Removable partial denture framework try-in

Dr Balendra Pratap SinghBDS, MDS, MAMS, FISDR, FPFA, FAAMP, ICMR-IFAssistant ProfessorDepartment of ProsthodonticsKing George’s Medical University, Lucknow

Introduction

The removable partial denture is a viable and effective treatment modality

The objectives of a successful removable partial denture are

• Preservation of health of remaining oral structures

• Restore function• Restore esthetics

Try-in Steps

1) Inspect the framework off the master cast

– Inspect for bubbles and other defects on the intaglio surface

– Check for abraded areas on the master cast– Check polished and non-polished areas– Check for adequate thickness

2) Check the framework on the master cast– Verify the design of the framework with the

laboratory prescription or diagnostic cast.– Inspect the rests (Be certain that all rests fit

perfectly and simultaneously into rest preparations).

– Rests should not be overcontoured causing unnecessary bulk or overextension, nor undercontoured causing weakness and possible fracture.

– Examine the relationship between the framework and the soft tissue areas.

– Check for proper adaptation and placement of clasps. (Clasps should have perfect adaptation to the teeth and all retentive areas and should be properly placed in relation to the height of contour.)

– Check the ease of framework removal.

3) Check the framework in the mouth– If the framework fits the cast but does not fit in

the mouth, it is likely the cast is not an accurate reproduction of the mouth.

– Causes—• Distorted impression, • an improperly poured cast, • an abraded cast, and/or • shifting teeth.

• The fitting of the framework to the mouth should be done in two phases: – (1) fitting the framework to the abutment teeth

and soft tissue and – (2) adjusting the framework to the opposing

occlusion.

4) Fit the framework to the abutment teeth– The best aid in trying in the framework is the use of a

disclosing medium.• There are numerous acceptable disclosing media on the

market: • Occlude (Pascal, Bellevue, Wash.), • Accufilm (Parkell, Farmingdale, N.Y.), • disclosing wax (Kerr/Division of Sybron Corp., Romulus,

Mich.), • pressure-indicating paste (Mizzy Inc., Clifton Forge, Va.), • Fit Checker (GC Dental Industrial Corp., Tokyo, Japan), and • chloroform and rouge.

4) Fit the framework to the abutment teeth (contd.)– Seat the framework in place in incremental steps with

minimal force.– Check for rocking of the framework in both

anteroposterior and buccolingual directions.– Check for close adaptation of rests, clasps arms, and

lingual plates.– Check for physiologic relief on distal extension

frameworks.– Check retention.– Check soft tissue contact or relief.

5) Adjusting the framework to the opposing occlusion.

– Identify natural tooth contacts in the centric occlusion (C0) or maximum intercuspation positions (MIP).

– Adjust the framework in the CO/MIP position.– Adjust the framework during eccentric

movements.– Occlusal adjustment of two frameworks (if

present in both arches).

6) Materials•The framework can be adjusted with various burs, coarse Carborundum stones, or both. All adjusted areas should be repolished with rubber points and wheels. •When relieving and polishing, avoid staying in one spot for extended periods of time to prevent the generation of localized areas of high temperature.

Summary

• The ultimate success of a properly designed removable partial denture depends on how well it fits and adapts to structures in the mouth. One of the most important steps to ensure an accurate fit is the seating of the framework.

Scientific answer: Based on trials meeting the inclusion criteria for this review, there is insufficient evidence to recommend a particular method of tooth replacement for partially edentulous patients.

General answer: Nothing is better than other one in terms of durability, function, comfort and appearance

Take home message

Reference: Iabt E, Carr AB, Worthington HV. Interventions for replacing missing teeth: partially absent dentition. Cochrane Database Syst Rev2012 Feb 15;2:CD003814.

What is your opinion to prescribe RDP, FDP (tooth supported) to replace missing teeth?