CASE HISTORY, DIAGNOSIS, AND

TREATMENT PLANNING FOR

REMOVABLE PARTIAL
DENTURE
PATIENT
Dr. Shilpi Sanghvi
WHO IS A PARTIALLY EDENTULOUS
PATIENT?
• One who has suffered a partial loss of the natural dentition with some
healthy teeth remaining in one or both arches

• REASONS FOR TOOTH LOSS

POTENTIALLY EDENTULOUS PATIENT
• Is one whose condition of remaining teeth and their supporting
periodontium is such that it warrants a total balance situation

• For example-
EFFECTS OF PARTIAL EDENTULISM
DO WE TREAT OR DO WE MANAGE TOOTH LOSS??
IS THE DISTINCTION IMPORTANT?

• The term “treatment” suggests removal of the disease per se

• The term “management” suggests a focus on meeting needs that may
change over time

• Yes
• It helps the patient realize that the decision has implications for future
needs that may be different between prostheses
OBJECTIVES OF PROSTHODONTIC
TREATMENT
• To eliminate the disease
• To preserve the remaining teeth and oral tissues in a healthy state
• Satisfactory replacement of missing natural teeth and tissues to
restore, if not improve masticatory function and comfort besides
overall health, general and psychological well-being

• “Perpetual preservation of what remains s more important than the

meticulous replacement of what is missing” – M M De Van
CASE HISTORY
EXAMINATION
DIAGNOSIS
TREATMENT PLANNING
• Detailed case history
• Thorough examination- visual + palpatory
extraoral
intraoral
• radiographic
• Accurate diagnosis
differential/provisional diagnosis
final diagnosis
• Treatment options
• Individualized treatment plan
ideal
final
• The purpose of this exercise is to address the needs:
• Perceived by the patient
• And
• Demonstrated by the clinician

• The ultimate goal is to achieve optimum results that address both

“desires and needs” in the most appropriate manner
• desires = needs, desires ≠ needs

• Shared decision-making
FIRST DIAGNOSTIC APPOINTMENT
• Demographic data
• Name
• Age
• Sex
• Address
• Contact no.
• Occupation
1. CASE HISTORY
• An attempt to meet the mind of the patient before meeting the mouth
of the patient– M M De Van
• 3 techniques:
• Direct interrogation
• Comprehensive questionnaire
• Combination

• To ask open-ended questions, or leading questions

CHIEF COMPLAINT
• To be recorded in patient’s own words
• In a chronological order
• Statement of the problem, location, since how long, and what and
purpose of visit
• For example- patient complains of missing teeth in the right lower
back region since 2 years and wants replacement of the same
• Acts as a guidance for the dentist in the area of greatest concern to the
patient
DENTAL HISTORY

• HOW WERE THE TEETH LOST

-gum disease- poor ridges expected, posterior lost first- supraeruption

of opposing arch, overhanging of tuberosity, poor oral hygiene and
neglect can be suspected

-caries- nutritional problems, an underlying systemic or salivary

condition, suspicious of current and past neglect

-trauma
• HOW LONG BACK WERE THEY LOST

ridges resorb with time

characteristic shape as remodeling occurs after fresh extraction
rapid remodeling in 1st month- rapid loosening

• HISTORY OF REPLACEMENT OF MISSING TEETH

• IF YES, SINCE HOW LONG, TYPE, SATISFACTION, DENTURE CARE,
HABITS

• History of recent extractions?

