CLINICAL WORKFLOW FOR # Removable Partial Denture DR. AHMAD HENDAWI DR. SHERYL TEO *DR. AHMAD HENDAWI* *DR. SHERYL TEO* Acrylic or Co-Cr? How do I assess the framework? Do I need a secondary impression? Do I need an MMR? Do I border mould? Is this impression good enough? Which impression material? How do I prevent my impression from getting stuck?  - Acrylic or Co-Cr? - Which impression material? - Is this impression good enough? - How do I prevent my impression from getting stuck? - Do I border mould? - Do I need an MMR? - Do I need a secondary impression? - How do I assess the framework? - ==Whether a tooth try-in is needed before processing.== - ==How to identify the first contact when inserting a denture and adjust conservatively.== - ==The workflow should begin with the patient’s overall condition and treatment needs, rather than with the edentulous classification alone.== Decorative illustration of two people thinking, surrounded by question marks and speech bubbles. Acrylic vs Co-Cr?  Acrylic vs Co-Cr? A panoramic dental radiograph (OPG) showing the maxilla and mandible. The image reveals multiple natural teeth with bright radiopaque restorations (fillings or crowns) in the posterior quadrants and a fixed bridge or implant-supported prosthesis replacing teeth in the anterior mandible. ```html <table> <tr> <td> <table> <tr> <td>DIAGNOSE BEFORE YOU DESIGN</td> </tr> <tr> <td>“What denture should I make?”<span style="text-decoration: line-through;">What denture should I make?</span></td> </tr> <tr> <td>“What is happening in this mouth?”</td> </tr> </table> </td> </tr> </table> ``` **Diagnose before you design** - "What denture should I make?" - "What is happening in this mouth?" **EXAMINATION** **Periodontal, restorative, occlusal, anatomical, functional, patient-related factors**  **Examination** Periodontal, restorative, occlusal, anatomical, functional, patient-related factors A composite panel of seven clinical photographs documenting the oral and facial condition of an elderly patient. The images include intraoral views showing severely worn dentition, multiple missing teeth, existing restorations, and carious lesions, as well as extraoral frontal views highlighting significant loss of vertical dimension of occlusion and collapsed lip support.  A composite image featuring clinical photographs of a patient's mouth showing severely worn and decayed teeth, along with extraoral views of the face. The bottom row displays three removable partial dentures (prostheses) with metal frameworks against a black background. CAN THIS TOOTH CONTRIBUTE? What is the individual and overall *prognosis? Periododontal support Mobility Caries / restorability Crown & root anatomy Strategic position Cleansability   What is the individual and overall *prognosis? - Periodontal support - Mobility - Caries / restorability - Crown & root anatomy - Strategic position - Cleansability > [!note] Lecturer — Tooth Contribution > A tooth should not be judged simply as good or bad; its value depends on the planned denture and overall rehabilitation. > > - A restorable tooth with a good prognosis may still be extracted if it does not fit the treatment plan. > - A questionable tooth may be retained when it is a terminal abutment or otherwise crucial to the prosthesis. Radiograph: A periapical dental X-ray showing the lower anterior teeth (incisors and canines). The image illustrates significant alveolar bone loss, with the crestal bone level reduced to approximately the mid-root or apical third of the roots, leaving these teeth with compromised periodontal support. Clinical intraoral photograph showing a row of posterior teeth with visible restorations, including a prominent dark metallic (amalgam) filling on the central tooth and composite or enamel-colored restorations on adjacent teeth. The image illustrates the clinical condition of the dentition relevant to assessing factors like caries, restorability, and cleansability. CAN THIS TOOTH CONTRIBUTE? What is the individual and overall *prognosis*? * Periodontal support * **Mobility** * Caries / restorability * Crown & root anatomy * Strategic position * Cleansability   What is the individual and overall *prognosis*? - Periodontal support - Mobility - Caries / restorability - Crown & root anatomy - Strategic position - Cleansability A dental radiograph showing a row of anterior teeth, likely mandibular incisors and canines. The image illustrates the roots embedded in the alveolar bone, providing visual evidence for assessing factors such as periodontal support and root anatomy. A close-up clinical photograph showing a row of posterior teeth (premolars and molars) in the oral cavity. The central tooth features a large, dark amalgam restoration, while the adjacent tooth above it displays visible enamel cracks on its surface. MOBILITY is a finding, not a prognosis! Why is it mobile? - periodontal disease - trauma from occlusion - periapical infection - traumatic injury - pathologic jaw lesion Is the cause controlled?   > Mobility is a finding, not a prognosis! Why is it mobile? - Periodontal disease - Trauma from occlusion - Periapical infection - Traumatic injury - Pathologic jaw lesion Is the cause controlled? > [!note] Lecturer — Mobility and Material Choice > Mobility itself is not a disease, so its cause should be identified and treated before deciding whether the tooth can contribute. > > - When mobility is caused by trauma from occlusion, manage the occlusal trauma first and then assess the tooth's response. > - A mobile tooth should not automatically be extracted; if mobility improves or does not progress, it may remain suitable for the denture. > - Mobility alone does not determine whether acrylic or cobalt-chromium is selected. A periapical radiograph (labeled 'a') showing the mandibular anterior teeth. The image reveals significant alveolar bone loss, with the crestal bone level reduced to approximately the middle third of the roots, illustrating severe periodontal support reduction. A close-up photograph of a dental model showing an anterior tooth being manipulated with two metal instruments. One instrument presses against the incisal edge while another pushes against the labial surface, illustrating mobility. PERIODONTITIS : stage, grade and current status | | 18 | 17 | 16 | 15 | 14 | 13 | 12 | 11 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | |---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---| | Mobility | | | 0 | | 0 | 0 | 0 | | | | | 0 | 0 | 0 | 0 | | | Implant | | | | | | | | | | | | | | | | | | Furcation | | | | | | | | | | | | | | | | | | Bleeding on Probing | | | | | | | | | | | | | | | | | | Plaque | | | | | | | | | | | | | | | | | | Gingival Margin | 0 -2 0 | | 0 -2 0 -1 -3 -1 -1 -2 -1 | | | 0 -2 0 | | | | | | Probing Depth | 2 1 2 | | 2 1 1 2 2 1 2 1 1 | | | 2 1 2 | | | | | | | Note | Furcation | Bleeding on Probing | Plaque | Gingival Margin | Probing Depth | |---|---|---|---|---|---|---| | | | | | | 0 0 2 1 1 1 | | | | | | | | 0 -2 | | | | | | | | 2 1 2 | | * Buccal The image depicts a dental chart with rows and columns representing teeth and various measurements indicated by blue and red squares. * Lingual * Buccal | | Sr. | 48 | 47 | 46 | 45 | 44 | 43 | 42 | 41 | 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | |---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---| | Gingival Margin | 0 0 2 3 2 3 -2 -3 -2 1 -1 1 -1 -2 -1 -1 -2 -1 -2 -2 1 1 1 1 | | Probing Depth | 3 3 3 3 2 3 3 -2 -2 1 1 2 1 1 1 1 | | Plaque | | | | | | | | | | | | | | | | | | Bleeding on Probing | | | | | | | | | | | | | | | | | | Furcation | | | | | | | | | | | | | | | | | | Implant | | | | | | | | | | | | | | | | | | Mobility | 0 0 0 | | | | | | | | | | | 0 | 0 | | | | | | | | | | | | | | | | 3 | 3 | | | 3 | | | | 4 | 8 | 3 | 0 | BOP% = 15 PD≥5mm Tooth loss BL/Age = 0.32 Envir. Syst./Gen. Polygon surface: 16.45448 Periodontal Risk: **medium**    Periodontitis: stage, grade and current status - BOP% = 15 - PD ≥ 5 mm - Tooth loss - BL/Age = 0.32 - Envir. - Syst./Gen. Polygon surface: 16.45448 Periodontal Risk: **medium** *(Dental chart with rows for Mobility, Implant, Furcation, Bleeding on Probing, Plaque, Gingival Margin, and Probing Depth across teeth 18–28 and 48–38, shown buccal and lingual, with measurements indicated by blue and red squares.)* A dental chart displaying clinical measurements for the upper teeth (quadrants 1 and 2) in a tabular format, including Mobility, Bleeding on Probing, Plaque, Gingival Margin, and Probing Depth. Below the table are schematic diagrams of the upper arch from Buccal and Palatal views, illustrating tooth positions with blue and red lines representing periodontal conditions. A detailed dental chart for the lower arch (mandible), displaying both lingual and buccal views of teeth 31-48. The diagram illustrates the gingival margin levels (red lines) and probing depths (blue areas) relative to the tooth roots, accompanied by tabular data recording measurements for mobility, furcation, bleeding on probing, plaque, and pocket depth. A radar chart (spider plot) visualizing periodontal risk assessment data across six axes. The specific values plotted include BOP% = 15, PD≥5mm, Tooth loss, BL/Age = 0.32, Syst./Gen., and Envir. PERIODONTITIS : stage, grade and current status **[BOX_A]** **PERIODONTITIS: STAGING** Staging intends to classify the severity and extent of a patient's disease based on the measurable amount of destroyed and/or damaged tissue as a result of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management. Initial stage should be determined using clinical attachment loss (CAL). If CAL is not available, radiographic bone loss (RBL) should be used. Tooth loss due to periodontitis may modify stage definition. One or more complexity factors may shift the stage to a higher level. See perio.org/2017wwdc for additional information. | | Periodontitis | Stage I | Stage II | Stage III | Stage IV | | :--- | :--- | :--- | :--- | :--- | :--- | | **Severity** | | | | | | | Interdental CAL<br>*(at site of greatest loss)* | 1 – 2 mm | 3 – 4 mm | ≥5 mm | ≥5 mm | | RBL | Coronal third<br>(<15%) | Coronal third<br>(15% - 33%) | Extending to middle<br>third of root and beyond | Extending to middle<br>third of root and beyond | | Tooth loss<br>*(due to periodontitis)* | No tooth loss | | ≤4 teeth | ≥5 teeth | | **Complexity** | | | | | | | Local | • Max. probing depth<br>≤4 mm<br>• Mostly horizontal<br>bone loss | • Max. probing depth<br>≤5 mm<br>• Mostly horizontal<br>bone loss | In addition to<br>Stage II complexity:<br>• Probing depths<br>≥6 mm<br>• Vertical bone loss<br>≥3 mm<br>• Furcation involvement<br>Class II or III<br>• Moderate ridge defects | In addition to<br>Stage III complexity:<br>• Need for complex<br>rehabilitation due to:<br> – Masticatory dysfunction<br> – Secondary occlusal trauma<br> (tooth mobility degree ≥2)<br> – Severe ridge defects<br> – Bite collapse, drifting, flaring<br> – < 20 remaining teeth<br> (10 opposing pairs) | | **Extent and distribution** | Add to stage as descriptor | For each stage, describe extent as:<br> • Localized (<30% of teeth involved);<br> • Generalized; or<br> • Molar/incisor pattern | | | | **[BOX_B]** **PERIODONTITIS: GRADING** Grading aims to indicate the rate of periodontitis progression, responsiveness to standard therapy, and potential impact on systemic health. Clinicians should initially assume grade B disease and seek specific evidence to shift to grade A or C. See perio.org/2017wwdc for additional information. | | | | Grade A:<br>Slow rate | Grade B:<br>Moderate rate | Grade C:<br>Rapid rate | | :--- | :--- | :--- | :--- | :--- | :--- | | **Primary criteria** | Direct evidence of progression | Radiographic bone loss or CAL | No loss over 5 years | <2 mm over 5 years | ≥2 mm over 5 years | | | Indirect evidence of progression | % bone loss / age | <0.25 | 0.25 to 1.0 | >1.0 | | | | Case phenotype | Heavy biofilm deposits<br>with low levels of<br>destruction | Destruction commensurate<br>with biofilm deposits | Destruction exceeds<br>expectations given biofilm<br>deposits; specific clinical<br>patterns suggestive of periods<br>of rapid progression and/or<br>early onset disease | | **Grade modificators** | Risk factors | smoking | Non-smoker | <10 cigarettes/day | ≥10 cigarettes/day | | | | Diabetes | Normoglycemic/<br>no diagnosis of <br>diabetes | HbA1c <7.0% in patients<br>with diabetes | HbA1c ≥7.0% in patients<br>with diabetes |   Periodontitis: stage, grade and current status #### Periodontitis: Staging Staging intends to classify the severity and extent of a patient's disease based on the measurable amount of destroyed and/or damaged tissue as a result of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management. Initial stage should be determined using clinical attachment loss (CAL). If CAL is not available, radiographic bone loss (RBL) should be used. Tooth loss due to periodontitis may modify stage definition. One or more complexity factors may shift the stage to a higher level. See perio.org/2017wwdc for additional information. | | | Stage I | Stage II | Stage III | Stage IV | | :--- | :--- | :--- | :--- | :--- | :--- | | **Severity** | Interdental CAL *(at site of greatest loss)* | 1 – 2 mm | 3 – 4 mm | ≥5 mm | ≥5 mm | | | RBL | Coronal third (<15%) | Coronal third (15% – 33%) | Extending to middle third of root and beyond | Extending to middle third of root and beyond | | | Tooth loss *(due to periodontitis)* | No tooth loss | | ≤4 teeth | ≥5 teeth | | **Complexity** | Local | • Max. probing depth ≤4 mm • Mostly horizontal bone loss | • Max. probing depth ≤5 mm • Mostly horizontal bone loss | In addition to Stage II complexity: • Probing depths ≥6 mm • Vertical bone loss ≥3 mm • Furcation involvement Class II or III • Moderate ridge defects | In addition to Stage III complexity: • Need for complex rehabilitation due to: – Masticatory dysfunction – Secondary occlusal trauma (tooth mobility degree ≥2) – Severe ridge defects – Bite collapse, drifting, flaring – < 20 remaining teeth (10 opposing pairs) | | **Extent and distribution** | Add to stage as descriptor | For each stage, describe extent as: • Localized (<30% of teeth involved); • Generalized; or • Molar/incisor pattern | | | | #### Periodontitis: Grading Grading aims to indicate the rate of periodontitis progression, responsiveness to standard therapy, and potential impact on systemic health. Clinicians should initially assume grade B disease and seek specific evidence to shift to grade A or C. See perio.org/2017wwdc for additional information. | | | | Grade A: Slow rate | Grade B: Moderate rate | Grade C: Rapid rate | | :--- | :--- | :--- | :--- | :--- | :--- | | **Primary criteria** | Direct evidence of progression | Radiographic bone loss or CAL | No loss over 5 years | <2 mm over 5 years | ≥2 mm over 5 years | | | Indirect evidence of progression | % bone loss / age | <0.25 | 0.25 to 1.0 | >1.0 | | | | Case phenotype | Heavy biofilm deposits with low levels of destruction | Destruction commensurate with biofilm deposits | Destruction exceeds expectations given biofilm deposits; specific clinical patterns suggestive of periods of rapid progression and/or early onset disease | | **Grade modificators** | Risk factors | Smoking | Non-smoker | <10 cigarettes/day | ≥10 cigarettes/day | | | | Diabetes | Normoglycemic / no diagnosis of diabetes | HbA1c <7.0% in patients with diabetes | HbA1c ≥7.0% in patients with diabetes | > [!note] Lecturer — Stage and Grade > The stage and grade influence how prominent the acrylic-versus-cobalt-chromium dilemma becomes. > > - Stages 1 and 2, particularly with grade A progression, may make cobalt-chromium more likely to be selected. > - Stages 3 and 4, particularly grades B and C, create greater uncertainty. > - Stage 4 carries a higher risk of further tooth loss, raising concern that teeth may need extraction soon after the denture is made. A data table titled 'PERIODONTITIS: STAGING' that categorizes the severity and complexity of periodontitis across four stages (Stage I to Stage IV). The columns detail specific clinical criteria for each stage, including interdental CAL, radiographic bone loss (RBL), tooth loss, local complexity factors like probing depths and furcation involvement, and extent descriptors. A grading matrix for periodontitis that classifies disease progression into three categories: Grade A (slow rate), Grade B (moderate rate), and Grade C (rapid rate). The table outlines primary criteria such as direct evidence of bone loss, indirect evidence via % bone loss/age, and case phenotype, alongside grade modifiers like smoking status and diabetes control. # PERIODONTITIS : ## stage, grade and current status ### STAGE - **Periodontitis:** Staging intends to classify the severity and extent of a patient's disease based on the measurable amount of destroyed and/or damaged tissue of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management. - Initial stage should be determined using clinical attachment loss (CAL). If CAL is not available, radiographic bone loss (RBL) should be used. Tooth loss due to periodontitis may modify stage definition. One or more complexity factors may shift the stage to a higher level. #### Periodontitis Staging Table | Periodontitis | Stage I | Stage II | Stage III | Stage IV | | :--- | :--- | :--- | :--- | :--- | | **Severity** | | | | | | Interdental CAL | 1 – 2 mm | 3 – 4 mm | ≥5 mm | ≥5 mm | | (at site of greatest loss) | | | | | | RBL | Coronal third (<15%) | Coronal third (15% – 35%) | Extending to middle third of root and beyond | Extending to middle third bone destruction | | (due to periodontitis) | No tooth loss | | | | | **Complexity** | | | | | | Local | • Max. probing depth <4 mm<br>• Mostly horizontal bone loss | Not applicable (radiographic bone loss <25-30%) | In addition to Stage II: • Vertical bone loss • Class II or III • Complex ridge defects | In addition to Stage III: • Tooth loss (>4 remaining teeth not deploitable) • Severe ridge defects • Bite collapse • < 20 remaining (10 opposing) | | | **Extent and distribution**: • Localized (<30% of teeth involved); • Generalized; or • Molar/incisor pattern | | | | **Text Overlaying Stage:** How severe? How complex? How much destruction? ### GRADE + TODAY - **Periodontitis:** Grading intends to categorize the rate of periodontitis progression, responsiveness to standard therapy, and potential impact on systemic health. - Initially assume grade B disease and seek specific evidence to shift to grade A or C. #### Periodontitis Grading Table | Periodontitis Grading | Grade A: Slow rate | Grade B: Moderate rate | Grade C: Rapid rate | | :--- | :--- | :--- | :--- | | **Progression** | | | | | Rate | ≤5-year | ≥1 mm over 5 years | ≥2 mm over 5 years | | % bone loss / age | <0.25 | 0.25 to 1.0 | >1.0 | | Radiographic changes | Not visible | Visible over 5 years | Significant | | Radiographic bone loss | No significant | Age-related | Destruction exceeds expectations given biofilm control; specific clinical patterns suggestive of periods of rapid progression and/or early onset disease | | **Additional Factors** | | | | | Smoking | Non-smoker | <10 cigarettes/day | ≥10 cigarettes/day | | Diabetes | Normoglycemic/no diagnosis of diabetes | HbA1c <7.0% in patients with diabetes | HbA1c ≥7.0% in patients with diabetes | **Text Overlaying Grade + Today:** How is it behaving? How fast is progression? Is disease controlled today?  