If trauma appears to be a contributory factor to the stomati-, tis, appropriate adjustments, such as occlusal c. should be advised to do this as much as possible. provide resistance to movement along both paths. Although this connector leaves a large area of the palate uncovered, it, does have the potential disadvantage that the anterior bar crosses, mucosa that is richly innervated and is contacted frequently by the tongue, during swallowing and speech. The flexibility of a clasp is dependant on its design. Also, subsequent transfer of two-dimensional information by, the technician from the paper diagram to the three-dimensional cast can, lead to errors of interpretation. This study examined 15 aspects of patient satisfaction and explored the factors found to be associated with dissatisfaction. creates a rest seat without penetration of the enamel. The position in which the handpiece must be held t, each other and to the path of insertion, should be established on, This cast can then be placed on a surveyor and the parallelism of. It is usually better to establish improved contours for retention by, restorative methods as outlined in Chapter 14 of, Undercut areas can also be created by the use of acid-etch composite, A broad area of attachment of the restoration to the enamel is desirable, as this will reduce the chance of the restoration being displaced and will. changes are likely to make the denture unwearable. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. lar removable partial dentures: a population-based study of patient satisfaction. Not only may an RPD help to restore appearance but it may actually improve it. Few teeth were lost by patients in the study. There is no requirement for a labial flange at UR3(13). with the guide surfaces which will be prepared on the abutment teeth. Thus supplementary retention must be, obtained by wide palatal coverage, full extension of the denture base, into the left buccal sulcus and around the left tuberosity. This is the direction in which the denture tends to be displaced in, function. designs which incorporate indirect retention. If interference from a tooth is present. When the ‘gate’ is closed, and locked into position, the denture is held securely by the ‘gate’ on the, labial aspect and by the reciprocating components on the lingual aspects, of the teeth. There are a number of precautions that can be taken to reduce the, chance of the denture being seated incorrectly, with extensive palatal coverage the escape channel for any excess reline, material is long and tortuous and therefore the choice of a low-viscosity, material is important. If the denture plaque control is poor the dentist should demonstrate the, plaque to the patient by the use of a disclosing solution, explain the. See our User Agreement and Privacy Policy. It emphasises the importance of co-operation between the dental team and patient to ensure that the balance of this 'equation' is in the patient's favour. or on the abutment tooth and the other housed in the denture. As shown in (a), a cobalt chromium clasp arm, approximately l5 mm long, should be placed in a horizontal undercut of 0.25 mm. F, verified that there is a significant reduction in one or mor, essential oral functions. In a UK survey people were asked, 'If, you had several missing teeth at the back would you prefer to have an, RPD or manage without?’ The chart shows that most people would, prefer to manage without and that the preference grows stronger with, increasing age. the rest seat. The areas that tend to collect most plaque are the proximal surfaces of abutment teeth adjacent to the saddle. design. the clinician, the dental technician and the patient. The, surveyor allows a vertical arm to be brought into contact with the, teeth and ridges of the dental cast, thus identifying parallel surfaces, Ideally the clinician, rather than the dental technician, surveys the. When teeth are lost from a dental arch the teeth adjacent to the, edentulous space may tilt and move into that space. 9 — Support for the indirect retainer, compressibility of mucosa allows movement of the denture to occur, If there is no alternative to mucosal support the indirect retainer, should cover a sufficiently wide area to spread the load and avoid, supported indirect retainers to the maxilla where the load can be. on wax patterns of crowns for abutment teeth. It should also be, remembered that the close fit of a denture will deteriorate following, resorption of the residual ridge. rests on UR7 (17) and UL7 (27) as far posteriorly as possible. Thus when the distal extension saddle sinks under oc, The RPI system is described in Figs 26–28, p653-654, P, sibly because the potential for support from the denture-bearing area is great, maxilla than in the mandible, ie the ‘support deficit’ is less. This support differential can, result in tipping of the denture when it is loaded during function, causing, an uneven distribution of load over the edentulous area. (2) If it rests on an, inclined tooth surface, movement of the tooth might occur with, resulting loss of support for the indirect retainer, Fig. single tooth should normally be grasped (, If coverage of the gingival margin by the connector is unavoidable, close, contact between the connector and gingival margin should be achieved, whenever possible. The occlusal rests on the molars, bridge the gap between the two teeth. A laboratory repair can then be undertaken. parallelism of surfaces without marking the cast. If the mouth is not inspected regularly to, identify treatment needs as they arise, there is the likelihood of, acceleration of tissue damage, which may prejudice the eventual, In this case the inflammation and hyperplasia of the palatal mucosa was, so severe that surgery had to be performed before further prosthetic, Causes of damage related to the wearing of RPDs, Harmful effects can arise from the wearing of RPDs in a variety of, an ill-designed prosthesis and from errors in the oc, If the patient, with the help of the dental team, can maintain, wearing RPDs, such as caries and periodontal disease, can be, required if optimal oral function and health ar, damage and their sequelae are summarised in the following table. This article describes a method of building RPD components into an effective design and indicates how the details of the design can be communicated clearly to the dental technician. study cast in preparation for designing an RPD. It is particularly important to shor, Indirect support can be of value for the K, is to solder the origin of the clasp to the metal base of the saddle and then cov, arm not to change the properties of the wrought alloy, These benefits are not obtained if an attempt is made t, pleted before the trial insertion of the metal fr, rest, should not approach closer than 1 mm to the ging, If a clasp is closer than 1 mm to the gingival margin there is the likelihood of gingival, If the clasp is not supported by a rest the separation of clasp tip and gingival, margin should be greater than 1 mm so that when the saddle sinks the clasp does not, If a clasp arm runs from maximum to least under, Only the terminal third of the clasp arm can cross the survey line and enter the under-, survey line. If there is no, reasonable alternative to this clasp, and mechanical retention is thought to be, essential, serious consideration must be given to surgical excision of the fraenal, A distal extension saddle should not be rigidly attached to the abutment, tooth by a combination of stiff clasp and long guide plates. The connector should be designed so that it is rigid and thus, distributes the functional forces throughout the structure of the denture, Summary of functions and essential qualities of connectors, qualities of the mandibular connectors is, Mention has already been made of lingually inclined teeth creating an, obstruction to the insertion of an RPD, and how a change in path of, insertion can sometimes avoid this obstruction (, occasions the lingual tilt is so severe that it is impossible to use any of the, lingual connectors. For the laboratory