Professional Documents
Culture Documents
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Points of View
Six Phases of Partial Denture Service
Education if patient
Diagnosis, treatment planning, design,
treatment sequencing, and mouth
preparation
Support jor distal extension denture bases
POINTS OF VIEW
if
occlusal
10
Fig. 2-1 A, Maxillary removable partial denture with complete palatal coverage. It is retained
by extracoronal retainers (clasps) on terminal abutments. B, Mandibular removable prosthesis is
retained by clasps on terminal abutments. C, Maxillary arch is prepared for an internal
attachment restoration. Note the dovetail preparations in the distal portions of the restored first
premolars. Male portions of the attachments will be inserted into dovetail preparations in
restored abutments. D, Internal attachment restoration in the patient's mouth. Note the precise
fit of male and female portions of the attachments. E, Mandibular internal attachment partial
denture viewed from the residual ridge side. Male portions of attachments can be seen at
anterior aspect of each denture base. Buccal extracoronal retentive arms assist in retaining the
denture.
Chapter
2
signed properly, the only advantage of the internal
attachment denture is esthetics, because abutment
protection and stabilizing components should be used
with both internal and external retainers. However,
economics permitting, esthetics alone may justify the
use of internal attachment retainers. Injudicious use of
internal attachments can lead to excessive torsional
load on the abutments supporting distal extension
removable partial dentures, especially in the mandible.
The use of hinges or other types of stressbreakers is
discouraged in these situations. It is not that they are
ineffective, but they are frequently misused. As an
example, in the mandibular arch, a stress-broken distal
extension partial denture does not provide for crossarch stabilization and frequently subjects
the edentulous ridge to excessive trauma from
horizontal and torquing forces. Therefore a rigid
design is preferred, and some type of extracoronal
clasp retainer is still the & most logical and frequently
used. It seems likely that its use will continue until a
more widely acceptable retainer is devised.
Dental treatment for patients must be highly
individualized. The dentist must be prepared to apply
the concept of optimum services to
patients whose individual circumstances, in spite of
their needs, may dictate no treatment,
limited treatment, or extensive treatment.
SIX
PHASES
OF
DENTURE SERVICE
PARTIAL
11
Education of patient
The term patient education is described in Mosby's Dental
Dictionary, 1998, as "the process of informing a patient
about a health matter to secure informed consent, patient
cooperation, and a high level of patient compliance."
Responsibility for the ultimate success of a removable
partial denture is shared by the dentist and the patient. It is
folly to assume that a patient will have an understanding
of the benefits of a removable partial denture unless he or
she is so informed. It is also unlikely that the patient will
have the knowledge to avoid misuse of the restoration or
be able to provide the required oral care and maintenance
procedures to ensure the success of the partial denture
unless he or she is adequately advised.
The finest biologically oriented removable partial
denture is often doomed to limited success if the patient
fails to exercise proper oral hygiene habits or ignores
recall appointments. One of the primary objectives for a
partial denture, preservation, will most likely not be
achieved with only token cooperation on the
part of the patient.
Patient education should begin at the initial contact
with the patient and continue throughout treatment. This
educational procedure is especially important when the
treatment plan and prognosis are discussed with the
patient. The limitations imposed on the success of
treatment through failure of the patient to accept
responsibility must be explained before definitive
treatment is undertaken. A patient will not usually retain
all the information presented in the oral educational
instructions. For this reason, patients should be
presented with written suggestions to reinforce the oral
presentations.
12
Chapter
2
13
14
Fig. 2-3 Cast on the right was made from an impression that
recorded anatomic form of residual ridge. On the left is the
same cast, with residual ridge recorded in a functional, or
supporting, form by a corrected impression. Note that the
supporting form of the ridge clearly delineates the extent of
coverage available for a denture base.
Chapter
2
II
I
15
Periodic recall
Initial placement and adjustment of the prosthesis are
certainly not the end of treatment for the partially
edentulous patient. Periodic recall of the patient to
evaluate the condition of the oral tissues, the response to
the tooth restorations, the prosthesis, the patient's
acceptance, and the patient's commitment to maintain oral
hygiene are all part of total treatment responsibility.
Changes in the oral structures or the dentures
must be ascertained early to avoid compromised
oral health; this can be accomplished by periodic recall.
Although a 6-month recall period is adequate for most
patients, a more frequent evaluation may be required for
some patients.
Chapter 20 contains some suggestions concerning this
sixth phase of treatment.
17
Chapter
Clasp-retained partial denture
2
SELF-ASSESSMENT
2. 7.
Failure
to provide
technician
with a orient
specific
Recording
of jawthe
relations
to properly
master
AIDS
design
and casts
necessary
to enable
the
opposing
to aninformation
articulator should
be delayed
REASONS
FOR
FAILURE
OF
CLASP1. In chronologie order of accomplishment, give the
technician
execute thehas
design
until the toframework
been fitted and a secondary
RETAINED
six PARTIAL
sequential,DENTURES
correlated phases in treating a
3. Failure of the technician to follow the design
impression has been made. True or false? Why?
and written instructions
partially edentulous patient with removable
8. In the fifth phase of treatment (initial placement of the
prostheses.
