Benefits of RPD

• Appearance
• Speech (V and F sound)
• Mastication: Prevent slipping of the food bolus into the edentulous area
• Prevent unwanted tooth movement (drifting – loss of space / over-eruption- loss of bone support
AND interference)
• Improve distribution of occlusal load (if no RPD, functional loading focused onto the remaining
teeth à destroy perio attachments à pathological tooth migration OR Excessive tooth wear/
damage to the existing restoration)
• Preparation for complete denture

Kennedy’s Classification

Upper: Class I, mod. 2 Lower: Class III, mod.1

Exostoses and Tori

The existence of abnormal bony enlargements should not be allowed to compromise the design of the
removable partial denture (Figure 13-5). Although modication of denture design can, at times,
accommodate for exostoses, more frequently this results in additional stress to the supporting
elements and compromised function. The removal of exostoses and tori is not a complex procedure,
and the advantages to be realized from such removal are great in contrast to the deleterious effects that
their continued presence can create. Ordinarily the mucosa covering bony protuberances is
extremely thin and friable. Removable partial denture components in proximity to this type of tissue
may cause irritation and chronic ulceration. Also, exostoses approximating gingival margins may
complicate the maintenance of periodontal health and lead to the eventual loss of strategic abutment
teeth.
Objectives of Periodontal Therapy
The objective of periodontal therapy is the return to health of supporting structures of the teeth,
creating an environment in which the periodontium may be maintained. The specific criteria for
satisfying this objective are as follows:

1. Removal and control of all etiologic factors contributing
to periodontal disease along with
reduction or elimination of bleeding on probing 


2. Elimination of, or reduction in, the pocket depth of all
pockets with the establishment of healthy
gingival sulci whenever possible 


3. Establishment of functional atraumatic occlusal relation- 
ships and tooth stability 


4. Development of a personalized plaque control program 
and a definitive maintenance schedule 


Dental radiographs can be used to supplement the clinical examination but should not be used as a
substitute for it. A critical evaluation of the following factors should be made: (1) type, location, and
severity of bone loss; (2) location, severity, and distribution of furcation involvements; (3) alterations
of the periodontal ligament space; (4) alterations of the lamina dura; (5) the presence of calcified
deposits; (6) the location and conformity of restorative margins; (7) evaluation of crown and root
morphologies; (8) root proximity; (9) caries; and (10) evaluation of other associated anatomic features,
such as the mandibular canal or sinus proximity.

Each tooth should be evaluated carefully for mobility. Unfortunately, there is no universally accepted
standard for mobility.

Tooth mobility is an indication of the condition of the supporting structures, namely, the
periodontium, and usually is caused by inflammatory changes in the periodontal ligament,
traumatic occlusion, loss of attachment, or a combination of the three factors. The degree of
mobility present, coupled with a determination of the causative factors responsible, provides additional
information that is invaluable in planning for the removable partial denture. If the causative factor can
be removed, many grade I and grade II mobile teeth can become stable and may be used successfully to
help support, stabilize, and retain the removable partial denture. Mobility in itself is not an indication
for extraction unless the mobile tooth cannot aid in support or stability of the removable partial
denture, or mobility cannot be reduced. (Grade III usually cannot be reversed and will not provide
support or stability.)

Advantages of Periodontal Therapy

First, the elimination of periodontal disease removes a primary causative factor in tooth loss.
Second, a periodontium free of disease presents a much better environment for restorative
correction. Elimination of periodontal pockets with the associated return of a physiologic
architectural pattern establishes a normal gingival contour at a stable position on the tooth
surface Third, the response of strategic but questionable teeth to periodontal therapy provides an
important opportunity for reevaluating their prognosis before the final decision is made to
include (or exclude) them in the removable partial denture design.
SEQUENCE OF ABUTMENT PREPARATIONS ON SOUND ENAMEL OR
EXISTING RESTORATIONS
Abutment preparations on sound enamel or on existing restorations that have been judged as acceptable
should be done in the following order:


1. Proximal surfaces parallel to the path of placement should be prepared to provide guiding planes
(Figure 14-1A).

2. Tooth contours should be modified (Figure 14-1B and C), lowering the height of contour so that (a)
the origin of circumferential clasp arms may be placed well below the occlusal surface, preferably
at the junction of the middle and gingival thirds; (b) retentive clasp terminals may be placed in the
gingival third of the crown for better esthetics and better mechanical advantage; and (c)
reciprocal clasp arms may be placed on and above a height of contour that is no higher than the cervical
portion of the middle third of the crown of the abutment tooth.

3. After alterations of axial contours are accomplished and before rest seat preparations are instituted,
an impression of the arch should be made in irreversible hydrocolloid and a cast formed in a fast-
setting stone. This cast can be returned to the surveyor to determine the adequacy of axial alterations
before proceeding with rest seat preparations. If axial surfaces require additional axial recontouring,
this can be performed during the same appointment and without compromise.

