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1. INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education

2. WHY CAST PARTIAL
DENTURES?
 21st
Century is an era of conservative
dentistry & more & more emphasis laid
down on preservation of dentition &
maintenance of oral health
 However in our country inspite of poor
oral health status, there is a lack of
attitude or ignorance towards oral
health resulting in loss of one or more
teeth

3. Study of Oral Health Status and Treatment Needs of the Elderly population in
the Community (n=1240, Delhi) Shah N, Parkash H, Sundaram KR
 Edentulousness, periodontal diseases
& dental caries are high among elderly
& is inversely related to income &
education level of people
 Most of the elderly (60%) had poor oral
health perception specially regarding
their masticatory ability

4. DENTITION STATUS AMONG
ELDERLY
15
18
49
18
0%
20%
40%
60%
80%
100%
Complete Edentulous One arch edentulous
One or more missing teeth Intact dentition
(n = 1240)

5. PROSTHODONTIC STATUS AMONG THE
ELDERLY
15
8.3
67
6.5
0
10
20
30
40
50
60
70
Complete
Edentulous
Complete
Dentures
Partial / one arch
Edentulous/
Partial Dentures

6. Oral health Care of the Elderly; Identifying the needs & feasible strategies for
service provisions (n= 96, Delhi)
 35.4% Complete edentulous
 56.3% Partial edentulous
 100% Dentate subjects had dental caries
 Periodontal problems more prevalent in
males
 TMJ problems & oral mucosal lesions
 Lack of attitude to utilize service
provisions
 Prefer to use on-site service provisions

7. Thus there is a greatThus there is a great
demand for replacement ofdemand for replacement of
missing teethmissing teeth

8. TREATMENT MODALITIES
 Acrylic Partial Denture/ Gum
Striper
 Cast Partial Denture
 Fixed Partial Denture
 Implant Supported
Prosthesis

9. ““ The preservation of thatThe preservation of that
which remains and not onlywhich remains and not only
the meticulous replacementthe meticulous replacement
of that which has been lost.of that which has been lost. ””
Muller DeVan (1952)Muller DeVan (1952)
THE MOTTO IS !!

10. GOALS FOR REHABILITATIONGOALS FOR REHABILITATION
 Eliminate diseaseEliminate disease
 Preserve what remainsPreserve what remains
 Establish or increaseEstablish or increase
masticatory efficiencymasticatory efficiency
 Develop & restore estheticsDevelop & restore esthetics
 Maintain or improveMaintain or improve
phoneticsphonetics

11. TO FULFILL THESE
GOALS
 The Cast Partial Denture is
the relatively good treatment
modality if followed
scientifically
 Cost Effectiveness

12. The use of removable partialThe use of removable partial
dentures (RPD’s) has beendentures (RPD’s) has been
predicted as one of the best growthpredicted as one of the best growth
opportunities for the dentalopportunities for the dental
profession, yet the number ofprofession, yet the number of
qualified clinicians andqualified clinicians and
technicians to use thesetechnicians to use these
opportunities continues toopportunities continues to

13. Although clinically provenAlthough clinically proven
implant therapies continue toimplant therapies continue to
grow in acceptance, yet stillgrow in acceptance, yet still
RPD treatment are preferredRPD treatment are preferred
because of patients’ medical,because of patients’ medical,
financial, or oral health valuefinancial, or oral health value
limitationslimitations

14. INDICATIONS FOR CAST PARTIALINDICATIONS FOR CAST PARTIAL
DENTURESDENTURES
 Great edentulous spanGreat edentulous span
 No posterior abutmentNo posterior abutment
 Excessive ridge resorptionExcessive ridge resorption
 AgeAge
 CostCost

15.  Reduced periodontal supportReduced periodontal support ofof
remaining teethremaining teeth
 Need forNeed for cross-archcross-arch
stabilizationstabilization
 Patient’s desirePatient’s desire
 Physically or emotionallyPhysically or emotionally
handicappedhandicapped

16.  The correct
diagnosis
 Biologically
designing the
prosthesis
 Properly executing
the plan
SUCCESSFUL PROSTHODONTIC CARESUCCESSFUL PROSTHODONTIC CARE
BY CAST PARTIAL DENTURE DEPENDSBY CAST PARTIAL DENTURE DEPENDS
UPONUPON

18. It is the determination of nature of the
disease
It is the process of evaluating
patient’s health as well as
resulting opinion formulated by
the clinician
OR

