Chrome-Cobalt RPD Clinical Sequence Template

Cobalt-Chromium RPD Clinical Sequence — Form 26

Chairside Form 26 for a cast cobalt-chromium removable partial denture — a rigid framework that is surveyed, designed and cast to a mouth prepared for it. Use Sequence A when the vertical dimension is unchanged, and Sequence B when you are increasing it. Material selection, the decision criteria and the impression tables live in Partial Denture Template; this sheet is the single-material, paste-and-go version.

Two signatures required

Form 26 is the reconstructive phase. You need two signatures — the prosth specialist and the clinic coordinators. No aesthetic work goes on this form.

When cobalt-chromium is the right choice

Cobalt-chromium suits a dentition that is favourable and stable. The framework is rigid and thin, it covers far less tissue than acrylic, it is easier for the patient to keep clean, and its design can be controlled precisely to support and brace the remaining teeth. What it asks for in return is commitment: to the design, to the mouth preparation, to the laboratory stages, and to the cost and the chair time.

That is the reason the material choice is a prognosis question rather than a Kennedy-class question. A framework cannot accommodate tooth loss the way acrylic can, so if further extractions are likely the case belongs on the acrylic pathway until the mouth settles. The full comparison and the periodontal reasoning are in Partial Denture Template.

Design first, then prepare

Every preparation on this sheet exists because the design asked for it. Survey and design the diagnostic cast, get the design approved, and only then prepare the mouth. Bring the articulator with the mounted casts to that review — two unattached casts do not show the occlusion, the prosthetic space, or what needs preparing.

Sequence A — cobalt-chromium RPD, vertical dimension unchanged

Appointment	What happens	Laboratory afterwards
1	Primary impressions and bite registration	Pour, articulate, preliminary survey; base and rim if one is needed
2	Diagnostic MMR — only when the case needs one	Mount at the recorded relationship
3	Preliminary tooth try-in — only when the case needs one	Set up the diagnostic teeth
4	Mouth preparation, special tray try-in and definitive impression	Master cast; resurvey; cast the framework
5	Framework try-in	Add a record base and wax rim to the framework
6	Maxillo-mandibular relationship on the framework	Set the teeth
7	Tooth try-in	Process the denture
8	Insertion	—
9	Review, about two weeks	—

A routine case runs in seven chairside appointments — 2 and 3 are the two that drop out, and a chairside rim collapses 5 and 6 into one. The survey and the design are not an appointment. They are desk work you do on the articulated casts the lab returns, and they are reviewed with the supervisor before any preparation starts. A survey crown, where the design calls for one, runs on PFM Survey Crown Template and adds its own appointments before Appointment 4.

Appointment 1 — Primary impressions and bite registration

Take an alginate impression in a suitable stock tray, modified where it needs it. Accept it only when the relevant teeth and the saddles are captured — this cast is what you will survey and design on.

Then decide how the diagnostic casts will be articulated, because that decides whether you see the patient again before the mouth preparation. Where the occlusion is stable and the patient closes predictably, a PVS bite registration taken now is enough and no further appointment is needed. Where it is not — the vertical dimension is changing, or the patient cannot close predictably — the case needs a diagnostic MMR on a base and rim, and that is Appointment 2.

For an intraoral conformative record you can take here and now: place a slightly tall bite block, soften it, have the patient close into their existing intercuspal position, add a PVS bite record over the wax if needed, and send the impressions and the record together.

Between appointments — laboratory: pour the primary impressions, articulate the casts, and carry out a preliminary survey. Ask for a base and rim as well if Appointment 2 is going ahead. The lab needs the articulated casts to assess the occlusal relationship, the prosthetic space, the likely tooth position, the proposed vertical dimension and the relationship between the abutments and the opposing teeth.

Appointment 2 — Diagnostic MMR

Only when the case needs one. A base and rim is unnecessary when the vertical dimension is not being changed and the patient closes predictably — a PVS bite registration from Appointment 1 does the job, and this appointment does not happen.

Where it is needed, try the base and rim in, check the adaptation and stability, and record the relationship. The rim can be made by the lab, built chairside on the diagnostic cast, or formed intraorally from a warmed bite block.

Between appointments — laboratory: mount the casts at the recorded relationship.