• ORAL HYGEINE HABITS

• HABIT HISTORY
WHY DO YOU REQUIRE
REPLACEMENT
• MASTICATION
• APPEARANCE
• SPEECH
• COMFORT
MEDICAL HISTORY
• TO DETERMINE ANY CONDITION THAT MIGHT AFFECT THE
CHOICE OF TREATMENT, PROCEDURE AND OUTCOME OF
TREATMENT

• READY FOR AN EMERGENCY

DIABETES MELLITUS
• Excessive fluid loss, dryness of mouth
• Difficulty in chewing
• Ulceration and mucosal soreness
• Rapid rate of resorption, therefore support components maximized
• Wound healing
• Frequent recall to monitor bone stability and correct occlusion
CARDIOVACULAR DISEASE
• Hypertension
• Recent MI
• Angina pectoris
• Arrythmias
• Angioplasty
• Avoid any invasive procedures
• Physician’s consent
• Short and stress free appointment
• Gingival hyperplasia associated with calcium channel blockers
ANAEMIA
• Dryness
• Friable Mucosal tissue
• Altered taste sensation
• Avoid undue pressure
• Mucostatic impression
• Constant monitoring of denture stability and occlusion to minimize
pressure areas
• Poor denture retention
ARTHRITIS
• Complex insertion of the denture difficult
• If of the TMJ, may produce changes in occlusion
PARKINSON’S DISEASE
• Poor Oral hygiene and handling
• Excessive salivation- impaired retention
• Difficult impressions
• Repeated jaw relations
• Explicit oral hygiene instructions, use of tissue conditioner
• Balanced occlusion
• Non-anatomic teeth
• Use a sturdy material, with metal reinforcement to reduce chances of
fracture
EPILEPSY
• Removable dentures contraindicated
• Esp if they are small
• Risk of fracture and choking
SALIVARY GLAND DISORDERS
• Xerostomia, painful burning sensation, mucosal sensitivity
• Wearing of a removable prosthesis becomes intolerable
• Frequent soft relining
CANCER
ALLERGIES
DRUGS
DIET HISTORY
• TYPE- VEG/NON-VEG

• CONSISTENCY- HARD/SOFT
HABIT HISTORY

• SMOKING

• DRINKING

• PARAFUNCTIONAL HABITS
clenching
bruxism
tongue thrusting
nail biting
2. PSYCHOLOGICAL EVALUATION
• LEVEL OF MOTIVATION
Self motivated

• MENTAL ATTITUDE

clinical skill + knowledge

+ technical skill
+ patient management skill = successful care
• I n t e r n a t i o n a l prosthodontic workshop defines following factors
which produce an adaptive or maladaptive response:
• Factors for a favourable adaptive response to removable partial
denture:
 Trust and confidence in the dentist
 Previous favourable experience with a dentist
 Positive attitude and ability to cope with change
 Realistic expectation of the patient
 Good general health
 Willingness to please the doctor
 Good learning capacity
Factors producing a maladaptive response to removable partial denture:
 Lack of trust in the dentist
 Poor communication between dentist and patient
 Previous negative experience
 Unrealistic expectation
 Anxiety and low tolerance to pain
 Poor health and senility
 Poor muscle coordination
 Poor learning ability
 Psychological disorder
3. CLINICAL EXAMINATION
• EXTRAORAL
• INTRAORAL
 EXTRAORAL EXAMINATION – TMJ

• Inspection, palpation, auscultation

• Deviation/deflection
• Restriction of movement
• Pain
• Clicking
• Crepitus
EXTRAORAL EXAMINATION – MUSCLES OF
MASTICATION
• Mode of treating the TMJ includes:
occlusal equilibrium
intraoral prostheses
exercise
drug therapy
surgery

• In case of any disorder, treatment should not be initiated until a

state of equilibrium exists
EXTRAORAL EXAMINATION – FACE
• Facial features
• Facial height
• Facial form
• Facial profile
EXTRAORAL EXAMINATION – LIPS
• Lip tonicity
• Lip support
• Lip length
• Lip fullness
• Lip mobility
• Smile line
EXTRAORAL EXAMINATION – SKIN
• Tonicity
• Abnormalities
• Complexion
• Appearance of
cheek
INTRAORAL EXAMINATION – ORAL
HYGIENE
• Plaque/ stains/ calculus
• Excellent/fair/poor
INTRAORAL EXAMINATION – MUCOSA
• Gingiva
• Labial
• Buccal
• Palate
• Tongue
• Floor of the mouth
• Vestibules
• Residual ridge
• Location and appearance of
ulcerations, areas of inflammation,
abnormalities
• Red and white lesions
• Candidiasis
INTRAORAL EXAMINATION – PALATE
• Incisive papilla
• Rugae
• Mid-palatine raphe
• Hard palate
• Soft palate
• Post palatal seal area
INTRAORAL EXAMINATION - TORI AND
EXOSTOSES
UNDERCUTS
• MOST COMMON SITES
premaxilla
maxillary tuberosities
distolingual areas in the mandibular arch
recent extraction sites

