UConn Dental: Prosthodontics Clinic Manual 11-12

Rev.
1/11

1

University of Connecticut School of Dental Medicine

Department of Reconstructive Sciences

Prosthodontics
Clinic Manual

Rev. 1/11

Clinic Protocols

I. Session Information
Clinic sessions begin promptly at 9:00AM every day and 1:00PM on Mondays, Tuesdays
and Fridays or 2:00PM on Wednesdays and Thursdays. At the very beginning of each
session, the student is expected to have their assigned operatory set up with all the
equipment and supplies needed to accomplish their goals for that session. If the student is
uncertain as to what equipment and supplies are needed for a particular procedure, he/she
should refer to the course manual for that discipline. Cassettes are not to be opened until
the patient has arrived to the clinic.

For any given clinic session, the student may not

begin patient treatment until
consulting with prosthodontic faculty. No exceptions. Patients should not be
dismissed without faculty approval. Violation of this policy may result in loss of clinic
privileges. Patients should never be in the clinic without a faculty member also present in
the clinic.
Patients must be dismissed by 11:45 in the morning and 4:45

in the afternoon session.
This allows 15 minutes for students to clean-up, return equipment to the dispensary, and
complete chart entries and computer work by 12:00 for the morning session and 5:00 for
the afternoon session.
The timely dismissal of patients must be adhered to when crowns and fixed prostheses are
brought to the Prosthetic Laboratory for final glazing or polishing. In order to ensure
this, crowns and fixed prostheses must be submitted to the lab with a faculty signed
prescription

no later than 10:45 in the morning and 3:30 in the afternoon. If a restoration
is taken to the laboratory later than these deadlines, the provisional must be recemented
and the patient scheduled for a separate delivery appointment.

II. Working with Faculty
The student may work with a number of different clinical preceptors for each patients
overall treatment plan. By not

limiting the student to working with the same clinical
preceptor for each visit, patients can be scheduled at the convenience of the patient and
student. There may be exceptions when it is in the patients and students best interest to
work with the same preceptor for a certain phase of treatment. One example is complete
dentures. It is helpful to work with the same preceptor for the wax try-in visits due to the
subjective nature of esthetics.
Prosthodontic Residents: Occasionally, prosthodontic residents will help cover the
predoctoral clinic. The residents may sign a students daily progress notes, but they may
not provide signatures for treatment plans or for submitting lab work to the prosthetic lab.
Rev. 1/11

3

III. Infection Control
Proper infection control procedures must be accomplished before and after the clinical
procedure for each patient. All impressions, interocclusal records, crowns, prostheses,
facebows and articulators (when necessary) must be properly disinfected before they are
removed from the clinic. In addition, all materials that have been worked on outside of
clinic must be disinfected if they will be used in direct patient care (e.g., denture bases,
record bases, facebows, etc.)

Students must pay close attention to what they are touching with gloved hands that have
been in the patients mouth. Many students are seen adjusting masks, glasses and hair
with dirty gloves. Students are also observed adjusting glasses, masks, hair, etc. with
clean gloves. These gloves should not be used in the patients mouth! Be aware of
cross-contamination either way. Infractions of the infection control policy will result in
corrective action.

IV. Clinic Supplies and Equipment
At the beginning of each clinic session, the student may obtain needed equipment and
instruments from the Dispensing Room. At the completion of treatment, all instruments
and equipment should be scrubbed clean before returning these items.

If a student removes supplies or equipment from a Clinic Dispensing Room without
permission from the Lead Dental Assistant and/or without recording their name and the
item on a "sign out sheet", or if any borrowed items are not returned to a Clinic Dental
Assistant within 24 hours, the student will not be permitted to treat patients in Clinic until
the borrowed item is returned or replaced.

V. Student Preparedness for Clinic Sessions
Students must be prepared for each session in prosthodontics. Students should not
rely solely on the faculty to take them step-by-step through each procedure. The student
is responsible to arrive prepared for the session, having reviewed the previously presented
material from the relevant preclinical course. Although the faculty do not expect the
student to work without any guidance, students are expected to have an understanding of
the steps involved and a plan for what needs to be accomplished in given session. For
example, if the student is delivering a crown, then the student must know the correct
sequence of procedures, know the appropriate instruments to use, and know the various
materials to be used (especially the cement.)

Rev. 1/11

V. Student Preparedness for Clinic Sessions, cont
If a student is unprepared for clinic and demonstrates a lack of understanding of the days
procedure that would jeopardize his/her patients safety, then faculty member may have
the student send the patient home without treatment and the student will receive a failing
grade for that session. Additionally, various corrective actions may be required by the
faculty to address the areas where the student is lacking in understanding or basic
knowledge. Students may be asked to write a relevant topic paper, perform remedial
typodont work or complete other relevant laboratory exercises. If the student does not
complete these requirements adequately, then the student may be removed from clinical
activity until corrective actions have been effectively addressed.

VI. School-wide Payment Policy
Patients must

pay 50% down PRIOR to the start of any prosthodontic procedures.
This includes complete dentures, RPDs, fixed, and implants. There has been a
misconception that half down is only necessary when the student is ready to
submit the prosthetic work to the lab. The patient must be making the half down
payment prior to the start of the prosthetic procedure.
The white PSR slip must be presented to the faculty prior to the start of any
procedures that will have a laboratory component. This will confirm that the
patient has made the appropriate payment. This is necessary whether the patient is
self-pay or Title 19.

NOTE: If the treatment is to be a cast post and core, then the patient must pay in
full for the cast post and core and

pay half down for the crown on the same tooth.

VII. Quadrant Dentistry
Students are to treat only one

quadrant at a time with fixed prosthodontics. This
means that a patient should not have provisionals in more than one quadrant at any given
time. If there is a perceived need for an exception to this policy, then the student must
have signed approval in the chart from Dr. Duncan. Failure to comply with this policy
may result in loss of clinic privileges or other disciplinary action.
Please review any treatment plans that will require the removal of multiple existing
crowns with Dr. Duncan or Dr. Taylor before proceeding. Crowns that need to be
removed to determine a tooths restorability should be done at the end of Phase 1
treatment. If these existing crowns are in multiple quadrants, the student MUST review
the treatment plan and sequence of treatment with Dr. Duncan or Dr. Taylor before
removing any crowns.

Rev. 1/11

5

VIII. Prosthodontic Open Hours
Prosthodontic Open Hours are held on Wednesdays from 12:00 to 2:00 in the
Reconstructive Sciences Conference Room (L6105) on the 6
th

floor. All available
prosthodontic faculty are present to answer questions. Students are encouraged to take
advantage of this time to discuss treatment plans, design RPDs, review lab work for
submission, and answer any questions that they might have relative to prosthodontics and
beyond. If, for some reason, Open Hours are cancelled, students will be notified via
email.
Students must NOT skip classes or mandatory meetings in order to attend Open
Hours.

Students must NOT seek out faculty in University Dentists or CIRD for signatures.
This is the facultys private practice time, and students should not interrupt faculty
in these settings.

IX. General Prosthetic Laboratory Protocol and Quality Control
All prosthetic work submitted to the prosthetic laboratory must be first signed by the
faculty member with whom the student was most recently working whenever possible.
(For example: Complete dentures should be signed by the faculty with whom the student
did the final esthetic try-in. Fixed work should be signed by the faculty with whom the
student made the final impression.) Cases will not be reviewed without appropriate
student and faculty signatures on submitted cases.

Once signed by the appropriate faculty, the student will bring the case to the prosthetic
lab. Cases are logged into the lab, reviewed by prosthodontic faculty for Quality Control,
assigned to a technician and given a return date. During the processing period, student
cases may be in various locations either inside or outside of the Prosthetic Laboratory.
Students are encouraged to "check up" on the progress of cases submitted. If the case
does not pass through Quality Control, the laboratory will contact the student. Be advised
that laboratory work does not commence for approximately two days (sometimes a bit
longer than two days) after the student brings a case into the lab.

Students are encouraged to work closely with the dental technicians in our prosthodontic
laboratory so that they are able to see cast restorations and removable prostheses in
various stages of fabrication.

Rev. 1/11

X. Patient Situations that are Unacceptable for Care in the
Undergraduate Clinics
Patients are routinely screened for acceptance into the dental school. Patients that are not
appropriate for care in the students clinics due to the complexity of their treatment needs
should be referred to the appropriate graduate clinic. The following is a list of patient
situations that are not appropriate for the undergraduate clinics.

1. Patients exhibiting evidence of severe tooth abrasion, attrition, and/or bruxism.

2. Dentate or partially dentate patients exhibiting evidence of collapse/loss of vertical
dimension of occlusion that will need to be increased either with fixed or removable
partial dentures.

3. Patients for whom it can be anticipated that a mandibular immediate complete
denture is the most likely treatment option. Mandibular immediate dentures are not
done in the predoctoral clinic.

4. Patients with conditions that affect the entire dentition or result in multiple missing
teeth in young individuals. These include multiple dental agenesis, amelogenesis and
dentinogenesis imperfecta, and ectodermal dysplasia.

5. Patients needing maxillofacial prostheses such as obturators, speech appliances,
palatal lifts, etc.

6. Patients requiring removable prostheses who have a history of therapeutic radiation
therapy to the head and neck.

7. Patients presenting with root resected teeth in need of restoration.

8. Patients with severe mental or emotional problems that would make them difficult to
manage for beginning students.

9. Patients desiring extensive and complex esthetic procedures such as multiple (more
than 4) esthetic veneers.

10. Patients who may require overdentures on natural teeth (with or without
attachments.)

Rev. 1/11

7

XI. Prosthodontics at Comminity Health Center Rotations
1. Students may receive up to 2 units of experiential fixed credit for crowns or bridges
complete at their community health center rotation. The student must have
completed all phases of treatment (prep, temp, impress, delivery) in order to receive
credit. The student must submit a form signed by the site faculty for verification.
This form can be found at the end of this manual.

2. Complete dentures and removable partial dentures may be done at community health
center rotations; however, they will not count toward the students minimal essential
experiences. Due to the small number of removable experiences, it is the facultys
desire to have direct interaction with the student in these cases to reinforce the
principles taught during the preclinical removable courses.

3. If a student has the opportunity to make a removable partial denture at CHC,
then the student must bring the patients diagnostic casts to Open Hours in
order to design the framework

. Again, the faculty would like the opportunity to
reinforce the RPD principles taught in preclinic. This will not occur when designing
frameworks with CHC site faculty.

Rev. 1/11

Diagnosis, Treatment Planning &
Sequencing Prosthodontic Treatment

I.

Data Collection Visit in Prosthodontics
The objectives for data collection sessions in clinic are for the student to:

1. Examine the patient and record data required for the complete assessment of
prosthodontic needs. The Operative Dentistry Worksheets can be used with dentate
or partially dentate patients to help record this data. Prosthodontic Worksheets can be
used to guide the examination of edentulous patients and/or make a tentative
treatment plan and/or RPD design when needed. Worksheets are not, however, to be
attached to the patient record.

2. Make alginate impressions, interocclusal records and a facebow transfer to generate
mounted diagnostic casts when indicated. Mounted diagnostic casts are required for
all patients you are treatment planning for tooth replacement with fixed or removable
partial dentures. Mounting of the casts is not necessary for complete denture patients
unless significant alveoloplasty is indicated.

3. Establish or begin to establish a detailed sequential

treatment plan including needed
prosthodontic treatment.
NOTE:
Once a prosthodontic faculty member has reviewed the patient data with the student,
then the faculty member should sign the prosthodontic box in the patient record
(Section IV--Exam and Treatment Planning Log). The left side is signed after the
patient data is reviewed. The right side is signed after the approved, and appropriately
sequenced, treatment plan has been printed out and reviewed by the faculty member.
Faculty should not sign both boxes without reviewing the printed treatment
plan.

Prosthodontic treatment plans may only be signed off (right side box) by full-time
prosthodontic faculty.

Part-time faculty or residents may not sign off treatment
plans.

