Removable Prosthodontics

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Copyright 2003, Elsevier Science (USA). All rights reserved.

Removable ProsthodonticsRemovable Prosthodontics

Chapter 52Chapter 52

Copyright 2003, Elsevier Science (USA).All rights reserved. No part of this product may be reproduced or transmitted in any

form or by any means, electronic or mechanical, including input into or storage in any

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the last page of each print-out.

Produced in the United States of America

ISBN 0-7216-9770-4


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IntroductionIntroduction

Removable prosthodontics is thespecialty of dentistry that replaces missingteeth with a removable prosthesis.

Removable partial denture, also referredto as a partial, replaces one or more teeth inthe same arch.

Removable full denture, also referred to

as a denture, replaces all of the teeth in onearch.

Removable prosthodontics is thespecialty of dentistry that replaces missingteeth with a removable prosthesis.

Removable partial denture, also referredto as a p

artial, replaces one or more teeth inthe same arch.

Removable full denture, also referred to

as a denture, replaces all of the teeth in onearch.


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Fig. 52-1 Removable partial denture.Fig. 52-1 Removable partial denture.


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Fig. 52-2 Full denture.Fig. 52-2 Full denture.


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ExtraoralFactors thatInfluence the Choiceof a Removable ProsthesisExtraoralFactors thatInfluence the Choiceof a Removable Prosthesis

Physical health

Mental health

Motivation

Age

Dietary habits

Socioeconomic factors

Occupation

Physical health

Mental health

Motivation

Age

Dietary habits

Socioeconomic factors

Occupation


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Musculature

Salivary flow

Residual alveolar ridge

Oral mucosa

Oral habits

Tori

Musculature

Salivary flow

Residual alveolar ridge

Oral mucosa

Oral habits

Tori

IntraoralFactors thatInfluence the Choiceof a Removable ProsthesisIntraoralFactors thatInfluence the Choiceof a Removable Prosthesis


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Indications for a Removable PartialDentureIndications for a Removable PartialDenture

To replace several teeth in the same quadrant orin both quadrants of the same arch.

As a temporary replacement for missing teeth ina child.

To replace missing teeth for patients who do notwant a fixed bridge or implants.

For the patient who finds it easier to maintaingood oral hygiene.

To serve as a splint to support periodontallyinvolved teeth.

To replace several teeth in the same quadrant orin both quadrants of the same arch.

As a temporary replacement for missing teeth ina child.

To replace missing teeth for patients who do notwant a fixed bridge or implants.

For the patient who finds it easier to maintaingood oral hygiene.

To serve as a splint to support periodontallyinvolved teeth.


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Contraindications for a RemovablePartial DentureContraindications for a Removable

Partial Denture

A lack of suitable teeth in the arch to support,stabilize, and retain the removable prosthesis.

Rampant caries or severe periodontal

conditions that threaten the remaining teeth inthe arch.

A lack of patient acceptance for estheticreasons.

Chronic poor oral hygiene.

A lack of suitable teeth in the arch to support,stabilize, and retain the removable prosthesis.

Rampant caries or severe periodontal

conditions that threaten the remaining teeth inthe arch.

A lack of patient acceptance for estheticreasons.

Chronic poor oral hygiene.


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Components of a Partial DentureComponents of a Partial Denture

Framework

The cast metal skeleton that providessupport for the remaining components of the

prosthesis. Connectors

Join various parts of the partial together

Major connector

Minor connector

Framework

The cast metal skeleton that providessupport for the remaining components of the

prosthesis. Connectors

Join various parts of the partial together

Major connector

Minor connector


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Retainer Known as a clasp, it supports and provides

stability to the partial denture by partiallycircling an abutment tooth.

Rest A metal projection designed to control the

seating of the prosthesis.

Artificial teeth

Constructed from either acrylic or porcelain.

Retainer Known as a clasp, it supports and provides

stability to the partial denture by partiallycircling an abutment tooth.

Rest A metal projection designed to control the

seating of the prosthesis.

Artificial teeth

Constructed from either acrylic or porcelain.

Components of a Partial Denture-contdComponents of a Partial Denture-contd


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Appointment Sequencing for a PartialDentureAppointment Sequencing for a PartialDenture

Appointment 1: Records

Updated health and dental history.

Prophylaxis.

Preliminary impressions. Radiographs.

Photographs.



Prophylaxis.

Preliminary impressions. Radiographs.

Photographs.


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Appointment 2: Preparation

Prepare the teeth.

Take the final impression.

Take the occlusal registration. Select the shade and mold of the teeth.

Prepare the laboratory prescription.

Appointment 2: Preparation

Prepare the teeth.

Take the final impression.

Take the occlusal registration. Select the shade and mold of the teeth.

Prepare the laboratory prescription.

