3. “Most clinicians also choose an RPD for a partially
edentulous patient if they need to restore lost residual
ridge, achieve appropriate esthetics, increase
masticatory efficiency, and improve phonetics but are
unable to do so with dental implants or fixed partial
dentures due to financial constraints or patient desires”
- Bohnenkamp DM Removable Partial Dentures :
Clinical Concepts, Dent Clin N Am 58 (2014) 69–89
“Problems related to RPDs may be associated with
errors in diagnosis and treatment planning, including
inadequate mouth preparation “
- McCord JF et al Dent Update 2003; 30: 88–97
4. According to GPT 8
Diagnosis : the determination of the nature of a
disease
Treatment plan : the sequence of procedures
planned for the treatment of a patient after
diagnosis
5. The delineation of each patient’s uniqueness
occurs through the patient interview and clinical
examination process.
The ultimate treatment is individualized to
address disease management and the
coordinated restorative and prosthetic needs
that are unique to the patient.
6. understanding the patient’s desires or chief
concerns/complaints regarding his or her
condition
ascertaining the patient’s dental needs through
a clinical examination,
developing a treatment plan that reflects the
best management of desires and need
Executing appropriately sequenced treatment
with planned follow-up
7. The dentist should follow a sequence
that includes:
1. Chief complaint and its history
2. Medical history review
3. Dental history review, especially
related to previous prosthetic
experience(s)
4. Patient expectations
8. Personal and psychological factors are
significant to the success of prosthodontic
treatment
House classification
- Philosophical
- Exacting
- Hysterical
- Indifferent
House classification
revisited :
- Ideal
- Submitter
- Reluctant
- Indifferent
- Resistant
9. The process of clinical examination involves
two stages :
- Medical examination
- Oral examination
A comprehensive medical history includes :
- systemic disorders (Chronic degenerative or
dysfunctional diseases)
- Medication history
- Diet
- Habits
11. Climacteric (i.e., menopausal changes)
Parkinsonism
Salivary gland disorders
TM disturbances
Post radiation therapy
Bell ’ s palsy
Lichen planus
Fungal infections
12. An oral examination should be accomplished in
the following sequence :
visual examination,
pain relief and temporary restorations,
radiographs,
evaluation of abutment and periodontium,
vitality tests of individual teeth,
determination of the floor of the mouth position,
Oral prophylaxis and impressions of each arch.
13. This includes : extra oral and intra oral examination.
TMJ - tenderness, mouth opening deviation & clicking
14. No of teeth present with their clinical evaluation
Malposed teeth
Carious teeth
Existing restoration- sensitivity to percussion
Periodontium
Residual ridges
Saliva
Investing structures
Occlusion and occlusal plane
Oral hygiene index
15. to determine the need and management of
acute needs and whether a prophylaxis is
required to conduct a thorough oral
examination.
to relieve discomfort arising from tooth defects
the extent of caries and arrest further caries
activity
16. areas of infection and other pathologies
the presence of root fragments, foreign objects,
bone spicules and irregular ridge formations
the presence and extent of caries and the
relation of carious lesions to the pulp and
periodontal attachment
evaluation of existing restorations : evidence
of recurrent caries, marginal leakage, and
overhanging gingival margins
17. the presence of root canal fillings
evaluation of periodontal conditions present
to evaluate the alveolar support of abutment
teeth, their number, the supporting length and
morphology of their roots
the relative amount of alveolar bone loss suffered
through pathogenic processes, and the amount of
alveolar support remaining
18. To locate inferior borders of lingual mandibular
major connectors.
oral hygiene status before prosthodontic treatment is
important.
The impression for the diagnostic cast is usually
made with an irreversible hydrocolloid in a stock
(perforated or rim lock) impression tray.
19. • Anatomic consideration
- Root length, size and form
• vitality tests
• caries evaluation
• Periodontal health
• Malpositions
• Analysis of Occlusal
Factors
20. • Supplements oral examination
• Permit a topographic survey of the dental arch
• Patient education and motivation
• Custom tray fabrication
• Constant reference
• Patient's record
21. verification of appropriate
mouth modifications for a
removable partial denture.
