Tissue damage by RPD

Causes of Damage related to the wearing of RPDs

Harmful effects can arise from wearing RPD in a variety of ways:

[Link] the plaque which is accumulated around any RPD;

[Link] direct trauma by individual components of RPD;
[Link] excessive functional forces transmitted by ill-designed
prosthesis
[Link] occlusal errors.
Damage to the Ginigival Margin
Damage to the Mucoperiosteum
Damage to the Teeth
Damage to the Bone of the Edentulous Ridge

Means of Avoiding Damage by RPD

Damage to the Gingival Margins
Periodontal Considerations in Clasp Design
Periodontal Considerations in Connectors Design
Damage to the teeth
 Damage to the teeth
The possible causes are:
[Link] movement of RPD base or clasps can abrade
hard tissue and caries may occur
[Link] occlusal rest may lead to enamel decalcification & caries
if the oral hygiene is not good
[Link] action between metal components of RPD and metallic
filling may affect tooth pulp.
[Link] pressure exerted by clasp arm without reciprocal arm,
leads to tooth tilt.
[Link] use of rigid connection between saddle & abutment (minor
connector) (I &II), leads to excessive torque on tooth and mobility
[Link] of RPD on occlusal rest with a flexible major connector,
leads to more lateral forces exerted on teeth & mobility.
Tooth Damage caused by vertical RPD movement
Tooth damage & decay caused by a poorly designed RPD
Epulis Fissuratum where RPD rests
Hyperplastic folds of an Epulis Fissuratum
caused by irritation of RPD flange
Means of avoiding damage by partial denture:

1- The denture design should not interfere with self-cleansing action

of cheek & tongue and must not offer spaces and traps in which food
debris can accumulate.
2- Clasp arm should not exert much pressure on the tooth.
3- The type of the clasp should be suitable for the condition of the
abutment (e.g. rigid clasps should be not used for weak abutments)
Periodontal Consideration in Clasp Design:
[Link] should be designed to minimize interference with normal
stimulation of gingival tissues.
[Link] should be at least 5 mm clearance between vertical components
(e.g. minor connectors, proximal plates, etc.)

[Link] should be at least 3 mm clearance between the approach arm

of bar clasps and gingival margin.
Periodontal Considerations in Major and
Minor Connectors Design:
[Link] major connectors must be located at least 6 mm
from the gingival margin.
[Link] major connectors should be located at least 3mm
from the gingival margins.
3. Minor connectors crossing gingival tissues must be relieved so
as not to impinge on the gingival tissues.
[Link] connectors should cover the least possible amount of
gingival tissue.
The reason for different distances of major connectors from gingival
margins is that maxillary casts are beaded to insure positive adaptation
of major connector whereas mandibular casts are relieved to prevent
contact of major connector against delicate mucosa
 Relief C under proximal plate A.
B indicates internal finish line

2 castings for same cast. A with excessive coverage. B improved design

RPD Base adjacent to abutments must
expose as much Gingival Tissue as possible

Inadequate gingival exposure.

Improved design with

adequate gingival exposure
Increased plaque accumulation

Areas collect most plaque are abutment

proximal surfaces adjacent to the saddle

These surfaces are difficult to clean

when using conventional toothbrush

Interdental brush cleans proximal

surfaces more effectively.
Increased plaque accumulation
More plaque collects under lingual plate than under lingual bar.

Lingual plate supported on natural teeth

& fits well against tooth surfaces.

Gingival inflammation caused by

increased plaque accumulation.
Unless the increased accumulation of plaque is prevented, root
caries is likely, which is associated with gingival recession .
If plaque persists on RPD impression surface, generalized
inflammation (Denture Stomatitis), may occur. Extent of
inflammation is demarcated by outline of palatal connector .
 Direct trauma from components

lingual bar is too close to gingival

margins. Continuous clasp offers
limited tooth support for RPD

RPD has sunk into tissues, stripping away gingival

tissues on distal & lingual aspects of canine
Transmission of excessive force

RPD is supported only on tissues of

edentulous area causing RRR. Lingual
bar is pushed down towards floor of
mouth

Amount of destroyed bone is

apparent as RPD is removed.
Transmission of excessive force

RPD transmits excessive force to a tooth which will become

mobile. Incorrectly designed cingulum rest (1) transmits a
horizontal force to canine that is damaging to periodontal tissues.
Incisal rest (2) transmits a more favorable vertical load
 Occlusal error

If occlusal surface of RPD is not designed correctly, normal jaw

closure is prevented by a premature occlusal contact
Premature Occlusal Contact :

(1) If premature contact is on a natural tooth, damage to the tooth

or its periodontal ligament may occur.

