Оглавление
James Field. Removable Prosthodontics at a Glance
CONTENTS
Guide
Pages
About the companion website
1 Introduction
Communication and expectations
The clinical process
2 The function of removable prostheses
Function
Restoring vs improving
Quality of life
Risks of removable prostheses
3 Stability and retention
Stability
Retention
Stability vs retention
The gag reflex
4 Patient assessment for complete dentures
The patient and the rationale for treatment
Prosthodontic history
Clinical examination
Ridge assessment
Assessment of existing prostheses
5 Edentulous ridge presentations
Upper edentulous ridges. Photograph 1
Photograph 2
Photograph 3
Lower edentulous ridges. Photograph 4
Photograph 5
Photograph 6
6 Patient assessment for partial dentures
The patient and the rationale for treatment
Prosthodontic history
Clinical examination
Ridge assessment
Partial denture classification
Assessment of existing prostheses
Radiographic assessment
7 Factors complicating success
Prognosis and justification
Risk factors. Patient factors
Clinical factors
Ridge anatomy
Technical factors
8 Accessibility and operator position
Posture and operating position
Move yourself, and the patient
Upper arches
Lower arches
Control of the prostheses and trays
Other considerations
9 Pre-prosthetic treatment
Extraoral assessment
Edentulous patients
Partially dentate patients
Periodontal disease and caries
Implants
10 Revisiting the anatomy
Upper arch
Lower arch
Anterior limiting anatomy
Posterior limiting anatomy
Medial limiting anatomy
11 Making a primary impression – complete dentures
Choice of tray
Material
Lower arches
12 Making a primary impression – partial dentures
Choice of tray
Material
Supportive materials
Impression materials
13 Special trays
Materials
Tray spacers and tissue stops
Handles
Material retention and support
Full seating
14 Compound and putty materials – handling and manipulation
Compound and greenstick
Compound
Greenstick
Difficult areas
Putty
15 Recording an upper functional impression
Checking the special tray
Important functional anatomy
Posterior border
Developing the peripheral extensions
The wash impression
Partial dentures
16 Recording a lower functional impression
Checking the special tray
Important functional anatomy
Labial sulcus
Posterior and disto-lingual anatomy
Developing the peripheral extensions
The wash impression
Partial dentures
17 Managing fibrous ridges
Mucostatic
Mucocompressive
18 Denture bases
Types of denture base
Permanent acrylic bases
Temporary bases
Alternative denture base materials
19 Recording the maxillo-mandibular relationship
The denture bases
Natural tooth contacts in partially dentate patients
The registration material
A passive process
The process
Checking the registration
20 Prescribing the upper wax contour
Using the previous denture as a guide
Lip support
Incisal level and the alar–tragal plane
Buccal corridors
Other useful markers
Tongue space and assessing speech
21 Prescribing the lower wax contour
The tongue
Lip support
Incisal level and plane
Buccal relationship
Vertical dimensions, tongue space and speech
22 Tooth selection and arrangement
Biological markers
Tooth shapes
Tooth sizes
Tooth shade and characterisation
Other considerations
23 Occlusal dimensions and occlusal schemes
Conform or reorganise?
Occlusal schemes
Complete denture occlusal schemes
Facebows
24 Respecting the neutral zone
Diagnosis
Managing the neutral zone
Pay close attention at registration stage or try-in
Consider prescribing the anterior segment in carding wax
The formal neutral zone impression
Effects of respecting the neutral zone
25 Assessing trial prostheses
What should be checked at try-in?
Features to check on the bench
Features to check in the mouth
Managing occlusal discrepancies
26 Fitting and reviewing finished prostheses
Returning on casts
Checking the fitting surface
Checking occlusal contacts
Reviewing the prostheses
27 Copying features from existing prostheses
Tooth arrangements
Fitting surface
Full denture contour
Modifying prostheses prior to copying
How to create modified copy dentures
Registration
Try-in
Fit
28 Classifying partial prostheses and material choices
Kennedy Classification
Applegate Classification
Potential difficulties with each class
Material choice
Periodontally involved teeth
Cost of rigid substructures
29 Designing partial prostheses
Preliminary registration
Other necessary information
A system of design
30 Saddles, rests and clasps. Saddles
Rests
Rest preparations
Direct retention – clasps
Indirect retention
31 Connectors and bracing
Bracing
Major and minor connectors
Minor connectors
Major connectors
32 Surveying and preparing guide planes
Should I survey for acrylic dentures?
Path of natural displacement
Path of insertion
Guide planes
Modifying the dentition
33 Designing frameworks – case examples
Example 1 – Upper Kennedy Class I, modification I
Example 2 – Lower Kennedy Class III, modification I
Example 3 – Upper Kennedy Class III, modification I
Example 4 – Upper Kennedy Class III, modification I
Example 5 – Upper Kennedy Class III, modification I
Example 6 – Lower Kennedy Class II
34 Precision attachments – the fixed–removable interface
Potential advantages of using precision attachments with a RPD
Potential disadvantages of using precision attachments with a RPD
Classifying precision attachments
Intracoronal attachments
Extracoronal attachments
Auxiliary attachments
Semi-precision rests
35 Dealing with frameworks and substructures
Try-in of the framework
Alloy teeth
Accounting for additions
Protecting small anterior saddles
Altering clasps
36 The altered cast technique and the RPI system
The altered cast technique
The RPI system
37 Swing-lock prostheses
What is a swing-lock prosthesis?
Indications
Contraindications
Assessing the periodontal condition
The latch assembly
Retentive elements
Connector design
38 Gingival veneers
Contraindications
Veneering materials
Indirect technique
Retention
Silicone vs acrylic
Shade taking
39 Immediate and training prostheses
Complete immediate dentures
Partial immediate dentures
Training prostheses
40 Occlusal splints
Splint types
Occlusal coverage
Records for construction
41 Implant-supported mandibular overdentures
Planning
Construction
Maintenance
42 Principles of restoring maxillary defects
Primary impressions
Major impressions
Framework designs
Obturator bungs
43 Tissue conditioners, liners and re-basing
Tissue conditioners
Soft liners
Degradation
Re-basing
44 Maintaining adequate oral hygiene
The impact of partial prostheses
Complicating factors
Cleaning partial and complete prostheses
Fixed prostheses
45 Troubleshooting loose or painful dentures
Loss of retention and displacement
Loss of retention
Increased displacement
Pain underneath denture bases
Other causes of pain
46 Gagging, other difficulties and making a referral
Managing the gagging patient
Functional analysis and patient control
Tongue spread and lip activity
Speech problems
Referral process
47 Summary of procedural stages. Prescribing the placement of teeth and recording jaw relations
Partial denture design
Partial denture provision
Complete denture provision
Modified copy denture provision
Implant-supported mandibular overdenture provision
Appendices
Appendix 1: Complete denture assessment proforma
Appendix 2: Restorative assessment proforma
Appendix 3: Referral letters
Appendix 4: Partial denture design sheet
Recommended and supplementary reading
Index
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