Periodontitis: stage, grade and current status #### Stage - Staging intends to classify the severity and extent of a patient's disease based on the measurable amount of destroyed and/or damaged tissue of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management. - Initial stage should be determined using clinical attachment loss (CAL). If CAL is not available, radiographic bone loss (RBL) should be used. Tooth loss due to periodontitis may modify stage definition. One or more complexity factors may shift the stage to a higher level. ##### Periodontitis Staging Table | Periodontitis | Stage I | Stage II | Stage III | Stage IV | | :--- | :--- | :--- | :--- | :--- | | **Severity** — Interdental CAL (at site of greatest loss) | 1 – 2 mm | 3 – 4 mm | ≥5 mm | ≥5 mm | | RBL | Coronal third (<15%) | Coronal third (15% – 35%) | Extending to middle third of root and beyond | Extending to middle third bone destruction | | Tooth loss (due to periodontitis) | No tooth loss | | | | | **Complexity** — Local | • Max. probing depth <4 mm • Mostly horizontal bone loss | Not applicable (radiographic bone loss <25–30%) | In addition to Stage II: • Vertical bone loss • Class II or III • Complex ridge defects | In addition to Stage III: • Tooth loss (>4 remaining teeth not deployable) • Severe ridge defects • Bite collapse • < 20 remaining (10 opposing) | | **Extent and distribution** | • Localized (<30% of teeth involved); • Generalized; or • Molar/incisor pattern | | | | *How severe? How complex? How much destruction?* #### Grade + Today - Grading intends to categorize the rate of periodontitis progression, responsiveness to standard therapy, and potential impact on systemic health. - Initially assume grade B disease and seek specific evidence to shift to grade A or C. ##### Periodontitis Grading Table | Periodontitis Grading | Grade A: Slow rate | Grade B: Moderate rate | Grade C: Rapid rate | | :--- | :--- | :--- | :--- | | **Progression** — Rate | ≤5-year | ≥1 mm over 5 years | ≥2 mm over 5 years | | % bone loss / age | <0.25 | 0.25 to 1.0 | >1.0 | | Radiographic changes | Not visible | Visible over 5 years | Significant | | Radiographic bone loss | No significant | Age-related | Destruction exceeds expectations given biofilm control; specific clinical patterns suggestive of periods of rapid progression and/or early onset disease | | **Additional Factors** — Smoking | Non-smoker | <10 cigarettes/day | ≥10 cigarettes/day | | Diabetes | Normoglycemic / no diagnosis of diabetes | HbA1c <7.0% in patients with diabetes | HbA1c ≥7.0% in patients with diabetes | *How is it behaving? How fast is progression? Is disease controlled today?* A close-up view of a circular object with a teal-green color, featuring an intricate, repeating geometric pattern that resembles a triangular lattice or grid. The surface appears reflective and textured, creating a bright, glowing effect in the center. PERIODONTITIS : stage, grade and current status Periodontitis Staging Staging intends to classify the severity and extent of a patient's disease based on the measurable amount of destroyed and/or damaged tissue of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management. Initial stage should be determined using clinical attachment loss (CAL). If CAL is not available, radiographic bone loss (RBL) should be used. Tooth loss due to periodontitis may modify stage definition. One or more complexity factors may shift the stage to a higher level. See perio.org/2017wwdc for additional | Periodontitis | Stage I | Stage II | Stage III | Stage IV | | :--- | :--- | :--- | :--- | :--- | | **Severity** | | | | | | Interdental CAL (at site of greatest loss) | 1 - 2 mm | 3 - 4 mm | $\ge$5 mm | $\ge$5 mm | | RBL | Coronal third (<15%) | Coronal third (15% - 33%) | Extending to middle third of root and beyond | Extending to middle third of root and beyond | | Tooth loss (due to periodontitis) | Less than 4 teeth | 4 teeth | No limit | No limit | | **Complexity** | | | | | | Local | • $\le$4 mm<br>• Mostly horizontal bone loss | • >4 mm<br>• Mostly horizontal bone loss | • Stage II complexity:<br> - Probing depths $\ge$6 mm<br> - Vertical bone loss $\ge$3 mm<br> - Furcation involvement Class II or III<br> - Moderate ridge defect | • Stage III complexity:<br>• In addition to Stage III complexity:<br>• Masticatory Secondary (tooth mobility)<br>• Bite collapse<br>• < 20 remaining (10 opposites) | | **Extent and distribution** | Add to stage as descriptor | For each stage, describe extent as:<br>• Localized (<30% of teeth involved);<br>• Generalized; or<br>• Molar/incisor pattern | | | | | | Grade A: Slow rate | Grade B: Moderate rate | Grade C: Rapid rate | | :--- | :--- | :--- | :--- | :--- | | **Progression** | Radiographic bone loss, probing depths, and clinical evidence of rapid progression. | No loss over 5 years | < 2 mm over 5 years | $\ge$ 2 mm over 5 years | | | Radiographic bone loss (phase of progression) | | | | | | Case phenotype | Heavy biofilm deposits with low levels of destruction | Destruction commensurate with biofilm deposits | Destruction exceeds expectations given biofilm deposits; specific clinical patterns suggestive of periods of rapid progression and/or early onset disease | | **Risk factors** | | | | | | Smoking | Non-smoker | < 10 cigarettes/day | $\ge$ 10 cigarettes/day | | Diabetes | Normoglycemic/no diagnosis of diabetes | HbA1c < 7.0% in patients with diabetes | HbA1c $\ge$ 7.0% in patients with diabetes | **Grade C** **Grade B** **Grade A**    Periodontitis: stage, grade and current status #### Periodontitis Staging Staging intends to classify the severity and extent of a patient's disease based on the measurable amount of destroyed and/or damaged tissue of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management. Initial stage should be determined using clinical attachment loss (CAL). If CAL is not available, radiographic bone loss (RBL) should be used. Tooth loss due to periodontitis may modify stage definition. One or more complexity factors may shift the stage to a higher level. See perio.org/2017wwdc for additional information. | Periodontitis | Stage I | Stage II | Stage III | Stage IV | | :--- | :--- | :--- | :--- | :--- | | **Severity** — Interdental CAL (at site of greatest loss) | 1 – 2 mm | 3 – 4 mm | ≥5 mm | ≥5 mm | | RBL | Coronal third (<15%) | Coronal third (15% – 33%) | Extending to middle third of root and beyond | Extending to middle third of root and beyond | | Tooth loss (due to periodontitis) | Less than 4 teeth | 4 teeth | No limit | No limit | | **Complexity** — Local | • ≤4 mm • Mostly horizontal bone loss | • >4 mm • Mostly horizontal bone loss | • Stage II complexity: – Probing depths ≥6 mm – Vertical bone loss ≥3 mm – Furcation involvement Class II or III – Moderate ridge defect | • Stage III complexity: – Masticatory dysfunction, secondary (tooth mobility) – Bite collapse – < 20 remaining (10 opposites) | | **Extent and distribution** | Add to stage as descriptor | For each stage, describe extent as: • Localized (<30% of teeth involved); • Generalized; or • Molar/incisor pattern | | | #### Periodontitis Grading | | | Grade A: Slow rate | Grade B: Moderate rate | Grade C: Rapid rate | | :--- | :--- | :--- | :--- | :--- | | **Progression** | Radiographic bone loss, probing depths, and clinical evidence of rapid progression | No loss over 5 years | <2 mm over 5 years | ≥2 mm over 5 years | | | Radiographic bone loss (phase of progression) | | | | | | Case phenotype | Heavy biofilm deposits with low levels of destruction | Destruction commensurate with biofilm deposits | Destruction exceeds expectations given biofilm deposits; specific clinical patterns suggestive of periods of rapid progression and/or early onset disease | | **Risk factors** — Smoking | Non-smoker | <10 cigarettes/day | ≥10 cigarettes/day | | Diabetes | Normoglycemic / no diagnosis of diabetes | HbA1c <7.0% in patients with diabetes | HbA1c ≥7.0% in patients with diabetes | Grade A • Grade B • Grade C A section of a staging table for periodontitis, showing columns for Stage I through IV and rows for Severity (CAL, RBL, Tooth loss), Complexity (Local factors), and Extent. Large yellow text overlaying the right side reads 'Stage III / IV', while large green text below it reads 'Stage I / II'. A close-up photograph of a circular, glowing teal-colored component with a complex, faceted internal pattern resembling a lattice or diamond structure. The object appears to be an optical element or light source emitting a bright, cool-toned illumination. A cropped section of a grading table for periodontitis, overlaid with large, colored text labels 'Grade B' in yellow and 'Grade A' in green. The underlying table lists criteria for disease progression rates, including radiographic bone loss over 5 years and case phenotypes such as biofilm deposits relative to destruction levels. # PROGNOSIS Pros | | | | | | | | | | | | | | - | | | | | | | | | | | | | | Perio | | | | | | | | | | | | | | + | | | | | | | | | | | | | | Endo | | | | | | | | | | | | | | + | | | | | | | | | | | | | | CO2 | + | | + | + | + | | + | | + | | - | | | + | | | | | - | | | | | TTP | - | | | | - | | | - | | | | | Tooth | 18 | 17 | 16 | 15 | 14 | 13 | 12 | 11 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 <br> <br> Tooth | 48 | 47 | 46 | 45 | 44 | 43 | 42 | 41 | 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 TTP | | | | | | | - | - | - | - | - | | | | | CO2 | | | | | | | + | + | + | + | + | | | | | Endo | | | | | | | | | | | | | | | | Perio | | | | | | | | | | | | | | Pros | | | | | | | | | | | | | | | | CPITN | | | | 2 | 2 | 2 - | 2 | - | Caries | Fissure sealant | Unerupted | | Tooth coloured restoration | Tooth wear | Partially erupted | | Amalgam restoration | Retained root | Impacted | | Full Metal Crown | Porcelain-bonded crown | Crack | | **P** Pontic | **PFM** Porcelain-fused metal crown | **]** Fracture | | **]}** Root canal treated | **}]}** Drifted | **]** Supraerupted | Prognoses | Class | Additional factors | Symbol Good | A | Anatomic irregularities | * Fair | B | iatrogenic compromising factors | Questionable | C | | Compromised | D | | Non-salvageable | X | |                                     Prognosis chart by tooth, with factor rows for Pros, Perio, Endo, CO2, and TTP marked positive (+) or negative (−) for teeth 18–28 and 48–38. Charting legend: | Caries | Fissure sealant | Unerupted | |---|---|---| | Tooth coloured restoration | Tooth wear | Partially erupted | | Amalgam restoration | Retained root | Impacted | | Full Metal Crown | Porcelain-bonded crown | Crack | | **P** Pontic | **PFM** Porcelain-fused metal crown | Fracture | | Root canal treated | Drifted | Supraerupted | Prognosis classes: | Prognoses | Class | Additional factors | Symbol | |---|---|---|---| | Good | A | Anatomic irregularities | * | | Fair | B | Iatrogenic compromising factors | | | Questionable | C | | | | Compromised | D | | | | Non-salvageable | X | | | CPITN scores: 2, 2, 2, −, 2, − > [!note] Lecturer — Integrated Prognosis > Prognosis should be considered as a whole rather than tooth by tooth or condition by condition. > > - Integrate periodontal and endodontic prognosis, restorability, occlusal requirements, and patient factors. > - Plan the prosthesis to accommodate the expected likelihood of future extractions or treatment changes. A dental chart table showing the upper right and left quadrants (teeth 18-28). The rows list clinical parameters: Pros (Prosthodontics), Perio (Periodontics), Endo (Endodontics), CO2, and TTP. Cells are color-coded or marked with symbols (+/-) to indicate findings for each tooth. A microscopic image showing a field of crystalline structures, likely viewed under polarized light given the bright cyan coloration against a black background. The crystals appear as numerous small, rectangular or rhomboid shapes scattered throughout the circular field of view. A schematic diagram illustrating a geometric concept, likely related to surface area or projection. It features a square outline containing a central grey rectangle and an upper yellow trapezoid, with arrows indicating rotation and direction. Schematic diagram illustrating a geometric transformation, showing a rectangular shape with yellow triangular sections being manipulated or rotated as indicated by the arrows. A simple geometric icon featuring a central gray horizontal band connecting yellow and white trapezoidal shapes. A yellow square icon featuring a white 'X' or cross shape, likely serving as a symbol for a specific status (such as 'Non-salvageable') within the chart. A stylized graphic icon resembling an envelope or abstract geometric shape, composed of yellow and white polygonal segments with black outlines. The image shows a simple geometric line drawing consisting of an outer square with lines connecting its corners to the corresponding corners of a smaller, concentric inner square. This creates a visual effect resembling a pyramid viewed from above or a rectangular room in perspective. A schematic diagram of a dental arch showing the numbering system for teeth. The top row displays numbers 18 through 28, and the bottom row displays numbers 48 through 38. A black-and-white line drawing of a square containing an inner rectangle, with diagonal lines connecting the corners to create a perspective view resembling a box or room. This is a classic example of an ambiguous figure used in psychology. A simple line drawing of a square with diagonals connecting the corners to a central horizontal line, creating a perspective effect similar to looking down a hallway or at an open box. A simple black-and-white line drawing of a square with an inner rectangle and connecting lines, resembling the top-down view of a pyramid or box. It is a generic geometric symbol without specific context. A simple line drawing of a square containing four diagonal lines connecting the corners to a smaller, central horizontal rectangle. A simple geometric line drawing consisting of a square outline with internal lines connecting the corners to two central points, forming a stylized box or envelope shape. This is a table showing dental prognosis data for the lower anterior teeth (labeled 42, 41, 31, 32, and 33). It lists clinical findings such as TTP (Tenderness to Percussion) and CO2 response, alongside color-coded cells in rows for Endo, perio, and Pros. A legend of dental charting symbols, illustrating various tooth conditions and restorations such as caries, crowns, fractures, and eruption status. Each symbol is paired with its corresponding text label. A small table titled 'CPITN' showing periodontal screening scores, with a row of three '2's and a second row containing '-', '2', '-'. A square symbol with a red circle in the center, used as a legend key for 'Drifted' in the accompanying dental chart. A square graphic featuring a central blue label with the text 'FS' surrounded by a border design. A small, square graphic icon featuring a stylized pyramid or envelope design with red letters 'UE' in the center. The image displays a simple geometric icon or logo consisting of a square outline containing an inner rectangle and two trapezoidal shapes at the top and bottom. The right portion of the central area is filled with yellow, while the rest is white. The image shows a square geometric icon with a smaller central square connected to the corners of the outer square by diagonal lines. A blue letter 'W' is positioned in the top trapezoidal section. A schematic symbol consisting of a square with diagonal lines connecting the corners to a smaller inner rectangle containing the red letters 'PE'. Based on the slide context, this represents a tooth that is partially erupted. A schematic diagram showing a square with an hourglass-shaped gray region in the center and white trapezoidal regions at the top and bottom. A small square icon with a black border containing the red letters 'RR' in the center, likely representing a specific tooth condition or restoration type as part of a legend. A small schematic icon depicting a square with an inner rectangle containing the text 'IMP', representing an impacted tooth in a dental chart. A schematic line drawing of a rectangular tooth crown viewed from the occlusal surface, featuring a red lightning bolt symbol on the right side to indicate a crack or fracture. A yellow circular icon with the text 'Full Metal Crown' inside, positioned within a square frame with diagonal lines. This symbol corresponds to the legend item for 'Full Metal Crown' in the provided slide text. A yellow circular icon containing the black text 'PBC', enclosed within a square frame with diagonal cross-lines. A yellow, rounded rectangular button or tag containing the word "Pontic" in black text. A small graphic icon featuring a yellow circle with the text 'PFM' inside, set against a square background with diagonal lines in the corners. This symbol corresponds to the legend entry for 'Porcelain-fused metal crown'. A square icon with a blue hash symbol (#) in the center. A vertical diagram showing a series of orange, U-shaped loops or curves stacked one above the other. This schematic likely represents a cross-section of tooth roots (specifically the curved roots of mandibular molars) within the alveolar bone. A generic, decorative icon depicting a rectangular box or container with an arrow pointing to the right, symbolizing export, sending, or moving content out. A black and white icon featuring a square with diagonal lines connecting the corners to a smaller central square, containing an upward-pointing arrow. A legend table defining the classification system for tooth prognoses. It lists five categories (Good, Fair, Questionable, Compromised, Non-salvageable) mapped to letter classes (A, B, C, D, X), along with symbols for additional factors: '*' denotes anatomic irregularities and '+' denotes iatrogenic compromising factors. **Acrylic vs Co-Cr?