R P D 2 0 1 6 S T U DY G U I D E

1 - PROSTHODONTICS [1.12.16]
PROSTHODONTICS
The restoration and maintenance of oral function, comfort, appearance and health by the
restoration of natural teeth or the replacement of missing teeth and oral or maxillofacial
tissues with artificial/prosthodontic substitutes
MAIN PROSTHODONTIC DIVISIONS
Fixed: replacement and/or restoration of teeth by artificial substitutes that are not
removable from the mouth
Removable: replacement of teeth and oral structures by artificial substitutes that are
removable from the mouth
o Can be either complete or partial
Implant: construction and placement of fixed or removable prostheses on any implant
device
Maxillofacial: rehabilitation of patients with intra or extra oral prosthetic devices
THE PARTIALLY EDENTULOUS PATIENT
Tooth Loss and Age
o Curent population estimates show that 13% of the US population is 65 years or
older. By 2030, expected to double
o It has been suggested that partially edentulous conditions are more common in the
maxillary arch, and the most commonly missing teeth are first and second molars.
Consequences of Tooth Loss
o Residual ridge no longer benefits from functional stimulus
o Loss of ridge volume
o Bone loss greater in mandible than maxilla
o Alteration in the oral mucosa
o Esthetic impact (may be more of a concern to patient than loss of function)
REMOVABLE PARTIAL DENTURE
A dental prosthesis that restores one or more but not all of the natural teeth and
associated parts and is supported and retained by the remaining teeth and/or mucosa and
which can be removed from the mouth by the patient.
CURRENT REMOVABLE PARTIAL DENTURE USE
Partially edentulous individuals not wearing a prosthesis were 6 times more likely to have
missing mandibular teeth (19.4%) than missing maxillary teeth (2.2%). This might
suggest more difficulty in the use of mandibular prosthesis.
PROSTHODONTIC TREATMENT OBJECTIVES
1. Restoration
2. Preservation of oral health
5.
6. TOOTH REPLACEMENT RULE
1

3. Improved mastication/function
4. Esthetics

The treatment of choice for partially edentulous patients is generally a fixed partial
denture when the mechanical, physiologic and financial conditions are favorable

7.
1.
2.
3.

RPD EXAMINATION
Radiographs panorex, full series of periapicals, bite wings
Intra oral exam hard and soft tissues
Diagnostic casts

8.
1.
2.
3.
4.
5.
6.

SIX PHASES OF PARTIAL DENTURE SERVICE

Education of Patient
Diagnosis, Treatment Planning, Design, Treatment Sequencing, and Mouth Preparation
Support for Distal Extension Denture Bases
Establishment and Verification of Occlusal Relations and Tooth Arrangements
Initial Placement Procedures
Periodic Recall

9. INDICATIONS FOR REMOVABLE PROSTHODONTICS CONTRAINDICATIONS FOR FIXED

PROSTHODONTICS
1. Age young or old
7.
a. Fixed is generally
2. Excess length of edentulous span
more expensive
3. Excess bone loss
8. 6.
Cross arch stabilization
4.
a. Abutment teeth
7. Physical or emotional problems
5.
b. Edentulous ridge
8. Immediate replacement after
6. 4.
No posterior/distal abutment
extractions
located behind an edentulous area
9. Poor complete denture prognosis
5. Financial
9.
10.REASONS FOR FAILURE OF CLASP-RETAINED PARTIAL DENTURES
1. Diagnosis and treatment planning
5. Support for denture bases
2. Mouth preparation procedures
6. Occlusion
3. Design of the framework
7. Patient-dentist relationship
4. Laboratory procedures
8.
9. R.P.D. TREATMENT PLANNING SEQUENCE
1. End product RPD = design first
2. Oral surgery extractions, alveoplasty, removal of tori, tuberosity reduction.
10.
a. immediate temporary replacements?
3. Periodontal therapy
4. Orthodontics?
5. Restorative = compatible with RPD
11.
a. Endo, post, core, full/partial coverage FPD
12.Note: Nesbit, sm. unilateral partials, outlawed in Pennsylvania b/c theyre swallowed or
aspirated & homies die
13.DENTAL SURVEYOR
Dental cast surveyor facilitates the design of a removable partial denture. It is an
instrument by which parallelism or lack of parallelism of abutment teeth and other oral
structures, on a stone cast, can be determined.