19. To get an over all picture
of the patient’s condition
To chart out treatment
To determine the
prognosis
IMPORTANCE OF DIAGNOSISIMPORTANCE OF DIAGNOSIS

20. Diagnoses
EVALUATION OF
FINDINGS
SIGNIFICAN
T FINDINGS
Information Gathering
Patient History
Clinical Examination
Radiographic
Examination
Diagnostic Aids
Problem
List

21.  The diagnostic process involves:
Analysis of Data:
Correlation of history & health
Previous Prosthodontic history
Intra & Extra-Oral examination
Interpretation of radiographs
Analyze articulated diagnostic
casts

22. SEQUENCESEQUENCE
 General information (name, age, sex,
occupation)
 Chief complaint with duration
 Recording the relevant medical
history
 Recording the relevant dental history
 Performing a thorough visual &
manual extra-oral & intra-oral
examination

23.  Radiographic examination
 Diagnostic cast interpretation
 Final Diagnosis
 Treatment planning
 Prognosis
 Treatment execution

25. NAME, AGE & SEXNAME, AGE & SEX
 Patient should be addressed by
name which would add to
personal touch & confidence of
the patient
 Helps in future correspondence
 Adaptability of tissues
decreases with age

26. Facility for learning &
coordination appears to
diminish with age
Males are more concerned
for comfort & function
while the women on
appearance

27. OCCUPATIONOCCUPATION
 For patients whose occupations
require them to deal with the public,
appearance is usually a primary
consideration
 A retired person often has more
time to play with his dentures & to
find minor problems with them
 It also indicates the socioeconomic
level of the patient

28. CHIEF COMPLAINT
 Chief complaint & duration should
be recorded as far as possible in the
patients own words & in
chronological order
 Patients must tell what problems
they had with their old dentures
 These complaint will act as a
guidance for the dentist in the area
of greatest concern to the patient

30.  Direct interrogation by the
dentist
 Comprehensive
questionnaire
 Combination of both
THERE ARE 3 BASIC TECHNIQUE FORTHERE ARE 3 BASIC TECHNIQUE FOR
OBTAINING THE INFORMATIONOBTAINING THE INFORMATION

31.  Direct Interrogation Technique
 This type of technique is guided by the
tone of the patient answers & can be very
revealing
 Questionnaire Approach
 Quick method
 It can be filled by patient in waiting room
 Combination Of Both
 It is the best system
 Form is filled by the patients & then
verbally reviewed by the dentist

33. MEDICAL HISTORYMEDICAL HISTORY
 Many of the removable prosthodontic
patients we treat are geriatric;
compromised health may have an
impact upon treatment
 Basic aim is to determine any
condition that might affect the
procedure & out come of the
treatment
 The positive health factors should be
in homeostasis against negative
factors

34. MEDICAL HISTORY INCLUDESMEDICAL HISTORY INCLUDES
 Systemic Diseases
 Medication
 Hospitalization
 Treatment Given

35. SIGNIFICANCE OF MEDICALSIGNIFICANCE OF MEDICAL
HISTORYHISTORY
 Diabetes Mellitus
 Anemia
 Hypertension
 Salivary Gland Disorders
 Bell’s Palsy
 Parkinsonism

36. DENTAL HISTORYDENTAL HISTORY
 Cause of tooth loss
 Caries
 Periodontal
 Trauma
 Others

37. ANY RESTORATIVE OR ENDODONTICANY RESTORATIVE OR ENDODONTIC
HISTORYHISTORY
 Examine all restorations on abutments
carefully, replace any questionable
restoration & ensure adequate bulk, depth
& width if placing rests
 If in doubt for Endodontic history
Do it!!

38.  Reason for the failure of the previous
denture???
 Gives An insight into
 Denture experience
 Denture care
 Para functional habits of the patients
 N.B.
 Patients who keep changing dentures in a
short period of time are difficult to satisfy
and risky to deal with
EXPERIENCE OF PREVIOUSEXPERIENCE OF PREVIOUS
DENTUREDENTURE

39. PSYCHOLOGICAL EVALUATION
 Determine the level of motivation
which determines the attitude of the
patient towards denture
 House’s Psychological classification
Philosophical
Exacting
Indifferent
Hysterical