Appointment 3 — Preliminary tooth try-in

Only when the case needs one. Sometimes you need the teeth before the metal. Ask for a diagnostic tooth arrangement when the anterior tooth position is uncertain, when there is a Class II or Class III interarch relationship, when the prosthetic space is limited, when the case is complex, when the denture teeth will sit labial to the ridge rather than over it, when the framework has to be extended labially to support that position, or when the vertical dimension is being changed.

Establish the tooth position here first, and design the framework to it afterwards — not the other way round.

Between appointments — surveying and design (desk work, no patient)

This is where the framework is designed, and it happens as soon as the casts are articulated: after Appointment 1 when a bite registration was enough, after Appointment 2 when a diagnostic MMR was needed, and after Appointment 3 when the tooth position had to be agreed first.

Survey the diagnostic cast to establish the undercuts (measured with the undercut gauge), the path of insertion (marked with the path arrow), the interferences and survey lines, and the support and guidance the design will use.

From that, plan the support, the bracing, the reciprocation and the retention: the rest locations, the retentive and reciprocal clasp positions, the indirect retention, the major and minor connectors, the guide planes, the denture bases, the available prosthetic space, and the mouth preparation the design requires. Size the retentive undercut to the alloy — cobalt- chromium engages 0.25 mm, cast gold 0.50 mm and wrought stainless-steel wire 0.75 mm.

Survey, then design, then prepare — in that order. Review the design with the supervisor and get it approved and documented before any preparation starts, and bring the articulator with the mounted casts to that review.

Then — laboratory: fabricate the special tray.

Appointment 4 — Mouth preparation, special tray try-in and definitive impression

Complete the control phase first — the perio, endo, restorative and surgical work that restores oral health. It has to be finished before the definitive impression is taken, because the cast records the mouth as it was on the day; if any of it happens afterwards and changes the relevant teeth or the ridge, the impression is taken again.

Then the biomechanical phase, which is the preparation the framework design asked for: the rest seats, the guide planes, the enamel recontouring, and the reduction of interferences on the planned path of insertion. Adjust the occlusal plane where it needs it — over-erupted lower anteriors against a missing upper segment, for example. Talk to the technician about the path of insertion and confirm the proposed adjustments in the mouth.

A rest seat you do not have to cut

If there is already space for the metal, the rest can sit on the tooth without preparation. A rounded marginal ridge favours leaving it alone; a marginal ridge with deep V-shaped grooves favours preparing a seat.

If a survey crown is part of the design, it is prepared, made and cemented before this appointment — the framework is surveyed and cast against the finished crown.

Try the tray in: seat it and check the gross extension, the seating, any interference and any sharp edges. Check it in function with cheek, lip and tongue movements, trim wherever the tray is displaced, then repeat and reassess. Border-mould when the functional extension of the base matters — a Kennedy I or II free-end saddle, a long Kennedy IV, a large tissue-supported saddle, or a posterior maxillary extension into functionally relevant soft tissue.

Block out the undercuts. The risk areas are black triangles and open embrasures, gingival recession, tipped teeth, undercuts beneath a bridge or pontic, and mobile or periodontally compromised teeth. Periphery wax, a light-cure gingival barrier, PTFE tape, Oraseal or a temporary restorative material all work. Block out from the buccal so the lingual extension is preserved. Alginate generally flexes out, heavy-body PVS is blocked interproximally, and polyether is always blocked out where undercuts are present.

A locked polyether impression is a genuine emergency

Set polyether locks into undercuts. Getting one out can mean removing a tooth with the impression, sectioning the tray, or cutting the material while it is still in the mouth, with a real risk of injuring the lips and soft tissues. Block out properly before you load it.

Apply tray adhesive. At OCHWA the PVS is Imprint 4 in heavy body, regular body and light body; use medium alone, heavy plus light, or medium plus light, keeping to one generation of the product. Light body goes where the detail matters — and on this pathway that means the rest seats, the guide planes, the prepared tooth surfaces, and the lingual and palatal plate contact areas, because the framework is cast to them.

Verify the preparations before you impress them. Then judge the impression: on a tooth-supported bounded saddle you need the rest seats, the guide planes, the saddle anatomy, the path-of- insertion information and the relevant tooth surfaces; on a free-end or long saddle you need the abutment teeth, the whole denture-bearing area, the buccal and lingual extension, the retromolar pad or tuberosity, and the functional peripheral form.

