*

The doctor started where he left off last lecture. So

this lecture will cover impression techniques in complete denture and the continuation of acrylic removable partial denture. Starting from data we get from history and oral examination you mount the cast on an articulator and analyze the diagnostic cast. This is not obligatory for all cases because some of the cases are straightforward and there is no need for mounting. Anyway, the end result you formulate a treatment plan and this treatment plan in removable partial denture is either metal or acrylic. We will skip all the steps related to the metal RPD. For acrylic RDPs you need to take primary impressions and final impressions for some cases, you do not need final impressions for all cases. In 4th year we have 2-3 visits, which means we either do secondary impressions with a custom tray or jaw relation.
(Primary impression secondary impression insertion) Or (Primary impression jaw relation insertion)

We usually take primary impressions using alginate, and in acrylic RPDs we can take the final impressions using alginate or rubber. Jaw relation registration if needed, try in of RPD if needed, insertion and review. These are the steps involved in constructing RPDs.
1

The cases that we

usually prefer in 4th year require only 2 visits, primary impression and insertion. If you have a case from A-Z like Kennedy class I, which has bilateral free end saddles, you will need 5 steps; primary impression, secondary impression (for max support + retention) jaw relation registration, try-in and insertion. These cases are not requirements for 4th year. _____________________________________________ * Principles for designing acrylic RPDs: - All principles that apply for metal RPDs also apply for acrylic RPDs but in different ways. 1- Casts should be surveyed. If you only have one missing tooth you only survey the working cast.
Why do we need surveying?

Surveying the casts in RPDs will help you in planning and designing.
-

Surveying is done when we have tilted teeth or deep undercuts, blocking undercuts, and to determine location of suitable undercuts. All the advantages we achieved from surveying metal framework RPDs are needed for acrylic RPDs.

- Acrylic RPDs are easier to adjust. - For proper planning and proper treatment you need surveying of the undercuts.
2

2- If you have a free end saddle you need maximum coverage for distal extensions so you can achieve maximum support. 3- Support: acrylic above survey line to gain support from teeth, relief gingival margin. It could be tooth-tissue supported or tissue supported. Acrylic RPDs are mainly tissue supported but there is some support from teeth. That is why we sometimes cover the lingual surfaces of teeth, to increase support. - If you want to cover the lingual surfaces of teeth you need to keep two factors in mind: (1) Occlusion: you cannot cover the tooth beyond the contact point of the opposing tooth, or else the patient will bite on the acrylic parts.
(2)

Gingival margin: can be easily traumatized and inflamed from the pressure of the denture, which is why we need to create a relief area on the cast.

4- Retention: We mainly use wrought wire clasps to retain acrylic RPDs (C clasps) but we also have other means of retention like adhesion, cohesion, neuromuscular control and undercuts. - We can modify the wire bending and create modified T clasps and modified Y clasps.

- The clasp should be 1 mm away from the gingival margin to avoid trapping food and gingival inflammation. - Clasps should be directed occlusally. - We normally use the least number of clasps to provide the optimum or needed retention and the least number of bends to avoid fatigue fracture of the clasp. - No space between the clasp and the facial surface of the tooth. This is a very important point. - The clasp should be 1 mm away from the proximal surface of the tooth. This space is should be filled with the acrylic material. - The clasp should not be placed in proximal undercuts or high occlusally. 5- Bracing and reciprocation: - Bracing is stability, to prevent side-to-side and rotational movement during function.
-

Acrylic on top of the saddle with prevent lateral movement, covering lingual surfaces of teeth with acrylic material will also prevent lateral movement.

- Reciprocation prevents lateral displacement of the lateral tooth upon placement and removal of the prosthesis.
-

Reciprocation should be rigid to allow flexure of the retentive arm.

4

In acrylic RPDs the retentive arm is reciprocated by the acrylic that should be lingual and at the same level as the tip of the clasp.

- We cannot reciprocate using a clasp in acrylic RPDs. 6- Connector: Major connector in acrylic is acrylic base plate. It should join all the components. 7- Indirect retention: To prevent dislodgement of the distal extension area away from the tissues. 8- Review design, draw it on the cast and write details if needed. __________________________________________ There is an important thing we have to balance out when creating acrylic RPDs. Maximum tissue coverage is needed for maximum support, retention and stability but on the other hand we have soft tissue health. Any covered soft tissue, relieved or unrelieved, will have some degree of inflammation even in people with excellent oral hygiene. We can also add the patients comfort to the previous factors. There are two types of acrylic RPDs: 1- Spoon denture.
5

Maxillary provisional RPD without clasps whose palatal resin base forms the shape of a spoon. The resin base does not contact the lingual surface of teeth and is confined to the central portion of the palate. It should not cover the lingual surfaces of teeth.

- It was often used during periodontal treatment because the resin base extension did not promote plaque accumulation around the teeth and permitted surgical procedures to be performed.
2-

Every design: - all connector borders at least 3 mm from gingival margins (does not cover teeth).

- Point contacts between artificial and natural teeth to reduce lateral stresses. - Posterior wire stops to prevent distal drift and subsequent opening of contacts. Also contribute to retention. - Balanced occlusion/ articulation or guidance from remaining teeth to reduce lateral stresses.

PART TWO
6

IMPRESSION TECHNIQUES IN COMPLETE DETURE - An impression is an imprint produced by the pressure of one thing upon or into the surface of another. *Primary impressions: - Conventional techniques - Template techniques *Definitive impressions or secondary impressions: - Conventional techniques - Selective pressure techniques - Functional techniques - Reline and rebase techniques (including secondary template impressions) Dr. Saleh said he will mainly focus on selective pressure techniques and functional techniques.

PRIMRY IMPRESSIONS: - Trays: metal or plastic, perforated or non-perforated and round cross section. - Materials: Impression compound or alginate. We prefer impression compound because it has many advantages

mainly that it is correctable, reversible, and also mucocompressive. Alginate is used in undercuts. - Requirements: Suitable trays and suitable sizes for the trays. *What is the main goal of taking primary impression in complete denture? To see the extension and to create a special tray. MAXILLARY ARCH
We have to see:

- The residual alveolar ridge - Hamular notches - Tuberosities - Labial and buccal sulci, muscle attachments, frena - Hard palate, postdam area. MANDIBULAR ARCH - Residual ridge - Retromolar pad - Labial and buccal sulci - Muscle attachments - Frena - Lingual sulcus - Lingual frenum
8

- Mylohyoid ridge - Retromyloyoid fossa (The last four areas are where most students make mistakes) The most important area for retention is the retromylohyoid fossa or the lingual pouch.

Fares H. Hanafieh