Dr Anas Alibrahim

BDS, MDSc (Pros), PhD

 Kennedy Classification
 Class 1: Bilateral free-end
saddle
 Class 2: Unilateral free-end
saddle
 Class 3: Unilateral bounded
 Class 4: Anterior, across the
midline
 All except class 4 have
modifications
Kennedy class I modifications
Kennedy class II modifications
Kennedy class III modifications
Kennedy class IV
Number Clinical Laboratory
of stage
History, examination, diagnosis,
and treatment planning
1 Primary impressions Fabrication of primary
casts and special trays
2 Border moulding (for free end Fabrication of
saddles) and secondary secondary casts and
impressions record blocks

3 Jaw relation registration and teeth Mounting onto

selection articulator, teeth
setting, and wax up
4 Trial insertion of waxed up Acrylic processing
denture
5 Insertion
6 Recall
History, Examination, Diagnosis, and
Treatment Planning
 History and main complaint

 Denture history: problems

with previous dentures,
timing of problems

 Dental history: previous

dental experiences, reasons of
loss of teeth, oral hygiene
History, Examination, Diagnosis, and
Treatment Planning
 Medical history:
 Diabetes, hypertension, Sjogren’s
syndrome: xerostomia
 Advanced stage of pregnancy, severe
anaemia, osteoporosis, cardiac failure:
Intolerance to supine position
 Cerebro-vascular accidents, facial
paralysis, parkinson disease:
compromised neuromuscular control
 Osteoporosis: increased rate of bone
resorption
 Social history: Smoking (including
hookah!) and alcohol
History, Examination, Diagnosis, and
Treatment Planning
 Extra-oral : facial symmetry, jaw
opening and closing movements, TMJ
 Intra-oral examination:
 Mouth open: oral hygiene, caries,
restorations (recurrent caries)
periodontal disease, tooth mobility,
length of edentulous spaces,
abnormal tooth movements
 Mouth closed: over-erupted teeth,
Inter-arch space, depth of anterior
overbite
 Radiographs
 C1 : Primary impressions - stock trays

 Metal or plastic
 Perforated or
unperforated
 Square cross section
 Ideally, there should be a
space of about 4mm
between the flange of
the tray and the surfaces
of the teeth
Limitations of stock trays
C1 : Primary impressions – Tray corrections
 Tray corrections:
 Materials:
a. Impression compound
b. Pink modelling wax
c. Silicone putty
 Use these materials to fill
dead spaces (distal
extension saddles and
palate) and modify
underextended areas
C1 : Primary impressions – Tray corrections
 Compound in teeth areas
should be removed:
 Prevent accurate re-
insertion of tray
 Eliminate space of
impression material
C1 : Primary impressions – Materials
 Elastic impression
materials should be used
 Reversible hydrocolloids
(agar – agar)
 Irreversible
hydrocolloids (Alginate)
 Silicone putty
(additional or
condensational)
 Use the right adhesive
C1 : Primary impressions
 Indelible pencil line is
drawn to indicate the
extension of the special
tray
 Drying out must be
prevented (if alginate) by
covering the impression
with a damp napkin and
placing it in a plastic bag
L1 - Fabrication of primary casts

 Impressions are poured

in plaster for fabrication
of primary casts
 L1 : Fabrication of special tray
 Cold or Light cured
acrylic can be used for
special trays
 Perforations?
 Wax spacer (3 mm)
 Borders should be 2
mm short of the full
depth of sulci at rest in
distal extension areas
 Fabrication of special tray – use
of stops
 Stoppers are made to
maintain intended spacing
for impression material and
to ensure consistent
positioning of tray
 Formed in laboratory by
cutting windows through the
wax spacer over which the
acrylic tray is fabricated
Fabrication of special tray – use
of stops
• Alternatively, stops can
be added in clinic using
a border moulding
material
• Suitable locations for
stops: areas related to
incisal and occlusal
surfaces of teeth, palate,
posterior border of
maxillary tray,
retromolar pads
C2 :Checking, correcting tray
correction, and border moulding
 Any areas of overextension
should be reduced
 Any areas of underextension
should be corrected
 In distal extension saddles,
mandibular tray should cover
retromolar pads and maxillary
tray should enclose tuberosities
and extend to hamular notches
 Green stick is added in distal
extension saddles and border
moulding is carried out
C2 : Secondary impressions - materials
Impression
materials