Between appointments — laboratory: pour the master cast and cast the framework to the approved design. Resurvey the master cast against the plan before the framework is cast.

Resurvey the master cast

The primary and master casts do not necessarily survey identically, because the path of insertion or the way the cast sits can differ. Check the master cast against the plan: path of insertion, guide planes, useful undercuts, rest locations, framework design. Where they differ, that difference tells you whether the path of insertion changed, or a guide plane, a rest or a tooth adjustment was inadequate — while there is still time to fix it.

Appointment 5 — Framework try-in

Prove the framework before anyone adds wax to it.

Start on the master cast: is it fully seated, is it tight, and does it match the prescription? Read that together with the clinical try-in, because some technicians deliberately make a framework tight so that it settles well in the mouth.

Then in the mouth, check it on five points — seating (full adaptation), support (the rests contact), stability (no rocking), retention (the clasps engage), and function (no occlusal or functional interference, with the reciprocal components and occlusal clearance checked). Fit checker or occlusal spray will locate the contacts.

If it does not seat, do not force it. Find the interference. The sources are tooth interference, a guide-plane discrepancy, rest interference, connector interference, a distorted framework, an incorrect path of insertion, an inaccurate definitive impression, a tooth that has moved, a discrepancy between the master cast and the patient, or inadequate mouth preparation. Identify the contact, make a minimal adjustment, reseat, reassess, and repeat only if you have to. Framework components are thin and fracture if over-reduced. Minor clasp adjustment, very limited rest adjustment and acrylic adjustment are what is permissible; adjustments to the clasp assembly need supervision, and you never adjust the terminal third of a retentive arm.

A major discrepancy is a remake, not more grinding. If the framework fits the cast but not the patient, look for clinical interference first, and if there is none, suspect the definitive impression — remaking a framework from the same inaccurate cast will not fix it.

Between appointments — laboratory: add a record base and wax rim to the verified framework.

The chairside rim, and when it is worth doing

You can skip that laboratory step and record the MMR at this same appointment by adapting a rim chairside — it saves an appointment and a laboratory fee. It is reasonable when the framework is stable, the vertical dimension is unchanged, the tooth position is predictable, the patient has adequate natural contacts, and you can control the rim accurately.

Warm the wax, adapt it to the edentulous area without letting it run under the framework or tip it, support it, shape it to the planned tooth position, then reseat and check the framework still seats. Add a PVS bite record over the wax if needed.

Send the framework to the lab for the rim instead when the rim would be unstable, when there is a major change in the vertical dimension, when the jaw relationship is complex, when the tooth position is uncertain, when there is a gap between the natural teeth with nothing to stabilise a chairside rim against, when the edentulous span is large, or when there is not enough time or skill to make a reliable record. The sequence below assumes the laboratory rim — take the chairside route and Appointments 5 and 6 collapse into one.

Appointment 6 — Maxillo-mandibular relationship on the framework

Record the MMR only on a framework you have verified. Seat the framework with its laboratory rim and confirm it still seats fully and that the rim is stable on it, then record the jaw relationship.

The rim is the technician’s blueprint. Record the tooth position, the labial support, the occlusal plane, the overjet, the overbite and the arch form, and mark the midline, the canine lines and the smile line — this matters most in a Kennedy Class IV. Select the shade and the mould.

Altered-cast technique — mandibular Kennedy I and II only

Where the case is a mandibular distal extension, record the free-end saddle in its functional form. With the verified framework and its base plate and wax rim, border-mould the free-end saddle with putty, take a light-body impression of the ridge, then have the lab trim the cast and pour new stone under the saddle.

Finger pressure goes on the rests only — never on the free-end saddle area. Hold constant pressure on the rests until the material has fully set, or the framework lifts. Have the patient move the tongue and retract the cheeks to record the soft tissues in function. The wax rim on the base plate means the bite registration can be taken immediately afterwards.

It is not indicated for the maxilla, where the hard palate supports the saddle, or for Class III. It does not transfer to an acrylic denture, which has no framework to carry the base plate or take the rest pressure.

Between appointments — laboratory: set the teeth.

Appointment 7 — Tooth try-in

A try-in is worth the appointment when several teeth are being replaced, in the aesthetic zone, when the tooth position or the occlusion is uncertain, or when the vertical dimension has been altered.

