DSRP 6602/6603 DISP 7212/7213 Lecture 2

Components, Tooth modifications

RPD Components

RPD Components
Major Connectors Minor Connectors Proximal Plates Rests Direct Retainers Indirect Retainers

Major Connectors
Connect parts of the prosthesis on one side of the arch to those on the opposite side All other parts are directly or indirectly attached to this component

Major Connectors
Rigidity is necessary to

Control the relationship of remaining teeth to each other, minimizing movement of the RPD

Control direction of force and torque against all remaining support structures & opposing occlusion
Provide greatest potential to control functional loading by utilizing and uniting all remaining structures of the arch

Maxillary Major Connectors

Maxillary Major Connectors

Considerations

Gingival tissue requires unrestricted superficial blood supply borders of MC should be minimum 6mm away & parallel to gingival margins The posterior limit for all maxillary MC should terminate just anterior to the vibrating line

All MC should cross midline at right angles, not diagonally, for better tongue acceptance

Maxillary Major Connectors

Types (4)

Full Palate Major Connector Single Palatal Strap Major Connector Anterior/Posterior Palatal Strap Major Connector

Horseshoe (U-shaped) Major Connector

Full Palate Major Connector

Full Palate Major Connector

Uniformly thin, broad, contoured plate following contours of/covering the (majority of the) palate Indicated in situations where remaining abutment tooth on either side is canine or 1st premolar, esp. in cases with severe vertical ridge resorption, complete denture scenario It is thought to be more readily accepted by underlying tissues and tongue because of close adaptation to palate, thinness, & thermal conductivity

Anterior/Posterior Strap Major Connector

What does this remind you of?

Anterior/Posterior Strap Major Connector

Very stable & rigid MC- strength from A/P straps linked by struts forming square frame, all components brace others against possible torque & flexure MX torus may be encircled by this MC Can be used with any Kennedy Class Posterior strap should be flat, at least 8mm wide, and located as far posteriorly as possible anterior to vibrating line

Single Palatal Strap Major Connector

Single Palatal Strap Major Connector

Indicated for situations with bilateral toothsupport and posterior edentulous spaces (Kennedy Class III) Sufficient rigidity = minimum 8mm width
Not indicated to connect anterior edentulous space with distal extension bases, for these cases use A-P strap Preferred by patients over an A-P strap

U-Shaped Major Connector

Horseshoe

U-Shaped Major Connector

Least desirable of MC designs, should never be used arbitrarily Lacks rigidity, allows lateral flexure under occlusal loads, leading to torquing to abutment teeth Useful in Class IV RPDs Primary indication is large inoperable torus, which extends posteriorly, inhibiting placement of posterior strap

Mandibular Major Connectors

Mandibular Major Connectors

Types (2)

Lingual Bar Major Connector Linguoplate Major Connector

Lingual Bar Major Connector

Located above moving tissue (floor of the mouth) and as far as possible below gingival tissue margins Superior border = 4mm below free gingival margin Inferior aspect has half-pear contour for greatest bulk & rigidity Preferred by patients over a linguoplate

Lingual Bar Major Connector

Note: 8 mm requirement vertically from FGM to base of bar. Boards require 7 mm minimum, (3 gingiva, 4 bar).

Lingual Bar Major Connector

Note: 4+ mm rule

National boards: 3+ mm rule

Linguoplate Major Connector

Superiorly should follow natural curvature of tooth contour above cingula, not extending above middle 1/3 of teeth The linguoplate itself is NOT considered an adequate indirect retainer. Must have terminal rests or cingulum rests beneath the plate in Kennedy Class I, IIs

Linguoplate Major Connector

Linguoplate Major Connector

Linguoplate Major Connector

Linguoplate Major Connector

Indications

Stabilization of periodontally mobile teeth by splinting Provision for future anticipated loss of teeth which may be added to the plate

RPD Components
Major Connectors Minor Connectors Proximal Plates Rests Direct Retainers Indirect Retainers

Minor Connectors
Connecting link from MC or denture base to all other RPD components Transfer stresses to abutment teeth and/or underlying supporting tissues Supports the clasp and rest assembly

Minor Connectors

Minor Connectors Retaining Denture Bases

Lattice Meshwork Ladder

Minor Connectors
Open lattice or ladder design preferable Should not interfere with setting of teeth Mandibular distal extension should extend at least 2/3 length of edentulous span 20 gauge wax relief between framework & basal seat

