Design Consideration in Reducing Stress in RPD

Design consideration in reducing stress in rpd/
oral surgery courses

1. 1. Design consideration inDesign consideration in the
control of stresses inthe control of stresses in
removable partial dentureremovable partial denture
INDIAN DENTAL ACADEMY Leader in continuing
Dental Education
2. 2. IntroductionIntroduction Maxwell -common
observation indicates the ability of living things to
tolerate force is largely dependent upon the magnitude
or intensity of the force.
www.indiandentalacademy.com
3. 3. Basic ConceptsBasic Concepts Stress Equalization
Physiologic Basing Broad Stress Distribution
4. 4. Stress EqualizationStress Equalization The rigid
connection between the denture bases and the direct
retainer on the abutment teeth is damaging and that
some type of stress director or stress equalizer is
essential to protect the vulnerable abutment teeth.
Stress EqualizerStress Equalizer-: According to GPT
7According to GPT 7 A device which relieves the
abutment teeth of all or part of occlusal forces.
5. 5. Types of Stress Equalizers Type I: Hinges,sleeves
and cylinders,and ball and- socket devices. Type II:
Designs having flexible connection which include the
use of wrought wire connection,divided major
connectors or other flexible devices for movement of
distal extension. www.indiandentalacademy.com
6. 6. AdvantagesAdvantages Reduced horizontal force.
Forces are distributed equally on abutment and the
soft tissue. Stimulating effect on the underlying tissue
thus reduced tissue changes. Frequency of relining is
reduced. www.indiandentalacademy.com
7. 7. DisadvantagesDisadvantages Fragile,complex and
costly. Vertical and horizontal forces are concentrated
on the residual ridge ,thus causing resorption.
Requires constant maintenance. Difficult to repair.
Bulky and annoying to patient.
8. 8. Physiologic BasingPhysiologic Basing The
equalization of stress can be best and most simply be
accomplished by some form of physiologic basing, or
lining, of the denture base. Mucosa is recorded in its
functioning form. Soft tissue offer more resistance to
further compression.This increases resistance
provided by mucosa equates to that of periodontal
ligament of abutment tooth. Artificial teeth will be
above occlusal plane in rest
position.www.indiandentalacademy.com
9. 9. RequirementsRequirements Direct retainer/retentive
clasps designed with minimal retention A rigid frame
work Well adapted, broad coverage denture bases.
10. 10. AdvantagesAdvantages Stimulating effect on
underlying tissue Simplicity in design and construction
Reduced stresses on abutment tooth
11. 11. DisadvantagesDisadvantages Not well
stabilized against lateral forces. Premature contacts.
12. 12. Broad Stress DistributionBroad Stress
Distribution Advocates believe that excessive trauma
to remaining teeth and the residual ridge can be
prevented by distributing occlusal forces over as much
the available area of teeth and soft tissue as possible.
13. 13. AdvantagesAdvantages Broad stress
distribution. Excellent horizontal stabilization.
Removable splinting. Easier and less expensive to
construct. Less danger of distortion and breakage of
denture. www.indiandentalacademy.com
14. 14. DisadvantagesDisadvantages Less
comfortable. Requires good maintenance of oral
hygiene. www.indiandentalacademy.com
15. 15. ROLE OF RPDROLE OF RPD
COMPONENTS IN STRESSCOMPONENTS IN
STRESS CONTROLCONTROL
16. 16. Major Connector:Major Connector: Rigid
Lingual plate properly supported by rest can aid in
stress distribution and support periodontally weakened
anterior teeth. It also adds rigidity thus increases cross
arch stabilization. Complete palatal major connector
that contacts lingual surfaces of all remaining teeth
distributes functional stress widely as possible.
17. 17. Minor ConnectorMinor Connector Offers
horizontal stability to partial denture against lateral
forces of prosthesis. Maximum contact of proximal
plate of minor connector with guiding plane provides
better horizontal stress distribution.
18. 18. RestsRests Properly prepared rest seats
control stress by directing the forces transmitted to
abutment teeth down the long axis of teeth.
19. 19. Direct RetainerDirect Retainer RPD should be
designed such that the clasp retention is kept to
minimum yet provide adequate retention to prevent the
dislodgement of the denture by unseating forces.
20. 20. Clasp DesignClasp Design Flexible clasp
produce least stresses than rigid clasp. Longer the
clasp more will be its flexibility. But they contribute less
resistance to horizontal forces. Cross section of clasp
arm. Material used for construction of clasp.
