Advanced Removable Partial Dentures - J. Brudvik (Quintessence, 1999) WW

171 Pages·1999·29.66 MB·English

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, Berl in. Loudon, Tokyo, Paris, Barcelona, Sao Paulo,

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I

l.ihntl)"of Con~n'~~ C;t lalogi ng-in-Puhlic:;tlion Data

Bru(hik. [nmes s.

Advanced removahlc part ial dentures I [anu-s S. Brudvik.

p.
em.

Includes index.
ISBN O-1i67 15-.3.'31 -2 (hard covr-r}
L f'urnal dentuu-s, Homovable. I. Tltk-.
Il) XL.\l: I. Deutun-, Partial. Hemovnhlr-. WU .515 USfiSa I!/!)!)]

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Editor: Lori Ball'IIMI\
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Introduction

Contents

IX

Chapter 1
Patient Evaluation, Diagnosis, and Treatment Planning
]

Initial Examination · Decision Making for RPD Treatment Planning >
Preliminary Impressions · PreprostheticTherapy

Chapter 2
H e~novahl e Partial Denture Design

Elements of Design· Design Specifics: Class I-IV

7

Chapter 3
Mouth Preparation
37
Surveying th e Diagnostic Cast · Diagnostic Mouth Preparatio n
>
Clinical Mouth Preparation

Chapter 4
Final Impressions and Master Casts
55
Altered Cast lmpressions
> Jaw Relatio n Records

Chapter 5
Laboratory Construction of the F ramework
63

Design Transfer · Bla ckout and Duplication >W axing· Spruing,
Investing, and Casting · Met al Finishing · A ddition of W ire Clasps·
Addition of Alte red Cast Trays

Chapter 6
Estahlishing the Tooth-Frame Relationship
7.5

Tooth Contact Surfaces > Static Fit • Functional Fit · Poor Casting Fit

Chapter 7
Completion of the Partial D t::nture
79

Jaw Relation Records · Placement of Denture Teeth·
Flasking,Tinting,and Packing · lnsertion
> Metal Occlusal Surfaces ·

Long-Term Maintenance

•

Chapter 8
Repairs, Additions, and Relines
93

Pick-up Impressions · Resin Repairs · Metal Repairs > Restorat ions
Under Existing RPDs • Crowns Under EXisti ng RPDs • Relines and
Rebases

Chapter f)
Special Prostheses
lO.5

Splinting with the RPD • Hinged Major Connectors · Rotational
Partial Dentures

Chapter 10 Precision Attachments
11,5

Common Clinical Procedures · Precision Attachment Systems

Chapter 11 Implants and Removable Partial Dentures

Class I and II Situations ' Class III and IV Situations

Index

I

1.5:3

160

T

he removable partial denture In" a1-

way~
1)('('11 Ill)-' speci al challenge
ill

dentistry. As a clinician, researcher; 1I('lIlal
laboratory director,'lect ure r, and IIIPHtor, I
have s[X'llt almost 3-5 years Il")ing to come
to grips wi tII tlie co mplexities orthis form or
prosthodouttc treatment. r would estimate
that 2()1}t of parual W{'aTeTS are more th an
just a little dissatisfied " ; 11. their denture.
Unlike \\il l. the fixed partial denture. till'
patient has the option of removing the p lUS-
thesis at tile slightest hint of discomfort.
physical or men tal. Civcu the actual state of
pructice-c-thc dentist docs only the occa-
_..ional partial denture with almost tota! T('-
Hance 011t Il t ~ dcutallal»lmlnty for desi gn as
well as construcuon-c-I .nnmost pessimistic
us to the e f1i.·d of this, or :Ill: ' oilie r text on
the subject.

\Vhile there are a number of excellent
baste texts Oil the rr-movuble pa rtial den-
ture. they arc all direc ted toward tht, un-
dergraduate dental studen t. I han ! not
fou nd anything that I can m e as an ad-
vanced text for the graduate student and
study club participant who wishes to pur-

Preface

Sill ' this form of therapy at the highest
level. After years of being asked if I had
ever considered putting Illy lecture mater-
ial in written form and protesting that I did
not have the time. my partial ret ire men t
from the University of \Va .~hillgt u Tl School
of Dentist ty has made
my excuses no

longer valid.