addition of a flange, an alginate impression in a stock, extended in the area where the flange is to be added using a suitable, can be added to the denture and shaped to conform to the area to be, covered by the flange. periodontal attachment has been reduced by periodontal disease. Fig. design to be at right angles to the occlusal plane. A clinical trial using the experimental gingivitis model developed for periodontal clinical research was performed to evaluate the effect of a removable partial denture mandibular major connector design on the surrounding gingival tissues. The keeper is housed in a gold coping fitted to a root-filled tooth. in different planes so that an 'L'-shaped girder effect is created. Fig. This survey was undertaken to pr, responded and the results of the survey are, given as pie charts indicating the expert group, level of agreement or disagreement with each, The experts’ comments on these principles, opinion of each of the design principles listed, this it should be assumed that, to be acc, able, a design statement is likely to apply t, those of the experts and consider the points, for a distal extension saddle by being placed on the. A small minority of patients find it very difficult, or even impossible, to, wear a denture because of a pronounced retching reflex. Angular cheilitis (lesions of the angles of the mouth) is characterized by maceration, erythema and crust formation. A clasp should always be supported by a rest. increase in caries and periodontal disease. However, approaching clasp has more potential for being hidden in the distobuccal, aspect of a tooth provided that there is a suitable undercut area for the, A low survey line (on the buccal side of the tooth) is present because the, tooth is tilted; thus there is a high survey line on the lingual side of the, tooth. It will be appreciated that the factors mentioned abo, will retain a denture satisfactorily and yet not stress the tooth. Fig. and are discussed in more detail in the subsequent sections. The subjects were returned to optimal oral health and repeated the experimental period with the alternate design. A partial denture is designed to fill in the gaps left by one or more missing teeth. FIXED PARTIAL DENTURE Definition “ A partial denture that is luted or otherwise securely retained to natural teeth, tooth roots and/or dental implant abutments that furnish the primary support to the prosthesis”- … If you continue browsing the site, you agree to the use of cookies on this website. The, percentage of the UK adult population that possessed four 'good', quadrants was found to be 54%. capable of being displaced posteriorly and of rotating in the hor-, izontal plane. Looks like you’ve clipped this slide to already. the denture, the clasp is bent upwards rather than flexed outwards. The, broad palatal plate connector also provides a surface that the patient’s. Dentists are faced with the demand for replacing missing teeth from patients with limited financial resources; therefore the replacement of missingteeth with an APD is a common occurrence. The remainder of this chapter is devoted to, In addition to its basic connecting role it contributes to the support and, bracing of a denture by distributing functional loads widely to the teeth, and, in appropriate maxillary cases, to the mucosa. When this can be achieved, as, for the saddle replacing UR6 (16) and UR5 (15), indirect retention is, abutments to be suitable for clasping. In contrast, the greater extent of the saddles in this tooth–mucosa, supported RPD presents more of a support problem. quences of tooth loss, as described in the following paragraphs. The use of a different coloured lead to that used in the survey, The resulting definitive RPD design prescription is given to the, dental technician with the final impression. resin, the limitations of the material should be borne in mind. relative to the path of displacement (2). to the design and construction of the denture. An ‘I’ bar would be suitable for a premolar tooth with a survey line of, The diagonal survey lines on the molar and premolar teeth shown here, indicate that there is a larger undercut on that part of the tooth which is, furthest away from the edentulous area. Correction of the occlusion is desirable before, constructing replacement dentures as adaptive mandibular posture and, mucosal inflammation resulting from this deterioration are likely to, After the saddles have been relined, occlusal contact can be re-, established by the addition of tooth-coloured cold-curing acrylic resin to, The fluid resin is applied to the occlusal surfaces of one of the dentures, and allowed to reach the dough stage before the denture is inserted into, the mandible is gently guided along the retruded arc of closure until even, occlusal contact is made at the appropriate vertical dimension. ment in oral health compared with a similar group 20 years ago, A nationwide survey showed that the majority of adults pre-, ferred to manage without a denture if several teeth wer, ing at the back of the mouth (Fig. (a) This RPD cannot be inserted in the mouth because failure to eliminate unwanted undercut on the. 14 — RPD designs which include indirect retention, direct retention from both abutments. Three points are, If the cast has been tilted for the final survey. This design is not valid until signed by a qualified clinician. An occlusal rest placed at the arrow in (1) would create a premature, occlusal contact (2), unless a rest seat was prepared to make room for it, Space for the rest should not usually be created by grinding the, mandibular buccal cusp as this is a supporting cusp contributing to the, The rest should be at least 1 mm thick for adequate strength. If, required to move it over the maximum bulbosity will put a considerable, strain on the fibres of the periodontal ligament and is likely to exceed the. Denture irritation hyperplasia, which is caused by chronic injury of the tissue in contact with the denture border, is present in about 12% of denture wearers. A natural appearance has been created by, using a ‘veined’ acrylic, by reproducing the pre-extraction form of, alveolar ridge and by making the distal margin of the flange thin and, With modern foods and methods of preparation it is unlikely that a, patient will suffer from malnutrition even though a large number of teeth, teeth reduce the efficiency of mastication: the bolus of food is allowed to, slip into the edentulous areas and thus escape the crushing and shearing, action of the remaining teeth. Clipping is a handy way to collect important slides you want to go back to later. If it is, considered essential to rely on mechanical retention, a possible solution, is to prescribe a more flexible gingivally approaching clasp. A molar ring clasp should have occlusal rests mesially and. T, that sufficient enamel has been removed during rest seat preparation to, accommodate this thickness of metal, the patient should be asked to, occlude on a strip of softened pink wax. A more stable and therefore more widely applicable design is the, modified spoon denture. The RPD design should strive to reduce the mechanical advantage, of the displacing force by placing the clasp axis as close as possible to, the saddle and by placing the indirect retainers as far as possible from, mount importance in determining the amount of indirect. remaining natural teeth to disclude the denture teeth on excursion. merits and limitations of these connectors. Hardened stainless steel wire, of clasp construction and progress to further consideration of, design and clinical use. In this, instance the inaccurate fit will encourage plaque formation with, consequent periodontal disease and caries, thus introducing an. their efficiency with the passage of time. A duplicate cast, is then made on which the denture is manufactured. It reduces gingival margin coverage to a. minimum, but a potential hazard is the risk of inhalation or ingestion. It also revealed that the, wearing of RPDs than younger individuals. (1) Periodontal problems should be treated and an adequate oral hygiene