tools, and tool motion
direction and magnitude. Due to the anatomical variances of dental restoration, the
milling machines combine burs with different sizes. The accuracy of milling is shown to
be within 10 µm. The first removable prosthesis based on 3D laser lithography was
manufactured in 1994. Subsequently, the removable prosthesis duplication technique
was improved using CAD/CAM with a computerized numerical control (CNC) system
and ball‑end mills in 1997. Then, fabricated individual physical flasks using a 3D printer.
Impressions of the edentulous maxilla and mandible or existing dentures are subjected to
laser scanning during CAD. Also, cone beam computed tomography is used for the
modification of previous dentures. CNC, laser lithography, and RP are used for the CAM
process. AvaDent and Dentca are the two available commercial manufacturers of
removable complete dentures with CAD/CAM, using a gadget for transferring the
maxillomandibular relation (MMR) to a digital articulator and finalizing the dentures
completely with CAD/CAM. In the process used by AvaDent, denture bases are milled

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / 9th Lec.
2019-2020
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

using a subtractive technique from prepolymerized denture resin. The Dentca technique
uses an additive process, wherein a trial denture can be prepared, if the dentist requires,
using RP (stereolithography [SLA]) before the conventional fabrication of a definitive
prosthesis. An electronic search was conducted in the PubMed/MEDLINE (National
Library of Medicine, Washington, DC), ScienceDirect, Google Scholar, and Web of
Science databases for identifying English articles using the following key word
combinations:

 “CAD/CAM and complete dentures”

 “CAD/CAM and removable partial dentures (RPDs)”
 “CAD/CAM and removable dentures”
 “CAD/CAM and removable prosthesis”
 “RP and complete dentures”
 “RP and RPDs”
 “RP and removable dentures”
 “RP and removable prosthesis”
 “Digitally designed and removable dentures”
 “Digitally designed and complete dentures”
 “Digital complete dentures”
 “Digital removable dentures”
 “Rapid manufacturing and removable dentures”
 “Milled,” “machined,” “computerized,” and “removable dentures.”

Techniques And Materials Used For Dental Computer‑Aided Manufacture

CAM includes subtractive and additive manufacturing techniques [Figure 1]. Early
CAM systems are based on subtractive method that was relied on cutting the restoration
from a prefabricated block using burs, drills, or diamond disks. Subtractive
manufacturing includes CNC machining used for the manufacture of crowns, posts,
inlays, and onlays. The subtractive production methods include spark erosion and milling.
The spark erosion can be defined as a metal substractive process using continuing sparks
to erode material from a metal block according to the CAD under required conditions.
Milling techniques are diamond grinding and carbide milling which are now found
together in chair-side and in Lab CAD/CAM devices together and as the latest transferred
technology from manufacture industry to dental use is laser milling, which was
announced in first quarter of 2015. Milling techniques are mostly dependent on the
device properties such as the dimensional approach and possibilities of working axis: 3
spatial direction X, Y, and Z which refers to 3 axis milling devices while 3 spatial

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / 9th Lec.
2019-2020
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

direction X, Y, Z and tension bridge refers to 4 axis milling device, and finally 3 spatial
direction X, Y, Z, tension bridge with milling spindle is classified as 5 axis milling
device. Additive 3D printing techniques include SLA, digital light projection (DLP), jet
(PolyJet/ProJet) printing, and direct laser metal sintering (DLMS)/selective laser sintering
(SLS). The SLA technique uses ultraviolet (UV) laser for layer‑by‑layer polymerization
of materials. The technique is used for the manufacture of dental models from
UV‑sensitive liquid resins. DLP uses UV laser and visible light for polymerization and is
used for the manufacture of dental models, wax patterns, removable partial frameworks,
and provisional restorations from visible light‑sensitive resins, wax, and composite
materials. After the material is printed, it is cured using a light‑emitting diode light source
or lamp. Also, polymethyl methacrylate (PMMA) is used in the DLP technique. Jet
(PolyJet/ProJet) printing uses a series of ink‑jet print heads and tiny pieces of material
jetted onto support material and create each layer of the part. Then, each jetted layer is
hardened using a UV lamp, light source, or heating. This technique is used for the
manufacture of dental models, surgical drill guides, aligners, wax patterns, and
removable frameworks from dental resin and waxes. DLMS/SLS is a powder‑based
technique wherein high‑power laser beam hits the powder, resulting in melt and fusion of
the powder particles. This technique is used for the manufacture of dental models,
copings, and surgical guides from cobalt‑chrome, palladium chrome, and nylon.