40.  PhilosophicalPhilosophical
Best mental
attitude
Well motivated
Cooperates with
the dentist and
learns to adjust

41.  ExactingExacting
Finds faults with every
thing that is done for them
Never happy with their
previous dentist because
the previous dentist did
not followed their
instruction
Firm control of these
patients is essential

42.  IndifferentIndifferent
Have little concern for their teeth
or oral health
Have little appreciation for the
efforts of their dentist
Such patients require more time
for instructions on the value &
use of dentures

43.  HystericalHysterical
These patient had bad results with
previous treatment & are therefore
doubtful that any one can help them
They think the world is against them
and doubt the ability of any one helping
them
They need kind & sympathetic help as
much as they need new dentures

44. Dentist should take moreDentist should take more
time then usual, in makingtime then usual, in making
examination of theseexamination of these
patients, since care andpatients, since care and
attention will help, theattention will help, the
patient begin to developpatient begin to develop
confidence in the newconfidence in the new
dentistdentist

45.  Trust & confidence in the dentist
 Previous favorable experience with a
dentist
 Positive attitude & ability to cope with
change
 Realistic expectation of the patient
 Good general health
 Willingness to please the doctor
 Good learning capacity
FACTORS FOR A FAVORABLE ADAPTIVE
RESPONSE TO REMOVABLE PARTIAL
DENTURE

46.  Lack of trust in the dentist
 Poor communication between dentist &
patient
 Previous negative experience
 Unrealistic expectation
 Anxiety & low tolerance to pain
 Poor health & senility
 Poor muscle coordination
 Poor learning ability
 Psychological disorders
FACTORS PRODUCING A MALADAPTIVE
RESPONSE TO REMOVABLE PARTIAL
DENTURE

47.  Proper history & management is
necessary
ANY H/O GAGGING

48. HABITS
 Pipe Smoking
 Tobacco Chewing
 Tongue Thrusting
 Bruxism
 Others

50. OBJECTIVES
 Elimination of disease
 Preservation, restoration &
maintenance of the health of the
remaining teeth & oral tissues
 Selected replacement of lost teeth for
the purpose of restoration of function
in a manner that ensures optimum
stability & comfort in an esthetically
pleasing manner

51. Gait
Built
GENERAL EXAMINATION

53. FACIAL PROFILE
 Angle classified facial
profile as:
Class I – normal or
straight profile
Class II – retrognathic
profile
Class III – prognathic
profile

54. SHAPE OF FACE
SQUARE SQUARE
TAPERING
TAPERING OVOID

55. VERTICAL FACE HEIGHT
NORMALNORMAL
OR
REDUCEDREDUCED

56. TONE OF FACIAL TISSUES
NORMALNORMAL
OR
POORPOOR

57. TEMPOROMANDIBULAR JOINT
 TMJ should be evaluated for the
following:
Normal
Clicking
Crepitation
Pain / Tenderness

58. MOVEMENTS OF
MANDIBLE
 Normal
 Deviated
 Lack Of Coordination

59. MOUTH OPENING
NORMALNORMAL
OROR
REDUCEDREDUCED

60. LIP LENGTH
 Normal / Short / Long
 Thin / thick

61. LIP SUPPORT
NORMALNORMAL
OROR
REDUCEDREDUCED

63. ““Good lighting, a clean mouthGood lighting, a clean mouth
mirror, a sharp explorer, andmirror, a sharp explorer, and
a calibrated periodontal probea calibrated periodontal probe
are required for theare required for the
examination”examination”

64. DENTAL EXAMINATION
 VisualVisual
Number & position of teeth
Carious & restored teeth present
Presence of any wear facets
Any wasting disease of teeth e.g.
abrasion, erosion etc
Malformations of teeth
Fracture of teeth
Condition of soft tissues

65.  Digital & ExploratoryDigital & Exploratory
Vitality Of Teeth:
Particularly of teeth to be used
as abutments / those having
deep restorations / deep
carious lesions
Firmness / mobility of teeth
Condition of restorations present

66.  The Ideal Abutment Tooth
Free from caries or restorations
Favorably contoured crown
Crown of adequate length
Healthy periodontal status
Long root with large surface area
Good vertical & horizontal position
within the arch
Stable opposing occlusion

67. PERIODONTAL EXAMINATION
 Oral hygiene status
 The dentist
observes whether
the patient follows
excellent, fair, or
poor oral hygiene
practices, as
evidenced by the
presence of food,
bacterial plaque or
calculus