established prior to the insertion of the denture; can be conferred on patients by RPDs and, at the same time, foreign object (the prosthesis) in the mouth of the patient. The abutment teeth on either side of the, A single path of insertion may be created if sufficient guide surfaces, are contacted by the denture; it is most likely to exist when bounded, Multiple paths of insertion will exist where guide surfaces are not. If the undercut is, less the retention will be inadequate. If the mouth is well cared for and the patient requests dentures, the RPD equation is favourably balanced. In order to understand the way in which indirect retainers are, located it is necessary to consider the possible movement of the, denture around an axis formed by the clasps. The retentive clasps can be placed, either buccal/buccal (as in the illustration) or lingual/lingual. A breakdown of the answers by age is, shown in the chart. It will also result, in a relatively greater share of the load being taken by the tooth. islation states that the dentist has ultimate r, all dental treatment, including the design and material of any, It is obviously essential for effective c. ple is a system based on the function of the RPD components: When producing a design diagram it is helpful to use a proforma, such as the example here, which includes the, However well the design diagram is produced, it still suffers from the, significant limitation of being a two-dimensional representation of a three-, dimensional object. This results in a bar whose maximum cross-, sectional dimension is oriented horizontally, The rigidity of a lingual bar increases by a square factor when its height, is increased and by a cube factor when its width is increased. At baseline and at days 7, 21 and 49, plaque index, gingival index and probing pocket depth measurements were recorded, and subgingival plaque samples were examined using darkfield microscopy. 1). same function as the simpler type of gauge. Although, this denture achieves some retention from clasps its success will depend, primarily on the muscles of the tongue and cheeks acting on the correctly. By tilting the cast, a path of insertion may be found which, avoids this interference. distributed over the hard palate (shaded area of the connector). Such horizontal forces are especially damaging to the periodontal. It is important to. If you wish to opt out, please close your SlideShare account. Gauges are provided to measure the extent of horizontal undercut, and are available in the following sizes: 0.25 mm, 0.50 mm and 0.75, mm. resisted by the mirror images of these components. it passes behind the spaces is an alternative solution. The time, effort and understanding taken to mak, need and demand for a prosthesis as an aid to c, In the same study people were asked, 'Do you find the thought of having a, partial denture to replace some of your teeth very upsetting, a little, upsetting or not at all upsetting?' (1) Anterior displacement of a maxillary Kennedy Class IV denture, can be resisted by elements of the framework contacting the disto-, palatal and disto-buccal surfaces of the teeth and, in some cases, by. Little is known about the outcomes of treatment with mandibular removable partial dentures provided by dentists in private dental practice. In many cases there, can be advantages if the dentist goes further and draws on the cast details, of other components such as minor connectors, guide plates, clasps and. The prevalence is about 15% among wearers of complete dentures. medium multi-tufted toothbrush, which gives good access to all parts of, the denture and good adaptability to the surface. Therefore the modest indirect r, This saddle has an occlusal rest and a clasp on the abutment tooth, and, well be preferred, a distal rest has been used in this example to simplify, the explanation which follows. The scene is set in this introduction, and the first article addresses basic clinical and patient-related factors involved in decision-making before commencing active prosthodontic treatment. If this false line is used in designing an RPD, errors. The design of resin-bonded !xed partial dentures has been moved to the chapters on partial coverage restora-tions. If this is, found not to be the case, the framework should be carefully adjusted to, The distal guide plate is positioned at the gingival end of a guide surface. However, diagnosis may be difficult and the more severe and dramatic tissue reactions to dentures may indicate underlying systemic diseases. disease there is unlikely to be complete resolution. Where only a single tooth intervenes between two saddles. If the patient persists in trying to seat. It, therefore remains to design bracing elements which will safely, distribute the lateral forces acting on the denture. The prescription must, include details of the materials to be used. The opinion of, prosthodontic experts regarding these statements. It is, therefore capable of transmitting more horizontal force to the tooth and, is a more efficient bracing component as a result (P, measure is appropriate depends upon the health of the periodontal. If the design of the denture is such that it transmits excessive force to a tooth there is. I, such refractory cases, oral antifungal agents such as Ampho-, very limited value and unless the underlying cause of the den-, of tooth preparation (see Figs 7.14, 7.15 and 7.17 of, purpose. A study of elderly men living in, the dental appearance of a group of elderly people as less attrac-, denture. be reasonably dextrous to successfully manage a denture of this type. (4) If the reciprocating clasp is placed on a tooth, without an adequate guide surface, it will lose contact with the tooth before the retentive arm has passed over the maximum bulbosity of the. the appropriate part of the circumference of the tooth (green area). A popular form, of design for the replacement of one or two anterior teeth in young, people is the 'spoon' denture. allow a significant degree of movement of the denture in function. need additional information or clarification. It is commonly assumed that a distal extension partial removable dentures rotates around the supporting rests when the saddle is occlusally loaded and that this rotation may expose the abutment teeth to a distal torque believed to be potentially harmful to their periodontal tissues. Principles of tooth preparation in Fixed Partial Dentures, Umm Al-Qura University Faculty of Dentistry, www.ffofr.org - Foundation for Oral Facial Rehabilitiation, No public clipboards found for this slide. The ring connector exhibits good rigidity for a relatively low bulk of, metal. These forces tend to displace the denture in both antero-posterior and, This article describes how bracing can be used, to produce stable RPDs which distribute forces, Eastman Dental Institute for Oral Health Care Sciences, U, The lateral forces in particular are capable of inflicting considerable, damage on the periodontal tissues and alveolar bone in the, edentulous areas. contacts the mesiolingual surface of the premolar tooth. diet to be eaten. survey line as shown in the illustration. A satisfactory work authorisation for an RPD design takes the form of an, annotated diagram of the design produced after a thorough assessment of. cast has resulted in acrylic resin being processed into the area. anterior to the midpoint of the buccal surface of the tooth. Acrylic resin baseplates were designed incorporating a variety of relationships of the connector to the gingival margin. create difficulties in tolerating the denture. denture for the modifications to be carried out, particularly if it, tion of the denture at the chairside wher, of polymers for direct use in the mouth significantly increases, the number of opportunities for adopting this approach. The design of rest seats on anterior teeth is shown in Figs 9 to 12. space by drifting and tilting of the adjacent teeth. Each design is only one of a number of possible solutions. It does not enter the sulcus ar, is a tissue undercut buccally on the alveolus more than 1 mm in depth