Temporary RPDs: Flashcards
Types of acrylic partial dentures:
- Temporary Removable Partial Dentures
- Interim Removable Partial Dentures
- Transitional Denture
- Treatment Denture
- Immediate RPD
What is a temporary RPD?
- A RPD made without a metal framework: the acrylic (PMMA) denture base acts as a major connector and the teeth and clasps are directly attached to the base
- Clasps are made of wrought wire or can be prefabricated and bent to shape
- It is also possible (though costly and time consuming) to cast individual clasp assemblies and attach those into the acrylic base)
When is a RPD considered temporary?
Interim Prosthesis Definition:
Is a fixed or removable dental prosthesis, or a maxillofacial prosthesis, designed to enhance aesthetics, stabilization, and/or function for a limited period of time, after which it is to be replaced by a definitive dental or maxillofacial prosthesis; often such prostheses are used to assist in determination of the therapeutic effectiveness of a specific treatment plan or the form and function of the planned for definitive prosthesis
What are the characteristics that define of a temporary RPD
As resulting from the definition
a fixed or removable dental prosthesis, designed to enhance aesthetics, stabilization, and/or function for limited period of time, after which it is to be replaced by a definitive dental or maxillofacial prosthesis; often such prostheses are used to assist in determination of the therapeutic effectiveness of a specific treatment plan or the form and function of the planned for definitive prosthesis
- Intended purpose of use &
- Intended duration of use
What are the possible consequences if a temporary RPD is used for a longer period than initially intended?
Risks to abutment teeth
- lateral forces
- excessive occlusal forces
- caries (due to extended coverage)
Risks to periodontal tissues
- denture bearing mucosa
- residual alveolar ridge resorption - periodontitis
Risks to the interim prosthesis
- denture base fracture
- fracture of artificial teeth (due to uneven distribution of forces)
Risks to the patient
- develop habits of functioning with suboptimal prosthesis design
- risk of swallowing or inhalation of fractured part of interim RPD
- loss of confidence
Loss of confidence:
- The most challenging time for a first time denture wearer is the initial period of adoption to a new denture (either RPD or CD)
- Temporary RPDs are suboptimal: they are made as quickly as possible at a cost as low as possible
- Retention, support and stability are compromised
- The thickness of the acrylic denture base is a source of discomfort
- Speech is difficult and requires time to adjust
- Mastication may be uncomfortable due to lack of tooth support
- Immediate RPDs are made off a modified cast, with no opportunity for trial insertion
- Also, these are placed in a mouth which is constantly changing as healing progresses
- The suboptimal fit deteriorates from the moment an immediate RPD is placed
A negative experience with the temporary RPD may be translated by the patient inability of the dentist to provide a well fitting and functioning prosthesis
Q. When do we need a provisional RPD?
- Immediate post-extraction placement
- Failing bridgework – unknown prognosis of abutment teeth must be investigated after removal of the bridge
- When further tooth loss is imminent but a replacement is required
- While waiting for something else, e.g. implant osseointegration, tissue response to periodontal treatment, patient decision on definitive treatment plan
- When there is a need to replace any number of teeth as quickly as possible
- When the means available are limited
- When there is a need to re-establish occlusal relationships, e.g. increase in OVD
- When there is a need to gradually condition the patient to wearing a removable prosthesis
Provisional RPD replacing anterior teeth:
- Main function: restore the appearance for social reasons
- May be at any age
Examples
- Children: hypodontia or trauma
- Adults: need to work and socialize
- Elderly patients: need to socialise, avoid embarrassment to family members
- Terminally ill patients: accept family visits with dignity
- Post mortem: maintain facial appearance!
Provisional RPD replacing anterior teeth:
Timing:
- Immediately post-extraction
- Several days to a few weeks post-extraction
- Months or years after extraction
Provisional RPD to maintain space until definitive treatment is completed:
Younger patients:
- until adjacent teeth have reached maturity to be used as abutments for fixed restoration or until implant placement is indicated
Hypodontia:
- multidisciplinary approach; early planning and intervention
Adult patients:
- prevent migration of adjacent teeth or overeruption of opposing teeth
Space maintenance:
Important considerations:
- Timing of intervention
- Interdisciplinary collaboration: Prosthodontics – Periodontology – Implantology– Orthodontics
- Patient compliance
- Denture base extension; support and stability, esp. if replacing single tooth
- Alternative option: Essix retainer
Provisional RPD to assess and establish occlusal changes:
- Most common: increase in OVD
- Fixed and removable options: RPD vs. cast splint vs. adhesive techniques Overdenture or overlay denture
Temporary RPDs as training prostheses:
When?
- Adoption of a removable prosthesis is not an easy task!
- Levels of tolerance and adaptability vary significantly among patients
- Increasing age: reduced adaptive capacity of the stomatognathic system Intolerance to palatal coverage
- Intolerance to transfer of occlusal loads to underlying mucosa
- Advancing residual ridge resorption
- Reduced muscular control
Temporary RPDs as training prostheses:
Most challenging cases:
- Periodontal patients about to lose significant number of teeth and will require complete denture treatment
- Failing full arch bridgework
- The ‘gagging’ patient
Temporary RPDs as training prostheses Rationale:
- Even if the transition to edentulousness is about to happen and is unavoidable, and provided that the patient is free of pain and the risk of significant damage to the denture bearing tissues is small, it is easier to adapt to a RPD and gradually convert this to an interim CD than to transition immediately to a CD
- Ideally, these patients should be treated early with RPD to allow sufficient time for adoption
- This is not always feasible
Temporary RPDs as training prostheses
The ‘gagging’ patient:
- Perhaps the most challenging group of patients in Removable Prosthodontics
- Severity may vary widely: from those who just state that they cannot tolerate impressions taken (but may have a 10-unit fixed bridge in their mouth!) to those who start retching the minute a mouth mirror is inserted in the oral cavity…
- In severe cases it may be impossible to offer any treatment at all
- If possible to record even partial impressions, a training RPD can be made with only a few artificial teeth, usually not extending beyond the premolars
- Over time, more teeth are added and the denture base is extended to the maximum tolerable
- Once full palatal coverage is achieved, the treatment may proceed with further tooth extractions and conversion to a complete denture
