Removable partial denture design protocol (This must be done at the onset of the treatment plan) 1.

Review diagnosis and treatment plan for RPD with instructor. 2. Decisions regarding teeth to be retained, surgical procedures to be employed, and restorations to be placed must be made with the ultimate design of the RPD in mind Identify and confirm suitability of abutments you will use to support the RPD

Make two maxillary and mandibular alginate impressions and pour in dental stone CAST 1: 1. Mark the first set of cast as Cast 1 and articulate them (by hand if possible, with record bases if needed) 2. Design a RPD by surveying the cast by placing it on a survey table. Tilt the cast anteriorly or posteriorly to achieve a line of draw for the proposed guide plane and undercut location for the proposed clasp design 3. Measure and show the location of the undercut (terminal portion of the clasp engaging in a 0.01 inch undercut gauge this is the undercut rod with one line as shown). Place a red dot on the cast where there is adequate undercut.

4. Tripod casts. Tripod loci must be visible in order to establish remount orientation. Survey must be done with only one (tilt) for all teeth 5. Diagnostic casts should have survey lines on abutment teeth and potential tissue undercuts 6. Draw the design on preliminary design form 7. The faculty and GPD must approve the design and submits it for further review and approval of the design. The study cast and preliminary design is submitted to the CDL where the design will be reviewed by the quality assurance team and signed. It will be returned to the module with the routine lab work. 8. Design is approved or altered and returned to the GPD. 9. Cast 1 is set aside and saved and the preliminary partial design form is placed in the patient record. Note: No tooth alteration can be performed without this signed form in the chart.

CAST 2: Mark the second set of cast as Cast 2 and using the already approved design draw the design on this cast. Make cast alteration representing tooth modifications such as rests, guide planes and contour modifications. This is practice before making these changes on your patients.

PATIENT: 1. The patients teeth are altered using Cast 2 as a guide to duplicate the design 2. Faculty approves alteration of the dentition. 3. An impression is taken according to the standard technique using medium body polyvinylsiloxane materials. 4. The master impression is reviewed by the faculty and approved by the GPD with their signature on the prescription to be poured (NOTE: For Kennedy Class I and II cases, final impressions must be made using custom trays. When fabricating custom trays, 2 layers of wax should be placed over the teeth. One layer of wax should be placed over the edentulous ridge). 5. Bring impression to the laboratory directly for pouring master casts. (Note student pours all other casts and counter models). 6. Student picks up cast from CDL 24 hours later. CDL will not separate the cast from the impression. In order to separate the cast from the impression place it in hot water to soften the wax spacer and compound if used for border molding. If you have thin and easily breakable teeth on casts, the tray may have to be sectioned. SURVEY AND DESIGN ON MASTER CAST: 1. Survey and tripod master cast just like on cast 1. Note: ONLY SURVEYING and TRIPODING MARKS SHOULD BE ON MASTER CASTS so that cast is not abraded in any way. Again, the location of undercut must be marked with a red pencil dot at the terminal portion of retentive clasp. 2. DRAW THE RPD DESIGN ON THE RPD WORK AUTHORIZATION FORM: Outline rest seats, major and minor connectors, type of clasps, tissue stops and denture base areas. 3. RPD work authorization form must be signed by the faculty and co-signed by the GPD. 4. Articulation is required when OPPOSING framework fabrication is requested, except when opposed by a complete denture. Master casts should have three index notches cut into the bases for remounting purposes. See figures below. 5. Casts should be presented attached to the mounting plates. 2

6. Submit to lab. FRAMEWORK TRY IN AND ADJUSTMENTS AND CONFIRMATION OF OCCLUSION AND JAW RELATIONS RECORDS: 1. After the framework is adjusted and properly seated. Assure that the occlusion is not altered or vertical increased with RPD components such as rests. 2. Fabricate occlusion rims or send to lab if this is extensive. (If casts are already articulated, rearticulation may not be necessary). 3. Articulate casts and select teeth with proper shade and mold. 4. Obtain artificial tooth selection form from the supply desk. 5. Forms must be completed listing all requested maxillary and mandibular anterior and posterior molds and shades. Check shade/mold availability chart located in clinics. 6. The form should include: Student I.D. number Patient I.D. number Shade Mould 7. Faculty must approve and sign tooth selection form 8. At any time of day, place form in box located outside of Central Dental Laboratory labeled TOOTH ORDER BOX. Each morning, CDL personnel will process these orders. 9. Students can pick-up their teeth orders between: 10:30 A.M. to 11:30 A.M. and 2:30 P.M. to 3:30 P.M. 10. Write a prescription signed by the faculty and co-signed by the GPD. Send articulated casts, frameworks to laboratory for tooth arrangement, INCLUDE TEETH. 11. Laboratory will return complete tooth arrangement and wax up. Check tooth arrangement to accept or send back for alterations. 12. Try-in patients mouth. Confirm vertical dimension, centric or maximum intercuspation records, esthetics and make changes if necessary. Write prescription and send to CDL to process RPD. Include shade for acrylic resin. Prescription form must be signed by the faculty and co-signed by the GPD. 3

13. Laboratory will return RPD processed and finished GENERAL CONSIDERATIONS Lingual plate should only be fabricated if necessary. Rest seats are not necessary on anterior teeth. Embrasure clasps are to be avoided Double palatal bars should be used selectively RPI should only be used if indicated Indirect retainers should only be placed when essential Rugae area are not to be covered when there are no missing anterior teeth U-shaped palatal design is to be used if anterior teeth are missing Flanges anterior of the molar area are to be avoided. Used only when there is significant loss of alveolar bone. Flanges are required in molar area with free end saddle. Teeth are to be butted when possible using teeth equal in size to patient's own teeth.