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A technique has been described for the fabrication of full coverage restorations for existing removable partial dentures. This method requires that the patient be deprived of the removable prosthesis during the fabrication of the fixed replacement unit. Clearly, this may not always be possible or desirable, however, when it is possible, the end result outweighs the inconvenience to the patient.
An in vitro study was performed to measure the influence of a simulated obturator on the amount of force required to dislodge a simulated unilateral removable partial denture with various clasp designs. The presence of an obturator reduces the retentive capability of a removable partial denture. Lingual retention appeared to provide more resistance to displacement than buccal retention. Infrabulge clasp designs appeared to be more retentive than suprabulge clasp designs.
Base metal alloys have been used for over 60 years to cast removable partial denture frameworks. Among other elements, these alloys principally contain nickel, chromium and cobalt, and may be divided into the nickel-containing and nickel-free alloys. Because of the potential biocompatibility hazard created by these and other elements found in the alloys, this group of materials has come under ever increasing scrutiny in the literature. This paper reviews pertinent literature and reports on the findings of a survey on the base metal alloys used in Alberta for the casting of removable partial denture frameworks.
Details are presented of the reaction of multiple prosthetic experts in 17 dental schools in the U.K. to 125 design rules for removable partial dentures. Those rules receiving support from 50% of the schools are candidates for inclusion in RaPiD, a knowledge-based assistant for the design of removable partial dentures.
In several clinical studies on removable partial dentures (RPDS), great attention was paid to the occurrence of reactions in periodontal tissue. In this article on causes of periodontal breakdown related to RPDS, the three main factors discussed were: 1) plaque and oral hygiene 2) coverage of the marginal gingival by parts of an RPD 3) occlusal forces that are transmitted to the remaining teeth and their periodontal tissues by the prosthesis.
One hundred forty-six patients, living in the community and attending a general dental practice, were examined on two occasions separated by 3 years to determine relationships among removable partial dentures, their design, and gingival recession. This study confirmed the relationship between the presence of a partial denture and an increase of gingival recession, but was unable to demonstrate any predictable relationship to the lack of tooth support, the material used for the dentures, or covering the gingival margins with lingual plates. These design factors may be less important than the maintenance of good oral hygiene for the prevention of periodontal disease in patients wearing removable partial dentures.
This study is a clinical survey of cobalt-chromium (Co-Cr) removable partial denture (RPD) wearers that aimed to investigate the effects of denture wearing on oral tissues. A random sample of patients who had received their dentures 5-6 years previously from a dental teaching hospital in Hong Kong was selected. Those who had been constantly wearing the RPDs were examined by one calibrated examiner under an optimal clinical setting. The patients' dental, periodontal and mucosal status were assessed. A total of 87 patients were examined. Mucosal lesions under the Co-Cr RPDs were uncommon in this study sample. However, there was a high prevalence of plaque, gingivitis and gingival recession, especially in dento-gingival surfaces in close proximity (within 3 mm) to the dentures. Thus, there is a special need for regular oral hygiene reinforcement, scaling and prophylaxis among RPD wearers. Despite a low caries incidence in the study sample, root caries were found to be associated with contact with the RPDs (P < 0.05) but coronal caries were not. It is recommended that coverage of the exposed root surfaces by RPD components should be avoided. Also, topical fluorides should be regularly applied onto exposed root surfaces as a preventive measure.
The (1) tooth-supported, (2) ridge-supported, and (3) tooth- and ridge-supported variations of the disjunct removable partial denture were studied. When testing loads were applied to three sites, bilaterally and unilaterally, it was found that the stresses were highest when the removable partial framework was tooth-support. No significant difference was recorded between the ridge-supported partial denture and the tooth- and ridge-supported partial framework. Further refinement of the pinsleeve mechanism may be necessary to effect better control over the distributions of the stresses.
This study photoelastically compared the stress distribution characteristics of two maxillary bilateral distal-extension removable partial denture designs, one using I-bar retention and the other using a semiprecision spring-loaded plunger attachment. Each prosthesis was subjected to vertical and horizontal extension-base loads. Comparisons were made from photographic recordings of isochromatic fringe distributions. The two retention designs produced comparable stresses with splinting of abutments for the plunger attachment. The attachment-retained prosthesis proved less stable with some loadings. Stress patterns followed three trajectories in the maxilla. A basis for stress distribution comparisons to other maxillary removable partial denture attachments is established.
The background, rationale, and technique for fabricating the remodified Hart-Dunn attachment system have been presented. This subpontic attachment is a product of clinical experience in managing the unilateral distal extension removable partial denture patient. Minimal retention, reduced torque throughout the arch during function, and distribution of force according to sound mechanical principles make this remodified subpontic attachment the preferred method of treating most unilateral distal extension removable partial denture patients.
