10 Final Fitting of R.P.D

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Assalamaa aleh kum

Final Fitting of the Removable Partial Dentures : 

Final Fitting of the Removable Partial Dentures Prof. Dr. S. Venugopal.

I. Pre-insertion inspection: : 

I. Pre-insertion inspection: Make sure that there are no rough areas or sharp margins on metal or resin. The inner aspect of clasps, bars, and bases are inspected for any deficiencies. High degree of polish will enable the appliance to be tolerated better, minimize the formation of calculus, and will prevent any soreness to the tongue, cheeks, or mucosa that might result from a rough surface or margin.

II. Insertion: : 

II. Insertion: Insert carefully into the mouth. The denture should be placed into position without further adjustment. If the denture cannot be placed, no attempt should be made to force it into place. Any interference should be detected and removed.

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Tissue surface refinement Pressure areas are removed with an acrylic bur, and the PIP process is repeated until there is even flattening of the PIP. Pressure indicator paste (PIP) is placed in liberal amounts on the tissue surface and spread with a bristle brush to form deep grooves in the paste.

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Periphery Refinement A roll of the wax (which is more resistant to pressure than PIP) is evenly adapted on the periphery. Disclosing wax is placed on the periphery of the denture base to identify overextension of the denture onto the tissue, when in function.

III. Stability: : 

III. Stability: Stability must be checked by applying pressure anteriorly and posteriorly alternatively. The denture should exhibit no movement. Distal extension cases may be an exception since displacement may occur if a mucostatic impression has been employed. If stability is correct an examination should be made of the fit of the various component parts, such as bars, clasps, occlusal rests, and the peripheral extension of the bases.

IV. Patient comfort: : 

IV. Patient comfort: The patient's opinion regarding the comfort of the denture should be sought at this stage. Any inconveniences should be adjusted.

V. Occlusion: : 

V. Occlusion: Blue articulating paper should be placed between the upper and lower jaws and the patient asked to close three or four times. In normal cases, the occlusal contact must be evenly distributed between the natural teeth and the denture under the full masticatory load.

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Natural teeth may be separated by premature contacts on artificial teeth. The latter must be carefully adjusted until the natural teeth meet in precisely the same way with or without the denture in place.

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The fitted prosthesis is placed in the mouth. Low fusing metal is poured into the alginate impression to reproduce natural teeth. An alginate impression is made of the prosthesis and of the remaining teeth. Occlusion Refinement: Clinical remount

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Heavy tooth contact is indicated by “target” markings, having a light centre surrounded by a ring of ink transferred from the paper.

VI. Esthetic: : 

VI. Esthetic: It may be necessary to carry out a little grinding at the incisal edge, to modify the contour slightly, but the major decisions on this subject should have been taken at the previous visit (try-in). The patient's opinion of the esthetics should be considered. When both are satisfied, the dentist should demonstrate to the patient how to insert and remove the PD, otherwise the patient may find difficulty and in extreme cases may not be able to remove the dentures at all, or to re-insert them. Patients should be discouraged from using clasp arms as a convenient means of removing the denture. The metal may become distorted and non-functional. The denture can usually be lifted by pressure at the buccal base peripheries instead of clasps.

Instructions to the Patient : 

Instructions to the Patient The patient must be informed that some discomfort may be expected in the beginning. This is due to that the denture is a foreign body that is not easily accepted by the musculature. The tongue as well, an important organ needs time to be accustomed to the presence of the bulk of the denture. Even if it is comfortable, the denture must be psychologically accepted before it can be considered an integral part of the oral mechanism.

The patient must be informed about: : 

The possibility of soreness. The possibility of phonetic problems The possibility of gagging or the reaction of the tongue to a foreign body. Contours that are too thick, too bulky or should be avoided and should be corrected especially the distolingual flange of the lower denture. The patient must be informed about:

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The mouth and the partial denture should be cleaned before and after retiring. Calculus may precipitate on the denture in some cases that necessitate taking extra care for its removal. Brushing the dentures daily can decrease deposition of calculus on it. The dentures should be removed at night to give rest to the oral tissues. They should be placed in a container and covered with water to prevent its dehydration and subsequent dimensional changes. The denture and supporting structures should be checked 24 hours after delivery.

Periodic Recall : 

Periodic Recall Periodic recall every six months should be the rule, if conditions are normal. In caries susceptibility and periodontally unhealthy patients, this period may be shorter. Increasing retention should be accomplished by contouring the clasp arm to engage a deeper undercut. Changes in the form of the supporting ridges, rather than lack of retention can be corrected by relining or rebasing .

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THANK YOU My sir… with your preaching I am here and sharing the knowledge with the world of new dental doctors…