p2 lab (prelims)

Patient Work UpPatient Work Upa. Patient Interview

b. Data gathering1. Chief complaint

2. History of present illness

3. Medical history

4. Dental History

5. Extraoral examination

6. Intraoral examination

1

Intraoral examinationIntraoral examination1.Visual-

• Position of teeth• Number of teeth• Caries• Condition of soft tissues

• Restorations present

• Oral Hygiene• Design possibilities related to esthetics and

function• Occlusion• Vertical space

• Horizontal rel’n of mand-maxilla in centric & eccentric positions

Intraoral examinationIntraoral examination2. Digital and exploratory- Firmness of teeth Depth of pockets Extent of caries Sensitivity of teeth Condition of restorations present Condition of soft tissue Action of tongue and muscles

affecting denture borders

Intraoral examinationIntraoral examination3. Roentgenographic Pathology ( cysts, tumors,

granulomas, etc) Amount of bone support Periodontal pockets Periodontal prognosis Caries Bone index areas

COMPONENTS OF RPD

FrameworkThe cast metal skeleton that provides support for the remaining components of the prosthesis.

ConnectorsJoin various parts of the partial together

Major connectorMinor connector

RetainerKnown as a clasp, it supports and provides stability to the partial denture by partially circling an abutment tooth.

RestA metal projection designed to control the seating of the prosthesis.

Artificial teethConstructed from either acrylic or porcelain.

Components of RPD FrameworkComponents of RPD Framework

Retentive arm

Reciprocal componentsOf clasp assembly

Retentive arm

0cclusal rest

Minor connectors

Cingulum extension Proximal platesExternal Finish line

Unit of a partial denture framework that connects all the parts of the prosthesis located on one side of the arch to the opposite side of the arch.

MaxillaryMaxillary Mandibular

CRITERIA FOR SELECTION CRITERIA FOR SELECTION

1.1. SUPPORTSUPPORT – major requirement

2.2. PRESENCE OF PALATAL TORIPRESENCE OF PALATAL TORI – may alter the requirements for the major connector

3.3. NEED FOR ANTERIOR TEETH NEED FOR ANTERIOR TEETH REPLACEMENT REPLACEMENT – requires a different configuration

4.4. REQUIREMENT FOR INDIRECT REQUIREMENT FOR INDIRECT RETENTIONRETENTION – not a major item of concern

CRITERIA FOR SELECTION CRITERIA FOR SELECTION

5. 5. NEED TO STABILIZE WEAKENED NEED TO STABILIZE WEAKENED TEETH TEETH

6. 6. PHONETIC CONSIDERATIONS PHONETIC CONSIDERATIONS

7. 7. MENTAL ATTITUDE OF THE MENTAL ATTITUDE OF THE PATIENTPATIENT

1. Palatal Strap

2. Double Palatal bar/ Anteroposterior bar (AP bar)

3. Palatal Horseshoe Connector

4. Full Palate Connector

PALATAL STRAPPALATAL STRAP

Most versatile and widely usedCan be made narrow or widerRarely annoying No interference to phonetics and speech

PALATAL STRAPPALATAL STRAP

INDICATIONS1. Class III edentulous

areas2. Tooth-bounded

edentulous spans3. Minimal need for

palatal support4. In cases where there

are 3 supporting abutments.

PALATAL STRAPPALATAL STRAPSTRUCTURAL DETAILS

Should be wide and thin.

Areal coverage is governed by the length of edentulous span and the amount of support it requires.

Anterior and posterior borders of the strap should be lightly beaded.

PALATAL BARPALATAL BAR

Narrow half-ovalThickest point at the center

Gently curved

PALATAL BARPALATAL BAR

Should not form a sharp angle at the juncture with the denture base

PALATAL BARPALATAL BAR

ADVANTAGEas an interim partial denture

DISADVANTAGESdifficult to adjustlittle support from the palatelimited to replacing one or two teeth on each side

DOUBLE PALATAL BAR /DOUBLE PALATAL BAR /ANTEROPOSTERIOR (AP) BARANTEROPOSTERIOR (AP) BAR

DOUBLE PALATAL BAR /DOUBLE PALATAL BAR /ANTEROPOSTERIOR (AP) BARANTEROPOSTERIOR (AP) BAR

most rigid maxillary major connector

rely on the abutment teeth

INDICATIONS

Anterior and posterior abutments are widely separated.