Rev. 1/11

9
II. Sequencing Prosthodontic Treatment

General Considerations:

1. The sequence of treatment should be dependent upon the particular needs of the
patient. Priority should be given to establishing and/or maintaining a solid posterior
occlusion before addressing anterior crowns or veneers.

2. Endodontically treated teeth should be restored with a core buildup, a cast post and
core and a provisional crown, or a final direct restoration maintaining occlusal and
proximal contact soon after endodontic therapy is completed. To this end, cast post
and cores may be included in Phase I treatment.

3. All fixed partial denture cases must have mounted diagnostic casts on a semi-
adjustable articulator with a diagnostic wax-up. The diagnostic wax-up of the
FPD must be reviewed and approved by faculty before

beginning any tooth
preparation. This is an extremely important step and there will be no exceptions to
this policy. If the student presents in clinic to begin tooth preparation for an FPD,
the student must have the mounted casts and wax-up available at that time. If not,
the student will be instructed to dismiss his/her patient.
4. Upon completion of the treatment planning process, a tentative RPD design should be
drawn on the RPD worksheet, signed by faculty, and placed in the daily treatment
notes. The design will be based on mounted diagnostic casts made from initial
alginate impressions made during the initial exam. The student should have the
mounted diagnostic casts and radiographs available when discussing a design with the
faculty. Operative treatment MUST NOT

be started without an approved RPD
design in the patients chart.
5. For more information on treatment sequencing, the student may refer to the didactic
materials provided in the RPD preclinical course.

6. Prosthodontic Open Hours is an ideal time for the student to review complex
treatment plans to establish an appropriate sequence and approach to a patients care.

Rev. 1/11

QR CODES FOR PROSTHODONTICS

FIXED PROSTH CODES
2740 CROWN PORC/CERAMIC Code for all ceramic crowns
2750 CROWN PORC/METAL Code for PFM crowns
2790 CROWN FULL CAST METAL Code for full gold crowns
2952 CAST POST AND CORE
2962 LAB VENEER PORC
Credit received if attending confirms
that student performed sufficient
amount of work independently
6240 BRIDGE PONTIC PORC Code for PFM pontics
6210 BRIDGE PONTIC CAST Code for full gold pontics
6750 BRIDGE CRN PORC
Code for PFM abutments on
self pay patients
6790 BRIDGE CRN CAST
Code for full gold abutments on self
pay patients
16013
UNDERGRAD SINGLE TOOTH
IMPLANT
Procedure conveniences MUST be
included and signed off in QR as
completed
State patients only:
D2750 and D2790 are the only acceptable codes for crowns on State patients.
Rev. 1/11

11

REMOVABLE PROSTH
CODES

5110 MAX COMP DENTURE
5120 MAND COMP DENTURE
5130 MAX IMMED DENTURE
One must always include a maxillary reline as well in the
treatment plan. Relines are NOT included in the cost of
immediate dentures.
5140 MAND IMMED DENTURE Not done in student clinics!
*5211 MAX TRANS PART
Code to be used when anterior and posterior teeth are being
replaced
*5212 MAND TRANS PARTIAL
Code to be used when anterior and posterior teeth are being
replaced
*5820 INTERIM PART DENT MAX
Code to be used when only 3-4 anterior teeth are being
replaced
*5821 INTERIM PART DENT MND
5213 MAX PART DENT/METAL
5214 MAND PART DENT/METAL
5410 ADJ COMP DENT/MAX
Adjustment codes do not generate charge, and they are to
be used within the first year of delivery.
5411 ADJ COMP DENT/MAND
5421 ADJ PART DENT/MAX
5422 ADJ PART DENT/MAND
15000 RECALL FOR CD/RPDS
One year after delivery, this code should be entered for all
denture recalls. It generates a nominal charge.

*Counts toward 1/3 arch of removable if all aspects have been completed by one
provider. Additionally, relines or rebases done for conventional dentures that a student
has made and that do not fit adequately are not credited as a 1/3 of an arch.
Rev. 1/11

REMOVABLE PROSTH
CODES, cont

5510 REPAIR COMP DENTURE
5520 REPLACE TOOTH CD
5610 REPAIR RESIN PARTIAL
5620 REPAIR CAST FRAMEWK
5630 REPAIR/REPLACE CLASP
5640 PD REPLACE TOOTH
5650 PART DENT ADD TOOTH
5660 ADD PART DENT CLASP
*5710 REBASE COMP MAX DENT
*5711 REBASE COMPMAND DENT
*5720 REBASE MAX PART DENT
*5721 REBASEMAND PART DENT
*5750 RELINE MAX CD LAB
*5751 RELINE MAND CD LAB
*5760 RELINE MAX PD LAB
*5761 RELINE MAND PD LAB
16014
UNDERGRAD IMPLANT
SUPPORTED
OVERDENTURE
Procedure conveniences MUST be included and signed off
in QR as completed

*Counts toward 1/3 arch of removable if all aspects have been completed by one
provider. Additionally, relines or rebases done for conventional dentures that a student
has made and that do not fit adequately are not credited as a 1/3 of an arch.
Rev. 1/11

13
FIXED PROSTHODONTICS

I. Crown and Bridge Restoration Protocol
All foundation restorations on a tooth that will receive a crown must
1. the restoration was done outside the SDM
be
replaced if:
2. the restoration was done at the SDM >3 years previously

For any full gold or PFM crown delivered, an alloy sticker (given to you by the
dental laboratory with the final crown) must

be placed in the patient record at the
time of crown delivery
Bridges spanning more than 4 units may NOT be done in the student clinics.
The only exceptions may be bridges from canine to canine, in approved cases.

The student MUST present a prepared typodont for any tooth to be prepared for
a crown or bridge in the clinic. For example, if the student will be preparing tooth
#3 for a full gold crown during that clinic session, then the student must present a
typodont with the same tooth and preparation design to the preceptor before
beginning treatment. If the student does not have the typodont prepared, then
the student MAY NOT begin the crown preparation during that session.

Phase I re-evaluation must always be completed prior to the start of any Phase II
treatment.

Diagnostic casts must be present in clinic with the student whenever fixed
prosthodontic work is planned. If the student does not have them, the student will
not be allowed to begin a crown preparation

until they have been made.
Treatment to be rendered MUST be on the treatment plan that has been
printed out and signed by the patient.

All fixed partial dentures must have a diagnostic wax up or cast duplicating this
wax up present for any fixed partial denture procedures.

All fixed partial dentures require a multi-unit provisional prior to making
the final impression. Example: A patient requires a bridge from 13-15. At the
first visit, #15 is prepared and provisionalized. At the second visit, #13 is
prepared and a 3-unit provisional is made from 13-15.

Rev. 1/11

II. Restoration of Endodontically Treated Teeth

Note: ALL teeth that require endodontic treatment MUST have a restorability
consult with a prosthodontic faculty prior to obturation. All caries must be
excavated before the consultation can be done. Also note that the faculty will likely
need to see the tooth in question without the rubber dam in place.

General Guidelines:
1. All posterior teeth which are endodontically treated should receive a crown. Anterior
teeth which have adequate tooth structure after endodontic therapy may not need to be
crowned. This will depend upon the amount of unsupported coronal tooth structure.
A prosthodontic consult is recommended at the time of obturation to confirm the need
for a crown in questionable circumstances.

2. All endodontically treated teeth do not

need to be restored with a post and core. Only
teeth with insufficient coronal tooth structure should be considered for a post and
core.
3. In general, endodontically treated teeth may be restored with amalgam core buildups,
composite core build-ups, or post and cores. Post and cores may be of two types:
either prefabricated post and cores or custom fabricated (cast) post and cores. This
choice will be specific to the tooth involved and will be made with faculty
consultation.

4. A cast post and core should be used primarily for anterior teeth and premolars, and
prefabricated posts with amalgam build-ups should be used for molars.

5. Indications for a cast post and core are:
a) anterior teeth and premolars
b) insufficient tooth structure remaining with no possibility of a 2 mm ferrule
c) inadequate isolation for a prefabricated post and composite core

6. Indications for a prefabricated post and core are:
a) molars whenever possible
b) enough tooth structure remaining to provide at least a 2 mm ferrule (usually no
post needed if 2+walls remain)
c) Title 19 patient for whom cast post and cores will not be covered (The option
of a cast post and core must be presented to these patients. The benefits and
risks of the chosen treatment must be made clear to the patient. Some patients
will opt to pay for a cast post and core if it is critical to the long-term prognosis
of the tooth.)

Rev. 1/11

15
7. For teeth that do not
pulp chamber as well as 1-2mm into prepared canal spaces (amalgam-pins).
require restoration with a cast post and core (usually molars and
sometimes premolars with a significant amount of coronal dentin remaining), gutta
percha will remain in the canal(s) and amalgam will serve as a "core" to allow an
ideal tooth preparation to be created. The amalgam will be placed directly into the

8. When pre-fabricated posts or custom cast post and cores are to be used to restore a
tooth, the post space will be prepared as part of the treatment procedure during post
fabrication in the prosthodontic or operative clinic--not in the endodontic clinic.

9. For cases where fixed and removable prostheses are treatment planned, all single
crowns that are planned for these cases must be made in the prosthodontic clinic.

10. If a composite core has been placed, then the student must use a resin or resin-
modified cement for the final crown.

11. The largest and least curved canal in a multi-rooted tooth is usually the best place to
create a post space.

12. The post length should generally be from 1/2 to 2/3 the length of the root, but there
should be no less than

4 mm of root filling material left in the apical portion of the
canal.
13. When the patient is seen in the Prosthodontic Clinic for fabrication of a custom cast
post and core, either an acrylic post and core pattern or an elastomeric impression
will be made. These are always done after

an adequate post space is made and
verified by prosthodontic faculty and the remaining coronal tooth structure has
proper axial and occlusal preparation.
14. To make an acrylic provisional restoration combined with a metal post (usually the
provisional restoration of choice for a tooth awaiting a custom post and core and
crown), please refer to the fixed prosthodontic textbook of choice for a detailed
description.

15. The Fixed Prosthodontic syllabus and the fixed prosthodontic course textbook of
choice thoroughly describe the post and core try-in, adjustment and cementation
procedures. Please be sure to review these procedures prior to arriving in clinic.

Rev. 1/11

III. Management of "Fixed/Removable" Cases
1.

Survey crowns
When "survey" crowns are planned in the same arch where teeth are to be replaced
with an RPD, the final RPD design must be on a surveyed diagnostic cast prior to

starting any crown preparation.
When requesting the fabrication of "survey" crowns from the Prosthetic Laboratory,
the path of insertion for the RPD must be indicated on the working cast (cast must be
tripoded) and the laboratory work authorization must include directions for the
placement of heights of contour (undercuts), guide planes and the size, shape and
location of rests on the crowns.

Upon receiving "survey crowns" back from the lab, the student must check to see that
all of the characteristics noted above are present prior to trying the crown(s) in the
mouth. (This means putting the crown on its working cast on the surveyor to be
certain that guide planes and undercuts are adequate. Changes cannot be made after
the crown is cemented!) The crowns must be cemented prior to making the final
impression for the RPD.

2.

Crowns or an FPD made opposing or adjacent to edentulous spaces
which are to be restored with an RPD
The placement of already-selected denture teeth onto the opposing arch should be
included as part of initial diagnostic "wax-up". This allows a matrix to be made over
the wax-up which can be used to assess the occlusal reduction needed over crown
preparations.

Denture teeth should be set opposing the working cast of the crowns or FPD when
submitting these crowns to the lab for fabrication.

Denture teeth should be set in edentulous spaces adjacent to dies on the working cast
during the fabrication of the crowns or FPD.

3.

Crowns or an FPD made opposing a complete denture
When fabricating a single crown, the student may not need to mount the working cast.
Please check with a full-time faculty member to verify.