This work is not inten ded to be a text-

book ill the classical sense. It is, rathe r. a
monog raph on the rem ovable partial den-
ture, writte n wi tlr the expec tation that the
reader will already have covered the basics
of the partial denture and is now ready to
take a more sophi...ticatcd look at this treat-
mcut modality It dops not have a btbl iogru-
phy, and the Illustrations consist of draw-
ings that
I have placed
011
countless

blackboa rds over the years ill all attempt 10
make things clr-ar to m)' students. \ \1.:lt 1'01.
lows an' my thoughts as they have evolved
over these yearsorpractice and teaclnug in
this f ascinating urea.

While I take complete rcsponstbtltty for

the content of thf.. work, r have l WC B aided
in
tlll ~ writing hy Illy friend and coworker,

vii

Advanced Removable Partial Dentures

[uuiuc Nr-mcrevr-r Coa l; \~ , who, as pro·
gram coordinatororthe (; radu alp Program
in Prosthodontics, has long stood watch
ove-r Illy faulty grammar and sentence
struct ure. I han:' also had the ln-lp of Dr
Alex Shor, presently in OIl f graduate pro-
gram, who has rovh-wed the entire hook to
provide insight and guidalll'l' from the eyt'S
or the pote-ntial readership.

viii

This boo k is dt'dicakd to Illy gradllale

suu k-nts-c-past, pn-sent , and hopc-Inllv fll-
tnfl"- --who provide. 0 11 a daily basis. the joy
ofsl"{'ing S( 1111{"O Il(' learn. It is also rk-dicatod
to Illy longtime friend ami colleague, the
eminent functional anatomist . Professor
J('an
I~ OI I 11' row~ki (Iftilt) Unlversity of Parts.

VII, who has h('('11 an inspiration in this
mailer as ill so mallYotln-r endeavors over
the H'aI~.

T

he removable partial denture bas lon g

!JPCH considered an in fer ior means of

replaci ng missing 'teet h and assoc iated
structures when compared 10 the fixed par-
tial de ntu re. Some have even spoken of it
as a stepping stone to a complete denture.
The old rhyme, "Little HPD , don't yon C'Y.
You'll be a CD by and by" may best express
our feelings toward this treatment modal-
ity. Many Slll\'CYS published over IIH~ years
in our journals indicate that den tistry docs
a rathr-r pOOT job witlr the HPJ). These re-
ports testify to the hid that most RPDs arc
created entirely bv the technician wtth a
,
,

minim um of Input from the clinician in the
form of mouth p reparat ion or de.sign.

Dental schools make it serious effort to

teac h the subject, and excellent texts for
the undergraduate are available. None-
theless, the state of removable partial den-
turcs scou in the commercial laboratories
and in the cross-sectional studies available
to
IL~ indicates that, in general, partials are

poorly designed
and
cons tructed
and

poorly maintained.

Introduction

Therefore, it is no wonder that patients
dislike their partials to tile point of not
wearing them and, if they can afford alter-
native treatment, request it routi nely It has
been my experience that the pattent who
states , "1 had a partial once and couldn't
wear it!" most likely hall a substandard
prosthesis; when treated ,vith a state-of-
the-art partial denture, the patient would
likely find it tolera ble and easily accept the
limitations of this fonu of tooth awl tissue
replacement.

Plainly stated. there ts a dramatic differ-

ence between the standard RPD and the
one that approaches the state of the art as
we know it today. It is in the attemplto cre-
ate that quality rem ovable part ial denture
that this book is written. It is intended to
serve as a KIdde to both gnHlwlfe students
in prosthodontics and conce rned general
practitione rs-to challenge the m to think
of the removable appliance as they would
the fixed partial denture, with all the same
considerations of soft tissue management,
cades control , periodontal support, ortho-

ix

Advanced Removable Partial Dentures

don tlc therapy. ami implant involveun-nt.
In almost eH'ry clinical situ ation . the pa-
tieut who requires a removable partial den-
turc will have a need for some fonn of fixed
prosthodontics as well, from
a simple
bonded rest to the most complex precision
attachments extending from fixed units.

Philosophy of Care

\\"hat makes a SlIt'('('SSflll RPD? At tilt, risk
ofoversimplificat ion . one could say that the
successful removable appliance Ill't'tl be
onlvIonI' things:
,.
, .

