RPD Clinical Sequence — Form 26
Paste-ready chairside checklists extracted from Clinical Sequence for Partial Dentures. Use Sequence A for a Co-Cr RPD with no OVD change, or Sequence B when increasing the OVD.
Sequence A — Co-Cr RPD, NO OVD increase
VISIT 1 — Preliminary impressions
- Alginate prelim impressions U/L (stock trays, periphery wax)
- Lab: study models (type 3 gypsum), base & rim if needed
VISIT 2 — Jaw relations & tooth selection
- Try in base & rim (chairside technique: Registration Sequence for a Removable Partial Denture)
- Record CR (leaf gauge, confirmative/MIP), facebow, protrusive
- OVD = RVD - freeway; verify “Mississippi 66” (closest speaking space)
- Mark midline / canines / smile line
- Select shade & mould
- Lab: mount on semi-adjustable articulator
VISIT 3 — Diagnostic wax-up, survey & design
- Review wax-up on duplicated model
- Survey & design framework (rests, clasps, connectors, guide planes)
- Decide if survey crown needed (prep at V4)
- Lab: special (custom) tray
VISIT 4 — Mouth prep & final impression (KEY)
- Complete control phase first (perio/endo/resto/surgical)
- Prep rest seats + guide planes; adjust height of contour; create undercuts
- If indicated: prep + fabricate + CEMENT survey crown BEFORE impression
- Try-in custom tray (not overextended)
- Border-mould (putty) -> light-body PVS on prepped teeth/rests -> heavy-body in tray
- Take final elastomeric impression
- Lab: bead/box/pour master model; duplicate (processing + investment); cast Co-Cr framework
VISIT 5 — Framework try-in + MMR
- Check off model: defects, smoothness, thickness, follows design
- In mouth: passive seating, rests seated, no rock, clasp position, soft-tissue clearance
- Adjust with fit-checker + carbide bur; NEVER terminal 1/3 of retentive arm
- Check occlusion with framework seated
- Record MMR on framework (acrylic base + wax rim on saddle)
- Altered-cast technique IF mandibular Kennedy I/II (pressure on rests only)
- Lab: cross-mount, tooth setting
VISIT 6 — Wax try-in
- Check occlusion, OVD, aesthetics, neutral zone
- Move teeth, don’t grind; get patient approval
- Lab: process denture
VISIT 7 — Insertion
- Inspect base: voids (->lab), nodules/sharp edges (remove chairside), overextensions (trim)
- Check retention, stability, extension, occlusion (articulating paper), OVD, appearance
- Reline if poor saddle adaptation (bite reg BEFORE pickup impression)
- Care / cleaning / adaptation instructions
VISIT 8 — Review (~2 weeks)
- Assess adaptation, address complaints
- Identify true pressure points (fit checker / light body), trim gradually
Sequence B — Co-Cr RPD, WITH OVD increase
VISIT 1 — Preliminary impressions
- Alginate prelim impressions U/L (stock trays, periphery wax)
- Lab: study models, base & rim
VISIT 2 — Jaw relations at NEW OVD (reorganised)
- Establish target increased OVD on wax rim (NOT MIP)
- Extraoral refs (nose-chin), RVD - freeway; verify phonetics
- Facebow + jaw relation at the new VD
- Select shade & mould; mark landmarks
- Lab: mount at new OVD
VISIT 3 — Diagnostic wax-up at new OVD
- Wax up to new OVD; confirm occlusal plane
- Plan composite build-ups and/or survey crowns to support new VD
- Survey & design framework
- Lab: special tray
VISIT 3b/4 — Stabilise the new OVD (extra step)
- Place composite build-ups and/or cement survey crowns to planned OVD
- Verify comfort, phonetics, occlusion; allow adaptation period
- NOTE: heavily worn dentitions -> consider prosthodontic referral
VISIT 4 onward — REJOIN SEQUENCE A (Visits 4-8)
- Mouth prep, final impression, framework try-in, try-in, insertion, review
- Final denture built to the INCREASED OVD
- Replace provisional composites with onlays/crowns later if planned