Removable Prosthodontics Test I

Immediate Dentures

Immediate denture – complete denture or partial denture fabricated for placement

immediately after removal of natural teeth

2 types – conventional immediate dentures (CID), interim immediate dentures (IID)

CID – is relined to serve as the final prosthesis, selected when only anterior teeth
remain or if the pt will allow the posterior teeth to be extracted prior

Advantages of ID – maintain pts appearance and psychological well being,

circumoral support for muscles VDO and facial height, less postoperative pain, easy
to duplicate for final denture, more easy adaptation for pt to dentures, maintain
nutrition

Disadvantages of ID – anterior ridge undercut caused by the presence of remaining

teeth may interfere with impressions and capturing the posterior undercut, VDO
and CR can be hard to establish with remaining teeth

If pt has posterior teeth in occlusion then no record base is needed

Pt is to wear ID for 24 hrs straight and return for a checkup then wear at night for
the next 7 days, pt should rinse out mouth 3-4 times a day during that 7 days

Ridge resorption is fastest during the first 3months

Classification system for CE

4 variables to be considered when classifying – physical findings, prosthetic history,

pharmaceutical history, and systemic disease

4 diagnostic criteria – bone height, residual ridge morphology, muscle attachment,

maxillomandibular relationships

Bone height – used for mandible only, most easily quantified criterion, loss of bone
volume affects denture bearing area, tissue and total facial height, given value of
type I-IV
Residual ridge morphology – used for maxilla, focuses on the vestibules, palatal
vault, tuberosity, hamular notch, and tori presence, given value of type A-D
Type A – resists movement, sufficient tuberosity and hamular notch, absence
of tori or exostoses
Type B – loss of posterior buccal vestibule, poorly defined tuberosity and
notch, resists movement, tori are rounded and don’t affect the posterior
extension
Type C – loss of anterior labial vestibule, palatal vault offers minimal
resistance to forces, palatal tori or exostoses with undercuts but don’t affect
posterior extension, anterior ridge offers minimum support, reduction of
post malar space by the coronoid process during opening
Type D – loss of anterior labial and posterior buccal vestibule, palatal vault
offers no resistance, tori or exostoses interfere with posterior border,
prominent anterior nasal spine

Muscle attachments – mandible only, effects of those attachments are most

important, attachments affect amount of attached mucosa and presence of vestibule,
given value of A-E
Type A – attached mucosal base without undue muscle impingement during
normal function
Type B – attached mucosal base everywhere but labial vestibule, mentalis
muscle attachment near crest of alveolar ridge
Type C – attached everywhere except anterior buccal and lingual vestibule
from canine to canine, genioglossus and mentalis attach near crest of alveolar
ridge
Type D – attached only in posterior lingual
Type E – no attached mucosa anywhere

Maxillomandibular relationships – characterizes the position of the teeth to the

ridge or dentition, given class I-III, class I allows teeth to be placed in a position
supported by the ridge, class III tooth position required to be outside normal ridge
relation to attain esthetics and phonetics

Integration of all subclasses leads to overall classification of I-IV

Class I edentulism – bone height of 21mm, ridge morphology of type A resisting

horizontal and vertical movements, muscle attachments of type A/B, M-M
relationship of class I

Class II edentulism – bone height of 16-20mm, ridge morphology A/B and resisting
movements, muscle attachments of type A/B, M-M relationship of class I, modifiers
of mild systemic disease or psychosocial considerations

Class III edentulism – bone height of 11-15mm, ridge morphology of type C with
minimal ability to resist movement of denture base, muscle attachments of type C
with location moderately influencing stability and retention of denture base, M-M
relationships of class I II or III, modifiers like need for pre-prosthetic surgery,
limited interarch space (18-20mm) and psychosocial considerations

Class IV edentulism – bone height of 10mm or less, ridge morphology of type D with
no resistance to horizontal or vertical movements, muscle attachments of type D/E
with location having a significant influence on stability and retention, M-M
relationship of class I II III, modifiers like major pre-prosthetic surgery, history of
parathesia, maxillofacial defects or ataxia, hyperactive tongue or gag reflex,
refractory pt