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / 9th Lec.
2019-2020
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

Manufacturing Process Of Removable Prosthesis With Computer‑Aided Design/

Computer‑Aided Manufacture And Rapid Prototyping

 Manufacturing Steps For Framework Of Partial Prosthesis

Designing of the RPD framework generally consists of four parts as base, plate, clasp,
major, and minor connector of the framework. Every part of the RPD framework must be
done proper design and thick value in the designing process. Because of the variety of
RPD parts and their irregular forms, 3D designing of RPD framework is taking much
time and complicated. For this reason, researchers investigated proper CAD/CAM
method and software for 3D designing of RPD framework for many years. Basically,
steps for manufacturing of framework of partial prosthesis with CAD/CAM and RP are:
First, dental casts are prepared using conventional impression method or digital
impression. Casts are scanned using digital scanner for conventional technique. Path of
insertion of the RPD is defined digitally, and then shape of the components of the
framework is designed 3D by dentists or laboratory technicians. Finally, digitally
designed metal RPD frameworks are produced with RP.

 Manufacturing Steps For Complete Dentures

First, models can be prepared using conventional impression or intraoral digital
impression. When digital impression is considered, practitioner will need for high speed,
high density, small size, and multifunctional device which has driven the development of
3D imaging. The precision of digital impression has been studied by several researchers
and found out that use of digital models is a relatively new technique that has an accuracy
of up to 10 µm, and the models have been found to be as reliable as traditional stone
casts. Therefore, casts are scanned using digital scanner for conventional technique. After
taking impression, the next step is making MMR transfer during complete prosthesis
fabrication using CAD/CAM. There are three options for MMR transfer during complete
prosthesis fabrication using CAD/CAM: The MMR can be transferred using conventional
impression and transfer techniques, the AvaDent system kit, or the Dentca system kit.
Two clinical appointments are required for the manufacture of removable complete
dentures using the Avadent and Dentca systems. In the first appointment, impressions are
recorded using special trays provided in the AvaDent or Dentca system. Then, the jaw
relation is recorded using an anatomical measuring device. The occlusal vertical
dimension (OVD) is determined using conventional methods. Subsequently, the centric
relation is recorded, and teeth are selected. The last step of the first appointment is the
delivery of the final impression to the manufacturer (AvaDent or Dentca).

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / 9th Lec.
2019-2020
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

At the laboratory, the denture borders are first defined and marked using the system’s
computer software. Then, the teeth are virtually set, and the prosthesis base is milled
from traditional denture resin material. A trial denture can be prepared as per the dentist’s
request. In the second clinical appointment, the dentures are delivered and any occlusal
adjustments made. These steps are similar to those for conventional prosthesis delivery.
Only the AvaDent technique of denture base manufacture is not conventional.

Advantages Of Digital Fabrication Of Dentures

 Decreased number of appointments.
 Shrinkage of acrylic base caused by milling of prepolymerized acrylic resin with
an increase in the strength and fit of dentures.
 Decreased duration of prosthesis manipulation.
 Decrease in the risk of microorganism colonization on the denture surfaces and
consequent infection.
 Advances in standardization for clinical research on removable prostheses.
 Easy reproduction of the denture and manufacture of a trial denture using stored
digital data.
 Superior quality control by clinicians and technicians.

