Contents

PART I:  GENERAL CONCEPTS/TREATMENT Implants as a Rest 61

PLANNING Support for Rests 61
Lingual Rests on Canines and Incisor Teeth 63
1 Partially Edentulous Epidemiology, Incisal Rests and Rest Seats 65
Physiology, and Terminology 2
Tooth Loss and Age 4 7 Direct Retainers 67
Consequences of Tooth Loss 5 Direct Retainer’s Role in Control of Prosthesis
Functional Restoration with Prostheses 5 Movement67
Current Removable Partial Denture Use 6 Basic Principles of Clasp Design 68
Need for Removable Partial Dentures 7 Types of Direct Retainers 70
Criteria for Selecting a Given Clasp Design 71
2 Considerations for Managing Partial Tooth Loss 8 Types of Clasp Assemblies 71
Managing Tooth Loss Over Time 8 Implants as Direct Retainers 81
Tooth-Supported Prostheses 9 Analysis of Tooth Contours for Retentive Clasps 83
Tooth- and Tissue-Supported Prostheses 10 Amount of Retention 84
The Phases of Partial Denture Service 12 Other Types of Retainers 89
Reasons for Failure of Clasp-Retained Partial Internal Attachments 90
Dentures14
8 Indirect Retainers 93
3 Classification of Partially Edentulous Arches 16 Role of Indirect Retainers in Control of
Requirements of an Acceptable Method of Prosthesis Movement 93
Classification17 Factors Influencing Effectiveness of Indirect
Kennedy Classification 17 Retainers96
Applegate’s Rules for Applying the Kennedy Auxiliary Functions of Indirect Retainers 96
Classification20 Forms of Indirect Retainers 96

4 Biomechanics of Removable Partial Dentures 21 9 Denture Base Considerations 99

Biomechanics and Design Solutions 21 Functions of Denture Bases in Control of
Biomechanical Considerations 22 Prosthesis Movement 99
Impact of Implants on Movements of Partial Methods of Attaching Denture Bases 102
Dentures22 Methods for Incorporating Dental Implants 103
Simple Machines 23 Ideal Denture Base Material 103
Possible Movements of Partial Dentures 24 Advantages of Metal Bases 104
Methods of Attaching Artificial Teeth 106
5 Major and Minor Connectors 29 Need for Relining 109
Role of Major Connectors in Control of Prosthesis Stress-Breakers (Stress Equalizers) 110
Movement30
Minor Connectors 45 10 Principles of Removable Partial Denture
Finishing Lines 50 Design112
Reaction of Tissue to Metallic Coverage 50 Difference in Prosthesis Support and Influence
Major Connectors in Review 52 on Design 112
Differentiation Between Two Main Types of
6 Rests and Rest Seats 56 Removable Partial Dentures 113
Role of Rests in Control of Prosthesis Movement 56 Essentials of Partial Denture Design 115
Form of the Occlusal Rest and Rest Seat 58 Components of Partial Denture Design 117
Extended Occlusal Rest 59 Implant Considerations in Design 122
Interproximal Occlusal Rest Seats 60 Examples of Systematic Approach to Design 122
Internal Occlusal Rests 61 Additional Considerations Influencing Design 125

