DR VIKAS AGGARWAL

INTRODUCTION
Fundamental to success of removable partial denture

Contributes to DeVans philosophy

"Mouth preparation" is a term intended to cover all

types of changes effected in the teeth, foundation ridges or oral structures which may be deemed necessary to accomplish a better partial denture result. (Applegate 3rd ed)

Classified as

1) pre prosthetic mouth preparation involves removal of any hindrances to prosthetic treatment 2) prosthetic mouth preparation that involves mouth preparation done to facilitate prosthetic treatment.
Pre prosthetic mouth preparation 1. Surgical preparation 2. Conditioning of abused and irritated tissues 3. Periodontal preparation 4. Treatment of muscular symptoms 5. Correction of occlusal plane 6. Conservative/endodontic preparation 7. Correction of malalignment Prosthetic mouth preparation 1. Developing guiding planes 2. Changing height of contour 3. Modifying retentive undercut. 4. Rest seat preparation

Emergency procedure :
Relief of pain or infection :

As early in the treatment process as possible all teeth

that are causing pain or discomfort because of caries or defective restorations should be treated to eliminate the possibility of an acute episode of pain occurring during the treatment procedure.
Asymptomatic teeth with advance carious lesion,

periodontal abscesses and other inflammatory responses should be treated in the same way.

ORAL SURGICAL PREPARATION

Should be completed as early as possible. Longer the interval between surgery & impression

procedure, more complete the healing & more stable the denture bearing area

Extractions

Planned extractions should occur

early in the treatment but not before completion of a careful and thorough evaluation of each remaining tooth in the dental arch.
Each tooth must be evaluated

concerning its strategic importance and its potential contribution to the success of the removable partial denture.

Residual roots should be removed adjacent to abutment teeth may contribute to the progression of periodontal pockets and compromise the results from subsequent periodontal therapy. Care of buccal and lingual cortical plate should be taken while extraction

Impacted teeth
All impacted teeth

including those in edentulous areas and those adjacent to abutment teeth, should be considered for removal.
Asymptomatic impacted

teeth in the elderly that are covered with bone, with no evidence of a pathological condition, should be left to preserve the arch morphology.

Malposed teeth
The loss of individual teeth or

groups of teeth may lead to extrusion, drifting or combinations of malpositioning of the remaining teeth. In most instances the alveolar bone supporting extruded teeth will be carried occlusally as the teeth continue to erupt. In such situations individual tooth or groups of teeth and their supporting alveolar bone can be surgically repositioned if orthodontic treatment is not possible

Cysts and odontogenic tumors

Panoramic roentgenograms of the jaws are

recommended to survey for unsuspected pathological conditions.

periapical roentgenogram should be taken to confirm or deny the presence of a lesion. consultation and if necessary perform a biopsy of the area.

When suspicious area appear an a survey film, a

Diagnosis should be confirmed through appropriate

Exostosis and tori

The presence of abnormal bony

enlargements should not be allowed to compromise the design of the partial denture The mucosa covering these enlargements is thin and friable. Partial denture components in proximity to this type of tissue can cause irritation and chronic ulceration Also, exostoses approximating gingival margins may complicate the maintenance of periodontal health and lead to the eventual loss of strategic abutment teeth

Hyperplastic tissue
All these forms of excess tissue

should be removed to provide a firm base for the denture. This removal will produce a more stable denture. can be removed with any preferred combination such as scalpel, curette, electrosurgery, or by laser All such excised tissues should be sent to oral pathologist for microscopic study

Fibrous tuberosities Soft flabby ridges Folds of redundant tissue in the vestibule or floor of the mouth Palatal papillomatosis.

Muscle attachments and frena

As a result of the loss of bone height, muscle attachments may come near the residual ridge crest. The mylohyoid, buccinator, mentalis, and genioglossus muscles are those most likely to introduce problems of this nature. mentalis and genioglossus muscles

occasionally produce bony protuberances at their attachments, which may also interfere with removable partial denture design. Repositioning of these supra-placed muscles by ridge extension is necessary in such condition to enhance comfort and function

Bony spines and knife edge ridges

Sharp bony spicules should be

removed and knife-edge ridges rounded to facilitate easy designing of the partial dentures. These procedures should be carried out with minimal bone loss.

