Mouth Prep RPD (Vikas)
Mouth Prep RPD (Vikas)
Mouth Prep RPD (Vikas)
INTRODUCTION
Fundamental to success of removable partial denture
types of changes effected in the teeth, foundation ridges or oral structures which may be deemed necessary to accomplish a better partial denture result. (Applegate 3rd ed)
Classified as
1) pre prosthetic mouth preparation involves removal of any hindrances to prosthetic treatment 2) prosthetic mouth preparation that involves mouth preparation done to facilitate prosthetic treatment.
Pre prosthetic mouth preparation 1. Surgical preparation 2. Conditioning of abused and irritated tissues 3. Periodontal preparation 4. Treatment of muscular symptoms 5. Correction of occlusal plane 6. Conservative/endodontic preparation 7. Correction of malalignment Prosthetic mouth preparation 1. Developing guiding planes 2. Changing height of contour 3. Modifying retentive undercut. 4. Rest seat preparation
Emergency procedure :
Relief of pain or infection :
that are causing pain or discomfort because of caries or defective restorations should be treated to eliminate the possibility of an acute episode of pain occurring during the treatment procedure.
Asymptomatic teeth with advance carious lesion,
periodontal abscesses and other inflammatory responses should be treated in the same way.
procedure, more complete the healing & more stable the denture bearing area
Extractions
early in the treatment but not before completion of a careful and thorough evaluation of each remaining tooth in the dental arch.
Each tooth must be evaluated
concerning its strategic importance and its potential contribution to the success of the removable partial denture.
Residual roots should be removed adjacent to abutment teeth may contribute to the progression of periodontal pockets and compromise the results from subsequent periodontal therapy. Care of buccal and lingual cortical plate should be taken while extraction
Impacted teeth
All impacted teeth
including those in edentulous areas and those adjacent to abutment teeth, should be considered for removal.
Asymptomatic impacted
teeth in the elderly that are covered with bone, with no evidence of a pathological condition, should be left to preserve the arch morphology.
Malposed teeth
The loss of individual teeth or
groups of teeth may lead to extrusion, drifting or combinations of malpositioning of the remaining teeth. In most instances the alveolar bone supporting extruded teeth will be carried occlusally as the teeth continue to erupt. In such situations individual tooth or groups of teeth and their supporting alveolar bone can be surgically repositioned if orthodontic treatment is not possible
enlargements should not be allowed to compromise the design of the partial denture The mucosa covering these enlargements is thin and friable. Partial denture components in proximity to this type of tissue can cause irritation and chronic ulceration Also, exostoses approximating gingival margins may complicate the maintenance of periodontal health and lead to the eventual loss of strategic abutment teeth
Hyperplastic tissue
All these forms of excess tissue
should be removed to provide a firm base for the denture. This removal will produce a more stable denture. can be removed with any preferred combination such as scalpel, curette, electrosurgery, or by laser All such excised tissues should be sent to oral pathologist for microscopic study
Fibrous tuberosities Soft flabby ridges Folds of redundant tissue in the vestibule or floor of the mouth Palatal papillomatosis.
occasionally produce bony protuberances at their attachments, which may also interfere with removable partial denture design. Repositioning of these supra-placed muscles by ridge extension is necessary in such condition to enhance comfort and function
removed and knife-edge ridges rounded to facilitate easy designing of the partial dentures. These procedures should be carried out with minimal bone loss.
submitted for pathological examination New or additional stimulation to the area introduced by the prosthesis may produce discomfort or even malignant changes in the tumor.
HYPERKERATOSIS, ERYTHROPLASIA AND ULCERATION
investigated regardless of their relationship to the proposed denture base. A biopsy of areas larger than 5 mm should be completed, and if the lesions are large (more than 2 cm in diameter), multiple biopsies should be taken
DENTOFACIAL DEFORMITY
Surgical correction of a jaw deformity can be made in
horizontal, sagittal or frontal planes. Mandible and maxilla may be positioned anteriorly or posterior and their relationship to the facial planes may be surgically altered to achieve improved appearance.
