Implant-enhanced Removable Partial Denture Therapy
2019 UCLA Hawaii SymposiumImplant- enhancedRemovable Partial Denture TherapyTing-Ling Chang, DDSClinical ProfessorDivision of Advanced ProsthodonticsUCLA School of Dentistry
Treatment Options for Replacement of Missing Tooth/or Teeth No treatment Implant supported restoration Fixed partial denture (bridge) Removable partial denture (RPD)*A fixed replacement is usually the preferred treatment of choice.All treatments produced significant improvement in OHRQoL. The least amount of improvement was observed in patients with RDPs. OHRQoL changes inpatients treated with FDPs and ISFPs were comparable.Swelem et al. Int J Prosthodont. 2014 Jul-Aug;27(4):338-47
RPD INDICATIONS1. Long edentulous spans2. Absence of adequate periodontal support3. Structurally and anatomically compromised abutments4. Need for cross-arch stabilization5. Distal extension6. Need to restore soft and hard tissue contours7. Anterior esthetics8. Age and health9. Attitude and desires of pt.10.Ease of plaque removal
20082011RPD INDICATIONS1. Long edentulous spans2. Absence of adequate periodontal support3. Structurally and anatomically compromised abutments4. Need for cross-arch stabilization5. Distal extension6. Need to restore soft and hard tissue contours7. Anterior esthetics8. Age and health9. Attitude and desires of pt.10.Ease of plaque removal
The demand for RPD Therapy is increasing! Aging population Economic considerations Osseointegrated ImplantsImproved versions of RPD’s that useimplants for partial supportUnited States65 y/o or older: 13% in 2007Europe16%Japan23%26% by 203027% by 205038% by 2050The proportion of this group who are edentulous has also been steadily falling
The demand for RPD Therapy is increasing! Aging population Economic considerations Osseointegrated ImplantsImproved versions of RPD’s that useimplants for partial support
The demand for RPD Therapy is increasing! Aging population Economic considerations Osseointegrated ImplantsImproved versions of RPD’s that useimplants for partial supportRPDoptionImplantRPDImplantFixedoptionPt group that can benefit from the Implant RPDtreatment option is largely untapped and haslots of potential to grow.
The bottom line:RPD treatment is necessary because patients’ needs will remain and continue to grow.And implants are not likely to replace the needfor RPD because of high cost andother factors.RPDoptionImplantRPDImplantFixedoptionBassi et al, 1996
The bottom line:RPD treatment is necessary because patients’ needs will remain and continue to grow.And implants are not likely to replace the needfor RPD because of high cost andother factors.RPDoptionImplantRPDImplantFixedoptionBassi et al, 1996
The keys of a successful RPD design (with or without dental implants) Patient selection for implant-enhanced RPD therapy The goal of the implant-enhanced RPD treatment option:esthetics versus comfort Treatment planning considerations: number and location of the implants,selection of the attachment
Three Key Elements for Long-term Success in RPD TherapyA RPD should be a well supported, stable, and retentive.Support- Resistance to occlusal or vertical seating forcesStability- Resistance to horizontal or torsional forcesRetention- Resistance to vertical dislodging forces
How to design a wellsupported, stable, andretentive RPD?Five Parts of Well-Designed RPDsDesign sequenceRestsMinor Connectors/Proximal PlatesMajor ConnectorsDenture Base ConnectorsRetainers
SupportResistance to occlusal or vertical seating forcesOf all three SSR support is the most importantbecause a well supported RPD can effectivelyprotect the remaining structures (teeth,mucosa, and underlying bone)
SUPPORT- Tooth vs. MucosaFrom: Rests (tooth support) Major connectors (mucosal support) Denture bases (mucosal support)
RestsTo control the prosthesis in relationship to the teeth and supporting structuresTo provide primary support for RPDThe rest should direct functional forces in the long axis of the tooth.Acrylic partial with rests
Imagine a RPD with no rests It becomes completely mucosal supportConsequences:Loss of vertical controlRidge resorptionMal-adaptation