Guide Plane
A flat area on a tooth surface created to follow the contour of the tooth and define the path of insertion Location: on the mesial &/or distal of abutment teeth facing an edentulous space Size: 2-3 x 2-3 mm depending upon the tooth Guide plate: the framework metal that engages the guide plane

Minor Connector: Proximal Plate

Proximal guide plate in metal Guide plane

Minor Connectors: proximal Guide Plates

Helps to maintain arch integrity by anterior-posterior bracing action (resistance to horizontal forces) Acts as a retainer (secondary) due to frictional contact with parallel guiding surfaces

Guide Platesstability, support, retention

Minor Connectors: Rests are cast to fit rest seats

Rests & Rest Seats

Rests provide vertical support

Prevent impingement of soft tissues by resisting tissue-ward movement Direct & distribute occlusal loads to supporting abutment teeth Preserve established occlusal relationships

Occlusal Rests & Rest Seats

Outline of rest seat should resemble rounded , with apex pointing toward center of tooth Should be as long as it wide At marginal ridge, base of should be at least 2.5mm for molars and premolars

Occlusal Rests & Rest Seats

Height of marginal ridge should be reduced at least 1.0-1.5 mm to allow for bulk of metal for strength & rigidity Floor of rest seat should be apical to marginal ridge, spoon-shaped, concave

Occlusal Rest Seats

Deepest part

Rests & Rest Seats

Angle formed by occlusal rest and mC from which it originates should be less than 90 so that forces can be directed down long axis of abutment tooth If angle >90, slippage could occur and orthodontic tooth movement may result

Occlusal Rests & Rest Seats

Embrasure Rests & Rest Seats

Rest Seats
May be placed within sound enamel

Enamel not at increased risk for caries given appropriate oral hygiene

May be placed on any restorative material scientifically proven to be fracture and distortion resistant Important to inform pt ahead of time of the chance of perforation through existing restoration, potentially necessitating replacement or repair (esp. crowns)

Cingulum Rests & Rest Seats

Canine preferred over incisors If lingual slope of chosen tooth is gradual rather than perpendicular, bonded composite rest seat preferred Cingulum rest preferred over incisal rest (less tendency to tip tooth and esthetically superior)

Cingulum Rest Seats

Incisal Rests & Rest Seats

Placed at incisal angles of anterior teeth Least desirable placement of rest seat, possible esthetic issue, may cause orthodontic movement due to unfavorable leverage

Rounded notch at incisal angle, with deepest portion apical to incisal edge

Single Incisal Rest

Tooth Modifications for RPD Designs

Tooth modifications
Guide planes Create an area of retention Change of survey line (height of contour) Rests Survey crown

Guide planes
Prepared on the mesial and/or distal of abutment teeth aligned with the crest of the edentulous ridge Extend from marginal ridge to junction of middle and gingival thirds, depending upon the contour of the tooth NOT a meat cleaver slice, rather a gentle re-shaping of enamel which follows the contour of the tooth, curved planes

Distal guide plane #21

Create an area of retention

This may be accomplished by enameloplasty or composite resin bonding Enameloplasty does not change the height of contour when creating retention below the survey line Composite resin bonding effectively moves the survey line occlusally or incisally

#13: survey line too gingival, composite resin bonding indicated facially to move retention occlusally

Change in survey line

This may be accomplished by enameloplasty or composite resin bonding or survey crown

Change in survey line

Raising the survey line occlusally increases retention below the line Lowering the survey line gingivally decreases retention below the line

Change in survey line

Remove interferences when seating the retentive and reciprocal clasp arms or guide planes (lowering the survey line)

NOTE: reciprocal arm must be in suprabulge

Enhance esthetics of clasp placement (lowering the survey line)

Lowering survey line on distofacial of #21 for clasp placement

Remove interferences on mesial of #25 & #29

Rests
In enamel, NOT dentin (recurrent caries) In existing amalgams, composite resins In created composite resins In survey crowns In pre-existing crowns and FPDs, be certain to obtain informed consent.why?

Occlusal rests mesial of #21(enamel) & #29(gold)

Composite resin cingulum rests to be bonded to #22, 27

Survey crown
Why? When all else fails or the tooth would be an excellent candidate for full coverage in its own right

FGSC #29 (the survey line is lousy)

Occlusal view of survey crown #29