CUSTOM OCCLUSAL TEMPLATE
greater than those involved
AS AN INSERTION GUIDE
FOR PRECISION REMOVABLE
PARTIAL DENTURES
ROBERT SRETER, D.D.S., M.S.
ne of the paramount rea-
O
sons for fabricating preci-
sion removable partial
dentures, or PRPDs, rather than
conventional removable partial
dentures, or RPDs, is to improve
esthetics, especially in the par-
tially edentulous maxilla. 1 cating factors that must be con-
Patients with a high lip line may
find the metal display of circum-
ferential clasps objectionable.
This is especially true when the
abutment teeth are maxillary
incisors or even premolars.
It is common to see a Kennedy
Class I or Class II situation, in
which many or all of the poste-
rior teeth are missing and the
remaining anterior teeth have
been splinted with fixed partial
denture full-coverage restora-
tions. Kennedy Class III and
Class IV patterns also lend
themselves to the placement of
PRPDs, even though they are
less frequently encountered. The
terminal teeth abutting the
edentulous areas contain the
female section of an intracoronal
precision attachment, while the
partial denture will contain the
1200 JADA, Vol. 130, August 2008
Copyright ©1998-2008 American Dental Association. All rights reserved.
PRPD are typically much
corresponding male section and a
lingual reciprocating arm. This
combination will obviate the dis-
play of metal and yield an
optimal esthetic result.
There are, however, a
number of potential compli-
sidered before treatment plan-
ning and fabrication of the
PRPD are carried out. 2 and time-consuming. Even for
Problems with
patient dexterity can
be solved by fabri-
cating a hard acrylic
resin template that
will fit onto the
occlusal surfaces.
With PRPDs, the abutment
teeth must be prepared for full
coverage. RPDs, however, do
not require crowns if the teeth
are healthy and in proper con-
tour. The duration of treatment,
complexity of treatment and
cost involved in fabricating a
with a conventional RPD. More-
over, laboratory support is more
critical when fabricating PRPDs
than when making conventional
RPDs. The slightest discrep-
ancy or lack of parallelism
between the attachments will
prevent the PRPD from seating
on the abutments.
PATIENT DEXTERITY
PROBLEMS
Another complicating factor that
must be addressed is patient
dexterity. Many patients, espe-
cially elderly patients and those
with arthritis, may experience
difficulty in seating the PRPD.
Lining up the male and female
components can be frustrating
patients with no dexterity prob-
lems or other physical limita-
tions, learning to place the PRPD
can be a real challenge. If the
PRPD has more than two abut-
ments, the problem may be com-
pounded. The patient may seat
one or more, but not all, of the
attachments. When this occurs,
the denture will not seat com-
pletely and may even become
wedged in an improper position.
SOLUTION
Problems with patient dexterity
can be solved by fabricating a
hard acrylic resin template that
will fit onto the occlusal sur-
faces of the maxillary or
mandibular arch (Figure). After
 CLINICAL DIRECTIONS

wall of the template against

Figure. A custom occlusal template is shown.
the crowns have been cemented
and the PRPD is seated in the
mouth, the practitioner makes
an irreversible hydrocolloid
impression intraorally. The
resulting model is then placed
in a machine (Sta-vac, Buffalo
Dental Mfg., and Biostar,
Scheu-Dental, are two exam-
ples) that fabricates a hard
acrylic resin occlusal template.
The Sta-vac machine requires
hard acrylic square sheets that
are 0.080 inch thick and 5
inches wide. The Biostar
machine requires hard acrylic
round sheets that are 2.0 mil-
limeters thick and 125 mm in
radius. The dentist trims the
template to the height of con-
tour so that the patient can
place and remove it easily
without the interference of
undercuts.
The patient can now easily
place the PRPD into the tem-
plate out of the mouth. He or
5 she can then place the labial
the permanently cemented
crowns to guide the PRPD into
its final seating position. This
approach automatically aligns
the male and female sections of
the precision attachments and
allows the patient to seat the
PRPD more easily. Some
patients will use the template
as a training device and then
abandon it as they become
accustomed to seating the
PRPD. Other patients will use
the template on an ongoing
basis because of their limited
ability to seat the PRPD.
The custom occlusal template
offers a simple, fast and inexpen-
sive solution to a potentially
frustrating problem. The restora-
tive dentist and prosthodontist
should include it in their arma-
mentarium for use as the need
arises.
Dr. Sreter is a clinical instructor, Department
of Prosthodontics, Hadassah School of Dental
Medicine, Hebrew University, Jerusalem,
Israel. Address reprint requests to Dr. Sreter,
13 Keren Hayesod St., Jerusalem, Israel.
1. Preiskel HW. Precision attachments in
dentistry. St. Louis: Mosby; 1973:41-78.
2. McGivney GP, Castleberry DJ.
McCracken’s removable partial prosthodon-
tics. St. Louis: Mosby; 1989:81.

DO YOU HAVE A TIP TO SHARE?

Do you have a time- or work-saving clinical technique to share with your colleagues? Submit it
to JADA’s Clinical Directions department. A Clinical Directions item should be a maximum of two
double-spaced typed pages and should include no more than one figure or illustration. Submit
items to Clinical Directions, JADA, 211 E. Chicago Ave., Chicago, Ill. 60611.

JADA, Vol. 130, August 2008