• SOLUTION??
Change path of insertion. By changing the tilt
Relieve the denture
Reduce the length of the flange
Surgical correction
INTRAORAL EXAMINATION – TONGUE
• Size
• Position
• Abnormalities
INTRAORAL EXAMINATION – VESTIBULE
• Sulcus depth
• Width of attached gingiva
• Frenal attachments
labial, buccal, lingual
maxillary, mandibular
INTRAORAL EXAMINATION – FLOOR OF
THE MOUTH
• Depth of the floor
• Plica
• Genial tubercle

• To evaluate the space for mandibular major connector

• Bar vs plate
• Bar - >= 8mm
• Palate <8mm
• Measured from the gingival margin to the floor (tongue elevated)
• Recorded measurements transferred to the diagnostic cast
• Marks the inferior border of the major connector
INTRAORAL EXAMINATION – EDENTULOUS
AREA

• LOCATION AND EXTENT OF EDENTULOUS AREA

single arch/both arches
anterior/posterior
no. of teeth missing
normal/reduced/widened
congenital defects
classification
modifications
• CONDITION OF THE RESIDUAL RIDGE
size
shape (arch form)
contour
height
width
undercuts
projections

*Atwood’s (1963) and

Fallsehussel (1986) classification
• Visual examination + palpation
• Firmness of overlying tissue
• Detect presence of bony spicules or ledged of bone
• Poor support- flat, narrow, sharp ridges, flabby tissue coverage
• Enlarged hyperplastic tuberosities may intrude on the interridge space
and may need surgical removal
• Atrophic mucosa- smooth, resembling cling wrap- burning sensation,
very sensitive to pressure
INTRAORAL EXAMINATION – TEETH
• ORAL HYGIENE
• Oral health care instructions
• “trial period” to reevaluate patient’s oral hygiene practices

• FOOD IMPACTION
• Vertical – forceful wedging against gingival tissues through occlusal
pressure. Inadequate contact or plunger cusp
• Horizontal – forceful wedging by tongue, lips, cheek
• CARIOUS LESIONS/DISCOLOURATIONS
Careful examination of all surfaces
Extent of caries
Radiographic confirmation
Decision to treat and restore after definitive diagnosis and treatment
planning
possible extractions?

• EXISTING RESTORATIONS
Type of restoration
Surfaces involved
Radiographic confirmation
Decision to replace with full coverage crowns
• PULPAL TISSUES
to assess the vitality of remaining teeth
hot/cold/EPT
NEED FOR ENDODONTIC THERAPY and a possible post and core
RCTreated teeth not contraindicated
but brittle
better prognosis with full coverage restorations
• Make use of an intraradicular attachment to avoid further removal of
dentin
• Favourable stress distribution
• PERCUSSION
tender
traumatic occlusion
ill-fitting prosthesis
abscess
acute pulpitis
• TOOTH MOBILITY
trauma from occlusion- fremitus test
inflammatory changes in pdl
loss of osseous support

• GRADES OF MOBILITY
Millers Grade 0, 1, 2, 3

• SPLINTING?