Presence of torus palatinus

Patients with mental attitude

Replacement of anterior & posterior teeth

Class I, II, and IV arches

DOUBLE PALATAL BAR /DOUBLE PALATAL BAR /ANTEROPOSTERIOR (AP) BARANTEROPOSTERIOR (AP) BAR

DOUBLE PALATAL BAR /DOUBLE PALATAL BAR /ANTEROPOSTERIOR (AP) BARANTEROPOSTERIOR (AP) BAR

STRUCTURAL DETAILS

ANTERIOR BAR- should be wide and flat.

BORDERS- positioned in the depression and slopes of the rugae rather than on the crests. POSTERIOR BAR- slightly beaded

- located well back in the palate, just anterior to the vibrating line.

PALATAL HORSESHOE /PALATAL HORSESHOE /U-SHAPED Major ConnectorU-SHAPED Major Connector

U-shaped connector replacing missing anterior

teeth

U-shaped connector used in conjunction with palatal

reinforced backings

PALATAL HORSESHOE /PALATAL HORSESHOE /U-SHAPED Major ConnectorU-SHAPED Major Connector

INDICATIONSINDICATIONS

1. Several anterior teeth are missing2. Palatal torus that extend posteriorly

and cannot be covered3. Periodontally weakened anterior teeth

require some stabilizing support4. Deep palatal vault which needs

stabilization

PALATAL HORSESHOE /PALATAL HORSESHOE /U-SHAPED Major ConnectorU-SHAPED Major Connector

STRUCTURAL STRUCTURAL DETAILSDETAILS

- thin- natural rugae

should be reproduced

- beaded posterior borders

PALATAL HORSESHOE /PALATAL HORSESHOE /U-SHAPED Major ConnectorU-SHAPED Major Connector

Least favorable Least favorable maxillary major maxillary major connector due to connector due to

its flexibilityits flexibility

FULL PALATE CONNECTOR/FULL PALATE CONNECTOR/COMPLETE PALATAL COVERAGECOMPLETE PALATAL COVERAGE

All Cast Complete Palate Major Connector All acrylic resin

FULL PALATE CONNECTOR/FULL PALATE CONNECTOR/COMPLETE PALATAL COVERAGECOMPLETE PALATAL COVERAGE

Combination of Metal and

Acrylic Resin

FULL PALATE CONNECTOR/FULL PALATE CONNECTOR/COMPLETE PALATAL COVERAGECOMPLETE PALATAL COVERAGE

All Metal

Avoid overextensions

Slight beading

FULL PALATE CONNECTOR/FULL PALATE CONNECTOR/COMPLETE PALATAL COVERAGECOMPLETE PALATAL COVERAGE

All AcrylicMaximum adhesion and

seal

Remaining teeth have a poor prognosis

Young patients

Short life expectancy of denture

Alterations are needed

FULL PALATE CONNECTOR/FULL PALATE CONNECTOR/COMPLETE PALATAL COVERAGECOMPLETE PALATAL COVERAGE

All AcrylicDisadvantage

weaker and less rigid than the metal

FULL PALATE CONNECTOR/FULL PALATE CONNECTOR/COMPLETE PALATAL COVERAGECOMPLETE PALATAL COVERAGE

Provides ultimate rigidity and support

Wide distribution of the functional load

Very little movement of the base during function

FULL PALATE CONNECTOR/FULL PALATE CONNECTOR/COMPLETE PALATAL COVERAGECOMPLETE PALATAL COVERAGE

STRUCTURAL DETAILS THIN

Natural anatomy of the palate should be reproduced

The material that covers the residual ridges should be refitted easily

POSTERIOR BORDER- can be made of either metal or acrylic resin.