POLYPS, PAPILLOMAS AND TRAUMATIC HEMANGIOMAS

All abnormal soft tissue lesions should be excised and

submitted for pathological examination New or additional stimulation to the area introduced by the prosthesis may produce discomfort or even malignant changes in the tumor.
HYPERKERATOSIS, ERYTHROPLASIA AND ULCERATION

All abnormal, white, red or ulcerative lesions should be

investigated regardless of their relationship to the proposed denture base. A biopsy of areas larger than 5 mm should be completed, and if the lesions are large (more than 2 cm in diameter), multiple biopsies should be taken

DENTOFACIAL DEFORMITY
Surgical correction of a jaw deformity can be made in

horizontal, sagittal or frontal planes. Mandible and maxilla may be positioned anteriorly or posterior and their relationship to the facial planes may be surgically altered to achieve improved appearance.

Ridge Augmentation Ridge augmentation can be carried out with either alloplastic materials like hydroxyapatite or with autogenous bone graft materials for proper bone support to the partial dentures

OSSEOINTEGRATED DEVICES : These devices offer a significant stabilizing effect on dental prosthesis through a rigid connection to living bone. Inclusion of strategically placed implants can significantly control prosthesis movement.

TREATMENT OF ABUSED AND IRRITATED SOFT TISSUES

Many removable partial denture

patients will require some conditioning of supporting tissues in edentulous areas before the final impression phase of the treatment.

Symptoms:
Inflammation and irritation of the mucosa covering

the denture bearing areas

Distortion of normal anatomic structures such as

incisive papillae, the rugae, the retromolar pads

Burning sensation in residual ridge areas

These conditions are usually associated with ill-fitting or poorly occluding RPD.

 A good HOME CARE PROGRAM. Rinsing the mouth with a prescribed saline

solution

Massaging the residual ridge areas, palatal rugae and tongue with a soft tooth brush. Removing the prosthesis at night and using a prescribed therapeutic multiple vitamin along with high protein, low carbohydrate diet. Some inflammatory, oral conditions caused by ill fitting dentures can be resolved by removing the dentures for an extended periods of time

Use of tissue conditioning materials

The tissue conditioning

materials are elastopolymers that have massaging effect on irritated mucosa, and because they are soft, occlusal forces are probably more evenly distributed.

Maximum benefit from using tissue conditioning materials may be obtained by

Eliminating defective or interfering occlusal contacts of old

dentures

Extending denture bases to proper form to enhance proper support,

retention and stability.

Relieving the tissue side of the dentures bases sufficiently (2 mm)

to provide space for even thickness and distribution of conditioning materials.

Applying the material in amounts sufficient to provide

support and a cushioning effect Following the manufacturer's directions

 The conditioning procedure should be repeated until the

supporting tissues display an undistorted and healthy appearance.

An improvement in irritated and distorted tissues is usually

noted within 3 or 4 changes of the conditioning material, but in some cases more changes are required. mucosa appears completely healthy.

The final impression procedure should be delayed until the

3) Periodontal preparation
The periodontal preparation of

the mouth usually follows any oral surgical procedure and is performed simultaneously with tissue conditioning procedures. The periodontal procedures are necessary to restore the mouth to the state of health required for definite treatment.

OBJECTIVES OF PERIODONTAL THERAPY

Removal and control of all etiological factors

contributing to periodontal disease, along with a reduction of BLEEDING ON PROBING. Elimination of or reduction in, pocket depths of all periodontal pockets, with the establishment of healthy gingival sulci. Establishment of functional atraumatic occlusal relationships and tooth stability Development of a personal plaque control program and definitive maintenance schedule.

Periodontal diagnosis and treatment planning

Diagnosis : The diagnosis of periodontal diseases is based on a systematic and carefully accomplished examination of the periodontium. It is performed using direct vision, palpation, periodontal probe, mouth mirror, and other auxiliary aids such as curved explorers, furcations probes, diagnostic casts and roentgenograms.

 Most important is careful exploration of the gingival

sulcus and recording the probing pocket depth.

The probe is inserted gently but firmly between the

gingival margin and the tooth surface, and the depth of gingival sulcus is determined circumferentially around each tooth.