21. 21. Circumferential ClaspCircumferential Clasp
Engage mesiobuccal undercut-shouldnt be used in
distal extension. Reverse circlet clasp that engage
distobuccal undercut is acceptable. Wedging effect of
reverse circlet clasp can be overcome by occlusal
rests. www.indiandentalacademy.com
22. 22. Vertical projection, or Bar,Vertical projection, or
Bar, clasp:clasp: The vertical projection T clasp
releases tortional stress on the terminal abutment
tooth.This releasing action is accomplished when
retentive clasp tip rotates gingivally into a greater
undercut as tissueward forces are applied to denture
base . Rotation takes place around distal occlusal rest.
23. 23. Combination ClaspCombination
Clasp:(Kotowicz:(Kotowicz 1973)1973) Circumferential
clasp with retentive arm made of wrought metal which
is more flexible and flex in all spatial plane.It has a
stress breaking action. Rest of the clasp are rigid and
better resist the lateral force. Indicated:Indicated:-
presence of mesiobuccal undercut -Presence of
cervical or buccal undercut.
24. 24. Kratochvil in 1963Kratochvil in 1963 Explained
the system with mesial rest. Long guide planes that
extend onto the tooth- tissue junction. I-bar retainer.
25. 25. RPI system: Krol ,1973Krol ,1973 Mesial
rest,proximal plate,I- bar. Minimal tooth
contact,minimal gingival coverage and stress control.
Mesioocclusal rest with minor connector placed into
the mesiolingual embrasure area but no tooth
contacting the adjacent tooth. Distal guide plane,
extending from the marginal ridge to the junction
between middle and the gingival third of the abutment
tooth.www.indiandentalacademy.com
26. 26. RPA system: Krol ,1980Krol ,1980 Rest,
proximal plate,Akers retentive clasp Modified
circumferential clasp www.indiandentalacademy.com
27. 27. Clasp PositionClasp Position Position of clasp
in relation to height of contour is more important than
the number of clasp. Quadrilateral configuration Tripod
configuration Bilateral configuration
28. 28. Quadrilateral ConfigurationQuadrilateral
Configuration Most often used in class III arches
particularly in presence of modification space.
Retentive clasp placed on each abutment tooth
adjacent to the edentulous area.
29. 29. Tripod ConfigurationTripod Configuration
Primarily for class II If there is a modification space on
the edentulous side,the teeth anterior and posterior to
the space are are clasped to bring about the tripod
configuration. www.indiandentalacademy.com
30. 30. Bilateral ConfigurationBilateral Configuration
Most of RPDs fall into this category. The clasp exert
little neutralizing effect on the leverage induced . Must
use other means of reducing stress.
31. 31. Indirect Retainer:Indirect Retainer: It helps the
direct retainer prevent displacement of the distal
extension denture by resisting the rotational movement
of the denture around fulcrum line established by the
occlusal rests. www.indiandentalacademy.com
32. 32. Located as far anterior and opposite side of
the fulcrum line. They counteract the forces attempting
to move the denture base away from the residual ridge
by moving the fulcrum far from the force. In class I
arch, indirect retainer is placed as far anterior to the
fulcrum line as possible.
33. 33. In class II arch, single indirect retainer on side
of arch opposite distal extension
34. 34. In class IV, indirect retainer placed posterior to
the fulcrum line. lingual plate major connector
supported at each end of anterior teeth by rests.
35. 35. Denture Base:Denture Base: Should cover
extensive area of supporting tissue as possible.
Should satisfy the snow shoe principle Denture
flanges should be as long as possible. Accurate
adaptation No overextension
36. 36. Forces of Adhesion and CohesionForces of
Adhesion and Cohesion To enhance quality of
retention throughTo enhance quality of retention
through adhesion and cohesion denture base-
adhesion and cohesion denture base- Must fit
edentulous ridge accurately Must cover maximum area
of available support. Quality of saliva.
37. 37. Atmospheric Pressure: Accurately casted
major connector with beaded margins can contribute
slight amount of peripheral seal and retention.
38. 38. Neuromuscular Control Properly contoured
borders of a denture base aid in retention by permitting
patient to use neuromuscular skills to avoid dislodging
base. Overextended denture bases will constantly be
unseated by the action of border tissues.
39. 39. Frictional ControlFrictional Control Guide
planes are placed on the proximal surfaces of the teeth
adjacent to the edentulous spaces or it can be created
on the restorations placed on the teeth. Guide planes
should be created on as many teeth as possible.
Guide planes increase retention of partial denture
through frictional contact.
40. 40. It is more importantIt is more important to
preserve whatto preserve what already exists than
toalready exists than to replace what isreplace what is
missingmissing www.indiandentalacademy.com
41. 41. References Clinical Removable Partial
Prosthodontics- Stewart ,Rudd,Kuebker,2ND edition.
