Table Of ContentAdvanced Removable
Partial Dentures
James S. Brudvik, DDS, FACI'
Professor Emeritus of Prosthodontics
University of\Vashington
School of Dentistry
Seattle, \Vashington
Quintessence )lublishing Co, Inc
ClJicago, Berlin. Loudon, Tokyo, Paris, Barcelona, Sao Paulo,
~toSC()W, Prague, and \Varsaw
l.ihntl)"ofCon~n'~~ C;tlaloging-in-Puhlic:;tlion Data
Bru(hik.[nmes s.
Advanced removahlc partialdenturesI [anu-s S. Brudvik.
p. em.
Includesindex.
ISBNO-1i6715-.3.'31-2(hardcovr-r}
L f'urnal dentuu-s,Homovable. I.Tltk-.
Il)XL.\l: I. Deutun-, Partial. Hemovnhlr-. WU .515 USfiSa I!/!)!)]
IlKm'5.R78 19!~J
fili.(i'lJ2-<k21
DNLM/DLC
for lJhrarvofCOII,gn.·SS
!)!l~21231
ell'
({) lmm()lIinh~ssl'rl(·tl PuhlishingCo,Inc-
I
()llilltessell(~~ Pllblishill1-((:0, 111('
5.')] KunberlvIJriV('
CamlStrean-l.Illinois60lSS
Allrip;hts rest:'I'Yl"fLThis hllok orany part tl...n-of may not b- n·prntllll't...l,stored ina retriP'l.J S:....tr-m,or
trunsunttcd in any form nr 1Iy any means. t'1l'ttnmie, mechanical, pllllhx"')IJ?oill~, or otherwise, \\;Ihllllt
or
priorwritten pt'TII1issilili the pllhli.sll<'r.
Editor:Lori Ball'IIMI\
Iksign/PrOOtiction: Mil-hat·1 Shanahan
Prinn...1inthe US,\
Contents
Introduction IX
Chapter 1 Patient Evaluation, Diagnosis, and Treatment Planning ]
Initial Examination · Decision Making for RPDTreatment Planning >
Preliminary Impressions · PreprostheticTherapy
Chapter 2 He~novahle Partial Denture Design 7
Elements of Design· Design Specifics:Class I-IV
Chapter 3 Mouth Preparation 37
Surveyingthe Diagnostic Cast · DiagnosticMouth Preparation
>
Clinical Mouth Preparation
Chapter 4 Final Impressions and Master Casts 55
Altered Cast lmpressions Jaw Relation Records
>
Chapter 5 Laboratory Construction ofthe Framework 63
DesignTransfer · Blackout and Duplication >Waxing· Spruing,
Investing,andCasting · Metal Finishing · Addition ofW ire Clasps·
Addition ofAltered CastTrays
Chapter 6 Estahlishing the Tooth-Frame Relationship 7.5
Tooth Contact Surfaces >Static Fit • FunctionalFit · Poor Casting Fit
Chapter 7 Completion ofthe Partial Dt::nture 79
Jaw Relation Records · Placement of Denture Teeth·
Flasking,Tinting,and Packing · lnsertion MetalOcclusalSurfaces ·
>
Long-Term Maintenance
•
Chapter 8 Repairs, Additions, and Relines 93
Pick-up Impressions · Resin Repairs · MetalRepairs > Restorations
Under Existing RPDs • Crowns Under EXisting RPDs • Relinesand
Rebases
Chapter f) Special Prostheses lO.5
Splintingwith the RPD • Hinged Major Connectors · Rotational
PartialDentures
Chapter 10 Precision Attachments 11,5
Common Clinical Procedures · PrecisionAttachment Systems
Chapter 11 Implants and Removable Partial Dentures 1.5:3
Class IandIISituations ' Class III and IV Situations
Index 160
I
Preface
T
he removable partial denture In" a1 Sill' this form of therapy at the highest
way~ 1)('('11 Ill)-' special challenge ill level. After years of being asked if I had
dentistry. As a clinician, researcher; 1I('lIlal everconsidered putting Illy lecture mater
laboratory director,'lecturer, and IIIPHtor, I ialin written form and protesting that I did
have s[X'llt almost 3-5 years Il")ing to come not have the time. my partial retirement
to gripswitIItlie complexitiesorthisform or from the University of\Va.~hillgtuTl School
prosthodouttc treatment. rwould estimate of Dentistty has made my excuses no
that 2()1}t of parual W{'aTeTS are more than longer valid.