A critical assessment of the sulcular health can be done by

judging the amount of bleeding on probing. This along with the pocket depth is an excellent indicator of health and disease.

 Dental radiographs can

be used to supplement the clinical examination but should not be used as a substitute for it.

1. Type location and severity of bone loss 2. Location, severity and distribution of furcation involvement. 3. Alteration of periodontal ligament space. 4. Alterations of the lamina dura 5. Calcified deposits 6. Location and conformity of restoration margins 7. Evaluation of crown and root morphologies. 8. Root proximity 9. Caries 10. Evaluation of other associated anatomic structures, such as mandibular canal or sinus proximity.

MOBILITY
Each tooth should be evaluated carefully for

mobility Normal mobility is in order of 0.05 to 0.10 mm. Grade I mobility slightly more than normal. Grade II moderately more than normal. Grade III severe mobility with vertical displacement.

Mobility is assessed with ends of two instruments.

If fingers are used the movement of soft tissue may mask accurate determination of mobility

Tooth mobility is usually caused by

Inflammatory changes in the periodontal ligament Traumatic occlusion Loss of attachment Combination.

Treatment planning
Depending on the extent and severity of the periodontal

changes present, a variety of therapeutic procedures, ranging from simple to relatively complex, may be indicated.
Periodontal treatment planning can usually be divided into

three phases. Disease control therapy phase-phase 1 Definitive periodontal surgery phase-phase 2 Maintenance phase- phase 3

Initial disease control therapy (phase 1) :

a) Oral Hygiene Instruction : The most effective motivation techniques require a good understanding by the patient of his/her periodontal condition. The patient should be instructed in the use of disclosing wafers, soft nylon toothbrush, and unwaxed dental floss Without good oral hygiene ,any dental procedure, regardless of how well it is performed, is ultimately doomed to failure

b) Scaling and root planning : Without meticulous removal of calculus, plaque,and toxic material in the cementum, other forms of periodontal therapy cannot be successful.

c) Elimination of local irritating factor other than calculus Overhanging margins of amalgam & inlay restoration. Overhanging crown margins. Open contacts leading to food impactions. Deep carious lesions should be eliminated before the start of definitive prosthetic treatment.

d) ELIMINATION OF OCCLUSAL INTERFERENCES

Poor occlusal relationship may act as a factor that

contributes to more rapid loss of periodontal attachment. Selective grinding procedure is generally applied at this stage. Occlusion on natural teeth needs to be perfected only to a point at which cuspal interference within the patients functional range of contact is eliminated and normal physiologic function can occur

Guide to Occlusal Adjustment (Schuyler1935)

Accurately mounted diagnostic casts are extremely

helpful in determining static cusp to fossa contacts of opposing teeth and as guide in the correction of occlusion anomalies 1) A static coordinated occlusal contact of the maximum number of teeth when the mandible is in centric relation to the maxillae should be the first objective. The procedure is as follows:a) A prematurely contacting cusp should be reduced the cusp point is in premature contact in both centric and eccentric relations. If a cusp point is in premature contact in centric relation only, the opposing sulcus should be deepened

 b) When anterior teeth are in premature contact in

centric relations, or in both centric and eccentric relations, corrections should be made by grinding the incisal edge of the lower teeth. If only in eccentric relation grind lingual inclines of maxillary teeth

2)evaluate opposing tooth contact or lack of contact in eccentric functional relations

First balancing side contacts are seen. Subluxation, pain, lack of normal functional movement of the joint, or loss of alveolar support of the teeth involved may be evidence of excessive balancing contacts. care must be exercised to avoid the loss of a static supporting contact in centric relation This static support in centric relation may exist between the lower buccal cusp fitting into the central fossae of the upper tooth or between the upper lingual cusp fitting into the central fossae of the lower tooth or may exist in both cases. Often only one of these cusps has this static contact So contacting cusp must be left untouched to maintain this essential support in the planned intercuspal position, and all corrective grinding to relieve premature contacts in eccentric positions would be done on the opposing tooth inclines.