I, Strong. in that it does not wear, break.

distort, or COII\I' apart when worn.
2. He/entire, so that it remains in position
in the patient's mouth duri ng usc and

g1VtoS tho patlcut confide nce that it will
continue to do so (JVP I" the life oftile par-
tial.

3. Est/wtie, to satisfy the patients cxpI'ela-

tious without undue evidence of its pws-

r-ncc.

,I. 1'(1;11-/1'(.'(', lIw,lIling that it docs not (.IlI\('

discomfort when in the mouth for the
short term ami that it causes no 101lg-
term damage to eit he r hard or soft tissue

OW l" the life of thopartial.

If these four requirements can hl' met,

the partial stands a good chance of long-
k rill success. Unfort unately, the
Sll l,(,(.'S.~ of

the partial in and of itself does 1I0t ~lI a r.m ­
h't' the long-tr-rm he-alth of the rr'maining
h't,th ami soft tissues. Matntenancc . there-
fore. becomes the primary factor ill the
long-term succe ss (If the treatment. The
profession has usually substituted conce rn
over the tn )e of clasp to be used for the
more fundamental requiremen ts (If n'WI-

x

lady scheduled
recall and
appropriate

mamtcuancc. Preparing tile mouth to its
very la-st state of hr-alth be fore starting
prosthodontic procedures and then keep-
ing the tissues in that state of health over
the life of the pa rtial is far mon- important
than .IIlY desigll considerations, It has he-
come obvious to me that a partial den ture
in a healthy mouth, assum ing that it meets
our four requirements. will he successful
regardless of its design.
lk -st placement
and clasp (I"sign, Intcrcstiug lLs Ilie}'may IK'
to argile ove-r from a tlu -orotical point of
vtew, an' simply not germane to the real

q llP SIiOIl vf what makes a success ful re-ruov-
'lhlf· partial denture. Suppositions derived
from bench studies do
not
nece ssarily

transfe r hithe clinical realities of long-tern
care.

l low loug should a properly d (~s ignpd ,

cohstrucu-d. and maintained
H.PD lu...t?

Good evidence exists that this state-of-the-
art pali ial cou ld be l'xpt,tkd to last a ruini-
mum of 10years, assuunug tha t the patien t
was se-en at reg ular intervals and that both
the mout h aut] the partial received the indi-
cateduuuntr-nancc. Partial.s pnl\ilIing glKxl
service for 20 ~l-'ars art' not unheard of, al-
tlltlllgllillt' long-term maintenance re-quire-
mcnts lncrcnsc dramatically afte r 10 years.

Th e constru ction of the removable par-

tial dent ure, more than allYother fonn of
dental the-rapy, is almost always delegated
to the dental laboratory since the equip-
mcnt required to prod uct.' all acceptable

ellst framework is not goillj!; to he found ill
the dent al offlce. In lllauy cases, the clint-
dan urav have never even met the techni-
d ans cn-ating the prostlu-sc-s. Tl us fact re-
quires that the clinicians maintain co ntr ol
by inserting themselves into the pmcess at
the critica l steps in construction . These
steps will he covered in depth in this book.

Since the actual construction is d{'lq~ated ,
the an'mge clinician is apt to have \'('r)" lit-
tie confidence Of experience in these mat-
tors and is likelv to take the technicians
view of
the
design
ami construction

prol'pss, a view thai will he more nu -chani-
cul than btologi cal. The wtsc chuiciau will
make a point or l"t'lllailling in close coutuct
with the techn ician and brin ging; th ( ~sc nux-
ilfurtos into the clinical aSjx'd s of eare
when ever possible.
The modern removable partial denture
com bines Iixcd and removable prosthod on-
tics and f(,,(plin 's a thorough understanding
of I10th aspects of care by the clinician and

Introduction

by the h·d lllid an. Unfortuuan-ly;the evolu-
tion of the dent al lnboratorv industrv has
.
.

separated
ted lllicians into often isolated

specialties: complete dentures. remova ble
partial dentures. and fixed partial dentures.
The technician who is knowledgeable in all
areas is a \'a ni.shillg hn·(·t1. To direct till'
con struction of the most
sophisticated

rest orations. the clinician must assume the
rcspouslblllty of coordi natin g the laboru-
tory phases. This text is intended to set
standards of care for tln- comprehensive-
management ofthe partially edentulous pa-
ttcnt who will req uifl' some form of a rc-
movable n-storattou.

xi