68. GINGIVA
 Color
 Texture
 Position
 Contour
 Consistency

69. PERIODONTIUM
 Sulcus Depth of
Prospective Abutments
 Base of the gingival
sulcus & periodontal
pockets are probed at
3 points on the buccal
surface & 3 points on
the lingual surface
 This record is essential
in determining the type
of periodontal therapy,
that may be required

70.  Degree of mobility of all mobile teeth
should be recorded
Class I – tooth demonstrate greater
than normal movement, but less than 1
mm of movement in any direction
Class II – tooth moves 1 mm from
normal position in any direction
Class III – tooth moves more than 2mm
in any direction, including the rotation
or depression, have an extremely poor
prognosis & usually will require
extraction
ANY TOOTH MOBILITY

71. Any open contacts
Any furcation involvement
Any high frenal
attachment
Determines selection of
mandibular major
connector

72. OCCLUSION
 General alignment
Normal/Crowding/Spacing/Rotation/
Supraeruption
The existing teeth should be examined
for occlusion
Teeth should have a good cusp to fossa
relationship
 Horizontal & Vertical Overlap
 Any Protrusive/Working interference
Must be corrected before treatment plan

73. EXAMINATION OF ORAL
MUCOSA
 Color of Mucosa
 Normal/ Pigmented
 Any Pathologic Changes
 Ulceration/ Swelling/None
 Tissue Reaction to Wearing of
Prosthesis
 Denture stomatitis/ Palatal papillary
hyperplasia / Epulis fissuratum / None

74. EXAMINATION OF RESIDUAL
RIDGE
 SHAPESHAPE
 ATWOOD’S CLASSIFICATIONATWOOD’S CLASSIFICATION::
OrderOrder II :: Pre-extractionPre-extraction
OrderOrder IIII :: Post extractionPost extraction
OrderOrder IIIIII :: High, well roundedHigh, well rounded
OrderOrder IVIV :: Knife edgeKnife edge
OrderOrder VV :: Low, well roundedLow, well rounded
OrderOrder VIVI :: DepressedDepressed

75.  Any Undercut

Tooth / tissue ??
Favourable / Unfavourable ???

76.  Any Torus Palatinus Or Mandibularis
 Dentist should note, if there is any presence
of palatal or lingual tori
 Generally, small tori do not have to be
removed when a patient is treated with
R.P.D.

77.  Inter-ridge Distance
 Normal / Reduced / Excessive
 Any High Muscle attachment
 Evaluation of Quantity & quality of
saliva
 Serous / Mucous
 Normal / Scanty / Excessive
 Evaluation of space for Mandibular
Major connector
 < 8mm / 8mm / > 8mm

79.  Complete Intraoral Radiographic Survey
o IOPA’s
o PANOREX
Objectives:
 To locate areas of infection & other pathosis
that may be present
 To reveal the presence of root fragments
foreign objects, bone spicules, & irregular
ridge formations
 To display the presence & extent of caries &
the relation of carious lesions to the pulp &
PDL

80.  To permit evaluation of existing restorations for
evidence of recurrent caries, marginal leakage &
overhanging gingival margins
 To reveal the presence of root canal fillings & to
permit their evaluation as to future prognosis
 To permit an evaluation of periodontal conditions
present & to establish the need and possibilities
for treatment
 To evaluate the alveolar support of abutment
teeth, their number, the supporting length &
morphology of their roots

81. Bone DensityBone Density ( quality & quantity
of bone)
Determined by bone height in
radiographs
True bone height : where
lamina shows marked decrease
in opacity

82.  Index AreasIndex Areas
 Reaction of bone adjacent to teeth that have been
subjected to abnormal stress serves as indication
of probable reactions of that bone when such
teeth are used as abutments for fixed or
removable restorations

83. Reaction ofReaction of
BoneBone
 Positive
o Adequate
supporting
trabecular
pattern
o Heavy
cortical layer
o A dense
lamina dura

84. NegativeNegative
BoneBone
ReactionReaction

85.  Alveolar Lamina DuraAlveolar Lamina Dura:
Thin layer of cortical bone that lines
sockets of teeth
Mesially tipped lower molar
Lamina dura thinner on coronal,
mesial & apicodistal & thicker on
coronal, distal & apicomesial
Lamina dura towards edentulous
area is heavier & trabeculations
arranged perpendicular to it