Assess the tooth position, the size, the shape and the shade, the aesthetics, the phonetics, the occlusion, the retention and stability, the vertical dimension where relevant, and the patient’s acceptance. Confirm the smile line, the canine line, the midline and the labial contour. Check the vertical dimension with shim stock — the patient should hold the shim between the same natural teeth with and without the denture in; if contact is lost with it in, the denture has opened the bite and it is corrected before processing. Move teeth rather than grinding them, and document the patient’s approval.

Between appointments — laboratory: process the denture.

Appointment 8 — Insertion

Work out the path of insertion and seat the denture gently. Where it does not seat, find the initial interference with PIP, occlusal spray or fit checker.

Adjust the acrylic first. The framework was verified before processing, so a new discrepancy is far more likely to be acrylic shrinkage or dimensional change from processing than the metal. Do not over-trim the embrasures, or the patient gets food packing.

Check the insertion on eight points: seating (full adaptation), support (the rests contact), stability (no rocking), retention (the clasps engage), occlusion (no interference), tissues (no impingement), insertion (the correct path confirmed), and removal (the patient can do it themselves). Adjust the acrylic and the occlusion as indicated, and reline if the saddle adaptation is poor — taking the bite registration before the pickup impression.

If the framework itself is discrepant at this stage, stop and reassess for a remake rather than grinding on.

Give care, cleaning and adaptation instructions, and arrange the review.

Appointment 9 — Review, about two weeks

Assess how the patient has adapted and deal with the complaints. Confirm the true pressure points here rather than over-adjusting at insertion: fit checker or light body will show them, and perforations mark strong contact. Trim gradually. Re-check the clasp retention and the occlusion.

Sequence B — cobalt-chromium RPD with an increase in vertical dimension

Appointment	What happens	Laboratory afterwards
1	Primary impressions and records	Study casts; diagnostic base and rim
2	Jaw relations at the new vertical dimension	Mount at the new OVD; diagnostic wax-up
3	Wax-up review and stabilising the new vertical dimension	Special tray
4	Mouth preparation, tray try-in and definitive impression at the new OVD	New master cast; resurvey; cast the framework
5	Framework try-in at the new OVD	Add a record base and wax rim to the framework
6	Maxillo-mandibular relationship at the new OVD	Set the teeth
7	Tooth try-in	Process the denture
8	Insertion	—
9	Review, about two weeks	—

The appointments are Sequence A’s. What changes is that the new vertical dimension is established and stabilised before the definitive impression, and the impression is taken again once the teeth have changed shape.

Appointment 1 — Primary impressions and records

As in Sequence A. The diagnostic base and rim is effectively always needed here, because it is what carries the new vertical dimension.

Appointment 2 — Jaw relations at the new vertical dimension

Establish the target increased vertical dimension on the wax rim rather than recording the existing intercuspal position. Use the extraoral references from the base of the nose to the chin, subtract the freeway space from the resting vertical dimension, and confirm with phonetics. Take the facebow and the jaw relation at the new vertical dimension, select the shade and mould, and mark the landmarks.

Between appointments — laboratory: mount the casts at the new vertical dimension and wax up to it.

Appointment 3 — Wax-up review and stabilising the new vertical dimension

Review the wax-up at the new vertical dimension and confirm the occlusal plane.

Then place the composite build-ups and cement the survey crowns to the planned vertical dimension. Verify comfort, phonetics and occlusion, and allow an adaptation period. A heavily worn dentition often warrants a prosthodontic referral, so assess the complexity before committing. Build-ups and crowns will usually take more than one appointment.

Survey crown and RPD together at a raised vertical dimension

Take the diagnostic MMR first to establish the new vertical dimension. Have the crown waxed up at that dimension before preparing the tooth, so minimal occlusal reduction is needed. After preparing and taking the secondary impression, send another MMR so the lab can articulate the casts for the crown. Only once the crown is cemented do you take the impression and records for the denture. See PFM Survey Crown Template.

Between appointments — surveying and design (desk work, no patient): survey and design the framework against the casts mounted at the new vertical dimension, exactly as in Sequence A, and get the design approved and documented before any preparation starts.

Then — laboratory: make the special tray.

Appointment 4 — Mouth preparation, tray try-in and definitive impression at the new vertical dimension

The teeth are no longer the shape the diagnostic cast recorded. Complete the biomechanical mouth preparation the approved design calls for on the built-up and crowned teeth, then take a new definitive impression and have a new master cast poured. Tray try-in, blockout, material choice and impression assessment are as in Sequence A, Appointment 4.