Lack of positive rests results in prosthesis displacement, whichcan destroy mucosa & periodontal attachmentPt’s existing partial with no positiverest- 100% mucosal supportIrritated andtraumatized softtissue resulting froma RPD withoutpositive rests
Positive RestA positive rest does not allow the prosthesis slide off the tooth or allow the tooth to moveout of exiting relationship to other teeth as increased occlusal pressure is exerted.Positive Circular Concave Rest SeatRest center is deeper than the surrounding area (spoon shape)
Ideal Locations for RestsThe teeth adjacent to the edentulous spaceAdditional teeth at the strategicposition with excellent rootmorphology
Symmetrical and EquitableRPD abutment on one side onlySignificant RPD movement isanticipatedImplant should be considered tofacilitate RPD therapyIdeal bilateral distribution of RPD abutments
SUPPORT- Tooth vs. MucosaFrom: Rests (tooth support) Major connectors (mucosal support) Denture bases (mucosal support)Primary Bearing Surface:TuberosityBuccal ShelvesRetromolar pad
SUPPORT- Tooth vs. MucosaSingle strapAP palatal strapFrom: Rests (tooth support) Major connectors (mucosal support) Denture bases (mucosal support)U-shape strapVarious major connectorsprovidemucosal support fromminimum tobroad coverage.Full palatal coverage
StabilityResistance to horizontal or torsional forces
STABILITYRPD design parts enable the resistance to horizontal forcesActive I-barReciprocationI-barFrom: Proximal Plates Bracing clasp arms Lingual plates Rests Denture bases
Proximal Plates for Stability Maintain arch integrity by anterior- posterior bracing actionCurvilinear parallelproximal plateTwo or more curvilinear proximal plates can provide side-to-side stability
RETENTIONRPD design parts enable theresistance to verticaldislodging forcesFrom: Retainers/clasps Proximal Plates on the RPD(guide planes on the tooth) Indirect Retainers(for extension base RPD only)
Active Retainers for RetentionActive retainer (retainer that engages undercut to provide retention for the RPD)-only the tip of the retainer is below the height of contour and engages the desired 0.01-0.02” undercut--the remaining of the retainer is position at/or above the height of contour (except infra-bulge retainers)Height of contour of the RPD abutment at agiven path of insertion
How to design a well supported, stable, and retentive RPD?Five Parts of Well-Designed RPDsDesign sequenceThe RPD design principlesremain the same for theimplant-enhanced RPDtherapyRests (support from teeth)Minor Connectors/Proximal Plates (stability)Major Connectors (support from mucosa)Denture Base ConnectorsRetainers (retention)
Treatment Goals of RPD:1. Stabilize the individual archand protect remaining structureBiomechanical sound design forImplant-enhanced RPD therapy2. Organize interarch function( VDO, Occlusal Plane, Centric)and esthetics
The keys of a successful RPD design (with or without dental implants) Patient selection for implant-enhanced RPD therapy The goal of the implant-enhanced RPD treatment option:esthetics versus comfort Treatment planning considerations: number and location of the implants,selection of the attachment
Implant-enhanced RPD Therapy: Patient Selection Kennedy Class I and II ( UCLA extension-based RPD):To obtain a Kennedy Class III (UCLA Tooth-Borne RPD) configuration withthe help from implant(s)Kennedy IKennedy IIKennedy IIIKennedy IVThis approach may not be easily achievable due to anatomic limitations
Candidates for Implant-enhanced RPD Therapy Kennedy Class I and II ( UCLA extension-based RPD) Compromised RPD abutment distribution:Lack of bilaterally positioned RPD abutment Patients with prior unsatisfied RPD experience Patients who are interested in less extensive tooth replacement treatment option(surgically and/or financially)
Case 1: Mr. JCPt JC before-treatment FMX(8/5/2005)
Case 1: Mr. JCXXPt JCbefore FMX (8/5/2005)XXXXXXXTreatment Plan:1. Extraction of #3, 5, 14, 15, and 312. Maxillary immediate treatment partial3. Possible implant placement to improve the treatment outcomes of maxillary cast RPD4. Mandibular cast RPD or implants to replace #30 (and #31).
