Vinay PavanKumar .

K
II year pg. student
Dept of Prosthodontics
AECS Maaruti College of Dental Sciences
 • Purpose &
Patient Uniqueness of Rx
interview • Shared Decision
Making

• General
Clinical examination
Examination • Oral examination
• Interpretation of
Treatment Examination Data
planning • phases
Development &
of Rx plan
“Most clinicians also choose an RPD for a partially
edentulous patient if they need to restore lost residual
ridge, achieve appropriate esthetics, increase
masticatory efficiency, and improve phonetics but are
unable to do so with dental implants or fixed partial
dentures due to financial constraints or patient desires”
- Bohnenkamp DM Removable Partial
Dentures : Clinical Concepts, Dent Clin N Am 58
(2014) 69–89

“Problems related to RPDs may be associated with

errors in diagnosis and treatment planning, including
inadequate mouth preparation “
- McCord JF et al Dent Update 2003; 30: 88–97
 According to GPT 8

 Diagnosis : the determination of the nature of a

disease

 Treatment plan : the sequence of procedures

planned for the treatment of a patient after
diagnosis
 The delineation of each patient’s uniqueness
occurs through the patient interview and clinical
examination process.

 The ultimate treatment is individualized to

address disease management and the
coordinated restorative and prosthetic needs
that are unique to the patient.
 understanding the patient’s desires or chief
concerns/complaints regarding his or her
condition

 ascertaining the patient’s dental needs through

a clinical examination,

 developing a treatment plan that reflects the

best management of desires and need

 Executing appropriately sequenced treatment

with planned follow-up
The dentist should follow a sequence
that includes:

1. Chief complaint and its history

2. Medical history review

3. Dental history review, especially

related to previous prosthetic
experience(s)

4. Patient expectations
 Personal and psychological factors are
significant to the success of prosthodontic
treatment

 House classification House classification

- Philosophical revisited :
- Exacting - Ideal
- Submitter
- Hysterical
- Reluctant
- Indifferent - Indifferent
- Resistant
 The process of clinical examination involves
two stages :
- Medical examination
- Oral examination
A comprehensive medical history includes :
- systemic disorders (Chronic degenerative or
dysfunctional diseases)
- Medication history
- Diet
- Habits
Systemic disordes include:

 Hypertension

 Diabetes

 Pernicious anemia

 Vitamin or nutritional deficiencies

 Osteoporosis

 Chronic pulmonary disease (i.e.,emphysema and

chronic bronchitis)
 Climacteric (i.e., menopausal changes)
 Parkinsonism
 Salivary gland disorders
 TM disturbances
 Post radiation therapy
 Bell ’ s palsy
 Lichen planus
 Fungal infections
An oral examination should be accomplished in
the following sequence :

 visual examination,
 pain relief and temporary restorations,
 radiographs,
 evaluation of abutment and periodontium,
 vitality tests of individual teeth,
 determination of the floor of the mouth position,
 Oral prophylaxis and impressions of each arch.
This includes : extra oral and intra oral examination.

TMJ - tenderness, mouth opening deviation & clicking

 No of teeth present with their clinical evaluation
 Malposed teeth
 Carious teeth
 Existing restoration- sensitivity to percussion
 Periodontium
 Residual ridges
 Saliva
 Investing structures
 Occlusion and occlusal plane
 Oral hygiene index
 to determine the need and management of
acute needs and whether a prophylaxis is
required to conduct a thorough oral
examination.

 to relieve discomfort arising from tooth defects

 the extent of caries and arrest further caries

activity
 areas of infection and other pathologies

 the presence of root fragments, foreign objects,

bone spicules and irregular ridge formations

 the presence and extent of caries and the

relation of carious lesions to the pulp and
periodontal attachment

 evaluation of existing restorations : evidence

of recurrent caries, marginal leakage, and
overhanging gingival margins
 the presence of root canal fillings

 evaluation of periodontal conditions present

 to evaluate the alveolar support of abutment

teeth, their number, the supporting length and
morphology of their roots

 the relative amount of alveolar bone loss suffered

through pathogenic processes, and the amount of
alveolar support remaining
  To locate inferior borders of lingual mandibular
major connectors.

 oral hygiene status before prosthodontic treatment is

important.