Between appointments — laboratory: resurvey the new master cast, pour it and cast the framework to the approved design.

Appointments 5 to 9 — Rejoin Sequence A

The framework try-in, the MMR on the laboratory rim, the tooth try-in, the insertion and the review run as in Sequence A — and the MMR is still recorded only on a verified framework. A major change in vertical dimension is one of the reasons to take the laboratory rim rather than a chairside one. Every record from here is taken at the new vertical dimension, and the finished denture is built to it. Provisional composite build-ups can be replaced with definitive onlays or crowns later if that was the plan.

Example laboratory prescriptions

What every slip carries before the job-specific part

The date, the patient details and the return date — enter the return date at least one day before the patient’s appointment. Then the job summary, the models required, the materials requested, the construction details, any enclosed design drawing, decontamination confirmation, the tutor’s signature and D-number, and your contact details. Register the job on LabMagic, and submit the Removable Prosthodontics and Laboratory Stages (Progress Monitor) with the slip — every stage on it is signed before the next one starts. The slip itself is a Titanium eForm; only the dates are editable on screen, so print it to mark the odontogram and write the requirements.

Turnaround runs to about 15 days for some prosthetic work, and a job returned for correction doubles that — so get the instruction right the first time.

What a cobalt-chromium slip has to detail, over and above an acrylic one: the study cast carrying the framework design, the major connector type, the clasp type for each abutment as well as where each clasp sits, and the rest locations — plus the teeth being replaced and the shade, which acrylic needs too. Two things are silent by default and only happen if you ask: bead lines on a maxillary major connector, and relief under a mandibular one.

After Appointment 1 — study casts, articulation and preliminary survey

Dear Lab,

Please pour up the maxillary and mandibular alginate impressions for study models, articulate them using the enclosed bite registration, and carry out a preliminary survey.

[Where the bite cannot be hand-related: Please fabricate an acrylic base with a wax rim for a diagnostic maxillo-mandibular record.]

Thank you.

Ask for an “acrylic base for wax rim (MMR)” in those words. A slip that says only “wax rim” comes back as a wax rim with no rigid base, and it will not hold a record.

After the survey and design — special tray

Dear Lab,

Please fabricate upper and lower special trays as follows: maxillary perforated special tray with 3 mm spacer for an alginate impression; mandibular non-perforated special tray with 2 mm spacer for a PVS impression, with tissue stops.

Thank you.

This one is the lecture’s own worked example (L5 RPD Hindawi). Name the arch, the material, perforated or not, the spacer, whether tissue stops are wanted, and what the impression is for. “Dear Lab, please make special tray” gives you no standing to criticise what comes back.

After Appointment 4 — master cast and framework

Dear Lab,

Please bead, box and pour the enclosed definitive impression as the master cast, and cast a cobalt-chromium framework to the design on the enclosed surveyed study cast.

The tripod reference points are marked on the cast base — please position the master cast to the same path of insertion.

• Major connector: [e.g. anterior-posterior palatal strap / lingual bar].
• Rests on [teeth __].
• Clasps: [tooth __] — [clasp type], retentive arm engaging a 0.25 mm undercut [buccal / lingual]; reciprocal arm on the [__] surface. Repeat for each abutment.
• Guide planes on [teeth __].
• Indirect retention: [__].
• Denture base: mesh over [saddle __], extended over two-thirds of the edentulous ridge [mandible] / covering the tuberosity [maxilla].
• Finish lines: internal finish line as a 90-degree butt joint; external finish line bevelled.
• Relief: [mandibular Kennedy I, II or IV: approximately 1.5 mm under the major connector / Kennedy III: none]. Relief under the mesh, leaving a window for the tissue stops.
• Bead line: [required along the borders of the maxillary major connector, fading out 6 mm from the gingival margins / not required].
• Finish the tissue surface, the major connector, the tooth contact areas and the mesh smooth but not highly polished.

Teeth to be replaced: [__]. Shade [__].

Thank you.

Bead lines and relief are the two the technician will not add on their own. Mandibular connectors take no bead line at all.

After Appointment 5 — framework returned for a record rim

Dear Lab,

The enclosed cobalt-chromium framework has been tried in and verified. Please add an acrylic record base and wax rim to the saddle area for a maxillo-mandibular record, shaped to the planned tooth position, and return it on the master cast.

