Discuss the role of treatment plan in partial denture /certified fixed orthodontic courses by Indian dental academy

TREATMENT PLAN IN PARTIAL DENTURES

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

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Introduction
Definitions
Indications & Contraindications
Advantages & Disadvantages
Basic requirements of removable partial denture
Role of treatment partial denture
- Appearance
- Space maintenance
- Reestablishing the occlusal relationship
- Conditioning teeth and residual ridge
- Interim restoration during treatment
- Surgical splint
- Night guard and mouth protecting devices
- As a vehicle for tissue treatment material
Repair & Maintenance
Summary and conclusion
References

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The use of provisional denture is one of the
critical phase…….
Although often regarded as merely serving a
temporary function, use of an interim
prosthesis will generate specific information
regarding the functional and aesthetic
requirements of the definitive restoration.


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There is much confusion in the terminology of
interim dentures.
Temporary dentures, transitional dentures,
provisional dentures, interim dentures and
treatment dentures.


Definitions
 Temporary partial denture; Interim denture;
provisional denture – A dental prosthesis to be
used for a short interval of time for aesthetics,
mastication, occlusal support or convenience or to
condition the patient to the acceptance of an
artificial substitute for missing natural teeth until
more definitive prosthetic therapy can be provided –
GPT8


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Transitional denture: A removable partial
denture serving as a temporary prosthesis to
which artificial teeth will be added as natural
teeth are lost, and which will be replaced after
post-extraction tissue changes have occurred.
Treatment denture: A dental prosthesis used
for the purpose of treating or conditioning the
tissues which are called upon to support and
retain a denture base.


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To restore the vertical dimension on a
temporary basis.
As a splint following oral surgical procedures.
As a night guard to protect the teeth.
To condition the teeth and residual ridge tissue
to support better the partial denture to follow.


Advantages:
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Allows more rapid placement of denture.

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Allows natural tooth position to be duplicated.

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Allows tooth position to be altered.

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Permits a test period for change in the tooth position
before definitive RPD are made.

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Requires simple technical procedures during
construction.

Disadvantages:
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Poorly made or badly maintained, they can result in
much dissatisfaction for both patient and dentist
even though it is an interim service.

Basic Requirements:
 Patient comfort and function.
 Positional stability.
 Periodontal health.
 Acceptable aesthetics and phonetics.
 Establishment of proper occlusion.
 Continual evaluation during treatment.


Patient comfort and function:
 Treatment partial denture is an effective
appliance for preparing a patient
psychologically, as well as physically, for the
future insertion of definitive RPD.
 It can be used as a trial appliance for the
patient who have never worn any removable
appliances previously.


Positional stability:
 Removable partial denture should maintain an
even contact with the opposing dentition…
 The optimal occlusal and proximal contacts
prevents……


Periodontal health:
 During fabrication and after insertion of a
transitional RPD, the state of health of both
hard and soft tissue must be maintained
optimally.
 The transitional RPD must be designed…..
Acceptable aesthetics and phonetics:
 It should provide acceptable cosmetics.


Establishment of proper occlusion:
 The transitional RPD is an important trial
appliance for establishing the vertical
dimension of occlusion.
 Once established, this becomes the template
from which the definitive or secondary
prosthesis is derived.


Continual Evaluation during treatment:
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The transition RPD should allow the denture
practitioner to evaluate the facts such as:
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Vertical dimension of occlusion.

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The chosen scheme of occlusion.

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The aesthetics and phonetics.

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Psychologic aspects during the ongoing treatment.


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Types of treatment partial denture:

Spoon shape denture

Every dentures


Flippers

Cusil

Nesbit

Mucosal supported denture


Role of Treatment partial denture:
Appearance
 The treatment RPD is capable of providing
acceptable cosmetics……..

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If the result is acceptable by the patient and the
practitioner, it can be duplicated in definitive
RPD.

Space maintenance:
 When a space results from recent extraction or
traumatic loss of teeth….
 In younger patient the space should be
maintained until the adjacent teeth have
reached sufficient maturity.
 In adult patient the maintenance of space
prevents …………..


Basic requirements:
 Be stable and strong enough to function in the
process of chewing.
 Restore esthetics.
 Prevent over eruption of opposing teeth or
drift of the adjacent teeth.
 Be easily and economically fabricated with
minimal tooth preparation.


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Advantages:
Facial profile as well as function and esthetics are
improved.
 It facilitates the cleaning of adjacent teeth.
 Material costs are minimal.
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Disadvantages:
There is complete dependence on patient and parent
cooperation.
 Failure to maintain good oral hygiene produces
pathologic changes and gingival inflammation.
Increased caries can be expected.
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Reestablishing occlusal
relationship:
 The transitional RPD is an
important trial appliance
for establishing the vertical
 It is a reversible means of
determining a patient’s
tolerance to an increase or a
decrease in vertical
 Once established, this
becomes the template from
which the definitive or
secondary prosthesis is
derived.