(2) If the saddle bears the brunt of force of closure, there is

localized mucosal inflammation & RRR of underlying bone.

(3) If the patient steers the mandible around premature contact

until a more comfortable occlusion is found, there is an
abnormal closing pattern with facial pain
Contribution of the clinician
Remaining teeth & tissues must be restored to a healthy state
& the patient is motivated to maintain this state.

This mouth is not fit to receive RPD.

due to chronic periodontal disease
and plaque accumulation

Patient responded well

to good oral hygiene
Inaccurate RPD fit will encourage plaque formation with
consequent periodontal disease & caries .
RPD worn for many years. Gingival tissues are healthy
& teeth are well supported by bone; in spite of little
opportunity to provide tooth support
Impression Surface Faults

Ulcer related to RPD borders due to overextension , is identified

& corrected . Disclosing media is needed for accurate location
in invisible areas ( as posterior region of the mouth )
 Mucosal Trauma

Inadequate Relief of undercut area results in Mucosal Trauma as RPD

is inserted or removed.
Other causes of localized Mucosal Trauma under impression surface :
1. Acrylic pearls
2. Pressure points from damaged cast
3. Inaccurate impression
Occlusal Surface Faults

RPD with premature contact in second molar region. Uneven

Contact in centric will load supporting tissues unevenly
Patient’s Oral & Denture Hygiene

Disclosing solution ( blue ) applied to teeth & dentures to

advice plaque control . Any unevenness at junction between
acrylic & metal will encourage plaque formation
Dentures whose retention depends on control by pt.’s musculature
may be loose if the pt. do not develop necessary skills
Tissue damage as hyperplasia , accelerated alveolar
resorption , and stripping of lingual gingiva together
with increased tooth mobility
If RRR is accompanied by wear of occlusal surface of acrylic
teeth, deranged occlusion will accelerate tissue damage.
Rebasing will not restore occlusal contacts . Teeth can
either be replaced or denture remade
Inadequate denture & oral hygiene hastens loss of natural teeth by
caries & periodontal disease and contributes to Denture Stomatitis
Long-term treatment of this patient will fail
High standard of plaque control. RPD maintains oral health
Distortion of tissues over edentulous ridge is about 500 micron under force,
whereas abutments show 20 micron of intrusion under the same load
Malpositioned maxillary dentition
due to loss of posterior occlusion
& excessive wear of opposing
lower anteriors

Restored dentition with

combination of endodontics,
periodontics, fixed and RPD
Palatal papillomatosis due to continual use
of an ill-fitting prosthesis.
 Inflamed denture-bearing mucosa
due to an ill-fitting RPD worn 24
hours a day

Abused tissue treated with tissue conditioner, removal of RPD for few
hours & denture-bearing area is healthy again
 Under-extended RPD base. Such
a reduced area of RR coverage
contributes to tissue damage

Denture base properly extended to

enhance support, stability, retention.
 Color changes in soft tissues indicates
irritation, due to overextended denture
base

White appearance occurs at the border

of overextended base , preceding ulcer
Indelible pencil circles soft RPD is seated & pencil mark
tissue irritation area is transferred to denture base

Responsible area is adjusted

Localized area of irritation PIP locates area causing irritation
beneath RPD base

Feeling intaglio surface of RPD

Responsible area is adjusted base to disclose irregularities
 Disclosing wax displaced
from pressure area

Articulating paper identify

occlusal interference
 It is difficult to identify
articulating paper marks on
highly polished metal

As such, metal surface is

roughened by fine stone
Articulating paper marks are readily identified on roughened surface
 Adjustments are made with
multifluted bur in high
speed handpiece

Metal gauge measures thickness of

RPD components. Rests & clasps
must be at least 1mm thick
 Indelible pencil marks posterior
border of major connector

RPD seated in the mouth

 Posterior border transferred to
palatal tissues to evaluate it

Overextension is shortened
with laboratory engine
Bead line is lost due to adjustment . It needs RPD remake
Cheek biting results in linear
ulceration of buccal mucosa

Cheek biting is minimized by

rounding lower buccal cusps
Tongue flatten & broaden as not confined by posterior
teeth or appropriate prostheses
 Abused Tissue on left buccal shelf area. RPD is either out of function
few days or relieved in affected area with soft liner to reduce trauma