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Support, Biological Biomechanics & Forces of

Partial Removable Denture Prostheses

DEN 7251
January 23, 2019

Gary Braun, DMD, MS, FACP, FAGD Jerry Raybeck, DDS, MBA, MAGD
Introduction to
Biomechanics of PRDPs

Stewart's Clinical Removable Partial Prosthodontics Phoenix,


Cagna, Defreest - Chapter 4
McCracken - Chapter 4, pg 21-28
Krol – Chapter 3, pg 13-26
Components of RDPs
Partial removable dentures are designed to not be rigidly
connected to teeth or tissues!
As a result. they are subject to movement in response to
functional load, interaction with tissues, and gravitational
forces

How much do teeth move normally?


How does something like this function?

What is the response to the te e th , the or al tissues,


the periodontium?
Movement
Movement can typically occur in 3 fundamental planes:
1. Horizontal Horizontal
2. Sagittal
3. Frontal

Sagittal
Sagittal

Phoenix 2008
Movement
Movement, however, does not occur only in a single
plane but a combination of planes

Forces that cause movement


typically are a combination of
force vectors

A dominant force vector can


usually be identified!
Stewart's Clinical Removable Partial Prosthodontics
Phoenix, Cagna, Defreest
Forces acting on RDPs
Forces acting upon RDPs are distinct from the resultant
possible movements

1. Vertical (Dislodging)
2. Horizontal (Lateral)
3. Vertical (Seating)
Vertical (Dislodging- lifting force)
Horizontal (Lateral force)
Vertical (Seating)
Vertical (Seating)
Biomechanical Classifications of
Partial RDPs Based Upon Support
Entirely Tooth-Supported (Tooth-borne)
Characteristics:
1. Abutment teeth border all edentulous areas where tooth replacement is
planned
2. Functional forces are transmitted through abutment teeth to bone
Entirely Tooth-Supported (Tooth-borne)

Functionally similar to a fixed partial denture:


1. Forces directed through long axes of abutments via periodontal ligaments
2. Off-axis loading is limited
Entirely Tooth-Supported (Tooth-borne)

Functionally similar to a fixed partial denture:


Retention, retention, retention!
Retention "form" comes in a different form with RDPs vs. FPDs . . o r does
it??

Guide planes are important in RDP retention!


Combined Tooth-Tissue-Supported (Tooth/Mucosa-borne)
Characteristics:
1. Exhibits one or more edentulous areas which are not bordered by abutment
teeth (distal extension RDPs)
2. Functional forces are transmitted through abutment teeth and mucosa to bone
Combined Tooth-Tissue-Supported (Tooth/Mucosa-borne)
Functionally different from FDPs and Tooth-Supported RDPs:
1. Forces are principally directed through non-axial forces of abutments via
periodontal ligaments
2. Off-axis loading is enhanced
Combined Tooth-Tissue-Supported (Tooth/Mucosa-borne)
Functionally different from FDPs and Tooth-Supported RDPs:
1. Forces are principally directed through non-axial forces of abutments via
periodontal ligaments
2. Off-axis loading is enhanced
3. Underlying soft tissue is 250x more
displaceable than abutment teeth
4. Denture bases rotate around
abutments and their respective
fulcrum axes
5. Resultant forces can be extremely
damaging to abutments

We must "think" about RDP design


differences basis upon support!!
Tissue-Supported (Mucosa-borne)

Characteristics:
1. Regardless of teeth present, support is derived entirely from mucosa
2. In USA, traditionally considered interim prostheses and are not definitive treatment
Tissue-Supported (Mucosa-borne) (Interim Prosthesis)

Are minimally functional:


1. Usually do not contain a metal framework, rest seats
2. Forces are not directed to abutment teeth, clasps only provide retention
Mechanical Levers & Control of
Forces in Removable Partial Dentures
Fparallel = m•g•sin(theta)
Fperpendicular = m•g•cos(theta)

Power

Fundamental Mechanics
Fundamental Mechanics

Power Resistance

Power = Resistance
Class I Lever
R F P

Class I Lever
F P

Class I Lever
Class II Lever
F R P

Class II Lever
Fulcrum Power
F P

Class II Lever
Class III Lever
F P R

Class III Lever


Fulcrum-Line Axis
Why should we know this?

