RPD REVIEW AND LABORATORY STEPS

This lecture Is summarizing to what u took until now .. specially in the lab
DENTIST-LABORATORY RELATION AND COMMUNICATION

Dentist (clinician) do the clinical work and technician do the laboratory work >> and In RPD most of the work is lab work so that the dentist-laboratory relation is very important for the success of metal framework RPD >> u can't separate between the clinical work and the technical work The technical work will effect the success or failure of the clinical work >> so how u assess the work is success or not .. it depend on ur knowledge in the technical work >> other than this , the technician may say this is a clinical failure and u say yes bcz u don't know .. but if u know all the technical steps involved in the metal RPD then u will tell the

technician that here is ur mistake , the clinician must know all the clinical steps and guide the technician in the laboratory steps The communication with the technician in the metal framework by :: 1) The metal framework must be drawn on sheet and on the primary cast 2) Writing >> you must describe the design by words >> for example :: mesial rest on the lower right 6 3) Sometimes drawing and writing not enough >> u call (contact) the technician to tell him about specific areas :: for example >> 4 is tilted and I will trim part of it After u draw and write >> the technician does a mistake and the RPD need to be repeated .. who is going to pay ??

Laboratory form and work authorization

1) As will as there is written sheet for the design and the case >> then u will can prove that this is his/her mistake >> he/she must pay for it >> so even in the dental legal issues it is very important to have written form 2) Also u must tell on the sheet at which date u want the framework to be ready >> then if the patient come to your clinic and thae work doesnt

finished yet >> u tell the technician this is ur mistake >> but if the finish date is not clear >> then u need to apologize to the patient and the technician 3) Infection Control >> When u take an impression >> it will be contaminated >> u must tell the technician on the form if this has been disinfected or not

RPD REVIEW
Now I want to review the metal framework steps from A-Z 1) History , Examination , Treatment plane >> we decided to do metal framework .. 2) Mouth preparation >> it differs than the tooth preparation >> u need to do treatment , retreatment , extractions , RCT etc >> every thing should precede prosthodontic treatment >> usually in most of patient prosthodontic treatment come last 3) Upper and lower primary impressions using Alginate (Rubber useable but expensive so we don't use it) >> even if we want to construct just upper RPD u must take impression to the lower arch for occlusion 4) Do we need interocclusal record (bit registration) >> yes and no >> It depends on the complexity of the case >> for example patient with

kinnedy class1 lower and upper .. u can't mount the cast manually (hand articulation) >> u need record blocks to be able to mount Assume u want to do major connector palatal coverage and u want to cover the palatal surfaces of teeth >> if the occlusion normal class 1 that's fine >> but if the patient class2 with deep bite u can't provide metal on the palatal surface of teeth bcz there is no space no room >> u need mounting for design Some cases with enough remaining teeth >> hand articulation will be enough This is will be question in the exam .. you need records blocks in all of the following cases except .. 5) Pour the primary impression with dental stone (Gypsum type III) 30ml water to 100g powder Type II>> 50-55ml/100g Type III >>28-32ml/100g Type IIII>>20ml/100g 6) Survey on the primary cast >> it is obligatory >> u must do it .. without survey u can't design the case .. In private clinic they don't do survey so u will expect that most RPD fail if not all 7) Designing process :: classification of the case and determining number and position of rests ( in general any design need at least 3 rests or something can do as the rest like the palatal coverage of the tooth / direct retainers / minor connectors and type of major connector with it's extension / determine the base and the teeth that would be replaced /

determine path of insertion >> the proper way of designing is by having the models mounted after record blocks Then you draw the design on the cast with pencil so easily u can modify and u draw the design on a paper and u write any specifications Who do the surveying ?? technician and clinician can do it BUT who do the designing ?? just clinician >> never ever let the technician do the design .. he can help u but never make decisions about the design 8) Construct Special tray on the primary cast >> now am a dentist and today there is clinical visit number 2 >> I will receive special tray and surveyed cast >> before I see the patient I draw the design on the cast >> so now u determine which teeth need modification 9) Tooth preparation/modification :: modify the guide planes (the first thing to prepare) , create undercuts if not found , prepare rest seats ( the last thing to prepare :: bcz if prepared early and then I trim from the tooth the rest seat will be distorted and then I will need to reprepare it ) 10) Secondary impression using Rubber material (the ideal material is additional silicon and specially the medium viscosity-regular-) can we use alginate ? not Ideally , but we can .. specially that nowadays there is high quality alginate >> but in general it's not recommended 11) Pour the Secondary Impression using dental stone or die stone

12) Secondary surveying to make sure that the modification that have been done in the patients' mouth are what we need Now this is the important point :: HOW I will do secondary surveying on different cast (secondary cast) than we did the original surveying on (primary cast) and how to know the tilt of this cast relative to the other one .. specially that the bases of the casts impossible to be the same

