# **Introduction to** ## **Removable Partial Denture** Dr Matsubara  Dr Matsubara Clinical photograph of a removable partial denture (RPD) on an upper dental cast. The prosthesis features a pink acrylic base with multiple natural-looking artificial teeth and polished chrome cobalt metal framework components including clasps, rests, and major connectors. This image visually demonstrates the design, materials, and clinical appearance of an RPD. # Masticatory System **** ## LEARNING OUTCOME * Discuss the importance of teeth for the digestive/masticatory system, aesthetics, pronetics, TMD * Discuss the impact of masticatory function on the mental health and cognitive function * Discuss bone remodeling after tooth loss * Provide the main reasons for tooth loss * Define and describe the Combination Syndrome * Discuss the indications, benefits and limitations of RPD  Upon completion of this section, students should be able to: - Discuss the importance of teeth for the digestive/masticatory system, aesthetics, phonetics, and the prevention of Temporomandibular Disorders (TMD). - Discuss the impact of masticatory function on mental health and cognitive function. - Discuss bone remodeling processes following tooth loss. - Identify and provide the main reasons for tooth loss. - Define and describe Combination Syndrome. - Discuss the indications, benefits, and limitations of Removable Partial Dentures (RPD). Logos of The University of Western Australia and the Oral Health Centre of Western Australia. These serve as institutional branding elements rather than a diagrammatic representation of the masticatory system. # Masticatory System THE UNIVERSITY OF WESTERN AUSTRALIA | Oral Health Centre of Western Australia ## Importance of Teeth * **The acquisition, cutting and trituration of food** * **Loss of masticatory efficiency** | Saliva: | | :--- | | Lubrication, | | Enzymes (amylase) | | Buffering capacity | --- **Digestive efficiency** nutrient extraction ### Change in diet **Fruits and vegetables** – less vitamins, immune system compromised **Fibers** - stomach and intestinal problems  Natural teeth play a critical role in the acquisition, cutting, and trituration of food. The loss of teeth leads to a significant reduction in masticatory efficiency. #### Role of Saliva in Digestion - Lubrication - Enzymes (amylase) - Buffering capacity #### Impact on Digestive Efficiency Tooth loss affects nutrient extraction and often leads to a change in diet: - **Fruits and vegetables:** Reduced intake leads to fewer vitamins and a compromised immune system. - **Fibers:** Reduced intake can result in stomach and intestinal problems. A schematic flow diagram illustrating the relationship between mastication and digestion. It features a text box labeled 'Saliva: Lubrication, Enzymes (amylase), Buffering capacity' connected via a red arrow to a box labeled 'Digestive efficiency', with the sub-label 'nutrient extraction' underneath. # Masticatory System * **The University of Western Australia** * **Oral Health Centre of Western Australia** ## Importance of Teeth * **Aesthetics** - Lip and cheeks support, vertical dimension **Premature ageing**      Teeth provide essential support for the lips and cheeks and maintain the vertical dimension of the face. Loss of this support can lead to premature ageing. Clinical photo of an elderly woman's profile showing the upper face with full lip and cheek support, illustrating the 'Aesthetics' concept mentioned in OCR. Clinical photo of the same elderly woman's profile showing collapsed lips and cheeks, labeled as 'Premature ageing' to demonstrate loss of vertical dimension. Photo of a dental cast (maxillary arch) showing teeth in occlusion, demonstrating the structural importance of teeth for mastication and aesthetics. Photo of a lower dental cast (mandibular arch), providing anatomical context for the masticatory system. Diagram of anterior teeth with a red outline tracing the gingival margin and interproximal spaces, visually representing the vertical dimension and esthetic zone referenced in the text. **Masticatory System** **The University of Western Australia** Oral Health Centre of Western Australia **Importance of Teeth** * Phonetics * Accurate pronunciation | | D | V | - | + | |---|---|---|---|---| | **labial** | | | | | | . | **p*** | **b*** | | _ | **f\*\*** | *v*<sup>*</sup> | | ~ | **m*** | | | D | V | - | + | |---|---|---|---|---| | **dental** | | | | | | . | *t*<sup>*</sup> | *d*<sup>*</sup> | | _ | *θ*<sup>*</sup> | *δ*<sup>***</sup> | | ~ | **n*** | | | D | V | - | + | |---|---|---|---|---| | **palatal** | | | | | | . | *K*<sup>*</sup> | *g*<sup>*</sup> | | _ | *X*<sup>****</sup> | *Y*<sup>***</sup> | | ~ | *ŋ*<sup>*</sup> | | | D | V | - | + | |---|---|---|---|---| | **velar** | | | | | | . | *k*\* | *g*\* | | _ | *X*\* | *y*\* | | ~ | *ay*\* | |---|---| | D | duration | | . | stop | | _ | continuant | | V | voicing | | - | voiceless | | + | voiced | | ~ | nasal |   Teeth are vital for phonetics and accurate pronunciation. Different tooth positions and contacts facilitate various speech sounds: - **Labial sounds:** p, b, f, v, m - **Dental sounds:** t, d, θ, δ, n - **Palatal sounds:** K, g, X, Y, ŋ - **Velar sounds:** k, g, X, y, ay #### Phonetic Classifications - **Duration:** Stop (.) or Continuant (_) - **Voicing:** Voiceless (-) or Voiced (+) - **Nasal:** (~) Four phonetic matrices (labial, dental, palatal, velar) showing consonant symbols with voicing and duration features. Legend table defining phonetic feature symbols: D (duration), V (voicing), -/+ (voiceless/voiced), ~ (nasal). **Masticatory System** **The University of Western Australia** | Oral Health Centre of Western Australia **Importance of Teeth** * **Good occlusion** * **Occlusal changes** Interferences Premature contacts Unbalanced muscle contraction **Temporomandibular** **disorders (TMD)**   Maintaining good occlusion is necessary for the health of the masticatory system. Occlusal changes can lead to: - Interferences - Premature contacts - Unbalanced muscle contraction These factors contribute to the development of Temporomandibular Disorders (TMD). Anatomical illustration of a set of molar and premolar teeth showing occlusal surfaces. The image demonstrates the alignment and contact points (occlusion) between upper and lower teeth, relevant to the slide's topic of 'Good occlusion' and 'Occlusal changes'. A composite medical diagram illustrating Temporomandibular disorders (TMD). It features a clinical photo of a woman in pain holding her jaw, linked by lines to an anatomical cross-section of the TMJ. The cross-section labels specific structures: 'Cheek bone', 'Jaw bone', and highlights an 'Inflamed joint' with a red marker. **Masticatory System** **The University of Western Australia Oral Health Centre of Western Australia** **Importance of Teeth** * **Mental health** * Tooth loss $\rightarrow$ **Low self-esteem** * **Loss of confidence** * **Psychological problems** * **Cognitive dysfunction** * Increased risk for dementia, Alzheimer’s disease  #### Psychological Impact Tooth loss is closely linked to mental health issues, including: - Low self-esteem - Loss of confidence - Psychological problems #### Cognitive Dysfunction There is an increased risk for dementia and Alzheimer’s disease associated with tooth loss. Flowchart diagram illustrating the link between tooth loss and mental health issues. The text 'Tooth loss' is connected via a red arrow to a rectangular box containing three bullet points: 'Low self-esteem', 'Loss of confidence', and 'Psychological problems'. # Masticatory System **THE UNIVERSITY OF WESTERN AUSTRALIA** | Oral Health Centre of Western Australia ## Cognitive dysfunction * Regular sensory stimulation of mastication is essential for maintaining the learning and memory functions of the aged **hippocampus** * The decrease of masticatory stimulation may reduce synaptic density in the **cerebral cortex** by decreasing sensory input to the cerebral cortex * **Cerebellar** functions also seem to be influenced by masticatory activity: the increase in cerebellar activity during chewing may improve certain motor functions Teixeira et al. 2014 doi: 10.7150/ijms.6801 Masticatory activity has a direct influence on brain function: - **Hippocampus:** Regular sensory stimulation from mastication is essential for maintaining learning and memory functions in the aged. - **Cerebral Cortex:** A decrease in masticatory stimulation may reduce synaptic density by decreasing sensory input. - **Cerebellum:** Chewing increases cerebellar activity, which may improve certain motor functions. |Masticatory System| |:---| |The University of Western Australia Oral Health Centre | |of Western Australia| |Source: Watanabe et. al 2015 https://doi.org/10.1016/j.jdsr.2014.09.002| |**Progression**| |:---| |**of dementia**| |**Atrophy of brain**| |:---| |↓| |**Periodontal disease(2,2)**| |**Intrinsic factor**| |**Reduction of**| |:---| |**masticatory**| |**function**| |**Decrease in cerebral blood flow(2,8)**| |:---| |**Decreased metabolic activity in the brain**| |**External factor**| |:---| |**Reduction of masticatory function (2,4)**| |**Core symptom**| |**Loss of teeth**| |:---| |**Chronic infection**| |**Behavioral and**| |:---| |**Psychological**| |**Symptoms**| |**Severe degree** |:---:| |**of care**|  #### Progression of Dementia and Masticatory Function The relationship between tooth loss and cognitive decline involves several factors: - **Intrinsic Factors:** Periodontal disease and chronic infection. - **External Factors:** Reduction of masticatory function leads to: - Decrease in cerebral blood flow - Decreased metabolic activity in the brain - Atrophy of the brain - **Core Symptoms:** Behavioral and psychological symptoms leading to a severe degree of care. Conceptual diagram illustrating the 'Masticatory System' and its relationship to dementia progression. The flowchart features three main sections: 'External factor' at the top (Reduced masticatory function leading to decreased cerebral blood flow), 'Intrinsic factor' in the center (Periodontal disease, chronic infection, loss of teeth, brain atrophy), and 'Progression of dementia' on the right (Core symptoms, severe care degree, behavioral/psychological symptoms). Arrows indicate causal links between these elements. # Masticatory System **The University of Western Australia** Oral Health Centre of Western Australia ## Importance of Teeth - **Maintenance of bone and soft tissues** ### Tooth loss ↓ **Loss of quality, width and height of bone**    Teeth are necessary for the maintenance of bone and soft tissues. Tooth loss leads to a loss of quality, width, and height of the alveolar bone. Clinical intraoral photo of the maxillary posterior region showing a gap between teeth (indicated by black arrows) and red arrowheads pointing to gingival tissue, illustrating the anatomical context of tooth loss. Clinical intraoral photo showing a missing tooth space outlined with dashed lines, demonstrating the physical absence of a tooth in the dental arch. Sequence diagram illustrating progressive alveolar bone resorption following tooth loss. Shows transition from intact periodontium to exposed root, then to reduced bone width and height, with blue arrows indicating pressure forces acting on the remaining bone structure. **Masticatory System** **Reasons for tooth loss** * **Congenitally missing teeth** * **Hypodontia:** 1 to 6 teeth absent * **Oligodontia:** > 6 teeth * **Anodontia:** all primary or permanent * Partial or total (ectodermal dysplasia associated) * Primary, Permanent or Both * Uni or bilateral <img>Missing upper central incisor, left upper lateral incisor and right upper canine. Right upper central incisor <img>   #### Congenitally Missing Teeth - **Hypodontia:** 1 to 6 teeth absent. - **Oligodontia:** More than 6 teeth absent. - **Anodontia:** All primary or permanent teeth absent (often associated with ectodermal dysplasia). These conditions can be partial or total, involve primary or permanent dentition, and occur unilaterally or bilaterally. Clinical photo showing a patient's anterior dentition with congenitally missing teeth. The image displays the upper and lower arches, highlighting the absence of specific teeth as described in the OCR text: 'Missing upper central incisor, left upper lateral incisor and right upper canine.' This visual demonstrates hypodontia or oligodontia. Clinical photo showing a child's mouth being pulled open by fingers to reveal severe tooth loss. The image corresponds to the text description of 'Partial or total (ectodermal dysplasia associated)' tooth loss, demonstrating an edentulous or near-edentulous state consistent with conditions like ectodermal dysplasia. **Masticatory System** Reasons for tooth Loss • Congenitally missing teeth • Caries • Periodontal disease   Common reasons for tooth loss include: - Congenitally missing teeth - Caries - Periodontal disease Clinical photo showing severe dental caries and tooth loss in the anterior maxillary and mandibular regions. The image demonstrates advanced decay with significant discoloration, structural breakdown of teeth, and missing teeth, illustrating 'Caries' as a reason for tooth loss. Clinical photo showing severe periodontal disease in the anterior mandibular region. There is extensive gingival recession, heavy calculus deposits (tartar), multiple missing teeth, and remaining teeth with deep pockets and mobility, illustrating 'Periodontal disease' as a reason for tooth loss. Masticatory System Reasons for tooth Loss • Congenitally missing teeth • Caries • Periodontal disease • Trauma • Oral and maxillo facial surgery Additional reasons for tooth loss include: - Trauma - Oral and maxillofacial surgery # Masticatory System ## Life Expectancy ### AUSTRALIA **2014** **Male life expectancy: 80.3 years** **Female life expectancy: 84.4 years.