14.

2 - KENNEDY CLASSIFICATION OF PARTIALLY EDENTULOUS

ARCHES (1.19.16)

15.REQUIREMENTS FOR ACCEPTABLE RPD CLASSIFICATION

1. Visualization of the type of arch
2. Differentiation between tooth supported and tooth + tissue supported cases
3. Logical in approach
4. Guide for potential design
5. Universally acceptable
16.
17.Classification System for the Partially Edentulous Patient American College of
Prosthodontists (this will be discussed over the summer term)
Diagnostic Criteria
1. Location and extent of the edentulous
3. Occlusal scheme
area(s)
4. Residual ridge
2. Condition of the abutment teeth
5.
6. KENNEDY CLASSIFICATION
1. Based on relationships of edentulous spaces to the abutment teeth
2. The most posterior edentulous space/spaces always determines classification
3. Additional edentulous spaces are designated as modifications
4. Four main types of arch classifications
KENNEDY CLASS I
o Bilateral edentulous areas located posterior/distal to the remaining teeth. Both
teeth and tissue supported (most complex)
KENNEDY CLASS II
o Unilateral edentulous area located posterior/distal to the remaining teeth. Both
teeth and tissue supported.
KENNEDY CLASS III
o Unilateral edentulous area with natural teeth both anterior and posterior to the
space. All tooth supported. (tooth-born partial)
Missing 1 central incisor = class III (because it doesnt cross the midline)

8.
1.
2.
3.

KENNEDY CLASS IV
o A single edentulous area minimum two teeth that crosses the midline and is
anterior to the remaining teeth. [not kennedy IV must cross the midline]
1.
[Kennedy IV] No modification spaces changes class
2.
Occasionally called a mesial extension case
3.
Can be all tooth or tooth + tissue supported
depends on size of
edentulous area
7.
APPLEGATES RULES FOR KENNEDY CLASSIFICATION
Classification should follow rather than precede any extractions of teeth that might alter
the original classification.
If a third molar is missing and not to be replaced, it is not considered in the classification.
If a third molar is present and is to be used as an abutment, it is considered in the
classification

4. If a second molar is missing and is not to be replaced, it is not considered in the

classification (eg., if the opposing second molar is likewise missing and is not to be
replaced.)
5. The most posterior edentulous area (or areas) always determines the classification.
6. Edentulous areas other than those determining the classification are referred to as
modifications and are designated by their number.
7. The extent of the modification is not considered, only the number of additional edentulous
areas.
8. There can be no modification areas in Class IV arches. (Other edentulous areas lying
posterior to the single bilateral areas crossing the midline would instead determine the
classification; see Rule 5.)
9.
10.KENNEDY SEQUENCING
1. Based partly on frequency
a. Class I most common, Class IV least common
2. Based on principles of design
11.a.
Cl. I tooth + tissue supported
12.b.
Cl. III, IV tooth supported
13.c.
Cl. II combo of Cl I & III particularly if modification space present
14.
15.ASSESS YO SELF (Figure 3.3 in the book.answers on bottom of next page)
16.
17.