For multiple anterior or posterior crowns, the working cast should be submitted to the
lab mounted opposing a cast of the current denture--if not being remade. If the
denture is being remade, then the working cast must be mounted opposing either a
wax rim that has been evaluated in the patients mouth or a final denture wax-up that
has also been verified in the patients mouth. Please note that a final wax up is the
most accurate method and is generally recommended. Confirmation with a full-time
faculty is advised if the student has questions.
Rev. 1/11

17

IV. Communication with the Prosthetic Laboratory

Items to be included with case:

1. mounted working and opposing cast with dies trimmed
2. complete work authorization (as described below)
3. interocclusal record
4. second pour of final impression (i.e., solid cast)
5. articulator
6. final impression
7. diagnostic wax up where appropriate
8. opposing occlusion rim or denture set-up where appropriate (refer to section:
Diagnosis, Treatment Planning & Sequencing Prosthodontic Treatment)
Guidelines for submitting Fixed
(evaluated by signing faculty and verified by Quality Control faculty)
Cases to the Laboratory
Working dies

die(s) correctly trimmed
finish line well-defined, and carefully marked with red pencil
die(s) stable and seated completely
preparation must have sufficient occlusal and axial reduction
preparation must have sufficient path of draw/resistance and
retention form

Articulated casts

articulation correct
opposing cast in good condition
mounted working cast, opposing cast and articulator are neat
and clean
cases involving bridges or multiple units must be mounted on a
semi-adjustable articulator

Work Authorization

whenever possible, should be signed by the preceptor who you
made the impression with
preceptor signature is only obtained when all materials are
present for evaluation (mounted casts with trimmed dies, solid
cast, complete work authorization)
in clinic
cases CANNOT be left on the Quality Control bench without a
student and faculty signature
all vital information must be included (type of margin desired,
type of occlusion desired, shade, etc.)

N.B. The student is expected to bring acrylic post and core patterns (accompanied
by a preceptor signed prescription) to the lab for investing and casting ASAP. The
student is does not invest this pattern.
Rev. 1/11

V. Items from the Laboratory
Be certain that all items received from the lab are disinfected before proceeding to
the patients mouth (this includes both fixed and removable items)

All crowns, post and cores and RPD frameworks that do not fit, MUST be
returned to the lab. The metals from these items can be reused. They should
NEVER be thrown away or given to the patient.

VI. Materials used in Prosthodontics
Students must be familiar with all materials that they are using in clinic to ensure
proper handling for patient, student and staff safety.

o TEMPORARY CEMENT REMOVER: Provisionals that have been
cleaned using temporary cement remover in the lab must be rinsed
thoroughly. Any gloves that have contacted the cement remover must
be changed. This material is extremely caustic and may cause
significant intraoral and extraoral burns if not handled properly.

o ACRYLIC MONOMER: Sensible precautions should be taken to
prevent monomer spills. Bottles should not be left open or placed on
operatory trays where they may be knocked to the floor. Facilities
management must be called to properly clean these spills, which
creates an unnecessary cost to the clinics. Not to mention, it smells
terrible!

Rev. 1/11

19
COMPLETE DENTURES

The following outlines all the procedures, materials, preceptor checks and laboratory
scripts necessary for fabricating complete dentures.

First Visit: Exam, Treatment Plan, Alginate Impressions

Student provides: Bowl, spatula

Clinic provides: 01 cassette, alginate, green stock trays (adhesive), metal edentulous
trays (no adhesive), Dr. Thompson marking sticks

Procedures to be completed:
Review patients medical history (oral diagnosis faculty consult)
Review patients dental history and perform intraoral and extraoral exam .
When complete, review with Prosthodontic faculty and finalize treatment
plan.
Bring patient to financial office.
Make alginate impressions after the patient has made a half down payment.

First Laboratory Exercises: Denture bases, mounting casts and occlusion rims

Pour casts in vacuum mixed yellow stone
Trim casts and mark border extensions and post dam in red pencil

PRECEPTOR CHECK
Carve post dam
Prepare wax pattern for bases2 sheets baseplate wax, ends at line at 90
degree angle
PRECEPTOR CHECK
Seal base pattern to cast, maintaining extension to red line!!
PRECEPTOR CHECK

PRECEPTOR SIGNATURE
Write prescription to lab: Please process denture bases, thank you
Fabricate mounting casts and occlusion rims
HAVE PRECEPTOR CHECK RIMS AND CASTS AT LEAST THE DAY
BEFORE THE PATIENT IS SEEN

Rev. 1/11

Second Visit: Adjust Denture Bases, Jaw Relationship Records

Student provides: Denture bases with rims and mounting casts, slow speed
handpiece, facebow

Clinic provides: 01 cassette, RDK (removable denture kit), PIP, Dr. Thompson
marking stick, acrylic burs, baseplate wax, aluwax, Hanau and
Lenk torches, Mould and Shade guides (Ivoclar or Trubyte), water
baths

Due to the time needed to completely adjust the denture bases properly, begin with the
maxillary denture base. When finished, adjust the lip support, incisal edge position, mark
midline, select shade and mould for the maxillary anteriors, and do a facebow transfer.
This will allow you to do a mini esthetic try-in at the next appointment and complete
your jaw relations. IF YOU HAVE TIME, YOU THERE IS NO REASON NOT TO
COMPLETE ALL

OF JAW RELATIONS AT THIS APPOINTMENT.
Adjust maxillary denture base with PIP.
PRECEPTOR CHECK
Adjust lip support and incisal edge position of upper rim
PRECEPTOR CHECK
Mark midline
Facebow transfer
Select shade and mould of teeth (an alginate of existing dentures is helpful)
PRECEPTOR CHECK

IF TIME PERMITS:
Adjust mandibular denture base with PIP.
PRECEPTOR CHECK
Determine vertical dimension
PRECEPTOR CHECK
Centric relation record
PRECEPTOR CHECK

Please dispense (Ivoclar or Trubyte) denture teeth
Prescription to request teeth from the lab:
Shade _____
Maxillary anterior mould ________
Mandibular anterior mould __________
Posterior mould _______ (specify if both max and mand are needed)
Thank you

Rev. 1/11

21
Second Laboratory Exercise: Set Teeth


Set maxillary 6 anteriors if jaw relations incomplete.

OR

Set all teeth if jaw relations are completed. If JRR is complete, you should
NEVER set ONLY the 12 anterior teeth. If JRR is complete, then set ALL
the teeth.

Third Visit: Complete Jaw Relationship Records/Esthetic Try-in

Student provides: Articulator with maxillary cast mounted and 6 anteriors set,
mandibular denture base, handpiece
(Remember: If JRR was complete at last visit, all teeth must be
set!)

Clinic provides: 01 cassette, RDK (removable denture kit), PIP, acrylic burs,
baseplate wax, aluwax, Hanau and Lenk torches, Mould guides,
water baths

Adjust mandibular denture base with PIP
PRECEPTOR CHECK
Evaluate esthetics of maxillary anteriors
PRECEPTOR CHECK
Determine vertical dimension
PRECEPTOR CHECK
Centric relation record
PRECEPTOR CHECK

Third Laboratory Exercise: Set Teeth

Finalize tooth arrangement, wax contours should be smooth and teeth wax
free
Articulator should be clean

Rev. 1/11

Fourth, (etc.) Visit: Esthetic Try-in

Student provides: Articulator casts mounted and all teeth set, handpiece

Clinic provides: 01 cassette, RDK (removable denture kit), acrylic burs, baseplate
wax, aluwax, Hanau and Lenk torches, water baths

Evaluation of esthetics and phonetics of anteriors
Evaluation of vertical dimension
Verify centric relation (you must know how to do this procedure!!)

Fourth, (etc) Laboratory Exercise: Set Teeth

When ready to submit to lab:
For monoplane posterior teeth, need bilaterally even contacts with teeth
contacting intimately
articulator clean
wax contours smooth
teeth wax free

Please beautify wax up
Prescription to laboratory:
Process, finish and polish dentures
Thank you
Preceptor signature

Delivery Visit:

Student provides: Articulator with maxillary and mandibular mounting casts
mounted, handpiece, processed dentures

aluwax, Hanau and Lenk torches, water baths, articulating paper

Adjust the fit of maxillary and mandibular denture bases with PIP
PRECEPTOR CHECK
Evaluate esthetics and phonetics
Verify centric relation (with aluwax!)
PRECEPTOR CHECK

Instruct patient on care and maintenance of dentures and schedule 24 hour
recall
Always be prepared to do a clinical remount and understand how occlusal
adjustments are made.
Rev. 1/11

23
Recall Visits:

Student provides: handpiece

Clinic provides: 01 cassette, PIP, acrylic burs

Evaluate fit and comfort of denture
Discuss with patient any difficulties encountered
Make adjustments
PRECEPTOR CHECK before adjusting and after completed

Schedule of recall appointments: 24 hours, 1 week, 2 weeks, 1 month, 6 months, then
yearly. The number of appointments may vary depending on the patients particular
needs.

Submitting Complete Denture Cases to the Laboratory
Work Authorizations must always by filled out completely and signed by the student and
the preceptor who was the last to supervise the case in the clinic. The preceptor will not
sign the prescription until all steps necessary to send the case to the lab are complete.

The following specific details will be checked by faculty:
The casts must be neatly mounted on a semi-adjustable articulator at correct vertical
dimension of occlusion.
There are no interferences at the heels of the casts.
For monoplane posterior teeth, the condylar inclination is set at 0 degrees.
A "tight" interocclusal relationship is present between the maxillary and mandibular
posterior teeth.
The anterior teeth have no
The wax contours are smooth, and the denture teeth are wax free.
interocclusal contact.

Rev. 1/11

IMMEDIATE DENTURES
Immediate Denture Protocol

Please refer to Section X of the Complete Denture Prosthodontics Syllabus

for a
complete description of the immediate denture technique. All students must read and be
familiar with this section prior to presenting with the patient for final impressions in the
prosthodontic clinic.

General Guidelines:
1. Immediate dentures are to be made for the maxillary arch only. Treatment planning
mandibular

immediate dentures is strongly discouraged and treatment cannot be done
in the student clinic. Please remember to include the cost of a reline in the original
treatment plan.
2. Posterior teeth should be extracted approximately two months prior to the date of the
final (anterior) extraction/immediate denture delivery appointment.

3. Final impressions for immediate dentures are to be made with alginate material in the
best fitting tray possible. This could be either a partially dentate

metal stock tray or a
green plastic stock tray.
4. Any mandibular prosthesis (complete denture or RPD) is tried in and adjusted at an
appointment other than the final extraction/immediate denture delivery
appointment.

The 24 hour post insertion appointment is generally an acceptable
time for delivery of the mandibular prosthesis.
5. The patient must be appointed for the OMFS clinic at either 9:00 AM or 1:00 PM
(2:00 PM if the 3
rd

year student has a 1:00 PM class) for the final extraction
appointment.
6. The day of the final extractions and the delivery of the immediate denture the
following must be done:

a) The student must check in with Prosthodontics Clinic faculty prior to the
extractions
b) The extractions will be done in the OMFS clinic
being done. Faculty will have the opportunity to evaluate the
prosthesis and then the student will place the immediate denture into a
disinfectant solution
c) The patient must be moved to the Prosthodontics Clinic no later than
10:30 AM or 3:30 PM in order for the student to have adequate time to
adjust and deliver the immediate denture
Rev. 1/11

25
RELINING DENTURES
Protocol

Please read the Complete Denture syllabus for the appropriate technique for manipulating
the materials for a denture lab processed reline. This section will discuss clinical
protocols on management of the patient and lab resources.

Relines will be indicated in various situations and the student must be certain as to which
one applies in order to enter the correct codes in QR and bill the patiently accordingly.

1. The patient requires a reline of a conventional maxillary or mandibular denture
because the processed bases were found to have inadequate retention at the JRR, esthetic
try-in or delivery visit. These patients are NOT charged for this reline. The denture
codes in QR should be kept as incomplete until the reline has been successfully delivered.
The student does not receive 1/3 arch credit for these reline procedures.

2. The patient requires a reline of an immediate denture. These patients must be
billed for any relines, as the fee is not included in the cost of the denture and MUST be
included as part of the initial treatment plan. The code to be used is 5750. The student
will receive 1/3 arch credit for these reline procedures.

3. All other relines will likely fall under the 5750 code for dentures that have been
made over one year ago by UCSDM. However, this must be evaluated by the faculty on a
case-by-case basis.