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This appliances are similar to cap splints that
cover the teeth. They distribute the occlusal
stress evenly to prevent any tooth
submergence.
They should occlude in centric relation and
centric occlusion to prevent the supraeruption.


Conditioning teeth and residual ridge:
 O.C.
Applegate has emphasized the
advantages of conditioning edentulous area
to provide stable support for distal extension
RPD.
 This is accompanied by having the patient
wear a treatment partial denture for a period
of time before fabrication of final denture.


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Conditioning residual ridge……

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Conditioning teeth:
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Tooth that is to be used as an abutment for a RPD
has been out of occlusion for sometime.

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Immediately on applying an occlusal load to the
tooth sufficient to support any RPD, some
intrusion of the tooth will occur…….

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Abutment teeth can be conditioned either
through occlusal coverage or through occlusal
rest.

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When a temporary RPD is worn, such abutment
teeth have an opportunity to became stabilized
under the loading of the temporary restoration.

Interim restoration during treatment:
 In some instances an existing RPD can be used
with modification as an interim RPD.
 It may include relining and adding teeth and
clasps to the existing denture.
 Converted to the transitional complete denture
for immediate placement.


Surgical splints:
 Surgical splints are used to protect
postoperative surgical sites in the oral cavity to
improve healing.
 They are most commonly used on maxillary
arch and the lingual side of the mandibular
ridge.


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Night guards and mouth protective devices:
It acts as an occlusal protective device.
 It is used to protect the teeth from damage due to
habits like bruxism and from cases with acute TMJ
disorders.
 It can also be used to prevent abnormal mandibular
closure.
 In sports it is used to protect the teeth from trauma.
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As a vehicle for tissue treatment material
Existing removable partial denture can be used for this
purpose , the tissue surface of the denture beneath the
area of the tissue irritation should be relieved by giving
space to carry treatment material.

Mode of action
-evenly

distributes the occlusal load over the denture
- produces an intimate tissue contact and has a
massaging effect on the soft tissue
- increases the blood flow and reduces the
inflammation

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REPAIR
Repair procedures for RPD varies according
to the damage component.
Denture base repair
The broken segments are available and can be
accurately repositioned, the sections are held
together and luted with sticky wax along the
fracture line.
 Dental stone is poured against the tissue side of
the denture base:
 The denture is seperated.
 The fracture margins are dovetailed.
 The pieces of denture are assembled and held in
position.
 Autopolymerizing resin is added along the
fracture line.
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Replacement of denture teeth:
 An accurate opposing cast and a jaw relation
record is necessary.
 The tooth of same mould and same shade is
selected.
 The ridge lap area should be relieved.
 The tooth is luted to the denture base with a
sticky wax.
 Autopolymerizing resin is added.

Multiple teeth replacement:
 If multiple teeth are to be replaced, a mounting
cast is poured against the tissue surface of the
RPD.
 The cast is articulated with the opposing cast.
 Teeth to be replaced are positioned and finally
the denture base is relieved.
 Gingival contours are waxed and denture is
flasked, packed and processed.

Maintenance of RPD:
 The need for strict oral hygiene and diet control
must be clearly understood while an treatment
partial denture is being worn.
 Adequate prophylactic measures must be taken
to prevent decalcification and caries in the
teeth contacted.
 It should never be worn continuously.
 Periodic dental visit should be advised for
followup.

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The utilization of properly
fabricated provisional
prosthodontic appliances
will permit a higher rate of
success of the definitive
treatment.
This phase of restorative
treatment should not be
merely considered a
temporary treatment but as
a template for the ensuing
prosthesis.

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Henderson D., McGivney G.P., Castleberry D.J. :
McCracken’s removable partial prosthodontics, 11th
Edn. St. Louis ; CV Mosby Co
Dental Clinics of North America: Full mouth
reconstruction – fixed removable.1987
Dental Clinics of North America:removable
prosthodontics .1984
Henderson D., McGivney G.P., Castleberry D.J. :
McCracken’s removable partial prosthodontics, 6th
Edn. St. Louis ; CV Mosby Co
R . J Methewson - fundamentals of paediatric
dentistry.3rd edn
S J Davies , R M Gray , J F McCord – good occlusal
practice in removable prosthodontics. BDJ 2001:10;191

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Discuss the role of treatment plan in partial denture /certified fixed orthodontic courses by Indian dental academy

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