Removable Partial Prosthodontics- McCracken,9th
edition. Removable Partial Denture-Robert P.Renner
Louis Boucher www.indiandentalacademy.com
42. 42. Removable Partial Prosthodontics-Joseph
E.Grasso, Ernest L.Miller,3rd edition. Removable
Denture Prosthodontics- A.A.Grant W.Johnson,2nd
edition. Designing of Partial Denture-Osbourne
43. 43. Advanced Removable Partial Denture, James
S. Brudvick. Partial Dentures, Fritz Singer. Kim et
al,Comparison of cast Ti-Ni alloy clasp extension with
conventional RPD clasps JPD 2004;91:374-82 Mona
K Marei,Measurement(in vitro)of the amount of force
required to dislodge specific clasps from different
depths of undercut JPD 1995;74:258-63.
44. 44. Arthur R Frechette,Influence of partial denture
design on distribution of force to abutment teeth JPD
1996;622 Hussein G El Charkawi,Effect of splinting of
load distribution of extracoronal attachment with distal
extension prosthesis in vitro- JPD 1996;76:315-20
RPD research and its clinical significance JPD
1978;39:203 www.indiandentalacademy.com
45. 45. THANKTHANK YOUYOU
46. 46. Discussion Frechette (1956),was the first one
to investigate the effect of RPD design on forces
imparted to the abutment teeth. Recent studies shows
new materials used in cast frame work,different clasp
designs. At least two teeth on each side should be
splinted when extracoronal distal extention attachment
prosthesis is used.(JPD 1996) Its also documented
that cast round clasp has more flexibity and when
incorporated in restproximal plate of Akers design for
distal extension resulted in better distribution of
torquing force.(JPD 1996)
47. 47. Ti-Ni alloy cast frame work is been introduced
because of its greater flexibility and accuracy of
fit.(JPD 2004) www.indiandentalacademy.com
48. 48. OcclusionOcclusion A smoothly functioning
occlusion that is in harmony with the movements of
both the TMJ and the neuromusculature will minimize
stress transferred to the abutment teeth and residual
ridge. Neither the metal of the framework nor the
artificial teeth of the partial denture should receive
initial occlusal contact as the jaws come together.
Artificial posterior teeth should have reduced
buccolingual width. Number of teeth being should be
reduced. Teeth should have sharp cutting surfaces
and sluiceways. Reduce the steep cuspal
inclines.www.indiandentalacademy.com
49. 49. Splinting of abutmentSplinting of abutment
Adjacent teeth may be splinted by means of crowns to
control stress transmitted to a weak abutment tooth.
Splinting two or more teeth actually increases the
periodontal ligament attachment area and distributes
the stress over a larger area of support.
50. 50. Periodontally used teeth can be stabilized
against horizontal forces by RPD, multiple rests and
clasps are used to contribute this horizontal
stabilization. Curved arch splinting results in both
bucco-lingual and mesiodistal stabilization. Splinting
with removable RPD result in cross arch stabilization.
51. 51. conclusionconclusion As we understand that
that the stresses created by the RPDs cannot be
nullified completely,so attempts has to be made to
control stresses by incorporating proper design
consideration as discussed.Thus the longevity of the
supporting hard and soft tissues can be increased.
52. 52. Thank you Thank you
53. 53. www.indiandentalacademy.com
54. 54. www.indiandentalacademy.com
55. 55. Methods of reducing stress toMethods of
reducing stress to abutment teeth and
supportingabutment teeth and supporting
tissues:tissues: According to Kratochvil
(1971)According to Kratochvil (1971) Decreasing the
mobility of the abutment teeth. Improving the
supporting ability of the edentulous area. Reducing the
amount of force applied to the abutment teeth and
residual ridges. Creating favorable distribution of the
load between the abutment teeth and the ridges.
56. 56. Decreasing the mobility of theDecreasing the
mobility of the abutment teethabutment teeth Perform
an occlusal equilibration. Splinting the teeth Preparing
and positioning of guiding planes properly Designing
and positioning of rest seat properly.
57. 57. Improving the supporting ability ofImproving
the supporting ability of the edentulous areathe
edentulous area Proper impression procedures
Maximum coverage of residual ridges Relining and
rebasing the prosthesis in a timely fashion
58. 58. Reducing the amount of force appliedReducing
the amount of force applied to the abutment teeth and
residualto the abutment teeth and residual
ridgesridges Reducing the number of posterior teeth
Reducing the buccolingual width Maintaining
sharpness of the cusps Adequate sluiceways
59. 59. Creating favorable distribution of theCreating
favorable distribution of the load between the abutment
teeth andload between the abutment teeth and the
ridgesthe ridges Provide physiologic influence on
edentulous denture base area. Extensive stress
distribution by use of rigid RPD design Select clasps
that provide direct retention Use of stress breaking
prosthesis. www.indiandentalacademy.com

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