** There is a significant increase of tooth loss with ageing Australian Bureau of Statistics   #### Life Expectancy in Australia (2014) - **Male:** 80.3 years - **Female:** 84.4 years There is a significant correlation between ageing and the increase of tooth loss. Line chart titled 'Life Expectancy at Birth by Region, 1950-2050' with source 'UN World Population Prospects, 2008'. X-axis shows time periods from 1960-1965 to 2040-2045. Y-axis represents life expectancy in years (0–90). Five colored lines represent different regions: World (blue), More developed regions (orange), Africa (yellow), Asia (green), Latin America and the Caribbean (maroon). All lines show an upward trend over time. Line graph titled 'Life expectancy at birth (years)' for Australia, sourced from Australian Bureau of Statistics. X-axis spans 1890–2015; Y-axis ranges 0–90 years. Two lines: dark blue for Males, light blue for Females. Both show steady increase over time, with females consistently higher than males. Caption notes 2014 values: Male = 80.3 years, Female = 84.4 years. Header: Masticatory System Main Text: Need and Demand for Treatment Information on the right: Most people prefer not to have missing back teeth replaced and the preference increases with age Graph Data: Y-axis title: Patients (%) X-axis title: Age (yrs) X-axis categories: 16-24 25-34 35-44 45-54 55-64 65 and over Legend: - Have RPD (%) - Manage without (%) Footer citation: Davenport, J. C et al: Br Dent J 2000  #### Need and Demand for Treatment Research indicates that most people prefer not to have missing back teeth replaced, and this preference increases with age. **Patient Management Trends by Age:** - **16-24 to 35-44:** Low percentage of RPD usage; high percentage managing without. - **45-54 to 65+:** Gradual increase in RPD usage, though many still manage without replacement. Stacked bar chart titled 'Need and Demand for Treatment' from Davenport et al (Br Dent J 2000). Y-axis represents Patients (%), X-axis shows Age groups: 16–24, 25–34, 35–44, 45–54, 55–64, 65 and over. Legend distinguishes between 'Have RPD (%)' (solid red) and 'Manage without (%)' (hatched beige). Trend shows increasing preference to manage without replacement with age. **Masticatory System** Need and Demand for Treatment Older people tend to find the usage of a RPD more upsetting then younger Davenport, J. C et al: Br Dent J 2000  Older individuals tend to find the transition to and usage of a Removable Partial Denture (RPD) more upsetting than younger patients. Stacked bar chart titled 'Need and Demand for Treatment'. The Y-axis represents 'Patients (%)' ranging from 0 to 100. The X-axis displays age groups: 16-24, 25-34, 35-44, 45-54, 55-64, and 65 and over. Each bar is divided into three segments representing levels of upset regarding RPD usage: dark blue for 'Very upsetting', light purple for 'A little upsetting', and white with diagonal hatching for 'Not at all upsetting'. A legend is included below the bars. # Masticatory System | **Maxillary teeth** | **Mandibular teeth** | |---|---| | **Tooth Loss** | **Inter-arch Difference** | | **Intra-arch Difference** | **Posterior teeth** | **Anterior teeth** | # The University of Western Australia # Oral Health Centre of Western Australia Tooth loss patterns vary between the maxillary and mandibular arches, as well as between anterior and posterior segments (intra-arch differences). The University of Western Australia | Oral Health Centre of Western Australia Mandibular RPD Maxillary Complete Denture Palmqvist et al: The combination syndrome: a literature review. J Prosthet Dent 2003   Combination Syndrome typically occurs when a Maxillary Complete Denture is opposed by a Mandibular Removable Partial Denture (RPD). Clinical photo of a mandibular RPD (Removable Partial Denture). The image shows the lower dental arch with a metal framework and artificial teeth. The gingival tissue appears pink and healthy. Clinical photo of a maxillary complete denture. The image shows the upper dental arch with a full set of artificial teeth. The patient's lips are closed, revealing the smile line. **Combination syndrome** **THE UNIVERSITY** **WESTERN** **AUSTRALIA** Oral Health Centre of Western Australia   Combination Syndrome involves specific destructive changes in the oral cavity resulting from specific occlusal relationships. Clinical photo showing a plaster cast of dental arches