lec 1 prostho
Post on 23-Dec-2015
27 Views
Preview:
DESCRIPTION
TRANSCRIPT
D R L AY L A A B U - NA B A’A . P H D, B D S , M F D RC S I
2 0 1 4
1
Introduction to Removable Prosthodontics II
OBJECTIVES2
At the end of this lecture you will be able to:
1. Define the Key Terms.
2. Explain the indications and contra indications for removable prostheses.
3. List treatment options for partially edentulous patients
4. List types of removable partial dentures.
5. List basic components of a partial dentures.
6. Overview clinical steps.
Dr Abu-Naba'a 2010
3
Defining Prosthodontics
Dr Abu-Naba'a 2010
4
Prosthodontics
pros·tho·don·tics \pro s´tha-do n´ti ks\ n, pl but sing or pl in constr (1947):
dental specialty pertaining to the diagnosis,
treatment planning,
rehabilitation and
maintenance of the oral function,
comfort,
appearance and
health of patients
GPT
5
Prosthodontics
with clinical conditions associated with
missing or
deficient teeth and/or
maxillofacial tissues
using biocompatible substitutes
GPT
6
Prosthesis
pros·the·sis \pro s-th ´si s\ n, pl–ses (1900)
1: an artificial replacement of an absent part of the human body
2: a therapeutic device to improve or alter function
3: a device used to aid in accomplishing a desired surgical result
7
Dr Abu-Naba'a 2010
8
Sub Divisions of the specialty
Prosthodontics
IMPLANTMAXILLOFACIALFIXEDREMOVABLE
Removable DENTURE Prosthesis
any dental prosthesis that can be readily inserted and removed by the patient.
Dr Abu-Naba'a 2010
9
10
Removable Partial prosthesis
11
Maxillofacial Prosthesis
Needed
After trauma
Surgical defects
Birth defects
Fixed Dental Prosthesis
any dental prosthesis that is
luted,
screwed or
mechanically attached
or otherwise securely retained
to natural teeth, roots, and/or dental implant abutments.
Dr Abu-Naba'a 2010
12
Implant Prosthodontics
the phase of prosthodontics concerning the replacement of missing teeth and/or associated structures by restorations that are attached to dental implants
Dr Abu-Naba'a 2010
13
Removable
Complete Dentures
Removable Partial
Dentures
- Conventional
- Attachment
Maxillofacial
Congenital Conditions
Cleft palate
Acquired Conditions
- Injuries
- Cancer
Facial & Intraoral
Prostheses
Can be Supported by
Ridge , teeth or Implants
Fixed
Crowns, Onlays
Fixed Partial
Dentures
(Bridges)
Fixed complete
dentures
Sub Divisions of the Prosthesis
Dental Implant
a prosthetic device or substance that is placed into or/and upon the jaw bone to support a fixed or removable dental prosthesis
Most used is the osseointegrated implant
Dr Abu-Naba'a 2010
16
17
Can be Supported by ,
teeth or Implants
RPD Terminology
Temporary RPDs:They are interim, transitional and
treatment RPDs mainly made from acrylic resin.
•Interrim
•Transitional
•Therapeutic
Definitive RPDs: Final and lasting RPDs that is
made mainly from Co-Cr alloy.
Types of RPD’s
Interim Definitive (permanent?)
RPD Terminology20
Bounded saddle RPD. Tooth born support.
Free end saddle RPD, Tooth-mucosa supported
Transitional RPD, Tissue supported RPD
Copyright © 2006 Thomson Delmar Learning. ALL
RIGHTS RESERVED.
-Abutment teeth border all edentulous areas
-Functional forces are transmitted through
abutment teeth to bone
Kennedy CL III, IV
Tooth borne (dento-alveolar support)
Supporting structures
Tooth
Periodontal ligaments
Alveolar bone
--Distal extension & anterior extension RPDs
--Functional forces are transmitted through
abutment teeth & mucosa to boneKennedy CL I, II
Tooth-Mucosal borne
Mucosal borne (muco-osseous support)
Supporting structures
Mucosa
Submucosa
Residual bone
OTHER Key Terms26
Abutment
Anatomical
Baseplate
Bite rim
Border molding
Centric occlusion
Connectors
Denture base
Framework
Muscle trimming
Non-anatomical
Overdenture
Relined
Rests
Retainer
Vertical dimension
Copyright © 2006 Thomson Delmar Learning. ALL
RIGHTS RESERVED.
27
Treatment Options
Treatment Objectives Oral Health
Restore and/or improve mastication
Restore health and comfort
Improve Quality of Life
ESTHETICS
Prevent occlusal disharmony
Consequences of teeth loss
Consequences of teeth loss
Treatment Options Partial Edentulism
No Replacement
Fixed Partial Denture (FPD)
Removable Partial Denture (RPD)
Implant crowns/FPD
Extractions & Complete Denture
No Replacement,
Shortened Dental Arch (SDA)
Patients can function with as few as 20 occluding teeth
No significant difference in
chewing
discomfort
No ReplacementShortened Dental Arch (SDA)
Require Anterior teeth + 4-6 occlusal units
Opposing PM’s = 1 occlusal unit
Opposing PM’s = 2 occlusal units
Symmetric loss need 4 units
Assymetric loss need 6 units
PRESENCE OF STABLE OPPOSING OCCLUSAL CONTACTS
Partial Dentures
Prosthesis replacing one or more, but not all teeth
Supported by teeth (abutments) and/or mucosa
May be fixed or removable
Fixed Partial Denture (FPD)
Removable Partial Denture (RPD)
FPD
Patients prefer to RPD
Porcelain ± Metal
Cemented
Need tooth (abutment) at either end
FPD
Must prepare (grind down abutments)
If too long, flexes, loosens or breaks
More expensive
If too long, flexes, loosens or breaks
Long-span saddles, 4 or more missing
Distal end saddle (extension base)
Need for cross-arch stabilisation
Physical or emotional problems
Esthetics, as when replacing soft tissue and bone.
