T H E C LINICA L GUIDE S ER I ES J C Davenport, R M Basker, J R Heath, J P Ralph & P 0 Glantz A CLINICAL GUIDE TO REMOVABLE PARTIAL DENTURES The authoritative refe rence fo r dental practitionersand st udents
1. THE CLINICAL GUIDE SERIES JC Davenport, R M Basker, J
RHeath, J P Ralph & P 0 Glantz A CLINICAL GUIDE TO REMOVABLE
PARTIAL DENTURES The authoritat ive reference fo r dental pract
itioners and st udents
2. Contents Preface Acknowledgements Part I -Patient assessment
Need and demand for treatment v VI 3 52 The removable partial
denture equation 3 Management options for the partially dentate
patient 4 RPDs and the elderly 5 The anatomy of the denture-bearing
areas 6 Jaw relationships 7 Information gathering: history,
examination, diagnosis and treatment planning 8 Preliminary
impressions 9 Articulators 15 21 25 33 39 47 53 Part 2 -
Preparation of the mouth 57 10 Initial prosthetic treatment 11
Surgery 12 Periodontal treatment 13 Orthodontic treatment 14
Conservative treatment 15 Tooth preparation 59 69 71 75 77 81 Part
3 - Prosthetic treatment 89 16 Working impressions 17 Recording the
jaw relationship 18 Trial insertion of the metal framework 19
Altered cast technique 20 Trial insertion of waxed -up dentures 21
Insertion of the completed denture 22 Review 91 99 107 111 115 123
129 Further reading Index 133 137
3. Part1 Patientassessment art 1 of this book opens by making
the important distinction between the need Pand the demand for
removable partial denture (RPD) treatment. A discussion of the
advantages and disadvantages that can result from fitting an RPD
(chapter 2),and an account of the various management options for
the partially dentate patient (chapter 3) follow. The increasingly
pertinent subject of RPDs and the elderly is con sidered next
(chapter 4), followed by a reminder of the relevant aspects of
intra-oral anatomy, and jaw and occlusal relationships (chapters 5
and 6). By applying this knowledge during the history taking and
examination of the patient, information is obtained to develop a
diagnosis and a provisional treatment plan (chap ter 7). However,
before the latter can be finalised, it is necessary to examine
study casts obtained from preliminary impressions of the patient's
mouth (chapter 8). These casts may need to be mounted on an
articulator (chapter 9).
4. Needanddemandfor Thave, whilst 'demand' refers to the
treatment requested by he term 'need' is commonly used to describe
the amount of treatment that dentists judge their patients ought to
the patients themselves. Most studies of prosthetic need and demand
show that the former is larger than the latter. The many reasqns
for this difference can be considered under the following headings.
Availability of treatment. Acceptability of treatment.
Accessibility of treatment. Availability Availability refers to
numbers of dentists, their particular skills, their accessibility
to the public and the economic realities of the community in which
they practise. Acceptability Acceptability describes the attitudes
of people to different forms of treatment. These attitudes are
influenced by such matters as education, personal finance, and
cultural background. Accessibility Accessibility highlights
important differences between people. For example, a particular
form of prosthetic treatment may be equally Figure 1.1 Whether or
not a removable partial denture (RPD) is worn by the patient is
dependent upon self-motivation. In a UK survey people were asked,
'If you had several missing teeth at the back would you prefer to
have an RPD or manage without?' The chart shows that most people
would prefer to manage without and that the preference grows
stronger with increasing age. It is almost as if the longer the
person has managed to avoid dentures the stronger is the wish to do
without them. available to young and old patients, but the latter
may find that the effort needed to seek out that treatment is just
too great. Recognizing the difference between need and demand
prompts the question, 'How many teeth must be lost before a patient
seeks prosthetic replacement?' Experience suggests that the answer
can vary greatly. On the one hand, the loss of one anterior tooth
is usually a powerful motivator for the patient, whereas another
patient may have had many posterior teeth extracted before they
seek the advice and help of a dentist. Although the restoration of
appearance can be a powerful motivating factor, not every patient
will seek treatment follow ing the loss of an anterior tooth. A
study of elderly men living in an area where dental treatment was
readily available and afford able showed that one in five had at
least one unrestored space towards the front of the mouth. In
another study, dentists rated the dental appearance of a group of
elderly people as less attrac tive than did the subjects
themselves. The dentist must therefore avoid preconceptions and
consider the thoughts and wishes of the individual patient before
recommending the provision of a denture. The time, effort and
understanding taken to make this judgement are likely to prevent
unnecessary treatment. There can thus be a large difference between
the perception of need and demand for a prosthesis as an aid to
chewing efficiency. Nutritional status is affected by
psychological, sociological and economic factors as well as by the
effectiveness of the dentition. 100% 90% 80% 60% 50% 40% 30% 20%
10% .!!lr:: ..a.. 16-24 25-34 35-44 45-54 Age (Yrs) 55-64 65 and
over Have RPD (%) 121Manage without (%) 3
5. A clinical guide to removable partial dentures 100% 90% 80%
70% 60% 50%!!!c GI :;:; aO ..I 30% 10% 0% 16-24 25-34 35-44 45-54
55-64 65 and Age (Yrs) over Very upsetting D A little upsetting
IZlNot at all upsetting For missing posterior teeth, the concept of
the shortened dental arch (SDA) is relevant. Here the needs for
oral health and 90 80 70 Ill