 3) To obtain maximum function and the distribution of functional stress in eccentric positions on the working side, necessary grinding must be done on the lingual surfaces of the upper anterior teeth
Corrective grinding on the posterior teeth at this time should always be done on the buccal cusp of the upper premolars and molars and on the lingual cusp of the lower premolars and molars

 4)Corrective grinding to relieve premature protrusive

contacts of one or more anterior teeth should be accomplished by grinding the lingual surface of the upper anterior teeth. elimination of premature protrusive contacts of posterior teeth done on their non functional cusp
5) Any sharp edges left by grinding should be rounded

off

SPLINTING
Some teeth loose their periodontal support rendering them

mobile To use these teeth as abutment additional support is required First the cause of mobility is to be eliminated Teeth may be immobilized during periodontal treatment by Acid etching the teeth with composite resin, Fiber reinforced resins Cast removable splints Intracoronal attachments

 Splinting can be achieved by a removable restoration

or by fixed restoration which becomes a permanent splint. Splinting of weakened teeth in partially edentulous arch located in a position where the partial denture will not require an unusual amount of support, is achieved by using fixed splinting, this maintains the continuity of the arch, avoids additional modification spaces, thus simplifying the construction and fitting of partial dentures and improving prognosis. Fixed splinting must be accomplished with full or partial coverage crowns soldered together; this gives additional resistance to antero-posterior stresses.

Definitive periodontal surgery (phase 2)

Periodontal surgery
After initial therapy is completed, the patient is reevaluated for the surgical phase. If oral hygiene is at an optimum level, yet pockets with inflammation and osseous defects are still present, a variety of periodontal surgical techniques should be considered to improve periodontal health.

Gingivectomy
supra bony pockets of fibrotic tissue, absence of deformities in the underlying bony tissue & pocket depth confined to attached gingiva

Periodontal flaps : Periodontal flap surgery involves the elevation of either mucosa alone or both the mucosa and the periosteum.

Guided tissue regeneration :

Guided tissue regeneration

(GTR) has been defined as those procedures that attempt regeneration of lost periodontal structures through differing tissue responses..

 Periodontal plastic surgery :

Elimination of pockets that traverse the mucogingival

junction. Creation of an adequate zone of attached gingiva. Correction of gingival recession by root coverage techniques.

Recall maintenance (phase 3)

This includes not only reinforcement of plaque control measures but also thorough debridement of supragingival and subgingival calculus and plaque on all root surfaces

4) TREATMENT OF MUSCULAR SYMPTOMS

Prior to adjustment of the occlusion of the teeth the

muscular symptoms should be analyzed. Therefore the first objective of the operator is to eliminate this muscle spasm. acrylic overlay splint with a flat occlusal surface which will eliminate premature tooth contacts causing deviation of the mandible leading to spasm. Adjunct therapies like short-wave therapy, infra-red radiation, and light massage are designed to increase the volume of the blood flowing through the muscles and thereby removing the offending metabolites. The use of muscle relaxant drugs like Diazepam 5-10 mg B.D is effective in relaxing the symptoms

5) CORRECTION

OF OCCLUSAL PLANE

The average plane established by the incisal and occlusal surfaces of

the teethit is not a plane, but represents the planar mean of the curvature of these surfaces (gpt 8th )
The occlusal plane in most partially edentulous mouths will be uneven

 Teeth that have been unopposed for a long time tend to overerupt, e.g. the maxillary molars if unopposed will migrate downwards carrying the maxillary tuberosity with them creating a problem to reestablish the occlusal plane

The occlusal plane can be corrected by

Reducing the height of overerupted teeth. The clinical crown lengthening to restore the correct occlusal plane, such as when teeth fail to erupt fully because of interferences from other teeth or lack of stimulation.

TREATMENT:
Orthodontic treatment Enameloplasty

The placement of cast onlays or crowns.

Extraction surgery

Orthodontic treatment

Enameloplasty:
Enameloplasty is used to describe the removal of a portion of the enamel surface of a tooth to accomplish specific purposes.

For the correction of the occlusal plane, the enameloplasty consists of reducing cusp height in order to level or harmonize the curve of the occlusal plane .
Reduction is done with tapered diamond cylinder or stones in high speed hand piece. The cut enamel surface is smoothened with carborundum containing rubber wheels and fluoride gels.