** Acrylic prosthesis: - Lightweight - Poor retention - Risk of fracture Co-Cr prosthesis: - Stronger - Better retention - More expensive  Acrylic prosthesis: - Lightweight - Poor retention - Risk of fracture Co-Cr prosthesis: - Stronger - Better retention - More expensive Radiograph: A panoramic dental X-ray showing the maxilla and mandible with several remaining teeth and a distinct radiopaque dental prosthesis (appearing as a metal framework or implant-supported structure) in the anterior mandible. **WHY CONSIDER...** ## Acrylic * Changing dentition * Questionable prognosis * Future extraction likely * Easy to modify / add teeth * Transitional treatment * Flexibility ## Co-Cr * Rigid * Thin * Less tissue coverage * Design-controlled support & bracing * Potentially more cleansable * ...in the right patient --- **Co-Cr** Acrylic Changing dentition Questionable prognosis Future extraction likely Easy to modify / add teeth Transitional treatment Flexibility Rigid Thin Less tissue coverage Design-controlled support & bracing Potentially more cleansable …in the right patient WHY CONSIDER... #### Acrylic - Changing dentition - Questionable prognosis - Future extraction likely - Easy to modify / add teeth - Transitional treatment - Flexibility #### Co-Cr - Rigid - Thin - Less tissue coverage - Design-controlled support & bracing - Potentially more cleansable - ...in the right patient - ==Extensive caries or uncertain restorability of several teeth== - ==Extremely mobile teeth== - ==Generally lower cost== - ==A well-made acrylic denture can be definitive, although it generally has greater tissue coverage than cobalt-chromium== - ==Less flexible when teeth are expected to be extracted or added later== # WHY CONSIDER... ## Acrylic - Changing dentition - Questionable prognosis - Future extraction likely - Easy to modify / add teeth - Transitional treatment - Flexibility ## Co-Cr - Rigid - Thin - Less tissue coverage - Design-controlled support & bracing - Potentially more cleansable - ...in the right patient #### Acrylic - Changing dentition - Questionable prognosis - Future extraction likely - Easy to modify / add teeth - Transitional treatment - Flexibility #### Co-Cr - Rigid - Thin - Less tissue coverage - Design-controlled support & bracing - Potentially more cleansable - ...in the right patient The patient is part of the design. **1** **b** **iology + prognosis + maintenance + cost + time + expectations = SHARED DECISION** The patient is part of the design. > Biology + prognosis + maintenance + cost + time + expectations = SHARED DECISION > [!note] Lecturer — Previous Prosthesis > The patient's previous prosthesis should be examined as part of the decision. > > - A patient accustomed to a thin cobalt-chromium denture may not tolerate a thicker acrylic prosthesis. > - Determine what worked, what did not work, and how the new design can improve on it. > - Include the patient's willingness to accept the time and cost involved in cobalt-chromium treatment. One patient journey. Two pathways. | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | Primary impression | Preliminary articulation | Preliminary Try-in | Survey + design | Special Tray | Mouth prep | Definitive impression | Framework | MMR | Tooth try-in | Insert | Acrylic  One patient journey. Two pathways. | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | Primary impression | Preliminary articulation | Preliminary Try-in | Survey + design | Special Tray | Mouth prep | Definitive impression | Framework | MMR | Tooth try-in | Insert | - Acrylic A photograph of a removable partial denture framework, likely made of Cobalt-Chromium (Co-Cr) given the metallic appearance. The image shows the metal major connector and clasps, with wax-up areas for the replacement teeth (denture base) on both sides. **** **1** Primary impression **2** Preliminary articulation **3** Preliminary Try-in **4** Survey + design **5** Special Tray **6** Mouth prep **7** Definitive impression **8** Framework **9** MMR **10** Tooth try-in **11** Insert **** Acrylic Co-Cr Definitive impression Special Tray? Primary impression Insert Tooth try-in? MMR? Special Tray+ design Mouth prep Preliminary articulation Survey Preliminary Try-in MMR Dintimont impression Framework   1. Primary impression 2. Preliminary articulation 3. Preliminary Try-in 4. Survey + design 5. Special Tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert - Acrylic - Co-Cr - Definitive impression - Special Tray? - Primary impression - Insert - Tooth try-in? - MMR? - Special Tray + design - Mouth prep - Preliminary articulation - Survey - Preliminary Try-in - MMR - Dintimont impression - Framework - ==Question marks indicate that a special tray, MMR, or tooth try-in may not be required in every case.== - ==Master-cast surveying== - ==Framework try-in== A solid, dark red circle on a black background. No discernible content is present. 1 Primary impression 2 Preliminary articulation 3 Preliminary Try-in 4 Survey + design 5 Special Tray 6 Mouth prep 7 Definitive impression 8 Framework 9 MMR 10 Tooth try-in 11 Insert # Acrylic : 1 - Primary Impression ### Aim: a diagnostic representation of the dentition and edentulous areas   1. Primary impression 2. Preliminary articulation 3. Preliminary Try-in 4. Survey + design 5. Special Tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert **Aim:** a diagnostic representation of the dentition and edentulous areas > [!note] Lecturer — Primary Tray Modification > A stock tray is normally used for the primary impression, but it may need modification to obtain a useful preliminary model. > > - The tray may be modified with compound, putty, green stick, or periphery wax. > - If it is short or contacts the ridge, it can be heated, widened, or extended. > [!note] Lecturer — Secondary Impression Criteria > A secondary impression may not be necessary when the case is tooth bounded or tooth supported, the edentulous space is short, and the primary alginate impression is sufficiently accurate. > > - ==A short bounded space replacing two teeth may not require a special tray if the alginate impression is very good.== > - A definitive impression should be strongly considered when the prosthesis is tissue supported, the acrylic must extend fully into the vestibule or sulcus, or the primary impression does not adequately capture the anatomy. A clinical photograph shows a modified stock impression tray held by a gloved hand, with red alginate impression material loaded into the posterior sections. A clinical photograph showing a lower arch dental impression made of pink alginate material. The impression captures the negative shape of the teeth and surrounding tissues, with circular voids visible where the teeth were located, indicating an edentulous area or specific tooth placement. 1 **Primary** impression **Preliminary** articulation **Survey** + design Special Tray **Mouth** prep **Definitive** impression **Framework** Try-in MMR Tooth try-in **Insert** 11 **2** **3** **4** **5** **6** **7** **8** **9** **10** **Acrylic** : Do we need a secondary impression? Ask about the edentulous span and what the impression must achieve **MAY NOT NEED** * Short bounded saddle * Single missing tooth    The acrylic workflow: 1. Primary impression → 2. Preliminary articulation → 3. Survey + design → 4. Special Tray → 5. Mouth prep → 6. Definitive impression → 7. Framework → 8. Try-in → 9. MMR → 10. Tooth try-in → 11. Insert. Ask about the edentulous span and what the impression must achieve. #### May Not Need - Short bounded saddle - Single missing tooth The image is a generic icon showing a person with a question mark above their head, flanked by arrows pointing to a cross and a checkmark. It represents a decision or choice but contains no specific clinical or anatomical information. A dental arch diagram illustrating a Class III Kennedy classification, depicting a unilateral free-end saddle edentulous area (missing posterior teeth on the left side) bounded anteriorly by natural teeth. The image is an occlusal illustration of a maxillary dental arch showing a single missing lateral incisor on the left side (viewer's left). The gap is bounded by adjacent teeth, depicting a short bounded saddle or single missing tooth scenario. Acrylic : Do we need a secondary impression? Ask about the edentulous span and what the impression must achieve PRIMARY impression Preliminary articulation Survey + design Special Tray Mouth prep Definitive impression Framework Try-in MMR Tooth try-in Insert 1 2 3 4 5 6 7 8 9 10 11 MAY NOT NEED Short bounded saddle Single missing tooth STRONGLY CONSIDER Kennedy I / II free-end saddle Long Kennedy IV Large tissue-supported Kennedy III  Ask about the edentulous span and what the impression must achieve. Workflow: Primary impression → Preliminary articulation → Survey + design → Special Tray → Mouth prep → Definitive impression → Framework → Try-in → MMR → Tooth try-in → Insert (steps 1–11). #### May Not Need - Short bounded saddle - Single missing tooth #### Strongly Consider - Kennedy I / II free-end saddle - Long Kennedy IV - Large tissue-supported Kennedy III A generic white line-art icon on a black background depicting a person's silhouette with a question mark above their head, flanked by left and right arrows, a cross symbol, and a checkmark symbol. It serves as a decorative visual metaphor for decision-making or inquiry. # Primary impression Preliminary articulation Survey + design Mouth prep Definitive impression Framework Preliminary Try-in MMR Tooth try-in Insert # 11 # 5 Special Tray Acrylic : ## PERFORATED TRAY * Alginate → 3mm spacer ## NON-PERFORATED TRAY * PVS * Polyether } 2mm spacer   Workflow: Primary impression → Preliminary articulation → Survey + design → Mouth prep → Definitive impression → Framework → Preliminary Try-in → MMR → Tooth try-in → Insert (steps 1–11; Special Tray is step 5). #### Perforated Tray - Alginate → 3mm spacer #### Non-Perforated Tray - PVS - Polyether Both with a 2mm spacer. > [!note] Lecturer — Spacer Guidelines > These spacer values are general guidelines rather than absolute rules. > > - A little more space may still function, but insufficient space may cause problems. > - The selected impression material should be used according to its instructions because different products may have different setting times and may not mix appropriately. > [!note] Lecturer — Bite Record Routine > A bite record should still be taken routinely, even when a full base and rim MMR may not be required. > > - Take the required impressions, record the bite, assess whether stable contacts are present, and then decide whether a base and rim are required. > - For cases without stable contacts, a diagnostic base and rim may be requested, treating the patient similarly to a complete-denture patient when establishing vertical dimension. A photograph of a white, U-shaped dental tray with multiple perforations on its surface and a handle at the posterior end. This is a special tray used for taking definitive impressions. A clinical photograph showing a white, U-shaped dental impression tray fitted with a blue, tooth-shaped spacer block. The setup illustrates the use of a special tray with a spacer for dental impressions. # 🦷 Stage 5: Special Tray – Dental Workflow & Prescription Essentials ## ⏳ Top Bar Workflow Overview ``` 1 ________ 2 ________ 3 ________ 4 ________ 5 ★ ________ 6 ________ 7 ________ 8 ________ 9 ________ 10 ________ 11 Primary Prem. Artic. Prem. Try-in Survey + design Special Tray Mouth prep Def. Impression Framework MMR Tooth Try-in Insert ``` --- ## MAIN CONTENT: "Acrylic : 5 - Special Tray" ### 🎯 Key Instruction: > **The laboratory / technician needs to know what comes next** ### ✅ What Must Be Specified ON THE PRESCRIPTION: - **Material planned** - **Tray perforated / non-perforated** - **Spacer requirement** - **Purpose of impression → removable / fixed** --- ## 📄 Digital Laboratory Request Form (OHCWA Laboratory Request) ### Header Info: - **Temp Number**: `TEMP00000` - **First Name**: `Peter` - **Last Name**: `Parker` - **Date Of Birth**: `12/09/1954` - **Lab Due Date**: `09/09/2026` - **Clinician**: `Stan Lee D-1922` - **Operator ID**: *(blank)* - **Select Group**: ✅ `DMD3`, ❌ `DMD4`, ❌ `DCD`, ❌ `GDP`, ✅ `SPEC` - **JOB Checkboxes**: - 🟦 Digital Scan — [ ] - 🟩 Impression — [✓] - ✅ Photos In Romexis ### Material Selection Table: | DENT | U | L | CROWN AND BRIDGE | TOOTH | ORTHO | |----------------|---|---|------------------------|-------|----------------| | FULL ACRYL | | | ZIRCONIA | | ESSIX RETAINER | | PART ACRYL | | | EMAX | | URA | | SPECIAL TRAY | ☑ | ☑ | PMMA | | MED STENT | | RELATIONS | | | ENAMIC | | RETAINER | | TRY IN | | | PFM | | TRUTANE | | PROCESS | | | GOLD | | HAWLEY | | CLASPS-(NUM) | | | RESIN BONDED | | TWIN BLOCK | | REPAIR | | | POST AND CORE | | BLEACHING TRAY | | RELINE | | | IMPLANT | | BIONATOR | | SOFTLINER | | | DIAGNOSTIC WAX UP | | SPECIAL TRAY | | CoCr | | | RAD GUIDE | | | | SPLINT | | | SURGICAL GUIDE | | | --- ## 🖼️ Visual Reference Diagrams (Dental Arch Templates + Spacer Drawings) --- ## 📝 handwritten instruction at bottom of form: > **INSTRUCTIONS** > Dear Lab, > Please fabricate Upper and Lower Special tray according to the following: > - Maxillary perforated special tray with 3mm spacer for Alginate impression > - Mandibular non-perforated special tray with 2 mm for PVS impression with tissue stops ---     Workflow overview (steps 1–11, Special Tray is step 5): Primary, Prem. Artic., Prem. Try-in, Survey + design, Special Tray, Mouth prep, Def. Impression, Framework, MMR, Tooth Try-in, Insert. #### Key Instruction > The laboratory / technician needs to know what comes next #### What Must Be Specified on the Prescription - Material planned - Tray perforated / non-perforated - Spacer requirement - Purpose of impression → removable / fixed #### Digital Laboratory Request Form (OHCWA Laboratory Request) - Temp Number: TEMP00000 - First Name: Peter - Last Name: Parker - Date Of Birth: 12/09/1954 - Lab Due Date: 09/09/2026 - Clinician: Stan Lee D-1922 - Operator ID: *(blank)* - Select Group: DMD3 ✓, SPEC ✓; DMD4, DCD, GDP not selected - JOB checkboxes: Digital Scan — [ ], Impression — [✓], Photos In Romexis #### Material Selection Table | DENT | U | L | CROWN AND BRIDGE | TOOTH | ORTHO | |------|---|---|------------------|-------|-------| | FULL ACRYL | | | ZIRCONIA | | ESSIX RETAINER | | PART ACRYL | | | EMAX | | URA | | SPECIAL TRAY | ☑ | ☑ | PMMA | | MED STENT | | RELATIONS | | | ENAMIC | | RETAINER | | TRY IN | | | PFM | | TRUTANE | | PROCESS | | | GOLD | | HAWLEY | | CLASPS-(NUM) | | | RESIN BONDED | | TWIN BLOCK | | REPAIR | | | POST AND CORE | | BLEACHING TRAY | | RELINE | | | IMPLANT | | BIONATOR | | SOFTLINER | | | DIAGNOSTIC WAX UP | | SPECIAL TRAY | | CoCr | | | RAD GUIDE | | | | SPLINT | | | SURGICAL GUIDE | | | *(Visual reference diagrams: dental arch templates + spacer drawings.)* #### Handwritten Instruction at Bottom of Form > INSTRUCTIONS > Dear Lab, > Please fabricate Upper and Lower Special tray according to the following: > - Maxillary perforated special tray with 3mm spacer for Alginate impression > - Mandibular non-perforated special tray with 2 mm for PVS impression with tissue stops > [!note] Lecturer — Laboratory Prescription > The prescription should communicate enough information for the technician to understand the clinical intention rather than requiring the technician to guess the material or design. > > - Specify the tray arch and whether tissue stops are required. > - State the intended prosthesis, such as an acrylic removable partial denture. > - ==A laboratory cannot be criticised for producing an unsuitable tray if the prescription did not provide enough information.