Ridge Augmentation Ridge augmentation can be carried out with either alloplastic materials like hydroxyapatite or with autogenous bone graft materials for proper bone support to the partial dentures
OSSEOINTEGRATED DEVICES : These devices offer a significant stabilizing effect on dental prosthesis through a rigid connection to living bone. Inclusion of strategically placed implants can significantly control prosthesis movement.
patients will require some conditioning of supporting tissues in edentulous areas before the final impression phase of the treatment.
Symptoms:
Inflammation and irritation of the mucosa covering
These conditions are usually associated with ill-fitting or poorly occluding RPD.
A good HOME CARE PROGRAM. Rinsing the mouth with a prescribed saline
solution
Massaging the residual ridge areas, palatal rugae and tongue with a soft tooth brush. Removing the prosthesis at night and using a prescribed therapeutic multiple vitamin along with high protein, low carbohydrate diet. Some inflammatory, oral conditions caused by ill fitting dentures can be resolved by removing the dentures for an extended periods of time
materials are elastopolymers that have massaging effect on irritated mucosa, and because they are soft, occlusal forces are probably more evenly distributed.
dentures
noted within 3 or 4 changes of the conditioning material, but in some cases more changes are required. mucosa appears completely healthy.
3) Periodontal preparation
The periodontal preparation of
the mouth usually follows any oral surgical procedure and is performed simultaneously with tissue conditioning procedures. The periodontal procedures are necessary to restore the mouth to the state of health required for definite treatment.
contributing to periodontal disease, along with a reduction of BLEEDING ON PROBING. Elimination of or reduction in, pocket depths of all periodontal pockets, with the establishment of healthy gingival sulci. Establishment of functional atraumatic occlusal relationships and tooth stability Development of a personal plaque control program and definitive maintenance schedule.
gingival margin and the tooth surface, and the depth of gingival sulcus is determined circumferentially around each tooth.
judging the amount of bleeding on probing. This along with the pocket depth is an excellent indicator of health and disease.
be used to supplement the clinical examination but should not be used as a substitute for it.
1. Type location and severity of bone loss 2. Location, severity and distribution of furcation involvement. 3. Alteration of periodontal ligament space. 4. Alterations of the lamina dura 5. Calcified deposits 6. Location and conformity of restoration margins 7. Evaluation of crown and root morphologies. 8. Root proximity 9. Caries 10. Evaluation of other associated anatomic structures, such as mandibular canal or sinus proximity.
MOBILITY
Each tooth should be evaluated carefully for
mobility Normal mobility is in order of 0.05 to 0.10 mm. Grade I mobility slightly more than normal. Grade II moderately more than normal. Grade III severe mobility with vertical displacement.
If fingers are used the movement of soft tissue may mask accurate determination of mobility
Treatment planning
Depending on the extent and severity of the periodontal
changes present, a variety of therapeutic procedures, ranging from simple to relatively complex, may be indicated.
Periodontal treatment planning can usually be divided into
three phases. Disease control therapy phase-phase 1 Definitive periodontal surgery phase-phase 2 Maintenance phase- phase 3
b) Scaling and root planning : Without meticulous removal of calculus, plaque,and toxic material in the cementum, other forms of periodontal therapy cannot be successful.
c) Elimination of local irritating factor other than calculus Overhanging margins of amalgam & inlay restoration. Overhanging crown margins. Open contacts leading to food impactions. Deep carious lesions should be eliminated before the start of definitive prosthetic treatment.
