Tooth VS Tooth Tissue

Supported RPD
What is an RPD?
A removable denture that replaces some teeth in a
partially edentulous arch; the removable partial denture
can be readily inserted and removed from the mouth by
the patient.
• Can be removed &
replaced by patient
• Less expensive
• Won’t necessarily
improve function if
patient has ≥ 4 occlusal
units
Indications for RPD's

Edentulous area too long

for fixed prosthesis
Longer than 4 units is
more complex
 Indications for RPD's

• No posterior abutment for

a fixed prosthesis
 Indications for RPD's

• Excessive alveolar bone

loss (esthetic problem)
 Indications for RPD's

• Poor prognosis for complete

dentures due to residual ridge
morphology
 Indications for RPD's

Reduced periodontal support of

remaining teeth

Won't support a fixed

prosthesis)
Other Indications for RPD's

Need for immediate replacement of extracted teeth

Cost/patient desire considerations
Cross-arch stabilization of teeth needed
 Types of RPD’s

Interim Definitive (permanent?)

Interim Denture
(Provisional; Temporary)

Used for short time to provide:

• Esthetics
• Mastication
• Occlusal support
Interim Denture

Partial denture made while crowns

are being fabricated for a definitive
RPD
 Transitional Denture

Prosthesis to which teeth will be

added
Replaced after post-extraction tissue
changes
Made with intention of subsequently
altering it
Definitive RPD
• Definitive RPDs are constructed after extensive diagnosis, treatment
planning, and thorough preparation of the teeth and tissues for the
prosthesis. The length of service of definitive RPDs is intended to be
many years (customarily 5-10 years).
 COMPONENTS OF AN RPD

• Major Connector
Connects parts together
Principal functions:
Unification
Rigidity
 Components of a RPD

• Minor Connector
Connects other components
to the major connector
Principle functions:
Unification
Rigidity
 Components of an RPD

• Direct Retainer
Provides retention against
dislodging forces.
Components of an RPD

• Direct Retainer
'Clasp' or 'clasp unit' composed of:
Rest
Retentive arm
Reciprocal arm
Minor connector
 Components of an RPD

• Denture Base
Covers the residual
ridges
Supports the denture
teeth
 Kennedy Classification

• Class I
• Bilateral edentulous areas
located posterior to all
remaining teeth
 Kennedy Classification

• Class II
• Unilateral edentulous area
located posterior to all
remaining teeth
 Kennedy Classification

• Class III
• Unilateral edentulous area
bounded by anterior &
posterior natural teeth
 Kennedy Classification

• Class IV
• Single, but bilateral
(crossing the midline)
edentulous area located
anterior to remaining teeth
Applegate's Rules for the Kennedy
Classification

• Rule 1:
• Classification should follow rather
than precede extraction
 Applegate's Rules for the
Kennedy Classification

• Rule 2:
• If 3rd molar is missing &
not to be replaced, it is not
considered in the classification
 Applegate's Rules for the
Kennedy Classification

• Rule 3:
• If the 3rd molar is present and to
be used as an abutment, it is
considered in the classification
Applegate's Rules for the
Kennedy Classification
• Rule 4:
• If the second molar is
missing and not to be replaced,
it is not considered in the
classification
 Applegate's Rules for the
Kennedy Classification

• Rule 5:
• The most posterior edentulous area
determines the classification
Applegate's Rules for the
Kennedy Classification

• Rule 6:
• Edentulous areas other than those
determining classification are
called modification spaces
 Applegate's Rules for the
Kennedy Classification