18.DENTAL SURVEYOR AND SURVEYING VOCABULARY

1. Dental surveyor
A paralleling instrument used to:
1. Determine the relative parallelism of two or more axial tooth surfaces and
2. Delineate the contours and relative positions of abutment teeth and associated
structures
2. Height of Contour (Survey Line)
A line encircling a tooth produced by a surveyor in a selected position that marks
the greatest circumference, bulge or convexity of a tooth, teeth or other associated
structures
3. Undercut
The portion of a tooth that lies between the height of contour and the gingival
tissues. Provides for clasp retained R.P.D.s.
4. Undercut gauge = Surveyor Tool
A vertical rod with a horizontal/round gauge at one end which is used to locate and
gauge/measure undercuts.
1. Vertical rod contacts survey line
2. Gauge contacts tooth surface in the angle of cervical convergence.
Silver .01 inch = .25mm-small
Copper
.02 inch = .50mm-medium
Black .03 inch = .75mm-large
5. Angle of cervical convergence
An angle viewed between a vertical rod contacting the height of contour of an
abutment tooth and the axial surface of the abutment. Angle apex at height of
contour and diverges toward the gingival area.
6. Infrabulge
The portion of the crown of a tooth that slopes or converges apical to the survey
line.
Undercut = Retention
7. Suprabulge
The portion of the crown of a tooth that slopes or converges toward the occlusal or
incisal tooth surface.
Non-undercut =Reciprocation or bracing
8. Guiding plane/planes
Vertically parallel axially or proximal surfaces of abutment teeth adjacent to
edentulous areas that direct the path of insertion/removal of a R.P.D.
9. Path of insertion
The direction in which a restoration moves from the point of initial contact of its
rigid parts with the abutment teeth to its final seated position.
10. Tripoding
Three marks recorded on a cast surface with the vertical surveying arm and the cast
base in a fixed position.
Permits repositioning cast on the surveying table after removal
5

19.

Answers to Figure 3.3

A. Class IV
F. Class III, mod 1

B. Class II, mod 2

G. Class IV

C. Class I, mod 1

H. Class II

D. Class III, mod E. Class III, mod 1

I. Class III, mod 5

20.
20.
20.

3.1 BIOMECHANICS OF RPD (1.26.16)

21.RPD
Since removable partial dentures are not rigidly attached to teeth, the control of potential
movement under functional load is critical to providing the best chance for stability
22.
23.FORCES INHERENT IN THE ORAL
25.
CAVITY
26.SIMPLE MACHINES
Direction
Lever
Duration
Wedge
Frequency
Inclined Plane
Magnitude
Screw
Pulley
24.
Wheel and Axle
27.LEVERS
Class I
o Most efficient lever
Class II wheelbarrow
Class III fishing pole
o You need to be able to
draw these and label
wheres the fulcrum,
wheres the effort arm
is and what resistance
is need to counteract it
o Least efficient
o Mandible is a class III
28.
29.
30.DESIGN OF RPD (think back to
FPD1)
Mechanical considerations
Biological considerations
Esthetic considerations
31.
32.ROTATIONAL MOVEMENTS
Sagittal Plane
o Fulcrum line
When rotation of movement that occurs about an axis through the most
posterior abutments
This is the center of rotation as the distal extension base moves toward the
supporting tissue when an occlusal load is applied
6

Axis of Rotation
May shift toward more anteriorly placed components, occlusal or incisal to
the height of contour of the abutment, as the base moves away from the
supporting tissue when vertical dislodging forces act on the partial denture
Frontal Plane
o Rotation around a longitudinal axis formed by the crest of the residual ridge
o Resisted primarily by the rigidity of the major and minor connectors to prevent
torque
Horizontal Plane
o Rotation around a vertical axis located near the center of the arch
o Movement occurs under function because diagonal and horizontal occlusal forces
are brought to bear on the partial denture
o

33.
34.CANTILEVER DESIGN
A cantilever is a beam supported at one end and can act as a first class lever
It should be avoided when ever possible in the oral cavity
A tooth is better able to tolerate a vertically directed force then a non-vertical, torquing or
horizontal force
35.

36.

3.2 MAXILLARY MAJOR CONNECTORS (1.26.16) (NOT ON

QUIZ 1)

37.RPD COMPONENTS
1. Major connector
2. Minor connectors
3. Rests
4. Direct retainers