== The image displays the official logo of The University of Western Australia, featuring a shield emblem with a black swan and open books on the left, alongside the university's name in blue text on the right. The logo for the Oral Health Centre of Western Australia, featuring a stylized green and blue butterfly icon next to the organization's name. A screenshot of a digital laboratory request form's material selection grid. The table is divided into columns for 'DENTURE' (with Upper/Lower checkboxes), 'CROWN AND BRIDGE', 'TOOTH', and 'ORTHO'. In the Denture column, the 'SPECIAL TRAY' row has both U and L boxes marked with an X. The figure displays four schematic line drawings related to dental arches and tooth morphology. On the left, two diagrams labelled '1' and '4' depict Maxilla and Mandible arches respectively, with red circles highlighting specific teeth marked by black 'X's (likely indicating tissue stops or retention areas). On the right, two unlabelled outlines of individual anterior teeth are shown with internal dashed grid lines. # Acrylic : 1. Primary impression 2. Preliminary articulation 3. Survey + design 4. Mouth prep 5. Definitive impression 6. Framework 7. Preliminary Try-in 8. MMR 9. Tooth try-in 10. Insert 11. Special Tray ## 5 - Special Tray ### INSTRUCTIONS **Dear Lab,** Please make special tray. --- ### INSTRUCTIONS **Dear Lab,** Please fabricate Upper and Lower Special tray according to the following: - Maxillary perforated special tray with 3mm spacer for Alginate impression - Mandibular non-perforated special tray with 2 mm for PVS impression with tissue stops ---   1. Primary impression 2. Preliminary articulation 3. Survey + design 4. Mouth prep 5. Definitive impression 6. Framework 7. Preliminary Try-in 8. MMR 9. Tooth try-in 10. Insert 11. Special Tray #### Instructions (Brief) Dear Lab, Please make special tray. #### Instructions (Detailed) Dear Lab, Please fabricate Upper and Lower Special tray according to the following: - Maxillary perforated special tray with 3mm spacer for Alginate impression - Mandibular non-perforated special tray with 2 mm for PVS impression with tissue stops A red circular emoji face with black 'X' marks for eyes and a large, open black mouth. A simple graphic of a green circular face with an open mouth and happy, arched eyes. Acrylic : 5 - Special Tray | Step | Title | Description | |------|-------|-------------| | 1 | SEAT | check:<br>• gross extension<br>• seating<br>• interference<br>• sharp edges | | 2 | FUNCTION | • cheek/lip manipulation<br>• tongue movements | | 3 | TRIM | adjust areas that displace the tray | | 4 | REASSESS | repeat the same movements | Top timeline (1–11): 1. Primary impression 2. Preliminary articulation 3. Preliminary Try-in 4. Survey + design 5. Special Tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert | Step | Title | Description | |------|-------|-------------| | 1 | SEAT | check: gross extension, seating, interference, sharp edges | | 2 | FUNCTION | cheek/lip manipulation; tongue movements | | 3 | TRIM | adjust areas that displace the tray | | 4 | REASSESS | repeat the same movements | Top timeline (1–11): 1. Primary impression 2. Preliminary articulation 3. Preliminary Try-in 4. Survey + design 5. Special Tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert Acrylic : 7 - Definitive Impressions Does every special tray need border moulding? Border mould when functional base extension matters. COMMON SITUATIONS - Kennedy I / II free-end saddle - Long Kennedy IV - Large tissue-supported saddle - Posterior maxillary extension where the denture base extends into functionally relevant soft tissue areas Does every special tray need border moulding? Border mould when functional base extension matters. #### Common Situations - Kennedy I / II free-end saddle - Long Kennedy IV - Large tissue-supported saddle - Posterior maxillary extension where the denture base extends into functionally relevant soft tissue areas > [!note] Lecturer — Border Moulding Assessment > Border moulding is not required in every partial denture; it is mainly considered when full extension and tissue support are important. > > - Before adding impression material, move the cheeks, lips, and tongue to assess the tray. > - If the tray moves substantially during functional movements, the corresponding border may be overextended. > - ==The goal is no significant movement during functional movements, rather than absolutely no movement under all hand pressure.== **7** Primary impression Preliminary articulation Preliminary Try-in Survey + design Special Tray **5** Mouth prep Definitive impression Framework MMR Tooth try-in Insert 11 **Acrylic : 7 - Definitive impression** Which material? **Polyvinyl Siloxane** **Alginate** **Polyether** <!--CAPTIONS_JSON_START> {"BOX_A": "Polyvinyl Siloxane", "BOX_B": "Alginate", "BOX_C": "Polyether"}    Which material? - Polyvinyl Siloxane - Alginate - Polyether A clinical photograph showing a dental impression tray loaded with a two-material impression system. The tray is coated in a bright green light-body material (visibly fluid with flow lines) overlying a magenta heavy-body material (stiff and bulk-holding) that fills the tooth voids, illustrating the 'wash' or dual-mix technique for capturing fine detail. A composite image showing a purple dental impression of an upper arch alongside a clinical photo of gloved hands mixing pink material in a container on a machine. A photograph showing a dental impression taken with polyether material, identifiable by its characteristic purple color and rigid consistency. The image includes the impression tray handle (labeled BS-3), the set impression capturing teeth and soft tissue, and the product packaging for 3M ESPE Impregum Penta H DuoSoft. **1** Primary impression **2** Preliminary articulation **3** Preliminary Try-in **4** Survey + design **5** Special Tray **6** Mouth prep **7** Definitive impression **8** Framework **9** MMR **10** Tooth try-in **11** Insert Acrylic : 7 - Definitive impression Which material? Polyvinyl Siloxane Alginate Polyether **COMMON** **RARE**  Which material? - Polyvinyl Siloxane - Alginate - Polyether - Common - Rare Clinical photograph of a dental impression tray filled with green and purple polyvinyl siloxane (PVS) impression material. The image illustrates the 'COMMON' category of material distribution, showing significant wash-out or voids in the tooth areas where the material has failed to capture detail. --- **1** Primary impression **2** Preliminary articulation **3** Preliminary Try-in **4** Survey + design **5** Special Tray **6** Mouth prep **7** Definitive impression **8** Framework **9** MMR **10** Tooth try-in **11** Insert # Acrylic : 7 - Definitive impression Polyvinyl Siloxane (PVS) HEAVY MEDIUM  Polyvinyl Siloxane (PVS) - Heavy - Medium > [!note] Lecturer — Impression Material Selection > At the dental school, PVS, including medium and light body combinations, was commonly used, although different clinicians may prefer different combinations such as heavy and light body. > > - Alginate can provide an acceptable definitive impression when the material and technique are appropriate. > - Experienced clinicians may use alginate for final impressions, but the alginate used and the clinician’s familiarity with it influence the result. A product photograph of a dual-syringe package for dental impression material, featuring white barrels with a yellow mixing tip and a pink label. The text on the label identifies it as 3M Impregum P4 Light Body polyvinyl siloxane (PVS) impression material. # Acrylic ## 7 - Definitive impression <table> <thead> <tr> <th>#</th> <th>Step</th> </tr> </thead> <tbody> <tr> <td>1</td> <td>Primary impression</td> </tr> <tr> <td>2</td> <td>Preliminary articulation</td> </tr> <tr> <td>3</td> <td>Preliminary Try-in</td> </tr> <tr> <td>4</td> <td>Survey + design</td> </tr> <tr> <td>5</td> <td>Special Tray</td> </tr> <tr> <td>6</td> <td>Mouth prep</td> </tr> <tr> <td>7</td> <td>Definitive impression</td> </tr> <tr> <td>8</td> <td>Framework</td> </tr> <tr> <td>9</td> <td>MMR</td> </tr> <tr> <td>10</td> <td>Tooth try-in</td> </tr> <tr> <td>11</td> <td>Insert</td> </tr> </tbody> </table> # Why light body? ## WHERE DETAIL MATTERS * Rest seats * Guide planes * Prepared tooth surfaces * Lingual plate contact * Palatal plate contact </img>Dental model showing impression technique</img> </img>Injectable dental implant sleeve</img>   #### Why Light Body? **Where detail matters:** - Rest seats - Guide planes - Prepared tooth surfaces - Lingual plate contact - Palatal plate contact *Dental model showing impression technique; injectable dental implant sleeve.* > [!note] Lecturer — Light Body Placement > Light body is useful for capturing surface detail in areas where a heavier material may drag or fail to record anatomy. > > - It may be placed on the teeth, tissues, in the tray, or in selected areas requiring greater surface detail. > - For a straightforward acrylic denture, medium-body material may be sufficient. Clinical photo showing a dental impression in the mouth with yellow material. A product photograph of a dental impression material cartridge, specifically 3M Impregum™ 4 Light. The cartridge features a yellow cap and a purple label indicating 'Light-Body Consistency' and a volume of 5 mL. 1 2 3 4 5 6 7 8 9 10 11 Primary impression Preliminary articulation Preliminary Try-in Survey + design Special Tray Mouth prep Definitive impression Framework MMR Tooth try-in Insert **7** Acrylic : **7** - Definitive impression Block out **SPOT THE RISK** * Black triangles / open embrasures / large interdental spaces * Gingival recession * Tipped teeth * Bridge or pontic undercuts * Mobile / periodontally compromised teeth **BLOCK OUT** * Periphery wax * Light-cure gingival barrier * PTFE / Teflon tape * Oraseal * Temporary restorative material   #### Spot the Risk - Black triangles / open embrasures / large interdental spaces - Gingival recession - Tipped teeth - Bridge or pontic undercuts - Mobile / periodontally compromised teeth #### Block Out - Periphery wax - Light-cure gingival barrier - PTFE / Teflon tape - Oraseal - Temporary restorative material > [!note] Lecturer — Undercut Block-Out > Undercuts should be blocked out when impression material may lock into them, especially with polyether, heavy PVS, or deep interproximal and tooth undercuts. > > - Polyether becomes very rigid and should not be used without blocking significant undercuts. > - Removal may otherwise require sectioning the tray or cutting the impression and may risk soft-tissue injury. > - Block-out should prevent locking while still allowing the material to extend into the required area. > [!note] Lecturer — Impression Defects > The impression should be assessed before acceptance for defects that affect the planned denture area. > > - Check for bubbles, drags, tears, or gaps, as well as the ridge, vestibular anatomy, abutments, rest seats, and guide planes. > - A defect between teeth may be acceptable if no acrylic or denture component will occupy that area. > - ==A major defect in a retromolar pad or buccal shelf area is not acceptable when those areas are required for support or extension.== A product photograph showing two dental dispensing syringes against a black background. The upper syringe is labeled 'OraSeal Caulking' and the lower blue syringe is labeled 'OpalDam Light Cured Gingival Barrier', illustrating specific materials used for blockout procedures. A photograph of a product label for "Periphery Wax Sticks" from Ainsworth Dental. The label describes the item as an "Adaptable wax to expand the periphery of impression trays" and lists the weight as 100g with checkboxes for "Soft" and "Hard". # Slide 1 Timeline 1. Primary impression 2. Preliminary articulation 3. Preliminary Try-in 4. Survey + design 5. Special Tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert # Main Content **Acrylic :** 7 - Definitive impression Did it record what I needed? ### TOOTH-SUPPORTED / BOUNDED SADDLE * Rest seats / guide planes * Saddle anatomy * Path-of-insertion information and relevant tooth surfaces ### FREE-END / LONG SADDLE * Abutment teeth * Entire denture-bearing area * Buccal + lingual extension * Retromolar pad / tuberosity * Functional peripheral form   Did it record what I needed? #### Tooth-Supported / Bounded Saddle - Rest seats / guide planes - Saddle anatomy - Path-of-insertion information and relevant tooth surfaces #### Free-End / Long Saddle - Abutment teeth - Entire denture-bearing area - Buccal + lingual extension - Retromolar pad / tuberosity - Functional peripheral form Clinical photograph of a yellow custom impression tray seated over purple modeling material, with a blue arrow pointing to a small rectangular window cut into the tray's anterior region. A split-screen clinical photograph comparing two views of a lower jaw dental model held by a gloved hand, illustrating the quality of an impression. The left side is marked with a green happy face emoji to indicate a correct result where the abutment teeth are clearly recorded, while the right side is marked with a red sad face emoji to indicate a failure where those areas are missing. # Acrylic : 9- MMR When do I need an MMR? ## REQUIRED / ESSENTIAL * Kennedy I / II free-end saddle * Long Kennedy IV * Unstable occlusal stops * VDO change  #### When Do I Need an MMR? **Required / Essential:** - Kennedy I / II free-end saddle - Long Kennedy IV - Unstable occlusal stops - VDO change A schematic diagram illustrating a dental arch classification, likely Kennedy Class I. It depicts the maxillary and mandibular teeth arranged in horseshoe shapes against a black background, showing bilateral edentulous areas located posterior to the remaining natural teeth. # Acrylic : 9- MMR ## When do I need an MMR? ### NOT ESSENTIAL * Kennedy III (when hand articulation is possible) The timeline for the procedure is as follows: 1. Primary impression 2. Preliminary articulation 3. Preliminary Try-in 4. Survey + design 5. Special Tray 6. Mouth prep 7. Definitive impression 8. Framework 9. **MMR** 10. Tooth try-in 11. Insert  #### When Do I Need an MMR? **Not essential:** - Kennedy III (when hand articulation is possible) #### Procedure Timeline 1. Primary impression 2. Preliminary articulation 3. Preliminary try-in 4. Survey + design 5. Special tray 6. Mouth prep 7. Definitive impression 8. Framework 9. **MMR** 10. Tooth try-in 11. Insert A schematic diagram showing occlusal views of individual teeth arranged in arch forms against a black background. The layout depicts multiple segments, including posterior teeth and anterior teeth, likely representing a dental survey or diagnostic setup for prosthodontic planning. # 1 Primary impression # 2 Preliminary articulation # 3 Preliminary Try-in # 4 Survey + design # 5 Special Tray # 6 Mouth prep # 7 Definitive impression # 8 Framework # 9 MMR # 10 Tooth try-in # 11 Insert **Acrylic : 9- MMR** When do I need an MMR? Do not ask only: "Can the patient bite together?" Ask: "Can the technician articulate these casts predictably?"  #### Procedure Timeline 1. Primary impression 2. Preliminary articulation 3. Preliminary try-in 4. Survey + design 5. Special tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert #### When Do I Need an MMR? Do not ask only: > "Can the patient bite together?" Ask: > "Can the technician articulate these casts predictably?" A composite of three clinical photographs showing a patient's mouth and dental casts mounted on an articulator. The images display a removable partial denture framework with pink acrylic record bases used to register the bite (MMR). One photo shows the intraoral view, while the others demonstrate how these records allow the technician to mount the upper and lower casts in correct occlusion. 1. Primary impression 2. Preliminary articulation 3. Preliminary Try-in 4. Survey + design 5. Special Tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert **1** **2** **3** **4** **5** **6** **7** **8** **9** **10** **11** Acrylic: 9- MMR Practical MMR guide for acrylic RPDs - “cast-rocking test” PUT THE MODELS TOGETHER * Are they stable? * Are they rocking / sliding?     #### Procedure Timeline 1. Primary impression 2. Preliminary articulation 3. Preliminary try-in 4. Survey + design 5. Special tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert #### Cast-Rocking Test Practical MMR guide for acrylic RPDs — "cast-rocking test" Put the models together: - Are they stable? - Are they rocking / sliding? > [!note] Lecturer — Bite Record Checking > The bite record itself must be checked before it is accepted. > > - Look for perforations and bubbles, confirm that the contacts correspond to the patient’s mouth, and remove excess material from interproximal areas. > - A record extending into interproximal areas may prevent the casts from seating properly and create an artificially open articulation. A close-up photograph of a smooth, white, dome-shaped object, likely made of plaster or acrylic, set against a black background. A distinct crack runs across the lower center of the object's surface. A studio product photograph of a handheld butane torch or blowtorch, featuring a black cylindrical fuel canister and base with a silver metallic head and red ignition button. Clinical photo of a commercial package containing multiple pink, rectangular bite blocks arranged in rows. The box label identifies the contents as "Bite Blocks" for detailed occlusal records. A clinical photograph shows a dental articulator (specifically labeled 'Denar Upper' and 'Denar Lower') holding pink maxillary and mandibular study models with teeth. The device is positioned to demonstrate the relationship between the two arches, illustrating the setup for checking stability or performing a cast-rocking test. **Primary impression** **Preliminary articulation** **Preliminary Try-in** **Survey + design** **Special Tray** **Mouth prep** **Definitive impression** **Framework** **MMR** **Tooth try-in** **Insert** # Acrylic : 9- MMR ## Can I scan the bite? **MORE PREDICTABLE** * Short bounded saddle * Stable teeth * Good access + moisture control * Reliable occlusal landmarks * Minimal tissue displacement **MORE CHALLENGING** * Long edentulous span * Free-end saddle * Mobile / displaceable tissues * Functional border required * Limited access or difficult tongue/cheek control * Few stable occlusal landmarks The scan can look beautiful... but the bite can stll be wrong Always validate the digital record clinically  #### Can I Scan the Bite? **More predictable:** - Short bounded saddle - Stable teeth - Good access + moisture control - Reliable occlusal landmarks - Minimal tissue displacement **More challenging:** - Long edentulous span - Free-end saddle - Mobile / displaceable tissues - Functional border required - Limited access or difficult tongue/cheek control - Few stable occlusal landmarks The scan can look beautiful... but the bite can still be wrong. > Always validate the digital record clinically. > [!note] Lecturer — Digital Bite Scanning > Digital bite scanning becomes more difficult with free-end saddles, long edentulous spaces, mandibular scans, saliva, or a lack of posterior contacts. > > - Examine the digital occlusion before exporting the record; a contact-only display may show that the scanner has failed to identify contacts present clinically. > - When following a conventional workflow, remain within that workflow rather than moving unnecessarily between digital records and printed models. A horizontal process timeline consisting of numbered circles connected by lines. Step 9 is highlighted with a solid red circle and white text, indicating the current stage in the workflow. # Navigation Bar 1 Primary impression 2 Preliminary articulation 3 Preliminary Try-in 4 Survey + design 5 Special Tray 6 Mouth prep 7 Definitive impression 8 Framework 9 MMR <kbd>1</kbd> 10 Tooth try-in 11 Insert # Content Area **Acrylic : 9- MMR** Can I scan the bite? **Mar 04, 2026 // 15 min read** **Guidelines for Digital Interocclusal Records: Part 1 – Dentate and Partially Dentate Patients** **Ahmad Hendawi** Ahmad Hendawi, Sheryl Teo, Adam Hamilton Adam Hendawi, Aaron Wong, Sheryl Teo, Adam Hamilton Ahmad Hendawi, Aaron Wong, Sheryl Teo, Adam Hamilton **Adam Hamilton** <kbd>i</kbd> <kbd>i</kbd> <kbd>i</kbd> **Aaron Wong** <kbd>i</kbd> **Sheryl Teo** <kbd>1</kbd> Adam Hamilton <kbd>1</kbd> Amazon <kbd>1</kbd> Amazon <kbd>1</kbd> Amazon DOI: **10.63580/ITI.FI.45775**         #### Can I Scan the Bite? *Guidelines for Digital Interocclusal Records: Part 1 – Dentate and Partially Dentate Patients* *Mar 04, 2026 // 15 min read* *Ahmad Hendawi, Sheryl Teo, Adam Hamilton, Aaron Wong* DOI: **10.63580/ITI.FI.45775** A black-and-white square matrix barcode with three distinct finder patterns located in the corners. A 3D digital rendering of a dental interocclusal record showing the maxillary and mandibular arches in a closed, occluded position. The model depicts pink gingival tissues and natural teeth, including a molar with a large dark occlusal restoration on the left side and anterior teeth with visible wear facets. A circular headshot photograph of a smiling man with short dark hair and a mustache, wearing a white collared shirt against a grey background. The image shows the name 'Ahmad Hendawi' above two social media icons: a purple Instagram logo and a purple LinkedIn logo. A circular headshot of a smiling man with short brown hair, wearing a suit and tie. This appears to be an author profile image. A circular portrait photo of a smiling man with short dark hair, wearing a blue shirt and tie. A row of three social media icons (Facebook, Instagram, and LinkedIn) displayed below the name 'Adam Hamilton'. A circular headshot of a smiling woman with long dark hair, positioned in the right column of the slide. - 5 - direct - 7 use Acrylic: 10/11 - Tooth try-in or direct finish? pdfslides acrylic ## Acrylic : 10 / 11 - Tooth try-in or direct finish? TOOTH TRY-IN IS PREFERRED * Multiple teeth * Aesthetic zone * Uncertain tooth position * Occlusal uncertainty * Altered VDO * Clinician/student uncertainty DIRECT FINISH MAY BE REASONABLE * Single straightforward tooth * Good neighbouring references * Stable occlusion * Minimal aesthetic risk TOOTH TRY-IN: WHAT ARE YOU APPROVING? * Tooth position * Aesthetics * Phonetics * Occlusion * VDO (where relevant) * Patient acceptance #### Tooth Try-In Is Preferred - Multiple teeth - Aesthetic zone - Uncertain tooth position - Occlusal uncertainty - Altered VDO - Clinician/student uncertainty #### Direct Finish May Be Reasonable - Single straightforward tooth - Good neighbouring references - Stable occlusion - Minimal aesthetic risk #### Tooth Try-In: What Are You Approving? - Tooth position - Aesthetics - Phonetics - Occlusion - VDO (where relevant) - Patient acceptance > [!note] Lecturer — Shade Documentation > When direct finishing is selected, a shade tab and a photograph of the shade in the patient’s mouth should be sent to the laboratory. > > - ==The photograph helps the technician verify the shade under the relevant clinical conditions.== > [!note] Lecturer — Try-In Assessment > The try-in should also be assessed for the smile line, canine line, midline, tooth size and shape, shade, retention, stability, and patient satisfaction. > > - The patient should confirm that the appearance is acceptable before processing. > - Vertical dimension can be checked by comparing natural tooth contact with denture tooth contact using shim stock between the same natural teeth with and without the denture. # Acrylic: 11 - Insert ### Top Progress Bar Primary impression Preliminary articulation Preliminary Try-in Survey +design Special Tray 1 2 3 4 5 Mouth prep Definitive impression 6 7 Framework MMR 8 9 Tooth try-in Insert 10 11 DO NOT JAM IT IN! PATH OF INSERTION * Posterior → anterior? * Right → left? * Simultaneous seating? LOOK FOR THE FIRST CONTACT, THEN ADJUST CONSERVATIVELY 1. Rigid acrylic interface 2. Clasp  > DO NOT JAM IT IN! #### Path of Insertion - Posterior → anterior? - Right → left? - Simultaneous seating? #### Look for the First Contact, Then Adjust Conservatively 1. Rigid acrylic interface 2. Clasp > [!note] Lecturer — Conservative Insertion Adjustment > Adjustments should be gradual: identify the first contact, remove a small amount of material, reseat the denture, and reassess. > > - Avoid large adjustments or prolonged adjustment without reassessing the cause. > - Over-trimming can open embrasures and cause food packing. > [!note] Lecturer — Surveyed Crown Risk > For a cracked tooth being considered for a surveyed crown, the patient should be informed that the tooth may fail. > > - A crown may brace the tooth, but adding a rest may affect the risk. > - The design should be assessed and approved before treatment. A clinical photograph of a dental arch showing a removable partial denture (RPD) in situ. The appliance features pink acrylic resin bases, artificial teeth, and metal clasps engaging the natural abutment teeth. WHY CONSIDER... **Acrylic** Changing dentition Questionable prognosis Future extraction likely Easy to modify / add teeth Transitional treatment Flexibility **Co-Cr** Rigid Thin Less tissue coverage Design-controlled support & bracing Potentially more cleansable ...in the right patient #### Why Consider Co-Cr #### Acrylic vs Co-Cr **Acrylic** - Changing dentition - Questionable prognosis - Future extraction likely - Easy to modify / add teeth - Transitional treatment - Flexibility **Co-Cr** - Rigid - Thin - Less tissue coverage - Design-controlled support & bracing - Potentially more cleansable > ...in the right patient # Acrylic Co-Cr 1. **Primary impression** 2. **Preliminary articulation** 3. **Preliminary Try-in** 4. **Survey + design** 5. **Special Tray** 6. **Mouth prep** 7. **Definitive impression** 8. **Framework** 9. **MMR** 10. **Tooth try-in** 11. **Insert** <div><table> <tr> <th>Process</th> <th>Acrylic</th> <th>Co-Cr</th> </tr> <tr> <td>Primary impression</td> <td>绿色</td> <td>绿色</td> </tr> <tr> <td>Preliminary articulation</td> <td>绿色</td> <td>绿色</td> </tr> <tr> <td>Preliminary Try-in</td> <td>黄色</td> <td>绿色</td> </tr> <tr> <td>Survey + design</td> <td>绿色</td> <td>绿色</td> </tr> <tr> <td>Special Tray</td> <td>--</td> <td>--</td> </tr> <tr> <td>Mouth prep</td> <td>--</td> <td>绿色</td> </tr> <tr> <td>Definitive impression</td> <td>--</td> <td>--</td> </tr> <tr> <td>Framework</td> <td>--</td> <td>绿色</td> </tr> <tr> <td>MMR</td> <td>--</td> <td>绿色</td> </tr> <tr> <td>Tooth try-in</td> <td>--</td> <td>--</td> </tr> <tr> <td>Insert</td> <td>--</td> <td>--</td> </tr> </table></div> #### Workflow Overview 1. Primary impression 2. Preliminary articulation 3. Preliminary try-in 4. Survey + design 5. Special tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert #### Process Comparison: Acrylic vs Co-Cr | Process | Acrylic | Co-Cr | |---|---|---| | Primary impression | Green | Green | | Preliminary articulation | Green | Green | | Preliminary try-in | Yellow | Green | | Survey + design | Green | Green | | Special tray | -- | -- | | Mouth prep | -- | Green | | Definitive impression | -- | -- | | Framework | -- | Green | | MMR | -- | Green | | Tooth try-in | -- | -- | | Insert | -- | -- | # Co-Cr : 2 - Preliminary articulation ## Primary impression | Preliminary articulation | Preliminary Try-in | Survey + design | Special Tray | Mouth prep | Definitive impression | Framework | MMR | Tooth try-in | Insert ## How can I articulate the diagnostic casts? **PVS BITE REGISTRATION** **DIAGNOSTIC MMR** Base and occlusal rim fabricated intraorally / on the study model or requested from the laboratory 1 2 3 4 5 6 7 8 9 10 11    #### How Can I Articulate the Diagnostic Casts? **PVS bite registration** **Diagnostic MMR** - Base and occlusal rim fabricated intraorally / on the study model, or requested from the laboratory A white arrow pointing diagonally downwards to the left against a black background. It serves as a directional indicator, likely pointing to a specific step or item in the adjacent workflow diagram. Clinical close-up photograph showing a purple polyvinyl siloxane (PVS) bite registration material placed between the maxillary and mandibular anterior teeth. The viscous impression material is captured in the act of registering the occlusal relationship, with the patient's teeth and gingiva visible surrounding the purple substance. A simple white arrow pointing diagonally downwards to the right against a black background. **1 — Primary impression** **2 — Preliminary articulation** **3 — Preliminary Try-in** **4 — Survey + design** **5 — Special Tray** **6 — Mouth prep** **7 — Definitive impression** **8 — Framework** **9 — MMR** **10 — Tooth try-in** **11 — Insert** Title Co-Cr: 3 - Preliminary Try-in Sometimes you need the teeth before the metal Flowchart / Text **CONSIDER DIAGNOSTIC TOOTH ARRANGEMENT WHEN** **ESTABLISH TOOTH POSITION FIRST** **DESIGN FRAMEWORK ACCORDINGLY** Bulleted List - Anterior tooth position is uncertain - Class II / III interarch relationship - Limited prosthetic space - Framework must support an unusual tooth position   #### Preliminary Try-In *Sometimes you need the teeth before the metal.* #### Consider Diagnostic Tooth Arrangement When - Anterior tooth position is uncertain - Class II / III interarch relationship - Limited prosthetic space - Framework must support an unusual tooth position > Establish tooth position first, then design the framework accordingly. Clinical photo: An intraoral frontal view showing a preliminary try-in of prosthetic teeth. The image displays artificial anterior teeth in the upper arch positioned against natural, worn lower teeth and red gingival tissue. A digital intraoral scan or 3D model of a maxillary arch showing a Kennedy Class IV edentulous situation (missing anterior teeth). Diagnostic tooth arrangement is visualized with virtual wax-up teeth positioned in the posterior quadrants and canine regions to establish tooth position before framework design. **1** Primary impression **2** Preliminary articulation **3** Preliminary Try-in **4** Survey + design **5** Special Tray **6** Mouth prep **7** Definitive impression **8** Framework **9** MMR **10** Tooth try-in **11** Insert Co-Cr : 4 - Survey and Design What does the preliminary survey tell you? THE SURVEY ANSWERS: * Undercuts * Path of insertion * Interferences * Support and guidance SURVEY ↓ DESIGN ↓ PREPARE SURVEYED DIAGNOSTIC CAST WITH: * Survey line * Undercut gauge * Proposed rest * Guide plane * Path arrow   #### What Does the Preliminary Survey Tell You? The survey answers: - Undercuts - Path of insertion - Interferences - Support and guidance Survey → Design → Prepare #### Surveyed Diagnostic Cast Includes - Survey line - Undercut gauge - Proposed rest - Guide plane - Path arrow - ==Rest locations, retentive and reciprocal clasp positions, indirect retention, and available prosthetic space== > [!note] Lecturer — Articulated Casts > The survey should be reviewed on articulated casts when occlusion and available space are relevant. > > - The articulated casts should remain on an articulator during assessment. > - Two unmounted casts do not provide the same information. A close-up photograph of a diagnostic dental cast showing the buccal surfaces of posterior teeth. A dark, wavy survey line is marked on the tooth surface, and a vertical metal undercut gauge (surveyor blade) is positioned against the tooth to measure the depth of the undercut. A clinical photograph showing a dental surveyor analyzing a diagnostic cast. The metal instrument probes the teeth to determine the path of insertion and identify undercuts. **6** **1** **2** **3** **4** **5** **6** **7** **8** **9** **10** **11** Primary impression Preliminary articulation Preliminary Try-in Survey + design Special Tray Mouth prep Definitive impression Framework MMR Tooth try-in Insert **Co-Cr : 6 - Mouth Prep** **Mouth preparation is design-driven** *Every preparation should have a reason* * Rest seats * Guide planes * Enamel recontouring * Interference reduction where appropriate    #### Mouth Preparation Is Design-Driven *Every preparation should have a reason.* - Rest seats - Guide planes - Enamel recontouring - Interference reduction where appropriate > [!note] Lecturer — Rest Seat Preparation > A rest seat may not require preparation when there is sufficient opposing space and the metal can sit on the tooth without creating an occlusal interference. > > - A rounded marginal ridge may provide a favourable situation. > - A deep V-shaped area is more likely to require preparation. A labelled anatomical diagram showing a metal framework (likely for a removable partial denture) fitted onto the lower dental arch. The illustration depicts specific design features such as occlusal rests on posterior teeth and guide planes, corresponding to the slide's topic of mouth preparation. A labelled illustration of a posterior tooth showing the placement of a metal guide plate on the proximal surface relative to the survey line. The diagram demonstrates how mouth preparation establishes parallel surfaces for component insertion. A dental illustration showing a metal clasp assembly engaging an abutment tooth. The retentive arm of the clasp is positioned into a prepared undercut on the buccal surface, while the rigid rest seat area contacts the occlusal surface. 1. Primary impression 2. Preliminary articulation 3. Preliminary Try-in 4. Survey + design 5. Special Tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert **Co–Cr** : **7 - Survey master model** **Re-survey the master cast and ask:** *Did we create what we planned?* **CHECK** * Path of insertion * Guide planes * Useful undercuts * Rest locations * Framework design   #### Re-Survey the Master Cast *Did we create what we planned?* Check: - Path of insertion - Guide planes - Useful undercuts - Rest locations - Framework design > [!note] Lecturer — Master Cast Comparison > The master cast should be compared with the preliminary cast after the definitive impression. > > - The casts may not survey identically because they cannot always be positioned at exactly the same angle. > - Comparison helps distinguish surveying differences, insufficient preparation, and changes in the definitive cast. A close-up photograph of a dental master cast with a survey design applied using green and red wax blocks. The green material outlines the planned clasp arms and guide planes on the abutment teeth, while the red block-out material covers undercuts in the edentulous span. A clinical photograph of a dental master cast with a wax-up framework design applied to it. The image illustrates the planned components using color-coded materials: green for major connectors, blue for clasps and arms, red for guide planes or rests, and yellow for specific rest seats. **1** Primary impression **2** Preliminary articulation **3** Preliminary Try-in **4** Survey + design **5** Special Tray **6** Mouth prep **7** Definitive impression **8** Framework **9** MMR **10** Tooth try-in **11** Insert Co-Cr : 8 - Framework Prove the framework *Do not add wax yet* **START ON THE MASTER MODEL** ↓ **CHECK** 1. Seating - full adaptation 2. Support - rest contact 3. Stability - no rocking 4. Retention - clasp engagement 5. Function - no interference poor adaptation good adaptation  #### Prove the Framework *Do not add wax yet.* #### Start on the Master Model — Check 1. Seating — full adaptation 2. Support — rest contact 3. Stability — no rocking 4. Retention — clasp engagement 5. Function — no interference *Poor adaptation vs good adaptation.* Two clinical photographs comparing the fit of a metal framework on a dental arch. The top image shows a framework seated on a master model with the label 'good adaptation' pointing to the close contact between the metal and the teeth, while the bottom image shows a framework in the mouth with the label 'poor adaptation' indicating a visible gap where the metal does not sit flush against the tooth structure. # Co-Cr : 8- Framework If it does not seat, do not force it FIND THE INTERFERENCE → POSSIBLE SOURCES * tooth interference * guide-plane discrepancy * rest interference * connector interference * distorted framework * incorrect path  #### If It Does Not Seat, Do Not Force It Find the interference → possible sources: - Tooth interference - Guide-plane discrepancy - Rest interference - Connector interference - Distorted framework - Incorrect path > [!note] Lecturer — Framework Seating Problems > If the framework fits the master model but not the mouth, the problem may relate to the impression or the patient’s teeth rather than the laboratory framework. > > - Fit checker or occlusal spray can help identify the area preventing seating. > - Sending the same model back for a remake will not correct an inaccurate impression. > - A substantial discrepancy may require a new impression and new framework. A simple white right-pointing arrow on a black background, serving as a directional symbol or bullet point. 