 The impression for the diagnostic cast is usually

made with an irreversible hydrocolloid in a stock
(perforated or rim lock) impression tray.
• Anatomic consideration
- Root length, size and form
• vitality tests
• caries evaluation
• Periodontal health
• Malpositions
• Analysis of Occlusal
Factors
• Supplements oral examination
• Permit a topographic survey of the dental arch
• Patient education and motivation
• Custom tray fabrication
• Constant reference
• Patient's record
 verification of appropriate
mouth modifications for a
removable partial denture.

 To determine the most

desirable path of placement
that will eliminate or minimize
interference to placement and
removal

 To locate and measure areas

of the teeth that may be used
for retention
 To determine whether tooth and
bony areas of interference will need
to be eliminated surgically or by
selecting a different path of
placement

 To determine the most suitable path

of placement that will permit
locating retainers and artificial teeth
to the best esthetic advantage.

 To permit an accurate charting of

the mouth preparation to be made
including the preparation of
proximal tooth surfaces to provide
guiding
• Occlusal plane & relationships
• Abutment tooth contours
• Rest seat areas
• Interarch space
• Residual ridge relation
• Tissue contours
 The objectives of any prosthodontic treatment
may be stated as follows:

 the elimination of disease

 the preservation, restoration, and maintenance

of the health of the remaining teeth and oral
tissues

 the selected replacement of lost teeth; for the

purpose of restoration of function

 comfort and in esthetically pleasing manner

 Based on diagnostic findings, The
American College of Prosthodontists (ACP)
has developed a classification system for
partial edentulism

 Criteria 1: Location and extent of the

edentulous area(s)
 Criteria 2: Abutment conditions
 Criteria 3: Occlusion
 Criteria 4: Residual ridge
 Edentulous area confined to a
single arch

 Abutment conditions -No

preprosthetic therapy is indicated

 Occlusal characteristics- Class I

molar jaw relationships are seen

 Residual bone height of ≥21 mm

 Edentulous area – Both arches

 Abutment- Abutments in 1 or 2
sextants have less tooth
structure or support intra or extra
coronal restorations

 Occlusion- Localized adjunctive

therapy Class I molar and jaw
relationships are seen

 Residual bone height of 16 to 20

mm
 Any posterior maxillary or
mandibular edentulous area
greater than 3 teeth or 2 molars.
Any edentulous areas including
anterior and posterior areas of 3 or
more teeth.

 Abutments in 3 sextants have

insufficient tooth structure to retain
or support intracoronal or
extracoronal restorations.
 Entire occlusion must be
reestablished. Class II molar
and jaw relationships are
seen.

 Residual alveolar bone

height of 11 to 15 mm
 Any edentulous area or
combination of edentulous
areas requiring a high level of
patient compliance

 Abutments in 4 or more
sextants have insufficient
tooth structure to retain or
support intracoronal or
extracoronal restorations.
 Entire occlusion must be
reestablished, including
changes in the occlusal
vertical dimension. Class II
div 2 and Class III molar and
jaw relationships are seen.

 Residual vertical bone height

of ≤10 mm
 Individual diagnostic criteria are evaluated and the
appropriate box is checked. The most advanced finding
determines the final classification
Classification System for Partial Edentulism, Journal of Prosthodontics Vol.
11, no. 3, 2002: 181 – 193.
1. Any single criterion of a more complex class
places the patient into the more complex class.

2. Consideration of future treatment procedures must

not influence the diagnostic level.

3. Initial preprosthetic treatment and/or adjunctive

therapy can change the initial classification level.
4. If there is an esthetic concern/challenge, the
classification is increased in complexity by one
level in Class I and II patients.