5. Stabilizing or reciprocal components

6. Indirect retainers
7. Base

8.
9. MAJOR CONNECTOR rigid appliance that will give us cross arch stability
The part of a RPD that joins the components on one side of the arch with those on the
opposite side of the arch.
Cross arch stability through the principle of broad distribution of stress.
Contributes to the support of the prosthesis.
o In the MX arch, major connectors have positive contact with the soft tissue
10.DESIGN FEATURES OF MAJOR CONNECTORS
1. Rigid construction
2. Compatible metal alloy-chrome/cobalt
3. No impingement of free gingival margins or boney prominences
4. No interference with moveable tissues
11.
a.
minimal tongue and phonetic interference
12.5. Facilitates tooth/denture base placement
13.6. Relief provided beneath the connector
14.TYPES OF MAXILLARY MAJOR
CONNECTORS
1. Palatal strap
2. Anterior/posterior palatal strap
7

3. Palatal Plate
a. All metal
b. Acrylic resin with framework
mesh
c. Combinations of above

4. Anterior strap (horseshoe-U-shaped)

5. Palatal bar
6. Anterior / posterior bar
15.
16.FEATURES ONLY UNIQUE TO MAJOR
CONNECTORS
1. Only one per RPD
2. Crosses the midline

3. All other RPD parts are directly or

indirectly attached
4. Rigid-resists flexing and torque
5. Tissue coverage determined by:
17.
a. Kennedy classification
18.
b. Operators design
19.
c. Minimal as necessary
6. Reasonably hygienic
7. Accepted by patient

20.PALATAL STRAP
Overview
o Consists of one wide, thin, strap or band of metal that crosses the palate.
o minimum A/P width of 8mm
o A/P width increases with increased length of edentulous spaces

Advantages
1. Simple
2. Rigid-three planes
3. Thin-minimal bulk
4. Minimal phonetic interference
5. High patient acceptance
6. Majority of Cl III
7. Some hard palate support

Disadvantages
1. Not compatible with a torus or
prominent raphe
2. Generally not suitable for
anterior tooth replacement
3. Questionable for use with Cl I or
Cl II RPD

PALATAL BAR
Overview
o Narrow half-oval bar that crosses the palate.
o less than 8mm thick anterior/posterior
o Can be objectionable to patient.
ANTERIOR-POSTERIOR PALATAL STRAPS
Overview
o As named-consists of both an anterior and posterior strap that cross the palate.
Joined by A/P segments on each side of the lateral slopes of the palate.
Advantages
1. Exceptional rigidity-closed circle
2. Circumvent tori, median raphe
3. Versatile
a. Cl I, II with ant. mod. Spaces
b. Cl III with ant. mod spaces
c. Cl IV 4 or more ant. teeth
Disadvantages
1. Possible phonetic interference
2. Little support from hard palate
3. Not for steep/high palatal vault

ANTERIOR STRAP U SHAPED CONNECTOR (horseshoe)

Overview
o Curved strap of metal that runs along the lingual surface of the palate and/or the
teeth. Resembles a small horseshoe.
Advantages
1. Circumvent tori, median raphe
2. Steep/high palatal vault
Disadvantages
1. Less rigid-can flex at open end
2. Phonetic interference
FULL PALATE CONNECTORS
Overview
o Covers the entire portion of the hard palate back to junction of the hard and soft
palates.
Possible materials used
a. All metal
b. Acrylic resin with framework mesh
c. Combinations of the above
Advantages
1. Ultimate in rigidity and support
2. Ideal for Class I
3. Transition experience = RPD to complete denture
Disadvantages
1. Torus would require surgery
2. Phonetic interference
3. Patient acceptance
4. Potential for papillary hyperplasia

1.

2.
3.
4.

MAXILLARY MAJOR CONNECTOR TISSUE SIDE

Scribed on the surface of master cast (referred to as beading)
a. .5 mm width/depth
b. Stops 6mm short of gingival margins
Provides a visible finish line for casting
Prevents food under major connector due to intimate contact with tissue
Reduce/eliminate over tori or raphe

SELECTION CRITERIA FOR MANDIBULAR MAJOR CONNECTOR

Lingual bar-Class III, IV
Lingual plate
a. Less than 8mm vert. space
b. Inoperable tori
c. High lingual frenum
d. Periodontally compromised
Lingual plate-long span I, II
1. Flat/resorbed extension bases
2. Form of indirect retention
3. Stabilize weak teeth
4. Later add/replace teeth

I.
II.

II.