Appointment Sequencing for a PartialDenture-contdAppointment Sequencing for a PartialDenture-contd


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Appointment 3: Try-in

Evaluate the fit, comfort, and function ofthe appliance.

Evaluate the shade, mold, and arrangementof the teeth.

Take new occlusal registration.

Note any changes on the laboratoryprescription.


Evaluate the fit, comfort, and function ofthe appliance.

Evaluate the shade, mold, and arrangementof the teeth.

Take new occlusal registration.

Note any changes on the laboratoryprescription.



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Appointment 4: Delivery

Have patient place partial.

Check occlusion.

Detect any pressure points. Check retainers for tension on the natural

abutment teeth.

Polish partial. Give patient home instructions.


Have patient place partial.

Check occlusion.

Detect any pressure points. Check retainers for tension on the natural

abutment teeth.

Polish partial. Give patient home instructions.



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Home Care Instructions for aPartial DentureHome Care Instructions for aPartial Denture

Store prosthesis in water or a moist airtightcontainer when not wearing it.

After eating, remove from mouth and brush orrinse the retainers, rests, and complete partial.

Brush and floss abutment teeth and naturalteeth to keep them free of food debris andplaque.

Advise patient not to adjust the partial denture.

Store prosthesis in water or a moist airtightcontainer when not wearing it.

After eating, remove from mouth and brush orrinse the retainers, rests, and complete partial.

Brush and floss abutment teeth and naturalteeth to keep them free of food debris andplaque.

Advise patient not to adjust the partial denture.


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Appointment 5: Postdelivery check

Evaluate the fit.

Check the mucosa for pressure areas and

sore spots. Evaluate the function of the prosthesis.

Appointment 5: Postdelivery check

Evaluate the fit.


sore spots. Evaluate the function of the prosthesis.



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Indications for a Full DentureIndications 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 acceptablealternatives are available.

The patient refuses alternative treatmentrecommendations.

The patient is edentulous.

The remaining teeth cannot be saved.

The remaining teeth cannot support a

removable partial denture, and no acceptablealternatives are available.

The patient refuses alternative treatmentrecommendations.


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Contraindications for a Full DentureContraindications for a Full Denture

Another acceptable alternative is available.

Physical or mental illness affects the patient'sability to cooperate during the fabrication ofthe denture and to accept or wear thedenture.

The patient is hypersensitive to denturematerials.

The patient is not interested in replacingmissing teeth.

Another acceptable alternative is available.

Physical or mental illness affects the patient'sability to cooperate during the fabrication ofthe denture and to accept or wear thedenture.

The patient is hypersensitive to denturematerials.

The patient is not interested in replacingmissing teeth.


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Components of a Full DentureComponents of a Full Denture

Base

Designed to fit over the residual alveolarridge and surrounding gingival area.

Flange Part of the base that extends over the

attached mucosa from the cervical marginof the teeth to the border of the denture.

Base

Designed to fit over the residual alveolarridge and surrounding gingival area.

Flange Part of the base that extends over the

attached mucosa from the cervical marginof the teeth to the border of the denture.


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Post dam

Retention of a maxillary denture dependson the suction seal.

Artificial teeth Fabricated from acrylic or porcelain.

Post dam

Retention of a maxillary denture dependson the suction seal.

Artificial teeth Fabricated from acrylic or porcelain.

Components of a Full Denture-contdComponents of a Full Denture-contd


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Appointment Sequencing for a FullDentureAppointment Sequencing for a FullDenture



Preliminary impressions.

Radiographs. Photographs.



Preliminary impressions.

Radiographs. Photographs.


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Appointment 2: Final impression

Essentials of a final impression for dentures

Landmarks of the dental arches are accuratelyreproduced.

Maxillary should include the hamular notches, postdam, tuberosities, and frenum attachments.

Mandibular should include the retromolar pads,oblique ridge, outline of the mylohyoid ridge andthe genial tubercles, plus the lingual, labial, and

buccal frena. Laboratory prescription

Appointment 2: Final impression

Essentials of a final impression for dentures

Landmarks of the dental arches are accuratelyreproduced.

Maxillary should include the hamular notches, postdam, tuberosities, and frenum attachments.

Mandibular should include the retromolar pads,oblique ridge, outline of the mylohyoid ridge andthe genial tubercles, plus the lingual, labial, and

buccal frena. Laboratory prescription

Appointment Sequencing for a FullDenture-contdAppointment Sequencing for a FullDenture-contd


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Appointment 3: Try-in ofbaseplate-occlusal rim

Occlusal rim records

Vertical dimensions evaluated. Occlusal relationship.

Smile line.

Canine eminence.

Select artificial teeth

Appointment 3: Try-in ofbaseplate-occlusal rim

Occlusal rim records

Vertical dimensions evaluated. Occlusal relationship.

Smile line.

Canine eminence.