Advantages of classification system – decrease rate of retreatment, save from

working on cases too advanced, more accurately diagnose and address pt needs,
improved inter-professional communication and third party communication, good
screening tool for academic institutions

Any single criteria of a more complex case places the pt into a more complex class

Classifications for Partial Edentulism

Kennedy classification advantages – simple, extremely comprehensive and practical,

permits visualization of the partially edentulous arch or RPD designed for that arch

Kennedy classifications – class I are bilateral edentulous areas located posterior to

remaining teeth, class II is a unilateral edentulous area located posterior to
remaining teeth, class III is a unilateral edentulous area with teeth anterior and
posterior to it, class IV is a single bilateral edentulous area located anterior to the
remaining teeth

Applegate’s additions to Kennedy – class V is an edentulous area bounded anterior

and posterior by teeth but which the anterior abutment is not suitable for support,
class VI is an edentulous area in which the adjacent teeth are good abutments and
cannot be prepped for a crown due to possible damage to the pulp

Applegate rules – most posterior edentulous area determines classification, there

cannot be any modification areas in class IV arches

Diagnostic criteria for classifying partial edentulism – location and extent of

edentulous areas, condition of the abutments, occlusion, residual ridge
characteristics

Class I – edentulous area is in 1 arch, does not compromise physiologic support of

abutments, doe not exceed 2 incisors in maxilla or 4 in mandible, does not exceed 2
premolars or a molar and premolar

Class II – areas in 1 or both arches, don’t compromise physiologic support,

abutments in 1 or 2 sextants have insufficient tooth structure and may require
localized adjunctive therapy, occlusal correction required, class I molar relationship,
Class II CE for the residual ridge

Class III – areas in 1 or both arches, compromises physiologic support of abutments,

edentulous areas greater than 3 teeth or 2 molars in the posterior or 3 or more teeth
in the anterior, abutments in 3 sextants have insufficient tooth structure and require
more substantial localized adjunctive therapy, requires reestablishment of entire
occlusal scheme without VDO change, class II molar relationship, Class III CE for
residual ridge

Class IV – extensive edentulous areas in 1 or both arches, compromise physiologic

support of abutments causing a guarded prognosis, abutments in 4+ sextants have
insufficient tooth structure and require extensive therapy, must change entire
occlusal scheme and VDO, class II division 2 or class III molar relationship, Class IV
CE for residual ridge, refractory pt, severe local or systemic disease, ataxia

If a pt presents with an edentulous mandible and a partially edentulous or dentate

maxilla then both arches are considered class IV in both systems because of the
long-term morbidity

Diagnosis and treatment planning for edentulous pts

Tx plan involves 4 distinct processes – understanding chief complaint, determining

pt needs, develop plan that addresses both, appropriately sequence the plan

Factors affecting tx plan – pt’s mental attitude, systemic conditions, dental history,
local oral conditions

Pt exam allows for the most accurate assessment of each pt’s prognosis for
treatment to be made and aids in identifying pitfalls to tx

Proper diagnosis and tx planning can provide more predictable and consistent
treatment outcomes

First appt – diagnose, tx plan, and impressions

7 type of data gathering – questioning, records, visual observation, radiography,

palpation, measurement, diagnostic casts

Existing denture exam – tooth chipping could be indicative of unbalanced occlusion,

plaque on tissue surfaces could signify poor denture base fit

Denture stability is enhanced by parallelism of the primary denture bearing areas

In class notes

PDI classification is only for complete edentulism, it cannot be applied to immediate

denture pts until all teeth are removed

Mandible traits to look for – bone height and muscle attachment

Maxilla traits to look for – vestibular depth and anterior bone resorption

Combination syndrome – pt with lower anterior teeth and no upper anterior teeth
tend to chew on anterior ridge causing bone loss and flabby tissue

Patient personality types – exacting, philosophical, indifferent, hysterical

Pts who are type III or IV have either worn dentures before or have been selected
for implant placement

Closest speaking space helps you find VDO, high VDO and the teeth will touch each
other, low VDO and can’t make sound

Immediate problem when change from vertical overlap of teeth to no vertical

overlap – show fewer teeth