Which lever is considered the:


“least advantageous”
“most advantageous”
Mechanical Power Arm
Advantage
Resistance Arm
Avant WE. Indirect retention in partial denture design. J Prosthet Dent. 1966 Nov-Dec;16:1103-10.
n

Avant WE. Indirect retention in partial denture design. J Prosthet Dent. 1966 Nov-Dec;16:1103-10.
Lever Classifications
Indirect Retainers= aid to reduce lifting of the prostheses

t
t
The lower the mechanical advantage, the more
lifting force is necessary on the extension base
to move denture base off it’s tissue “seat”

Increasing distance between fulcrum/resistance


and power source reduces total force required
to dislodge the simulated prosthesis
FORCE MECHANICS - CLASS I
TRIANGULAR OR TRIPOD FOR CLASS II
ARCH- how stable is #30 area?
Kennedy CLASS III RDP
Take-away:

Our goal in removable prosthodontics


is to reduce the amount of movement
of the prosthesis.
Take-away:

By incorporating principles of class II


and III lever systems, we can effectively
“reduce the mechanical advantage” of
the distal-extension RDP thus reducing
the total amount of prosthesis
movement!
The Biological Foundation for the
Partial Removable Denture Prosthesis
Support= Broad Stress Distribution

P P P P
S S S S

P- primary
S- secondary
*Retention Stability

*RETENTION: ANATOMICAL- Size of the denture bearing area & quality of the denture
bearing area. Parallel ridge walls. PHYSIOLOGICAL : Saliva =Adhesion /cohesion -
Interfacial surface tension & capillarity atmospheric pressure. Gravity, MECHANICAL:
Undercuts Retentive springs; Magnetic forces; Denture adhesives Suction chambers &
discs; Palatal implants; MUSCULAR: Oral musculature; Facial musculature
P S
P P S
P
S S
S

Support- Broad Stress Distribution = think


“Snowshoe Effect” is kindest to soft tissue
and underlying bone…
RDP Clasp Components

Steffel 1962
RDP Clasp Components

More Tipping Less Tipping


RDP Retention & Stabilization - Clasping
RDP Retention & Stabilization – Minor Connectors
RDP Retention & Stabilization – Guide Surfaces

More parallel, more retentive


Biological Response of Force
Mechanics Associated with
Partial RDP Movement
Periodontal Ligaments Root Anatomy

Proffit 2012 Newman 2012


Mechanisms of Forces

Center of
Rotation

Vertical Horizontal
Mechanisms of Forces

Proffit 2012
Mechanisms of Forces

P F

F
R

R
P F R

Mechanisms of Forces
Distal rest Mesial rest

P F P F

R R

Mechanisms of Forces
Forces generated in a vertical direction
through the center of a tooth are best
for maintenance of the periodontium of
that tooth

Forces should be as close to the center


of long axis of the tooth as possible,
outside of this causes horizontal rotation
(and potential bone loss)
Forces generated in a lateral direction
are not well tolerated by the bone and
periodontium

Lateral forces cause both compression


and tension to the periodontal
membrane ultimately transmitting to
the bone and causing resorption

Radiographically this is seen as a


widened periodontal ligament
Biological Design of RDPs

When considering proper design for removable partial


dental prostheses to properly transmit forces to abutment
teeth, the design should:

1. Transmit forces down the abutment


tooth in a vertical direction
2. Transmit forces parallel to the long
axis of the tooth
3. Prevent or minimize lateral forces

Newman 2012
Abutment Teeth

Predicted longevity of the prosthesis depends on the


“strength”, status, and needs of proposed abutment teeth
Characteristics of “ideal” abutment
teeth for RDPs:
1. Broad, square angular shape crown
2. Large divergent roots, non-conical
3. Caries free
4. Vital
5. Intact, unrestored enamel surfaces
6. Widely distributed
1. Broad, non-symmetrical crown shape
2. Large clinical crown & divergent roots
3. Caries free (& periodontally sound)
4. Vital
5. Intact, unrestored enamel surfaces
6. Widely distributed
Gradual loss of natural teeth creates changes in occlusion,
support, and position in dental arch

Wide distribution of abutment teeth increases stability


Take a Break…then
it’s lab time!