[Where the altered-cast technique is planned: please add the base plate and wax rim so the free-end saddle can be border-moulded at the next appointment.]

Thank you.

Ask for an “acrylic base for wax rim (MMR)” in those words. A slip that says only “wax rim” comes back without the rigid base, and it will not hold a record.

After Appointment 6 — tooth setting on the framework

Dear Lab,

Please mount the casts using the enclosed facebow and centric relation record, and set up the teeth on the framework for a wax try-in.

Teeth to be replaced: [__]. Shade [__], mould [__].

The midline, canine lines, smile line and labial contour are marked on the rim. Please set the teeth to the marked positions, with [__] mm overjet and [__] mm overbite.

Full-face photographs with the rim in the mouth, smiling and at rest, are attached.

[Altered cast: please trim the master cast at the marked line and pour new stone under the free-end saddle from the enclosed altered-cast impression before mounting.]

Thank you.

After Appointment 7 — processing

Dear Lab,

The wax try-in was approved by the patient [or: approved with the following changes: __].

Please finalise, process, polymerise and finish the denture on the framework as tried in.

Please maintain the waxed labial flange contour through processing — it is carrying the lip support.

Thank you.

Where this wording comes from

The special-tray example is quoted from L5 RPD Hindawi. Everything else here is built to the field lists in L9 Clinical Sequence (“Laboratory Requirements by Denture Type”), L5 Major and Minor Connectors (bead lines, relief, finish lines, mesh extension), L7 Survey and Design and L10 RPDs Summary (path of insertion and tripoding), Laboratory Prescriptions (a complete-denture note, so its rim dimensions do not transfer) and the OCHWA slip checklist in Treatment Planning session 1. The vault holds no worked RPD prescription wording for any stage other than the special tray, so treat these as models to adapt, not as house-approved text.

Copy-pastable checklist — Sequence A, vertical dimension unchanged

COBALT-CHROMIUM REMOVABLE PARTIAL DENTURE — [arch: upper / lower / both] — teeth replaced: [__]

APPOINTMENT 1 — PRIMARY IMPRESSIONS AND BITE REGISTRATION
- Take alginate impressions of both arches in modified stock trays.
- Confirm the relevant teeth and saddles are captured.
- Take a PVS bite registration.
- Decide whether the casts can be articulated from this record, or whether the case needs a diagnostic MMR at Appointment 2.
- Lab work: pour the primary impressions, articulate the casts, and carry out a preliminary survey. Ask for a base and rim as well if Appointment 2 is going ahead.

APPOINTMENT 2 — DIAGNOSTIC MMR (only when the case needs one)
- Try in the base and rim, and check the adaptation and stability.
- Record the jaw relationship.
- Lab work: mount the casts at the recorded relationship.

APPOINTMENT 3 — PRELIMINARY TOOTH TRY-IN (only when the case needs one)
- Assess the diagnostic tooth arrangement and agree the tooth position.
- Lab slip: any changes required.

DESK WORK, NO PATIENT — SURVEY AND DESIGN
- Survey the articulated diagnostic cast and record the undercuts, the path of insertion, the interferences and the survey lines.
- Design the framework: the rest locations, the retentive and reciprocal clasp positions, the indirect retention, the major and minor connectors, the guide planes and the denture bases.
- Size the retentive undercut to the alloy: cobalt-chromium 0.25 mm, cast gold 0.50 mm, wrought stainless-steel wire 0.75 mm.
- List the mouth preparation the design requires.
- Review the design with the supervisor, bringing the articulator with the mounted casts, and get it approved and documented before any preparation starts.
- Lab work: fabricate the special tray.
- Lab slip: the tray material, perforated or non-perforated, the spacer, and whether tissue stops are wanted.
    Alginate: perforated, 3 mm spacer. PVS or polyether: non-perforated, 2 mm spacer.

