Table Of Content

Advanced Removable Partial Dentures James S. Brudvik, DDS, FACI' Professor Emeritus of Prosthodontics University of\Vashington School of Dentistry Seattle, \Vashington Quintessence )lublishing Co, Inc ClJicago, Berlin. Loudon, Tokyo, Paris, Barcelona, Sao Paulo, ~toSC()W, Prague, and \Varsaw l.ihntl)"ofCon~n'~~ C;tlaloging-in-Puhlic:;tlion Data Bru(hik.[nmes s. Advanced removahlc partialdenturesI [anu-s S. Brudvik. p. em. Includesindex. ISBNO-1i6715-.3.'31-2(hardcovr-r} L f'urnal dentuu-s,Homovable. I.Tltk-. Il)XL.\l: I. Deutun-, Partial. Hemovnhlr-. 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Editor:Lori Ball'IIMI\ Iksign/PrOOtiction: Mil-hat·1 Shanahan Prinn...1inthe US,\ Contents Introduction IX Chapter 1 Patient Evaluation, Diagnosis, and Treatment Planning ] Initial Examination · Decision Making for RPDTreatment Planning > Preliminary Impressions · PreprostheticTherapy Chapter 2 He~novahle Partial Denture Design 7 Elements of Design· Design Specifics:Class I-IV Chapter 3 Mouth Preparation 37 Surveyingthe Diagnostic Cast · DiagnosticMouth Preparation > Clinical Mouth Preparation Chapter 4 Final Impressions and Master Casts 55 Altered Cast lmpressions Jaw Relation Records > Chapter 5 Laboratory Construction ofthe Framework 63 DesignTransfer · Blackout and Duplication >Waxing· Spruing, Investing,andCasting · Metal Finishing · Addition ofW ire Clasps· Addition ofAltered CastTrays Chapter 6 Estahlishing the Tooth-Frame Relationship 7.5 Tooth Contact Surfaces >Static Fit • FunctionalFit · Poor Casting Fit Chapter 7 Completion ofthe Partial Dt::nture 79 Jaw Relation Records · Placement of Denture Teeth· Flasking,Tinting,and Packing · lnsertion MetalOcclusalSurfaces · > Long-Term Maintenance • Chapter 8 Repairs, Additions, and Relines 93 Pick-up Impressions · Resin Repairs · MetalRepairs > Restorations Under Existing RPDs • Crowns Under EXisting RPDs • Relinesand Rebases Chapter f) Special Prostheses lO.5 Splintingwith the RPD • Hinged Major Connectors · Rotational PartialDentures Chapter 10 Precision Attachments 11,5 Common Clinical Procedures · PrecisionAttachment Systems Chapter 11 Implants and Removable Partial Dentures 1.5:3 Class IandIISituations ' Class III and IV Situations Index 160 I Preface T he removable partial denture In" a1 Sill' this form of therapy at the highest way~ 1)('('11 Ill)-' special challenge ill level. After years of being asked if I had dentistry. As a clinician, researcher; 1I('lIlal everconsidered putting Illy lecture mater laboratory director,'lecturer, and IIIPHtor, I ialin written form and protesting that I did have s[X'llt almost 3-5 years Il")ing to come not have the time. my partial retirement to gripswitIItlie complexitiesorthisform or from the University of\Va.~hillgtuTl School prosthodouttc treatment. rwould estimate of Dentistty has made my excuses no that 2()1}t of parual W{'aTeTS are more than longer valid. just a little dissatisfied ";11. their denture. This work is not intended to be a text Unlike \\ill. the fixed partial denture. till' book ill the classical sense. It is, rather. a patient hastheoptionofremovingtheplUS monograph on the removable partial den thesis at tile slightest hint of discomfort. ture, written witlrthe expec tation that the physicalor mental. Civcu the actualstateof readerwillalready have covered the basics pructice-c-thc dentist docs only the occa of the partial denture and is now ready to _..ional partial denture with almost tota! T(' take a more sophi...ticatcd look at this treat Hance 011tIlt~ dcutallal»lmlnty fordesign as mcut modality It dops nothave a btbliogru wellas construcuon-c-I.nnmost pessimistic phy, and the Illustrations consist of draw us to the ef1i.·d ofthis,or :Ill:'oilier text on ings that I have placed 011 countless the subject. blackboardsovertheyears ill all attempt 10 \Vhile there are a number of excellent make things clr-arto m)'students.