Case 1: Mr. JCMaxillary RPD is a distal extension RPDThere will be an axis of rotationdefined by the two most distal rests
RPD Design Sequence:1. Rests
RPD Design Sequence:1.Rests2.Proximal plates/minor connector
RPD Design Sequence:1.Rests2.Proximal plates/minor connector3. Major connector
RPD Design Sequence:1.Rests2.Proximal plates/minor connector3. Major connector4. Denture base connector
0.01”0.01”RPD Design Sequence:1.Rests2.Proximal plates/minor connector3. Major connector4. Denture base connector5. Retainers
Choice of Major Connectors:Anterior-posteriorpalatal strapFull palate coverage:Acrylic vs. MetalSupport from the teeth:Number and theperiodontal status of theremaining teeth Support from themucosa Sum of Support
Treatment Benefits of This Maxillary Implant-enhanced RPDAdding implant to:1. More even and equal distribution of RPD abutment forsupport and stability2. Attachment(s) on implant(s) to provide retention andeliminate retainer on #8- More optimal esthetic resultThree implants were recommended for this patient due tothe large palatal defect (decreased mucosal support)Number of implants needed (1, 2, or 3?)1. Biomechanical consideration to avoidimplant overloading2. Anatomic consideration3. Treatment cost4. Available inter-arch space
Case 1: Mr. JCMaxillary veneer graftTwo implants (4mm wide11.5 mm long) placedat #5 and 7 sites
Case 1: Mr. JCRPD design without implants
November 2008Pick-up Impression (Open Tray) at implant fixture level
5mm cuff height3mm cuff height
About ERA attachments 0.5mm less vertical space and has adiameter of almost1.0mm lessMicro ERA:20% smallerDifferent cuff heights, compatiblewith major implant systems7 toleranceThree additional5 ,11 , and 17 angled attachments
About ERA attachments Black Processing MaleWhite Light RetentionOrange Moderate RetentionBlue Heavy RetentionGrey Very Heavy RetentionYellow More retention than greyRed The Most retentive0.4 mm vertical resiliency
Case 1: Mr. JC
Case 1: Mr. JCRests prep on the existingPFMs
Case 1: Mr. JC
Case 1: Mr. JCWhite-colored ERA plastic insert- the least retentive one
Case 1: Mr. JC
Case 1: Mr. JC
October 2010(2 year Follow UP)
Case 2: JKPt JK, 80 y/o male, presented for implant consultation for implant-supported FPDMedical history was significant for gout, DM II, CAD, MI, angioplasty/stent placement, CHF and ImplantableCardioverter Defribrillator (ICD) placementBilateral sinus lift and graft/implants to replacement 3, 4, 5, 6, 7, 12, 13, 14, and (#2/15)
Case 2: JK#3#4 site#4#5 #6#3 site#5 siteMaxillaryRight posteriorQuadrantCT Evaluation#6 site
Case 2: JK#14#12#12 #13#5 site#5#13#6#14MaxillaryLeft posteriorQuadrantCT Evaluation#13 and 14 sitesrevealedinadequate bonevolume and requiresinus graft
Case 2: JKDue to complex medicalhistory, pt requested totake small steps for eachsurgery.#8 was extracted andsocket preservationwith Bio-Oss.