within, resulting in possible irritation of the buccal mucosa, and the trapping of food debris, A gingivally-approaching clasp is an appropriate choice under suc, it can be made long enough to achieve adequate fle, generally of the order of 7 mm. This is because the anterior and posterior bars can be positioned. clasp axis and therefore contribute little to the indirect retention. Budtz-Jorgenson E. Oral mucosal lesions associat, Final results of a 4-year longitudinal in, Chandler J A and Brudvik J S. Clinical evaluation of patients eig. contribution being made by the rest on UR7 (17). Full palatal coverage with cobalt chromium has two disadvantages. An RPD will prevent this escape of the. In this example there is existing periodontal, disease. swing-lock design allowed optimum use to be made of the incisors. are three widely spaced lines parallel to the path of insertion. The swing-lock denture has a hinged labial bar which has extensions into, undercuts on the labial surfaces of the teeth. Some of these materials are damaged by the use of alkaline perborate, denture cleansers and others by alkaline hypochlorites. does not contribute to support by distributing loads directly to. The length of the gingivally approaching clasp arm can therefore be, increased to give greater flexibility which can be a positive advantage, when it is necessary to clasp a premolar tooth or a tooth whose. There are sufficient teeth at the front of, the mouth to satisfy the demands of appearance and speech. The path is variable but is assumed for the purpose of. lingual bar is determined by the shape of a prefabricated wax pattern. move in the directions indicated and disengage from the tooth surface. removal (2), causing clasps to flex beyond their proportional limit. Successful clasp, retention allows the palatal coverage to be reduced to a minimum. When elimination of undercuts is required on a cast which is not to, be duplicated, a material such as zinc phosphate cement, which can, resist the boiling out procedure, is used. The dangers of, partially dentate patient considered. On occasions, there is insufficient room between gingival margin and, floor of the mouth for either a sublingual or lingual bar, should be avoided wherever possible because it might well tip the, delicate balance between health and disease in favour of the latter, cross-sectional area of this connector and thus some reduction in rigidity, Fig. The combination of limited space for the bar and its increased length as, it travels around the outer circumference of the dental arch makes it, difficult to achieve rigidity although, in this example, the short spans, construction of dentures with cast metal frameworks, there are, The main advantages of acrylic dentures are their relativ, tions or relines will be needed. The greatest possible mucosa support for the saddle, is achieved by extending the denture base onto the pear, and to the full functional depth of the lingual and buccal sulci. The provision of, a thin acrylic training base, which in the maxilla may be of horseshoe, design, is useful in overcoming the reflex. It is possible that the pr, patient is instructed in meticulous oral hygiene proc, Fig. This, force of attraction imparts a degree of security to the denture, without. Incisal rest seats, therefore have a wider application in this situation, in spite of their, inferior appearance. matory exudate. the clasp arm or the depth of undercut engaged.. The functional, forces can be shared between teeth and mucosa by using a larger, connector that extends posteriorly to the junction of hard and soft, palates. In this tooth-supported RPD, a simple mid-palatal plate has been used. © 2008-2020 ResearchGate GmbH. By adjusting the vertical position of the gauge until the shank and. Again, a ring clasp is a solution to the problem: the bracing portion, of the clasp is on the left side of the tooth and the retentive portion on, A high survey line poses particular difficulties on a premolar tooth. A denture, restoring the posterior teeth is frequently not worn by the patient for the, little resistance to its displacement in a posterior direction; secondly, there is very little motivation to wear the denture as the anterior teeth, will be more stable. connector will be rigid and will avoid coverage of the gingival margins. Retention will also be assisted by the buccal placement of. They include denture stomatitis, angular cheilitis, traumatic ulcers, denture irritation hyperplasia, flabby ridges, and oral carcinomas. The positioning of the minor connectors joining, rests to a saddle will vary according to whether an 'open' or 'closed' design is, a minimum to conform to the key design principle of simplicity, The major connector (coloured black) links the saddles and thus unifies, the structure of the denture. The relationship to age is shown in the, chart. 9 — Improved distribution of occlusal load, The loss of a large number of teeth puts an increasing functional burden, on the remaining teeth. The, disadvantage of this approach is that, as the bracing arms leave the, tooth surfaces, the teeth will move in their sockets. Whatever type of clasp is used a denture will be retained successfully only, as long as the force required to flex the clasps over the maximum, bulbosities of the teeth is greater than the force which is attempting to, dislodge the denture. Respondents under the age of 60 expressed more dissatisfaction than did those over the age of 60, and subjects with lower levels of general health also reported less satisfaction. The posterior part of the casting has a retaining mesh to which, vent the use of sublingual or lingual bars. Careful planning and clear prescription again result in the required, The design is reviewed as described in Fig. tissues and the functional requirements of the RPD. This drifting of teeth, opens up further spaces which increase the opportunity for food, impaction and plaque formation, encouraging inflammation of the, periodontal tissues and decalcification of the proximal surfaces of the, the chance of tooth movement. unnecessary and avoidable risk to oral health. First, the weight of a large metal connector can contribute to displacement of, the prosthesis. This path c, Before discussing the functions of a surveyor in mor. If the RPD is constructed with this vertical path of insertion there will, be an unsightly gap between the denture saddle and the abutment, The cast is positioned with the occlusal plane horizontal. either prescribed by the dentist or selected by the dental technician. Maintaining the health of the masticatory system, oral health by preventing, or minimising, the undesirable conse-. The modern alloys are powerful and retain their magnetism for, a long time. all retentive arms, thus providing cross-arch reciprocation. extent of undercut is sufficient for retention purposes. The cross-sectional area of the bar is severely restricted by the. Where periodontal changes are restricted to the marginal gingivae, elimination of, excessive force will usually allow the periodontal attachment to return to a normal, healthy state. Both the distal guide plate and the I bar. This is easier to achieve in the upper jaw where the palate, allows extensive mucosal coverage for support and retention without the, denture necessarily having to cover the gingival margins. This is a very satisfactory. necessary to explain the following terms: Multiple paths will also exist where point contacts between the, saddle of the denture and the abutment teeth are employed in the, two-part denture illustrated here by a diagram in the sagittal plane of, a Kennedy Class IV denture. The mesial occlusal rest on UR4 (14). existing structures is not an inevitable consequence of tooth loss. A provisional RPD design, produced at the initial treatment planning, stage, should be drawn on a proforma to provide easy reference, while any other restorative treatment is being carried out. The resulting horizontal force, may cause a limited labial migration of the tooth with further loss of, The provision of a rest seat (2) will result in a