IMPORTANT CONSIDERATIONS FOR DENTURE RELINES

ALWAYS SCHEDULE YOUR RELINES WITH THE LAB BEFORE

SCHEDULING YOUR APPOINTMENTS FOR THE PATIENT!
NOTE: In order for the Lynal to act as an impression for a reline, the
denture must be worn for a minimum of 1 hour! The ideal time is 24
hours. The maximum is approximately one week. The condition of the
Lynal will be the determining factor.

The prescription reads: Please use cold cure processing with clear resin for
this reline (or rebase). Thank you. (Please confirm with the preceptor that
this is the correct material for the situation being addressed clinically.)

The denture will be processed overnight, so the patient must plan to be
without the denture for 24 hours.

Delivery of a relined denture is the same as delivering a conventional
denture (Section IX of syllabus.) You must adjust internally with PIP,
check CR, VDO and occlusion. Recalls must also be scheduled similar to a
conventional denture delivery.
Rev. 1/11

REMOVABLE PARTIAL DENTURES

Guidelines for Submitting Removable Partial Denture

Cases to the
Laboratory

For metal framework fabrication

:
The final impression should be made with alginate and a
Master casts must be poured in vacuumed
metal stock tray
Tuberosities and hamular notches must be included on maxillary cast for Kennedy
Class I and Class II RPDs
die stone
Tongue area flat and retromolar pads included on mandibular cast
Trimmed "land" area 3 - 4 mm, full vestibule and adequate thickness (1/2 to 3/4")
of cast
Cast notched for mounting
Master cast surveyed and tripoded only
Detailed drawing of framework on diagnostic cast or duplicate of master cast with
a red
Casts mounted on a semi-adjustable articulator if there is potential for occlusal
interferences with rests or connectors
pencil
Detailed description of each component written on lab authorization
Faculty will not sign prescription until all of the above are completed

The student is expected to set the denture teeth on the framework

:
In order for the student to accomplish this, faculty will look for the following:

A positive, accurate and stable interocclusal record is present
No interferences at heels of casts
Casts mounted neatly on semi-adjustable articulator at correct vertical dimension of
occlusion
Record bases and framework fully seated on cast
No occlusal interferences from rests or connectors
Complete tooth order instructions given

Note

:
The student will submit the case to the Laboratory for wax refinement and processing
after all of the denture teeth are set in baseplate wax on the framework and the correct
tooth position is verified by faculty. The extensions of the denture base areas must be
marked on the master cast in red pencil using the same guidelines as established for
flange extensions for a complete denture. Faculty must sign the prescription.
Rev. 1/11

27

Tips for Designing RPDs

I. Questions:
1. What teeth are to be replaced and why?

2. Will the RPD be tooth supported or tooth-tissue supported?

3. What is the condition of the potential abutment teeth (periodontal condition, caries, etc)?

4. Are there acceptable undercut areas on abutment teeth?

5. Would modification of axial/proximal contours or heights of contour improve the prognosis
of the RPD?

6. Is there sufficient occlusal clearance to accommodate occlusal rests and other components?

7. Does your clasp assembly design incorporate 180 encirclement for distal extension
situations?

8. Are there anatomic concerns (tori, excessive soft tissue, tissue undercuts, etc.) that must be
corrected or avoided with the proposed design?

9. Given the patients past disease history and current status, should the RPD be designed with
the potential for modification should teeth be lost in the future?

Note: If the student has any opportunity to fabricate an RPD at a Community
Health Center Rotation, then the RPD MUST be designed at UCONN with full-time
prosth faculty at open hour.

II. Guidelines for RPD framework design
1. Every component added must have a specific function (KISS principle).

2. To survey, begin with the occlusal plane parallel to the floor.

3. Select a major connector that will fit into the space available (lingual bar vs. lingual plate)
and will provide support where necessary (maxillary distal extension situations).

4. Spaces narrower than 5mm between minor connectors should be plated closed.

5. Eliminate anterior modification spaces whenever possible (or whenever practical).

6. Identify the fulcrum line and then provide indirect retention for distal extension situations.

7. Rest on all teeth

adjacent to edentulous spaces (exceptions: incisors or weak/mobile teeth).
8. Rest on the side adjacent

to the edentulous space in tooth bound spaces.
Rev. 1/11

II. Guidelines for RPD framework design, cont
9. Rest on the side of the tooth away
occlusion or restorations dictate otherwise).
from distal extension spaces (exception: when

10. Mesial occlusal rests on first premolars are preferable to cingulum rests on canines.

11. When tipped mandibular molars are present, place large mesial occlusal rests on them for
support, but do not clasp them under normal circumstances.

12. The horizontal retentive arm (Grasso clasp) is the standard clasp for most indications.
Deviations from this general approach should be verified with a faculty preceptor.

13. Clasp only two teeth in distal extension situations (exception: some Kennedy Class II
situations).

14. Avoid embrasure rests whenever possible.

15. Cast restorations for RPD abutments MUST be evaluated for occlusal rest position, shape,
size and occlusal clearance as well as appropriate proximal, lingual and buccal contours prior
to cementation. A note that this evaluation has taken place must be entered into the daily
Progress Notes.

III. Transitional/Interim Partial Dentures
Transitional partial dentures that involve both anterior and posterior teeth are
billed using the 5211 or 5212 codes in QR (maxilla and mandible
respectively.)

Interim partial dentures that replace only 3 to 4 teeth are billed using the
5820/5821 codes.

The student must set the teeth for all transitional or interim RPDs.

Students should not be fabricating flippers for patients. All work
should be directed through the prosthetic laboratory, and patients must
be billed accordingly.

Note: State insurance will only pay for one prosthesis every 5 years. If a
patient requires an interim RPD and a conventional RPD, then the patient
must be informed that he/she must pay for the interim RPD out of pocket.

Rev. 1/11

29
Students Guide to RPDs

The typical removable partial denture patient will require a comprehensive treatment
plan. This will require you to complete your data collection for all of the patients perio,
endo, and operative needs. The partial denture is only one phase of the patients
treatment, but it must be considered at the outset when developing the overall treatment
plan.
************************************************************************

Clinical Visit: Exam, Data Collection, Alginate Impressions

Student provides: Bowl, spatula, red/blue pencil

Clinic provides: 01 cassette, alginate, green stock trays (adhesive), EPT, disclosing
solution

Review patients medical history (oral diagnosis faculty consult if not
already completed)
Review patients dental history and perform intraoral and extraoral exam
completing perio, operative and endo data bases.
Make alginate impressions for diagnostic casts

The first appointment with the patient should be used to complete data collection. It is
always a good idea to make impressions for diagnostic casts at this time. They will be
invaluable for later consultations with faculty. At this stage the student should begin to
consider a design for an RPD if indicated. A consultation with a pros faculty or team
leader early on may save you time with data collection if many teeth are hopeless or will
not be functional in the RPD. They may recommend that a facebow transfer be done at
this time to later assist in mounting the diagnostic casts.

************************************************************************

Clinical Visit: Treatment Planning

Student provides: Trimmed and articulated diagnostic casts, completed data base

Clinic provides: 01 cassette

Obtain consults from perio, endo, operative and prosthodontics
If you have not already done so, the prosthodontic faculty will request you
to have your diagnostic casts mounted for evaluation of occlusion, etc.
This may require an additional clinical appointment before the RPD can be
finally designed.

Rev. 1/11

The patient will do A LOT of waiting at the consultation appointment. It is always a
good idea to have your patient bring a book to this appointment. (It also may take longer
than one appointment to finish treatment planning consultations.)

************************************************************************

Clinical Visit: Mounting Diagnostic Casts (if not already done, i.e. record
bases need to be made)

Student provides: Trimmed diagnostic casts, Triad record bases with occlusion rims,
articulator and facebow, slow speed handpiece, bowl and spatula

wax, aluwax, Hanau and Lenk torches, hot water bath (set at 125
F)

Facebow transfer
Interocclusal record using the essentially the same techniques as taught in
the complete denture course

************************************************************************

Laboratory Procedure: Designing RPD

After you have discussed the case with one of the prosthodontic faculty and an
RPD has been decided upon, a final design must be worked up.
THE STUDENT MUST NEVER TAKE THE TIME TO FINALIZE A
PARTIAL DENTURE DESIGN WHILE A PATIENT IS WAITING IN THE
CHAIR!!!!!! Designs should be finalized with faculty during Wednesday 12-2
pm open hours in the Reconstructive Sciences conference room (L6105). Before
discussing a design with a faculty member, the student must have worked up a
tentative design to discuss with the faculty.
When discussing the design with faculty the student will need:
A surveyor
The patients chart with radiographs
Mounted diagnostic casts
Red pencil
Your tentative design on a sheet of paper
When the design is completed and approved by the faculty, it must be
transferred into the progress notes of the chart using the design sheet on the
following page. Both the student and the faculty member must sign the design.
Rev. 1/11

31

Rev. 1/11

************************************************************************

Clinical Visits: Complete Phase I therapy


All perio, restorative and endo treatment must be completed and a Phase I Re-
evaluation must be done before any Phase II treatment (crowns, bridges, RPDs) can be
started. Once the Phase I re-eval is done and the appropriate signatures are entered into
the chart, mouth preparation can begin for the partial denture. All operative and crown
and bridge procedures must be considered part of the mouth preparation. What you
dont want to have happen is cement a crown and then have to remove it and remake it
because you forgot that the crown needed rests, undercuts, etc.

************************************************************************

Clinical Visit: Mouth Preparation and Final Impression

Student provides: Mounted diagnostic casts with design, high speed handpiece, bowl,
spatula, vacuum mix bowl

Clinic provides: 02 cassette, general burs, metal trays, alginate

Mouth preparation
Final impression with alginate in metal
Alginate of the opposing arch is also necessary
tray
Final impression is poured within 15 minutes in vacuum mixed die stone
making certain all borders are included.
NOTE: IF composite resin cingulum rests are planned for mandibular
canines, they will probably require a separate visit
(The cast(s) should be separated
from the impression 45-60 minutes after pouring so the surface is not
damaged by remaining in contact with the drying alginate. The cast(s)
should be allowed to dry overnight before trimming, surveying, etc.)

************************************************************************

Rev. 1/11

33
Laboratory Procedures: Submitting Case to Lab for Framework Fabrication

The trimmed master cast is surveyed and tripoded.
A laboratory prescription is written and then reviewed and signed by
preceptor.
The case is submitted to the laboratory including:
master cast
study cast with design drawn
opposing cast (mounted if necessary to evaluate occlusion)
signed work authorization

It will take 10 working days for the framework to be returned from the lab assuming the
case is not held up in Quality Control.

************************************************************************

Clinical Visit: Framework Try-in and Jaw Relationship Records

Student provides: Framework on master cast, cast of opposing arch, high and slow
speed handpieces, bowl, spatula, facebow, articulator, metal
calipers, red pencil

Clinic provides: RDK tub, general burs, acrylic burs, disclosing materials (fit
checker, PIP, etc.), pliers for adjusting clasps, torches, wax, hot
water bath

Framework is adjusted and seated.
Occlusion is carefully checked to insure that the RPD framework does
NOT
Record base and occlusion rims are made using baseplate wax on
framework.
alter the normal occlusal contacts.
J aw relationship records are completed (following the procedures outlined
for complete dentures)

************************************************************************

Laboratory Procedure: Set Teeth

Set teeth, wax contours should be smooth and teeth wax free
Denture teeth usually will require adjustment/alteration to fit into the
space available and to articulate properly with opposing natural teeth.
Articulator should be clean

************************************************************************
Rev. 1/11

Clinical Visit: Esthetic Try-In and Verification of JRR

Student provides: Mounted casts with teeth set on frameworks, slow speed
handpiece, bowl, spatula, articulator

wax, aluwax, Hanau and Lenk torches, water baths

Evaluation of esthetics and phonetics
Evaluation of vertical dimension
Verify centric relation (if mounted in CR)
Verify correct occlusion

An esthetic try-in may not be necessary if no anterior teeth are being replaced and there
are no doubts about the accuracy of the jaw relationship records. Check with your
preceptor.

