MOUTH PREPARATION

FOR REMOVABLE
PARTIAL DENTURE

Sanah basheer
Part II regular
CONTENTS
• Introduction
• Definition
• Objectives
• Preparation of mouth
1. Non prosthodontic preparation.
2. Prosthodontic prepration.
• Preparation of abutment tooth
• Conclusion
• references
INTRODUCTION
• Mouth preparations are procedures that change or modify
existing oral structures or conditions, to facilitate placement and
removal of prosthesis for its efficient physiologic function and
long-term success.
DEFINITION
• Mouth preparations are identified as those procedures that are
accomplished to prepare the mouth for the reception of
prosthesis
OBJECTIVES
• Establishing state of health in supporting and contiguous
tissues.
• Eliminating interferences or obstructions.
• Establishing acceptable occlusal plane.
• Alteration of natural tooth form for the requirements of form and
function of prosthesis.
CLASSIFICATION
Classified as
1.General preparation of the mouth which involves nonprosthodontic preparation
(where no prosthetic procedure is performed) and prosthodontic preparation (which
may involve some prosthetic procedures like crowns).

2.Specific preparation of abutment teeth to create guiding planes, retentive

undercuts and occlusal rests.
• MOUTH PREPRATION

1. Preparation of mouth

1. Non prosthodontic preparation

• Relief of pain and infection

• Oral surgical preparation
• Tissue conditioning
• Periodontal preparation
• Endodontic and restorative
• Orthodontic considerations
2. Prosthodontic preparation

• Correction of occlusal plane

• Correction of malalignment
• Supportiong weak tooth
• Preparation of abutment tooth

1. Abutment requiring minor modifications

2. Abutment requiring cast restoration
1. Relief of Pain and Infection
• Dental conditions that are causing discomfort should be
addressed as soon as possible. Necessary endodontic and
surgical procedures should be completed. Carious lesions
should be treated to decrease the likelihood that an acute
episode of pain will occur during the course of treatment.
• Gingival tissues should be treated to minimize the probability
that periodontal abscess and other inflammatory responses will
occur. Scaling ,root planing and prophylaxis should be
performed and a rigorous oral hygiene programm should be
estabilished and carefully monitored.
2. Oral surgical procedures.
• EXTRACTION
Extraction of non strategic teeth that would present complication or
those that may be detrimental to design of the removable partial
denture is a necessary part of the overall treatment plan.
• Diagnostic mounting allows confirmation of the need for extraction
after clinical examination
Removal of residual roots
• Generally , all retained roots or root fragment should be removed.
• Residual roots adjacent to the abutment teeth may contribute to the
progression of periodontal pockets and compromise the result of
subsequent periodontal therapy.
• Removal is accomplished from facial or palatal surface to preservethe
ridge height
Impacted teeth
• All impacted teeth, including those in edentulous areas, as well
as those adjacent to abutment teeth, should be considered for
removal.
• It is removed to avoid acute and chronic infection with extensive
bone lose later
Malposed teeth
• The loss of individual teeth or groups of teeth may lead to
extrusion, drifting, or combinations of mai positioning of the
remaining teeth.
• Surgical repositioning of these teeth is contemplated only after
orthodontic treatment is ruled out.
Cysts and odontogenic tumor.
• Panoramic radiographs should be taken for ruling out
unsuspected pathology. Radiolucencies and radiopaci-ties
noted in the radiograph should be investigated, and the
diagnosis should be confirmed through biopsy.
• Surgical removal should be done.
Exostoses and Tori
• Mucosa covering these bony protuberances is usually thin and
liable to ulcerate. Exostoses approximating gingival margins
may complicate the maintenance of periodontal health and may
lead to the loss of abutment teeth.
• Denture design may be modified to accommodate the exostosis
but could result in additional stress to the supporting elements
and compromised function
• surgical removal of exostoses and tori is done
Hyperplastic tissue
• Hyperplastic tissues are seen in the form of fibrous tuberosities,
soft flabby ridges, folds of redundant tissue in the vestibule or
floor of the mouth, and palatal papillomatosis.
• Removal of this excess tissue provides a firm base for the
denture and reduces stress on supporting teeth and tissues
Muscle attachments and freni
• As a result of the loss of bone height, muscle attachments may
insert on or near the residual ridge crest. The mylohyoid,
buccinator, mentalis, and genioglossus muscles are most likely
to introduce problems of this nature.
• Maxillary labial and mandibular lingual frenum most commonly
interfere with denture design.
• Bony spines and knife edge ridges
- Sharp bony spicules should be removed and knife like crests gently
rounded.