with an overlay material (likely impression or diagnostic wax) draped over the anterior region, demonstrating anatomical relationship relevant to Combination syndrome diagnosis. Clinical intraoral photo showing the floor of the mouth with prominent vascularization and mucosal changes consistent with oral manifestations of Combination syndrome. # Combination syndrome  Combination Syndrome. Panoramic dental radiograph (orthopantomogram) showing the maxilla and mandible. The title 'Combination syndrome' indicates the context of the case. A red dotted line traces the inferior border of the maxillary alveolar process bilaterally, highlighting a significant loss of vertical bone height in the posterior regions (premolars and molars), while the anterior region appears to have retained more bone height. Several teeth are visible in the mandibular arch with radiopaque restorations. # Combination syndrome • Edentulous maxilla is opposed by natural mandibular anterior teeth • loss of bone from the anterior portion of the maxillary ridge • Overgrowth of the tuberosities • Extrusion of mandibular anterior teeth • Loss of alveolar bone and ridge height beneath the RPD   #### Clinical Characteristics Combination Syndrome is characterized by the following when an edentulous maxilla is opposed by natural mandibular anterior teeth: - Loss of bone from the anterior portion of the maxillary ridge. - Overgrowth (hypertrophy) of the tuberosities. - Extrusion of mandibular anterior teeth. - Loss of alveolar bone and ridge height beneath the mandibular RPD bases. Clinical radiograph (X-ray) of the mandible and maxilla. The image shows an edentulous maxilla opposed by natural mandibular anterior teeth. Red lines are drawn to highlight anatomical features: one line traces the contour of the atrophic maxillary ridge, and another horizontal line indicates the level of the mandibular alveolar bone beneath the remaining teeth. Clinical photograph of a dental study model showing a combination syndrome presentation. The model depicts a severe underbite with significant resorption of the upper jaw (edentulous maxilla) and overgrowth of the posterior tuberosities, contrasting with the protruding lower anterior teeth. # PROSTHODONTICS * **Replace missing teeth and oral tissues** * **Restore and maintain form, function, appearance, and health** | **Fixed Prosthodontics** | **Removable Prosthodontics** | **Maxillofacial Prosthodontics** | | :--- | :--- | :--- | | Replace coronal portion of teeth and are rigidly fixed to the remaining teeth or implants | Replacement of missing teeth and supporting tissues which is designed to be removed by the patient. | Replace or restore lost or missing structures in the head and neck | </img>     Prosthodontics aims to replace missing teeth and oral tissues to restore and maintain form, function, appearance, and health. #### Treatment Categories 1. **Fixed Prosthodontics:** Replaces the coronal portion of teeth; rigidly fixed to remaining teeth or implants. 2. **Removable Prosthodontics:** Replacement of missing teeth and supporting tissues designed to be removed by the patient. 3. **Maxillofacial Prosthodontics:** Replaces or restores lost or missing structures in the head and neck. Clinical photo showing a fixed prosthodontic restoration (likely crowns or bridges) on the upper dental arch, illustrating rigid fixation to remaining teeth. Photo of removable partial dentures with metal clasps and acrylic bases, demonstrating replacement of missing teeth designed for patient removal. Photo of a complete lower denture (full removable prosthesis), representing replacement of missing teeth and supporting tissues. Photo of a maxillofacial prosthesis (facial prosthetic device) replacing a nose structure, demonstrating restoration of lost structures in the head and neck region. **The University of Western Australia** Oral Health Centre of Western Australia Partial Edentulous Patients Fixed vs Removable Clinical decision-making for partially edentulous patients involves choosing between fixed and removable options. # Partial Edentulous Patients ## Fixed vs Removable ### Contraindications for FPD * **Age of patients:** * < 18 year old, old patients with low manual dexterity * **Length of edentulous area** ### Ante’s Law    #### Clinical Contraindications - **Patient Age:** Patients under 18 years old (due to pulp size/growth) or elderly patients with low manual dexterity. - **Length of Edentulous Area:** Excessively long spans that violate Ante’s Law. Labeled dental diagram illustrating a partial edentulous case with