Onlay
Conservative method
The occlusal surface of a tooth to be covered by an onlay rest should be free of pits and fissures or should be made so by eliminating the defects with small burs or stones.

The use of chrome- cobalt can cause extreme wear of natural teeth. Tooth colored resin may be processed over the metal, however this will wear rapidly.
One of the simplest methods -the use of cast gold onlays, which an either lengthen or shorten the crown height of a tooth.

Crowns:
When the crown height of the tooth must be changed to harmonize the occlusal plane. the facial, lingual, or proximal surfaces must be altered to produce a more desirable height of contour, a guiding plane, or a retentive undercut. Before the tooth is prepared to receive the crown, mounted diagnostic casts should be measured to ascertain how much crown reduction is necessary to correct the occlusal plane.

Endodontics with Crown or Coping

If strategically positioned teeth in the dental arch are retained, the prognosis of the partial denture is improved markedly.

These teeth include mandibular second or third molars that may be used to serve as posterior abutment so as the prosthesis may be all tooth supported.
Other are those in the center of a long anterior edentulous span either mandibular or maxillary.

 If the overeruption has been so gross as to obliterate the

remaining interarch space, the crown of the tooth can be removed at the gingival crest and a coping constructed. The tooth will serve as a vertical stop, preventing excessive vertical or horizontal movement of the prosthesis.

Extraction
Eg. If orthodontic treatment cannot be accomplished to realign severely malposed molars or premolars, extraction must be considered. When teeth interfere with the placement of the major connector and no other solution (such as crowning the tooth) feasible, extraction must be planned.

Surgery
Maxillary segmental osteotomy is done to superiorly repositioning posterior segments of maxilla. This is one of the most effective methods of regaining interarch space lost due to downward migration of the teeth and tuberosity

6) CONSERVATIVE/ENDODONTIC PREPARATION

Fillings:When fillings are required in abutment or other

teeth, only gold or amalgam are suitable materials to come into contact with partial dentures as these materials have the necessary strengths to form a foundation for occlusal rests Onlays: The occlusal surfaces of worn teeth can be restored by onlays. Endodontic with crown/coping:a grossly carious tooth which can serve as strategic abutment tooth must be restored with endodontic therapy followed by cementation crown which will allow such tooth/teeth to serve as normal abutments.

7) CORRECTION OF MALALIGNMENT
Teeth that are malposed, facially or lingually are more

difficult to correct There are definite, limitation to the repositioning of these malposed teeth. Orthodontic correction of these malposed teeth is the first line of treatment. Enameloplasty and crowns are also treatment choices. Surgical intervention is planned only if all other measures fail to reposition these malposed teeth

II) Prosthetic Mouth Preparation

It is done to modify the existing structures to further

enhance the placement of prosthesis. It mainly involves reshaping of teeth The steps involved are: 1. Developing guiding planes 2. Changing height of contour 3. Modifying retentive undercut 4. Abutment preparation using cast crowns 5. Rest seat preparation

Guiding Planes
Guiding planes are those surfaces on the teeth, parallel relationship to each other, so that they may serve to determine positively the direction of appliance movement (Applegate 1954)
GPT-8 defines them as two or more vertically parallel surfaces of abutment teeth, so orientated as to direct the path of placement of removable partial dentures.

Functions of guiding planes

To provide single path of placement and removal 2. To ensure planned and intended action of the retentive and bracing components of the partial denture 3. To eliminate detrimental strain to the abutment teeth while placing and removing the prosthesis 4. To eliminate gross food traps between the abutment teeth and the denture base
1.

Guiding planes on abutment teeth adjacent to tooth supported segments:

A cylindrical diamond point is generally the instrument to make the preparation. A gentle, light sweeping stroke from the buccal line angle to the lingual line angle should be used

 The flat surface created should ideally be 2 to 4mm in occlusogingival height The reduction must not be a straight slice across the tooth surface; rather it should follow the curvature of the surface so that nearly uniform amounts of enamel are removed

Guiding planes on abutment teeth adjacent to distal extension edentulous spaces

The tooth preparation on the proximal surface of abutment

teeth adjacent to distal extension edentulous spaces is accomplished in the same manner with a cylindrical diamond stone held parallel to the path of insertion. The principal difference between this guiding plane and the planes on teeth bordering a tooth-supported segment is that the occlusogingival height of the plane is reduced to 1.5 to 2mm.
Thus provides grater freedom to movement hence less torqueing forces

Guiding planes on lingual surfaces of abutment teeth

Mandibular posterior teeth are usually inclined lingually with a

resultant high lingual survey line. Minor recontouring can frequently improve the position of the survey line to allow placement of the reciprocal clasp arm in its proper position

To provide maximum resistance to lateral stresses. The occlusogingival height of the preparation is 2 to 4 mm. The

plane ideally should be located in the middle third of the clinical crown of the tooth.