contributes to more rapid loss of periodontal attachment. Selective grinding procedure is generally applied at this stage. Occlusion on natural teeth needs to be perfected only to a point at which cuspal interference within the patients functional range of contact is eliminated and normal physiologic function can occur
helpful in determining static cusp to fossa contacts of opposing teeth and as guide in the correction of occlusion anomalies 1) A static coordinated occlusal contact of the maximum number of teeth when the mandible is in centric relation to the maxillae should be the first objective. The procedure is as follows:a) A prematurely contacting cusp should be reduced the cusp point is in premature contact in both centric and eccentric relations. If a cusp point is in premature contact in centric relation only, the opposing sulcus should be deepened
centric relations, or in both centric and eccentric relations, corrections should be made by grinding the incisal edge of the lower teeth. If only in eccentric relation grind lingual inclines of maxillary teeth
3) To obtain maximum function and the distribution of functional stress in eccentric positions on the working side, necessary grinding must be done on the lingual surfaces of the upper anterior teeth
Corrective grinding on the posterior teeth at this time should always be done on the buccal cusp of the upper premolars and molars and on the lingual cusp of the lower premolars and molars
contacts of one or more anterior teeth should be accomplished by grinding the lingual surface of the upper anterior teeth. elimination of premature protrusive contacts of posterior teeth done on their non functional cusp
5) Any sharp edges left by grinding should be rounded
off
SPLINTING
Some teeth loose their periodontal support rendering them
mobile To use these teeth as abutment additional support is required First the cause of mobility is to be eliminated Teeth may be immobilized during periodontal treatment by Acid etching the teeth with composite resin, Fiber reinforced resins Cast removable splints Intracoronal attachments
or by fixed restoration which becomes a permanent splint. Splinting of weakened teeth in partially edentulous arch located in a position where the partial denture will not require an unusual amount of support, is achieved by using fixed splinting, this maintains the continuity of the arch, avoids additional modification spaces, thus simplifying the construction and fitting of partial dentures and improving prognosis. Fixed splinting must be accomplished with full or partial coverage crowns soldered together; this gives additional resistance to antero-posterior stresses.
Gingivectomy
supra bony pockets of fibrotic tissue, absence of deformities in the underlying bony tissue & pocket depth confined to attached gingiva
Periodontal flaps : Periodontal flap surgery involves the elevation of either mucosa alone or both the mucosa and the periosteum.
(GTR) has been defined as those procedures that attempt regeneration of lost periodontal structures through differing tissue responses..
junction. Creation of an adequate zone of attached gingiva. Correction of gingival recession by root coverage techniques.
muscular symptoms should be analyzed. Therefore the first objective of the operator is to eliminate this muscle spasm. acrylic overlay splint with a flat occlusal surface which will eliminate premature tooth contacts causing deviation of the mandible leading to spasm. Adjunct therapies like short-wave therapy, infra-red radiation, and light massage are designed to increase the volume of the blood flowing through the muscles and thereby removing the offending metabolites. The use of muscle relaxant drugs like Diazepam 5-10 mg B.D is effective in relaxing the symptoms
5) CORRECTION
OF OCCLUSAL PLANE
the teethit is not a plane, but represents the planar mean of the curvature of these surfaces (gpt 8th )
The occlusal plane in most partially edentulous mouths will be uneven
Teeth that have been unopposed for a long time tend to overerupt, e.g. the maxillary molars if unopposed will migrate downwards carrying the maxillary tuberosity with them creating a problem to reestablish the occlusal plane
TREATMENT:
Orthodontic treatment Enameloplasty
Orthodontic treatment
Enameloplasty:
Enameloplasty is used to describe the removal of a portion of the enamel surface of a tooth to accomplish specific purposes.
For the correction of the occlusal plane, the enameloplasty consists of reducing cusp height in order to level or harmonize the curve of the occlusal plane .
Reduction is done with tapered diamond cylinder or stones in high speed hand piece. The cut enamel surface is smoothened with carborundum containing rubber wheels and fluoride gels.
Onlay
Conservative method
The occlusal surface of a tooth to be covered by an onlay rest should be free of pits and fissures or should be made so by eliminating the defects with small burs or stones.
The use of chrome- cobalt can cause extreme wear of natural teeth. Tooth colored resin may be processed over the metal, however this will wear rapidly.
One of the simplest methods -the use of cast gold onlays, which an either lengthen or shorten the crown height of a tooth.
Crowns:
When the crown height of the tooth must be changed to harmonize the occlusal plane. the facial, lingual, or proximal surfaces must be altered to produce a more desirable height of contour, a guiding plane, or a retentive undercut. Before the tooth is prepared to receive the crown, mounted diagnostic casts should be measured to ascertain how much crown reduction is necessary to correct the occlusal plane.
These teeth include mandibular second or third molars that may be used to serve as posterior abutment so as the prosthesis may be all tooth supported.