1 2 3 4 5 6 7 8 9 10 11 Primary impression Preliminary articulation Preliminary Try-in Survey + design Special Tray Mouth prep Definitive impression Framework MMR Tooth try-in Insert **Co-Cr** : 8- Framework What can be adjusted? **POSSIBLE EXAMPLES** * Minor clasp adjustment * Very limited rest adjustment * Acrylic component adjustment **MAJOR DISCREPANCY ≠ MORE GRINDING** **REMAKE FRAMEWORK**  #### What Can Be Adjusted? Possible examples: - Minor clasp adjustment - Very limited rest adjustment - Acrylic component adjustment > Major discrepancy ≠ more grinding → remake framework > [!note] Lecturer — Framework Adjustments > Framework adjustments require caution because components may be thin, and excessive adjustment may weaken or fracture the framework. > > - Clasp adjustment is not always the solution. > - Add-on components should not be adjusted casually. > - Framework adjustment should involve the supervisor. A close-up photograph showing a rotary dental bur grinding the inner surface of a metal clasp arm on a removable partial denture framework. The image illustrates the physical process of adjusting or polishing the Co-Cr framework components. 1. Primary impression 2. Preliminary articulation 3. Preliminary Try-in 4. Survey + design 5. Special Tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert 11 **Co-Cr** : 8 / 9 - Framework ± MMR Framework fits, what is next? *Can we safely save a visit?* **OPTION 1** Send to lab ↓ Lab adds rim ↓ Patient returns ↓ Record MMR Unstable rim Major VDO change Complex jaw relationship Uncertain tooth position Inadequate time / skill to make reliable record  #### Framework Fits, What Is Next? *Can we safely save a visit?* #### Option 1: Send to Lab Send to lab → Lab adds rim → Patient returns → Record MMR #### When to Choose This Option - Unstable rim - Major VDO change - Complex jaw relationship - Uncertain tooth position - Inadequate time / skill to make a reliable record - ==A laboratory-made rim is particularly useful when the edentulous space is extensive, the vertical dimension is being increased, or natural teeth do not provide stable contacts== A clinical photograph showing a maxillary dental cast with a metal framework (Co-Cr) fitted onto it. Pink blocks of wax are attached to the framework in the posterior edentulous regions, representing the preliminary jaw registration rims used for recording the Maxillomandibular Relationship (MMR). **1**. Primary **2**. Preliminary **3**. Survey + design **4**. Mouth prep **5**. Definitive **6**. Framework **7**. Preliminary **8**. MMR **9**. Tooth try-in **10**. Insert **11**. Special Tray **12**. Articulation **Co-Cr** : **8 / 9** - **Framework ± MMR** **Framework fits, what is next?** **Can we safely save a visit?** --- **OPTION 1** Send to lab ↓ Lab adds rim ↓ Patient returns ↓ Record MMR --- **OPTION 2** Adapt rim chairside ↓ Record MMR today ✓ Save appointment ✓ Save lab fee --- <script> </script>  #### Framework Fits, What Is Next? *Can we safely save a visit?* #### Option 1: Send to Lab Send to lab → Lab adds rim → Patient returns → Record MMR #### Option 2: Adapt Rim Chairside Adapt rim chairside → Record MMR today - Save appointment - Save lab fee Clinical photograph of a dental cast showing a metal framework (Co-Cr) fitted onto the model, with pink wax blocks attached to represent an occlusal rim for recording maxillomandibular relations. **11** 1. Primary impression 2. Preliminary articulation 3. Preliminary Try-in 4. Survey + design 5. Special Tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert Co-Cr : 8 / 9 - Framework ± MMR How to build the rim chairside? Warm ↓ Adapt ↓ Support ↓ Shape ↓ Re-seat **COMMUNICATE** • Tooth position • Labial support • Occlusal plane • Overjet • Overbite • Arch form  #### How to Build the Rim Chairside? Warm → Adapt → Support → Shape → Re-seat #### Communicate - Tooth position - Labial support - Occlusal plane - Overjet - Overbite - Arch form > [!note] Lecturer — Chairside Wax Rim > When adapting a wax rim chairside, avoid excess wax beneath the framework and prevent tipping or movement. > > - Shape the rim to follow the planned tooth position and curvature of the arch. > - Form the labial contour when anterior tooth position is important. > - The wax rim acts as a blueprint for the tooth arrangement. - ==Smile line, canine line, midline, tooth size and shape, tooth shade, and the intended vertical dimension== A close-up clinical photograph shows a pair of hands holding a dental cast with a metal framework and wax rim, illustrating the process of building or adapting the rim chairside. ### Visual heading row (process map) | # | Step | |---|----------------------------| | 1 | Primary impression | | 2 | Preliminary articulation | | 3 | Preliminary Try-in | | 4 | Survey + design | | 5 | Special Tray | | 6 | Mouth prep | | 7 | Definitive impression | | 8 | Framework | | 9 | MMR | |10 | **Tooth try-in** (active) | |11 | Insert | ### Main content **Co–Cr** : **10 - Tooth try-in** What are you assessing? **ASSESS** - Tooth position - Aesthetics - Phonetics - Occlusion - Retention and stability - VDO (where relevant) - Patient acceptance #### Tooth Try-In: What Are You Assessing? Assess: - Tooth position - Aesthetics - Phonetics - Occlusion - Retention and stability - VDO (where relevant) - Patient acceptance 1. Primary impression 2. Preliminary articulation 3. Preliminary Try-in 4. Survey + design 5. Special Tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert # Co-Cr : 11 - Insert Framework discrepancy? → STOP + RE-ASSESS FOR REMAKE ## ASSESS 1. Seating - full adaptation 2. Support - rest contact 3. Stability - no rocking 4. Retention - clasp engagement 5. **Occlusion - no interference** 6. **Tissues - no impingement** 7. **Insertion - correct path** 8. **Removal - patient capable** Adjust acrylic / occlusion as indicated <p align="center"></p>  #### Insert > Framework discrepancy? → Stop + re-assess for remake #### Assess 1. Seating — full adaptation 2. Support — rest contact 3. Stability — no rocking 4. Retention — clasp engagement 5. Occlusion — no interference 6. Tissues — no impingement 7. Insertion — correct path 8. Removal — patient capable Adjust acrylic / occlusion as indicated. > [!note] Lecturer — Processing Discrepancy > The acrylic may shrink or change during processing, creating a discrepancy even when the framework and tooth try-in were previously satisfactory. > > - Assess the acrylic first using pressure-indicating paste or fit checker. > - Confirm framework seating, check occlusion, and adjust conservatively. - ==Check the prognosis and suitability of the remaining teeth== - ==Re-survey the master cast before framework fabrication== - ==Check indirect retention, prosthetic space, interferences, and occlusal clearance== - ==Consider whether a new impression is needed if the framework does not fit== - ==Decide whether a laboratory-made or chairside rim is appropriate== - ==Confirm tooth position, aesthetics, phonetics, occlusion, vertical dimension, support, stability, and retention== > [!note] Lecturer — Workflow Planning > These checklists are learning aids for the first several cases, until the workflow becomes familiar. > > - Plan from the final treatment objective backwards and understand why each record or impression is being taken. > - Communicate clearly with the laboratory and assess models, impressions, articulations, and frameworks rather than accepting them automatically. > - Consider the patient’s prognosis, expectations, time, and cost to help reduce remakes, errors, and unnecessary adjustments. A clinical photograph showing the intaglio (tissue-facing) view of a completed removable partial denture with a cobalt-chromium metal framework. The image displays the internal surface of the acrylic saddles, including a distinct honeycomb or grid-like retention pattern on the left side, and the metal clasps extending from the framework. <html><body><table><tr><th colspan="3">Acrylic</th></tr><tr><th>1</th><th>2</th><th>3</th></tr><tr><th>Primary<br>impression</th><th>Special<br>Tray</th><th>Definitive<br>impression</th></tr></table> <table> <tr><th>Acrylic</th></tr> <tr><th>1</th><th>2</th><th>3</th><th>4</th><th>5</th><th>6</th></tr> <tr><td>Primary impression</td><td>Special Tray</td><td>Definitive impression</td><td>MMR</td><td>Tooth try-in</td><td>Insert</td></tr> </table> <table> <tr><th>Co-Cr</th></tr> <tr><th>1</th><th>2</th><th>3</th><th>4</th><th>5</th><th>6</th><th>7</th><th>8</th><th>9</th><th>10</th><th>11</th></tr> <tr><td>Primary impression</td><td>Preliminary articulation</td><td>Preliminary Try-in</td><td>Survey + design</td><td>Special Tray</td><td>Mouth prep</td><td>Definitive impression</td><td>Framework</td><td>MMR</td><td>Tooth try-in</td><td>Insert</td></tr> </table> #### Acrylic RPD — Clinical Stages 1. Primary impression 2. Special tray 3. Definitive impression 4. MMR 5. Tooth try-in 6. Insert #### Co-Cr RPD — Clinical Stages 1. Primary impression 2. Preliminary articulation 3. Preliminary try-in 4. Survey + design 5. Special tray 6. Mouth prep 7. Definitive impression 8. Framework 9. MMR 10. Tooth try-in 11. Insert Acrylic C C Primary impression IIA Special Tray IIIA Definitive impression IIIIV MMR NV Tooth try-in VII Insert ### Acrylic Removable Partial Denture Clinical Checklist **1. Primary Impression** * [ ] Alignate + suitable stock tray * [ ] Accept only if relevant teeth and saddles are captured * [ ] Decide: special tray / secondary impression? * [ ] Lab instructions: * [ ] Final impression material: * [ ] Perforations * [ ] Spacer Requirement: * [ ] Tissue Stops **2. Special Tray** * [ ] Assess on the model * [ ] Check gross extension, seating, sharp edges and interference * [ ] trim -> smooth -> reassess * [ ] Border mould needed **3. Definitive Impression** * [ ] Adhesive * [ ] Identify and block undercut * [ ] Check extension, defects, distortion and safety * [ ] Lab instructions: * [ ] Please Pour Impressions * [ ] Can casts articulate predictably? * [ ] If not: Fabricate hard record base / rim * [ ] Clasps position **4. MMR** * [ ] Record a repeatable jaw relationship * [ ] Same CD MMR Principles * [ ] Lab instructions: * [ ] Setup teeth on the same hard base * [ ] Tooth shape: * [ ] Shade: **5. Try-in** * [ ] Essential for multiple teeth, aesthetics or occlusal uncertainty * [ ] Direct finish may suit small bounded saddles * [ ] Assess aesthetics, phonetics, occlusion and VDO where relevant * [ ] Document patient approval * [ ] Lab instructions: * [ ] Any changes: * [ ] Please Process **6. Insert** * [ ] Identify path of insertion: do not force * [ ] If not seated: Adjust * [ ] Rigid acrylic interference * [ ] clasp retention * [ ] Assess extensions and pressure areas * [ ] Patient inserts/removes; hygiene and review arranged AHMAD HENDAWI | THE UNIVERSITY OF WESTERN AUSTRALIA | SheriMelco { "BOX_A": "Co-Cr", "BOX_B": "THE UNIVERSITY OF WESTERN AUSTRALIA", "BOX_C": "THE UNIVERSITY OF WESTERN AUSTRALIA" } 1 Primary impression 2 Preliminary articulation 3 Preliminary Try-in 4 Survey + design 5 Special Tray 6 Mouth prep 7 Definitive impression 8 Framework 9 MMR 10 Tooth try-in 11 Insert ### Co-Cr Removable Partial Denture Clinical Checklist Part 1 of 2 **1. Primary Impression** * [ ] Alignate + suitable stock tray * [ ] Accept only if relevant teeth and saddles are captured * [ ] Decide if diagnostic base and rim is required for preliminary articulation * [ ] Lab instructions: * [ ] Pour Primary impressions * [ ] Fabricate diagnostic base and rim. Then clinically proceed with diagnostic MMR, then ask lab to articulate * [ ] Articulate Models using bite reg if * [ ] diagnostic base and rim are not needed * [ ] Preliminary Survey **2. Special Tray** * [ ] Assess on the model * [ ] Check gross extension, seating, sharp edges and interference * [ ] trim -> smooth -> reassess * [ ] Border mould if needed **3. Preliminary Articulation / Preliminary Try In** * [ ] Assess interarch relationship and prosthetic space * [ ] Ask for preliminary tooth setup in complex cases * [ ] Lab instructions: * [ ] Any changes: * [ ] Please Process **4. Survey + Design** * [ ] Survey diagnostic cast: path, undercuts and interferences * [ ] Plan support, bracing, reciprocation and retention * [ ] Design connector, rests, clasps and bases * [ ] Identify required mouth preparations * [ ] Supervisor approval and design documented * [ ] Lab instructions: * [ ] Fabricate special tray (PVS/Inon perforated with 3mm spacer and tissue stops) **5. Framework Try-in** * [ ] Check on master cast, the * [ ] Assess seating, support, S and function * [ ] If not seated: do not force why and ask * Lab instructions: * [ ] Please pour secondary * [ ] Fabricate metal frame the design **6. Synthetic / Definitive Impression** * [ ] Check gross extension, seating, sharp edges and interference * [ ] trim -> smooth -> reassess * [ ] Border mould if needed * [ ] Adhesive * [ ] Verify preparations before * [ ] Light body on rests, guide plate-contact areas * [ ] Check extension, defects * [ ] Framework still seats and rim is stable * [ ] Record a repeatable jaw relationship * [ ] Same CD MMR Principles * [ ] Lab instructions: * [ ] Setup teeth * [ ] Tooth shape: * [ ] Shade: * [ ] Attach full face photos with rim in mouth: * [ ] Smiling and at rest **7. MMR** * [ ] Only after verified framework * [ ] Can it be recorded today with a chairside rim? * [ ] If yes: Warm, adapt, support, shape and re-seat * [ ] Framework still seats and rim is stable * [ ] Record a repeatable jaw relationship * [ ] Lab instructions: * [ ] Same CD MMR Principles * [ ] Setup teeth * [ ] Tooth shape: * [ ] Shade: * [ ] Attach full face photos with rim in mouth: * [ ] Smiling and at rest **8. Insert** * [ ] Identify path of insertion: do not force * [ ] If not seated: adjust * [ ] first interference (PIP. Occlusal spray, Fit checker) * [ ] Assess extensions and pressure areas * [ ] Patient inserts/removes; hygiene and review arranged AHMAD HENDAWI | THE UNIVERSITY OF WESTERN AUSTRALIA | SheriMelco    #### Acrylic RPD — Clinical Checklist **1. Primary Impression** - Alginate + suitable stock tray - Accept only if relevant teeth and saddles are captured - Decide: special tray / secondary impression? - Lab instructions: - Final impression material: - Perforations - Spacer requirement: - Tissue stops **2. Special Tray** - Assess on the model - Check gross extension, seating, sharp edges and interference - Trim → smooth → reassess - Border mould needed **3. Definitive Impression** - Adhesive - Identify and block undercuts - Check extension, defects, distortion and safety - Lab instructions: - Please pour impressions - Can casts articulate predictably? - If not: fabricate hard record base / rim - Clasp positions **4. MMR** - Record a repeatable jaw relationship - Same CD MMR principles - Lab instructions: - Setup teeth on the same hard base - Tooth shape: - Shade: **5. Try-in** - Essential for multiple teeth, aesthetics or occlusal uncertainty - Direct finish may suit small bounded saddles - Assess aesthetics, phonetics, occlusion and VDO where relevant - Document patient approval - Lab instructions: - Any changes: - Please process **6. Insert** - Identify path of insertion: do not force - If not seated: adjust - Rigid acrylic interference - Clasp retention - Assess extensions and pressure areas - Patient inserts/removes; hygiene and review arranged #### Co-Cr RPD — Clinical Checklist (Part 1 of 2) **1. Primary Impression** - Alginate + suitable stock tray - Accept only if relevant teeth and saddles are captured - Decide if diagnostic base and rim is required for preliminary articulation - Lab instructions: - Pour primary impressions - Fabricate diagnostic base and rim; then clinically proceed with diagnostic MMR, then ask lab to articulate - Articulate models using bite reg if diagnostic base and rim are not needed - Preliminary survey **2. Special Tray** - Assess on the model - Check gross extension, seating, sharp edges and interference - Trim → smooth → reassess - Border mould if needed **3. Preliminary Articulation / Preliminary Try-in** - Assess interarch relationship and prosthetic space - Ask for preliminary tooth setup in complex cases - Lab instructions: - Any changes: - Please process **4. Survey + Design** - Survey diagnostic cast: path, undercuts and interferences - Plan support, bracing, reciprocation and retention - Design connector, rests, clasps and bases - Identify required mouth preparations - Supervisor approval and design documented - Lab instructions: - Fabricate special tray (PVS/iron perforated with 3 mm spacer and tissue stops) **5. Framework Try-in** - Check on master cast - Assess seating, support, stability and function - If not seated: do not force — identify why and ask - Lab instructions: - Please pour secondary - Fabricate metal frame to the design **6. Syringe / Definitive Impression** - Check gross extension, seating, sharp edges and interference - Trim → smooth → reassess - Border mould if needed - Adhesive - Verify preparations before: - Light body on rests, guide plate-contact areas - Check extension, defects - Framework still seats and rim is stable - Record a repeatable jaw relationship - Same CD MMR principles - Lab instructions: - Setup teeth - Tooth shape: - Shade: - Attach full face photos with rim in mouth: smiling and at rest **7. MMR** - Only after verified framework - Can it be recorded today with a chairside rim? - If yes: warm, adapt, support, shape and re-seat - Framework still seats and rim is stable - Record a repeatable jaw relationship - Lab instructions: - Same CD MMR principles - Setup teeth - Tooth