teeth labeled A2p, A1m, and A2m. The image shows the root surface areas of abutment teeth relative to the missing teeth, likely demonstrating Ante's Law. Labeled dental diagram showing another configuration of teeth with labels A1p, A2p, A1m, and A2m. Similar to the previous diagram, it visualizes root surface area relationships for fixed partial denture planning. Labeled dental diagram displaying tooth positions with labels Ac, A1p, A2p, A1m, and A2m. This appears to be a third example used to illustrate contraindications or principles related to fixed partial dentures in partially edentulous patients. **Partial Edentulous Patients** **Fixed vs Removable** **Contraindications for FPD** * Loss of supporting tissues    #### Tissue Considerations - Significant loss of supporting tissues (bone and soft tissue) may contraindicate a Fixed Partial Denture (FPD) due to aesthetic and hygiene challenges. Clinical diagram showing a dental cast model with red lines outlining the vestibular depth and tissue contours. The image demonstrates 'Loss of supporting tissues' as indicated by the text, highlighting insufficient space for a fixed partial denture (FPD) due to shallow vestibule or alveolar resorption. Intraoral clinical photograph showing severe anterior tooth wear, gingival recession, and lack of adequate bone support in the maxillary anterior region. This visual supports the contraindication for FPDs due to compromised periodontal structures. Lateral facial profile photograph demonstrating loss of lower facial height and collapsed lip support, consistent with significant alveolar bone loss. This illustrates the aesthetic and functional consequences of losing supporting tissues relevant to FPD planning. The University of Western Australia | Oral Health Centre of Western Australia **Partial Edentulous Patients** **Fixed vs Removable** **Indications of RPD** * Long-span edentulous area * No distal abutment tooth   #### Primary Indications - Long-span edentulous areas. - Absence of a distal abutment tooth (distal extension cases). Clinical photo of a partial edentulous lower jaw showing a long-span missing area with remaining anterior and posterior teeth. The image illustrates the condition 'Long-span edentulous area' as an indication for RPD. Clinical photo of a partial edentulous upper jaw showing a large gap in the posterior region with only two molar-like teeth remaining on either side. This visual demonstrates the condition 'No distal abutment tooth', which is an indication for RPD. # Partial Edentulous Patients ## Fixed vs Removable ### Indications of RPD * Long-span edentulous area * No distal abutment tooth * Reduced periodontal support for remaining teeth * Need for cross-arch stabilization  #### Structural and Periodontal Indications - Long-span edentulous areas. - No distal abutment tooth. - Reduced periodontal support for remaining teeth. - Requirement for cross-arch stabilization. Clinical intraoral photograph of a maxillary partial removable partial denture (RPD) in place. The image demonstrates the appliance's design and fit for an edentulous patient. Visible features include metal clasps engaging the remaining natural teeth on both sides of the arch, likely premolars or molars, to provide retention. A central major connector spans the midline over the palate. The prosthetic teeth are visible in the anterior region, replacing the missing front teeth. This visual serves as an example of the 'Fixed vs Removable' comparison mentioned in the slide title. **Partial Edentulous Patients** **Fixed vs Removable** **Indications of RPD** * Long-span edentulous area * No distal abutment tooth * Reduced periodontal support for remaining teeth * Need for cross-arch stabilization * Excessive bone loss * Limited manual dexterity  #### Comprehensive Indications - Long-span edentulous area. - No distal abutment tooth. - Reduced periodontal support for remaining teeth. - Need for cross-arch stabilization. - Excessive bone loss. - Limited manual dexterity. A structured list of indications for Removable Partial Dentures (RPD) in partial edentulous patients. The text is organized under the heading 'Indications of RPD' with bullet points including: Long-span edentulous area, No distal abutment tooth, Reduced periodontal support for remaining teeth, Need for cross-arch stabilization, Excessive bone loss, and Limited manual dexterity. <table><thead> <tr> <th colspan="3"> <p>Premolar Replacement for