Other are those in the center of a long anterior edentulous span either mandibular or maxillary.
remaining interarch space, the crown of the tooth can be removed at the gingival crest and a coping constructed. The tooth will serve as a vertical stop, preventing excessive vertical or horizontal movement of the prosthesis.
Extraction
Eg. If orthodontic treatment cannot be accomplished to realign severely malposed molars or premolars, extraction must be considered. When teeth interfere with the placement of the major connector and no other solution (such as crowning the tooth) feasible, extraction must be planned.
Surgery
Maxillary segmental osteotomy is done to superiorly repositioning posterior segments of maxilla. This is one of the most effective methods of regaining interarch space lost due to downward migration of the teeth and tuberosity
6) CONSERVATIVE/ENDODONTIC PREPARATION
teeth, only gold or amalgam are suitable materials to come into contact with partial dentures as these materials have the necessary strengths to form a foundation for occlusal rests Onlays: The occlusal surfaces of worn teeth can be restored by onlays. Endodontic with crown/coping:a grossly carious tooth which can serve as strategic abutment tooth must be restored with endodontic therapy followed by cementation crown which will allow such tooth/teeth to serve as normal abutments.
7) CORRECTION OF MALALIGNMENT
Teeth that are malposed, facially or lingually are more
difficult to correct There are definite, limitation to the repositioning of these malposed teeth. Orthodontic correction of these malposed teeth is the first line of treatment. Enameloplasty and crowns are also treatment choices. Surgical intervention is planned only if all other measures fail to reposition these malposed teeth
enhance the placement of prosthesis. It mainly involves reshaping of teeth The steps involved are: 1. Developing guiding planes 2. Changing height of contour 3. Modifying retentive undercut 4. Abutment preparation using cast crowns 5. Rest seat preparation
Guiding Planes
Guiding planes are those surfaces on the teeth, parallel relationship to each other, so that they may serve to determine positively the direction of appliance movement (Applegate 1954)
GPT-8 defines them as two or more vertically parallel surfaces of abutment teeth, so orientated as to direct the path of placement of removable partial dentures.
To provide single path of placement and removal 2. To ensure planned and intended action of the retentive and bracing components of the partial denture 3. To eliminate detrimental strain to the abutment teeth while placing and removing the prosthesis 4. To eliminate gross food traps between the abutment teeth and the denture base
1.
The flat surface created should ideally be 2 to 4mm in occlusogingival height The reduction must not be a straight slice across the tooth surface; rather it should follow the curvature of the surface so that nearly uniform amounts of enamel are removed
teeth adjacent to distal extension edentulous spaces is accomplished in the same manner with a cylindrical diamond stone held parallel to the path of insertion. The principal difference between this guiding plane and the planes on teeth bordering a tooth-supported segment is that the occlusogingival height of the plane is reduced to 1.5 to 2mm.
Thus provides grater freedom to movement hence less torqueing forces
resultant high lingual survey line. Minor recontouring can frequently improve the position of the survey line to allow placement of the reciprocal clasp arm in its proper position
To provide maximum resistance to lateral stresses. The occlusogingival height of the preparation is 2 to 4 mm. The
plane ideally should be located in the middle third of the clinical crown of the tooth.
spaces provide the parallelism needed to ensure stabilization, minimize wedging action between the teeth, decrease undesirable space between the denture and the abutment tooth, increase retention through frictional resistance.
than a sufficient retentive undercut. For the procedure to be successful, the buccal and lingual surfaces should be nearly vertical. If surface to receive undercut is sloped, indentation has to be excessively deep. If opposing surface is sloped, the reciprocal clasp arm cannot prevent retentive clasp tip from dislodging. A round end tapered diamond held parallel to gingival margin is used to create a gentle depression
in the form of a gentle depression, not a pit or hole Retentive undercut should be in the form of a gentle depression. Create slight concavity (0.010 inch deep, 4mm MD, 2mm OG), parallel to gingival margin
tooth and designating its greatest circumference at a selected axial position determined by a dental surveyor gpt 8th The height of contour is changed most frequently to provide better positions for clasp arms Ideally the retentive clasp arm should be located no higher than the junction of the gingival and the middle thirds. This position not only enhances the esthetic quality of the clasp, but also places clasp nearer the tooths centre of rotation The height of contour is best lowered by using tapered diamond stones.