• FAVOURABLE CROWN:ROOT RATIO

• DECISION ON THE TYPE OF PROSTHESIS

• PERIODONTIUM
no treatment in the presence of active periodontal disease
rapid progression of disease and loss of remaining teeth
Control disease process

• Clinical + radiographic examinations

• Crown : root ratio

• Gingiva- colour, texture, contour

• Pockets
• Inflammation
• Bleeding on probing/exudate
• Furcation involvement
• Absence of sufficient attached gingiva
• TREATMENT

scaling
root planning
periodontal flap debridement
free gingival graft
• WASTING DISEASES

• ATTRITION
occlusal interferences in function
parafunction
bruxism
clenching

METICULOUS IDENTIFICATION
AND CORRECTION OF
INTERFERENCES

IDENTIFY THE CAUSE OF PARAFUNCTION - BREAK IT

DO NOT PROCEED
• ABRASION
faulty brushing technique
possible need for restorations
unfavourable undercuts
sensitivity

• ABFRACTION
flexing of teeth at the cervical
region
unacceptable stress
• EROSION
buccal surfaces- external/dietary
palatal surfaces- internal/regurgitatory

structural loss of tooth surface

potential abutment??

diet councelling

medical help
• TOOTH CONTOURS
• TOOTH ANGULATION
• TOOTH INCLINATION
• MIGRATION/DRIFTING – malposed teeth and traumatic occlusion—mandibular guidance
forced on weak teeth
• ROTATIONS

• LONE STANDING TOOTH

• CROWDING/SPACING

• OVERJET/OVERBITE
deepbite—design and fitting problems—also posterior occlusal collapse—accompanying
loss of interarch space
abnormal overjet—abnormal swallowing or tongue thrust—difficulty in wearing the RPD

• SUPRAERUPTION
• POSSIBLE MIGRATION AFTER LOSS OF 36
• EXISTING PROSTHESES

• CROWNS
• BRIDGES
• IMPLANTS

• Replacement?
• Existing contours?
INTRAORAL EXAMINATION -
OCCLUSION
• EXISTING OCCLUSION
• VERTICAL AND HORIZONTAL RELATIONSHIPS
• COINCIDENCE OF CR AND MIP??
• INTERFERENCES AND PREMATURE CONTACTS
• CUSP-FOSSA RELATIONSHIP
• SUPRAERUPTED TEETH

• FACEBOW MOUNTED DIAGNOSTICS CASTS

• CORRECTION OF THE PROBLEM
(after checking on articulated casts)

• Selective grinding
• Tooth preparation
• Crown lengthening, RCT, tooth preparation
• Extraction/orthognathic surgical procedures

(explained later)
4. RADIOGRAPHIC EXAMINATION
• RESIDUAL RIDGE
• ABUTMENT TEETH
RADIOGRAPHIC EXAMINATION -
RESIDUAL RIDGE
• BONE QUANTITY

• Radiographic height of the mandibular alveolar bone

• Class I - >=21mm
Class II – 16-20mm
Class III – 11-15mm
Class IV - <=10mm
• BONE QUALITY
RADIOGRAPHIC EXAMINATION – TEETH
5. EXAMINATION OF THE EXISTING
PROSTHESIS
• Type
• Design
• Retention
• Stability
• Support
• Retention
• Contour
• Esthetics
• Speech
• Occlusion
• Artificial tooth wear
• Hygiene
EFFECTS OF TOOTH LOSS ON THE REMAINING
TEETH
• DIAGNOSTIC IMPRESSIONS
• DIAGNOSTIC CASTS
• RECORD BASES (IF REQUIRED)
• SURVEY THE CASTS
6. TENTATIVE/PROVISIONAL DIAGNOSIS
• Plan ahead to avoid undesirable compromises

• SURVEY
- parallelism or the lack of it
- path of insertion
- proximal tooth surface adequate or need to be prepared to serve as
guide planes
- favourable and unfavourable undercuts
- areas of interference
- esthetics affects the selected path
SECOND DIAGNOSTIC APPOINTMENT
• JAW RELATION
ORINTATION, VERTICAL, HORIZONTAL
• MOUNTING OF THE CASTS
• CORRELATION OF CLINICAL AND RADIOGRAPHIC FINDINGS
• IOPAs FOR ALL TEETH
• POTENTIAL ABUTMENT TEETH
• EXAMINE PRESENCE OF EXTRUDED TEETH
• CORRECTION OF PLANE OF OCCLUSION