86.  Root Morphology:Root Morphology:
Determine ability of perspective
abutment teeth to resist additional
rotational forces
Teeth with multiple & divergent roots
resist better than fused & conical
roots
 Third Molars:Third Molars:
Unerupted 3rd
molars should be
considered as perspective future
abutments to eliminate need for
distal extension RPD’s

87. DIAGNOSTIC CASTS
 It should be an accurate reproduction of
all the potential features that aid in
diagnosis
 Purpose
Teeth Locations
Teeth Contours
Occlusal Plane Relationship
Residual Ridge Contour, Size & Mucosal
Consistency

88. Oral Anatomy
delineating Prosthesis
Extensions (vestibules,
retromolar pads,
pterygomaxillary
notch, hard/or soft
palatal junction, floor
of mouth & frena)

89.  Fabrication Of IndividualFabrication Of Individual
Impression TraysImpression Trays
 May Be Used As A ConstantMay Be Used As A Constant
Reference As The WorkReference As The Work
ProgressesProgresses
 Pencil marks indicating the
type of restorations, areas of
tooth surfaces to be
modified, location of rests,
design of RPD along with
path of placement & removal
for future reference & for
patient

90.  Diagnostic Cast MountingDiagnostic Cast Mounting:
Occlusal plane orientation & impact on
the opposing arch
Tooth to palatal soft tissue
relationship
Tooth - to - ridge relationship
Vertically
Horizontally

91. Supplement oral examination by
permitting a view of the occlusion
from lingual and buccal aspect
Study of existing occlusion & study
of possibilities of improvement e.g.
Occlusal Adjustment
Occlusal Reconstruction
Both

92. Degree of Over closureDegree of Over closure
Amount of interocclusal space
available
Possibilities of interference to
the location of rests
Diagnostic wax-up for analysis &Diagnostic wax-up for analysis &
modification of mountedmodification of mounted
diagnostic castsdiagnostic casts

93.  Permit a topographic survey of the dentalPermit a topographic survey of the dental
archarch
To determine the parallelism or lack of
parallelism of tooth surfaces involved
To determine need for mouth
preparation including
Proximal surfaces
Retentive & non-retentive areas of the
abutment teeth
Areas of interference to placement &
removal
Esthetic effects of the selected path
of insertion

94.  To Permit A Logical & ComprehensiveTo Permit A Logical & Comprehensive
Presentation To The Patient Of Present & FuturePresentation To The Patient Of Present & Future
Restorative Needs & Hazards Of Future NeglectRestorative Needs & Hazards Of Future Neglect
Evidence of tooth migration & existing results
of such migration
Effects of further tooth migration
Loss of occlusal support & it’s consequences
Hazards of traumatic occlusal contacts
Cariogenic & periodontal implications of
further neglect

95. FINAL DIAGNOSIS
 Depends Upon Number and Location ofDepends Upon Number and Location of
Edentulous SpanEdentulous Span
 Kennedy’s Classification
CLASS I

96. CLASS II

97. CLASS III

98. CLASS IV

99.  Kennedy Class VKennedy Class V
An edentulous area bounded
anteriorly & posteriorly by natural
teeth but the anterior abutment
(lateral incisor) is not suitable for
support
O.C. APPLEGATE (1960)

100.  Kennedy Class VIKennedy Class VI
 An edentulous area in which adjacent
teeth are capable of support for a FPD, but
possible damage to the pulp might occur if
crown preparations were attempted
O.C. APPLEGATE (1960)

101. PROGNOSIS
 Refers to an estimation of the
likelihood of a favorable outcome
of a treatment & is usually
expressed as :
Excellent
Good
Favorable
Unfavorable

102. POSITIVE NEGATIVE
GOOD GENERAL HEALTH POOR HEALTH
PERIODONTALLY STABLE PERIODONTAL DISEASE
(+) BONE FACTOR (-) BONE FACTOR
GOOD OCCLUSION INTERCEPTIVE OCCLUSAL
CONTACTS
ARCH INTEGRITY BAD HABIT PATTERNS
GOOD NUTRITION POOR NUTRITION

103. CONCLUSION
 Diagnosis is the key to success
of any treatment
 It must be sequentially carried
out to undertake proper
treatment which in turn builds the
confidence of the patient &
thereby enhances the success of
the prosthesis

104.  Treatment of partially edentulous
patient requires the knowledge &
the skill of the dentist in every
phase of dental practice
 Many failures in RPD treatment are
due to inadequate diagnosis &
inappropriate treatment plan