************************************************************************

Laboratory Procedure: Finalize Wax Up to Submit to Lab for Processing of Teeth


The case is ready to submit to the lab when:
Appropriate occlusion developed specific to case
Articulator clean
Wax contours smooth
Final extensions of denture flanges marked in red pencil on cast and/or
wax extended to appropriate coverage
Teeth wax free

Please beautify wax up
Work authorization to laboratory:
Process, finish and polish
Thank you
Preceptor signature

************************************************************************

Rev. 1/11

35
Clinical Visit: Delivery

Student provides: High and slow speed handpieces, red pencil, metal calipers,
processed partial dentures

aluwax, Hanau and Lenk torches, water baths, articulating paper,
pliers for adjusting clasps

Adjust the fit the partial dentures (you may need to adjust the metal as well
as the acrylicideally it should only be acrylic!)
Verify occlusion
Evaluate esthetics and phonetics
Instruct patient on care and maintenance of partial dentures
Schedule recall for 24 hours

************************************************************************
Clinical Visit: Recalls

Student provides: Handpieces

Clinic provides: 01 cassette, PIP, acrylic burs, articulating paper

Evaluate fit and comfort of partial denture
Discuss with patient any difficulties encountered
Make adjustments
PRECEPTOR CHECK before adjusting and after completed

************************************************************************

PLEASE UNDERSTAND THIS IS ONLY A ROUGH GUIDE. EACH PATIENT
WILL BE DIFFERENT AND MAY REQUIRE SIGNIFICANT MODIFICATIONS
FROM THE SEQUENCE AND/OR PROCEDURES DESCRIBED ABOVE. THIS
SHOULD SERVE AS A GENERAL REFERENCE ONLY WITH YOU FILLING IN
THE DETAILS WITH INFORMATION GATHERED FROM LECTURES,
READING AND ASKING QUESTIONS!

NOTE: All removable prosthesis deliveries require recall appointments.
This includes relines and transitional partial dentures.

Credit for any removable prosthesis is not granted until the student
has completed the one month recall with the patient.
Rev. 1/11

IMPLANTS

UCONN Undergraduate Single Tooth Implant Protocol

The single tooth implant protocol allows each dental student to offer single tooth implant
restorations to their patients and 2 implants for an overdenture patient.

I. General Treatment Planning Information:
Consultation with prosthodontic faculty must be the first step

before committing
to treatment. This is required! Consultation should be with Drs. Dhingra,
Duncan, Nazarova, Patch or Taylor only. Diagnostic casts and appropriate
radiographs are okay for consult with above faculty. The orange treatment
planning sheet will be REQUIRED with requisite signatures (see checklist below).
Only single tooth replacement is available. Posterior teeth only (premolars
and 1
st

molars)
Adjacent implants may not be done in the predoctoral clinics. Patients
requiring side-by-side implants must be referred to either graduate
prosthodontics or AEGD for treatment planning this area.

Only sites that do not

require augmentation (grafting) prior to implant placement
are acceptable.
See the most current fee schedule for procedure costs. The fee includes the cost of
the implant, abutment, crown and surgical guide. It does not cover the cost of pre-
operative radiographs.

The code is 16013 in procedure group 61.

The procedure conveniences must be
included.
The restoration will be a cemented crown on a standard solid abutment, no
angled are to be used in the student clinics.

The implant will either be a standard solid regular or wide neck implant. No
narrow neck implants will be used on student cases.

Patients who are offered this treatment must have a good track record (i.e.,
reliable, prompt, compliant, etc.)

Patients who smoke are not eligible.
Rev. 1/11

37

Patients for whom elective surgical procedures are contraindicated are not
appropriate candidates for this treatment option. (e.g., uncontrolled diabetics,
chronic systemic steroid use, immune-compromised, etc.)

Patients must be made fully aware that if, at the time of surgery, it is discovered
that a graft is needed to place the implant or anything other than a standard
abutment will be required to restore the implant, then the patient will become a
residents patient and must pay resident fees. The patient must sign the Student
Implant Program Consent Form which is attached to the orange checklist
sheet.

Students may work with either Oral Surgery or Perio for implant placement.

II. Pre-operative Sequencing:
Prosthodontic consultation is done during treatment planning.
Faculty approval of implant treatment must be obtained at this
stage. Consultation with PROSTHODONTIC FACULTY must be
the FIRST step before committing to treatment.

This is required!
The student obtains a surgical consult from Periodontal or Oral Surgery
FACULTYnot a resident. Reminder: this only occurs AFTER a
prosthodontic consult. Surgery consults should NOT be obtained from a resident
in either discipline. Patient surgical consultation may be obtained at same clinic
session as prosthodontic consultation or at a subsequent visit. The informed
consent reviewed and signed. Additional radiographs (panorex, etc.) deemed
necessary should be ordered at this time.

A surgical guide is fabricated by the student and must be approved by
prosthodontic faculty and surgeon.

The fee is collected prior to the surgery appointment.

III. Surgery:
During surgery the student assists the resident/faculty in placement of the implant.

Peri-operative antibiotic medication and post-operative pain medication will be
given as directed by the resident/faculty involved with surgery.

The implant should not be signed off in QR as complete at this
time! Only the implant placement is complete--please note the appropriate
procedure conveniences.
Rev. 1/11

residents patient and must pay resident fees.

IV. Post-Operative Period:
The student should contact the patient by telephone 24 hours post-placement to
verify that the patient is comfortable.

The patient is seen for follow up 1 week after implant placement.

A minimum of 6 weeks post-surgery is necessary for healing/osseointegration.

V. Restorative Procedure:
A solid abutment is selected and inserted into the implant.

A final impression is made.

The implant/abutment must

be covered either with a protective cap or with a
provisional crown.
The final restoration is cemented with zinc phosphate cement.

VI. Follow-up/Recall:
6 month recall.

Annual recall.

Periapical radiographs should be taken at the 1 year recall and then every 3 years
unless there is concern about the health/stability of the implants

Rev. 1/11

39
The following will answer some of the logistical questions regarding implants in the
student clinics:
VII. Additional Logistic Information:
1. Procedure codes: The code to be used for the predoctoral implant (see most current
fee schedule for cost) is found under the heading of "other implant services." The single
implant crown code is 16013. Procedure conveniences MUST BE INCLUDED!! The
procedure conveniences will cover the implant placement, abutment connection,
impression and crown delivery for code 16013. The appropriate steps are covered for the
overdenture code.
2. Abutment connection: Abutments should be connected in Clinic 4. The Straumann
kits have the appropriate instrumentation for either the overdenture or implant crown.
The implant should not be entered as complete until the crown is
delivered!
3. Clinic and lab implant components: The components that are needed to restore
single implant crowns (abutments, impression copings, protective caps, lab analogs, etc.)
and implant overdentures are available at central support.
4. Treatment planning: Be sure to follow the protocol above.
A few important reminders and updates:
Patients who require grafts, sinus lifts, immediate placement, etc will not be
eligible for the student program. Only straightforward, uncomplicated and ideal
sites should be considered.

residents patient and must pay resident fees.
Only posterior teeth may be replaced: premolars and 1st molars.
Rev. 1/11

MANDATORY CHECKLIST FOR STUDENT IMPLANT PROGRAM

Patient Name:
TOO #:
Consult with Prosth Faculty FIRST STEP OF DATA COLLECTION
Student must have mounted diagnostic casts and radiographs
Date:
*Faculty Signature:
Comments:
Consult with Surgical Faculty (Resident Consults are Unacceptable)- Data Collection
Assessment of Alveolar Bone Volume - by Surgical Faculty (Perio/OSurg)
Can be by radiograph, sounding, clinical exam
Consent signed
Date:
**Faculty Signature:
Comments:
Surgical guide approved by prosthodontic faculty
*Signature: Date:

Consult with Surgical Faculty - Final Review
Must Be At Least 3 Months Post Extraction
Must Review Surgical Guide
**Faculty Signature: Date:

Fee collected for procedure
prior to implant placement!

*Acceptable Prosth Faculty Signatures: Drs. Dhingra, Duncan, Nazarova, Patch, or Taylor
** Acceptable Surgery Faculty Signatures: OSURG Goupil, Landesberg, Piecuch, Shafer, Song
PERIOAlmas, Cantner, Diaz, Dongari, Ioannidou, LaPorta, Nichols, Schincaglia
Rev. 1/11

41
UCONN Undergraduate Implant Overdenture Protocol

The protocol is very straightforward and provides every student the opportunity to offer
dental implant anchorage to one patient for whom s/he has already fabricated a
mandibular complete denture.

The student assists a resident or faculty member with the placement of the first implant
and then places the second implant assisted by the resident or faculty member. The
implants are placed anterior to the mental foramina in the lateral incisor

position.
Following implant placement the patient avoids use of the denture for a week to 10 days
and the student then relieves the denture and places a soft temporary liner to allow its use
during the remainder of the healing period. The protocol recommends a six-week healing
period prior to loading the implants. At the six-week stage the student places ball anchor
attachments into the implants and the denture is permanently relined incorporating the
retentive matrices in the base of the denture.
With no cost components and instrumentation from the company, the entire process of
implant placement and restoration is minimal and well within the financial capability of
most of our denture patients. Please refer to most current fee schedule for precise cost
which includes the surgical and restorative phases unless the patient requests sedation
during surgery. In that case an additional fee will be charged to the patient.

I. General Treatment Planning Information
Under NO circumstances should implants be mentioned in the treatment
planning of a patient for complete dentures. Only after successful delivery

of
new dentures should you discuss the possibility of implant anchorage for the
mandibular denture. The student should not and cannot promise implants before
the dentures are made because it is possible that your patient may not be an
implant candidate for any number of reasons.
Refer to the fee schedule for the current fee for the student complete implant
procedure. This fee includes the implants, surgical guide, surgery, prosthodontic
components and reline. Any radiography performed or sedation during surgery
will require additional cost to the patient and/or their insurance carrier.

The implant treatment option is available only

for patients with new dentures that
were fabricated in our clinics.
Patients who are offered this treatment must have a good track record (i.e.,
reliable, prompt, compliant, etc.)

Patients who smoke are not eligible.
Rev. 1/11

Patients for whom elective surgical procedures are contraindicated are not
appropriate candidates for this treatment option. (e.g., uncontrolled diabetics,
chronic systemic steroid use, immune-compromised, etc.)

Consultation with prosthodontic faculty must be the first step before
committing to treatment. This is required! Consultation should be with Drs.
Dhingra, Duncan, Patch, Nazarova or Taylor only. Diagnostic casts and
appropriate radiographs are okay for consult with above faculty. Treatment
planning sheet will be REQUIRED with requisite signatures (see checklist
below). Surgical guide must be approved by prosthodontic faculty (not
surgeon!).

Students may work with either Oral Surgery or Perio for implant placement.

II. Pre-operative Sequencing
Prosthodontic consultation is done during treatment planning. Faculty approval of
implant treatment must be obtained at this stage. Consultation with
prosthodontic faculty must be the first step

before committing to treatment.
This is required!
The student obtains a surgical consult from Periodontal or Oral Surgery
FACULTY. Reminder: this only occurs AFTER a prosthodontic consult.
Surgery consults should NOT be obtained from a resident in either discipline.
Patient surgical consultation may be obtained at same clinic session as
prosthodontic consultation or at a subsequent visit. The informed consent
reviewed and signed. Additional radiographs (panorex, etc.) deemed necessary
should be ordered at this time.

The fee is collected prior to any further procedures commencing.

Surgical guides are mandatory

for implant placement. The mandibular denture is
duplicated in clear acrylic resin by the student. Help/supervision of this procedure
can be obtained in the dental lab. The surgical sites will be marked on the
duplicate denture (surgical guide) and holes (5 mm in diameter) will be drilled
through the surgical guide. Surgical guide must be approved by prosthodontic
faculty (not surgeon!).
The patient must be made aware that the implant procedure will require that they
be without the mandibular denture for 7-10 days following surgery and for 2 days
following the reline appointment.

Rev. 1/11

43

III. Surgery
During surgery the student assists the resident/faculty in placement of the first
implant and then the student places the second assisted by the resident/faculty.