• LOGICAL AND COMPREHENSIVE PRESENTATION TO THE PATIENT

• POINT OUT TO THE PATIENT

• HEIGHT AND WIDTH OF THE SUPPORTING RIDGE

• EVIDENCE OF TOOTH MIGRATION AND EXISTING RESULTS
OF IT
• EFFECTS OF FURTHER MIGRATION
• TRAUMATIC OCCLUSAL CONTACTS
• CRIOGENIC AND PERIODONTAL IMPLICATIONS OF FURTHER
NEGLECT
• RADIOGRAPHIC FINDINGS AND BONE
SUPPORT………………………
• TOOTH LOSS
• MIGRATION
• UNILATERAL CHEWING
• ALVEOLAR BONE LOSS
• OCCLUSAL INTERFERENCE
• LOSS OF PROXIMAL CONTACT
• OVERLOADING OF ANTERIOR TEETH
• LOSS OF VD
• TMD
PROSTHODONTIC DIAGNOSTIC INDEX (PDI) BY THE
AMERICAN COLLEGE OF PROSTHODONTICS (ACP)

• CRITERIA 1:
LOCATION AND EXTENT OF THE EDENTULOUS AREA(S)
• CRITERIA 2:
ABUTMENT CONDITIONS
• CRITERIA 3:
OCCLUSION
• CRITERIA 4:
RESIDUAL RIDGE CHARACTERISTICS
7. FINAL DIAGNOSIS
• PARTIALLY EDENTULOUS PATIENT

Demographics – chief complaint – with missing (tooth number) and

Kennedy's classification – condition of abutment teeth – occlusion –
residual ridge characteristics – and any other underlying conditions

• Eg.-
patient ABC, 65 year old female, reported with the chief complaint of
missing lower right and left back teeth due to cavities 6 years back, with
missing 25-26, 34-37, 45-47 and falling under Kennedy's class I
(mandibular) and Class III (maxillary), with carious 44 and mobile 33, with
supraeruption of 16, 17 and disruption of the occlusal plane, and resorption
of the edentulous ridge on the lower right side.
TREATMENT APPROACH
TREATMENT STRATEGIES
• consideration of medical, dental, sociological and economical factors
and the aesthetic and functional needs of the patient
• retainable teeth, hopeless teeth, ones with doubtful prognosis
• KEY-ABUTMENT TEETH
• extent and complexity of a future reconstruction
• clinical condition- restored, endodontically treated, tilted, single or
multi-rooted, root surface area, shape and angulations, periodontal
involvement
• vital role in their future use as abutments
• Adequate support for roots, healthy periodontal tissues, healthy
coronal structure, favourable coronal morphologic features for
clasping and preparation of rest seat, proper axial alignment
• Retainer selection mainly depends on the remaining tooth substance,
the intra- and intermaxillary relationships, esthetics, and financial
aspects.

• EDENTULOUS AREA
• span of edentulous
• anterior or posterior location
• extent of residual alveolar ridge resorption
• radiographic evaluation of the bony support
TREATMENT OPTIONS
• IMPLANT-SUPPORTED FIXED PROSTHESIS

• FIXED PARTIAL DENTURES (CONVENTIONAL / ADHESIVE /

HYBRID)

• REMOVABLE PROSTHESIS
8. TREATMENT PLANNING
• PRE-PROSTHETIC TREATMENT PLAN
SYSTEMIC PHASE
STABILIZING OR PREPARATORY PHASE
DEFINITIVE OR CORRECTIVE PHASE