Case 2: JKAfter 6-month pt was satisfied with theinterim partial and the definitive prosplan was confirmedfor implant-assisted RPDMaxillary Interim Partialto reevaluate patient’sperceived satisfactiontoward to removableprosthesisNo rests100% mucosal supportfor reversible testing onImplant candidate
Case 2: JKNobelReplaceGroovy Implant4.3 mm by13 mm long#4 site#5 site#12
Case 2: JKNobel Replace Groovy Implants4.3 mm by 13 mm longwere placed at #4, 5, 12 sites
Case 2: JK
Case 2: JKDesign Principles forImplant-assisted RPDRestsMinor connectors/Proximal platesMajor connectorsDenture connectorsRetainersPositive rests#7: mesial circular concave rest#9: cingulum rest#11: cingulum rest
Case 2: JKLocatorabutment
Locator Attachment Implant0-6 mmOrder by soft tissueheight in mmwww.preat.com/locimplant.htmwww.ZestAnchors.com
Case 2: JKFinal Impression for RPD frameworkImplant impression can be obtained with open tray impression copings atthe implant fixture level during the RPD framework impression OR thealtered cast impression procedure
Case 2: JK
Case 2: JKInterarch Space Consideration
Case 2: JKImplant positions were obtained at the fixture level during the alteredcast impression (open tray impression coping)Indirect method (lab processing) for Locator attachments to reducechair timeBlack locator pattern for processingReplace with desirableretention locator pattern(Blue, the least retentive)
Implants are relativelyParallel to each other (up to20 between implants)To overcome implantangulation om
Implants’ angulations
Case 2: JKImplant-enhanced RPD Same Design Principles of RPD Biomechanical Considerations of Implant(s) and Abutment teeth Improve outcomes More affordable option than implant fixed option
Case 3: Pt KB
Case 3: Pt KBPatient presented with fractured #21 and 22splinted crowns at the subgingival level#26-27 splinted crowns present no clinical mobility withgood margin integrityLack of RPD abutment at patient’s left quadrant presentschallenge for RPD (multiple axis of rotations ontwo abutments
In clinical practice, mandibular distal extension RPDs receive a poor reputation amongboth dentists and patients. Patients’ appreciation is unpredictable and complaintsinclude food retention underneath the saddle and pain, resulting from the inheritedbiomechanical disadvantages and the rotational movement under mastication.Patients discontinue wearing them or insist on replacement by a new one at a high rate.The limitations of the md extension based RPD must be discussed and implant-enhancedRPD for mandibular extension based scenarios should be considered as an alternativeoption.
Case 3: Pt KBExtraction of retained roots #21 and 22Immediate implant placement
Case 3: Pt KB
Case 3: Pt KB
Case 3: Pt KB
Case 3: Pt KB
Case 3: Pt KB
Case 3: Pt KBFollow upafter 3 years offunctional loadingFeb 21, 201710 years follow up
Candidates for Implant-enhanced RPD Therapy Kennedy Class I and II ( UCLA extension-based RPD) Compromised RPD abutment distribution:Lack of bilaterally positioned RPD abutment Patients with prior unsatisfied RPD experience Patients who are interested in less extensive tooth replacement treatment option(surgically and/or financially)
Long-term Implant Survival Rate in Implant-enhanced RPD 32 consecutive patients(mean age 56.8 years) with 64 Branemark (Mark III) implants.Follow-up 8 years Satisfaction, implant survival, and prosthetic success were evaluated Kennedy classification (Class I 19, Class II 10, Class III 3) The implants primarily functioned as retention elements connected to the dentures with aresilient ball attachmentBortolini el al.Journal of Prosthodontics 20 (2011) 168–172