Peri-operative antibiotic medication and post-operative pain medication will be
given as directed by the resident/faculty involved with surgery.

IV. Post-Operative Period
One week to 10 days following surgery the denture is relieved over the implant
sites and soft liner is placed.

A minimum of 6 weeks post-surgery is necessary for healing/osseointegration.

V. Reline Procedure
The abutments, abutment analogs, and retentive matrices are obtained from the
staff in the Reconstructive Sciences office (L-6078). The initial checklist must be
handed presented at this time to receive the components and required patient
information must be entered in the implant log.

During the reline appointment the soft, temporary reline material is completely
removed from the denture.

The cover screws are removed from the implants, the implants irrigated, and the
ball anchor abutments placed into the implants with finger tightening. Faculty
evaluation of the height of the abutments must be obtained prior to torque
tightening the abutments.

When deemed acceptable the abutments are tightened
to 35 Ncm.
Periapical radiographs should be made at this appointment and will serve as the
baseline record of peri-implant bone levels.

A reline impression is made in the denture using medium body polyvinylsiloxane
(Reprosil). The reline should be done with a closed mouth technique to maintain
correct occlusal contact with the upper denture. There must be no contact
between the ball anchor and the denture base. If show-through to the denture is
seen, the denture should be relieved further and the reline impression redone. The
analogs are inserted into the impression and a cast is carefully poured in yellow
stone with the assistance of staff in the dental lab or faculty. The lab will process
the reline over a 24 hour period (The student must provide the retentive matrices
to the lab for processing).
Rev. 1/11

The relined denture should be checked with PIP and the retentiveness of the
matrices should be evaluated. If the patient is not able to easily place and remove
the denture the matrices should be adjusted to decrease the retention.

VI. Follow-up/Recall
The student should contact the patient by telephone within 24 hours of delivery to verify
that the patient is comfortable.

One week recall visit to evaluate tissue health and patient comfort/satisfaction.

6 month recall.

Annual recall. If any calculus is present on the implant components, use only a
plastic

scaler (available in each clinic).
Periapical radiographs should be taken at the 1 year recall and then every 3 years
unless there is concern about the health/stability of the implants.

1. Procedure codes: The code to be used for the predoctoral overdenture is found under
the heading of
VII. Additional Logistical Information:
"other implant services." The overdenture code is 16014. Procedure
conveniences MUST BE INCLUDED!! The procedure conveniences will cover the
implant placement, abutment connection, impression and reline for code 16014.
Rev. 1/11

45
Rev. 1/11

Rev. 1/11

47

PROGRESS EVALUATIONS

PROGRESS EVALUATIONS
SUMMARY:

3
RD
BRIDGE 19-20 WITH PROVISIONAL
YEAR TYPODONT PROGRESS EVALUATION

4
TH
BRIDGE 6-8 WITH PROVISIONAL

TREATMENT OUTCOMES ASSESSMENT PROGRESS EVALUATION

REMOVABLE PROSTHODONTICS OSCE-TYPE PROGRESS EVALUATION

CLINICAL PROSTHODONTIC PROGRAM PROGRESS EVALUATION

Rev. 1/11

I. Typodont Progress Evaluations (PE)
1. The 3
rd
year PE and 4
th
year PE require bridge preparations and provisionals. The 3
rd
year
PE involves teeth 19 through 21, and the 4
th
2. The 3
year PE involves teeth 6 through 8.
rd
year PE forms are green, and the 4
th
3. Appropriately designated typodont teeth (colored) will be signed out from the dispensary.
Only these teeth will be considered for grading as a PE.
year forms are blue. You have 6 hours from
start to finish. You are on the honor code to track the time used.
4. The student should bring the typodont to the Division Office (L6078) for grading.
5. Grading occurs on Wednesdays during Open Hours when multiple faculty are available.
Please keep this in mind when deadlines are approaching. Special grading
accommodations will not be made, please plan accordingly.
6. Only self-evaluated sheets will be graded. Grading is done using the criteria that follow
this page.
7. You may bring in a putty matrix or vacu-form matrix with you. This is not included in the
6 hours. You may make your provisional with an indirect technique, but this must be done
within the 6 hours and in the appropriately designated working environment.
8. You may make a diagnostic cast of your preparations to evaluate them, but you may not
confer with anyone regarding this cast. This work must be included in the 6 hours allotted
to work on the PE.
9. Work should be completed on the mannequin stand with the shroud. (Similar to NERBs)
10. You may not solicit feedback on any stage of the PE from any source. All work is to be
completed independently. Any deviation from this will be considered an honor code
violation.
11. If the 3
rd
year competency is passed by the 3
rd
year March APC meeting, you will receive
one unit of fixed to count toward your total experience. If the 4th year competency is
passed by the 4
th
year December APC meeting, you will receive one unit of fixed to count
toward your total experience. The 4
th
year progress evaluation may be challenged during
the 3
rd
12. You may abort the PE at anytime if you feel that it will not pass. This is part of your
ability to self-evaluate. You MUST, however, return the teeth that you started
working on in order to receive a new set of teeth. Having multiple sets of teeth out
will be considered an Honor Code violation.
year.
13. The typodont teeth for passed progress evaluations will be removed from the typodont and
kept by the Division.

Rev. 1/11

49
Evaluation criteria for full cast crown preparation for tooth #19

Finish line & Walls External outline Internal outline
Treatment
management
I
Smooth walls
0.5-1.0 mm
coronal to CEJ
Light chamfer on buccal and lingual continues to
proximal
No damage to
gingival shroud
Smooth, continuous and well-
defined margins
Buccal: 0.8-1.0 mm axial reduction in two planes;
Lingual: 0.8 to 1.0 mm reduction
No damage to
adjacent tooth
Angle of convergence of 6-10 Rounded line and point angles
o

Functional cusp: 1.5 mm
Nonfunctional cusp: 1.0 mm
Maintains general occlusal anatomy
II
Slight roughness of walls
More than 1.0
mm coronal to
CEJ or less than
0.5mm coronal
to CEJ
Inappropriate size of margin for 1 location
Slight damage to
gingival shroud

Slight roughness of margins
Slightly discontinuous margins
Slight lack of definition
Buccal and lingual: slightly over (>1.0mm) or under
(<0.8mm)
Under tapered (0-5
o
) or over tapered
(>10
o
Slight lack of rounded line or point angles
)

Functional cusp: slightly over (>1.5 mm) or under
(1.0 mm) reduced
Non-functional cusp: Slightly over reduced (1.0-1.5
mm) or under reduced (>0.5 but <1.0 mm)
III
Poorly defined and moderate
roughness of walls
More than 1.5
mm coronal to
CEJ
or at the level of
gingival margin
Presence of shoulder margin
Moderate damage of
gingival shroud
Moderate roughness of margins or
margins are
non-continuous
Buccal and lingual: moderately over( 2.0 mm) or
under (<0.5 mm) reduced
Slight damage to
adjacent tooth
Over tapered (>16
o
Moderate lack of rounded line or point angles )

Functional cusp: moderately over reduced (2.0-2.5
mm)
Non-functional cusp: moderately over reduced (1.5-
2.0 mm)
IV
Unfinished and severe roughness of
walls
Finish lines are
subgingival
Inappropriate size for 2 or more locations or
presence of butt-joint margin at proximal or lingual
surface
Severe damage to
gingival shroud
Severe roughness of margins or
unsupported enamel remaining
Buccal and lingual: severely over (>2.0mm) or
under reduced (<0.3 mm) or no two-plane buccal
reduction
Moderate to severe
damage to adjacent
tooth
Undercut between any set of
opposing axial surfaces or line
angles
Severe lack of rounded line or point angles
Wrong tooth
prepared Functional cusp: reduction 2.5 mm or <1mm
Non-functional cusp: reduction 2.0mm or 0.5
mm

Rev. 1/11

Evaluation criteria for full cast crown preparation for tooth #21

Finish line & Walls External outline Internal outline Treatment management
I
Smooth walls
0.5-1.0 mm coronal
to CEJ
1.0-1.2mm Shoulder with internal rounded line
angle on the buccal and gradually diminishing
from mesial and distal to 0.5 mm chamfer on
lingual
No damage to gingival
shroud
Smooth, continuous and
well-defined margins
Buccal: 1.0 - 1.5 mm axial reduction in two planes
Lingual: 0.8 to 1.0 mm reduction
No damage to adjacent
tooth Angle of convergence of
6-10
Rounded line and point angles
o

Functional cusp: 1.5-2.0 mm
Non-functional cusp: 1-1.5mm
Maintains general occlusal anatomy
II

More than 1.0 mm
coronal to CEJ or
less than 0.5mm
coronal to CEJ
Inappropriate size of margin for 1 location
Slight damage to
gingival shroud

Slight roughness of
margins
Slightly discontinuous
margins
Slight lack of margin
definition
Buccal: slightly over (>1.5mm) or under
(<1.0mm)
Lingual: slightly over (1.0mm) or under
(<0.8mm)
Under taper (0-5
o
) or over
taper (>10
o
)
Functional cusp: slightly over (2.0-2.5mm) or
under (1.0-1.5 mm) reduced
Non-functional cusp: Slightly over reduced (1.5-
2.0 mm) or under reduced (0.5-1.0 mm)
III
Poorly defined and
moderate roughness of
walls
More than 1.5 mm
coronal to CEJ
Or at the level of
gingival margin
Presence of chamfer on the buccal or undermined
enamel at any location
Moderate damage of
gingival shroud
Moderate roughness of
margins or margins are
non-continuous
Buccal: moderately over(>2.0 mm) reduced
Lingual: moderately over (1.5 mm) reduced
Slight damage to
adjacent tooth
Over taper (>16
o
Moderate lack of rounded line or point angles )

Functional cusp: moderately over reduced (2.5-
3.0 mm)
Non-functional cusp: moderately over reduced
(2.0-2.5mm)
IV
Unfinished and severe
roughness of walls
Finish lines are
subgingival
Inappropriate size for 2 or more locations or
presence of shoulder margin at lingual surface
Severe damage to
gingival shroud
Severe roughness of
margins or unsupported
enamel remaining
Buccal: severely over (>3.0mm) or under
(<0.5mm) reduced or no two-plane buccal
reduction
Lingual: severely over (>1.5 mm) or under (0.5
mm) reduced
Moderate to severe
damage to adjacent
tooth
Undercut between any set
of opposing axial surfaces
or line angles
Wrong tooth prepared

Functional cusp: reduction > 3.0 mm or < 1.0 mm
Non-functional cusp: reduction>2.5mm or <0.5
mm

Rev. 1/11

51
Evaluation criteria for provisional fixed partial denture acrylic restoration
(3 unit #19-21)

Line of
Withdraw
Margin Integrity & Surface
Finish
Facial/Lingual/Interproximal
Contours & Proximal Contacts &
Pontic Design
Anatomy & Occlusion
Treatment
Management
I
Abutments
have the
appropriate
line of draw
for the FPD
acrylic
restoration
All marginal areas are well
adapted to the tooth w/o
horizontal or vertical
extensions
The contours are harmonious
with adjacent teeth forming
proper embrasures and
conducive for gingival health
Provisional restoration reproduces normal
occlusal anatomy of the abutment teeth and
pontic tooth.
No damage
or slight
damage to
gingival
shroud

The surface of the
restoration is smooth and
with a minimum of voids
Good interproximal contacts
as determined by thin
articulating foil (shimstock)
Connector is in correct position and of
proper size both buccolingually and
occlusocervically
The internal form
conforms to the shape of
the abutment and provides
resistance and retention
Pontic: Spheroid (convex
mesio-distal and bucco-
lingual tissue side contour)
and clears the height of the
residual ridge by at least 1
mm.
Occlusal contact is present for both
restoration and other teeth (which had
contact prior to the restoration placement) as
determined by thin articulating foil
II
There is a
slight variance
to the line of
withdraw