4. Occlusal rest areas should be prepared that will direct occlusal forces along the long axis of the
abutment tooth (Figure 14-1D). Mouth preparation should follow the removable partial denture design
that was outlined on the diagnostic cast at the time the cast was surveyed and the treatment plan
confirmed. Proposed changes to abutment teeth should be made on the diagnostic cast and outlined
in colored pencil to indicate the area, amount, and angulation of the modification to be done (see
Chapter 12).

McCracken (P.206): an amalgam alloy restoration, if properly condensed, is capable of supporting

an occlusal rest without appreciable flow for a long period.
Measure the height of the floor of the mouth
Aim:

1. locate inferior border of the lingual major connector

2. Determine the height of the floor of the mouth

The first method is to measure the height of the floor of the mouth in relation to the lingual gingival
margins of adjacent teeth with a periodontal probe (Figure 5-6). When these measurements are taken,
the tip of the patient’s tongue should just lightly touch the vermilion border of the upper lip.

The second method is to use an individualized impression tray for which lingual borders are 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 upper border should follow the natural curvature of the supra-cingular surfaces of the teeth
and should not be located above the middle third of the lingual surface, except to cover
interproximal spaces to the contact points. The half-pear shape of a lingual bar should still form the
inferior border that provides the greatest bulk and rigidity. All gingival crevices and deep embrasures
must be blocked out parallel to the path of placement to avoid gingival irritation and any
wedging effect between the teeth. In many instances, judicious recontouring of the lingual proximal
surfaces of overlapped anterior teeth permits closer adaptation of the linguoplate major connector,
eliminating otherwise deep interproximal embrasures to be covered

Indications of the use of a linguoplate

1. When the lingual frenum is high or the space available for a lingual bar is limited. When a
clinical measurement from the free gingival margins to the slightly elevated floor of the mouth is less
than 8 mm, a linguoplate is indicated in lieu of a lingual bar. The use of a linguoplate permits the
inferior border to be placed more superiorly without tongue and gingival irritation and without
compromise of rigidity.

2. In Class I situations in which the residual ridges have undergone excessive vertical resorption. Flat
residual ridges offer little resistance to the horizontal rotational tendencies of a denture. A correctly
designed linguoplate will engage the remaining teeth to help resist horizontal rotations.
3. For stabilizing periodontally weakened teeth, splinting with a linguoplate can be of some value
when used with definite rests on sound adjacent teeth. The cingulum bar accomplishes stabilization
along with the other advantages of a linguoplate. However, it is frequently more objectionable to the
patient’s tongue and is certainly more of a food trap than is the contoured apron of a linguoplate.

4. When the future replacement of one or more incisor teeth will be facilitated by the addition of
retention loops to an existing linguoplate.

Mandibular Linguoplate
Indications for Use:

(1) When the alveolar lingual sulcus so closely approximates the lingual gingival crevices that
adequate width for a rigid lingual bar does not exist.

(2) In those instances in which the residual ridges in Class I arch have undergone such vertical
resorption that they will offer only minimal resistance to horizontal rotations of the denture
through its bases.

(3) For using periodontally weakened teeth in group function to furnish support to the prosthesis and
to help resist horizontal (off-vertical) rotation of the distal extension type of denture.

(4) When the future replacement of one or more incisor teeth will be facilitated by the addition of
retention loops to an existing linguoplate.

Characteristics and Location:

(1) Half-pear shaped with bulkiest portion inferiorly located.

(2) Thin metal apron extending superiorly to contact cingula of anterior teeth and lingual surfaces
of involved posterior teeth at their height of contour.

(3) Apron extended interproximally to the height of contact points (i.e., closing interproximal
spaces).

***(4) Terminal rests should always be provided at either end to stabilize the denture and to
prevent orthodontic movement of the teeth contacted.

(5) Superior border finished to continuous plane with contacted teeth.

(6) Inferior border at the ascertained height of the alveolar lingual sulcus when the patient’s tongue is
slightly elevated.

Blockout and Relief of Master Cast:

(1) All involved undercuts of contacted teeth parallel to the path of placement. deep embrasures must
be blocked out parallel to the path of placement to any wedging effect between the teeth

(2) All involved gingival crevices. (to prevent gingival irritation)

(3) Lingual surfaces of alveolar ridge and basal seat areas the same as for a lingual bar.
Sublingual Bar
A modification of the lingual bar that has been demonstrated to be useful when the height of the floor
of the mouth does not allow placement of the superior border of the bar at least 4 mm below the free
gingival margin is the sublingual bar. The bar shape remains essentially the same as that of a lingual
bar, but placement is inferior and posterior to the usual placement of a lingual bar, lying over and
parallel to the anterior floor of the mouth. It is generally accepted that a sublingual bar can be used
in lieu of a lingual plate if the lingual frenum does not interfere, or in the presence of an anterior lingual
undercut that would require considerable blockout for a conventional lingual bar. Contraindications
include interfering lingual tori, high attachment of a lingual frenum, and interference with elevation of
the floor of the mouth during functional movements.