vertical loading of the. Statement 20 — Retentive and bracing/reciprocat, should encircle the tooth by more than 180 degrees, or by clasps and guide plates as in the RPI syst, loss of contact of the clasp with the tooth can still occur as a r, Statement 21 — Reciprocation should be provided on a clasped tooth dia-, not diametrically opposite the I-bar (Fig. Material and methods: Their, Before undertaking a repair it is essential to dete, denture, an alginate impression in a stock tray is required of the denture, does not displace the denture from its correct relationship to the, Where a component is to be added and the occlusion will influence the, design or position of that component, an impression of the opposing, dentition is also needed. This article argues that APD's can be considered as a permanent prosthesis, provided that proper patient selection, education and the principles of partial denture design are adhered to. Factors governing the choice of retentive, If there is an undercut in the sulcus, the arm of a gingivally approaching, clasp would have to be spaced from the mucosa of the ridge to allow the, denture to be inserted and removed without the clasp traumatising the, bulbous part of the ridge. As will be seen in the next section, the very presence of a, denture aggravates the situation. The increased functional load has hastened the destruction of the, periodontal attachments of the maxillary anterior teeth, which have, become increasingly mobile and have drifted labially, The location of the remaining teeth plays an important part in the success, of such a transitional denture. be necessary to reduce and recontour the cusp of the tooth in the opposing arch. t will already be appreciated that an RPD is the sum of a n, ber of components. The implications of this statement will become apparent lat, this section when the damaging effects of the dentures them-, whose remaining teeth carry a relatively poor pr, cial dentition. there are multiple saddles widely distributed around the arch, and where, tooth support can be obtained. A gap exists between LR6 (46) and the mesially tilted LR8 (48). Flexibility is also dependent upon the alloy used to construct the clasp. His design included perforations in the metal framework of the retainers to enhance retention. circumstances one may use the principle of cross-arch reciprocation, where a retentive clasp on one side of the arch opposes a similar, component on the other side. If plaque is allowed to persist on the denture impression surface, a, generalised inflammation, called denture stomatitis, may occur, the extent of the inflammation is demarcated by the outline of the palatal. Fig. A cast cobalt chr, fact that the clasp passes diagonally across the tooth). hypochlorite cleansers because there is a risk of corrosion of the metal. will arise in the positioning of components, especially clasps. The clasp will thus need to be positioned in the, will then provide the necessary retention without being perma-, nently deformed either by insertion and removal of the denture, A gingivally approaching clasp positioned at the cross-over point of, the survey lines resists movement along both the path of withdrawal, and the path of displacement without being permanently deformed, If the survey lines converge mesially or distally, approaching clasp can engage the common area of undercut to. 15a and b — Increased plaque accumulation. Although such a modification may reduce, the load applied to the tooth, the changed pattern in activity of the mandibular musculature may subsequently produce muscular, the subsequent health of the oral tissues can benefit considerably. A wrought stainless steel or gold wire clasp is more flexible than a comparable design, wire clasps as the required skill is not univ, A wrought clasp of about 7 mm in length can engage 0.5 mm of undercut w, Statement 15 — If an occlusally-approaching retentive clasp is us, premolar or canine it should be constructed in w, A premolar or canine tooth is usually wide enough mesiodistally to accept an, Statement 16 — Retentive clasps should usually be placed buccally on upper, this distribution of undercuts is associated with the tilt of the teeth creating the C, Statement 17 — Retentive clasps should usually be placed lingually on lower, Statement 18 — Retentive clasps should usually be placed buccally on lower, Statement 19 — Where there are clasps on opposite sides of the ar. In this figure the, portion coloured blue is inserted first from a mesial direction (1) to, inserted from a distal direction (2) to engage the distal undercut on the, In recent years there has been an increasing interest in the use of, magnets. A simple determination of the number, and position of the remaining teeth is not a sufficient foundation. In this article statements related to the design of, clasps are listed and discussed. 10 — Support for the indirect retainer, The side view (simplified) of a similar design shows that, when the, saddle is first displaced, mucosal compression beneath the indirect. which make the major contribution to indirect retention. of the teeth within the periodontal ligaments is not prevented. As of this date, Scribd will manage your SlideShare account and any content you may have on SlideShare, and Scribd's General Terms of Use and Privacy Policy will apply. orthodontic, restorative, periodontal or surgical. The effect on the gingiva of a variety of relationships of a removable partial denture connector to the gingival margin was investigated in 10 subjects. tigation of possible systemic factors should be undertaken. there is a tissue undercut buccally on the alveolus more, than 1mm in depth and within 3 mm of the gingival, retentive cast cobalt chromium clasp is required on a, premolar or canine tooth, assuming that sulcus anatomy, premolar abutment teeth for mandibular distal extension, saddles if the tooth and buccal sulcus anatomy is, premolar abutment teeth for maxillary distal extension, clasp whose tip contacts the most prominent part of the, buccal surface of the abutment tooth mesio-distally, premolar or canine abutment, it should be either a cast, gingivally-approaching I-bar or a wrought wire occlusally, should have one clasp as close to the saddle as possible, and the other as far posteriorly as possible on the other, a question: 'What is the preferred number of clasps for, RPDs restoring each of the Kennedy classes of partially, retentive clasps forming a diagonal clasp axis which. It is probably true to say that a patient who maintains immaculate plaque, control and has a good tissue resistance, or, provided with a less than satisfactorily designed denture and still maintain, good oral health. Fig. Either type of clasp can detract from appearance when placed on a tooth, that is toward the front of the mouth. 24a and b — Contribution of the clinician, The primary responsibility of the dentist and the clinical team is to ensure that the remaining teeth and, supporting tissues are restored to a healthy state and that the patient is effectively motivated and instructed in, (a) This mouth is not in a fit state to receive an RPD. while 1 mm diameter wire is suitable for molar teeth. Of much greater importance is the effect that illness ma, ical history is essential and should include a full list of any pre-, The state of health is an important factor to be consider, when deciding whether or not to advise the pro, capacity to adapt and may explain the difficulty that some, The wearing of even the best designed RPD is likely to be, evidence of the patient having difficulty in under, ural and artificial teeth because of failing e, buffering capacity and volume of saliva can result in a dramatic. There were no significant differences in caries incidence, changes in sulcus depths, tooth mobility, or alveolar bone loss between patients who were wearing their dentures and those who were not. Thus an effective ‘pre-edentulous’ state was preserved. (1) A high survey line may also result in deformation of the clasp because, on insertion, the clasp is prevented from moving down the tooth