Select artificial teeth



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Appointment 3: Try-in ofbaseplate-occlusal rim-contd

Occlusal registration measurements

Centric relation. Protrusion.

Retrusion.

Lateral excursion.

Appointment 3: Try-in ofbaseplate-occlusal rim-contd

Occlusal registration measurements

Centric relation. Protrusion.

Retrusion.

Lateral excursion.



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Denture is evaluated for fit, comfort, and stability.

Appearance of the denture, including the shade,mold, and alignment of the teeth, is verified.

Retention of the denture setup is checked as thepatient verbalizes the f, v, s, and th sounds;swallows; and yawns.

Occlusion of the denture is checked.

Laboratory prescription for the completion of thedenture is prepared.


Denture is evaluated for fit, comfort, and stability.

Appearance of the denture, including the shade,mold, and alignment of the teeth, is verified.

Retention of the denture setup is checked as thepatient verbalizes the f, v, s, and th sounds;swallows; and yawns.

Occlusion of the denture is checked.

Laboratory prescription for the completion of thedenture is prepared.



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New denture is inserted into the patient'smouth.

Shade and mold of the artificial teeth are

checked for natural appearance.

Patient is requested to perform facialexpressions and the actions of swallowing,chewing, and speaking, using s and th sounds.

Occlusion is checked. Home instructions are given.


New denture is inserted into the patient'smouth.

Shade and mold of the artificial teeth are

checked for natural appearance.

Patient is requested to perform facialexpressions and the actions of swallowing,chewing, and speaking, using s and th sounds.

Occlusion is checked. Home instructions are given.



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Thoroughly rinse the oral tissues at least oncedaily.

All surfaces of the denture should be

thoroughly cleaned with a denture brush andmild abrasive.

When dentures are not in the mouth, theymust be stored in a moist, airtight container to

prevent drying and warpage.

Thoroughly rinse the oral tissues at least oncedaily.

All surfaces of the denture should be

thoroughly cleaned with a denture brush andmild abrasive.

When dentures are not in the mouth, theymust be stored in a moist, airtight container to

prevent drying and warpage.

Home Care Instructions for a FullDentureHome Care Instructions for a FullDenture


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Appointment 6: Postdelivery of a fulldenture


sore spots. Schedule recall appointment.

Appointment 6: Postdelivery of a fulldenture


sore spots. Schedule recall appointment.



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Immediate DenturesImmediate Dentures

Type of denture that is placed immediatelyafter the extraction of a patient's remaininganterior teeth. This type of denture serves asa compress and bandage to protect thesurgical site.

Type of denture that is placed immediatelyafter the extraction of a patient's remaininganterior teeth. This type of denture serves asa compress and bandage to protect thesurgical site.


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Construction of an Immediate DentureConstruction of an Immediate Denture

Occlusal wax rims are completed with posteriorteeth and tried in before extraction of anteriorteeth. The denture, complete with the anteriorteeth, is constructed, sterilized, and ready for

placement at the time of surgery. Surgical template

Clear plastic impression tray of the anteriorarea that the surgeon uses as a guide in

properly contouring the remaining alveolarridge.

Occlusal wax rims are completed with posteriorteeth and tried in before extraction of anteriorteeth. The denture, complete with the anteriorteeth, is constructed, sterilized, and ready for

placement at the time of surgery. Surgical template

Clear plastic impression tray of the anteriorarea that the surgeon uses as a guide in

properly contouring the remaining alveolarridge.


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Denture ReliningDenture Relining

Relining is accomplished by placing a newlayer of denture resin over the tissue surfaceof the prosthesis.

Impression is taken with the present

denture used as the impression tray. Patient is instructed to close-in normal

occlusion.

Denture and written prescription are sentto the laboratory technician for relining.

Relining is accomplished by placing a newlayer of denture resin over the tissue surfaceof the prosthesis.

Impression is taken with the present

denture used as the impression tray. Patient is instructed to close-in normal

occlusion.

Denture and written prescription are sentto the laboratory technician for relining.


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Denture RepairsDenture Repairs

Simple repairs can be handled in the dentaloffice laboratory by using cold-cured acrylics.

Complicated repairs, particularly those

involving the replacement of teeth or thecomplex fracture of the denture, are usuallysent to the dental laboratory technician.

Simple repairs can be handled in the dentaloffice laboratory by using cold-cured acrylics.

Complicated repairs, particularly those

involving the replacement of teeth or thecomplex fracture of the denture, are usuallysent to the dental laboratory technician.


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Fig 52-19 Broken denture.Fig 52-19 Broken denture.


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Denture DuplicationDenture Duplication

Because dentures can break or require timefor relining, the patient should have aduplicate denture made.

Because dentures can break or require timefor relining, the patient should have aduplicate denture made.

Removable Prosthodontics

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