• Rule 7:
• The extent of the modification is not
considered, only the number
 Applegate's Rules for the
Kennedy Classification
Rule 8:
There is no modification space in Class IV
Comparison
• The Class I type and the distal extension side of the Class II type
derive their primary support from tissues underlying the base and
secondary support from the abutment teeth
The Class III type derives all of its support from the abutment teeth
• Classes I, II, and IV removable partial dentures introduce an important
variable in the support of the prosthesis. They are not completely tooth
supported but derive varying degrees of support from the tissues of the
residual ridge.
• A Class III removable partial denture is entirely tooth supported. As a
result, forces are directed within the long axes of the abutments and
are transmitted to the associated periodontal tissues., limited
movement is possible, and this movement can result in non-axial
loading of the abutment teeth during function.
• Third, the need for some kind of indirect retention exists in the distal
extension type of partial denture, whereas in the tooth-supported,
Class III type, no extension base is present to lift away from the
supporting tissues because of the action of sticky foods and the
movements of tissues of the mouth against the borders of the denture.
This is so because each end of each denture base is secured by a direct
retainer on an abutment tooth. Therefore the tooth-supported partial
denture does not rotate about a fulcrum, as does the distal extension
partial denture.
• Fourth, the manner in which the distal extension type of partial
denture is supported often necessitates the use of a base material that
can be relined to compensate for tissue changes. Acrylic-resin is
generally used as a base material for distal extension bases.
• The Class III partial denture, on the other hand, which is entirely tooth
supported, does not require relining except when it is advisable to
eliminate an unhygienic, unesthetic, or uncomfortable condition
resulting from loss of tissue contact. Metal bases therefore are more
frequently used in tooth-supported restorations, because relining is not
as likely to be necessary with them.
Differences in Support
• The distal extension partial denture derives its major support from the
residual ridge with its fibrous connective tissue covering.
• The length and contour of the residual ridge significantly influence the
amount of available support and stability (Figure 10-3).
• The movement of the base under function determines the occlusal efficiency
of the partial denture and also the degree to which the abutment teeth are
subjected to torque and tipping stresses.
• The negative impact of the residual ridge character on the support provided
to the occlusion in a specific arch can be addressed through the use of a
dental implant, rendering displaceable tissue with movement potential into a
more resistant support for occlusion
Impression Registration.
• An impression registration for the fabrication of a partial denture must fulfil the following
two requirements:
1. The anatomic form and the relationship of the remaining teeth in the dental arch, as well
as the surrounding soft tissues, must be recorded accurately so the denture will not exert
pressure on those structures beyond their physiologic limits

2. The supporting form of the soft tissues underlying the distal extension base of the partial
denture should be recorded so firm areas are used as primary stress–bearing areas and
readily displaceable tissues are not overloaded. Only in this way can maximum support of
the partial denture base be obtained
• Zinc oxide–eugenol impression paste can also be used when only the extension base area
is being impressed.
• No single impression material can satisfactorily fulfill both of the previously mentioned
requirements.
Differences in Clasp Design
• The tooth-supported partial denture, which is totally supported by
abutment teeth, is retained and stabilized by a clasp at each end of each
edentulous space.
• Because this type of prosthesis does not move under function (other than
within the physiologic limitations of tooth support units), the only
requirement for such clasps is that they flex sufficiently during placement
and removal of the denture to pass over the height of contour of the teeth
in approaching or escaping from an undercut area.
• While in its terminal position on the tooth, a retentive clasp should be
passive and should not flex except when one is engaging the undercut area
of the tooth for resisting a vertical dislodging force.
• In the combination tooth- and tissue-supported RPD, because of the anticipated
functional movement of the distal extension base, the direct retainer adjacent to the distal
extension base must perform still another function, in addition to resisting vertical
displacement. Because of the lack of tooth support distally, the denture base will move
tissueward under function proportionate to the quality (displaceability) of the supporting
soft tissues, the accuracy of the denture base, and the total occlusal load applied.
• Because of this tissue-ward movement, a mesial rest may not transmit as much stress to
the abutment tooth because of the reduction in leverage forces that results from a change
in the fulcrum position.
• This serves the purpose of reducing or “breaking” the stress, hence the term stress-
breakers, and is a strategy that is often incorporated into partial denture designs through
various means.
• Wrought-wire or bar-type retentive arm more effectively accomplishes this purpose with
greater simplicity and ease of application. A retentive clasp arm made of wrought wire
can flex more readily in all directions than can the cast half round clasp arm. Thereby, it
may more effectively dissipate those stresses that would otherwise be transmitted to the
abutment tooth.
• Reciprocation and stabilization against lateral and torquing movements must
be obtained through use of the rigid cast elements that make up the remainder
of the clasp. This is called a combination clasp because it is a combination of
cast and wrought materials incorporated into one direct retainer.
• It is frequently used on the terminal abutment for the distal extension partial
denture and is indicated where a mesiobuccal but no distobuccal undercut
exists, or where a gross tissue undercut, cervical and buccal to the abutment
tooth, exists. It must always be remembered that the factors of length and
material contribute to the flexibility of clasp arms.
• From a materials physical property standpoint, a short wrought-wire arm may
be a destructive element because of its reduced ability to flex compared with a
longer wrought-wire arm. However, in addition to its greater flexibility
compared with the cast circumferential clasp, the combination clasp offers the
advantages of adjustability, minimum tooth contact, and better esthetics, which
justify its occasional use in tooth-supported designs.
• The amount of stress transferred to the supporting edentulous ridge(s)
and the abutment teeth will depend on:
(1) the direction and magnitude of the force;
(2) the length of the denture base lever arm(s);
(3) the quality of resistance (support from the edentulous ridges and
remaining natural teeth); and
(4) the design characteristics of the partial denture.
Thank you