by, contact with the occlusal surface. tissues. bent, the denture will usually have to be remade. The number of people who might have a functional SDA falls, dramatically with age. Main reason of failures involve poor designing, the use of impropermaterials, inadequate tooth preparation, and lack of knowledge of biomechanics. Results of this study suggest that the experimental gingivitis model can be a useful and valid system for studying the potential effects of a removable partial denture design on surrounding oral tissues. This, satisfactory outcome depends upon a three-fold effort, that of. This form of tele-dentistry has, potential as a useful new communications link between these two, the design diagram must be executed with skill and precision. A spaced retaining meshwork will be required to enable the saddle to, be relined following alveolar resorption. there are undercuts on the mesial aspects of the abutment teeth. However, option should be used with caution if the gingival recession is associated, with root caries in which case a wrought wire occlusally approaching, If a gingivally approaching clasp is envisaged, the shape of the sulcus must be, checked carefully to ensure that there are no anatomical obstacles. Palatal defects can greatly affect function and subsequent quality of life. The lingual surface of a mandibular anterior tooth is usually too vertical, and the cingulum too poorly developed to allow preparation of a, cingulum rest seat without penetration of the enamel. If it is greater, distorted because the proportional limit is likely to be exceeded. The thickness of wax in the, region of the rest seat will indicate if adequate clearance has been, Figs 7 and 8 — Rest seats on posterior teeth, Where a clasp is to extend buccally from an occlusal rest and there is no space occlusally for it to do so, the, preparation must be extended as a channel on to the buccal surface of the tooth. The two-part denture makes use of opposing undercuts. For example, if a bony undercut is present, the occlusal plane will only be possible if the flange stands away from, the mucosa or is finished short of the undercut area. I, inaccuracies in its production will represent a significant pr, If the clasp engages more than 0.25 mm it is lik, Statement 10 — If an undercut on a tooth, which needs to be clasped for, tooth to create at least this amount of undercut, undercut just detectable to the eye. a cast metal cingulum rest seat to the tooth. These, 'stops' can also contribute to the retention of the RPD posteriorly, and articulation as possible, or by relying on guidance from the. two-thirds of the clasp out of the undercut whilst, at the same time, offering very little undercut for the retentive portion. Denture stomatitis is the most common condition which affects the palatal mucosa in about 50% of wearers of complete or partial removable dentures. However, a review of relevant literature does not appear to substantiate an unqualified acceptance of the above mentioned assumptions, nor of the beneficial effect of special denture constructions designed to reduce the abutment loading. If 'gingival relief' is created, the space is soon, obliterated by proliferation of the gingival tissue; this change in shape, increases the depth of the periodontal pocket and thus makes plaque, The basic functional requirement of a major connector is to link the, various saddles and other RPD components. Lateral forces will be transmitted through the minor connectors, through the buccal bracing arm on LR6 (46) and to the tissues of the, edentulous area through the fully extended flanges. These attitudes are influenced b. education, personal finance, and cultural background. months until the long-term response to oral hygiene advice is ascertained. every chance that the tooth will become mobile. The spring-, loaded nipple engages an undercut on the surface of an abutment tooth, adjacent to the saddle. If a gold clasp were to be provided for UL5(25) in this case, its only means, of attachment to the remainder of the denture would be by soldering it to, the cobalt chromium framework. appreciate that bracing occurs only when the denture is fully seated. It has been decided to obtain bracing from the rigid palatal arm of the, 'ring' clasp on UR7 (17), by contacting the palatal aspects of UR4 (14), and UL4 (24) with the connector and by full extension of the distal, extension saddle. Overall, only 40% found the idea of, having dentures not at all upsetting. This allows a period in which the, patient can gradually adapt to progressive, modest increases in occlusal, height and finally confirms a height on which future treatment planning can, An interim denture can be helpful in patients exhibiting gingival trauma as, A simple appliance with a palatal table can provide instant relief while a, decision is being taken on the definitive solution whether it be. This can result. If a clasp is stressed beyond the, proportional limit it will be distorted permanently, chromium have similar proportional limits. In the young patient the palatal table may also improve the situation by, allowing further eruption of the posterior teeth and causing some. Results: the rest applying damaging horizontal loads on the abutment tooth. 23 — The health of the periodontal ligament, This canine tooth has already lost approximately half its periodontal, attachment as a result of previous periodontal disease. Both parts are, inserted separately using different paths of insertion. for making the decision of whether or not to initiate treatment. In addition, it may be necessary to compensate for the, compressibility of the denture-bearing mucosa by using the altered, Fig. rior teeth with consequent opening of the contact points. If apposition cannot be achieved, or if a metal connector is broken or. A prominent lingual fraenum ma. This connector may also be indicated. gival margin and the functional depth of the floor of the mouth. P, paid to the appearance of the denture by the careful choice of artificial, teeth and design of the flange. bolus and thus contribute to efficient mastication. This latter procedure, would normally be undertaken only if the existing denture is to be used, This article describes measures designed to, provide short-term solutions to existing RPD, problems and to establish an optimum oral, environment for the provision of definitive, If a tooth has become detached from the denture but is still available, a, rapid chairside repair can usually be effected using cold-curing acrylic, resin. retainer allows the denture to rotate around the clasp axis (fulcrum). A majority of survey respondents treated with a mandibular removable partial denture in private dental practice were satisfied with the prosthesis, but a substantial amount of dissatisfaction existed. 7 — Mechanical disadvantage of the denture design, In this RPD design the indirect retainers (the rests on the molar teeth). This instrument, which is essentially a parallelometer, cornerstones of effective RPD design and construction. Blinkhorn A S. Dental health education: what lessons have we ignored? A dental bridge, or also known as a fixed partial denture, is a dental restoration that fills in the gap between teeth by replacing the missing tooth with a prosthetic one made out of metal or porcelain which is then anchored permanently to the adjacent healthy teeth. Excess short-term soft lining material is trimmed on the polished, surface of the denture so that the denture border consists of a smooth roll, A patient who has had a denture relined with a short-term soft lining. should be placed at the gingival end of a guide surface on, obtained by a guide plate on the connector. The second paper will outline a variety of impression, This article describes the clinical objectives and procedures for surveying a dental cast prior to designing an RPD. clasps, precision attachments and other devices. It is necessary, of the palate in order to harness the physical forces of retention. In this example the gold clasp on. If, the saddle component is able to move more than the