Mandibular Sublingual Bar

Indications for Use: The sublingual bar should be used for mandibular removable partial dentures
when the height of the floor of the mouth in relation to the free gingival margins will be less than 6
mm. It also may be indicated whenever it is desirable to keep the free gingival margins of the
remaining anterior teeth exposed and depth of the floor of the mouth is inadequate to place a lingual
bar.

Contraindications for Use: Remaining natural anterior teeth severely tilted toward the lingual.

Characteristics and Location: The sublingual bar is essentially the same half-pear shape as a lingual
bar, except that the bulkiest portion is located to the lingual and the tapered portion is toward the
labial. The superior border of the bar should be at least 3 mm from the free gingival margin of the
teeth. The inferior border is located at the height of the alveolar lingual sulcus when the patient’s
tongue is slightly elevated. This necessitates a functional impression of the lingual vestibule to
accurately register the height of the vestibule.

Blockout and Relief of Master Cast: (1) All tissue undercuts parallel to path of placement. (2) An
additional thickness of 32-gauge sheet wax when the lingual surface of the alveolar ridge is undercut or
parallel to the path of placement. (3) One thickness of baseplate wax over basal seat areas (to elevate
minor connectors for attaching acrylic- resin denture bases).
Complete Palatal Coverage Major Connector
Indications for Use: (1) In most situations in which only some or all anterior teeth remain. (2) Class
II arch with a large posterior modification space and some missing anterior teeth. (3) Class I arch with
one to four premolars and some or all anterior teeth remaining, when abutment support is poor and
cannot otherwise be enhanced; residual ridges have undergone extreme vertical resorption; direct
retention is difficult to obtain. (4) In the absence of a pedunculated torus.

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
attachment of acrylic-resin extension posteriorly. (3) Contacts all or almost 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.

Blockout and Relief of Master Cast: (1) Usually none required except relief of elevated median palatal
raphe or any small palatal exostosis. (2) One thickness of baseplate wax over basal seat areas (to
elevate minor connectors for attaching acrylic-resin denture bases).

Rest
The primary purpose of the rest is to provide vertical support for the partial denture. In doing so, it also
does the following:

1. Maintains components in their planned positions 


2. Maintains established occlusal relationships by preventing settling of the denture 


3. Prevents impingement of soft tissue 


4. Directs and distributes occlusal loads to abutment teeth 


Denture base
Theoretically, the tooth-supported partial denture base that replaces anterior teeth must perform the
following functions: (1) provide desirable esthetics; (2) support and retain the artificial teeth in such
a way that they provide masticatory efficiency and assist in transferring occlusal forces directly to
abutment teeth through rests; (3) prevent vertical and horizontal migration of remaining natural
teeth; (4) eliminate undesirable food traps (oral cleanliness); and (5) stimulate the underlying tissues.

Advantage of cast metal over acrylic denture base

disadvantages are that it is difficult to adjust and reline. A commonly stated advantage is that the
stimulation it gives to the underlying tissues is so beneficial that it prevents some alveolar
atrophy. = after tooth loss, the regression of the crescent shape alveolar bone (first decrease in width,
then decrease with height)
Accuracy and Permanence of Form
1. cast more accurately (Evidence of this fact is that an additional posterior palatal seal may be
eliminated entirely when a cast palate is used for a complete denture)

2. Accurate metal castings are not subject to distortion by the release of internal strains, as are most
denture resins.

3. provides an intimacy of contact that contributes considerably to the retention of a denture.

(Sometimes called interfacial surface tension, direct retention from a cast denture base is
significant in proportion to the area involved

4. Permanence of form of the cast base is also ensured because of its resistance to abrasion from
denture cleaning agents.

Comparative Tissue Response

1. the greater density and the bacteriostatic activity contributed by ionization and oxidation of
the metal base.

Thermal Conductivity
1. Temperature changes are transmitted through the metal base to the underlying tissues
(patient’s acceptance of a denture and may help avoid the feeling of the presence of a foreign
body)

Weight and Bulk

Metal alloy may be cast much thinner than acrylic-resin and still have adequate strength and
rigidity. (0.8mm)

EXCEPT: In the maxillary arch, an acrylic-resin base may be preferred to the thinner metal base to
provide fullness in the buccal angles or to fill a maxillary buccal vestibule (in case of extreme
alveolar bone loss). Acrylic-resin may also be preferred over the thinner metal base for esthetic
reasons.