contours and enamel surfaces cannot be corrected to produce them, cast restorations must be planned. Guiding planes, height of contour and retentive undercuts can be placed in the wax patterns for the cast restorations. Also many abutment teeth will require restorations for more routine reasons such as caries, endodontic therapy etc.
prosthesis that contacts the occlusal surface of a tooth or restoration, the occlusal surface of which may have been prepared to receive it Rest seat -the prepared recess in a tooth or restoration created to receive the occlusal, incisal, cingulum, or lingual rest
Function as an indirect retainer in a distal extension partial denture. Designed between spaced teeth to reestablish continuity of arch and prevent further drifting or tipping of tooth It is used as onlay on abutment tooth to establish a more acceptable occlusal plane and to prevent extrusion of tooth
Extension 1/3rd to 1/2 of mesiodistal diameter. 1/2 of the distance between buccal and lingual cusp tips.
Floor Inclined towards the center. Spoon shaped. Enclosed angle with the proximal surface less than 90
An occlusal rest must be at least 1 mm thick at its thinnest point if chrome alloy is used for the framework or 1.5 mm if gold is to be used
Preparation
Create an outline using small diamond bur
removed with the same bur. Deepest portion of the rest seat is towards the center of the tooth. Verify preparation by red beading wax. Polishing of preparation is done using carborundum impregnated rubber point in low speed hand piece
placed in the wax patterns. The preparation for the rest seat must be carved in the wax after the establishment of guiding planes.
occlusal harmony, an attempt should be made to contour them to satisfy the requirements of the proposed prosthesis.
planes in existing restorations. Patients must be always be thoroughly informed of the possibility of need to replace existing restorations before mouth preparation.
If an existing crown, onlay, or inlay is penetrated
restoration is less desirable than that in either sound enamel or a gold restoration. Amalgam alloy tends to flow when placed under constant pressure.
Preparation extends over the occlusal embrasure of two approximating posterior teeth, from the mesial fossa of one tooth to the distal fossa of other. Insufficient tooth removal will generally lead to occlusal interferences between the clasp and the opposing cusps. Relieving the metal to gain occlusal freedom ultimately lead to breakage of the clasp during function.
It should be approximately 1.5 to 2 mm wide and 1 to 1.5 mm deep. The inclines of the preparation must be rounded after the preparation is complete
abutment tooth by an occlusal rest than by a lingual or incisal rest. A canine is preferred over an incisor for support of a denture. When a canine is not present, multiple rests on incisor teeth are needed in place of a single rest on a single incisor tooth. A lingual rest is preferred to an incisal rest.
surface of an anterior tooth if the tooth is sound the patient practices good oral hygiene the caries index is low.
The cingulum should also be prominent to present a
gradual slope to the lingual surface rather than a steep vertical slope. This is the principal reason why mandibular canines are poor candidates for a lingual rest
smooth curve from one marginal ridge to other. Should cross the centre of tooth incisally to cingulum. The rest seat itself is V shaped. The labial incline of lingual surface makes one wall. Other wall starts of cingulum and inclines labio-gingivally towards the centre of tooth. The deepest point of the rest seat will be over the cingulum.
the rest seat should be carved in the wax pattern and not cut in the cast restoration.
When the rest seat in the wax pattern is carved, a definite
rest preparation can be developed that will direct the forces of occlusion through the long axis of the abutment tooth.
teeth, they may be used successfully on select patients if the abutment tooth is sound.
On incisor teeth an incisal rest is usually used as a last resort to
diamond bur in a high-speed handpiece The first cut is made vertically 1.5 to 2 mm deep in the form of a slice or notch and approximately 2 to 3 mm inside the proximal angle of the tooth.
After all sharp angles and points have been reduced by the flame-
Although some metal will show, the display can be kept to a minimum without jeopardizing the effectiveness
CONCLUSION
The preparation of mouth is fundamental to a
successful removal partial denture. The prime objective of all the mouth preparation procedures is to return the mouth to optimum health and to eliminate any condition that compromises the success of the partial denture.
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