A Quickie Breakdown of Partial Dentures

Adam Kirkpatrick & Ulf Temnitzer Making partials can be pretty overwhelming at first, but it is actually pretty easy once you get the basics down. In light of that, I have made this quickie breakdown so that you have an idea of whats going on before you have to start memori ing the nitty gritty details. !lso, this is a good refresher for those of us who have gone through the class and have forgotten things. "artial dentures are made for people who are missing some teeth and have some stable teeth left. #epending on the conformation of the teeth that remain, there are some different ways to make a partial more stable. $here are % different classifications of the stability of the teeth, and they are &ennedy 'lass I, II, III and I(.

$here are all these classifications, but you really only have to worry about whether it is tooth)borne or mucosa)borne, and if its a &ennedy 'lass I(, you might do a rotational path partial. $his dictates what type of clasps you can use. If you have a patient that has more than one of these classifications, you go with the lowest number, and other missing areas are added as modifications. !lso, there are modifications for each classification. *ave a look at the picture to figure them out. +ets not get ahead of ourselves, though. +ets have a look at the different parts of a partial.

'omponents of a "artial -. .. 0. %. 2. 3. 5. $he main components of a partial are, 'lasps /ests Ma1or 'onnectors Minor 'onnectors !crylic retention meshwork "ro4imal plates Indirect retainers

'lasps +ets talk about these first. $here are only 0 types of clasps mainly used here at "acific, and they are, -. !kers .. /"I 0. /"' 6asically, you always use an !kers clasp when you have a tooth)borne situation, and you use stress releasing clasps 7either an /"I or /"'8 when you have a tooth) mucosa)borne situation 7distal e4tensions8. If you have to use an /"I or /"', you would want to use the /"I if the situation qualifies. $hat is the basics of clasps 9 you can learn more about them from the book.

'lasps 9 More Info 7some nitty gritty8 Akers. :se this for tooth borne area. It has a rest, pro4imal plate, retention arm and bracing arm. $he pro4imal plate is on the same side of the rest and sort of waterfalls off of it. $he two arms come off of the pro4imal plate 9 the retention arm is usually on the buccal and the bracing arm is usually on the lingual. $he retention arm is the one that actually engages the undercut of the tooth and the bracing arm basically 1ust makes sure that the tooth is hugged and doesnt become mobile. ;ust as a side note, you can have two !kers clasps back to back on two ad1acent teeth.

/est

"ro4imal "late

RPI. :se this for tooth)mucosa borne areas 7i.e. distal e4tensions8. In fact, this is the preferred one for that. It has a mesial /est, "ro4imal plate and I bar 7the I in /"I8. $he rest is always on the mesial, the I bar goes on the facial and engages the undercut 7and stays below the survey line8, and the pro4imal plate is always on the distal. $he pro4imal plate e4tends from - mm above the survey line down to the gingiva. <ou cant use an /"I if anything gets in the way of the I bar 7super inclined teeth, undercut in the gums less than 0mm away from the tooth8. "ro4imal "late I 6ar

Mesia l /est =.=-= undercu t

RPC. :se this for tooth)mucosa borne areas 7i.e. distal e4tensions8. $his is what you use if you cant use an /"I 7if the tooth is inclined too much or if the soft tissue undercut is less than 0 mm away from the tooth8. It has a /est, "ro4imal plate and 'lasp 7the ' in /"'8. ;ust like the /"I, the rest is always on the mesial and the pro4imal plate is always on the distal. $he pro4imal plate still e4tends from - mm above the survey line down to the gingiva. Instead of the I bar, however, this has a clasp. $he clasp comes off of the pro4imal plate and engages an undercut on the facial. Mesia l /est =.=-= undercu t "ro4imal "late

'lasp

>n both of the stress releasing clasps 7/"I and /"'8, the pro4imal plate disengages the guide plane on the tooth when the denture has force e4erted on it. #uring chewing, the denture sinks into the tissue a little and basically rotates the pro4imal plate out of contact into the undercut area of the abutment tooth. /ests $here are only a few types of rests that we mainly use here at "acific and they are, -. .. 0. %. >cclusal ?4tended >cclusal 'ingulum 6all

<eah, rests are pretty simple. <ou can put them either on the mesial or distal of teeth depending on the situation. More details below and in the book.

