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1Mouth Preparation For Removable Partial

Dentures

Presented by:Dr. Mujtaba AshrafMDS II

Non-Prosthodontic Preparation

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INTRODUCTION

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Mouth preparations for partial dentures follow in logical sequence after oral diagnosis and treatment planning. We might say that mouth preparation begins where treatment planning leaves off.

-William L. McCrackenMouth preparations for partial dentures; JPD;1958

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The problems of the dentist in making a removable partial denture are similar to the problems of the architect in designing a building. The architect must interpret the effect conditions at the building site will have on the building. He searches for defects that need correction to assure success. The dentist likewise directs his attention toward detecting, correcting, and eliminating imperfections.

George Ward Glann;Mouth preparation for RPD, JPD;1960

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Mouth preparations are identified as those procedures that are accomplished to prepare the mouth for reception of prosthesis.

Renner RP, Boucher LJ; 1987

Mouth preparation is a term intended to cover all types of changes effected in the teeth, foundation ridges or oral structures which may be deemed necessary to accomplish a better partial denture result.

Applegate OCEssentials of Removable Partial Denture Prostheses;1965

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More specifically they are the procedures that change or modify existing oral structures of conditions to Facilitate placement and removal of prosthesis Facilitate its efficient physiologic function Enhance its long term success

05/02/2023 7Objectives In Planning Mouth Preparations

To establish a state of health in the supporting and contiguous tissues.

To eliminate interferences or obstructions to the placement, removal and function of prosthesis.

To establish an acceptable occlusal scheme. To establish an acceptable occlusal plane. To alter natural tooth form to accommodate

requirements of form and function of prosthesis.

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Mouth preparation

Prosthodontic procedures

Procedures related to Occlusion

•Restorative dentistry (fixed partial dentures) 

Non prosthodontic procedures

•Oral surgery •Orthodontics •Periodontics •Endodontics

Classification

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NON-PROSTHODONTIC PREPARATION

Relief of pain and infection Oral surgical preparation Tissue conditioning Periodontal preparation Endodontic and restorative treatment Orthodontic treatment

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Relief Of Pain And Infection

• Teeth that are causing pain or discomfort due to caries or defective restoration and infection should be treated to eliminate pain.

• Large carious lesion which is asymptomatic should be restored with an intermediate restoration to prevent possibility of any acute pain during treatment.

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• Gingival tissues should also be treated early to eliminate acute infections like abscesses.

• Scaling, root planing, and prophylaxis should be performed, and a rigorous oral hygiene program should be established and carefully monitored.

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Oral Surgical Preparation

• Should be completed as early as possible. • Longer the interval between surgery & impression

procedure, more complete the healing & more stable the denture bearing area.

• The important consideration is that the patient should not be deprived of any treatment that would enhance the success of the removable partial denture.

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EXTRACTION

Planned extractions should occur early in the treatment regimen but not before a careful and thorough evaluation of each remaining tooth in the dental arch is completed.

Extraction of nonstrategic teeth that would present complications or those that may be detrimental to the design of the removable partial denture is a necessary part of the overall treatment plan.

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Removal Of Residual Roots

All retained roots or root fragments should be removed particularly if they are in close proximity to the tissue surface or if there is evidence of associated pathologic finding.Residual roots adjacent to abutment teeth may contribute to progression of periodontal pockets.

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Impacted Teeth

All impacted teeth including those in edentulous areas as well as those adjacent to abutment teeth should be removed.

Asymptomatic impacted teeth in elderly that are covered with bone with no evidence of pathologic condition should be left to preserve arch morphology

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If an impacted tooth is left, this should be recorded in the patient’s record, and the patient should be informed of its presence.Roentgenograms should be taken at reasonable intervals to ensure that no adverse changes occur.

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Malposed Teeth

The loss of individual teeth or groups of teeth may lead to extrusion, drifting or combinations of malpositioning of the remaining teeth. The alveolar bone supporting the extruded teeth is also carried occlusally in some instances. In such situations individual tooth or groups of teeth and their supporting alveolar bone can be surgically repositioned if orthodontic treatment is not possible.

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Cysts And Odontogenic Tumors

Panoramic radiographs should be taken for ruling out unsuspected pathology.Radiolucencies and radiopacities noted in the radiograph should be investigated, and the diagnosis should be confirmed through biopsy.Surgical removal should be done.

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Exostoses And Tori

The existence of abnormal bony enlargements should not be allowed to compromise the design of the removable partial denture.Mucosa covering these bony protuberances is usually thin and liable to ulcerate.