Non elastic Elastic

Synthetic
Hydrocolloids
elastomers

Reversible Irreversible Polysulphide Polyether Silicones

Addition Condensation
silicone silicone
C2 – secondary impression
 Impression can be made
using alginate or
medium body
elastomeric impression
material
L2 – Fabrication of secondary cast

 Secondary impression is
poured in stone for
fabrication of secondary
(master) cast
Number Clinical Laboratory
of stage
History, examination, diagnosis,
and treatment planning
1 Primary impressions Fabrication of primary
casts and special trays
2 Border moulding (for free end Fabrication of
saddles) and secondary secondary casts and
impressions record blocks

3 Jaw relation registration and teeth Mounting onto

selection articulator, teeth
setting, and wax up
4 Trial insertion of waxed up Acrylic processing
denture
5 Insertion
6 Recall
 Intercuspal position
 Maximal intercuspal position:
the complete intercuspation of the
opposing teeth independent of
condylar position
 Also referred to as the best fit of
the teeth regardless of the
condylar position
 Achieved with no discernible
anteroposterior or lateral slide of
the mandible
 It is a position that we (dentate
subjects) should be able to find
spontaneously
 Represents the closest relationship
of mandible to maxilla
Retruded contact position
 Retruded contact position:
that guided occlusal
relationship occuring at the
most retruded position of the
condyles in the joint cavity
 1-1.5 mm distal to intercuspal
position
 Fewer tooth contacts than in
intercuspal position
 Greater vertical separation of
mandible from maxilla than
in intercuspal position
Rest position and freeway space
 When the muscle of mastication
are relaxed
 Is the position at which rest
vertical dimension is measured
during prosthetic treatments
 A space is present between
maxillary and mandibular teeth
(freeway space or interocclusal
distance)
 The space is of wedge shape
 The separation between incisor
is within the range 2-4 mm
C3 - Jaw relation registration
 Objective
 Can be recorded at the
intercuspal position or
the retruded position
 Complexity depends on
the number and occlusal
relationship of the
remaining teeth
Number and occlusal relationship of the
remaining teeth – stable intercuspal position
 Sufficient teeth with
stable intercuspal
position
 Casts can be easily
and accurately placed
in the intercuspal
position
 No need for occlusal
rim
Number and occlusal relationship of the
remaining teeth – occlusal stop
 Occlusal stop at a
desired jaw relationship
(acceptable intercuspal
position)
 Difficult to be
reproduced with casts
because of insufficient
number of occluding
units
 Occlusal rim is required
Number and occlusal relationship of the remaining
teeth – unacceptable intercuspal position
 Occlusal stop at an
undesired jaw relationship
(unacceptable intercuspal
position)
 Unacceptable position
could be a result of tilting,
or drifting, or loss of tooth
substance
 Often associated with
mandibular deviation and
reduced occlusal vertical
dimension
 Occlusal rim is required
Number and occlusal relationship of the remaining
teeth – absence of occlusal contact

 Remaining teeth can’t

produce an occlusal stop
 Occlusal rims are required
 Jaw relation is usually
recorded at the retruded
contact position
 Category Presence Occlusal stop Occlusal Recording
of occlusal (desired/undesired) rims of jaw
stop relationship

Stable Present Desired Not At existing

intercuspal required intercuspal
position position

Occlusal Present Desired required At existing

stop intercuspal
position

Unacceptable Present Undesired required At a new

intercuspal desired
position position

Absence of Absent --- required At retruded

occlusal contact
contact position
Occlusal rims
 Placed on temporary
bases of acrylic resin or
shellac
 Should have good
stability and retention in
the mouth
 Adjusted until desired
jaw relation is achieved
 Bite is then recorded
using a suitable bite
registration material
 In “unacceptable
intercuspal position” and
“absence of occlusal
contact” cases, rest vertical
dimension should be
assessed (1)
 Occlusal vertical dimension
(2) should then be adjusted
until freeway space is
adequate (2- 4 mm)
 Freeway space (3) = rest
vertical dimension (1) -
Occlusal vertical dimension
(2)
 When guidance from
posterior teeth has
been lost “absence of
occlusal contact”, bite
is recorded with the
mandible in the
retruded position
C3 – Teeth selection
 Select teeth that have the
same crown length and
width as the patient’s
natural teeth
 Select a shade which
matches the patient’s own
natural teeth
 Design principles
1. Keep design simple
2. Keep acrylic away from gingival
margins as far as possible
3. Use Wrought clasps for retention
where possible
4. Maximum coverage in distal
extension saddles
5. Narrower and shorter occlusal table
in distal extension saddles
6. Polished surface should be shaped
correctly to enhance retention and
stability by muscular forces
7. Place teeth in neutral zone (distal
extension saddle cases)
L3 – Mounting casts onto articulator,
teeth setting, wax up