To determine the most
desirable path of placement
that will eliminate or minimize
interference to placement and
removal
To locate and measure areas
of the teeth that may be used
for retention
22. To determine whether tooth and
bony areas of interference will need
to be eliminated surgically or by
selecting a different path of
placement
To determine the most suitable path
of placement that will permit
locating retainers and artificial teeth
to the best esthetic advantage.
To permit an accurate charting of
the mouth preparation to be made
including the preparation of
proximal tooth surfaces to provide
guiding
25. The objectives of any prosthodontic treatment
may be stated as follows:
the elimination of disease
the preservation, restoration, and maintenance
of the health of the remaining teeth and oral
tissues
the selected replacement of lost teeth; for the
purpose of restoration of function
comfort and in esthetically pleasing manner
26. Based on diagnostic findings, The American
College of Prosthodontists (ACP) has
developed a classification system for partial
edentulism
Criteria 1: Location and extent of the
edentulous area(s)
Criteria 2: Abutment conditions
Criteria 3: Occlusion
Criteria 4: Residual ridge
27. Edentulous area confined to a
single arch
Abutment conditions -No
preprosthetic therapy is indicated
Occlusal characteristics- Class I
molar jaw relationships are seen
Residual bone height of ≥21 mm
28. Edentulous area – Both arches
Abutment- Abutments in 1 or 2
sextants have less tooth
structure or support intra or extra
coronal restorations
Occlusion- Localized adjunctive
therapy Class I molar and jaw
relationships are seen
Residual bone height of 16 to 20
mm
29. Any posterior maxillary or
mandibular edentulous area
greater than 3 teeth or 2 molars.
Any edentulous areas including
anterior and posterior areas of 3 or
more teeth.
Abutments in 3 sextants have
insufficient tooth structure to retain
or support intracoronal or
extracoronal restorations.
30. Entire occlusion must be
reestablished. Class II molar
and jaw relationships are
seen.
Residual alveolar bone
height of 11 to 15 mm
31. Any edentulous area or
combination of edentulous
areas requiring a high level of
patient compliance
Abutments in 4 or more
sextants have insufficient
tooth structure to retain or
support intracoronal or
extracoronal restorations.
32. Entire occlusion must be
reestablished, including
changes in the occlusal
vertical dimension. Class II
div 2 and Class III molar and
jaw relationships are seen.
Residual vertical bone height
of ≤10 mm
33. Individual diagnostic criteria are evaluated and the
appropriate box is checked. The most advanced finding
determines the final classification
Classification System for Partial Edentulism, Journal of Prosthodontics Vol.
11, no. 3, 2002: 181 – 193.
34. 1. Any single criterion of a more complex class
places the patient into the more complex class.
2. Consideration of future treatment procedures must
not influence the diagnostic level.
3. Initial preprosthetic treatment and/or adjunctive
therapy can change the initial classification level.
35. 4. If there is an esthetic concern/challenge, the
classification is increased in complexity by one
level in Class I and II patients.
5. In the presence of TMD symptoms, the
classification is increased in complexity by one or
more levels in Class I and II patients.
6. In the situation where the patient presents with
an edentulous mandible opposing a partially
edentulous or dentate maxilla, Class IV.
36. Implant supported fixed dental prosthesis
Fixed dental prosthesis
Removable partial denture
Complete denture
Combination of the above
No treatment at all
37. Distal extension situations
After recent extractions
Long span
Need for cross-arch stabilization
Excessive loss of residual bone
Sound abutment teeth
Abutment with guarded prognosis
Economic considerations
38. It is a communication model
a process where the provider and the patient
identify together the best course of care.
it addresses the need to fully inform patients
about risks and benefits of care options
ensures that patient values and preferences
play a prominent role in the process.
40. Valplast RPDs with
anterior flexible nylon
clasps.