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Exostoses approximating gingival margins may complicate the maintenance of periodontal health and may lead to the loss of abutment teeth.

Denture design may be modified to accommodate the exostosis but could result in additional stress to the supporting elements and compromised function.If so surgical removal of exostosis and tori is done.

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Hyperplastic Tissue

Hyperplastic tissues are seen in the form of fibrous tuberosities, soft flabby ridges, folds of redundant tissue in the vestibule or floor of the mouth, and palatal papillomatosis.

All these forms of excess tissue should be removed to provide a firm base for the denture.

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This removal will produce a more stable denture, will reduce stress and strain on the supporting teeth and tissues, and in many instances will provide a more favorable orientation of the occlusal plane and arch form for the arrangement of the artificial teeth.

Hyperplastic tissue can be removed with any preferred combination of scalpel, curette, electrosurgery, or laser.

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Bony Spines And Knife Edge Ridges

Sharp bony spicules should be removed and knife like crests gently rounded.If, however, correction of a knife-edge residual crest results in insufficient ridge support for the denture base, the dentist should resort to vestibular deepening.

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An easy bidigital pressure after tooth extraction, which could be considered as the simplest alveoloplasty procedure, may prevent most of alveoloplasties.

The only exception for the need of bidigital pressure after tooth extraction would be a planned future implantation at the same site.

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Alveolar Bone Augmentation

Ridge augmentation is done for atrophic ridges, flat palatal vault and mild to moderate anteroposterior ridge relation discrepancy.It is done with synthetic graft materials like hydroxyapatite and autogenous bone grafts.It enhances the support and stability of the denture.

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Conditioning Of Abused AndIrritated Tissues

Many removable partial denture patients require some conditioning of supporting tissues in edentulous areas before the final impression phase of treatment begins.

Conditioning of the tissue is required if: Denture-bearing mucosa is irritated or inflamed. Anatomical structures like rugae, incisive papilla and

retromolar pad are distorted. Burning sensation in tongue, ridge area, cheeks and

lips.

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These conditions are usually associated with ill-fitting or poorly occluding removable partial dentures, nutritional deficiencies, endocrine imbalances, diabetes, blood dyscrasias and bruxism

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• If denture is the problem, patient is advised against wearing them till the tissues return to normal.

• If this is not possible, tissue conditioner are used to provide a soothing and cushioning effect on the irritated mucosa till mucosa becomes normal.

• Recommended home care during this period would include patients rinsing with saline solution three times in a day.

• Massaging the soft tissues,• Using multivitamins and high protein, low carbohydrate

diet.

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Inflamed and distorted denture bearing mucosa due to an ill-fitting prosthesis that is worn 24 hours a day.

After the tissue abuse is treated via modification of the denture base with a tissue conditioning resilient liner material, the prosthesis is removed for portions of the day, and the abused tissue is massaged, the denture bearing foundation is healthy again.

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PERIODONTAL PREPARATION

Periodontal preparation usually follows or is performed simultaneously with oral surgical procedures and is completed before restorative procedure.The success of the prosthesis depends directly on the health and integrity of the supporting structures of the remaining teeth.

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Objectives Of Periodontal Therapy

1. Removal and control of all etiologic factors contributing to periodontal disease along with reduction or elimination of bleeding on probing.

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2. Elimination of, or reduction in, the pocket depth of all pockets with the establishment of healthy gingival sulci whenever possible.

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3. Establishment of functional atraumatic occlusal relationships and tooth stability.4. Development of a personalized plaque control program and a definitive maintenance schedule.

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TREATMENT PLANNING

There are three phasesPhase 1: Initial disease control therapyPhase 2: Definitive periodontal surgery Phase 3: Recall maintenance 

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Initial Disease Control Therapy

• Oral hygiene instructions.• Scaling and root planing is done for removal of

calculus and plaque deposits from coronal and root surfaces of teeth.

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• Elimination of local irritating factors other than calculus like overhanging margins of amalgam alloy and inlay restorations, overhanging crown margins, open contacts leading to food impaction.

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• Elimination of gross occlusal interferences• Temporary splinting of mobile teeth to allow any

periodontal procedures to be performed.• Use of night guard as a temporary splint and to

stimulate any unopposed teeth.

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The removable acrylic resin splint with a flat occlusal plane can be used effectively as a form of temporary stabilization and as a means of eliminating excessive lateral forces created by clenching and grinding habits.