Vertical or horizontal
overextension or short
margin at 1 location (and
less than 0.5mm x 0.5mm
on either #19 or 21) and all
marginal areas are well
adapted to the teeth
The contours of provisional
restoration deviates slightly
from the normal contour of
the abutment teeth or pontic
tooth
Provisional restoration reproduces normal
occlusal anatomy of the abutment teeth and
pontic tooth with only slightly deviation
Moderate
damage to
gingival
shroud

The surface of the
restoration is smooth with
a minimum number of
voids
Slightly over or under
contoured (<1mm) and/or
slightly lacking of proper
embrasures
Connector is incorrectly positioned (<1mm
out of position) and of slightly improper
dimensions
The internal form, due to
adjustment, deviates
slightly from the shape of
the abutment but still
provides resistance and
retention
Pontic: Spheroid (convex
mesio-distal and bucco-
lingual tissue side contour)
and clear the height of the
residual ridge >1 mm but no
more than 3 mm
Occlusal contact on restoration prevents
other teeth from contacting as determined
by thin articulating paper or restoration
lacks any occlusal contact as determined by
thin articulating paper
III
There is
significant
variance to the
line of draw
which requires
adjustment to
either the
retainers or the
abutments to
seat the
restoration
margin at 2 locations (and
less than 1.0 mm x 1.0mm
on either #19 or 21) and all
marginal areas well
restoration deviates
significantly from the normal
contour of the abutment teeth
or pontic tooth
Provisional restoration deviates significantly
from normal occlusal anatomy
Severe
damage to
gingival
shroud
The surface of the
restoration exhibits
significant irregularities
including voids, pits, or
porosities.
Lack of interproximal contact
as determined by thin
articulating foil but not by
eye
Connector is incorrectly positioned (>1mm
out of position) and has significantly
improper dimensions
significant from the shape
of the abutment and
compromises resistance
and retention form
Pontic has a flat tissue
surface contour
by thin articulating foil or restoration lacks
any occlusal contact as determined by thin
articulating foil
Rev. 1/11

Evaluation criteria for provisional fixed partial denture acrylic restoration
(3 unit #19-21), cont.

IV
The line of
draw for the
FPD
restoration is
decidedly at
variance
Generalized absence of
marginal adaptation
and/or generalized
vertical or horizontal
margin
restoration do not resemble
the normal contours of the
abutment teeth or pontic
tooth
Provisional restoration does not resemble
the normal anatomy of the abutment teeth
or pontic tooth
Wrong tooth
or teeth
is/are
replaced in
any location
of the
typodont.
Tooth or
teeth is/are
misplaced in
M-D and B-L
orientation.
The surface of the
restoration is rough
and/or porous or the
restoration is fractured
Lack of interproximal contact
as determined by eye or
excessive interproximal
contacts and cause the
adjacent tooth/teeth moved
Connector is incorrectly positioned (>2 mm
out of position) and has severely improper
dimensions
The internal form grossly
deviates from the shape of
the abutment of there is
total lack of retention and
resistance
Pontic has a concave tissue
surface contour and/or has
no interproximal embrasures
by eye or restoration lacks any occlusal
contact as visible by eye
There is premature contact in excursive
movement

Rev. 1/11

53

Evaluation criteria for prepared porcelain fused to metal abutment # 6 for FPD 6-7p-8
Finish lines &Walls External outline Internal outline
Treatment
management
I
Smooth walls
The cervical finish line is
placed 0 - < 0.5 mm
coronal to the crest of
gingival shroud
Facial shoulder with internal round line angles; width
uniform and adequate for restoration design (1.0-1.2
mm); extending to just past mesial and distal line angles
and gradually diminishing to 0.5 mm chamfer on lingual
No damage to
gingival shroud
Smooth, continuous and
well-defined margins
Sufficient tooth structure removed (including labial,
lingual) for metal-ceramic restoration with two plane
reduction on the labial
No damage to
adjacent tooth
Angle of convergence of
6-10
o
Maintains canine contour after prepared

Incisal reduction: 1.5-2 mm
Sufficient interocclusal distance (1-1.5 mm) for metal
ceramic restoration with porcelain occlusal contacts

II
and/or margins
placed 0.5- < 1.0 mm
gingival shroud

placed subgingival to the
crest of gingival shroud
but not more than 0.5 mm
Margin width varies slightly, but is adequate for
restoration design
Slight damage
to gingival
shroud

Slight damage
the adjacent
tooth/teeth but
polishing at the
proximal
surface was
done
Finish line is slightly
irregular
Axial walls slightly under-reduced or slightly over-
reduced
Under taper (0-5
o
) or
over taper in range of 10-
16
o

Slight lack of canine contour after preparation

Incisal reduction: 1-1.5 mm or 2-2.5 mm
Interocclusal distance: Slightly under-reduced or slightly
over-reduced
III
Moderately rough walls
and/or margins
placed 1.0-1.5 mm coronal
to the crest of gingival
shroud

Shoulder margin width exists and varies significantly in
width but not more than 1.5 mm or less than 0.7 mm
Moderate
damage of
gingival shroud
Finish line is non-
continuous or
significantly irregular
The axial walls are significantly under-reduced or
significantly over-reduced
Slight damage
to adjacent
tooth
Over taper (>16
o
) but
less than 20
Moderate lack of rounded line or point angles
o
Moderate lack of canine contour after prepared

Incisal reduction and interocclusal distance: significantly
under-reduced or significantly over-reduced
IV
Unfinished and severe
roughness of walls
and/or margins
placed subgingival to the
crest of gingival shroud by
0.5mm or more

placed more than 1.5 mm
gingival shroud
Facial shoulder width: 1.5mm or more in width or
facial shoulder not present
Severe damage
to gingival
shroud
Finish line is
unacceptable and/or
having unsupported
enamel remaining
The axial walls are severely under-reduced or over-
reduced
No two plane reduction of the labial wall
Moderate to
severe damage
to adjacent
tooth
Undercut between any
set of opposing axial
surfaces or line angles or
decidedly excessive
taper
Loss of canine contour after prepared
Wrong tooth
prepared
Incisal reduction: more than 3 mm or less than 1 mm
Interocclusal distance: Severely under-reduced or
severely over-reduced.

Rev. 1/11

Evaluation criteria for prepared porcelain fused to metal abutment # 8 for FPD 6-7p-8

Finish line & Walls External outline Internal outline
Treatment
management
I
Smooth walls
The cervical finish
line is placed 0- < 0.5
mm coronal to the
crest of gingival
shroud
Facial shoulder with internal round line angle width uniform
and adequate for restoration design,(1.0-1.2 mm) extending to
mesial and distal and gradually diminishing to 0.5 mm chamfer
on lingual
No damage to
gingival shroud
Smooth, continuous
and well defined
margins
Sufficient tooth structure removal (including labial, lingual) for
metal-ceramic restoration with two plane reduction on the
labial
No damage to
adjacent tooth
Angle of
convergence of 6-10
o

Incisal reduction : 1.5-2 mm
Sufficient interocclusal distance (1-1.5 mm) for metal ceramic
restoration with porcelain occlusal contacts

II
Slight roughness of
walls and/or
margins
The cervical finish
line is placed 0.5-
<1.0 mm coronal to
the crest of gingival
shroud

The cervical finish
line is placed
subgingival to the
crest of gingival
shroud but not
more than 0.5 mm
Margin width varies slightly, but is adequate for restoration
design
Slight damage to
gingival shroud

Slight damage the
adjacent tooth/teeth
but polishing at the
proximal surface was
done
Finish line is slightly
irregular
Axial walls are slightly under-reduced or slightly over-reduced
Under taper (0-5
o
) or
over taper in range
of 10-16
o

Incisal reduction: 1-1.5 mm or 2-2.5 mm
Interocclusal distance : Slightly under-reduced or slightly over-
reduced
III
Moderately rough
walls and/or
margins
The cervical finish
line is placed 1.0-1.5
mm coronal to the
crest of gingival
shroud

Shoulder margin width exists and varies significantly in width
but not more than 1.5 mm or less than 0.7 mm
Moderate damage of
gingival shroud
Finish line is non-
continuous or
significantly
irregular
The axial walls are significantly under-reduced or significantly
over-reduced
Slight damage to
adjacent tooth Over taper (>16
o
) but
less than 20
Moderate lack of rounded line or point angles
o

Incisal reduction and Interocclusal distance : Significantly
under-reduced or significantly over-reduced
IV
Unfinished and
severe roughness of
walls and/or
margins
The cervical finish
line is placed
subgingival to the
crest of gingival
shroud 0.5mm or
more

The cervical finish
line is placed more
than 1.5 mm coronal
to the crest of
gingival shroud
Facial shoulder width: 1.5mm or more in width or facial
shoulder not present.
Severe damage to
gingival shroud
Finish line is
unacceptable and/or
having unsupported
enamel remaining
The axial walls are severely under-reduced or over-reduced
No two plane reduction on the labial axial wall
Moderate to severe
damage to adjacent
tooth
Undercut between
any set of opposing
axial surfaces or line
angles or decidedly
excessive taper
Wrong tooth
prepared
Incisal reduction: more than 3 mm or less than 1mm
Interocclusal distance: Severely under- or over-reduced.

Rev. 1/11

55
Evaluation criteria for provisional fixed partial denture acrylic restoration (6-7p-8)

Line of
withdraw
Margin integrity & surface
finish
Facial/Lingual/Interproximal Contours
& Proximal contacts&Pontic Design
Anatomy & Occlusion
Treatment
management
I
Abutments
have the
appropriate
line of draw
for the FPD
acrylic
restoration
All marginal areas well
adapted to the tooth w/o
horizontal or vertical
extensions
The contours are harmonious with
adjacent teeth forming proper
embrasures and conductive for
gingival health
Provisional restorations
reproduce normal occlusal
anatomy of the abutment teeth
and pontic tooth.
No damage or
slight damage to
gingival shroud

No acrylic resin
residue or dust
left in gingival
sulcus and/or
on typodont
The surface of the
a minimum of voids
Good interproximal contacts as
determined by thin articulating
foil (shimstock)
Connector is in correct position
and of proper size both
labiaolingually and
incisocervically
The internal form
conforms to the shape of
the abutment and provides
resistance and retention
Pontic: Modified ridge lap or
ovate pontic without any concave
area under pontic.
Occlusal contact present for
both restoration and other teeth
(which had contact prior to the
restoration placement) as
foil
II
There is a
slight
variance to
the line of
withdraw

margin at 1 location and
less than 0.5 mm x 0.5 mm
(either #6 or 8) and all
marginal areas well
restorations deviate slightly from
the normal contour of the
abutment teeth or pontic tooth
Provisional restorations
reproduce normal occlusal
anatomy of the abutment teeth
and pontic tooth with only
slightly deviation Moderate
damage to
gingival shroud

Minimal acrylic
resin residue or
dust left on
typodont
The surface of the
a minimum number of
voids
Slightly over or under contoured
(<1mm) and/or slightly lacking of
proper embrasures
Connector is incorrectly
positioned (<1mm out of
position) and of slight improper
dimensions
slightly from the shape of
the abutment but still
provides resistance and
retention
Pontic: Modified ridge lap or
ovate pontic with slightly
deviation in shape
Occlusal contact on restoration
prevents other teeth from
contacting as determined by
thin articulating foil or
restoration lacks any occlusal
contact as determined by thin
articulating foil
III
There is
significant
variance to
the line of
draw which
requires
adjustment to
either the
retainers or
the
abutments to
seat the
restoration
margin at 2 location and
less than 1.0 mm x 1.0 mm
(either #6 or 8) and all
marginal areas well
restorations deviate significantly
from the normal contour of the
abutment teeth or pontic tooth.
Provisional restorations deviate
significantly from normal
occlusal anatomy
Severe damage
to gingival
shroud

Moderate
amount acrylic
resin residual or
dust left on
typodont
The surface of the
restoration exhibits
significant irregularities
including voids, pits, or
porosities
Lack of interproximal contact as
foil but not by eye.
positioned (>1mm out of
position) and of significantly
improper dimensions
significant from the shape
of the abutment and
compromises resistance
and retention form.
Pontic has a flat tissue surface
contour

Rev. 1/11

Evaluation criteria for provisional fixed partial denture acrylic restoration (6-7p-8), cont.