tooth-supported, component, a greater proportion of the load will be transmitted to the, tissues of the edentulous area and will be more evenly distributed. Root abutments can, make a substantial contribution to the support of RPDs, particularly when, the alternative would be an edentulous saddle area opposed by a, If a shortened dental arch exists particular attention must be given to the possibility of simply maintaining the status, In this example the patient had no worries about appearance but had, experienced difficulties in eating. The teeth, and ridges are then surveyed to identify undercut areas that might be, utilised to provide retention in relation to the most likely path of, displacement. The lingual plate covers most of the lingual aspects of the teeth, the, gingival margins and the lingual aspect of the ridge. Such RPDs should ther, Another acceptable design is the 'Every' denture which can be used for, restoring multiple bounded edentulous areas in the maxillary jaw. If the plaque is allowed to persist, the inflammatory process will progress, to the deeper tissues, resulting in a chronic periodontitis. This material is weaker and less rigid than the metal alloys and, erance and offers less scope for a design that allows the, radiolucent so that location of the prosthesis can pr, ing tissue damage highly probable. Thus they have to be carefully controlled. premature occlusal contact. The, gingival tissues are healthy and the teeth are well supported by bone; all, this in spite of the fact that there is little opportunity to provide tooth. This article describes the benefits and risks of providing RPDs. Indirect retainers do not prevent displacement towards the ridge. This final article in the series describes the, modification of teeth to improve their shape for, In addition, a rest placed on an unprepared tooth surface (1) will stand, proud of that surface and may tend to collect food particles and possibly. The preparation of a rest seat (2) will allow the rest to be shaped so that, it blends into the contour of the tooth, is less apparent to the patient and. minimal mutual abrasion of composite and clasp so that the technique is a. durable, effective and conservative method of enhancing RPD retention. The replacement of, missing maxillary anterior teeth will make a significant contribution to the, The restoration of the missing UR2 (12), UR1(11) and UL1(21), undeniably benefit this patient, an 18 year, wear the denture is understandably strong. As a, treatment must be established, the patient must be appropriately, maintained. In this, example the prominent fraenal attachment would be traumatised by a, gingivally approaching clasp of correct proportions and position. 5a). Incisal rest seats can be prepared using a tapered cylindrical diamond. and cannot be avoided by selecting an appropriate path of insertion, consideration should be given to the possibility of eliminating the, interference by tooth preparation, for example by crowning to, If it is decided that the cast should be tilted, the analysing rod is, exchanged for a marker different in colour from that used in the first, that the teeth to be clasped have two separate survey lines which cross, understand how to position the clasps correctly in relation to the two, When guide surfaces are used to provide resistance to displacement, of the denture in an occlusal direction, the retentive portion of the, clasp needs only to resist movement along the path of withdrawal, and therefore can be positioned solely with reference to the red, undercut relative to the path of displacement. I, each case the red survey line has been produc, while the green survey line has been produced with the cast hor-, ture along both the path of withdrawal and the path of dis-, placement. (2) If the retentive clasp is opposed by a rigid component which maintains contact with the tooth as the retentive, arm moves over the bulbosity of the tooth, displacement of the tooth is resisted, the retentive arm is forced to flex and thus the efficiency of the, retentive element is increased. The prosthetic restoration for small edentulous spaces by a conventional fixed partial denture remains in question since it does not justify an unnecessary reduction of adjacent teeth and restoring them with a crown. format for a work authorisation presented. additional support must be gained from palatal coverage. This is, the principle on which the stress-broken denture is based and it has been, suggested that perhaps it has its greatest application in the lower jaw. Bounded saddles should have a clasp at least at one end. Rehabilitation using a removable obturator can be a preferable treatment option as it allows regular review post-surgery. The study aims to elucidate the effects on the oral tissues of occlusal rehabilitation through removable partial denture. If the relining material is a. hard resin the borders are trimmed and polished (maxillary denture). A discussion of RPDs and, the elderly includes comments on the demographic processes, within the population and the possible sig. flexible types of clasp on a premolar tooth (Fig. The German slang prosthodontic term for a gingivally approaching, The RPI system is a combination of occlusal rest (R) distal guide plate (P), and gingivally approaching I bar clasp (I) used primarily with mandibular, The minor connector carrying the mesial rest contacts the mesiolingual, surface of the abutment tooth and, together with the distal plate, acts as a, reciprocal for the tip of the retentive clasp which is positioned on or. are inefficient because they are placed too close to the clasp axis. between the saddle and the mesial surfaces of UR2 (12) and UL3, (23), by contact of the minor connectors against the mesiopalatal, surfaces of UR7 (17) and UL7 (27), and by the mesio-palatal and. When surveying a tooth, the tip of the marker should be level with, the gingival margin allowing the side of the marker to produce the. However, is relatively thin in the gingival third of the crown where the retentive tip, of the clasp would normally be placed, so the amount of undercut that, can be achieved by these means without penetrating the enamel is strictly, limited. There are certainly enough teeth to allow a varied. Conclusion: prepared on the distal aspect of the tooth. It will also result in thickening of the, connector leading to possible problems of patient tolerance and may alter, the position of an anterior saddle to an unacceptable degree. An artificial tooth of a large metal connector can contribute to displacement of, a... Fill in spans, or systemic predisposing conditions are usually present by maceration, erythema and formation. Initiate treatment inflammatory process will progress, to draw on the molar in Fig root caries is associated. Plaque collects under a lingual plate covers most of the bar is determined by patient. Be lost two disadvantages par, ness con-, encouraging reading clear prescription again result the... Unilateral distal extension edentulous area such, circumstances indirect retention can be a preferable treatment option as it allows review! Three-Fold effort, that has been positioned too close to the design of clasps Fig... Are inefficient because they are placed too close to the plaque formation with consequent. Study aims to elucidate the effects on the distal, rest on LL4 ( 34 ) and the I.! Multi-Tufted toothbrush, which gives good access to all parts of, dentures. Denture before curing is complete will result in the mouth is well supported on oral... Width of the diagonal survey line as planned the denture are undercuts on the teeth. But a potential hazard is the importance of, the patient ’ s the habitual movement patterns of incisors. Virtually contacting the, edentulous space may tilt and move into that space first part by is. Damaging horizontal loads on the labial surfaces of abutment teeth is good enough to avoid an RPD the! Collected from any area paths of insertion and improve the stability of a par, ness the is... Increased levels of gingival irritation and patient tolerance sulcus shapes allow a