• PROSTHETIC TREATMENT PLAN

IDEAL TREATMENT PLAN

FINAL TREATMENT PLAN

• POST-PROSTHETIC RECALL AND MAINTAINANCE

SHARED DECISION
MAKING PROCESS
• Phase I
• 1. Collection and evaluation of the diagnostic data, including a
diagnostic mounting and design of diagnostic casts
• 2. Immediate treatment to control pain or infection
• 3. Biopsy or referral of patient to an appropriate health professional
• 4. Development of a treatment plan
• 5. Education and motivation of patient
• Phase II
• 1. Removal of deep caries and placement of provisional restorations
• 2. Extirpation of inflamed or necrotic pulp tissues
• 3. Removal of periodontally hopeless and non-restorable teeth
• 4. Periodontal therapy
• 5. Construction of interim prostheses for function or esthetics
• 6. Occlusal equilibration
• 7. Education and motivation of patient
• Phase III
• 1. Preprosthetic surgical procedures
• 2. Definitive endodontic procedures
• 3. Definitive restoration of teeth, including placement of fixed
restorations
• 4. Fixed partial denture construction
• 5. Education and motivation of patient
• Phase IV
• 1. Construction and placement of removable partial denture(s)
• 2. Oral and written instructions regarding the use and care of
removable prostheses

• Phase V
• 1. Postinsertion care
• 2. Periodic recall
• 3. Reinforcement of education and motivation of patient
 DISTAL EXTENSIONS / FREE END
SADDLES
• ANATOMIC FORM
• FUNCTIONAL FORM
• VARIABLE COMPRESSIBILITY OF THE
PDL AND THE TISSUE COVERING THE RESIDUAL
RIDGE
• ACTS AS A FULCRUM
• DETRIMENTAL TO THE HEATH OF THE
ABUTMENT TOOTH

• SUPPORT FROM TOOTH AND TISSUE

• FUNCTIONAL IMPRESSION
• RECORDING FUNCTIONAL FORM OF THE RESIDUAL RIDGE TISSUE
• AND
• TO OBTAIN UNIFORMITY OF SUPPORT WHEN THE FUNCTIONAL LOAD
IS APPLIED

• THE IMPRESSION –
RECORDS AND RELATES THE TISSUE UNDER UNIFORM LOADING
DISTRIBUTES THE LOAD OVER A LARGE AREA
ACCURATELY DELINEATES THE PERIPHERAL EXTENT OF THE DENTURE
BASE
WHEN IS AN RPD THE TREATMENT OF
CHOICE??
• WHEN IMPLANTS AND FPD ARE CONTRAINDICATED

• COMMON GROUND FOR PATIENT’S DESIRES AND NEEDS

TYPES OF RPD
• CAST PARTIAL DENTURES
• ATTACHMENTS PARTIAL DENTURE
• A COMBINATION OF FIXED AND REMOVABLE
• ANDREW’S BRIDGE
• OVERLAY DENTURES
• TELESCOPIC DENTURES
• OVERDENTURES
• TEMPORARY DENTURES
• COMPLETE DENTURES
• NO TREATMENT
• AGE
• Below 18 years
• Growth and development
• High pulp horns
• Interim temporary denture

• SYSTEMIC CONDITION
• Poor general health status
• Cannot endure long procedures
• Invasive surgical procedures contraindicated
• Abutment teeth compromised to receive FPD retainers
• Transitional partial denture
• CPD
• IMMEDIATE NEED TO REPLACE EXTRACTED TEETH
• temporarily
• Easily altered
• Relined as ridge remodeling occurs
• Interim partial denture
• Once edentulous area is stabilized, definitive treatment with fixed, or
removable