Patient Satisfaction (scale 1-5) Before1 year after treatment1.31 0.434.59 0.47 Caution!! All patients evaluated in this study presented requesting new prosthesesbecause they were not satisfied with their current RPDs Patient satisfaction was improved with RPD/implant treatment but may beoverestimated.Bortolini el al.Journal of Prosthodontics 20 (2011) 168–172
Implant and RPD Failure Rate The overall implant success was 93.75% (4/64 failures) The overall prosthesis success of IR-RPD rehabilitation was 100%. Periimplant soft tissues and residual edentulous ridges remainstable over time Bone resorption around the implants is within acceptable limits andis comparable to that seen with standard implants.Bortolini el al.Journal of Prosthodontics 20 (2011) 168–172
Prosthetic Complications and Maintenance Over 8 Years of F/ULoose abutmentTooth substitutionRelining2 cases in 2 patients29 times in 24 patients93 relinings in 32 patientsResilient components were replaced annuallyBortolini el al.Journal of Prosthodontics 20 (2011) 168–172
Other Characteristics of This StudyImplant positionsImplant positionLateral incisorCanineFirst premolarSecond premolarMaxilla121146Mandible01093Majority of the implants were placedin the more anterior positions(outside the anatomic limitations)Implant sizes (Branemark MKIII)Implant size (mm)Number of implants3.75 103.75 11.53.75 133.75 155 105 11.5815221522All implants were 10 mm or longerBortolini el al.Journal of Prosthodontics 20 (2011) 168–172
Take Home MessageFor patients with concerns of traditional RPD treatment,implant-assisted RPD can improve patient’s satisfaction andoffers comparable high implant survival rate and stable periimplant condition after 8 years of follow-up.Bortolini el al.Journal of Prosthodontics 20 (2011) 168–172
The keys of a successful RPD design (with or without dental implants) Patient selection for implant-enhanced RPD therapy The goal of the implant-enhanced RPD treatment option:esthetics versus comfort Treatment planning considerations: number and location of the implants,selection of the attachment
What do we want to accomplish with implant(s)to enhance the outcomes of RPD therapy?Esthetics or Comfort?Patient expectation and preference?Jensen et al. Clin Implant Dent Relat Res. 2017Clinical Oral Implant Research 2016J of Dentistry 2016
NoteworthyProspective comparison study, cross-over randomized trialEdentulous MaxillaLocator attachmentStraumann Implant SystemPremolar (PM) implant:3.3 mm x 8 mmMolar (M) implant:4.1 mm x 6 mmJensen et al. Clin Implant Dent Relat Res. 2017Clinical Oral Implant Research 2016J of Dentistry 2016
Implant RPD Prospective comparison study, cross-over randomized trial 30 subjects: upper edentulous, lower partial edentulous (Kennedy class I) Implants placed at the premolar and molar regions Mandibular bilateral distal extension RPD w/o implants,with premolar implants only, and with molar implants only.3 months to test each implant position. Use Locator attachmentJensen et al. Clin Implant Dent Relat Res. 2017Clinical Oral Implant Research 2016J of Dentistry 2016
RandomizedProspectiveCross-over (comparison) clinical trial
Study Design Number of implant(s): one on each quadrant How implants used: resilient Locator attachment Size/Length: Premolar site 3.3 x 8 mm Molar site 4.1 x 6 mm Patient-centered subjective outcomes: OHIP-NL49 , contentment assessmenton a Visual Analogue Scale Objective outcomes: chewing ability test ( Mixing Ability Index, MAI), numberof hrs wearing the prosthesis Pt preferred implant position: premolar or molar siteJensen et al. Clin Implant Dent Relat Res. 2017Clinical Oral Implant Research 2016J of Dentistry 2016
OHIPThe Oral Health Impact Profile (OHIP) questionnaire - a sophisticated and well validated instrument for assessment of OHRQoL .The lower the OHIP score is, indicate less disease-related disruptive impairment.