Guiding planes on anterior abutment teeth :

Guiding planes on anterior teeth adjacent to edentulous

spaces provide the parallelism needed to ensure stabilization, minimize wedging action between the teeth, decrease undesirable space between the denture and the abutment tooth, increase retention through frictional resistance.

When prepare parallel guiding surfaces on anterior abutment

Stay on the lingual half to optimize esthetics

Enameloplasty to modify retentive undercuts

If abutment tooth has less

than a sufficient retentive undercut. For the procedure to be successful, the buccal and lingual surfaces should be nearly vertical. If surface to receive undercut is sloped, indentation has to be excessively deep. If opposing surface is sloped, the reciprocal clasp arm cannot prevent retentive clasp tip from dislodging. A round end tapered diamond held parallel to gingival margin is used to create a gentle depression

 The retentive undercut must be created

in the form of a gentle depression, not a pit or hole Retentive undercut should be in the form of a gentle depression. Create slight concavity (0.010 inch deep, 4mm MD, 2mm OG), parallel to gingival margin

Enameloplasty to change height of contour

height of contour -a line encircling a

tooth and designating its greatest circumference at a selected axial position determined by a dental surveyor gpt 8th The height of contour is changed most frequently to provide better positions for clasp arms Ideally the retentive clasp arm should be located no higher than the junction of the gingival and the middle thirds. This position not only enhances the esthetic quality of the clasp, but also places clasp nearer the tooths centre of rotation The height of contour is best lowered by using tapered diamond stones.

Abutment preparation using Inlays Onlays and Crowns

If the remaining teeth do not possess usable natural

contours and enamel surfaces cannot be corrected to produce them, cast restorations must be planned. Guiding planes, height of contour and retentive undercuts can be placed in the wax patterns for the cast restorations. Also many abutment teeth will require restorations for more routine reasons such as caries, endodontic therapy etc.

Shaping the Wax Pattern

The die of the tooth preparation in the cast of the remainder arch is analyzed on the surveyor. Once correct tilt is established substitute analyzing rod with wax knife and carve guiding plane by shaving the wax. Pattern must be carved to place height of contour at the junction of gingival and middle third for retentive clasp.

Refining can be done in cast restoration.

Occlusal rest seat preparation

Rest -rigid extension of a partial removable dental

prosthesis that contacts the occlusal surface of a tooth or restoration, the occlusal surface of which may have been prepared to receive it Rest seat -the prepared recess in a tooth or restoration created to receive the occlusal, incisal, cingulum, or lingual rest

Transmit the forces apically

Act as a vertical stop

Maintain the retentive clasp in its proper position

Function as an indirect retainer in a distal extension partial denture. Designed between spaced teeth to reestablish continuity of arch and prevent further drifting or tipping of tooth It is used as onlay on abutment tooth to establish a more acceptable occlusal plane and to prevent extrusion of tooth

Conventional rest preparations in posterior teeth

Form Triangular in outline with base at marginal ridge and apex pointing towards the centre of the tooth. Apex of the triangle should be rounded as should all external margins of preparation Should follow outline of mesial or distal fossa.

Extension 1/3rd to 1/2 of mesiodistal diameter. 1/2 of the distance between buccal and lingual cusp tips.

Floor Inclined towards the center. Spoon shaped. Enclosed angle with the proximal surface less than 90

An occlusal rest must be at least 1 mm thick at its thinnest point if chrome alloy is used for the framework or 1.5 mm if gold is to be used

Preparation
Create an outline using small diamond bur

The island of enamel within the outline can then be

removed with the same bur. Deepest portion of the rest seat is towards the center of the tooth. Verify preparation by red beading wax. Polishing of preparation is done using carborundum impregnated rubber point in low speed hand piece

Occlusal rest seat preparations in new cast restorations :

Occlusal rest seats in cast restorations should always be

placed in the wax patterns. The preparation for the rest seat must be carved in the wax after the establishment of guiding planes.

