p2 lab (prelims)
TRANSCRIPT
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