Limitations And Disadvantages Of Digital Fabrication Of Dentures

 Manufacturing challenge caused by impression‑taking and OVD‑recording
procedures, MMR transfer, and maintenance of lip support, which are all similar
to the procedures used in the conventional process.
 Inability to define the mandibular occlusal plane.
 Expensive materials and increased laboratory cost compared with those for
conventional methods.
 Lack of trial denture manufacture by the Avadent system,[which precludes the
evaluation of dentures by patients and dentists before final denture fabrication.

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / 9th Lec.
2019-2020
Lec.18 Prosthodontics 3th grade Asst. Prof. Dr. Salah Al-Rawi (BDS, MSc, PhD)

Asst. Prof. Dr. Salah Kh. Al-Rawi (BDS, MSc, PhD) 3th Grad / 9th Lec.
2019-2020
 PROSTHODONTICS

3rd class Dr.Osama Alheeti

Flexible Denture
Flexible dentures or Soft dentures are an excellent alternative to
traditional hard-fitted dentures, when traditional dentures cause
discomfort to the patient that cannot be solved through relining. Soft
dentures are not the same as a soft reline for traditional dentures. Soft
relines use a soft putty-like substance to separate gums from the hard
acrylic in dentures. Flexible dentures use a special flexible resin that
prevents them from chafing the gums, allows the wearer to chew
properly. Some of the commercially available products are: Valplast,
Duraflex, Flexite, Proflex, Lucitone Impak whereas valplast and lucitone
are monomer free.

Advantages:
1.Translucency of the material picks up underlying tissue tones, making it
almost impossible to detect in the mouth.
2.No clasping is visible on tooth surfaces (when used in manufacturing of
clear clasps), improving aesthetics.
3.It is comfortable for the patient (thin and lightweight), so it does not
fracture even if it is thrown intentionally from some height whereas
patient with full acrylic partial or complete dentures often visit the dentist
with broken or fractured prosthesis as these are brittle.
4.The material is exceptionally strong and flexible which allows it to
engage the undercut beneath the bony exostosis that is not possible in
rigid partial dentures.
5.Complete biocompatibility is achieved because the material is free of
monomer and metal, these being the principle causes of allergic
reactions in conventional denture materials.

6. Flexible dentures may be used as an alternate treatment plan in

rehabilitating the anomalies such as ectodermal dysplasia.

Effect on the oral mucosa: Flexible dentures exhibit viscoelastic

behavior that lead to improvement in masticatory function and patients
comfort compared with hard dentures .They show little effects on the
mucosa of denture bearing area and little changes on the mucosa. Denture
bearing area of flexible denture is healthier with less tissue changes
compared with traditional acrylic denture. Flexible removable partial
dentures can adapt to the shape and movement of mouth and for this
reason, these are far more comfortable to wear.

Disadvantages:
1.not used for long-term restorations and is intended only for provisional
or temporary applications. Metal frame partial dentures remain the"
standard" for long-term restorations.
2.Flexible dentures tend to absorb the water content and will discolor
often. The acrylic teeth are mechanically bonded to thermoplastic nylon.
Hence the teeth can come out of the prosthesis.
3.When comparing it with cast partial dentures the flexible dentures do
not give the patients sense about hot or cold eatables as these are bad
conductors.
4.When grinding this prosthesis, proper ventilation, masks, and vacuum
systems should be used and the procedure is sensitive technique.
5.Extreme caution is necessary when processing to avoid skin contact
with the heated sleeve, cartridge, furnace, heating bay, hot cartridge,
injection insert, piston head adapter, hot flasks and heat lamps.
Flexible denture base material:

It is polyamide nylon thermoplastic material that does not sacrifice

function and preserves aesthetics. It is available in the form of granules in
cartridges of varying sizes. It was first introduced by the name of valplast
and flexiplast to dentistry in 1956.
Injection-molding technique is used for fabrication of flexible denture
base prosthesis. Acrylic resin teeth do not bond chemically with flexible
denture base resin. They are mechanically retained by making T shape
holes undercuts (as shown below) into which denture base resin flows to
retain teeth mechanically.