Support
for denture
restorations),
threebases
things are done before the patient
Experience with the clasp-retained partial denture made
2. If responsibility for the success of treatment is
1.
Inadequate
coverage
seat tissuesTwo of these are
is given possessionofofbasal
the denture(s).
by the methods outlined has proved its merit and justifies
shared by the dentist and the patient, what must be
2. Failure
to record basal
seat tissues
in a support
(1)
correction
of
denture
base
contours
and occlusal
its continued use. The occasional objection to the
undertaken to prepare patients to accept their
ingdiscrepancies
form
that may have resulted from processing
visibility of retentive clasps can be minimized through
responsibility?
and (2) review of patient education, including
Occlusion
the use of wrought-wire clasp arms. There are few
3. Because treatment planning is the sale
1. Failure
to develop
a harmonious
occlusion
adjustment
expectations.
What
other step must be
contraindications for use of a properly designed claspresponsibility of the dentist, which, if any, of the
2.
Failure
to
use
compatible
materials
for
opposing
accom
retained partial denture. Practically all objections to this
following may be omitted as noncontributory to
occlusal
plishedsurfaces
during the appointment?
type of denture can be eliminated by pointing to defitotal treatment: (1) a complete health history, (2) a
9. What is therelationship
purpose of periodic recall of patients
Patient-dentist
ciencies in mouth preparation, denture design and
history of past dental experiences, (3) an oral
treated
with
removable
partialadequate
dentures?dental
1.
Failure
of
the
dentist
to provide
fabrication, and patient education; these follow:
examination, (4) a roentgenographic examination,
information,
includingreason
care and
usethe
of clasp
10.health
Whatcare
is the
one predominant
why
(5) an evaluation of occlusal relations of
prosthesis
type of partial denture is used more often in most
remaining teeth, (6) a survey of diagnostic casts,
2. Failure
of thethan
dentist
recall
opportu type of
practices
is totheprovide
internal
attachment
nities
on a periodic basis
(7) cost, or (8) patient desires?
prosthesis?
3.
of the patient
to exercise
dental healthand those
4. A specific design of the removable restoration
11.Failure
Deficiencies
in design
and afabrication
Diagnosis
treatment
planning
care regimen and respond to recall
mustandbe
planned
before mouth preparation
related
to
patient
education
are
the
culprits of limited
1. Inadequate diagnosis
procedures.
The
dentist
(can-should
not)
delegate
success
in
treatment
with
removable
prostheses.
A removable partial denture designed and fabricated
2. Failure to use a surveyor or to use a surveyor
the responsibility
forplanning
the design to a dental so that itAvoiding
these
deficiencies
will make
goal of
properly
during treatment
avoids the
errors
and deficiencies
listedthe
is one
laboratory technician.
prosthetic
dentistry
obtainable.
This goal
is to
.
that
proves
the
clasp
type
of
partial
denture
can
be
made
Mouth
5. preparation
Stability inprocedures
a removable restoration (is-is not) functional, esthetically
, and pleasing, and long lasting without
1. Failure to properly sequence mouth preparation
desirable to help maintain the health of oral damage to the supporting structures. The proof of the
procedures
structures.
A tooth-supported
merit of this type of restoration lies in the knowledge that
2. Inadequate
mouth
preparations, restora
usually resulting
tion
usually
(can-cannot)
be the
madedesign
more of the
(1) it permits treatment for the largest number of patients,
from insufficient planning of
stable
than aorrestoration
by teeth
partial
denture
failure to supported
evaluate that
mouthand at reasonable cost;
residual ridges.
preparations
have been properly accomplished
(2) it provides restorations that are comfortable
3. Failure
to return
supporting
tissues
to optimum
6. When
a removable
partial
denture
is supported and efficient over a long period of time, with adequate
health
before
impression
procedures
both
by teeth
and residual
ridges, support by the support and maintenance of occlusal contact relations; (3)
ridge should be made as equal as it can provide for healthy abutments, free of caries and
Designresidual
of the framework
possible
the support
1. Incorrect
use to
of clasp
designsgiven by the teeth. This periodontal disease; (4) it can provide for the continued
2. Use may
of cast
be clasps
accomthat have too little flexibility,
health of restored, healthy tissues of the basal seats; and
are too
broad
tooth coverage,
and have
too
little ridge(5) it makes possible a partial denture service that is
plished
byinrecording
which form
of the
residual
consideration
esthetics
in makingfor
impressionsanatomic
(static) or
definitive and not merely an interim treatment.
3. Flexible
or
incorrectly
located major and minor
functional?
Removable partial dentures thus made will contribute
connectors
to a concept of prosthetic dentistry that has as its goal the
4. Failure to use properly located rests
promotion of oral health,
Laboratory procedures
the restoration of partially edentulous mouths, and an
1. Problems in master cast preparation
elimination of the ultimate need for complete dentures.
a. Inaccurate impression
b. Poor cast-forming procedures
c. Incompatible impression materials and gyp
sum products
16