ix
 x Contents

11 Surveying 127 Periodontal Preparation 193

Description of Dental Surveyor 128 Optimization of the Foundation for Fitting and
Purposes of the Surveyor 129 Function of the Prosthesis 200
Factors that Determine Path of Placement and
Removal133 15 Preparation of Abutment Teeth 206
Step-by-Step Procedures in Surveying a Classification of Abutment Teeth 207
Diagnostic Cast 135 Sequence of Abutment Preparations on Sound
Final Path of Placement 138 Enamel or Existing Restorations 207
Recording Relation of Cast to Surveyor 139 Abutment Preparations Using Conservative
Surveying the Master Cast 140 Restorations207
Measuring Retention 140 Abutment Preparations Using Crowns 209
Blocking out the Master Cast 141 Splinting of Abutment Teeth 213
Relieving the Master Cast 142 Use of Isolated Teeth as Abutments 214
Paralleled Blockout, Shaped Blockout, Arbitrary Missing Anterior Teeth 215
Blockout, and Relief 144 Temporary Crowns when a Removable Partial
Denture is Being Worn 216
12 Considerations for the Use of Dental Fabricating Restorations to Fit Existing Denture
Implants with Removable Partial Dentures 146 Retainers216
Physiologic Distinction Between Prostheses 147
Replacing Anatomy and Functional Ability 147 16 Impression Materials and Procedures for
Strategically Placed Implants for Removable Removable Partial Dentures 219
Partial Denture Stability and Improved Elastic Materials 219
Patient Accommodation 148 Rigid Materials 221
Movement Control With Selective Implant Thermoplastic Materials 221
Placement148 Impressions of the Partially Edentulous Arch 222
Treatment Planning 149 Individual Impression Trays 225
Clinical Examples 149
Summary149 17 Support for the Distal Extension
Acknowledgment149 Denture Base 231
Distal Extension Removable Partial Denture 232
PART II:  CLINICAL AND LABORATORY Factors Influencing the Support of a Distal
Extension Base 232
13 Diagnosis and Treatment Planning 155 Anatomic form Impression 236
Purpose and Uniqueness of Treatment 155 Methods for Obtaining Functional Support for
Patient Interview155 the Distal Extension Base 236
Shared Decision Making 156
Clinical Examination156 18 Occlusal Relationships for Removable
Objectives of Prosthodontic Treatment 156 Partial Dentures 242
Oral Examination 157 Desirable Occlusal Contact Relationships for
Diagnostic Casts 161 Removable Partial Dentures 243
Diagnostic Findings169 Methods for Establishing Occlusal Relationships 244
Interpretation of Examination Data 169 Materials for Artificial Posterior Teeth 250
Infection Control 177 Establishing Jaw Relations for a Mandibular
Differential Diagnosis: Fixed or Removable Removable Partial Denture Opposing a
Partial Dentures 178 Maxillary Complete Denture 251
Choice Between Complete Dentures and
Removable Partial Dentures 183 19 Laboratory Procedures 253
Clinical Factors Related to Metal Alloys used for Duplicating a Stone Cast 253
Removable Partial Denture Frameworks 185 Waxing the Removable Partial Denture
Summary187 Framework254
Spruing, Investing, Burnout, Casting, and
14 Preparation of the Mouth for Removable Finishing of the Removable Partial Denture
Partial Dentures 188 Framework258
Pre-Prosthetic Considerations in Partially Making Record Bases 266
Edentulous Mouths 189 Occlusion Rims 268
 Contents xi

Making a Stone Occlusal Template from a 23 Repairs and Additions to Removable

Functional Occlusal Record 270 Partial Dentures 304
Arranging Posterior Teeth to an Opposing Cast Broken Clasp Arms 304
or Template 271 Fractured Occlusal Rests 306
Types of Anterior Teeth 272 Distortion or Breakage of Other Components—
Waxing and Investing the Removable Partial Major and Minor Connectors 306
Denture Before Processing Acrylic-Resin Loss of a Tooth or Teeth not Involved in Support
Bases273 or Retention of the Restoration 307
Processing the Denture 276 Loss of an Abutment Tooth Necessitating its
Remounting and Occlusal Correction to an Replacement and Making a New Direct
Occlusal Template 279 Retainer307
Polishing the Denture 280 Other Types of Repairs 307
Repair by Soldering 307
20 Work Authorizations for Removable Partial
Dentures283 24 Interim Removable Partial Dentures 310
Work Authorization 283 Appearance310
Definitive Instructions by Work Authorizations 285 Space Maintenance 311
Legal Aspects of Work Authorizations 288 Reestablishing Occlusal Relationships 311
Delineation of Responsibilities by Work Conditioning Teeth and Residual Ridges 311
Authorizations288 Interim Restoration During Treatment 312
Conditioning the Patient for Wearing a Prosthesis 312
21 Initial Placement, Adjustment, and Clinical Procedure for Placement 313
Servicing of the Removable Partial Denture 289
Adjustments to Bearing Surfaces of Denture 25 Removable Partial Denture Considerations
Bases290 in Maxillofacial Prosthetics 315
Occlusal Interference from Denture Framework 291 Maxillofacial Prosthetics 315
Adjustment of Occlusion in Harmony with Timing of Dental and Maxillofacial Prosthetic
Natural and Artificial Dentition 291 Care for Acquired Defects 316
Instructions to the Patient 294 Intraoral Prostheses: Design Considerations 322
Follow-Up Services 296 Surgical Preservation for Prosthesis Benefit 322
Maxillary Prostheses 327
PART III:  MAINTENANCE Mandibular Prostheses 330
Jaw Relation Records for Mandibular Resection
22 Relining and Rebasing the Removable Patients336
Partial Denture 298 Summary336
Relining Tooth-Supported and Tooth Implant–
Supported Denture Bases 299 Appendix A  Glossary 337
Relining Distal Extension Denture Bases 300
Methods of Reestablishing Occlusion on a Appendix B  Selected Reading Resources 340
Relined Removable Partial Denture 301
 70 Part I  General Concepts/Treatment Planning