Subjective Evaluation: OHIP Copy and paste J Dentistry table 2In the present study of patients with apoorly functioning bilateral free-ending mandibular RPD, solelyproviding a new RPD proved also being effective.The addition of implant significantly improved overall qualityof the RPD and pt satisfactionJensen et al. Clin Implant Dent Relat Res. 2017Clinical Oral Implant Research 2016J of Dentistry 2016
Objective Evaluation Masticatory performance was studied by means of a mixing ability test.Pristine wax tabletfor the mixing abilitytestMixed tablet and flattenedafter 15 chewing strokes15 chewing strokesJensen et al. Clin Implant Dent Relat Res. 2017
Objective Evaluation Masticatory performance was studied by means of a mixing ability test.The flattened wax is then photographed and analyzedA lower Mixing Ability Index (MAI) score implies a better mixed tablet, hence bettermasticatory performance.Jensen et al. Clin Implant Dent Relat Res. 2017
Objective Evaluation Masticatory performance was studied by MAI Masticatory performance as expressed by the MAI did not change significantly after a new RPD Masticatory performance was statistically significant improved with implant support, to a level thanprior to treatment and after provision of a new, unsupported RPD. The MAI was comparable to dentatepatient group (18.3). The implant position, M or PM, had no significant effect on masticatory performanceJensen et al. Clin Implant Dent Relat Res. 2017
Implant RPD: Patient ExpectationsPt expectationsImplant RPDNew RPDOld RPDThe data suggest that patients’ expectations of contentment withan ISRPD were met since no significant difference was seenbetween expected and actually achieved contentment.This is seen as an important indicator of the quality of treatment.It enhances the reputation of the health care provider and implantdentistry in general. It transforms new patients into loyalcustomers and brings new referrals by ‘word of mouth’.Jensen et al.J of Dentistry 2016 55:92-98
Take Home Message Mandibular implant support favorably influences oral health related patient-based outcomemeasures in patients with a bilateral free-ending situation. The majority of patients prefer the implant support to be in the molar region.Patient Characteristics:Upper edentulous, lower partial edentulous (Kenney I)Mean age : 60.9 y/oShorter implants: pm site 3.3x 8 mm, molar site 4.1 x 6 mmJensen et al. Clin Implant Dent Relat Res. 2017Clinical Oral Implant Research 2016J of Dentistry 2016
Take Home Message Implant-retained partial overdentures with resilient attachments are a predictable and cost-effectivetreatment option for partially edentulous patients. When implant is placed to the more distal position which is preferred position based on the OHIPNL49, an anterior clasp/retainer can not be avoided with esthetic consequences. (pre-treatmentinformed consent: esthetics versus comfort) Published literatures reported comparable high implant success rate and increasing patientsatisfaction for removable partial denture associated with implants in the extension-based situations.
Long-term success of implantsdepends onbiomechanical equilibrium
ImplantBiomechanicsANTICIPATED LOAD1. Occlusal factorsCusp anglesWidth of occlusal tableGuidance typeAnterior guidanceGroup function2. Cantilever forcesConnection to natural dentitionSize of occlusal tableCantilevered prostheses3. Parafunctional habits(bruxism)4. BrachycephalicsLOAD BEARING CAPACITY1. Quality of bone site2. Quality of bone implant interface3. Implant microsurfacesMachined vs. rough surfaces4.ImplantNumber and ArrangementLinear vs. CurvilinearLength and diameterAngulationBiomechanics Equilibrium
Case 4: ABPt AB, 52 y/o male, maxillary partialdentate, 6 implants placed
Case 4: ABPt AB, 4 out of 6 maxillary implants failed toosseointegration
Case 4: ABFixture level pick up impressionLabially angled implant angulation was noted
ImplantBiomechanicsFor Pt ABLOAD BEARING CAPACITY1. Quality of bone site ?2. Quality of bone implant interface?3. Implant microsurfaces4. ImplantNumber (fewer than tx plan) andarrangementLinear vs. CurvilinearLength and diameterAngulation (labial angled)ANTICIPATED LOAD1. Occlusal factors2. Cantilever forces3. Parafunctional habits(bruxism)4. Brachycephalics
ImplantBiomechanicsFor Pt ABLOAD BEARING CAPACITY1. Quality of bone site ?2. Quality of bone implant interface?3. Implant microsurfaces4. ImplantNumber (fewer than tx plan) andarrangementLinear vs. CurvilinearLength and diameterAngulation (labial angled)5. Tooth support6. Mucosal supportANTICIPATED LOAD1. Occlusal factors2. Cantilever forces3. Parafunctional habits(bruxism)4. Brachycephalics5. Use implants mainly forretentionBiomechanics Equilibrium
Case 4: AB#8 and 9 splinted together with two ERAAttachmentsERA attachment impression housingswere picked up at #8 and 9 sites at thesame time of implant final impression
Case 4: AB
Case 4: ABTwo custom ERA Attachmentson the implants were made1. Correct the labial angulation2. Follow the path of insertionwith the two ERAs of #8 & 9
Case 4: ABImplant Prosthesis Design Concept1.Implants’ labially inclined angulation were corrected by customabutment with ERA plastic patterns2. Due to the failure history of the other 4 implants, maximizethe support by positive rests on #2, 8, 9, 14 and palatal majorconnector coverage3. Implants are mainly designed for retention (from ERAs).Support and stability are mainly from teeth and mucosa4. #8 and 9 are splinted and ERAs are designed to maximize theesthetics
Case 4: AB
Case 4: ABBlue-colored (higher retention)ERA wereused on the teeth #8/9White-colored (the least amountof retention) ERA wereused on the implants.