The destruction of the crown underlying a partial denture can render useless an otherwise acceptable prosthesis unless some means can be found for building up the tooth under the prosthesis. The aim of this article is to introduce a technique in which light-curing glass-ionomer resin cement is utilized for the direct restoration of removable partial denture abutments. The cavity preparation is completed in the customary manner. The cement is applied en masse and covered with a suitable translucent separating sheet. The denture is reinserted and the restoration is light cured from the perimeter of the abutment. The denture is removed, and, with the aid of a suitable disclosing medium, the restoration is trimmed carefully to avoid reducing the intimate adaptation between the restoration and the removable partial denture. The technique is offered with full acknowledgement that it is a compromised treatment option.
A procedure is described for conversion of an existing removable partial denture into a complete denture using autopolymerizing tooth-colored acrylic resin, acrylic resin denture repair material, and a clear matrix template. The shape, color, and position of the lost natural teeth may be duplicated in the transitional denture, minimizing the psychological concerns of the patient regarding esthetics and social impact. Because the patient is never without teeth, an appropriate healing time can occur before fabrication of the definitive prosthesis.
The treatment of a patient with a major defect in the anterior region of the mandible is described. A large part of the anterior dental arch and underlying mandibular bone was involved in the defect. A removable partial denture supported by implants as well as residual teeth was used to restore the defect. Compared with a traditional removable partial denture, which was used by the patient for several years as an interim prosthesis, the application of implants resulted in improved functional comfort and stability.
Reduced interarch distance, resulted from extrusion of antagonist teeth and/or down growth of alveolar bone due to long-time absence of natural teeth without adequate restoration in this area, is found in many cases. In such condition, it is difficult to fabricate a distal free-end removable partial denture with conventional resin base because of insufficient space for denture base resin, metal framework and artificial teeth, and the long-term prognosis of the denture is questionable due to minimized strength of the denture base. In this article, the authors demonstrate the clinical and laboratory methods and procedures for distal extension removable partial denture construction in reduced interach distance condition. Partial metal base in the insufficient vertical space area of the ordinary denture base is altered, the metal occlusal scheme and buccal resin facing are designed, instead of resin denture teeth. These designs provide strength, esthetic and masticatory function to the denture, and the denture base is convenient for future denture repair or relining.
A cast connector is a solderless union between two metal components, an alternative to soldering. Cast connectors depend upon mechanical retention for their strength and integrity and are mostly used in repairing or adding to prostheses cast in base metal alloys. Two techniques using cast connectors are described. One is for a removable partial denture that requires the replacement of an anterior tooth or teeth incorporating diastemas or unusual surface anatomy and color variations. Stock denture teeth may not adequately replicate such teeth. A solution to the problem is to extend a porcelain-compatible base metal cast connector from the removable partial denture framework onto the pontic site. A ceramometal pontic reproducing the unusual characteristics of the natural teeth may then be placed by vacuum-firing porcelain directly onto the framework. A second technique is described whereby multiple ceramometal anterior crowns may be splinted together by creating interproximal retentive zones in the frameworks, casting connectors into the retentive zones, and proceeding with porcelain application.
The purpose of this study was to compare prosthetic, functional and occlusal conditions in twenty-seven patients treated with distally extending cantilever bridges and twenty-six patients treated with removable partial dentures (RPD) in the mandible. All patients had a complete upper denture. Mean age of the patients in both groups was about 69 years. The patients were under a supervised oral hygiene care throughout the 2-year study period. There were 6.9 +/- 1.7 mandibular teeth left in the bridge group and 7.5 +/- 1.7 in the RPD group and the mean number of posterior teeth (natural teeth/denture teeth/pontics) in occlusion was 4.1 +/- 1.1 and 7.3 +/- 1.4, respectively. During the study period signs and symptoms of mandibular dysfunction became significantly aggravated in the RPD group, P less than 0.05. A balanced occlusion in the muscular contact position was observed in 90% of the patients in the bridge group and in 76% of the RPD wearers. During the study period the need for dental or prosthetic treatment was negligible in the patients treated with bridges. In the RPD group, twenty-two teeth were restored with fillings due to caries and in eight patients major adjustments of the sublingual bar were necessary due to irritation of the oral mucosa. This study has shown that treatment with distally extending cantilever bridges in the mandible is a favourable alternative to treatment with removable partial dentures in elderly patients with a reduced dentition.
Although computer-aided design and manufacture techniques have shown some promising applications in the fabrication of crowns, inlays, and maxillofacial and oral surgery, the field of removable prosthodontics has not embraced these technologies so far. This article describes the development and investigation of computer-aided techniques that may eventually enable prosthodontic procedures such as surveying and the production of sacrificial patterns to be performed digitally. A 3-dimensional computer model of a conventional cast from a patient was obtained using an optical surface capture device (a scanner). The shape of a number of components of a removable partial denture framework was modeled on the 3-dimensional scan electronically, using computer-aided design software. A physical plastic shape of the components was produced using a Rapid Prototyping machine and used as a sacrificial pattern. Techniques to allow digital cast surveying before the production of sacrificial patterns were also developed. The results show that digital dental surveying and machine-produced sacrificial patterns can be accomplished. This article forms a basis for further developments leading to a fully integrated approach to the computer-aided design and fabrication of removable partial denture frameworks.
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