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A Quickie Breakdown of Partial Dentures: Adam Kirkpatrick & Ulf Temnitzer

The document provides a quick overview of the components and design process for partial dentures. Partial dentures are used when some teeth are missing but others remain stable. There are different types of clasps and connectors used depending on factors like whether the partial is tooth-borne or tissue-borne. The main components include clasps, rests, connectors, and acrylic. The design process involves analyzing tooth and tissue undercuts, surveying those features, and determining the appropriate clasps, rests, and connectors based on the classifications and modifications needed.

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0% found this document useful (0 votes)
73 views11 pages

A Quickie Breakdown of Partial Dentures: Adam Kirkpatrick & Ulf Temnitzer

The document provides a quick overview of the components and design process for partial dentures. Partial dentures are used when some teeth are missing but others remain stable. There are different types of clasps and connectors used depending on factors like whether the partial is tooth-borne or tissue-borne. The main components include clasps, rests, connectors, and acrylic. The design process involves analyzing tooth and tissue undercuts, surveying those features, and determining the appropriate clasps, rests, and connectors based on the classifications and modifications needed.

Uploaded by

Naresh Teres
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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A Quickie Breakdown of Partial Dentures

Adam Kirkpatrick & Ulf Temnitzer Making partials can be pretty overwhelming at first, but it is actually pretty easy once you get the basics down. In light of that, I have made this quickie breakdown so that you have an idea of whats going on before you have to start memorizing the nitty gritty details. Also, this is a good refresher for those of us who have gone through the class and have forgotten things. Partial dentures are made for people who are missing some teeth and have some stable teeth left. Depending on the conformation of the teeth that remain, there are some different ways to make a partial more stable. There are 4 different classifications of the stability of the teeth, and they are Kennedy Class I, II, III and IV.

There are all these classifications, but you really only have to worry about whether it is tooth-borne or mucosa-borne, and if its a Kennedy Class IV, you might do a rotational path partial. This dictates what type of clasps you can use. If you have a patient that has more than one of these classifications, you go with the lowest number, and other missing areas are added as modifications. Also, there are modifications for each classification. Have a look at the picture to figure them out. Lets not get ahead of ourselves, though. Lets have a look at the different parts of a partial.

Components of a Partial 1. 2. 3. 4. 5. 6. 7. The main components of a partial are: Clasps Rests Major Connectors Minor Connectors Acrylic retention meshwork Proximal plates Indirect retainers

Clasps Lets talk about these first. There are only 3 types of clasps mainly used here at Pacific, and they are: 1. Akers 2. RPI 3. RPC Basically, you always use an Akers clasp when you have a tooth-borne situation, and you use stress releasing clasps (either an RPI or RPC) when you have a tooth-mucosa-borne situation (distal extensions). If you have to use an RPI or RPC, you would want to use the RPI if the situation qualifies. That is the basics of clasps you can learn more about them from the book.

Clasps More Info (some nitty gritty) Akers. Use this for tooth borne area. It has a rest, proximal plate, retention arm and bracing arm. The proximal plate is on the same side of the rest and sort of waterfalls off of it. The two arms come off of the proximal plate the retention arm is usually on the buccal and the bracing arm is usually on the lingual. The retention arm is the one that actually engages the undercut of the tooth and the bracing arm basically just makes sure that the tooth is hugged and doesnt become mobile. Just as a side note, you can have two Akers clasps back to back on two adjacent teeth.

Rest Proximal Plate

RPI. Use this for tooth-mucosa borne areas (i.e. distal extensions). In fact, this is the preferred one for that. It has a mesial Rest, Proximal plate and I bar (the I in RPI). The rest is always on the mesial, the I bar goes on the facial and engages the undercut (and stays below the survey line), and the proximal plate is always on the distal. The proximal plate extends from 1 mm above the survey line down to the gingiva. You cant use an RPI if anything gets in the way of the I bar (super inclined teeth, undercut in the gums less than 3mm away from the tooth). Proximal Plate I Bar

Mesi al Rest 0.010 underc ut

RPC. Use this for tooth-mucosa borne areas (i.e. distal extensions). This is what you use if you cant use an RPI (if the tooth is inclined too much or if the soft tissue undercut is less than 3 mm away from the tooth). It has a Rest, Proximal plate and Clasp (the C in RPC). Just like the RPI, the rest is always on the mesial and the proximal plate is always on the distal. The proximal plate still extends from 1 mm above the survey line down to the gingiva. Instead of the I bar, however, this has a clasp. The clasp comes off of the proximal plate and engages an undercut on the facial. Mesi al Rest 0.010 underc ut Proximal Plate

Clasp

On both of the stress releasing clasps (RPI and RPC), the proximal plate disengages the guide plane on the tooth when the denture has force exerted on it. During chewing, the denture sinks into the tissue a little and basically rotates the proximal plate out of contact into the undercut area of the abutment tooth. Rests There are only a few types of rests that we mainly use here at Pacific and they are: 1. Occlusal 2. Extended Occlusal 3. Cingulum 4. Ball Yeah, rests are pretty simple. You can put them either on the mesial or distal of teeth depending on the situation. More details below and in the book.