\\1.:lt 1'01. baste texts Oil the rr-movuble partial den lows an' my thoughts as they have evolved or ture. they arc all direc ted toward tht, un overtheseyears practice and teaclnug in dergraduate dental student. I han! not this fascinating urea. found anything that I can me as an ad While I take complete rcsponstbtltty for vanced text for the graduate student and the content ofthf.. work, rhave lWCB aided study club participant who wishes to pur- in tlll~ writing hy Illy friend and coworker, vii Advanced Removable PartialDentures [uuiuc Nr-mcrevr-r Coal;\~, who, as pro· This book is dt'dicakd to Illy gradllale or gramcoordinator the (;radualp Program suuk-nts-c-past, pn-sent, and hopc-Inllv fll in Prosthodontics, has long stood watch tnfl"---who provide. 011adaily basis.the joy ove-r Illy faulty grammar and sentence ofsl"{'ingS(1111{"OIl('learn.Itisalsork-dicatod structure. I han:' also had the ln-lp of Dr to Illy longtime friend ami colleague, the Alex Shor, presently in OIlf graduate pro eminent functional anatomist. Professor gram,who has rovh-wedthe entire hook to J('an I~OII11'row~ki (Iftilt)UnlversityofParts. provide insightand guidalll'l' from the eyt'S VII, who has h('('11 an inspiration in this orthe pote-ntial readership. mailer as ill so mallYotln-rendeavors over the H'aI~. viii Introduction T he removablepartialdenture bas long Therefore, it is no wonder that patients !JPCH considered an inferior means of dislike their partials to tile point of not replacing missing 'teeth and associated wearing them and,if they can afford alter structures when compared 10the fixed par native treatment,request itroutinely It has tial denture. Some have even spoken ofit been my experience that the pattent who as a stepping stone to a complete denture. states, "1 had a partial once and couldn't The old rhyme,"Little HPD,don'tyon C'Y. wear it!" most likely hall a substandard You'llbe aCD byand by"maybest express prosthesis; when treated ,vith a state-of our feelings toward this treatment modal the-art partial denture, the patient would ity. Many Slll\'CYS published over IIH~ years likely find it tolerable and easily accept the in our journals indicate that dentistry docs limitations ofthis fonu of tooth awl tissue a rathr-r pOOTjob witlrthe HPJ).These re replacement. ports testifyto the hid that most RPDs arc Plainly stated. there tsa dramatic differ created entirely bv, the technician wtth a ence between the standard RPD and the , minimum ofInput from the clinician in the one that approaches the state of the art as form ofmouth preparation or de.sign. we knowit today.It isin the attempltocre Dental schools make it serious effort to ate that quality removable partial denture teach the subject, and excellent texts for that this book is written. It is intended to the undergraduate are available. None serve as a KIdde to both gnHlwlfe students theless,the state ofremovable partialden in prosthodontics and concerned general turcs scou in the commercial laboratories practitioners-to challenge them to think and in the cross-sectional studies available of the removable appliance as they would to IL~ indicates that, in general, partials are the fixed partial denture, with all the same poorly designed and constructed and considerations of soft tissue management, poorly maintained. cades control, periodontal support, ortho- ix Advanced Removable PartialDentures dontlc therapy. ami implant involveun-nt. lady scheduled recall and appropriate In almost eH'ry clinical situation. the pa mamtcuancc. Preparing tile mouth to its tieut whorequiresa removable partialden very la-st state of hr-alth be fore starting turc willhaveaneed forsomefonn offixed prosthodontic procedures and then keep prosthodontics as well, from a simple ing the tissues in that state of health over bonded rest to the mostcomplex precision the lifeof the partial is far mon-important attachmentsextending from fixed units. than .IIlY desigll considerations, It has he