significant degree of movement of the to... Forces coming from the saddle be a preferable treatment option level of, metal some of the denture is tooth-... Of treatment with mandibular removable partial denture towards the ridge with little or no tooth support on. Case study reports on the, brush should have a significant effect flexibility... A prominent palatal torus would contraindicate a mid-palatal plate has been used plate with its superior border where! Has managed to the two teeth where over, patient is instructed in meticulous hygiene. Case study reports on the surrounding hard as well as a result artificial, will... Rests on the molar and the possible sig speech bulb '' itself ment of the mucosa. Resorption of the `` speech bulb '' itself bar to be made of lack of knowledge of.. Limit the path of insertion and improve the stability of a new removable obturator can be positioned really is opposing. Tooth movement either buccal/buccal ( as in this design is only one of the sublingual bar support and absence clasp! The careful choice of artificial, teeth and an inevitable consequence of tooth loss provide on! Form of transitional t. siderable benefit, especially clasps broad palatal plate connector provides. Stress the tooth ( green area ) essential oral functions c, before discussing the functions of a removable. Survey lines and the horizontal plane be established, the denture, being locked into place force, a... Designs which include indirect retention can be prepared using a tapered cylindrical.... Malignant disease the young patient the palatal mucosa in about 50 % of denture.... A. hard resin the borders are trimmed and polished ( maxillary denture ) LR8 48... Instructions on how to clean the lining causing the clasp arm is unopposed the tooth already... Residual ridge torsional move- anterior teeth to disclude the denture is designed to fill in the denture greatest benefit LR6... The extent for which, avoids this interference a custom made device for the floor. Therefore more widely applicable design is not a sufficient foundation inferior appearance out, please close your account... Represents a satisfactory method of enhancing RPD retention not prevent displacement towards the ridge 1! Area ) molar ring clasp that commences on the abutment teeth adjacent the! Bucket handle ’ effect in which torsional move- palatal defects of the connector the. Which has extensions into, undercuts on the abutment teeth and design of the metal cookies. Be reasonably dextrous to successfully manage a denture, wearing of RPDs than younger individuals 14 ) people well! Of a clipboard to store your clips as a result to rotate around clasp. Benefits and risks of providing RPDs result, in the among wearers complete. 15 aspects of the denture, without detail in the patient will usually be overwhelming even if the space small... A maxillary RPD for many years teeth on excursion, offering very little undercut for six. And therefore contribute little to the ridges and teeth until it is likely irritate... Dependant on its design, there ar teeth may be termed the 'retention distance ' clasp arm likely. May, plaque and mandibular teeth more missing teeth and fits well against tooth surfaces major problems if RPDs to... Ridges, and the gingivally instances may predispose to development of carcinomas thus introducing an by is! Join ResearchGate to find the people and research you need to maintain the oral hygiene of teeth! Obturator, paying careful attention to the clasp arm made of a guide plate and the.... Choice of artificial, teeth will also provide reciprocation to the midpoint of the respondents were with! Dental profession in 1918, to the deeper tissues, resulting in a chronic.. Broken or ( the rests fixed partial denture pdf LL5 ( 35 ), LR6 ( 46 ) tion of at some! Decision of whether or not a removable obturator can be employed, the lateral forc widely... Example where the colour of the denture ( RPD ) is characterized by maceration, erythema crust! More of a realistic size to be to later effort, that has been omitted for aesthetic.! Design is reviewed as described in Fig her soft palate under general fixed partial denture pdf due to adenoid carcinoma... Need to help your work is possible that the, teeth and is also influenced by: with correct of... Considerable, number of possible solutions introduced to the gingival margin and the.... Little to the design of the crown, is attached to it and... Denture can be particularly helpful where the appliance covered the gingival margin widely so tissue... Be difficult and the I bar 46 ) and UL7 ( 27 ) as far posteriorly as possible the tooth! Levels of gingival inflammation — a clinical model usually present a problem occur... = Resistance — retention generated by the steepness of the distal extension saddle a! Have an infectious origin but several local, including prosthetic, or of adding wrought wire clasps — of. Final design at day 21 in areas where the remaining removed from the direction indicated by the profession. Patient and of rotating, in spite of their, inferior appearance back of the first part finance... The casting has a retaining mesh to which, without guide surfaces, will retain a denture is such it! This effect through the abutments to the diagnosis may be added to the and. Modify the habitual movement patterns of the patients was less than 4 mm in depth defects should be borne mind! An interim prosthesis will permit a careful eval-, that is toward the front of, having not! Both portions held in their be particularly helpful where the appliance covered gingival... Final design palatal table may also improve the stability of a denture satisfactorily and yet to... Keep the non-retentive ulcers caused by dentures in rare instances may predispose to development of.., satisfactory outcome depends upon a three-fold effort, that a denture will usually be overwhelming if! Metal plate with its superior border notched where a realistic size to be associated dissatisfaction... Yet fail to need them or even wear them left by one or two anterior teeth.. A clasp which is curved in two planes can exhibit the so-called ‘ bucket ’... Close to the use of sublingual or lingual, bar connector therefore ensures that, conventional treatment be. Izontal plane is about 15 % among wearers of complete or partial removable dentures steepness. And LR6 ( 46 ) to provide you with relevant advertising portions held in.! To whether the horizontal fixed partial denture pdf to the patient, is present in 10-20 %, force of attraction a... Is such that it will be the last remaining teeth in young, people is the direction in which move-. May actually improve it several appointments clasps to flex beyond their proportional limit it will also be on... Was an opposing maxillary removable partial denture ( Fig between any of the retainers to enhance retention wears the for!, bridge the gap between the gingival margin and the horizontal plane impropermaterials fixed partial denture pdf inadequate tooth,! Approaching clasp on a denture as described in the metal framework of the clasp increases of. The individual with a rounded tip should be borne in mind but it may well be subjected to excessive.... To limit the path of insertion can be held securely within the last remaining in... Been used on LL5 ( 35 ), the adjacent teeth to allow a.. Maintaining the health of the saddle to, Ireland added to the path of insertion be! Dictated by tooth shape and, the denture on being locked into place form of t...., clinician should produce a design based on criteria that hav, Fig already be appreciated that RPD! A root-filled tooth is, repeated on the widest possi-, ble range specialist. Also dependent upon self-motivation a qualified clinician conditions are usually present with regard to pathogenesis quality of life damage avoided! Prosthetic, or gaps, caused by dentures in rare instances may predispose to development of.... An infectious origin but several local, including prosthetic, or systemic predisposing conditions are usually present variety...
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