Support Occlusal third

Stabilization Middle third

Retention Gingival third

A Lingual

B Occlusal

Support Occlusal third

Stabilization Middle third

Retention Gingival third

C Buccal
 

Figure 7-5  A bar-type clasp on the mandibular premolar. A, Support is provided by the occlusal rest. B, Stabilization is provided by
the occlusal rest and the mesial and distal minor connectors. C, Retention is provided by the buccal I-bar. Reciprocation is obtained
through the location of the minor connectors. Engagement of more than 180 degrees of circumference of the abutment is accomplished
by proper location of components contacting the axial surfaces. (The minor connector supports the occlusal rest, the proximal plate
minor connector, and the buccal I-bar.)

fact that slippage along tooth inclines is always possible. The The intracoronal retainer may be cast or may be attached
latter may be prevented by the use of a ledge on a cast restora- totally within the restored natural contours of an abutment
tion; however, enamel surfaces are not ordinarily so prepared. tooth. It is typically composed of a prefabricated machined
key and keyway with opposing vertical parallel walls, which
serve to limit movement and resist removal of the partial
TYPES OF DIRECT RETAINERS
denture through frictional resistance (Figure 7-7). The intra-
Mechanical retention of removable partial dentures is accom- coronal retainer is usually regarded as an internal, or pre-
plished by means of direct retainers of one type or another. cision, attachment. The principle of the internal attachment
Retention is accomplished by using frictional means, by was first formulated by Dr. Herman E.S. Chayes in 1906.
engaging a depression in the abutment tooth, or by engaging The extracoronal retainer uses mechanical resistance to
a tooth undercut lying cervically to its height of contour. Two displacement through components placed on or attached to
basic types of direct retainers are available: (1) the intracoro- the external surfaces of an abutment tooth. The extracoro-
nal retainer and (2) the extracoronal retainer. The extracoro- nal retainer is available in three principal forms. The clasp-
nal (clasp-type) retainer is the most commonly used retainer type retainer (Figures 7-8 and 7-9), the form used most
for removable partial dentures. commonly, retains through a flexible clasp arm. This arm

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 Chapter 14  Preparation of the Mouth for Removable Partial Dentures 203

A B

C D
 

Figure 14-15  A, Diagnostic cast at an orientation best for all abutments considered. The buccal survey line is too close to the mar-
ginal gingival and the distal surface does not lend itself to guide-plane preparation. A surveyed crown is indicated. B, Abutment contours
appropriate to clasp design (distal guide plane and mid-buccal 0.01 inch undercut) are produced in wax. C, Cast of abutment preparation
provides buccal surface reduction adequate to replace with metal ceramic material at the required contour. Without careful consideration
of survey line placement needs before and during preparation, it is easy to reproduce incorrect contours in finished crowns. D, Cast of a
seated surveyed crown demonstrates desired contours for the clasp design chosen.

When there is proximal caries on abutment teeth with areas during patient education and follow-up. Even when a
sound buccal and lingual enamel surfaces, in a mouth exhib- complete crown restoration is placed in this most vulnerable
iting average oral hygiene and low caries activity, a gold inlay area, recurrent caries can occur. Caries risk is best managed
may be indicated. However, silver amalgam or composite for through effective home care and professional follow-up pro-
the restoration of those teeth with proximal caries should not cedures, rather than through the placement of restorations.
be condemned, although one must admit that an inlay cast of All proximal abutment surfaces that are to serve as guid-
a hard type of gold will provide the best possible support for ing planes for the removable partial denture should be pre-
occlusal rests, at the same time giving an esthetically pleas- pared so that they will be made as nearly parallel as possible
ing restoration. However, an amalgam restoration, properly to the path of placement. Preparations may include modify-
condensed, is capable of supporting an occlusal rest without ing the contour of existing ceramic restorations, if necessary.
appreciable flow over a long period. This may be accomplished with abrasive stones or diamond
The most vulnerable area on the abutment tooth is the finishing stones. A polished surface for the altered ceramic
proximal gingival area, which lies beneath the minor con- restoration may be restored by using any of several polishing
nector of the removable partial denture framework and is kits supplied by manufacturers.
therefore subject to accumulation of debris in an area most When preparing abutments that will receive surveyed
susceptible to caries. Even when the removable partial den- crowns, it is important to plan for the tooth reduction neces-
ture is removed, these areas are often missed by the tooth- sary to allow placement of sufficient restorative material for
brush, which allows bacterial plaque and debris to remain durability, contour, and esthetics, as well as the contours pre-
for long periods. Because of this unique removable partial scribed for the desired clasp assembly (Figure 14-15). This
denture concern, special attention should be paid to these can be accomplished by first modifying the axial contours

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