FULL PALATE CONNECTOR/FULL PALATE CONNECTOR/COMPLETE PALATAL COVERAGECOMPLETE PALATAL COVERAGE

STRUCTURAL DETAILS border must be precisely established

MetalMetal slight bead should be provided

Acrylic Acrylic post dam seal should be located in the zone of the palate where the mucosa is resilient

SKELETAL DESIGN

provides less intrusion on to the tissues thicker in cross-section

CRITERIA FOR SELECTIONCRITERIA FOR SELECTION

1. Requirement for Indirect Retention

2. Horizontal Stability and Stress Distribution

3. Anatomic Considerations

4. Esthetics

5. Contingency Planning

6. Patient Preference Factor

1.1. Lingual bar Lingual bar2.2. Kennedy bar or double lingual bar Kennedy bar or double lingual bar

3.3. Lingual plate Lingual plate 4.4. Labial bar Labial bar5.5. Sublingual bar Sublingual bar

LINGUAL BARLINGUAL BAR

Simplest typeShould be used when there are no extraordinary requirementsBetter tolerated by patients than any other type of mandibular connector

LINGUAL BARLINGUAL BARSTRUCTURAL DETAILS

SUPERIOR BORDER - should clear the gingival margins of the lower anterior teeth by 2 to 3 mm.

INFERIOR BORDER – must not interfere with the lingual frenum or with the genioglossus muscle.

LINGUAL BARLINGUAL BARSTRUCTURAL

DETAILS

Should follow the contour of the lingual surface of the mandible, with no actual contact with the mucosa. 0.5 mm – space between the tissue and the tissue-bearing surface of the bar.

LINGUAL PLATELINGUAL PLATE

Linguoplate, Lingual Strap

Lingual Apron, Lingual Shield

LINGUAL PLATELINGUAL PLATE

STRUCTURAL DETAILS

Upper border – placed in the middle third of the lingual surface of anterior teeth. Metal should follow the contour of the lingual surfaces.

LINGUAL PLATELINGUAL PLATE

Must be left out of the mouth for at least 8 hours

LINGUAL PLATELINGUAL PLATE

Plating is not confined to anterior teeth but may be extended onto

the posterior teeth.

LINGUAL PLATELINGUAL PLATE(Other Considerations)(Other Considerations)

Presence of lingual tori Abnormally high lingual frenum Heavy calculus formation Need for IR Stabilizer Contingency planning

LINGUAL PLATELINGUAL PLATE

encourage plaque formation

DOUBLE LINGUAL Bar / DOUBLE LINGUAL Bar / KENNEDY Bar / SPLIT BarKENNEDY Bar / SPLIT Bar

Continuous Lingual bar

Excellent indirect retainer

Horizontal stability

Distributes stresses to

all teeth

DOUBLE LINGUAL Bar / DOUBLE LINGUAL Bar / KENNEDY Bar / SPLIT BarKENNEDY Bar / SPLIT Bar

INDICATIONS

Axial alignment of anterior teeth requires excessive block out.

Presence of wide diastema.

Crowded anterior teeth.

DOUBLE LINGUAL Bar / DOUBLE LINGUAL Bar / KENNEDY Bar / SPLIT BarKENNEDY Bar / SPLIT Bar

STRUCTURAL DETAILS

Presence of vertical stop

Lower bar- should conform to the design of a lingual bar.

DOUBLE LINGUAL Bar / DOUBLE LINGUAL Bar / KENNEDY Bar / SPLIT BarKENNEDY Bar / SPLIT Bar

Allows free flow of saliva and food

through the interproximal embrasures

Interrupted Double Interrupted Double Lingual BarLingual BarModification of Kennedy BarWhen the Kennedy bar is cosmetically

distracting because of a prominent diastema

The UPPER BAR is indiscernible.

Interrupted Lingual PlateInterrupted Lingual Plate

Modification of lingual plateLarge interdental spacesLingual plate is divided into units ,

extended onto the lingual surfaces

LABIAL BARLABIAL BAR

INDICATIONS

Inoperable,large lingual torus. Severe inclination of lower anterior or premolar teeth.

LABIAL BARLABIAL BAR

STRUCTURAL DESIGN

Same with lingual bar,

but a bit thinner.

Main Problem

ESTHETICS – bar is positioned low into the labial vestibule

STRUCTURAL DETAILS THAT STRUCTURAL DETAILS THAT APPLY TO ALL APPLY TO ALL

MAJOR CONNECTORSMAJOR CONNECTORS Rigidity Impingement of the Free Gingival Margin

- at least 6 mm (maxillary)- at least 3 mm (mandibular)

Avoidance of Dead-End Apertures Border Contour Beading the Borders