Occlusal rest seat preparation in existing cast restorations

If the existing restorations display marginal integrity and

occlusal harmony, an attempt should be made to contour them to satisfy the requirements of the proposed prosthesis.

It is usually not too difficult to prepare acceptable guiding

planes in existing restorations. Patients must be always be thoroughly informed of the possibility of need to replace existing restorations before mouth preparation.
If an existing crown, onlay, or inlay is penetrated

during the rest seat preparation, the restoration must be replaced.

 Occlusal rest seat preparation an amalgam restorations :

An occlusal rest preparation in a multi surface amalgam

restoration is less desirable than that in either sound enamel or a gold restoration. Amalgam alloy tends to flow when placed under constant pressure.

Rest Seat Preparation for Embrasure Clasp:

Preparation extends over the occlusal embrasure of two approximating posterior teeth, from the mesial fossa of one tooth to the distal fossa of other. Insufficient tooth removal will generally lead to occlusal interferences between the clasp and the opposing cusps. Relieving the metal to gain occlusal freedom ultimately lead to breakage of the clasp during function.

 As the preparation passes over the buccal and lingual embrasures,

It should be approximately 1.5 to 2 mm wide and 1 to 1.5 mm deep. The inclines of the preparation must be rounded after the preparation is complete

Rest seat preparation on anterior teeth

Lingual, or cingulum, rests on canine and incisor teeth An occlusal rest on a molar or a premolar is preferred over a lingual or an incisal rest on anterior teeth to provide support for a partial denture.
Forces are better directed along the long axis of the

abutment tooth by an occlusal rest than by a lingual or incisal rest. A canine is preferred over an incisor for support of a denture. When a canine is not present, multiple rests on incisor teeth are needed in place of a single rest on a single incisor tooth. A lingual rest is preferred to an incisal rest.

Lingual Rest Seat preparation In Enamel

A lingual rest seat may be prepared in the enamel

surface of an anterior tooth if the tooth is sound the patient practices good oral hygiene the caries index is low.
The cingulum should also be prominent to present a

gradual slope to the lingual surface rather than a steep vertical slope. This is the principal reason why mandibular canines are poor candidates for a lingual rest

 Outline Form Half moon shaped forming

smooth curve from one marginal ridge to other. Should cross the centre of tooth incisally to cingulum. The rest seat itself is V shaped. The labial incline of lingual surface makes one wall. Other wall starts of cingulum and inclines labio-gingivally towards the centre of tooth. The deepest point of the rest seat will be over the cingulum.

Lingual rest seat preparation in cast restorations

If a cast restoration is to be placed on the abutment tooth,

the rest seat should be carved in the wax pattern and not cut in the cast restoration.
When the rest seat in the wax pattern is carved, a definite

rest preparation can be developed that will direct the forces of occlusion through the long axis of the abutment tooth.

Incisal rest seat preparation :

Incisal rest seats should be used only on enamel surfaces. Although incisal rests are the least desirable rests for anterior

teeth, they may be used successfully on select patients if the abutment tooth is sound.
On incisor teeth an incisal rest is usually used as a last resort to

stabilize the removable prosthesis.

 The incisal rest seat preparation is begun with a flame-shaped

diamond bur in a high-speed handpiece The first cut is made vertically 1.5 to 2 mm deep in the form of a slice or notch and approximately 2 to 3 mm inside the proximal angle of the tooth.
After all sharp angles and points have been reduced by the flame-

shaped diamond point, the preparation is polished with carborundum-containing wheels.

The incisal rest will restore the lost contour of the incisal edge.

Although some metal will show, the display can be kept to a minimum without jeopardizing the effectiveness

CONCLUSION
The preparation of mouth is fundamental to a

successful removal partial denture. The prime objective of all the mouth preparation procedures is to return the mouth to optimum health and to eliminate any condition that compromises the success of the partial denture.

Thank you