Flexible partial denture:

The removable partial denture can be fabricated from metal alloy, acrylic
resin and thermoplastic resins. The removable cast partial denture is a
definitive prosthesis which has been in use in dental profession since
decades for rehabilitation of partially edentulous patients. It consists of a
metal base (made up of base metal alloys, commonly with cobalt-
chromium alloy), with acrylic teeth attached to it. Metal retentive clasp
holds the cast partial denture in place. The metallic appearances of the
clasp may be restrictive for treating the patients who are very much
concerned about the aesthetics. When maxillary posterior teeth are
missing and only anterior teeth are present, placement of metallic clasps
on canines may not be acceptable to the patients.

The second type of removable partial denture is all acrylic resin

prosthesis, which is also known as temporary, interim removable partial
denture or a “FLIPPER”. It acts as a space maintainer and is usually used
to restore the function during the treatment until the definitive prosthesis
is fabricated.

The flexible partial denture aesthetically has several advantages over the
other two types of partial dentures. There is no metal/wire clasps used in
FRPDs. Instead of metal clasps. The clasps of flexible removable partial
denture are extensions of denture base into undercut areas and they are
also made up of flexible thermoplastic material with
excellent esthetics, which can be adjusted by dipping the clasp area in
boiling water and then bending with the plier in or out to increase or
decrease the retention.

Different clasp designs are used:

Main clasp Circumferential clasp

Combination clasp (of main clasp Continuous circumferential clasp and circumferential

clasp)
 Partial dentures with resin clasp and metal framework

It is also an option for cosmetic improvement of teeth that appear

elongated due to recession of gums and also for patients who are allergic
to acrylic.

The insertion technique for RPD:

Immediately prior to inserting the RPD in patient’s mouth, immerse it in

very hot tap water. Leave it in the water for about 1 minute, remove it and
allow cooling to the point where it will be tolerated by the patient. Gently
insert it in the mouth. The hot water permits a smooth initial insertion and
good adaptation with the natural tissues in the mouth. If the patient senses
any discomfort because of tightness of a clasp, the clasp may be loosened
slightly by immersing that area of the partial in hot water and bending the
clasp outward. If a clasp requires tightening, bend clasp inward.

The adjustment for FRPD:

If any reduction is needed due to persistent irritation, the RPD must be

handled differently than acrylic. It is recommended to use green mounted
stones. Use a delicate touch with the hand piece rotating between 20,000
and 25,000 rpm in rapid repetitive motion. Then it is smoothened and
polished with rubber wheel. The resin will melt if there is prolonged
contact with a bur or wheel, so continuously move the instrument over
the surface.

Using green mounted stone to trim adjustment kit

Special instructions for flexible denture wearer:

The patient should be instructed to practice good oral hygiene and clean
prosthesis regularly after every meal, in order to maintain appearance and
cleanliness of the prosthesis because it is prone to staining by various
ingredients of food, tea and coffee if it is not polished properly and
cleaned by the patient regularly. The prosthesis should be removed during
the brushing of the natural teeth, to avoid the scratching of the prosthesis .

To help your flexible partial denture to look and feel like new,
please follow these simple instructions:

1- Always rinse your flexible partial under running hot tap water for
approximately 20 to 30 seconds before wearing it. The small flexible
clasps will get hard and could break if this is not done.
2- Do not wear your partial to bed. Remove at night and keep it in
water when not being worn to keep it hydrated.
3- Rinse your appliance after eating to remove food particles.
4- Always remove your flexible partial denture to brush your
teeth. Toothpaste is great for your teeth but not for your
partial. Brushing your partial with toothpaste may remove the polish
and roughen the surface over time. Use a gentle soap and your
toothbrush to clean your new partial.
5- Bring your partial to your dentist for ultrasonically dental
cleaning. Loose particles can be removed with the use of a sonic
denture cleaner. Ultrasonic cleansing devices don't replace brushing
but they do help to make your overall cleaning efforts more effective.