 Casts are mounted on

articulator according to
the provided bite
registration
 Teeth setting and wax up
 C4 – Trial insertion of waxed up denture
 Check wax up design
 Check retention and stability (wrought
wires are not incorporated at this stage)
 Check extensions
 Check appearance
 Check that jaw relation registration is
correct
 Natural teeth should contact in the
same way with the trial denture in the
mouth as they do without the trial
denture (when stable intercuspal
position or desired occlusal stop)
 Even contact between teeth at the
optimal occlusal vertical dimension in
RCP (when absence of occlusal contact)
 Determine post dam area
L4 – Acrylic processing
Flasking
↓
Dewaxing
↓
Packing
↓
Curing (processing)
↓
Defalsking
↓
Finishing and polishing
 C5 – Insertion of the completed denture
 Check that the acrylic
finish is satisfactory
 Insert denture in the
mouth
 Check extension of acrylic
 Check appearance
 Check occlusion
Checking acrylic finish – impression
surface

1. An undercut flange
2. Acrylic spicules
3. Acrylic nodules
4. Sharp acrylic margins
Fitting of acrylic partial dentures
 Common areas requiring
adjustment:
A. Interproximal C
extensions A
B. The region where clasp B

exits from resin

C. Tissue undercuts
Pressure indicating paste (PIP)
 PIP is used to
identify:
• Undercut areas on
impression surfaces
• Pressure areas on
impression surfaces
• Overextended borders
and flanges
C5 – Insertion of the completed
denture – assessment of occlusion

 Visual assessment
 Articulating paper
 Shimstock
C5 – Insertion of the completed denture –
assessment of occlusion- articulating paper
C5 – Insertion of the completed denture –
assessment of occlusion- shimstock
C5 – Insertion of the completed denture –
adjustment of occlusion
 Supporting cusps
(functional cusps):
Maxillary palatal and
mandibular buccal
 Contact between the
functional cusps and the
opposing fossae maintain
the occlusal vertical
dimension
 In general, try to avoid
adjusting functional cusps
Important instructions
 Cut your food into small pieces, and take your time chewing. Avoid tough and
sticky food during the first weeks

 Clean your denture after every meal. A soft brush with soap and cold water can
be used. Alternatively, denture cleanser can be used

 Clean your denture over a basin filled with water

 Remove your dentures at night and store them in water to prevent dimensional
changes

 Pain and soreness might occur with new dentures. Adjustments may be
required. Leave out dentures and arrange appointment with your dentist. Wear
the dentures the day you have appointment so the dentist can see the sore areas

 Never attempt to adjust the denture yourself

C6 - Recall
 First review visit should be arranged after one to
three days

 Periodic recall at least once a year

 If any problem arises, appointment should be

arranged.

 Dentures usually need to be relined/rebased or

even replaced after five years or more
References
 McCracken's Removable Partial Prosthodontics , 12th ed: Alan B. Carr and
David T. Brown (Chapter 23, Interim removable partial dentures)
 A Clinical Guide To Removable Partial Dentures : Davenport et al. (Chapter
6)
 A Clinical Guide To Removable Partial Dentures : Davenport et al. (Chapter
7)
 A Clinical Guide To Removable Partial Dentures : Davenport et al. (Chapter
8)
 A Clinical Guide To Removable Partial Dentures : Davenport et al. (Chapter
16)
 A Clinical Guide To Removable Partial Dentures : Davenport et al. (Chapter
17)
 A Clinical Guide To Removable Partial Dentures : Davenport et al. (Chapter
20)
 A Clinical Guide To Removable Partial Dentures : Davenport et al. (Chapter
21)
 Handout
Thank you