just a little dissatisfied ";11. their denture. This work is not intended to be a text
Unlike \\ill. the fixed partial denture. till' book ill the classical sense. It is, rather. a
patient hastheoptionofremovingtheplUS monograph on the removable partial den
thesis at tile slightest hint of discomfort. ture, written witlrthe expec tation that the
physicalor mental. Civcu the actualstateof readerwillalready have covered the basics
pructice-c-thc dentist docs only the occa of the partial denture and is now ready to
_..ional partial denture with almost tota! T(' take a more sophi...ticatcd look at this treat
Hance 011tIlt~ dcutallal»lmlnty fordesign as mcut modality It dops nothave a btbliogru
wellas construcuon-c-I.nnmost pessimistic phy, and the Illustrations consist of draw
us to the ef1i.·d ofthis,or :Ill:'oilier text on ings that I have placed 011 countless
the subject. blackboardsovertheyears ill all attempt 10
\Vhile there are a number of excellent make things clr-arto m)'students.\\1.:lt 1'01.
baste texts Oil the rr-movuble partial den lows an' my thoughts as they have evolved
or
ture. they arc all direc ted toward tht, un overtheseyears practice and teaclnug in
dergraduate dental student. I han! not this fascinating urea.
found anything that I can me as an ad While I take complete rcsponstbtltty for
vanced text for the graduate student and the content ofthf.. work, rhave lWCB aided
study club participant who wishes to pur- in tlll~ writing hy Illy friend and coworker,
vii
Advanced Removable PartialDentures
[uuiuc Nr-mcrevr-r Coal;\~, who, as pro· This book is dt'dicakd to Illy gradllale
or
gramcoordinator the (;radualp Program suuk-nts-c-past, pn-sent, and hopc-Inllv fll
in Prosthodontics, has long stood watch tnfl"---who provide. 011adaily basis.the joy
ove-r Illy faulty grammar and sentence ofsl"{'ingS(1111{"OIl('learn.Itisalsork-dicatod
structure. I han:' also had the ln-lp of Dr to Illy longtime friend ami colleague, the
Alex Shor, presently in OIlf graduate pro eminent functional anatomist. Professor
gram,who has rovh-wedthe entire hook to J('an I~OII11'row~ki (Iftilt)UnlversityofParts.
provide insightand guidalll'l' from the eyt'S VII, who has h('('11 an inspiration in this
orthe pote-ntial readership. mailer as ill so mallYotln-rendeavors over
the H'aI~.
viii
Introduction
T
he removablepartialdenture bas long Therefore, it is no wonder that patients
!JPCH considered an inferior means of dislike their partials to tile point of not
replacing missing 'teeth and associated wearing them and,if they can afford alter
structures when compared 10the fixed par native treatment,request itroutinely It has
tial denture. Some have even spoken ofit been my experience that the pattent who
as a stepping stone to a complete denture. states, "1 had a partial once and couldn't
The old rhyme,"Little HPD,don'tyon C'Y. wear it!" most likely hall a substandard
You'llbe aCD byand by"maybest express prosthesis; when treated ,vith a state-of
our feelings toward this treatment modal the-art partial denture, the patient would
ity. Many Slll\'CYS published over IIH~ years likely find it tolerable and easily accept the
in our journals indicate that dentistry docs limitations ofthis fonu of tooth awl tissue
a rathr-r pOOTjob witlrthe HPJ).These re replacement.
ports testifyto the hid that most RPDs arc Plainly stated. there tsa dramatic differ
created entirely bv, the technician wtth a ence between the standard RPD and the
,
minimum ofInput from the clinician in the one that approaches the state of the art as
form ofmouth preparation or de.sign. we knowit today.It isin the attempltocre
Dental schools make it serious effort to ate that quality removable partial denture
teach the subject, and excellent texts for that this book is written. It is intended to
the undergraduate are available. None serve as a KIdde to both gnHlwlfe students
theless,the state ofremovable partialden in prosthodontics and concerned general
turcs scou in the commercial laboratories practitioners-to challenge them to think
and in the cross-sectional studies available of the removable appliance as they would
to IL~ indicates that, in general, partials are the fixed partial denture, with all the same
poorly designed and constructed and considerations of soft tissue management,
poorly maintained. cades control, periodontal support, ortho-
ix
Advanced Removable PartialDentures
dontlc therapy. ami implant involveun-nt. lady scheduled recall and appropriate
In almost eH'ry clinical situation. the pa mamtcuancc. Preparing tile mouth to its
tieut whorequiresa removable partialden very la-st state of hr-alth be fore starting
turc willhaveaneed forsomefonn offixed prosthodontic procedures and then keep
prosthodontics as well, from a simple ing the tissues in that state of health over
bonded rest to the mostcomplex precision the lifeof the partial is far mon-important
attachmentsextending from fixed units. than .IIlY desigll considerations, It has he
come obvious to me that a partial denture
in a healthy mouth, assuming that it meets
Philosophy of Care our four requirements. will he successful
regardless of its design. lk-st placement
and clasp(I"sign, IntcrcstiuglLsIlie}'mayIK'
\\"hat makesa SlIt'('('SSflll RPD? At tilt, risk to argile ove-r from a tlu-orotical point of
ofoversimplification.one could saythatthe vtew, an' simply not germane to the real
successful removable appliance Ill't'tl be qllPSIiOIlvfwhat makesasuccessfulre-ruov
onlvIon things: 'lhlf· partial denture. Suppositions derived
I'
,. ,.