/ests 7nitty gritty8 -. >cclusal 9 use on posterior teeth for most situations o @eed to be a minimum of -.2 mm thick at the marginal ridge o Apoon shaped o -B0 facio)lingual width of the tooth 7or C the distance between cusp tips, same thing8

.. ?4tended >cclusal 9 use on posterior teeth if tooth is tipped to direct the force along the long a4is

0. 'ingulum 9 use on anterior teeth o ( or : shaped in cross section o Atraight or inverted : shaped from the lingual

%. 6all 9 use on anterior teeth o /ounded outline form o >n mesial or distal half of tooth at 1unction of gingival and middle -B0 rds o May need to be filled with amalgam if penetrates into the dentin

Ma1or 'onnector $his is the bulk that holds the partial together and provides stability. 6asically, you want to get away with covering as little gingiva as possible while still maintaining the strength because having a bulky partial sucks for patients. $hese are the different ma1or connectors that we mainly use at "acific, Ma4illa o Dull "alatal "late o Modified "alatal "late o Midpalatal Atrap o !nterior "alatal Atrap 7*orseshoe8 o !)" Atrap Mandible o +ingual bar o +ingual plate

$here are different reasons for using all of these different ones, and youll need to learn about those in the book. $he ma4illary ma1or connectors need to be a minimum of E mm wide. >n the mandible, you would use a lingual bar when you have 5 mm or more from the gingival margin to the base of the lingual vestibule 70 mm of space between the gingival margin and metal F % mm minimum width of lingual bar8. If you dont have 5 mm or more, you would use a lingual plate.

!nterior "alatal Atrap

Dull "alatal "late

Modified "alatal "late

!)" "alatal Atrap

Midpalatal Atrap Minor 'onnector

+ingual 6ar

+ingual 6ar

+ingual "late

@ot too much to say here. It is 1ust the part that connects the rests and stuff to the ma1or connector. $hey are easy. $he only thing you need to keep in mind is how far away the metal framework has to be from the gingival margin. If it is too close, you will cause plaque retention and tissue irritation. >n the ma4illa, you need to have a minimum of 3 mm from any metal 7ma1or or minor connectors8 to the closest gingival margin. >n the mandible, you need to have a minimum of 0 mm from any metal 7ma1or or minor connectors8 to the closest gingival margin. !lso, you need to make sure that the minor connectors are at least 2 mm away from any of the other vertical features.

!crylic Meshwork

!gain, easy pee y. ;ust the metal meshwork that holds on the acrylic. <ou want about one hole in the metal for each tooth you are replacing. *ave a look at the ma1or connector pictures if you want to see what it looks like. "ro4imal "lates $his goes along a guide plane that you prepare on the teeth with a bur. $here are several guide planes made on the teeth, and they guide the partial to seat in the right place. ;ust like with a crown, they need to draw with each other, which I hear is pretty tough to do. $he pro4imal plates are the metal parts of the partial that sit against the guide planes. >n abutment teeth with stress releasing clasps 7/"I or /"'8, the pro4imal plate reaches only - mm above the survey line. @ow a word about the guide planes. $hey are on the occlusal -B0 of abutment teeth that are ad1acent to an edentulous area 7basically anywhere that the partial will slide against8. $hey are meant to be parallel to the path of insertion of the partial so it is guided into place. Indirect /etainers <ou only need these with a distal e4tension partial. >n these partials, there is a fulcrum line that e4ists if you draw a line between the two distal most rests. 6asically, if you eat a sticky food and it tries to pull off the distal e4tension, the partial will fulcrum and push down in the front. $he more room it has to push down in the front, the more it will lift off in the back. Make senseG In order to stabili e this, you can 1ust put a brace anterior to the fulcrum line so that the partial doesnt have anywhere to push down in the front. $hat keeps it from lifting off in the back. $his brace is called an indirect retainer and it is basically 1ust a rest connected to the partial with a minor connector that keeps the distal e4tension of the partial seated during eating and talking. Indirect retainer resisting lift off "art of denture that lifts off Dulcru m line

