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Remavable partial denture Hebah ra3d ramadneh

3essam el-3alam

3/2/2013

Removable Partial Dentures

In this semester we will talk about removable partial denture , which is more difficult than complete denture because its smaller and need other steps to be done . Partial Denture is a prosthesis that replaces one or more missing teeth. (not all teeth )

In partial prosthodontics we have 2 types:

1- interim prosthodontics(Interim (transitional)) : (),, ***Its almost (not always ) made by acrylic (look like complete denture ), it has clasps .

2-diffinitive prosthodontics(permanent) :the final one ***it has metal frame work its usually made of cobalt chromium which is very strong material (not corrode easily) & its biocompatible for the tissue in the mouth .

we can also use nickel chromium its a strong material ,but its still has problem with the tissue in the mouth , 5% of people has nickel sensitivity so, we try not to use nickel in dentistry .
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NOTE: _ we use chromium to protect the cobalt material because chromium is faster to react with oxygen . _ In the lab we will make metal frame work denture . In the clinic you will meet different cases with diferent missing teeth so, its difficult to describe each case to the technicians so we have different classification systems were designed, and these were done in North America. The classification system that you have already been familiar with is Kennedys classification with Applegates modifications. Dr Kennedy proposed this classification 90 years ago, Kennedys classification has some deficiencies and thats why Mr. Applegate came along and made some modifications. We have different classes in kennedys classification : * class-I: the most missing teeth , the anterior teeth is present but the posterior teeth is lost .we can describe it as bilateral disextension (Bilateral edentulous). it can be upper or lower but in both side (both side missing).

* class-II: instead of having missing teeth in both side , we have missing teeth
in one side ,its unilateral disextension, Unilateral edentulous (one side missing ) .

* class-III: we have spaced missing teeth , that mean missing teeth in the
anterior and posterior part of the mouth we called it bound spaced ( .) its a Unilateral area bounded by anterior & posterior natural teeth.

* class-IV: its just like class-III but its special ,it bilateral cross the midline.

Remember this: Class I . 2 edentulous areas Class II.1 edentulous area.

Applegates modifications:
the first one is space modification : you have additional space ,it has nothing to do with the number of missing teeth ,it deal with the number of missing space . EXs: - if you have patient with kennedys class-I and he miss his central incisor you called it kennedys class-I modification-1(class-I mod-I) .if this patient also lost his lateral incisor in the same side we also called it kennedys class-I modification- because its deal with number of spaces not the number of the missing teeth . - if you have patient with kennedys class-I and he miss his canine and lateral incisor in the Rt and in the Lf , we called it kennedys class-I modification-1-2 (class-I mod-I,II). - NOTE: There is no modification space in Class IV). Only ClassI,II,II has modification space. because I take the most posterior edentulous area and the anterior space becomes a modification. *** WE COUNT THE SPACES NOT THE MISSING TEETH ***

In class III I have one edentulous space, there is a mistake in the slides its not bilateral its just unilateral (one edentulous area, it can be 2 but it has different name), now if this space crosses the midline it becomes class IV. Sometimes there are other missing spaces, not the typical form that Kennedy talked about. For example if I have a tooth
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missing here (the star in the picture), what should I call it?? There is an Applegates rule says that I always choose the most posterior edentulous part ,the one that is the most posterior is the distal extension ,which is Kennedy's class II, what should I call the other space (here its the star )?? Applegate said that if I have an additional edentulous area I dont care to the number of teeth, it could be one or two, and each additional missing space is called a modification space, not according to the number of missing teeth but according to the bounded spaces. So this is class II mod I. The other problem with Kennedy's classes is, here I have class IV, what if I have teeth missing, here the stars in the picture>>> I take the most posterior edentulous area and the anterior space becomes a modification. Even though it crosses the midline which is another rule of Applegate (There is no modification space in Class IV). Class I,II,III can have a modification ,its commonsense, if I have class IV modification I (which cant happen) it should be class III any way, here is my explanation any edentulous area other than the one in class IV will be for sure in the posterior part because class IV should cross the midline which means that its anterior to any edentulous areas and as Applegate said that we choose the most posterior, so if I have any additional edentulous area with class IV it will transform to a modification instead of a class by itself.

Now we will talk about 3rd molar :

many people born without 3rd molar so we cant include it in our calcification (if the third molar is not included in my design, its not included in the classification ) .

Sometimes there are teeth in the mouth that I dont use in my design. What if I tell you that this upper 3rd molar has no lower 3rd molar so usually in Applegate
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modification you will see that if the third molar is not included in my design, its not included in the classification so if Im not using the 3rd molar ,this becomes a unilateral extension of edentulous area which is Kennedy class II

If I delete this molar it becomes class II

Now this is true for 3rd and 2nd molar, unless I give you specific information then you have to take specific default, now again lets go to Applegates rules. 1- Classification should follow rather than precede extraction: If a patient come to you and has a periodontal disease extract the teeth then make the classification, or imagine the patient without that tooth or teeth. 2- If 3rd molar is missing & not to be replaced, it is not considered in the classification. 3- If the 3rd molar is present and to be used as an abutment, it is considered in the classification. 4- If the second molar is missing and not to be replaced, it is not considered in the classification. 5- The most posterior edentulous area determines the classification. 6- Edentulous areas other than those determining classification are called modification spaces. 7- The extent of the modification is not considered, only the number. 8- There is no modification space in Class IV.

***Now let us talk about very important issue , which is about forces affect the denture ,the supported tissue , . - Natural teeth connected with the bone by periodontal ligament (2-4mm), so, it can move around 0.5 mm in all direction . - In the complete denture , its fixed on a soft tissue above the bone so the bone resolved but the story is the same in all part of the mouth so, the patient compensate with these condition . - in the partial denture the problem is : its support by soft tissue and teeth (soft tissue support & teeth support or its called tooth-tissue supported )so , the tooth which locate at the end of the bounded space will affected by more force , more load because the motion and rotation will be around it and with time it will be lost , BUT our job is to maintain the healthy tissue which is exist there .So, if you have teeth in one part of the mouth and no teeth in the other part then you have a big problem so, now we have other type of calcification which depend on the

load distrepution and support form:

***in the complete denture we have tissue born prostheses or tissue supported prostheses (all denture supported by tissue). ***in the metal frame work partial denture we have 3 story (according to kenndys classes): 1- class-III & class-IV(short span) ,we have teeth in both side of bounded space so we have tooth supported prostheses . we remove part of enamel but not reach the dentine then we put the partial denture above it . 2-class-I & class-II, we have tooth in the front and tissue in the back so; we have tooth-tissue supported prostheses. And this is the problem because when the patient masticate he will compress the tissue and put more load on the tooth ,,, so, nowadays most of our study is to reduce these force and load to maintain the remaining structure in the mouth . 3- Acrylic and interim partial denture and are tissue born prostheses WHY? Because the acrylic material is weaker than metal so, it will rupture if we put it above hard part (tooth) and by metal we can make thin extension but by acrylic we cant so, its like the complete denture (NO tooth supported). DONE BY : hebah ramadneh !!! !