A cast metal framework
with metal clasps and
flexible nylon polyamide
retentive clasps
Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am
2014; 58: 69–89
41. Mandibular overlay
unilateral distal extension
RPD with tooth-colored
acrylic resin processed to
the metal framework
Mandibular overlay RPD
metal framework
Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am
2014; 58: 69–89
42. Minimize rotation about an axis in a Kennedy
Class I or II arch, or any long modification span
direct retainers
rests
43. Phase I
Collection and
evaluation of data
Pain, infection control
Biopsy
Patient motivation
Phase II
Removal of deep caries
Extirpation of necrotic
pulp
Extraction of non-
retainable teeth
Periodontal treatment
Interim prosthesis
Occlusal equilibrium
Patient education
44. Phase III
Preprosthetic surgical procedures
Definitive endodontic procedures
Definitive restoration of teeth
Fixed partial denture construction
Reinforcement of education and motivation of the
patient
45. Phase IV
Construction of removable partial denture
Reinforcement of education and motivation of
patient
Phase V
Post insertion care
Periodic recall
Reinforcement of education and motivation of patient.
46. The four components of a SOAP note are
Subjective, Objective, Assessment, and Plan
The SOAP note format is used to standardize
medical evaluation entries made in clinical
records. The SOAP note is written to facilitate
improved communication among all involved in
caring for the patient and to display the
assessment, problems and plans in an
organized format.
47. Plan the amount of time and appointment schedule
Provides information to the patient.
Estimate the professional fees for the treatment.
Coordinate the schedule for dental laboratory
procedures
Meet the legal requirements of informed consent
48.
49. Carr AB, Brown DT, McCracken’s Removable Partial
Prosthodontics, 12th edition, Canada, Elsevier Publishers,
2011, pp:150-184
Stewart, Rudd, Kuebkar, Clinical Removable Partial
Prosthodontics, 2nd edition, India, All India Publishers and
Distributors, 2001, pp:117-220
Jones DJ,Gracia LT, Removable Partial Dentures : A
Clinician’s guide, 1st edition, Singapore, Wiley-Blackwell,
2009, pp : 11-38
Garry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR,
Koumjian JH, Arbree NS, Classification system for partial
edentulism, J Prosthodont 2002;11,3:181-193
50. McCord JF, Grey JA, Winstanley RB, Johnson A, A
Clinical Overview of Removable Prostheses: 1. Factors
to Consider in Planning a Removable Partial Denture,
Dent Update 2002; 29: 376-381
Bohnenkamp DM Removable Partial Dentures : Clinical
Concepts, Dent Clin N Am 2014; 58: 69–89
Gamer et al, M. M. House mental classification
revisited: Intersection of particular patient types and
particular dentist’s needs, J Prosthet Dent 2003;89:297-
302
Davenport JC, Basker RM, Heath JR, Ralph JP, Glantz
PO, The removable partial denture equation, Brit Dent J
2000; 189: 414–424
Notas do Editor
The interview, an opportunity to develop rapport with the patient, involves listening to and understanding the patient’s chief complaint or concern about his or her oral health. A fundamental objective of the patient interview, which accompanies the diagnostic examination, is to gain a clear understanding of why the patient is presenting for evaluation;this involves having the patient describe the history related to the chief complaint.
Mouth preparation procedures are influenced by the choice of major connectors
When an RPD is inserted, it is especially important that the patient ’ s remaining natural teeth and tissues receive consistent and meticulous oral hygiene procedures in order for an acceptable degree of oral health to be maintained. The patient ’ s oral hygiene status before prosthodontic treatment provides reliable evidence of the importance that the patient attaches to this critical factor and refl ects if appropriate maintenance and oral hygiene instructions were provided and/or were understood from the prior treatment.
Vitality tests should be given particularly to teeth to be used as abutments and those having deep restorations or deep carious lesions.Radio graphic interpretation : Bone density, Periodontal ligaments and the lamina dura, Root configuration, Radiolucent or radiopaque lesions