shape: - Shade: - Attach full face photos with rim in mouth: smiling and at rest **8. Insert** - Identify path of insertion: do not force - If not seated: adjust - First interference (PIP, occlusal spray, Fit Checker) - Assess extensions and pressure areas - Patient inserts/removes; hygiene and review arranged - ==Identify the first contact and adjust conservatively== A horizontal process flow diagram illustrating the clinical workflow for a Co-Cr Removable Partial Denture. The timeline consists of eleven numbered steps connected by a line, with specific stages highlighted in yellow (3, 9, 10) against green circles. A logo featuring the stylized initials 'ST' followed by the name 'Sheryl Teo' in a serif font, with a tagline underneath. The image displays the official logo of The University of Western Australia, featuring a shield with a black swan and open books alongside the university's name in blue text. THANK YOU AH | AHMAD HENDAWI ST | Sheryl Teo _{PROSTHODONTICS}    THANK YOU - AH — Ahmad Hendawi - ST — Sheryl Teo *Prosthodontics* A QR code graphic featuring a central asterisk symbol. A posed studio portrait of two clinicians, a man in a white shirt and tie seated on the left and a woman in a white blouse seated on the right. They are positioned in front of a digital background graphic illustrating a dental implant treatment plan, featuring a wireframe jaw model with superimposed teeth and screw implants. A square QR code featuring three standard finder patterns in the corners and a central asterisk-like symbol within the data matrix. ## Case: OPG Presentation for Removable Partial Denture ### Question **Scenario:** A patient presents to the clinic with missing teeth, and an OPG is shown to the students. **What's shown:** An OPG of a patient with missing teeth. **Consider:** Beyond simply identifying the edentulous spaces and missing teeth, what factors must be evaluated to decide between an acrylic or chrome denture? ### Answer **Observations:** - Periodontal prognosis (mobility, stage, grade) - Restorability and remaining tooth structure - Occlusal anatomical function - Patient-related factors and previous prosthesis history **Reasoning:** The decision for acrylic versus chrome is not based solely on Kennedy classification or missing teeth. The clinician must evaluate the overall condition of the mouth, including whether teeth are useful for the denture design, the cause of mobility, and what the patient previously tolerated, to ensure the new design improves upon the previous one. **Takeaway:** Look beyond the edentulous spaces and evaluate the periodontal prognosis, restorability, occlusal function, and previous prosthesis history to guide the decision between acrylic and cobalt chrome. ## Case: Erratic Tooth Impeding Denture Design ### Question **Scenario:** A patient has a super erratic tooth that is getting in the way of the occlusal scheme. **What's shown:** A sound, non-mobile tooth that does not need restoration but is impeding the balanced denture design. **Consider:** Should this tooth be kept or extracted? ### Answer **Observations:** - The tooth is sound, not mobile, and doesn't need restoration. - It is impeding the creation of a balanced denture. **Reasoning:** Even if a tooth is restorable and has a good prognosis, if it doesn't fit the treatment plan or impedes a balanced denture, there is no point in keeping it. The focus should be on whether the tooth is useful for the overall prosthesis design. **Takeaway:** A tooth's usefulness for the overall prosthesis design is more important than just its individual restorability or prognosis. ## Case: Bounded Saddle Replacing Two Teeth ### Question **Scenario:** A patient needs a denture replacing just two teeth in a bounded saddle. **What's shown:** A bounded edentulous space replacing two teeth. **Consider:** Is a special tray and secondary impression needed for this case? ### Answer **Observations:** - The space is a bounded saddle. - Only two teeth are being replaced. **Reasoning:** For a bounded saddle, there is no need to extend the acrylic flange into the full vestibule for tissue support. If the primary alginate impression is good, it can be used as the final impression without a special tray or secondary impression. **Takeaway:** Bounded saddles replacing a few teeth may not require a special tray or secondary impression if the primary impression captures the necessary anatomy. ## Case: Rural Patient Driving Four Hours ### Question **Scenario:** A patient in a rural area has driven four hours to the clinic and wants to minimize chair time and appointments. **What's shown:** A clinical scenario of a patient with limited availability and long travel distance. **Consider:** How can the impression workflow be modified to save the patient an extra trip? ## Case: OPG Presentation for Removable Partial Denture ### Question **Scenario:** A patient presents to the clinic with missing teeth, and an OPG is shown to the students. **What's shown:** An OPG of a patient with missing teeth. **Consider:** Beyond simply identifying the edentulous spaces and missing teeth, what factors must be evaluated to decide between an acrylic or chrome denture?   ### Answer **Observations:** - Periodontal prognosis (mobility, stage, grade) - Restorability and remaining tooth structure - Occlusal anatomical function - Patient-related factors and previous prosthesis history **Reasoning:** The decision for acrylic versus chrome is not based solely on Kennedy classification or missing teeth. The clinician must evaluate the overall condition of the mouth, including whether teeth are useful for the denture design, the cause of mobility, and what the patient previously tolerated, to ensure the new design improves upon the previous one. **Takeaway:** Look beyond the edentulous spaces and evaluate the periodontal prognosis, restorability, occlusal function, and previous prosthesis history to guide the decision between acrylic and cobalt chrome. ## Case: Erratic Tooth Impeding Denture Design ### Question **Scenario:** A patient has a super erratic tooth that is getting in the way of the occlusal scheme. **What's shown:** A sound, non-mobile tooth that does not need restoration but is impeding the balanced denture design. **Consider:** Should this tooth be kept or extracted? ### Answer **Observations:** - The tooth is sound, not mobile, and doesn't need restoration. - It is impeding the creation of a balanced denture. **Reasoning:** Even if a tooth is restorable and has a good prognosis, if it doesn't fit the treatment plan or impedes a balanced denture, there is no point in keeping it. The focus should be on whether the tooth is useful for the overall prosthesis design. **Takeaway:** A tooth's usefulness for the overall prosthesis design is more important than just its individual restorability or prognosis. ## Case: Bounded Saddle Replacing Two Teeth ### Question **Scenario:** A patient needs a denture replacing just two teeth in a bounded saddle. **What's shown:** A bounded edentulous space replacing two teeth. **Consider:** Is a special tray and secondary impression needed for this case? ### Answer **Observations:** - The space is a bounded saddle. - Only two teeth are being replaced. **Reasoning:** For a bounded saddle, there is no need to extend the acrylic flange into the full vestibule for tissue support. If the primary alginate impression is good, it can be used as the final impression without a special tray or secondary impression. **Takeaway:** Bounded saddles replacing a few teeth may not require a special tray or secondary impression if the primary impression captures the necessary anatomy. ## Case: Rural Patient Driving Four Hours ### Question **Scenario:** A patient in a rural area has driven four hours to the clinic and wants to minimize chair time and appointments. **What's shown:** A clinical scenario of a patient with limited availability and long travel distance. **Consider:** How can the impression workflow be modified to save the patient an extra trip?  Case: OPG Presentation for Removable Partial Denture A panoramic dental radiograph (OPG) showing the maxilla and mandible. The image reveals multiple natural teeth with bright radiopaque restorations (fillings or crowns) in the posterior quadrants and a fixed bridge or implant-supported prosthesis replacing teeth in the anterior mandible. A composite panel of seven clinical photographs documenting the oral and facial condition of an elderly patient. The images include intraoral views showing severely worn dentition, multiple missing teeth, existing restorations, and carious lesions, as well as extraoral frontal views highlighting significant loss of vertical dimension of occlusion and collapsed lip support. A close-up clinical photograph showing a row of posterior teeth (premolars and molars) in the oral cavity. The central tooth features a large, dark amalgam restoration, while the adjacent tooth above it displays visible enamel cracks on its surface. A clinical photograph showing a dental impression tray loaded with a two-material impression system. The tray is coated in a bright green light-body material (visibly fluid with flow lines) overlying a magenta heavy-body material (stiff and bulk-holding) that fills the tooth voids, illustrating the 'wash' or dual-mix technique for capturing fine detail. ### Answer **Observations:** - The patient has a long travel distance and limited time. - A standard multi-step special tray workflow would require multiple visits. **Reasoning:** The clinician can customize the primary stock tray impression (e.g., adding putty or border molding directly) to capture the necessary extensions in a single visit, skipping the special tray step to save the patient time and travel. **Takeaway:** Patient circumstances, such as travel distance and time constraints, can justify modifying the standard impression workflow to save appointments. ## Case: Stuck Polyether Impression ### Question **Scenario:** A polyether impression gets stuck in the patient's mouth due to undercuts. **What's shown:** A clinical scenario where a rigid impression material locks into undercuts. **Consider:** What is the immediate management when a polyether impression is stuck? ### Answer **Observations:** - Polyether is extremely hard when set. - The impression is locked in undercuts and cannot be removed. **Reasoning:** The clinician must section the special tray and cut the impression material intraorally to release the undercuts. This is a risky procedure that can tear soft tissue, emphasizing the need to block out undercuts before taking a polyether impression. **Takeaway:** Always block out undercuts before using polyether to prevent the impression from locking and requiring intraoral sectioning. ## Case: Assessing Impression Deficiencies ### Question **Scenario:** A student presents an impression with a drag or deficiency and asks if it is acceptable to proceed. **What's shown:** An impression with a drag in the buccal area versus a deficiency in the retromolar pad area. **Consider:** How does the location of an impression deficiency affect the decision to proceed? ### Answer **Observations:** - A drag in the buccal area where no denture extension is planned. - A deficiency in the retromolar pad or buccal shelf area. **Reasoning:** A drag in an area not relevant to the denture design (like the buccal vestibule where the denture won't extend) is acceptable. However, a deficiency in a critical support area like the retromolar pad means the impression failed its purpose and must be retaken. **Takeaway:** Evaluate impression deficiencies based on their relevance to the planned denture design and tissue support areas. ## Case: Missing 15, 16, 17 and Need for MMR ### Question **Scenario:** A patient presents missing teeth 15, 16, and 17, with all other teeth present. **What's shown:** A dentition with a unilateral free-end saddle (missing 15, 16, 17). **Consider:** Does this patient need a Maxillomandibular Relationship (MMR) record? ### Answer **Observations:** - The patient is missing 15, 16, and 17. - The rest of the dentition is present. **Reasoning:** While there are posterior occlusal stops on the other side, free-end saddles (Kennedy Class 1 and 2) can cause models to tilt during articulation. The lab technician needs stable models, so an MMR is recommended to ensure accurate articulation and prevent rocking. **Takeaway:** Even with existing occlusal stops, free-end saddles require an MMR to prevent model tilting and ensure accurate articulation. ## Case: Modifying the Missing Molar Scenario for MMR ### Question **Scenario:** The lecturer modifies a previous scenario: instead of missing 15, 16, 17, the patient has a first molar present but is missing the second molar, with stable occlusal stops. **What's shown:** A dentition with a missing second molar but stable posterior occlusion. **Consider:** Does this patient need an MMR? ### Answer **Observations:** - The patient has a long travel distance and limited time. - A standard multi-step special tray workflow would require multiple visits. **Reasoning:** The clinician can customize the primary stock tray impression (e.g., adding putty or border molding directly) to capture the necessary extensions in a single visit, skipping the special tray step to save the patient time and travel. **Takeaway:** Patient circumstances, such as travel distance and time constraints, can justify modifying the standard impression workflow to save appointments. ## Case: Stuck Polyether Impression ### Question **Scenario:** A polyether impression gets stuck in the patient's mouth due to undercuts. **What's shown:** A clinical scenario where a rigid impression material locks into undercuts. **Consider:** What is the immediate management when a polyether impression is stuck?  ### Answer **Observations:** - Polyether is extremely hard when set. - The impression is locked in undercuts and cannot be removed. **Reasoning:** The clinician must section the special tray and cut the impression material intraorally to release the undercuts. This is a risky procedure that can tear soft tissue, emphasizing the need to block out undercuts before taking a polyether impression. **Takeaway:** Always block out undercuts before using polyether to prevent the impression from locking and requiring intraoral sectioning. ## Case: Assessing Impression Deficiencies ### Question **Scenario:** A student presents an impression with a drag or deficiency and asks if it is acceptable to proceed. **What's shown:** An impression with a drag in the buccal area versus a deficiency in the retromolar pad area. **Consider:** How does the location of an impression deficiency affect the decision to proceed?   ### Answer **Observations:** - A drag in the buccal area where no denture extension is planned. - A deficiency in the retromolar pad or buccal shelf area. **Reasoning:** A drag in an area not relevant to the denture design (like the buccal vestibule where the denture won't extend) is acceptable. However, a deficiency in a critical support area like the retromolar pad means the impression failed its purpose and must be retaken. **Takeaway:** Evaluate impression deficiencies based on their relevance to the planned denture design and tissue support areas. ## Case: Missing 15, 16, 17 and Need for MMR ### Question **Scenario:** A patient presents missing teeth 15, 16, and 17, with all other teeth present. **What's shown:** A dentition with a unilateral free-end saddle (missing 15, 16, 17). **Consider:** Does this patient need a Maxillomandibular Relationship (MMR) record?  ### Answer **Observations:** - The patient is missing 15, 16, and 17. - The rest of the dentition is present. **Reasoning:** While there are posterior occlusal stops on the other side, free-end saddles (Kennedy Class 1 and 2) can cause models to tilt during articulation. The lab technician needs stable models, so an MMR is recommended to ensure accurate articulation and prevent rocking. **Takeaway:** Even with existing occlusal stops, free-end saddles require an MMR to prevent model tilting and ensure accurate articulation. ## Case: Modifying the Missing Molar Scenario for MMR ### Question **Scenario:** The lecturer modifies a previous scenario: instead of missing 15, 16, 17, the patient has a first molar present but is missing the second molar, with stable occlusal stops. **What's shown:** A dentition with a missing second molar but stable posterior occlusion. **Consider:** Does this patient need an MMR?  