• Polyps, Papillomas, and Traumatic Hemangiomas

- all abnormal soft tissue lesions should be excised and submitted

for pathologic examination before a removable partial denture is
fabricated
Hyperkeratoses , erythroplasia and
ulcerations
• All abnormal white, red, or ulcerative lesions should be
investigated, regardless of their relationship to the proposed
denture base or framework.
• The lesions should be removed and healing accomplished
before the removable partial denture is fabricated.
Dentofacial deformities
• Patients with these deformities have multiple missing teeth and
malocclusion as a part of the problem
• Correction of the deformity should form part of the treatment
plan to replace teeth and develop a harmonious occlusion
Alveolar bone augmentation
• Ridge augmentation is done for atrophic ridges, flat palatal
vault and mild to moderate anteroposterior ridge relation
discrepancy.
• It is done with graft materials

• It enhances the support and stability of denture

3.Conditioning of abused and
irritated tissues.
• Conditioning of tissue is required if:
1. Inflammation and irritation of the mucosa covering denture-bearing
areas
2. A burning sensation in residual ridge areas, the tongue, and the
cheeks and lips
3. Anatomical structures like rugae, incisive papilla, and retromolar pad
are distorted

• These conditions are usually associated with ill-fitting or poorly

occluding removable partial dentures. Tissue conditioners are used to
provide a soothing effect on irritated mucosa
4. Periodontal preparations.
• Periodontal preparation usually follows or is performed
simultaneously with oral surgical procedures and is completed
before restorative procedures.
• The success of the prosthesis depends on the health and
integrity of the periodontal tissues of the remaining teeth and
the following procedures are performed to achieve this
objective.
Objectives of periodontal therapy.
I. Removal and control of all etiologic factors contributing to
periodontal disease along with reduction or elimination of
bleeding on probing
II. Elimination of, or reduction in, the pocket depth of all pockets
with the establishment of healthy gingival sulci whenever
possible
III. Establishment of functional traumatic occlusal relationships
and tooth stability
IV. Development of a personalized plaque control program and
a definitive maintenance schedule
Initial disease control therapy
• Initial disease control therapy includes the following procedures:
• Oral hygiene instructions.
• Scaling and root planning.
• Elimination of local irritating factors other than calcu-lus-like
overhanging margins of restorations and open contacts leading to food
impactions.
• Elimination of gross occlusal interferences.
• Temporary splinting of mobile teeth to allow any periodontal procedures
to be performed.
• Use of night guard as a temporary splint and to stimulate any
unopposed teeth.
Definitive periodontal surgery
• After the initial therapy if periodontal problems persist, then
gingivectomy, periodontal flap and reconstructive surgical
procedures, as indicated, may be planned to eliminate
periodontal disease.
Recall maintenance
• This is very important in maintaining periodontal health
• It includes reinforcement oral hygiene measures and thorough
scaling and root planning.
• patients with a history of moderate to severe periodontitis
should be placed on a 3- to 4 month recall system to maintain
results achieved by nonsurgical and surgical therapy
5. Endodontic and restorative
treatment.
• Teeth with pulpal involvement and root end pathology are candidates
for endodontic therapy.
• Restorative therapy like - crowns, inlays, onlays, restoration of carious
lesions and replacement of defective restorations should be
integrated with endodontic treatment.
Orthodontic treatment
• Orthodontic preparation is carried out to achieve the following:

1. Reduce the need for prosthetic teeth as much as possible.

2. Position the teeth to allow the most natural prosthetic
replacement of teeth.
3. Create sufficient vertical height to allow room for placement of
artificial teeth.
4. Allow sufficient occlusal guidance on natural teeth
II. Prosthodontic preparation.
• Correction of occlusal plane
1. Enameloplasty
2. onlay
3. crowns
4. Endodontics with crown or coping
5. Extraction
6. surgery
• Correction of malalignment
1. orthodontic realignment
2. Crown
3. Enameloplasty
• Provision of support for weakened teeth
1. Removable splinting
2. fixed splinting
3. overdenture abutment
Correction of occlusal plane
Uneven occlusal plane is common in partially edentulous
situations due to:
• Supraeruption and infraeruption
• Mesial migration
• Tipping of teeth
• Malrelationship of jaws
i. enameloplasty
• occlusal reshaping, Esthetic Reshaping (GPT9)
• The intentional alteration of the surfaces of teeth to change their
form.
• The enamel is contoured using high-speed tapered diamonds
and polished with carborundum wheels or points. Fluoride
treatment of the tooth surface increases its resistance to caries.
Onlay .
• It is a conservative method of correcting occlusal plane as minimal
tooth preparation is required compared to a full veneer crown.
• It maintains the natural contours of facial and lingual enamel surfaces
as only occlusal surface is prepared.
• The occlusal surface of the tooth being prepared should be free of
pits and fissures. It can be made of chrome or gold alloy.

• Disadvantages:
• Less retention
• More metal display
Crowns.
• When the height of contour, retentive undercut or guiding plane
needs to be altered, crown is preferred to change the occlusal
plane
Endodontics with crown or coping
• Retaining teeth in strategic positions will greatly improve the
prognosis of the partialdenture.
• Retaining mandibular second or third molars to serve as posterior
abutments will support the prosthesis and will prevent it from beinga
more complicated distal extension situation
• . Endodontics followed by crown or overdenture coping will restore
occlusal plane and allow the teeth to be retained.
• Extraction
Malposed teeth and teeth interfering with placement of major
connector requireextractions to correct occlusal plane as they
compromise the success of treatment.

• Surgery
Surgical repositioning of one or both jaws, fully or partly, can be
contemplated tocorrect occlusal plane. These include osteotomies and
repositioning procedures.
Correction of malalignment
Malaligned teeth create the following difficulties:
• Maintenance of oral hygiene.
• Determining a simple path of insertion.
• Establishing guiding planes.
• Placement of clasp arms of direct retainers.
Teeth which are malposed facially or lingually are more difficult to
correct than supraerupted teeth.
The following methods can be adopted for their:
1.Orthodontic realignment
2.Crown
3.enameloplasty
Provision of support for weakened
teeth
• Over denture abutment

Teeth strategically positioned in the arch with more than 50% bone
loss can be retainedas overdenture abutments.
They resist the tissueward forces and provide support.
Retaining such a tooth distal to edentulous space will convert a
potential distalextension base into a tooth supported situation,
improving the function of denture.
Preparation of abutment teeth.
OBJECTIVES :
• Direct stress along the tooth axis
• Eliminate interferences by recontouring of teeth
• Create retention by simple alteration procedure
• Allow placement and removal of prosthesis without transmitting
wedging type of stress against teeth with which it comes in
contact.
• CLASSIFICATION:

1. Abutment teeth that require only minor modification to their

coronal portion.
2. Abutment teeth that have cast restoration.
Abutment teeth that require only
minor modification to their coronal
portions
Sequence of preparation.

• Preparation of guiding planes

• Modification of height of contour
• Preparation of retentive undercuts
• Rest seat preparation
Abutment teeth that have cast restoration
Cast restorations like inlays, onlays and crowns are planned on
abutments in the following situations:

• If Enameloplasty does not achieve usable natural contours, as in

tipping, rotation, malalignment, supra- and infraeruption of abutment.
• Presence of caries, defective restorations, tooth fracture and
endodontic treatment in abutment tooth.
• The guiding planes, height of contour, retentive undercuts and
occlusal rests are prepared on the wax patterns of these restorations
with mounted casts on the surveyor
Conclusion.
• The success or failure of a RPD depends on how well the
mouth preparations are accomplished.
• It is only through intelligent planning and competent execution
of mouth preparations that the partial denture can satisfactorily
restore lost dental functions and contribute to the health of the
remaining oral tissues
References.
• McCracken WL. Mouth preparations for partial dentures.

• Stewart's clinical removable partial prosthodontics

4 edition
• McCracken's removable partial prosthodontics 13 th edition
• Textbook of prosthodontics- V Rangarajan/ TV Padmanabhan.
Thankyou