Unicuspids</p> </th> </tr> </thead> <tbody> <tr><td></td><td><p>Premolar</p></td><td><p>Unicuspids</p></td></tr> <tr><td></td><td><p>Maxillary</p></td><td><p>Maxillary</p></td></tr> <tr><td></td><td><p>Mandibular</p></td><td><p>Mandibular</p></td></tr> <tr><td></td><td>Hemi-arch contention</td><td>Hemi-arch contention</td></tr> <tr><td></td><td>Bilateral (or Unilateral)</td><td>Bilateral (or Unilateral)</td></tr> <tr><td></td><td>More common</td><td>Less common</td></tr> </tbody> </table></img>  #### Tooth Replacement Variations - **Premolar Replacement:** Common in both maxillary and mandibular arches; often involves bilateral hemi-arch contention. - **Unicuspid Replacement:** Less common; utilized in specific maxillary or mandibular configurations. Flowchart illustrating the classification of Prosthodontics. The top level branches into three categories: 'Fixed Prosthodontics', 'Removable Prosthodontics', and 'Maxillofacial Prosthodontics'. 'Removable Prosthodontics' further divides into 'Partial Dentures' and 'Complete Dentures'. 'Partial Dentures' is subdivided into 'Interim' and 'Definitive'. The University of Western Australia | Oral Health Centre of Western Australia ## Interim RPD • Provisional prosthesis • Improve aesthetic and function until a definitive appliance can be delivered Indications: • Loss of additional tooth is inevitable • Healing process – function and protection • Carrier for treatment material (soft tissues conditioners) An interim RPD is a provisional prosthesis designed to improve aesthetics and function until a definitive appliance can be delivered. #### Indications - When the loss of additional teeth is inevitable. - During the healing process to provide function and protection. - As a carrier for treatment materials, such as soft tissue conditioners. Interim RPD **BENEFITS** * Simple to make * Easy to repair/add * Particularly useful in the early **Control Phase** of management of complex cases **RISKS** * Requires adaptation * Damage supporting structures * Poor retention * Mobility - **compromised function/phonetics/aesthetics** * Limited longevity  #### Benefits - Simple to manufacture. - Easy to repair or add teeth to. - Useful during the early **Control Phase** of complex case management. #### Risks - Requires patient adaptation. - Potential to damage supporting structures. - Poor retention and stability. - Mobility leading to compromised function, phonetics, and aesthetics. - Limited longevity. Clinical photo showing an Interim Removable Partial Denture (RPD) in the maxillary anterior region. The image displays pink acrylic denture teeth and base covering the gingival tissue, replacing missing teeth to the right of the central incisors. This visual demonstrates the aesthetic and functional application of an interim prosthesis mentioned in the text. Definitive RPD THE UNIVERSITY OF Western AUSTRALIA Oral Health Centre of Western Australia    Definitive Removable Partial Dentures. Clinical photo of the anterior maxillary region showing edentulous space between central incisors and adjacent teeth. The gingival tissue appears erythematous and inflamed. Clinical photo of the anterior maxillary region after placement of a definitive RPD (Removable Partial Denture). The prosthesis restores the missing central incisors with natural-looking artificial teeth. Photo of the definitive RPD prosthesis outside the mouth. It shows a metal framework with clasps for retention and artificial teeth replacing the missing anterior teeth. # **Definitive RPD** **THE UNIVERSITY OF** **WESTERN** **AUSTRALIA** **Oral Health Centre** **of Western Australia** **BENEFITS** * Improved stabilization and retention * Better distributions of functional load * Can be highly aesthetic **RISKS** * Technically difficult and complex * Longevity - ? * Can damage supporting tissues when not well planned * Significant investment    #### Benefits - Improved stabilization and retention compared to interim versions. - Better distribution of functional loads. - High aesthetic potential. #### Risks and Limitations - Technically difficult and complex to design and fabricate. - Uncertain long-term longevity. - Potential to damage supporting tissues if not well-planned. - Requires significant financial and clinical investment. Clinical intraoral photograph of a maxillary arch showing a cast metal removable partial denture (RPD) framework. The image demonstrates the 'Definitive RPD' mentioned in the text, specifically illustrating the 'Improved stabilization and retention' through the use of rigid metal clasps engaging the remaining teeth. Clinical intraoral photograph of a maxillary arch featuring an implant-supported or hybrid prosthesis. This visual supports the text's point that Definitive RPDs can be 'highly aesthetic,' showing natural-looking crowns supported by visible abutments/implants on the left side. Clinical intraoral photograph of a mandibular arch displaying a full set of anterior teeth with crowns. This serves as a visual example of the aesthetic potential of definitive prosthetic rehabilitation discussed in the benefits section. THE UNIVERSITY OF WESTERN AUSTRALIA Oral Health Centre of Western Australia **Thirteenth Edition** **McCracken’s** **REM.