Case 4: AB
Case 4: AB
Case 4: ABLessons Learned from Pt AB Despite the best effort implants sometimes still fail. Prosthodontic contingencyplan needs to be discussed during the consult. Fewer implants with poor angulation Support, stability, and retention Turn a compromised biomechanics situation around to a esthetic treatmentoutcome with good long-term prognosis
Pt IRPanoramicCase 5: IR
Pt IR 1990 Panoramicafter removal of failed blade implantand hopeless teethCase 5: IR
Pt IR1991 Panoramic after placement of 5 implants to restore the partially dentate mandibleCase 5: IR
Pt IR1996 PanoramicCase 5: IR
Pt IR2003 FMX12 y/o functional loading on the mandibular implantsCase 5: IR
Case 5: IRLong-term Success in Implant-enhanced RPD Therapy:RPD Design Principles and Implant Biomechanical Equilibrium2-implant tissue bar with one ERA attachment to provide retention,improved stability, and improved support for the upper right quadrantPositive rests on #2 and 5Active I-bar (0.01” retention) on #2Passive I-bar on # 5 for bracing/stability
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Active retainer (retainer that engages undercut to provide retention for the RPD)--the remaining of the retainer is position at/or above the height of contour (except infra-bulge retainers)-only the tipof the retainer is below the height of contour and engages the desired 0.01-0.02” undercut He
risk factor for the failure of acrylic in the material design [22-24]. More recently, investigators have studied the effects of loading a Kennedy class I implant-assisted removable partial denture (IARPD) or implant-supported removable partial denture (ISRPD)
An implant restoration will maintain your surrounding bone and soft tissue, and replace your missing tooth with a natural-looking restoration. Traditional treatment options: Before and after clinical example: Dental implant option: Removable Partial Denture A removable partial denture can lead to further bone and tooth loss.
Attaining of e"ective suction in a mandibular complete denture is one of hard clinical techniques that no one has ever achieved so far and this issue has received much attention in recent years 1 3). If any denture adhesive commercially available is applied to a maxillary complete denture, the denture becomes less mobile and better chewing for a patient. Likewise a mandibular complete denture .
Cantilevered Fixed Partial Denture 123 these procedures due to any reason, an alternate treatment modality in the form of cantilever prosthesis exists. It is also preferred in the posterior region to avoid removable prosthesis. A cantilever fixed partial denture is prosthesis with one or more abutments at one end and unsupported at the other .
Complete denture impression: it's a negative registration of the entire denture bearing, stabilizing and seal area of either the maxilla or the mandible. Objectives of impression making: Complete denture impression procedures must provide five objectives: 1. Retention 2. Stability 3. Support for denture 4. Aesthetic 5.
fill the denture, but rather should follow the internal contours. Figure 11: To facilitate correct positioning of the denture, have an assistant help you to retract the lip so that both the anterior and the posterior vestibules can be seen simultaneously. Seat the denture until the impression material expresses over the denture
An immediate complete denture is a full arch prosthetic, inserted immediately following the extraction of all remaining . ' function without a phase of complete edentulism. As well as conventional complete denture, immediate complete denture success is determined by the fulfillment of retention, support, and stability of the denture.
and esthetic confirmation at the second visit. A redesigned complete denture was printed as a mold to fabricate final denture that was delivered at the third visit. To evaluate accuracy of impression made by diagnostic denture, the final denture was used as a tray to make impression, and 3D comparison was used to analyze their difference.