*ow to !naly e, Aurvey and #esign a "artial >nce you know the stuff we 1ust discussed, this part isnt that hard. Hranted, there are a million different scenarios that change what will be e4actly done but if you get the basics it isnt that tough. !naly ing is the process of figuring out where the undercuts are. Aurveying is the process of drawing on the cast to show where those undercuts are. #esigning is the process of figuring out what e4actly the partial is going to look like. $here is an order you do things that makes this process easier, and it is, !naly ing and Aurveying, o Pat of insertion !tilt"# :se the analy ing rod to find the most ideal path of insertion 7must be pretty close to parallel with the floor8 o $ark Teet # :se led in the surveyersurveyor to mark the heights of contour on teeth that you are thinking about clasping so that the undercuts are visible. o Mark $issue . :se led in the surveyersurveyor to mark the soft tissue where you think an undercut may be. o Tripod# Blue. +ock everything in position on the surveyersurveyor and scratch 0 little hori ontal lines on the cast. <ou want these lines to be out of the way of the rest of your design if possible and as far away from each other as possible. $his will allow you to put the cast and table back into the same position if you move it. >nce you scratch the lines in, you mark it with a little F in blue and circle it. o A%utment Clasp Undercut &ocations !#'(')"# Blue# <ou use an undercut marker to mark an =.-= undercut in the strategic areas where you will engage that undercut with a clasp. $ooth Modification o Rests# 'arve out the rests to their final dimension. o *uide Planes# Drom line angle to line angle and all parallel to each other. $hey should follow the contour of the teeth. o +ei, t of Contour# If you need to, you can modify the teeth so the clasps fit in a better location or to optimi e the position of the =.-= undercut. #esign, o Rests# Red# >utline the rests on the appropriate teeth. o *uide Planes# Blue# >utline the guide planes that you carved into the teeth. o Pro-imal Plate# Red# Dor an !kers clasp, this will 1ust come right off the occlusal rest straight down to the gingiva and e4tend away from the tooth .mm. Dor an /"I or /"', this will e4tend from halfway up the guide plane down to the gingiva and e4tend away from the tooth .mm. o $inor connector# Red# $his must be at least .mm wide and will e4tend down the tooth and away from the gingiva at least 3mm on the ma4illa and 0mm on the mandible. o $a.or Connector# Red# >utline the most appropriate ma1or connector for that patient. >n the ma4illa, keep in mind it needs to be at least Emm wide and at least 3mm away from the gingiva. >n the mandible, a lingual

bar needs to be %mm wide in the anterior and at least 0mm away from the gingiva. o Acr/lic Retention $es work# Red# $here needs to be - hole for each tooth and the metal needs to be .mm wide. o Plastic !acr/lic"# Blue# It should e4tend into the vestibule when it is needed for retention 7mucosa borne8 and should only e4tend a little way past the metal for tooth borne situations. o Clasps# Red# !kers, /"I or /"'. Aee above for e4act specifications. !gain, here is the order of things, and youll learn more about it as you go. <ou will have to have an idea about your final design while youre doing the analy ing and surveying to know what you are looking for. /otational "ath "artial #enture, 'ertain partials can be designed so that one portion seats first and the rest is rotated into place. ! straight path of insertion is not possible since the minor connectors in the edentulous area e4tend into the undercut. $he retention mechanism is rigid and contains a rest and a minor connector.

$here are three possibilities of rotation. !nteroposterior 7!"8, !nterior segment is seated first and the posterior segment is rotated into place "osteroanterior 7"!8, "osterior segment is seated first and the anterior segment is rotated into place +ateral, >ne side is seated first and the other side is rotated into place $he rest off of the retentive minor connector 7the one without a clasp8 must be -.2 to .mm in thickness, almost parallel walled, and should be prepped perpendicular to the long a4is of the tooth 7see the picture above8. $he rest should e4tend more than half the mesiodistal dimension of the abutment tooth. !dvantages and #isadvantages of /otational "ath "artial #enture, ! rotational path partial denture minimi es the plaque accumulation by having less tooth coverage 7clasps8. Aince anterior clasps often can be eliminated, the end product may be much more esthetic. *owever, the rotational path technique shows less tolerance for errors, the ad1ustments of the retentive components is difficult, and requires well prepared rest seats or even restorations to develop such a rest seat. Aurveying and #esigning /otational "ath "artials Dirst, the model is placed in a = degree position where it is surveyed for undercuts and heights of contour. $he model is tripodi ed by drawing two vertical red lines on each side of the model. $hen, the undercut for the retentive minor connector 7the one without a clasp8 is determined to =.=.=I all other clasps should be designed with a =.=-= undercut as usual. $ilt the model so that the survey rod is parallel to the undercutting surface of the abutment teeth 7the ones that you will put the retentive minor connectors on8. Mark two blue lines an each side of the model in order to tripodi e the initial path of insertion. !fter you have done this, move the table back to the original position and survey and design the cast as usual.

*ave fun in /emovable, its your last lab classJ