Tripodization :: put 3 marks on the cast

1) The marks on the sites of the cast >> this way helpful when we will use the same cast more than one time on the surveying table 2) but if u want to use different casts u must take 3 marks on anatomical land marks 13) Block out and relief of master cast :: PSA >> parallel , shaped and arbitary Internal finish line is determined by relief on the master cast External finish line is determined at waxing up on the refractory wax 14) Duplication of the master cast into investment :: u can draw the design on the refractory cast but gently bcz refractory cast is an accurate cast so any defect in it will be serious one a) Investment material can tolerate high temperature b) Investment do significant expansion which will compensate for the casting shrinkage c) Investment porous :: so casting gases can escape through these pores >> if pores stay in the cast they will cause casting defects

15) Framework Wax up :: Ready made pattern wax for every thing except the rests bcz it depends on the dentist preparation 16) Casting 17) Finishing and polishing 18) Metal framework try-in >> u will receive metal framework which fit (must be fit) on the master cast Metal framework fit on the master cast but doesn't fit patients' mouth >> clinical due to the impression or technical where the technician made mistake from the binging and continue or maybe he made a mistake in duplicating and then trim from the master cast to make the framework fit 19) Jaw relation registration :: sometimes we do JRR :: can we use facebow ? yes ..do we need to use facebow in every case ? no .. but its not our issue now to discuss facebow 20) Teeth selection :: now the RPD is differ than CD bcz in CD u need to select the shade , shape and size but in RPD u need to select the shade only , when the patient miss from 4-4 then u will treat with them as CD choos shade , shape and size and even u need record block and determine the midline , high smile line , low smile line .. etc 21) mounting of secondary cast on the articulator >> teeth setting >> wax finishing and polishing 22) Teething wax try-in and chick esthetics , phonetics , intercuspation .. etc >> Does metal framework RPD try in eliminate needs of teething wax try in ? No .. but maybe in very small number of teeth

23) Flasking , dewaxing , packing , curing and deflasking and there is another technique called injection >> without lost wax technique 24) Finishing and polishing 25) Insertion and adjustment >> we have adjustment most of the time 26) Review >> it isn't optional >> more than 90% of the patient who are satisfy with there prosthesis at insertion have complains at review >> even if the patient call u and say that every thing is ok >> u must bring him back bcz maybe he isn't aware about the problem

LABORATORY PROCEDURE
1) Primary Cast 2) Special Try >> What is the difference between tha special try for CD and RPD >> a) have a spacer bcz there are teeth >> if it is closely fitting it may break and it will be hard to insert and hard to removed b) it doesn't have to be 2mm shorter than the sulcus except if there is free saddle area bcz we will do border molding in the clinic on the secondary impression not to achieve retention ( already retention achieved by the clasps ) but to achieve maximum tissue coverage on the free saddle area to reduce the stresses on abutment

c) perforated bcz I will use alginate or rubber and then record block (if needed) , surveying , tripodization and designing ( it is dentist responsibility but it's laboratory step :: that mean u don't need the presence of the patient) 3) Secondary Cast 4) Retripodizing , surveying , design transfer , blockout (P S A) and relief 5) Duplication >> we will take impression to the master cast there are two types of materials >> a) Reversible hydrocolloid :: Agar-agar :: now agar-agar converted from gel-sol with temperature .. sol above 90 degree .. let the tempreture reach 63 >> pour it >> let it to bench cool or put it in water path b) Additional Silicon (flowable) Then I make refractory cast (investment cast , duplicatory cast) >> materials >> I) Gypsum bonded phosphate (low heat) >> used for casts around 700 degree such as gold II) Phosphate bonded investment (high heat) >> 1000 degree >> such as cobalt chromium After refractory cast made it will be wet .. you remove it from the impression >> dry in the oven on 93degrees for half an hour >> then trimming the base so each area will be close from the design about 6mm >> bcz if more than 6mm the extra will not come back it will stay in the

mold :: there is material called peeswax (am not sure :( to make the surface of the refractory cast smooth without irregularities 5) Waxing framework >>there is material called sticky liquid we can apply it on the cast so the pattern wax will stick to the cast 6) Sprueing the framework >> channeles where the casting material will enter >> the size of sprues , the number of sprues >> according to manufacturers recommendation and the type of alloy >> the most important thing is t avoid narrow sprues and sharp angled spurs 7) Investing the refractory cast (two-part mold) First part >> up to 46 mm to be accurate on details and after set >> Second part will be applied >> and mold will be formed 8) wax elimination by oven (burnout) 9) casting 10) casting recovery 11) Sprue removal < the first step in finishing , and then finishing the framework The first step in polishing is the electrical polish >> will remove all irregularities 12) Fitting the framework 13) Final polishing >> by rubber wheels 14) Sectioning and soldering if needed >> when there is miss casting 15) Wrought-wire retentive clasp arms if needed >> have a lot of techniques to be attached

There is the funnel where u do casting >> u will apply investment by brush as a layer to make the details accurate >> then u continue the investment by metal ring >> put the cast in the oven to eliminate the wax >> on the casting machine (made of coil) >> heat up to 1300 >> then u use alloy ingot in container called crucible >> when the coil heats up >> the crucible heats up >> the ingot melt >> casting started

Done By ::: HaNaa JadAllah