APPOINTMENT 4 — MOUTH PREPARATION, SPECIAL TRAY TRY-IN AND DEFINITIVE IMPRESSION
- Complete the control phase first: the perio, endo, restorative and surgical work.
- Prepare what the approved design requires: the rest seats, the guide planes, the enamel recontouring, and the reduction of interferences on the path of insertion.
- Adjust the occlusal plane where the design calls for it.
- Confirm the survey crown, where the design includes one, is already cemented.
- Verify every preparation before impressing it.
- Seat the bare tray and check the gross extension, the seating, any interference and any sharp edges.
- Check it in function with cheek, lip and tongue movements, and trim wherever the tray is displaced.
- Decide whether to border-mould.
- Block out the undercuts from the buccal, matching the blockout to the impression material.
- Apply tray adhesive.
- Border-mould if the case calls for it.
- Put light body on the rest seats, the guide planes, the prepared tooth surfaces, and the lingual and palatal plate contact areas, then load the tray and take the impression.
- Assess the impression against what the saddle type requires.
- Lab work: pour the master cast, resurvey it against the plan, and cast the framework to the approved design.

APPOINTMENT 5 — FRAMEWORK TRY-IN
- Check the framework on the master cast first: fully seated, and matching the prescription.
- Try it in the mouth and check five points: seating (full adaptation), support (the rests contact), stability (no rocking), retention (the clasps engage) and function (no occlusal or functional interference).
- Locate any contact with fit checker or occlusal spray.
- If it does not seat, do not force it. Find the interference, adjust minimally, reseat and reassess.
- Never adjust the terminal third of a retentive arm, and get supervision before adjusting a clasp assembly.
- Check the occlusion with the framework seated.
- Lab work: add a record base and wax rim to the verified framework.

APPOINTMENT 6 — MAXILLO-MANDIBULAR RELATIONSHIP ON THE FRAMEWORK
- Seat the framework with its laboratory rim, and confirm it still seats fully and that the rim is stable on it.
- Record the jaw relationship.
- Record the tooth position, the labial support, the occlusal plane, the overjet, the overbite and the arch form.
- Mark the midline, the canine lines and the smile line.
- Select the shade and the mould.
- For a MANDIBULAR Kennedy I or II distal extension, take an altered-cast impression.
    Border-mould the free-end saddle with putty on the framework and its base plate.
    Take a light-body impression of the ridge, keeping constant finger pressure ON THE RESTS ONLY until it has fully set, with the patient moving the tongue and retracting the cheeks.
    Take the bite registration immediately afterwards on the wax rim, and have the lab trim the cast and pour new stone under the saddle.
- Lab work: set the teeth.
- Lab slip: the tooth shape, the shade, and full-face photographs with the rim in the mouth, smiling and at rest.

APPOINTMENT 7 — TOOTH TRY-IN
- Assess the tooth position, size, shape and shade, the aesthetics, the phonetics, the occlusion, the retention and stability, and the vertical dimension.
- Confirm the smile line, the canine line, the midline and the labial contour.
- Check the vertical dimension with shim stock, with and without the denture in.
- Move the teeth rather than grinding them.
- Document the patient's approval.
- Lab work: process the denture.
- Lab slip: any changes required, and full-face photographs with the try-in in the mouth.

APPOINTMENT 8 — INSERTION
- Work out the path of insertion and seat the denture gently. Do not force it.
- Where it does not seat, find the interference with PIP, occlusal spray or fit checker, and adjust the acrylic first.
- Check the insertion on eight points: seating (full adaptation), support (the rests contact), stability (no rocking), retention (the clasps engage), occlusion (no interference on articulating paper), tissues (no impingement, extensions and pressure areas assessed), insertion (the correct path confirmed) and removal (the patient can do it themselves).
- Adjust the acrylic and the occlusion as indicated.
- Reline if the saddle adaptation is poor. Take the bite registration BEFORE the pickup impression.
- Give care, cleaning and adaptation instructions, and arrange the review.

APPOINTMENT 9 — REVIEW, ABOUT TWO WEEKS
- Assess how the patient has adapted and address the complaints.
- Identify the true pressure points with fit checker or light body, and trim gradually.
- Re-check the clasp retention and the occlusion.

Copy-pastable checklist — Sequence B, with an increase in vertical dimension

COBALT-CHROMIUM REMOVABLE PARTIAL DENTURE AT AN INCREASED VERTICAL DIMENSION — [arch: upper / lower / both] — teeth replaced: [__]

APPOINTMENT 1 — PRIMARY IMPRESSIONS AND RECORDS
- Take alginate impressions of both arches in modified stock trays.
- Take a bite registration.
- Lab work: pour the study casts and make a diagnostic base and rim.