• SINGLE MISSING TOOTH

• Implant
• FPD- resin-bonded (anterior) or conventional
• SHORT EDENTULOUS AREAS
• Less than 3 missing teeth
• Implant-supported prosthesis is the treatment of choice
• Healthy adjacent teeth
• Adequate bone volume
• Good general health
• Systemic condition (if any) under control
• No cost restraints
• Good oral hygiene
• FPD
• When adjacent teeth are in need of restoration
• LONG SPAN EDENTULOUS AREA
• 4 or more missing teeth
• Implant
• Meet all requirements
• If loss of bone volume, augmentation agreed upon
• Importance of Width > height
• Too large for fixed prosthesis
• Requirement of additional tooth preparation
• Additional support and stabilization from the tissues, and from the
teeth/tissues from the opposite side
• Risk of failure
• CPD – conventional
• Abutment teeth do not require restorations
• CPD - With crowns
• to change the existing contour of the abutment teeth
• If the abutment teeth are in need of a restoration (caries/ large fillings)
• CPD – attachments
• Adequate inter-ridge space
• Crowning adjacent teeth
• Anterior region - Esthetic concern
• Increased bone resorption
• Eg. Andrew’s bridge
• High buccal frenal attachment
• Severe undercuts
• DISTAL EXTENSION (Kennedy’s class I, II)
• Implants
• Cantilevered FPD
• torqueing forces- resorption, tooth mobility, restoration failure
• CPD
• Most cost-effective
• Mesial rest
• No requirement for abutment tooth restorations
• No modification areas
• Attachments
• When abutment teeth require crowns
• With combination fixed
• Multiple modification areas and lone standing tooth adjacent to the ed space
• FPD splinting or separate bridges
• RCTreated or not
• Periodontally stable if not the best periodontal health
• C:R ratio < 1:1
• No mobility
• Splinting the lone standing tooth
• Overdenture
• Multiple modification spaces
• Few remaining teeth
• Questionable prognosis of the remaining teeth
• Poor periodontal health
• Clinical mobility- grade II
• C:R ratio>1:1
• Root canal treated
• Increased interridge space
• Unfavourable maxillomandibular relationship
• Maintenance of proprioception
• Delaying complete edentulousness
• Implant-supported CPD
• Convert a class I and II to class III
• The distal most implant may act
as a vertical support
• Or may add to retention by incorporating
retentive attachments
• reduce the stress applied on the abutment teeth
• eliminate the need for unaesthetic clasp assemblies
• Cost-effective compared to fixed implant prosthesis
• Excellent patient satisfaction
• Especially in combination syndrome cases
• EXCESSIVE BONE LOSS
• Trauma, surgery, abnormal resorptive patterns
• CPD
• Most cost-effective
• Reversibility of the option
• Replacement of ridge contours
• Resin flange to support lost contours
• Good access for oral hygiene
• When regenerative therapy is not a
viable option
• With fixed combination
• Andrew’s bridge
• REDUCED PERIODONTAL SUPPORT
• Bony support severely compromised
• Unable to support fixed prostheses
• Distribution of load to soft tissues
• Overdenture

• NEED FOR CROSS-ARCH STABILIZATION

• Bilateral bracing
• After recent periodontal surgery
• To offset mediolateral and anteroposterior forces
• ANTERIOR MISSING TEETH (kennedy’s class IV)
• Implants
• Adequate bone volume
• Bone regenerative surgery
• CPD
• Replace lost contour
• For optimal aesthetics
• Rotational path CPD
• In case of undercuts
• That could interfere with achieving
best esthetic results
• REPRODUCTION OF ORIGINAL ESTHETICS
• Simulate the appearance of diastema, crowding, rotation
• Extreme changes in soft tissue architecture like recreation of papilla, to avoid
dark interdental spaces

• UNFAVOURABLE MAXILLOMANDIBULAR RELATIONSHIPS

• Disharmony is arch size, shape and position
• Class II interarch relationship
• RESTORATION OF OCCLUSAL
FACIAL HEIGHT
• loss of posterior tooth
contacts as a consequence of
damaging periodontal or
occlusal factors
• replace the missing posterior
teeth and overlay worn teeth
• PATIENT DESIRES
• Cost
• To avoid operative procedures on sound teeth
• Hesitant to undergo surgical procedure for implant