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Definitive Periodontal Surgery

GingivectomyPeriodontal FlapMucogingival surgical procedures

05/02/2023 40Parts Of Gingiva

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Gingivectomy:  It is indicated to eliminate supra bony pockets.Pocket depth confined to band of attached gingiva.

05/02/2023 42Periodontal flaps:They may be used to perform osseous recontouringOsseous recontouring may be indicated for pocket elimination, when crown lengthening is needed.

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Guided tissue regeneration: (GTR) has been defined as those procedures that attempt regeneration of lost periodontal structures through differing tissue responses.

The GTR procedure commonly involves the use of an osseous graft along with a resorbable membrane.This technique has the potential to lead to substantial improvement of the periodontal condition when used around carefully selected two- and three-walled osseous defects and mandibular furcation involvements.

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Tooth presented with a grade 2 furcation involvement with the probe entering 3 mm in a horizontal direction. A GTR procedure using a combination of a bone graft and a nonresorbable membrane was planned.

Following hand and ultrasonic instrumentation, decalcified freeze-dried bone allograft was grafted around the furcation.

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A nonresorbable membrane was placed over the bone graft.

The flap was then sutured with a nonresorbable expanded polytetraethylene suture.

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Two months following surgery, the membrane was removed.The presence of red rubbery tissue filling the previously exposed furcation site.This tissue has the potential to form osseous tissue and close the access to the furcation entrance.

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Periodontal Plastic Surgery:Earlier known as Mucogingival surgical procedures :applied to those procedures used to resolve problems involving the interrelationship between the gingiva and the alveolar mucosa.

They are considered when an abutment tooth for a removable partial denture lacks adequate attached keratinized gingiva and requires root coverage to facilitate partial denture construction and maintenance 

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The objectives of periodontal plastic surgery are:• elimination of pockets that transverse the

mucogingival junction,• creation of an adequate zone of attached gingiva,• correction of gingival recession by root coverage

techniques,• relief of the pull of frena and muscle attachments on

the gingival margin

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Recall Maintenance

• This is very important in maintaining periodontal health.

• It includes reinforcement of oral hygiene measures and thorough scaling and root planing.

• Frequency of recall appointments depends on susceptibility and severity of periodontal disease.

• Patients with previous moderate to severe periodontitis should be placed on 3 to 4 months recall system

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Advantages Of Periodontal Therapy

• Elimination of periodontal disease removes primary etiologic factor in tooth loss

• Periodontium free of disease presents a much better environment for restorative correction

• Response of teeth to periodontal therapy provides an important opportunity for reevaluating their prognosis before final decision is made to include or exclude them in partial denture design 

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Orthodontic Considerations

Orthodontic preparation is carried out to achieve the following:. Reduce the need for prosthetic teeth as much as possible.. Position the teeth to allow the most natural prosthetic replacementof teeth.. Create sufficient vertical height to allow room for placement of artificial teeth.. Allow sufficient occlusal guidance on natural teeth.

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Unfortunately in many patients a large number of teeth are missing so there may not be enough remaining teeth to serve as an anchor from where the moving force can be applied.

Orthodontic movement of malpositioned teeth should be the first option.

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Endodontic And Restorative Treatment

Teeth with pulpal involvement and root end pathology are candidates for endodontic therapy. Restorative therapy like - crowns, inlays, onlays, restoration of carious lesions and replacement of defective restorations should be integrated with endodontic treatment.

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 Use of pulpless teeth as an abutmentIt is considered when pulpless teeth that has been treated endodontically is presented as a potential abutment in mouth of patient for whom a removable partial denture is to be made.

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CONCLUSION

The success or failure of a removable partial denture depends on how well the mouth preparations were accomplished. It is only through intelligent planning and competent execution of mouth preparations that the denture can satisfactorily restore lost dental functions and contribute to the health of the remaining oral tissues.

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REFERENCES

• Stewart’s clinical removable partial prosthodontics, 3rd ed• McCrackens removable partial prosthodontics, 12th ed• Removable partial dentures-A Practitioners’ Manual, Olcay Şakar• McCracken, W. L:Mouth Preparations for Partial Dentures, J. Pros. Den.

6:39-52, 1956• Mills M. Mouth preparation for removable partial dentures. J Am Dent

Assoc 1960;60:154-159• Glann G.W, Ralph C. Mouth preparation for removable partial dentures.

J. Pros Den 1950:10:698-706

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