APPOINTMENT 2 — JAW RELATIONS AT THE NEW VERTICAL DIMENSION
- Establish the target increased vertical dimension on the wax rim.
- Use the extraoral references from the base of the nose to the chin, and subtract the freeway space from the resting vertical dimension.
- Confirm with phonetics and the closest speaking space.
- Take the facebow and the jaw relation at the new vertical dimension.
- Select the shade and the mould, and mark the midline, the canine lines, the smile line and the labial contour.
- Lab work: mount the casts at the new vertical dimension and wax up to it.

APPOINTMENT 3 — WAX-UP REVIEW AND STABILISING THE NEW VERTICAL DIMENSION
- Review the wax-up at the new vertical dimension and confirm the occlusal plane.
- Place the composite build-ups and cement the survey crowns to the planned vertical dimension.
- Verify the comfort, the phonetics and the occlusion, and allow an adaptation period.
- Where a survey crown is part of the plan: take the diagnostic MMR first, have the crown waxed up at the new dimension before preparing the tooth, send another MMR after preparation for the crown articulation, and take the denture records only once the crown is cemented.
DESK WORK, NO PATIENT — SURVEY AND DESIGN AT THE NEW VERTICAL DIMENSION
- Survey and design the framework against the casts mounted at the new vertical dimension.
- Get the design approved by the supervisor and documented before any preparation starts.
- Lab work: make the special tray.

APPOINTMENT 4 — MOUTH PREPARATION, TRAY TRY-IN AND DEFINITIVE IMPRESSION AT THE NEW VERTICAL DIMENSION
- Complete the control phase before this impression.
- Prepare what the approved design requires on the built-up and crowned teeth.
- Verify every preparation before impressing it.
- Try in the special tray and run the seat, function, trim and reassess loop. Border-mould if the case calls for it.
- Block out the undercuts and apply tray adhesive.
- Take a NEW definitive impression that reflects the built-up teeth and the cemented crowns.
- Put light body on the rest seats, the guide planes and the prepared surfaces.
- Lab work: pour a NEW master cast, resurvey it against the plan, and cast the framework to the approved design.

APPOINTMENT 5 — FRAMEWORK TRY-IN AT THE NEW VERTICAL DIMENSION
- Check the framework on the master cast first, then in the mouth on the five points: seating, support, stability, retention and function.
- Locate any interference with fit checker or occlusal spray. If it does not seat, do not force it.
- Adjust minimally.
- Check the occlusion with the framework seated, at the NEW vertical dimension.
- Lab work: add a record base and wax rim to the verified framework.

APPOINTMENT 6 — MAXILLO-MANDIBULAR RELATIONSHIP AT THE NEW VERTICAL DIMENSION
- Seat the framework with its laboratory rim, and confirm it still seats fully and that the rim is stable on it.
- Record the MMR at the NEW vertical dimension.
- Confirm the midline, the occlusal plane, the labial support and the tooth position on the rim.
- Select the shade and the mould.
- For a mandibular Kennedy I or II distal extension, take an altered-cast impression, with finger pressure ON THE RESTS ONLY.
- Lab work: cross-mount the casts and set the teeth.
- Lab slip: the tooth shape, the shade, and full-face photographs with the rim in the mouth.

APPOINTMENT 7 — TOOTH TRY-IN
- Check the occlusion, the NEW vertical dimension, the aesthetics, the phonetics and the neutral zone.
- Assess the tooth position, the retention and stability, and the patient's acceptance.
- Check the vertical dimension with shim stock.
- Move the teeth rather than grinding them.
- Lab work: process the denture.

APPOINTMENT 8 — INSERTION
- Work out the path of insertion and seat the denture gently.
- Where it does not seat, find the interference with PIP, occlusal spray or fit checker, and adjust the acrylic first.
- Check the eight points: seating, support, stability, retention, occlusion, tissues, insertion and removal.
- Check the occlusion with articulating paper at the NEW vertical dimension.
- Reline if the saddle adaptation is poor. Take the bite registration BEFORE the pickup impression.
- Give care, cleaning and adaptation instructions.

APPOINTMENT 9 — REVIEW, ABOUT TWO WEEKS
- Assess how the patient has adapted and address the complaints.
- Identify the true pressure points with fit checker or light body, and trim gradually.
- Re-check the clasp retention and the occlusion.
- Replace the provisional composite build-ups with definitive onlays or crowns later if that was the plan.