from bench studies do not necessarily
I, Strong. in that it does not wear, break.
transferhitheclinicalrealitiesoflong-tern
distort,orCOII\I' apart whenworn.
care.
2. He/entire, so that it remains in position
llow loug should a properly d(~signpd,
in the patient's mouth during usc and
cohstrucu-d. and maintained H.PD lu...t?
g1VtoS tho patlcut confidence that it will
Good evidence exists that this state-of-the
continue todo so the lifeoftile par
(JVPI"
art paliialcould be l'xpt,tkd to last a ruini
tial.
mum of 10years, assuunugthat the patient
3. Est/wtie, to satisfythe patients cxpI'ela
was se-en at regular intervals and that both
tious withoutundue evidence ofitspws
the mouthaut]the partial received the indi
r-ncc.
cateduuuntr-nancc. Partial.spnl\ilIingglKxl
,I. 1'(1;11-/1'(.'(',lIw,lIlingthat it docsnot(.IlI\('
service for 20 ~l-'ars art' not unheard of, al
discomfort when in the mouth for the
tlltlllgllillt'long-term maintenance re-quire
short term ami that it causes no 101lg
mcnts lncrcnsc dramaticallyafter 10years.
termdamage toeitherhard orsoft tissue
The construction of the removable par
the life ofthopartial.
OW l"
tial denture, more than allYother fonn of
If these four requirements can hl' met, dental the-rapy, is almost always delegated
the partial stands a good chance of long to the dental laboratory since the equip
k rill success. Unfortunately,the Slll,(,(.'S.~ of mcnt required to product.' all acceptable
the partialin and ofitselfdoes 1I0t ~lIar.m ellst framework is not goillj!; to he found ill
h't' the long-tr-rm he-alth of the rr'maining the dental offlce. In lllauy cases, the clint
h't,th amisoft tissues. Matntenancc. there dan urav have never even met the techni
fore. becomes the primary factor ill the dans cn-ating the prostlu-sc-s. Tlus fact re
long-term success (If the treatment. The quires that the clinicians maintain contr ol
profession has usually substituted concern by inserting themselves into the pmcess at
over the tn)e of clasp to be used for the the critical steps in construction. These
more fundamental requirements (If n'WI- stepswillhe covered in depth in this book.
x
Introduction
Since the actual construction is d{'lq~ated, bythe h·d lllidan.Unfortuuan-ly;the evolu
the an'mge clinician isapt to have \'('r)" lit tion of the dental lnborator.v industr.v has
tie confidence Of experience in these mat separated ted lllicians into often isolated
tors and is likelv to take the technicians specialties: complete dentures. removable
view of the design ami construction partialdentures.and fixed partial dentures.
prol'pss, a view thai willhe more nu-chani The technician who is knowledgeable in all
cul than btological. The wtsc chuiciau will areas is a \'ani.shillg hn·(·t1. To direct till'
make a point or l"t'lllailling in close coutuct construction of the most sophisticated
with the technician and bringing; th(~sc nux restorations. the clinician must assume the
ilfurtos into the clinical aSjx'd s of eare rcspouslblllty of coordinating the laboru
wheneverpossible. tory phases. This text is intended to set
The modern removable partial denture standards of care for tln- comprehensive
combinesIixcdand removable prosthodon management ofthepartiallyedentulouspa
tics and f(,,(plin's a thorough understanding ttcnt who will requifl' some form of a rc
ofI10th aspects ofcare bythe clinician and movable n-storattou.
xi