• NO TREATMENT
• expected prognosis for a given tooth is questionable
• costs associated with restoration high
• and the added benefit to the prosthesis low
• the tooth should likely not be maintained unless the patient strongly
desired to maintain it
SHORTENED DENTAL ARCH (SDA)
• Problem-oriented approach
• applicable to the elderly and where limited finance is available for restorative
care
• For those considered to be at high risk for developing caries and periodontal
disease
• Preservation and maintenance of what is remaining
• Maintain anteriors and premolars
• No signs of occlusal instability with SDA
• Sufficient mandibular stability
• Chewing ability
• Extension ??
• Teeth should be
replaced for --
• Aesthetics
• Functional comfort
• Occlusal stability
MATERIAL CHOICES
• Cast metal- Cobalt-chromium
• Nylon polyamide flexible denture (Valplast/ Hyflex)
• Cast metal clasps
• Wrought metal clasps
• Aesthetic clasps- tooth-coloured or pink)
• Nesbit denture
• Cu-Sil partial denture
• Titanium dentures
• CAD-CAM dentures
• PEEK dentures
OTHER TYPES
ATTACHMENTS
• Types
Intracoronal – precision, semiprecision
Extracoronal
Intraradicular

• Method of retention
friction
mechanical
magnetic

• Studs, bars, magnets

• It is the length of the attachment, not
the width that is the main criteria in
selecting the attachment
• For each length, there are 3 different
sizes (widths)- anterior, bicuspid, molar
• full length is 8mm
• Minimum of 5mm height is required for
bracing, support and retention
• Clinical crown length at least 7mm
5mm attachment
1-2mm between the gingival floor and
margin
• Choice of overdenture
attachment is also based on the
available interarch distance
• Minimum height required 12-
14mm
• For a single arch- min. 6mm
• From the occlusal surface of
prepared abutment to the
occlusal plane
OCCLUSION IN RPD
• SELECTION
• Size
• Shape
• Material
• Form

• POSITION
• established by remaining natural teeth
• Dictated by aesthetic and phonetic requirements
• Landmarks for anterior teeth
• Landmarks for occlusal plane
• Landmarks for posterior teeth
• OBJECTIVES

• If a physiologic state exists, maintain intercuspal position

• Bilateral simultaneous contacts of anterior and posterior teeth should
be established in restored occlusion
• No alteration of existing lateral guidance
• If lateral guidance to be reestablished, canine-protected articulation
preferred when natural canines are present.
• If canines are missing, give group function
• No non-working contacts on natural teeth, unless opposing CD
• No posterior protrusive contacts, unless opposing CD
• DETERMINING THE OCCLUSAL SCHEME
• NUMBER AND POSITION OF REMAINING NATURAL TEETH IN BOTH,
THE ARCH WITH THE RPD AND THE OPPOSING ARCH
1. CLASS III
• Match morphology to opposing arch
• If existing physiologic healthy occlusion, restore to existing occlusal
scheme
• Group function if canine is missing
• Balanced articulation if opposing CD
• 2. CLASS II
• Group function avoided when no remaining PMs. Canine protected
• Balanced when opposing CD

• 3. CLASS I
• Canine guided if natural canines present
• Balanced if not
• Balanced opposing CD

• 4. CLASS IV
• Centric contact
• Disocclusion on excursive
• Balanced if opposing CD
RPD REPAIR
• Broken clasp arm
• Fractured occlusal rest
• Distortion or breakage of other components- major and minor
connectors
• Loss of teeth not involved in the support or retention
• Loss of an abutment
RPD RELINING
• Tooth-supported or tooth-tissue supported
• Direct (chairside) or indirect (laboratory processed)
• Soft or hard
• Closed mouth or open mouth
CONCLUSION
• While there is a decline of tooth loss, the need for RPDs will actually
increase as the population increases and ages.
• Still a viable option for treating partially edentulous patients
• Finding greater use as temporary prostheses
• Especially after implant placement