5. In the presence of TMD symptoms, the

classification is increased in complexity by one or
more levels in Class I and II patients.

6. In the situation where the patient presents with

an edentulous mandible opposing a partially
edentulous or dentate maxilla, Class IV.
 Implant supported fixed dental prosthesis
 Fixed dental prosthesis
 Removable partial denture
 Complete denture
 Combination of the above
 No treatment at all
 Distal extension situations
 After recent extractions
 Long span
 Need for cross-arch stabilization
 Excessive loss of residual bone
 Sound abutment teeth
 Abutment with guarded prognosis
 Economic considerations
 It is a communication model

 a process where the provider and the patient

identify together the best course of care.

 it addresses the need to fully inform patients

about risks and benefits of care options

 ensures that patient values and preferences

play a prominent role in the process.
 Computer-
designed
polycarbonate RPD
framework.

Digital partial design and manufacturing: using 3D printing

technology to fabricate RPD frameworks
 Valplast RPDs with
anterior flexible nylon
clasps.

A cast metal framework

with metal clasps and
flexible nylon polyamide
retentive clasps

Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am

2014; 58: 69–89
 Mandibular overlay RPD
metal framework

Mandibular overlay
unilateral distal extension
RPD with tooth-colored
acrylic resin processed to
the metal framework
Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am
2014; 58: 69–89
Minimize rotation about an axis in a Kennedy
Class I or II arch, or any long modification span

 direct retainers
 rests
Phase I Phase II
 Collection and  Removal of deep caries
evaluation of data  Extirpation of necrotic
 Pain, infection control pulp
 Biopsy  Extraction of non-
 Patient motivation retainable teeth
 Periodontal treatment

 Interim prosthesis

 Occlusal equilibrium

 Patient education
Phase III
 Preprosthetic surgical procedures

 Definitive endodontic procedures

 Definitive restoration of teeth

 Fixed partial denture construction

 Reinforcement of education and motivation of the

patient
 Phase IV
 Construction of removable partial denture
 Reinforcement of education and motivation of
patient

Phase V
 Post insertion care
 Periodic recall
 Reinforcement of education and motivation of patient.
 The four components of a SOAP note are
Subjective, Objective, Assessment, and
Plan

 The SOAP note format is used to standardize

medical evaluation entries made in clinical
records. The SOAP note is written to facilitate
improved communication among all involved in
caring for the patient and to display the
assessment, problems and plans in an
organized format.
 Plan the amount of time and appointment schedule

 Provides information to the patient.

 Estimate the professional fees for the treatment.

 Coordinate the schedule for dental laboratory

procedures

 Meet the legal requirements of informed consent

 Carr AB, Brown DT, McCracken’s Removable Partial
Prosthodontics, 12th edition, Canada, Elsevier Publishers,
2011, pp:150-184

 Stewart, Rudd, Kuebkar, Clinical Removable Partial

Prosthodontics, 2nd edition, India, All India Publishers and
Distributors, 2001, pp:117-220

 Jones DJ,Gracia LT, Removable Partial Dentures : A

Clinician’s guide, 1st edition, Singapore, Wiley-Blackwell,
2009, pp : 11-38

 Garry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR,

Koumjian JH, Arbree NS, Classification system for
partial edentulism, J Prosthodont 2002;11,3:181-193
 McCord JF, Grey JA, Winstanley RB, Johnson A, A
Clinical Overview of Removable Prostheses: 1. Factors
to Consider in Planning a Removable Partial Denture,
Dent Update 2002; 29: 376-381

 Bohnenkamp DM Removable Partial Dentures : Clinical

Concepts, Dent Clin N Am 2014; 58: 69–89

 Gamer et al, M. M. House mental classification

revisited: Intersection of particular patient types and
particular dentist’s needs, J Prosthet Dent
2003;89:297- 302

 Davenport JC, Basker RM, Heath JR, Ralph JP, Glantz

PO, The removable partial denture equation, Brit Dent
J 2000; 189: 414–424