**OVABLE **PARTIAL PROSTHODONTICS** Alan B. **Carr** David T. **Brown** ELSAIER  #### Recommended Textbook **McCracken’s Removable Partial Prosthodontics** Thirteenth Edition Authors: Alan B. Carr and David T. Brown Publisher: Elsevier Book cover figure for 'McCracken's Removable Partial Prosthodontics', Thirteenth Edition. The image contains a composite of five clinical and radiographic panels: (top-left) an intraoral clinical photo showing edentulous arches with remaining abutment teeth; (top-middle) a close-up photo of a metal partial denture framework on a model; (top-right) a full-arch dental photograph showing the completed prosthesis in place; (bottom-left) a close-up photo of prepared abutment teeth; (bottom-center) a periapical radiograph showing the underlying bone and tooth roots. [^1]: Original PDF page 1: [[L1 Introduction to RPD.pdf#page=1|L1 Introduction to RPD, p.1]] [^2]: Original PDF page 2: [[L1 Introduction to RPD.pdf#page=2|L1 Introduction to RPD, p.2]] [^3]: Original PDF page 3: [[L1 Introduction to RPD.pdf#page=3|L1 Introduction to RPD, p.3]] [^4]: Original PDF page 4: [[L1 Introduction to RPD.pdf#page=4|L1 Introduction to RPD, p.4]] [^5]: Original PDF page 5: [[L1 Introduction to RPD.pdf#page=5|L1 Introduction to RPD, p.5]] [^6]: Original PDF page 6: [[L1 Introduction to RPD.pdf#page=6|L1 Introduction to RPD, p.6]] [^7]: Original PDF page 7: [[L1 Introduction to RPD.pdf#page=7|L1 Introduction to RPD, p.7]] [^8]: Original PDF page 8: [[L1 Introduction to RPD.pdf#page=8|L1 Introduction to RPD, p.8]] [^9]: Original PDF page 9: [[L1 Introduction to RPD.pdf#page=9|L1 Introduction to RPD, p.9]] [^10]: Original PDF page 10: [[L1 Introduction to RPD.pdf#page=10|L1 Introduction to RPD, p.10]] [^11]: Original PDF page 11: [[L1 Introduction to RPD.pdf#page=11|L1 Introduction to RPD, p.11]] [^12]: Original PDF page 12: [[L1 Introduction to RPD.pdf#page=12|L1 Introduction to RPD, p.12]] [^13]: Original PDF page 13: [[L1 Introduction to RPD.pdf#page=13|L1 Introduction to RPD, p.13]] [^14]: Original PDF page 14: [[L1 Introduction to RPD.pdf#page=14|L1 Introduction to RPD, p.14]] [^15]: Original PDF page 15: [[L1 Introduction to RPD.pdf#page=15|L1 Introduction to RPD, p.15]] [^16]: Original PDF page 16: [[L1 Introduction to RPD.pdf#page=16|L1 Introduction to RPD, p.16]] [^17]: Original PDF page 17: [[L1 Introduction to RPD.pdf#page=17|L1 Introduction to RPD, p.17]] [^18]: Original PDF page 18: [[L1 Introduction to RPD.pdf#page=18|L1 Introduction to RPD, p.18]] [^19]: Original PDF page 19: [[L1 Introduction to RPD.pdf#page=19|L1 Introduction to RPD, p.19]] [^20]: Original PDF page 20: [[L1 Introduction to RPD.pdf#page=20|L1 Introduction to RPD, p.20]] [^21]: Original PDF page 21: [[L1 Introduction to RPD.pdf#page=21|L1 Introduction to RPD, p.21]] [^22]: Original PDF page 22: [[L1 Introduction to RPD.pdf#page=22|L1 Introduction to RPD, p.22]] [^23]: Original PDF page 23: [[L1 Introduction to RPD.pdf#page=23|L1 Introduction to RPD, p.23]] [^24]: Original PDF page 24: [[L1 Introduction to RPD.pdf#page=24|L1 Introduction to RPD, p.24]] [^25]: Original PDF page 25: [[L1 Introduction to RPD.pdf#page=25|L1 Introduction to RPD, p.25]] [^26]: Original PDF page 26: [[L1 Introduction to RPD.pdf#page=26|L1 Introduction to RPD, p.26]] [^27]: Original PDF page 27: [[L1 Introduction to RPD.pdf#page=27|L1 Introduction to RPD, p.27]] [^28]: Original PDF page 28: [[L1 Introduction to RPD.pdf#page=28|L1 Introduction to RPD, p.28]] [^29]: Original PDF page 29: [[L1 Introduction to RPD.pdf#page=29|L1 Introduction to RPD, p.29]] [^30]: Original PDF page 30: [[L1 Introduction to RPD.pdf#page=30|L1 Introduction to RPD, p.30]] [^31]: Original PDF page 31: [[L1 Introduction to RPD.pdf#page=31|L1 Introduction to RPD, p.31]] [^32]: Original PDF page 32: [[L1 Introduction to RPD.pdf#page=32|L1 Introduction to RPD, p.32]] [^33]: Original PDF page 33: [[L1 Introduction to RPD.pdf#page=33|L1 Introduction to RPD, p.33]] [^34]: Original PDF page 34: [[L1 Introduction to RPD.pdf#page=34|L1 Introduction to RPD, p.34]]