Discuss the role of treatment partial denture

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Contents • 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

INTRODUCTION

• 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.

• 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

• 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.

Indications

• 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:

• Allows more rapid placement of denture.

• Allows natural tooth position to be duplicated.

• Allows tooth position to be altered.

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

• Requires simple technical procedures during construction.

Disadvantages:

• 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:

• The transition RPD should allow the denture

practitioner to evaluate the facts such as:

– Vertical dimension of occlusion.

– The chosen scheme of occlusion.

– The aesthetics and phonetics.

– Psychologic aspects during the ongoing treatment.

• Types of treatment partial denture:

Spoon shape denture

Every dentures

Flippers Nesbit

Cusil Mucosal supported denture

Role of Treatment partial denture:Appearance• The treatment RPD is capable of providing

acceptable cosmetics……..

• 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.

• Advantages:– Facial profile as well as function and esthetics are

improved.– It facilitates the cleaning of adjacent teeth.– Material costs are minimal.

• 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.

Reestablishing occlusal relationship:

• The transitional RPD is an important trial appliance for establishing the vertical dimension of occlusion.

• It is a reversible means of determining a patient’s tolerance to an increase or a decrease in vertical dimension of occlusion.

• Once established, this becomes the template from which the definitive or secondary prosthesis is derived.

• 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.

• Conditioning residual ridge……

• Conditioning teeth:– Tooth that is to be used as an abutment for a RPD

has been out of occlusion for sometime.

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

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

– 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.

• 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.

• 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

REPAIRRepair 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.

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.

Summary & Conclusion

• 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.

References• 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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