Rests (nitty gritty) 1. Occlusal use on posterior teeth for most situations o Need to be a minimum of 1.5 mm thick at the marginal ridge o Spoon shaped o 1/3 facio-lingual width of the tooth (or the distance between cusp tips, same thing)

2. Extended Occlusal use on posterior teeth if tooth is tipped to direct the force along the long axis

3. Cingulum use on anterior teeth o V or U shaped in cross section o Straight or inverted U shaped from the lingual

4. Ball use on anterior teeth o Rounded outline form o On mesial or distal half of tooth at junction of gingival and middle 1/3rds o May need to be filled with amalgam if penetrates into the dentin

Major Connector This is the bulk that holds the partial together and provides stability. Basically, you want to get away with covering as little gingiva as possible while still maintaining the strength because having a bulky partial sucks for patients. These are the different major connectors that we mainly use at Pacific: Maxilla o Full Palatal Plate o Modified Palatal Plate o Midpalatal Strap o Anterior Palatal Strap (Horseshoe) o A-P Strap Mandible o Lingual bar o Lingual plate

There are different reasons for using all of these different ones, and youll need to learn about those in the book. The maxillary major connectors need to be a minimum of 8 mm wide. On the mandible, you would use a lingual bar when you have 7 mm or more from the gingival margin to the base of the lingual vestibule (3 mm of space between the gingival margin and metal + 4 mm minimum width of lingual bar). If you dont have 7 mm or more, you would use a lingual plate.

Anterior Palatal Strap

Full Palatal Plate

Modified Palatal Plate

A-P Palatal Strap

Midpalatal Strap Minor Connector

Lingual Bar

Lingual Bar

Lingual Plate

Not too much to say here. It is just the part that connects the rests and stuff to the major connector. They are easy. The only thing you need to keep in mind is how far away the metal framework has to be from the gingival margin. If it is too close, you will cause plaque retention and tissue irritation. On the maxilla, you need to have a minimum of 6 mm from any metal (major or minor connectors) to the closest gingival margin. On the mandible, you need to have a minimum of 3 mm from any metal (major or minor connectors) to the closest gingival margin. Also, you need to make sure that the minor connectors are at least 5 mm away from any of the other vertical features.

Acrylic Meshwork Again, easy peezy. Just the metal meshwork that holds on the acrylic. You want about one hole in the metal for each tooth you are replacing. Have a look at the major connector pictures if you want to see what it looks like. Proximal Plates This goes along a guide plane that you prepare on the teeth with a bur. There are several guide planes made on the teeth, and they guide the partial to seat in the right place. Just like with a crown, they need to draw with each other, which I hear is pretty tough to do. The proximal plates are the metal parts of the partial that sit against the guide planes. On abutment teeth with stress releasing clasps (RPI or RPC), the proximal plate reaches only 1 mm above the survey line. Now a word about the guide planes. They are on the occlusal 1/3 of abutment teeth that are adjacent to an edentulous area (basically anywhere that the partial will slide against). They are meant to be parallel to the path of insertion of the partial so it is guided into place. Indirect Retainers You only need these with a distal extension partial. On these partials, there is a fulcrum line that exists if you draw a line between the two distal most rests. Basically, if you eat a sticky food and it tries to pull off the distal extension, the partial will fulcrum and push down in the front. The more room it has to push down in the front, the more it will lift off in the back. Make sense? In order to stabilize this, you can just put a brace anterior to the fulcrum line so that the partial doesnt have anywhere to push down in the front. That keeps it from lifting off in the back. This brace is called an indirect retainer and it is basically just a rest connected to the partial with a minor connector that keeps the distal extension of the partial seated during eating and talking. Indirect retainer resisting lift off Part of denture that lifts off

