REMOVABLE PARTIAL

DENTURE

INTRODUCTION
 Every prosthetic treatment is associated
with the placement of foreign object (the
prosthesis) in the mouth. As a direct
consequence of such placement the
burden on the tissues in the oral cavity
will be increased.
 For example, plaque more readily
accumulates on alloplastic materials than
biologic ones.
 Furthermore,even non-toxic materials will
release small amounts of their
components into the oral cavity.
 To justify prosthetic treatment and
to ensure that it is beneficial to the
patient,
 the need for such treatment must be
established.
 the patient must be appropriately
motivated,
 the dentures properly designed,
constructed and maintained.
 Thus the initial step in determining if
prosthetic treatment is indicated
must always be the assessment of:
 The patient’s wishes and concerns
 The relevant dental and medical
history
 The results of the extra-oral and
intra-oral examinations
 Oral hygiene habits and status
 The essential oral functions of
appearance, mastication and speech.
 We will discuss the introduction
under the following headings

 The benefits of RPDs

 Tissue damage associated with RPDs
 Preserving oral health
 The importance of teamwork
BENEFITS
 Appearance
 Speech
 Mastication
 Maintaining the health of the masticatory
system:
—preventing undesirable tooth movement
—improving distribution of occlusal load
 Preparation for complete dentures.
 Appearance

RPD not only help to restore appearance but it may actually

improve it.
(a) This patient’s maxillary lateral incisors had never developed
and she was concerned about the spacing of the anterior teeth.
(b) The combination of orthodontic movement of the central
incisors and the provision of RPDs improved the appearance.
Appearance

If an incisor is not replaced soon

after extraction, successful
treatment at a later date may be
compromised. Here, the
adjacent teeth have drifted into
the unrestored space. The
reduced space does not allow for
an artificial tooth of a realistic
size to be used on a denture. If a
reasonable aesthetic result is to
be obtained the space must be
reestablished by orthodontic
treatment.
Speech

 The loss of maxillary anterior teeth

may prevent the clear reproduction of
certain sounds, particularly the ‘F’
and ‘V’ which are made by the lower
lip contacting the edges of the
maxillary incisors.
 The replacement of missing maxillary
anterior teeth will make a significant
contribution to the quality of speech.
 Mastication

Gaps that arise through the loss of posterior teeth reduce the
efficiency of mastication: the bolus of food is allowed to
slip into the edentulous areas and thus escape the crushing and
shearing action of the remaining teeth. An RPD will prevent this
escape of the bolus and thus contribute to efficient mastication.
Undesirable tooth movement
Improved distribution of occlusal load

If the periodontal attachments

of the remaining teeth are
healthy, the increased load may
result in excessive tooth wear
or may cause damage to
existing restorations. The
restoration of gross loss of
tooth substance,as in this
example, is likely to involve
complex and prolonged
treatment.
Preparation for complete dentures

 In patients whose remaining teeth carry a relatively

poor prognosis and for whom, in due course,
complete dentures are inevitable a simple acrylic
RPDs could be provided.

 The patient is able to serve a

prosthetic‘apprenticeship’ with appliances which
receive some stability from the few remaining teeth.
In the fullness of time these transitional dentures
become more extensive as further teeth are
extracted and the patient is gradually eased into the
totally artificial dentition.

 This form of transitional treatment can be of

considerable benefit, especially for the elderly
patient.
Summary of damage that may result from RPDs

causes Teeth Periodontal Edentulous Muscles of

tissues areas mastication

Plaque Decalcification Inflammation of Inflammation of

accumulation and caries gingival tissues. mucous
Progression to membrane
underlying
structures
Direct trauma Abrasion and Inflammation of Localized
from fracture of teeth gingival tissues. inflammation of
components and restorations Progression to mucous
underlying membrane.
structures Denture induced
hyperplasia.
Transmission Tooth mobility. Inflammation of
of excessive Aggravation of mucous
functional existing membrane
forces. periodontal Resorption of
disease bone
Occlusal error Tooth mobility. Inflammation of Muscles
Aggravation of mucous dysfunction.
existing membrane
periodontal Resorption of
disease bone
Plaque accumulation
 Research has documented a relationship
between plaque accumulation and the
wearing of RPDs.
 It is possible that the presence of a denture
influences the quality of the plaque; it
certainly affects the quantity. Not only does
more plaque accumulate around the teeth in
the jaw in which the denture is placed, but
also more is found around the teeth in the
opposing jaw unless the patient is instructed
in meticulous oral hygiene procedures.
 Plaque acumulation

it has been shown that more plaque collects under a lingual plate
than under a lingual bar.
(a) The lingual plate is well supported on the natural teeth and fits
well against tooth surfaces.
(b) However, gingival inflammation has been caused by the
increased accumulation of plaque.
Direct trauma
Excessive force transmission
Occlusal error
Occlusal error

 If the occlusal surface of the RPD is not designed

correctly,There are three possible sequelae:
 (1) If the 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 the force of
closure, there will be localised mucosal inflammation
and resorption of the underlying bone.
 (3) If the patient attempts to steer the mandible
around the premature contact until a more
comfortable occlusal position is found, this abnormal
closing pattern throws increased demands on
certain muscles of mastication, which may result in
the patient complaining of facial pain
Balancing the equation
 There is now firm evidence that the
wearing
 of RPDs can be compatible with
continued oral health.
 This satisfactory outcome depends
upon a three-fold effort, that of the
clinician, the dental technician and
the patient.
The clinician
 The primary responsibility of the
dentist and the clinical team is to
ensure that
 the remaining teeth and supporting
tissues are restored to a healthy
state and that the patient is
effectively motivated and instructed
in how to maintain this state.
Clinician responsibility

 The second area of responsibility of the

clinician is in relation to the design and
construction of the denture. Accuracy of the
clinical procedures must, of course, be
ensured. In addition, the clinician should
produce a design based on criteria that have
 been shown to promote continued oral health:
 Effective support
 Clearance of gingival margins
 Simplicity
 Rigid connector.
Dental technician
 The dental technician’s contribution is
directed towards the careful
translation of the prescribed denture
design into the denture itself, and
 accurate construction and positioning
of the denture components.
Technician’s role

Note the space.

Favorable for
plaque accumulation.
Patients’ responsiblity
 The level of disadvantage of RPD is
influenced primarily by the patient’s dental
awareness and plaque control.
 When the balance of the equation leans
towards disadvantage it is likely that it will
be in the patient’s best interest that a
denture is not prescribed.
 Of course, where a denture is required to
replace an anterior tooth or teeth, the
demand from the patient will usually be
overwhelming even if the level of plaque
control is less than satisfactory.