Case: Rural Patient Driving Four Hours > Answer A product photograph showing two dental dispensing syringes against a black background. The upper syringe is labeled 'OraSeal Caulking' and the lower blue syringe is labeled 'OpalDam Light Cured Gingival Barrier', illustrating specific materials used for blockout procedures. A split-screen clinical photograph comparing two views of a lower jaw dental model held by a gloved hand, illustrating the quality of an impression. The left side is marked with a green happy face emoji to indicate a correct result where the abutment teeth are clearly recorded, while the right side is marked with a red sad face emoji to indicate a failure where those areas are missing. Clinical photograph of a yellow custom impression tray seated over purple modeling material, with a blue arrow pointing to a small rectangular window cut into the tray's anterior region. A schematic diagram illustrating a dental arch classification, likely Kennedy Class I. It depicts the maxillary and mandibular teeth arranged in horseshoe shapes against a black background, showing bilateral edentulous areas located posterior to the remaining natural teeth. A schematic diagram showing occlusal views of individual teeth arranged in arch forms against a black background. The layout depicts multiple segments, including posterior teeth and anterior teeth, likely representing a dental survey or diagnostic setup for prosthodontic planning. ### Answer **Observations:** - The patient has stable occlusal stops (e.g., first molars occluding). - There is no free-end saddle. **Reasoning:** With stable occlusal stops and a bounded or tooth-supported situation (like a Kennedy Class 3 with tripod contact), the models can be stabilized without an MMR. The technician can articulate the models predictably using a bite registration. **Takeaway:** Stable occlusal stops and the absence of free-end saddles may allow for articulation without a formal MMR, provided there is tripod contact. ## Case: Kennedy Class 3 Model and Tripod Contact ### Question **Scenario:** The lecturer passes around a Kennedy Class 3 model to demonstrate articulation. **What's shown:** A Kennedy Class 3 model with posterior and anterior teeth present. **Consider:** How can you determine if an MMR is needed based on model articulation? ### Answer **Observations:** - The model has posterior teeth and anterior teeth. - It forms a tripod contact (two posteriors, one anterior). **Reasoning:** If there is tripod contact, the models can be stabilized on the articulator without rocking. Therefore, a bite registration is sufficient, and a full MMR with base and rims is not strictly necessary. **Takeaway:** Tripod contact (two posteriors and one anterior) provides sufficient stability for model articulation without needing a full MMR. ## Case: Replacing a Single Central Incisor ### Question **Scenario:** A patient needs a denture replacing only a single central incisor (tooth 11). **What's shown:** A partial denture design replacing one anterior tooth with stable occlusion and good articulation. **Consider:** Is a tooth try-in appointment necessary? ### Answer **Observations:** - Only one tooth (tooth 11) is being replaced. - Occlusal contacts are stable, and a bite registration was taken. **Reasoning:** If the occlusion is stable, the shade is correctly chosen (preferably with a photo), and the articulation is accurate, a tooth try-in can be skipped, and the case can proceed directly to the final denture. **Takeaway:** A tooth try-in may be omitted for simple, single-tooth replacements with stable occlusion and clear aesthetic instructions. ## Case: Framework Try-in with Fit Checker ### Question **Scenario:** A cobalt chrome framework is tried in the patient's mouth but doesn't sit fully. **What's shown:** A framework that is not fully seated, assessed using fit checker or occlusal spray. **Consider:** How do you identify and manage the interference preventing the framework from seating? ### Answer **Observations:** - Fit checker shows the material rubbing off only in one specific area, indicating a premature contact. - Occlusal spray shows contact only in that localized area. **Reasoning:** The localized rub-through indicates an interference. The clinician should make minimal adjustments to that specific area on the framework (or acrylic) and reseat, rather than adjusting the clasps or forcing it in. **Takeaway:** Use fit checker or occlusal spray to localize interferences during a framework try-in, and make minimal, targeted adjustments. ## Case: First Visit with No Occlusal Stops ### Question **Scenario:** A patient presents for their first visit with upper and lower alginate impressions, but has no occlusal stops. **What's shown:** A patient with missing teeth and no stable occlusal contacts. **Consider:** What is the workflow for establishing the vertical dimension in this scenario? ### Answer **Observations:** - The patient has stable occlusal stops (e.g., first molars occluding). - There is no free-end saddle. **Reasoning:** With stable occlusal stops and a bounded or tooth-supported situation (like a Kennedy Class 3 with tripod contact), the models can be stabilized without an MMR. The technician can articulate the models predictably using a bite registration. **Takeaway:** Stable occlusal stops and the absence of free-end saddles may allow for articulation without a formal MMR, provided there is tripod contact. ## Case: Kennedy Class 3 Model and Tripod Contact ### Question **Scenario:** The lecturer passes around a Kennedy Class 3 model to demonstrate articulation. **What's shown:** A Kennedy Class 3 model with posterior and anterior teeth present. **Consider:** How can you determine if an MMR is needed based on model articulation?   ### Answer **Observations:** - The model has posterior teeth and anterior teeth. - It forms a tripod contact (two posteriors, one anterior). **Reasoning:** If there is tripod contact, the models can be stabilized on the articulator without rocking. Therefore, a bite registration is sufficient, and a full MMR with base and rims is not strictly necessary. **Takeaway:** Tripod contact (two posteriors and one anterior) provides sufficient stability for model articulation without needing a full MMR. ## Case: Replacing a Single Central Incisor ### Question **Scenario:** A patient needs a denture replacing only a single central incisor (tooth 11). **What's shown:** A partial denture design replacing one anterior tooth with stable occlusion and good articulation. **Consider:** Is a tooth try-in appointment necessary? ### Answer **Observations:** - Only one tooth (tooth 11) is being replaced. - Occlusal contacts are stable, and a bite registration was taken. **Reasoning:** If the occlusion is stable, the shade is correctly chosen (preferably with a photo), and the articulation is accurate, a tooth try-in can be skipped, and the case can proceed directly to the final denture. **Takeaway:** A tooth try-in may be omitted for simple, single-tooth replacements with stable occlusion and clear aesthetic instructions. ## Case: Framework Try-in with Fit Checker ### Question **Scenario:** A cobalt chrome framework is tried in the patient's mouth but doesn't sit fully. **What's shown:** A framework that is not fully seated, assessed using fit checker or occlusal spray. **Consider:** How do you identify and manage the interference preventing the framework from seating?  ### Answer **Observations:** - Fit checker shows the material rubbing off only in one specific area, indicating a premature contact. - Occlusal spray shows contact only in that localized area. **Reasoning:** The localized rub-through indicates an interference. The clinician should make minimal adjustments to that specific area on the framework (or acrylic) and reseat, rather than adjusting the clasps or forcing it in. **Takeaway:** Use fit checker or occlusal spray to localize interferences during a framework try-in, and make minimal, targeted adjustments. ## Case: First Visit with No Occlusal Stops ### Question **Scenario:** A patient presents for their first visit with upper and lower alginate impressions, but has no occlusal stops. **What's shown:** A patient with missing teeth and no stable occlusal contacts. **Consider:** What is the workflow for establishing the vertical dimension in this scenario? Case: Modifying the Missing Molar Scenario for MMR > Answer A composite of three clinical photographs showing a patient's mouth and dental casts mounted on an articulator. The images display a removable partial denture framework with pink acrylic record bases used to register the bite (MMR). One photo shows the intraoral view, while the others demonstrate how these records allow the technician to mount the upper and lower casts in correct occlusion. Dewar Uppel A clinical photograph shows a dental articulator (specifically labeled 'Denar Upper' and 'Denar Lower') holding pink maxillary and mandibular study models with teeth. The device is positioned to demonstrate the relationship between the two arches, illustrating the setup for checking stability or performing a cast-rocking test. Two clinical photographs comparing the fit of a metal framework on a dental arch. The top image shows a framework seated on a master model with the label 'good adaptation' pointing to the close contact between the metal and the teeth, while the bottom image shows a framework in the mouth with the label 'poor adaptation' indicating a visible gap where the metal does not sit flush against the tooth structure. ### Answer **Observations:** - The patient has no occlusal stops. - Primary alginate impressions are taken. **Reasoning:** The clinician should request diagnostic base and rims from the lab. The patient is then treated similarly to a complete denture patient to determine the desired vertical dimension and freeway space. Once the diagnostic MMR is taken, the clinician must stick to that vertical dimension throughout the treatment. **Takeaway:** When there are no occlusal stops, use diagnostic base and rims to establish and lock in the vertical dimension early in the treatment plan. ## Case: RPD with Surveyed Crown ### Question **Scenario:** A patient needs an acrylic RPD and a surveyed crown on a tooth that requires an increase in vertical dimension. **What's shown:** A treatment plan combining a surveyed crown and a removable partial denture. **Consider:** How should the vertical dimension and crown design be managed before preparing the tooth? ### Answer **Observations:** - The patient needs an RPD and a surveyed crown. - The vertical dimension needs to be increased. **Reasoning:** A diagnostic MMR must be taken first to decide the new vertical dimension. The crown is then waxed up to the new vertical dimension before preparation. This ensures the tooth is prepared correctly for the final vertical dimension, avoiding excessive reduction or inadequate space for the crown and denture. **Takeaway:** Always perform a diagnostic MMR to establish the final vertical dimension before preparing a tooth for a surveyed crown in an RPD case. ## Case: Tooth 37 with a Large Crack ### Question **Scenario:** A student presents a case where tooth 37 has a large crack, and they are considering a survey crown for an RPD. **What's shown:** A cracked tooth (37) being considered as an abutment for a survey crown and RPD. **Consider:** Should the cracked tooth be crowned, and what are the risks?  ### Answer **Observations:** - Tooth 37 has a large crack. - It is being considered for a survey crown to serve as an abutment. **Reasoning:** Crowning the tooth can embrace it and reduce the potential for crack propagation. However, placing an occlusal rest on a cracked tooth increases the risk of failure. The clinician must warn the patient about this risk and obtain informed consent, ensuring the design minimizes lateral forces. **Takeaway:** A survey crown can protect a cracked tooth, but placing a rest on it increases the risk of failure; the patient must be warned and informed consent obtained. ### Answer **Observations:** - The patient has no occlusal stops. - Primary alginate impressions are taken. **Reasoning:** The clinician should request diagnostic base and rims from the lab. The patient is then treated similarly to a complete denture patient to determine the desired vertical dimension and freeway space. Once the diagnostic MMR is taken, the clinician must stick to that vertical dimension throughout the treatment. **Takeaway:** When there are no occlusal stops, use diagnostic base and rims to establish and lock in the vertical dimension early in the treatment plan. ## Case: RPD with Surveyed Crown ### Question **Scenario:** A patient needs an acrylic RPD and a surveyed crown on a tooth that requires an increase in vertical dimension. **What's shown:** A treatment plan combining a surveyed crown and a removable partial denture. **Consider:** How should the vertical dimension and crown design be managed before preparing the tooth? ### Answer **Observations:** - The patient needs an RPD and a surveyed crown. - The vertical dimension needs to be increased. **Reasoning:** A diagnostic MMR must be taken first to decide the new vertical dimension. The crown is then waxed up to the new vertical dimension before preparation. This ensures the tooth is prepared correctly for the final vertical dimension, avoiding excessive reduction or inadequate space for the crown and denture. **Takeaway:** Always perform a diagnostic MMR to establish the final vertical dimension before preparing a tooth for a surveyed crown in an RPD case. ## Case: Tooth 37 with a Large Crack ### Question **Scenario:** A student presents a case where tooth 37 has a large crack, and they are considering a survey crown for an RPD. **What's shown:** A cracked tooth (37) being considered as an abutment for a survey crown and RPD. **Consider:** Should the cracked tooth be crowned, and what are the risks? ### Answer **Observations:** - Tooth 37 has a large crack. - It is being considered for a survey crown to serve as an abutment. **Reasoning:** Crowning the tooth can embrace it and reduce the potential for crack propagation. However, placing an occlusal rest on a cracked tooth increases the risk of failure. The clinician must warn the patient about this risk and obtain informed consent, ensuring the design minimizes lateral forces. **Takeaway:** A survey crown can protect a cracked tooth, but placing a rest on it increases the risk of failure; the patient must be warned and informed consent obtained. Case: First Visit with No Occlusal Stops > Answer [^1]: Original PDF page 1: [[L5 RPD Hindawi.pdf#page=1|L5 RPD Hindawi, p.1]] [^2]: Original PDF page 2: [[L5 RPD Hindawi.pdf#page=2|L5 RPD Hindawi, p.2]] [^3]: Original PDF page 3: [[L5 RPD Hindawi.pdf#page=3|L5 RPD Hindawi, p.3]] [^4]: Original PDF page 4: [[L5 RPD Hindawi.pdf#page=4|L5 RPD Hindawi, p.4]] [^5]: Original PDF page 5: [[L5 RPD Hindawi.pdf#page=5|L5 RPD Hindawi, p.5]] [^6]: Original PDF page 6: [[L5 RPD Hindawi.pdf#page=6|L5 RPD Hindawi, p.6]] [^7]: Original PDF page 7: [[L5 RPD Hindawi.pdf#page=7|L5 RPD Hindawi, p.7]] [^8]: Original PDF page 8: [[L5 RPD Hindawi.pdf#page=8|L5 RPD Hindawi, p.8]] [^9]: Original PDF page 9: [[L5 RPD Hindawi.pdf#page=9|L5 RPD Hindawi, p.9]] [^10]: Original PDF page 10: [[L5 RPD Hindawi.pdf#page=10|L5 RPD Hindawi, p.10]] [^11]: Original PDF page 11: [[L5 RPD Hindawi.pdf#page=11|L5 RPD Hindawi, p.11]] [^12]: Original PDF page 12: [[L5 RPD Hindawi.pdf#page=12|L5 RPD Hindawi, p.12]] [^13]: Original PDF page 13: [[L5 RPD Hindawi.pdf#page=13|L5 RPD Hindawi, p.13]] [^14]: Original PDF page 14: [[L5 RPD Hindawi.pdf#page=14|L5 RPD Hindawi, p.14]] [^15]: Original PDF page 15: [[L5 RPD Hindawi.pdf#page=15|L5 RPD Hindawi, p.15]] [^16]: Original PDF page 16: [[L5 RPD Hindawi.pdf#page=16|L5 RPD Hindawi, p.16]] [^17]: Original PDF page 17: [[L5 RPD Hindawi.pdf#page=17|L5 RPD Hindawi, p.17]] [^18]: Original PDF page 18: [[L5 RPD Hindawi.pdf#page=18|L5 RPD Hindawi, p.18]] [^19]: Original PDF page 19: [[L5 RPD Hindawi.pdf#page=19|L5 RPD Hindawi, p.19]] [^20]: Original PDF page 20: [[L5 RPD Hindawi.pdf#page=20|L5 RPD Hindawi, p.20]] [^21]: Original PDF page 21: [[L5 RPD Hindawi.pdf#page=21|L5 RPD Hindawi, p.21]] [^22]: Original PDF page 22: [[L5 RPD Hindawi.pdf#page=22|L5 RPD Hindawi, p.22]] [^23]: Original PDF page 23: [[L5 RPD Hindawi.pdf#page=23|L5 RPD Hindawi, p.23]] [^24]: Original PDF page 24: [[L5 RPD Hindawi.pdf#page=24|L5 RPD Hindawi, p.24]] [^25]: Original PDF page 25: [[L5 RPD Hindawi.pdf#page=25|L5 RPD Hindawi, p.25]] [^26]: Original PDF page 26: [[L5 RPD Hindawi.pdf#page=26|L5 RPD Hindawi, p.26]] [^27]: Original PDF page 27: [[L5 RPD Hindawi.pdf#page=27|L5 RPD Hindawi, p.27]] [^28]: Original PDF page 28: [[L5 RPD Hindawi.pdf#page=28|L5 RPD Hindawi, p.28]] [^29]: Original PDF page 29: [[L5 RPD Hindawi.pdf#page=29|L5 RPD Hindawi, p.29]] [^30]: Original PDF page 30: [[L5 RPD Hindawi.pdf#page=30|L5 RPD Hindawi, p.30]] [^31]: Original PDF page 31: [[L5 RPD Hindawi.pdf#page=31|L5 RPD Hindawi, p.31]] [^32]: Original PDF page 32: [[L5 RPD Hindawi.pdf#page=32|L5 RPD Hindawi, p.32]] [^33]: Original PDF page 33: [[L5 RPD Hindawi.pdf#page=33|L5 RPD Hindawi, p.33]] [^34]: Original PDF page 34: [[L5 RPD Hindawi.pdf#page=34|L5 RPD Hindawi, p.34]] [^35]: Original PDF page 35: [[L5 RPD Hindawi.pdf#page=35|L5 RPD Hindawi, p.35]] [^36]: Original PDF page 36: [[L5 RPD Hindawi.pdf#page=36|L5 RPD Hindawi, p.36]] [^37]: Original PDF page 37: [[L5 RPD Hindawi.pdf#page=37|L5 RPD Hindawi, p.37]] [^38]: Original PDF page 38: [[L5 RPD Hindawi.pdf#page=38|L5 RPD Hindawi, p.38]] [^39]: Original PDF page 39: [[L5 RPD Hindawi.pdf#page=39|L5 RPD Hindawi, p.39]] [^40]: Original PDF page 40: [[L5 RPD Hindawi.pdf#page=40|L5 RPD Hindawi, p.40]] [^41]: Original PDF page 41: [[L5 RPD Hindawi.pdf#page=41|L5 RPD Hindawi, p.41]] [^42]: Original PDF page 42: [[L5 RPD Hindawi.pdf#page=42|L5 RPD Hindawi, p.42]] [^43]: Original PDF page 43: [[L5 RPD Hindawi.pdf#page=43|L5 RPD Hindawi, p.43]] [^44]: Original PDF page 44: [[L5 RPD Hindawi.pdf#page=44|L5 RPD Hindawi, p.44]] [^45]: Original PDF page 45: [[L5 RPD Hindawi.pdf#page=45|L5 RPD Hindawi, p.45]] [^46]: Original PDF page 46: [[L5 RPD Hindawi.pdf#page=46|L5 RPD Hindawi, p.46]] [^47]: Original PDF page 47: [[L5 RPD Hindawi.pdf#page=47|L5 RPD Hindawi, p.47]] [^48]: Original PDF page 48: [[L5 RPD Hindawi.pdf#page=48|L5 RPD Hindawi, p.48]] [^49]: Original PDF page 49: [[L5 RPD Hindawi.pdf#page=49|L5 RPD Hindawi, p.49]] [^50]: Original PDF page 50: [[L5 RPD Hindawi.pdf#page=50|L5 RPD Hindawi, p.50]] [^51]: Original PDF page 51: [[L5 RPD Hindawi.pdf#page=51|L5 RPD Hindawi, p.51]] [^52]: Original PDF page 52: [[L5 RPD Hindawi.pdf#page=52|L5 RPD Hindawi, p.52]] [^53]: Original PDF page 53: [[L5 RPD Hindawi.pdf#page=53|L5 RPD Hindawi, p.53]] [^54]: Original PDF page 54: [[L5 RPD Hindawi.pdf#page=54|L5 RPD Hindawi, p.54]] [^55]: Original PDF page 55: [[L5 RPD Hindawi.pdf#page=55|L5 RPD Hindawi, p.55]] [^56]: Original PDF page 56: [[L5 RPD Hindawi.pdf#page=56|L5 RPD Hindawi, p.56]] [^57]: Original PDF page 57: [[L5 RPD Hindawi.pdf#page=57|L5 RPD Hindawi, p.57]] [^58]: Original PDF page 58: [[L5 RPD Hindawi.pdf#page=58|L5 RPD Hindawi, p.58]] [^59]: Original PDF page 59: [[L5 RPD Hindawi.pdf#page=59|L5 RPD Hindawi, p.59]] [^60]: Original PDF page 60: [[L5 RPD Hindawi.pdf#page=60|L5 RPD Hindawi, p.60]]