Fulcru m line

How to Analyze, Survey and Design a Partial Once you know the stuff we just discussed, this part isnt that hard. Granted, there are a million different scenarios that change what will be exactly done but if you get the basics it isnt that tough. Analyzing is the process of figuring out where the undercuts are. Surveying is the process of drawing on the cast to show where those undercuts are. Designing is the process of figuring out what exactly the partial is going to look like. There is an order you do things that makes this process easier, and it is: Analyzing and Surveying: o Path of insertion (tilt). Use the analyzing rod to find the most ideal path of insertion (must be pretty close to parallel with the floor) o Mark Teeth . Use led in the surveyersurveyor to mark the heights of contour on teeth that you are thinking about clasping so that the undercuts are visible. o Mark Tissue . Use led in the surveyersurveyor to mark the soft tissue where you think an undercut may be. o Tripod. Blue. Lock everything in position on the surveyersurveyor and scratch 3 little horizontal lines on the cast. You want these lines to be out of the way of the rest of your design if possible and as far away from each other as possible. This will allow you to put the cast and table back into the same position if you move it. Once you scratch the lines in, you mark it with a little + in blue and circle it. o Abutment Clasp Undercut Locations (.010). Blue. You use an undercut marker to mark an 0.10 undercut in the strategic areas where you will engage that undercut with a clasp. Tooth Modification o Rests. Carve out the rests to their final dimension. o Guide Planes. From line angle to line angle and all parallel to each other. They should follow the contour of the teeth. o Height of Contour. If you need to, you can modify the teeth so the clasps fit in a better location or to optimize the position of the 0.10 undercut. Design: o Rests. Red. Outline the rests on the appropriate teeth. o Guide Planes. Blue. Outline the guide planes that you carved into the teeth. o Proximal Plate. Red. For an Akers clasp, this will just come right off the occlusal rest straight down to the gingiva and extend away from the tooth 2mm. For an RPI or RPC, this will extend from halfway up the guide plane down to the gingiva and extend away from the tooth 2mm.

o Minor connector. Red. This must be at least 2mm wide and will extend down the tooth and away from the gingiva at least 6mm on the maxilla and 3mm on the mandible. o Major Connector. Red. Outline the most appropriate major connector for that patient. On the maxilla, keep in mind it needs to be at least 8mm wide and at least 6mm away from the gingiva. On the mandible, a lingual bar needs to be 4mm wide in the anterior and at least 3mm away from the gingiva. o Acrylic Retention Meshwork. Red. There needs to be 1 hole for each tooth and the metal needs to be 2mm wide. o Plastic (acrylic). Blue. It should extend into the vestibule when it is needed for retention (mucosa borne) and should only extend a little way past the metal for tooth borne situations. o Clasps. Red. Akers, RPI or RPC. See above for exact specifications. Again, here is the order of things, and youll learn more about it as you go. You will have to have an idea about your final design while youre doing the analyzing and surveying to know what you are looking for. Rotational Path Partial Denture: Certain partials can be designed so that one portion seats first and the rest is rotated into place. A straight path of insertion is not possible since the minor connectors in the edentulous area extend into the undercut. The retention mechanism is rigid and contains a rest and a minor connector.

There are three possibilities of rotation. Anteroposterior (AP): Anterior segment is seated first and the posterior segment is rotated into place Posteroanterior (PA): Posterior segment is seated first and the anterior segment is rotated into place Lateral: One side is seated first and the other side is rotated into place The rest off of the retentive minor connector (the one without a clasp) must be 1.5 to 2mm in thickness, almost parallel walled, and should be prepped perpendicular to the long axis of the tooth (see the picture above). The rest should extend more than half the mesiodistal dimension of the abutment tooth. Advantages and Disadvantages of Rotational Path Partial Denture: A rotational path partial denture minimizes the plaque accumulation by having less tooth coverage (clasps). Since anterior clasps often can be eliminated, the end product may be much more esthetic. However, the rotational path technique shows less tolerance for errors, the adjustments of the retentive components is difficult, and requires well prepared rest seats or even restorations to develop such a rest seat. Surveying and Designing Rotational Path Partials First, the model is placed in a 0 degree position where it is surveyed for undercuts and heights of contour. The model is tripodized by drawing two vertical red lines on each side of the model. Then, the undercut for the retentive minor connector (the one without a clasp) is determined to 0.020; all other clasps should be designed with a 0.010 undercut as usual. Tilt the model so that the survey rod is parallel to the undercutting surface of the abutment teeth (the ones that you will put the retentive minor connectors on). Mark two blue lines an each side of the model in order to tripodize the initial path of insertion. After you have done this, move the table back to the original position and survey and design the cast as usual.

Have fun in Removable, its your last lab class!

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