IV
The line of
draw for
the FPD
restoration
is
decidedly
at variance
Generalized absence of
marginal adaptation
and/or generalized
vertical or horizontal
margins
restorations do not resemble the
normal contours of the abutment
teeth or pontic tooth
Provisional restorations do not
resemble the normal anatomy
of the abutment teeth or pontic
tooth.
Wrong tooth or
teeth is/are
replaced in any
location of
typodont
Tooth or teeth
is/are misplaced
in M-D and B-L
orientation

Significant
amount of
acrylic resin
residue or dust
left on typodont
The surface of the
restoration is rough
and/or porous or the
restoration is fractured
Lack of interproximal contact as
determined by eye or excessive
interproximal contacts which cause
the adjacent tooth/teeth to move
positioned (>2 mm out of
position) and of severely
improper dimensions
The internal form grossly
deviates from the shape of
the abutment and there is
total lack of retention and
resistance.
Pontic has a concave tissue surface
contour and/or has no interproximal
embrasures.
Occlusal contact on restoration
prevents other teeth from
contacting as determined by
eye or restoration lacks any
occlusal contact as visible by
eye
There is premature contact in
excursive movement

Rev. 1/11

57
3
RD
Rev. 1/11

4
th

Rev. 1/11

59
II. Treatment Outcomes Assessment (TOA) Progress Evaluation

1. Two TOA progress evaluations must be completed by graduation.

2. They are to be completed on patients for whom you have completed Phase II
treatment and are ready for placement on a recall program (either OHM or denture
recall).

3. The progress evaluation may be challenged during 3
rd
or 4
th

year.

Rev. 1/11

III. Removable Prosthodontics OSCE-type Progress Evaluation
The student will challenge an online comprehensive clinical OSCE-type exam
focusing on all aspects of complete and removable partial denture prosthodontics.
The student must pass with a minimum of 70%.

a. Prerequisite: Completion of a complete denture and a removable partial
denture.
b. Remediation: If remediation should be necessary, the student may
challenge the exam an additional time without additional patient treatment.
If any additional remediation is required, the student may be required to
complete another set of prerequisite patients.

Challenging PE: When the student is prepared to challenge the PE, then he/she must
notify Dr. Duncan via email. The PE will be offered once a month. The time and
location will be verified by Dr. Duncan once she confirms the students eligibility to
challenge the PE.

The following outline provides the student with a guide to prepare for the
Removable Prosthodontics Progress Evaluation. The course manuals and lectures
posted on Blackboard from the Complete Denture and RPD courses should be used
for reference. The progress evaluation will assess the student with clinically based
questions from the objectives listed below.

Learning Objectives

I. Complete Denture Prosthodontics

A. Denture Bearing Tissues:

1. Recognize normal, healthy denture bearing tissues.
2. Distinguish between favorable and unfavorable edentulous ridge
contours, arch shapes and other anatomic supporting structures
for denture wear.
3. Identify common pathologic conditions commonly associated with
denture wear.
a. Inflammatory papillary hyperplasia
b. Epulis fissuratum
c. Angular cheilitis
d. Combination syndrome
4. Identify non-pathologic conditions of the hard and soft tissues that will require
surgical intervention.

Rev. 1/11

61
B. Complete Denture Impressions

1. Describe the appropriate techniques for accurately manipulating alginate
for a final impression for an edentulous arch.
2. Recognize an acceptable final alginate impression of either edentulous
arch.
3. Describe the impact of an unacceptable impression on the outcome of the
final prosthesis.

C. Complete Denture Master Casts

1. Describe the appropriate techniques for use of the dental stone used for pouring
complete denture master casts.
2. Recognize an acceptable edentulous master cast for either edentulous arch.
3. Describe the impact of various types of unacceptable master casts on the
outcome of the final prosthesis.

D. Complete Denture Bases

1. Recognize acceptable laboratory processed denture bases.
2. Recognize a properly adapted denture base with the use of pressure
indicating paste.
3. Identify properly extended denture base flanges.
4. Recognize an adequate or inadequate posterior palatal seal.

E. Complete Denture Occlusion Rims and Mounting Casts

1. Identify properly contoured occlusion rims prepared for initial jaw relationship
records.
2. Identify properly fabricated mounting casts.

F. J aw Relationship Records for Complete Dentures

1. Recognize the appropriate sequence for obtaining jaw relationship records and
understand the rationale for this sequence.
2. Describe the proper use of a facebow.
3. Describe the techniques for recording centric relation including the materials and
their manipulation.
4. Recognize an accurate centric relation record.
5. Recognize what is appropriate lip support, incisal edge length, midline and VDO
with occlusion rims.

G. Esthetic Try In for Complete Dentures

1. Recognize the appropriate sequence for procedures at the esthetic try in
appointment and understand the rationale for this sequence.
2. Identify an esthetic denture arrangement including the following:
i. Appropriate midline
ii. Appropriate shade of denture teeth
iii. Appropriate arrangement of denture teeth relative to the smile line,
buccal corridor, and plane of orientation.
iv. Appropriate lip support and incisal edge length
v. Appropriate appearance of vertical dimension
3. Describe the technique for verifying centric relation on the articulator.
4. Describe factors that would indicate the vertical dimension is either excessive or
insufficient.
Rev. 1/11

H. Processing of Complete Dentures

1. Recognize a properly processed denture.
2. Understand the potential reasons for receiving a denture back from the lab with
errors in processing or finishing. Such errors might include the following:
i. Porosity of the denture base
ii. Flanges shorter or longer than desired
iii. Tooth position altered
iv. Vertical dimension altered
v. Positives or negatives in the denture bases

I. Delivery of Complete Dentures

1. Recognize a properly fitting denture.
2. Describe the indications for performing a clinical remount and the techniques
involved in a clinical remount.

II. Removable Partial Denture Prosthodontics

A. RPD Supporting Tissues:

1. Apply the same criteria as listed in I. 1. above for complete dentures
to the supporting tissues for partial dentures.
2. Evaluate teeth and determine their prognosis and potential acceptability as
abutments for a partial denture.

B. Designing RPD frameworks

1. Identify the proper use of all components of an RPD based upon the appropriate
principles of design and biomechanics. (Review the corresponding
lectures/discussions from the RPD course.)
2. Apply the essential biomechanical principles relative to designing all
classifications of partial dentures.
3. Utilize the standard design concepts all classifications of partial dentures.

C. RPD Mouth Preparation, Impressions, and Master Casts

1. Recognize the indications for altering the axial height of contour on abutment
teeth.
2. Describe the appropriate sequencing of mouth preparation.
3. Recognize the appropriate shape and dimensions of occlusal and cingulum rests
and describe the consequences if these rests are not correctly prepared.
4. Describe the factors involved in generating an accurate final impression.
5. Recognize an acceptable RPD impression.
6. Identify the properties of an acceptable RPD master cast.

Rev. 1/11

63
D. RPD Framework Fabrication and Try-In

1. Create a work authorization for a removable partial denture framework and
describe which casts must be submitted and how they must be prepared for
fabrication of a removable partial denture framework.
2. List the steps in fitting and seating a removable partial denture framework.
3. Recognize the indications for remaking a framework.

E. J aw Relationship Records for RPDs

1. Describe the materials and technique involved in fabricating record bases and
occlusion rims for RPDs.
2. Recognize when a record of maximum intercuspation can be used versus a
centric relation record for mounting RPDs.

F. Esthetic Try In RPDs

1. The student should be able to recognize the indications for an esthetic try-in
with an RPD.
i. The student should be able to apply all the same principles of
evaluating esthetics as described above for complete dentures.
2. Describe the principles of RPD occlusion and how to obtain them.

G. Processing of RPDs

1. Recognize how processing may alter the fit the RPD framework.

H. Delivery of RPDs

1. Recognize a properly fitting partial denture after the acrylic portions have been
processed to it.
2. Recognize appropriate occlusion with the RPD and remaining natural dentition.
3. Evaluate properly fitting clasps.
4. Recognize when a RPD needs to be remade.
5. List appropriate post-insertion instructions for the patient.

Rev. 1/11

IV. Clinical Prosthodontic Program Progress Evaluation

Clinical Expectations and Evaluation
Clinical evaluation of student performance in Prosthodontics is intended to be objective
and based upon clearly defined criteria.

The evaluation system measures the degree of mastery of the student for each clinic
session. All clinic sessions are evaluated and all clinic sessions are weighted the same.
The procedure performed is not the basis of evaluation. Appropriate performance for the
clinic session is the subject of evaluation. Protection of the patient, provision of optimal
dental care and efficient clinical education are the goals of the faculty and the focus of the
evaluation system.

Each clinic session is graded as pass/fail. A satisfactory mark signifies acceptable
performance in all criterion categories. An unsatisfactory mark signifies a less than
acceptable performance as defined by the listed criteria. To successfully complete the
clinical phase of prosthodontics, a student must maintain a cumulative average of 90%.
The students average will be reviewed prior to each APC meeting to assess clinical
progress. If the students average falls below 90%, then appropriate remediation will be
developed on an individual basis.

It is the students responsibility to make certain that the preceptor completes the grade
form in QR on the computer.

CATEGORIES FOR ASSESSMENT
Knowledge/Clinical Judgment

: e.g. Students knowledge base; ability to apply
principles or concepts; abilities in critical thinking and decision making,
understanding of own limits; ability to work independently or without excessive
faculty assistance, etc.
Technical Skill

: e.g. Student can apply basic concepts or theory to action/practice;
exhibits sill in provision of dental care; etc.
Professionalism/Patient Management

: e.g. Students rapport with patients;
interactions with staff and faculty; ethical behavior; general patient management;
etc.

Rev. 1/11

65

STATEMENTS FOR PROSTHODONTIC CLINICAL EVALUATION
Satisfactory:
a. Student required expected level of assistance for current stage of development and
level of experience.
b. Student's ability to manage time was acceptable.
c. Student displayed appropriate judgment.
d. Student displayed adequate clinical skill for current stage of development and level of
experience.

Unsatisfactory:
a. Student required more assistance than expected for current stage of
development and level of experience.
b. Student's ability to manage time was unacceptable.
c. Student displayed poor judgment.
d. Student displayed less than adequate clinical skill for current stage of development
and level of experience.

PROSTHODONTIC CLINIC SESSION EVALUATIONS
(Found in QR grades)

Rev. 1/11

MINIMAL ESSENTIAL EXPERIENCES
The minimal essential experiences for each class can be found on the students homepage
on Blackboard.

Please be reminded that these are minimal

experiences. Students who have been
identified as having difficulty progressing through the prosthodontic clinical program
may be required to complete additional experiences to show an adequate level of
competence (as assessed through the clinic session evaluations and APC reporting.)
As a student completes a minimal essential experience, he/she must log it in the tracking
book that is kept in the conference room of dental clinic 4. Each class has an
appropriately labeled book. When logging information, please include the procedure
completed, the tooth or arch worked on, the patients name and TOO number, as well as
the date delivered. The faculty you delivered with should then sign the book in the
appropriate spot.

Information regarding procedures completed in then verified with what has been entered
into QR. It is very important to be sure that entries in QR are timely and accurate.

NOTE: Credit will not be assigned for procedures that have been incorrectly
entered into QR. Please be sure that correct codes are being utilized and that teeth
numbers are also correct.

Rev. 1/11

67
Community Health Center
Crown Experience Tracking Sheet

Student Name: ______________________

Patient Name: ______________________

Tooth #: ________

Preparation approved:

__________________________________
CHC Faculty Signature Date

Impression approved:

__________________________________

Delivery approved:

__________________________________

In order for a student to receive credit for a crown experience (at UCONN or a
CHC) the student must complete all procedures from start to finish him/herself.

A maximum of 2 crowns completed at a CHC may be applied to the total
minimal experiences for prosthodontics.

This form should be attached to your prosthodontic experience tracking sheet for
UCONN. Be sure to make a copy for yourself!

UConn Dental: Prosthodontics Clinic Manual 11-12

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

UConn Dental: Prosthodontics Clinic Manual 11-12

Uploaded by

Copyright:

Available Formats

Rev.

You might also like