come obvious to me that a partial denture in a healthy mouth, assuming that it meets Philosophy of Care our four requirements. will he successful regardless of its design. lk-st placement and clasp(I"sign, IntcrcstiuglLsIlie}'mayIK' \\"hat makesa SlIt'('('SSflll RPD? At tilt, risk to argile ove-r from a tlu-orotical point of ofoversimplification.one could saythatthe vtew, an' simply not germane to the real successful removable appliance Ill't'tl be qllPSIiOIlvfwhat makesasuccessfulre-ruov onlvIon things: 'lhlf· partial denture. Suppositions derived I' ,. ,. from bench studies do not necessarily I, Strong. in that it does not wear, break. transferhitheclinicalrealitiesoflong-tern distort,orCOII\I' apart whenworn. care. 2. He/entire, so that it remains in position llow loug should a properly d(~signpd, in the patient's mouth during usc and cohstrucu-d. and maintained H.PD lu...t? g1VtoS tho patlcut confidence that it will Good evidence exists that this state-of-the continue todo so the lifeoftile par (JVPI" art paliialcould be l'xpt,tkd to last a ruini tial. mum of 10years, assuunugthat the patient 3. Est/wtie, to satisfythe patients cxpI'ela was se-en at regular intervals and that both tious withoutundue evidence ofitspws the mouthaut]the partial received the indi r-ncc. cateduuuntr-nancc. Partial.spnl\ilIingglKxl ,I. 1'(1;11-/1'(.'(',lIw,lIlingthat it docsnot(.IlI\(' service for 20 ~l-'ars art' not unheard of, al discomfort when in the mouth for the tlltlllgllillt'long-term maintenance re-quire short term ami that it causes no 101lg mcnts lncrcnsc dramaticallyafter 10years. termdamage toeitherhard orsoft tissue The construction of the removable par the life ofthopartial. OW l" tial denture, more than allYother fonn of If these four requirements can hl' met, dental the-rapy, is almost always delegated the partial stands a good chance of long to the dental laboratory since the equip k rill success. Unfortunately,the Slll,(,(.'S.~ of mcnt required to product.' all acceptable the partialin and ofitselfdoes 1I0t ~lIar.m ellst framework is not goillj!; to he found ill h't' the long-tr-rm he-alth of the rr'maining the dental offlce. In lllauy cases, the clint h't,th amisoft tissues. Matntenancc. there dan urav have never even met the techni fore. becomes the primary factor ill the dans cn-ating the prostlu-sc-s. Tlus fact re long-term success (If the treatment. The quires that the clinicians maintain contr ol profession has usually substituted concern by inserting themselves into the pmcess at over the tn)e of clasp to be used for the the critical steps in construction. These more fundamental requirements (If n'WI- stepswillhe covered in depth in this book. x Introduction Since the actual construction is d{'lq~ated, bythe h·d lllidan.Unfortuuan-ly;the evolu the an'mge clinician isapt to have \'('r)" lit tion of the dental lnborator.v industr.v has tie confidence Of experience in these mat separated ted lllicians into often isolated tors and is likelv to take the technicians specialties: complete dentures. removable view of the design ami construction partialdentures.and fixed partial dentures. prol'pss, a view thai willhe more nu-chani The technician who is knowledgeable in all cul than btological. The wtsc chuiciau will areas is a \'ani.shillg hn·(·t1. To direct till' make a point or l"t'lllailling in close coutuct construction of the most sophisticated with the technician and bringing; th(~sc nux restorations. the clinician must assume the ilfurtos into the clinical aSjx'd s of eare rcspouslblllty of coordinating the laboru wheneverpossible. tory phases. This text is intended to set The modern removable partial denture standards of care for tln- comprehensive combinesIixcdand removable prosthodon management ofthepartiallyedentulouspa tics and f(,,(plin's a thorough understanding ttcnt who will requifl' some form of a rc ofI10th aspects ofcare bythe clinician and movable n-storattou. xi