Immediate replacement
Patients desires
Unfavorable maxillomandibular realationship
Indications
Indications
To replace several teeth in the same quadrant or in both quadrants of the same arch.
As a temporary replacement for missing teeth in a child.
To replace missing teeth for patients who do not want a fixed bridge or implants.
For the patient who finds it easier to maintain good oral hygiene.
To serve as a splint to support periodontallyinvolved teeth, when there is excessive bone loss
Treatment Option: RPD
Can be removed & replaced by patient
Less expensive
Won’t necessarily improve function if patient has ≥ 4 occlusal units
Indications for RPD's
Edentulous area too long for fixed prosthesis
Longer than 4 units is more complex
Indications for RPD's
No posterior abutment for a fixed prosthesis
Indications for RPD's
Excessive alveolar bone loss (esthetic problem)
Indications for RPD's
Poor prognosis for complete dentures due to residual ridge morphology
Indications for RPD's
Reduced periodontal support of remaining teeth
Won't support a fixed prosthesis)
Treatment Option: Complete Dentures
Remaining teeth are hopeless
Other options are too complex/expensive
Treatment Option: Implant Prostheses
Implant Crowns
Implant Bridges
Implant Dentures
Interim Denture (Provisional; Temporary)Used for short time to provide:
Esthetics
Mastication
Occlusal support
Interim Denture
Partial denture made while crowns are being fabricated for a definitive RPD)
Transitional Denture
Prosthesis to which teeth will be added
Replaced after post-extraction tissue changes
Made with intention of subsequently altering it
Advantages of a Removable Partial
Copyright © 2006 Thomson Delmar Learning. ALL
RIGHTS RESERVED.
50
Less expensive
than fixed
prostheses
Proper occlusal
plane is
maintained
Fewer intraoral
procedures
than fixed pros.
May support
periodontally
involved teeth
Stabilizes
the arches
Restores
function when
no distal teeth
present
Restores
long span
of lost
dentition
Easier for good
oral hygiene of
abutments
Easily repaired
and adjusted
Extraoral Factors that Influence the Choice of Removable Prosthesis type
Physical health
Mental health
Motivation
Age
Dietary habits
Socioeconomic factors
Occupation
Intraoral Factors that Influence the Choice of Removable Prosthesis type
Musculature
Salivary flow
Residual alveolar ridge
Oral mucosa
Oral habits
Tori
Contraindications
A lack of suitable teeth in the arch to support,
stabilize, and retain the removable prosthesis.
Rampant caries
Severe periodontal conditions that threaten the
remaining teeth in the arch.
A lack of patient acceptance for esthetic reasons.
Chronic poor oral hygiene with no motivation
to improve oral conditions
When Indicated for a Full Denture
The patient is edentulous.
The remaining teeth cannot be saved.
The remaining teeth cannot support a removable partial denture, and no acceptable alternatives are available.
The patient refuses alternative treatment recommendations.
55
RPD Basic Components
Components of an RPD
RetainersDirect
Indirect
Connectors Major
Minor
Rests
Proximal plates
Plastic or acrylic
retention area
Denture base
Teeth
Components of an RPD
Major Connector
• Connects parts together
• Principal functions:
• Unification
• Rigidity
• Minimal
Retention by adhesion
Components of a RPD
Minor Connector • Connects other components to
the major connector
• Principle functions:
• Links major connector to
other components
• Adds to indirect retention
and reciprocation
Components of an RPD
Direct Retainer• Provides retention
against dislodging forces.
Components of an RPD
Direct Retainer
• 'Clasp' or 'clasp unit'
composed of:• Rest• Retentive arm• Reciprocal arm • Minor connector
Rests
Rigid extension that prevents movement towards tissue
Principle functions:
• Support
• Adds to indirect retention
• Adds to reciprocation if in
lingual side
Proximal plate
Rigid vertical extension contacting the proximal surface of tooth
Principle functions:
• Stability
• Adds to indirect retention
• Provides a definitive path of insertion
Plastic retention area
Part of the RPD where acrylic is attached
Principle functions:
• Mechanical retention to the acrylic
Components of an RPD
Denture Base
•Covers the residual ridges
•Supports the
denture teeth
ATTACHMENTS
S E Q U E N C E O F C L I N I C S
67
CLINICAL SERVICE
Clinic visit Lab visit
Clinic 1 Exam, Records, Primary impression
Clinic 2 Tooth preparation, secondary impressions
Clinic 3 Metal try-in, altered cast impression, and jaw registration
Clinic 4 Teeth try-in
Clinic 5 Delivery
Lab 1 Surveying and treatment
plan
Lab 2 Metal framework production
Lab 3 Tooth setting
Lab 4 Acrylic processing
Lab5 If needed for repair or
remount
68
Part A: Removable Partial Dentures
Replaces one or more teeth in one arch
Retained and supported by underlying tissues and remaining teeth
69
Study models
Photographs
Visual aids
Radiographs
Treatment plan
Examination/ Consultation
top related