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Removable Partial Denture with dual path of insertion: clinical case report

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DOI: 10.14295/bds.2017.v20i2.1331

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 open access scientific journal VOLUME 20 N 0 02 - 2017

Ciência
Odontológica
Brasileira

Benign fibrous histiocytoma of the tongue: a case report

Ciência
Odontológica
Brasileira
UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos

CAS E R E P O R T doi: 10.14295/bds.2017.v20i2.1331

Removable Partial Denture with dual path of insertion: clinical

case report
PPR com dupla trajetória de inserção: relato de caso clínico
Eduardo Shigueyuki UEMURA1, João Maurício Ferraz da SILVA1, Alberto Noriyuki KOJIMA1, Carlos Rocha Gomes TORRES2, Cleiton
Santos VIEIRA
1 - São Paulo State University (Unesp) – Institute of Science and Technology – Department of Dental Materials and Prosthodontics – São
José dos Campos – SP - Brazil.
2 - São Paulo State University (Unesp) – Institute of Science and Technology – Department of Restorative Dentistry – São José dos Campos
– SP - Brazil.

Abstract Resumo
Removable Partial Dentures (RPD) with dual path Próteses parciais removíveis (PPR) com dupla
of insertion are designed to overcome conventional trajetória de inserção são próteses projetadas
RPD esthetic limitations, through the use of proximal para superar limitações estéticas das próteses
undercuts for rigid direct retainers. Therefore, dual convencionais, utilizando-se retentores diretos
path RPD is considered a variation of conventional rígidos nas áreas retentivas proximais dos dentes
RPD. This paper reports a clinical case where proper suportes. Desta forma, a PPR com dupla trajetória
function as well as excellent esthetics were obtained da inserção é considerada uma variação da PPR
with this type of RPD. tradicional. O objetivo deste artigo é relatar um caso
clínico onde se obteve uma resolução funcional e
altamente estética através deste tipo de PPR.

KEYWORDS Palavras-chave
Dual path design; Rotational path; Removable partial Dupla trajetória de inserção; Trajetória de inserção
denture. rotacional; Prótese parcial removível.

INTRODUCTION Jacobson [3] says that a modification in

the insertion path is classically made through

I n times where aesthetics are primordial, even changes in anteroposterior and/or side-to-side
in the case of removable partial dentures, inclination of the model in the delineator, or
the dual or rotational insertion path, can, in with the use of a rotational path of insertion.
determineted cases, be an excellent aesthetic In prostheses with conventional insertion
solution. In a conventional removable partial path, the location of the retentive terminal, if
denture, to compensate the lack of contour, visible, it becomes a problem when the patient
position and inclination of supports teeth, speaks or smiles. An alternative would be the use
variations in the insertion path is often indicated, of precision or semi-precision attachments, but
usually perpendicular to the occlusal plane when these devices have the disadvantage of the high
the study model in delineator is [1,2]. cost and the laboratory technique ascertained.

146 Braz Dent Sci 2017 Apr/Jun;20(2)

 Uemura ES et al.
Removable Partial Denture with dual
path of insertion: clinical case report

Other alternative, mainly in cases of insertion relatively perpendicular to the occlusal

Class IV Kennedy, would be the use of proximal plane. In the insertion path, all the supports are
plaques on guide planes, but this combination seated almost simultaneously. In the rotational
has the disadvantage of loosing the friction insertion, the direct drive retainer gain the
retention after extended use of the RPP, as well retentive area through a translational movement
as part of view proximal plaque in vestibular (Figure 2a) and posteriorly by a trajectory of
entrance standard (Figure 1). Although for rotational insertion, the prosthesis reaches the
some professionals, the no use of a visible final seating position (Figure 2b). Thus, by
proximal plaque can result in a loss of clamp having two separate paths, some authors called
requirements, the circumscription. Although
as dual trajectory prosthesis [4,8-10].
little uncovered, the use of rotational insertion
path may, in many cases, solve this problem. The union of an imaginary line between
the rotational center positioned at the gingival
The “design” of a RPD with rotational
portion of the minor connector or proximal plate,
path of insertion basically use a small metal
structure as the rigid direct retainers, that determines the insertion axis for the rotational
replaces conventional clamps [4-6]. Usually this trajectory. Within this, an vertical removal of
rigid retention is given by minor connector or this prosthesis is impossible, to remove, it is
proximal plaque, that due to the close contact necessary a reverse movement in relation to the
with the proximal surface of the retentive insertion through the rotational path.
abutment, promotes retention when under The “design” of a double insertion RPD
extrusive forces action. allows access to the retentive area of the
Jacobson [7] relates that customarily abutment through the rotational insertion
conventional RPD are made using a path of [3,5,9].

Figure 1 - Visible proximal plates when adapted on guide planes.

147 Braz Dent Sci 2017 Apr/Jun;20(2)

 Uemura ES et al.
Removable Partial Denture with dual
path of insertion: clinical case report

Figure 2 - a) setting of the rotational centers; b) final setting by rotation of the prosthesis.

Classification of RPD with double We could offer various treatments such

insertion as superior rehabilitation through partial
fixed prosthesis, RPD retained by attachment,
There are several methods of classification,
conventional RPD and a implant-supported
however, we believe that the simplest
prostheses. The use of attachments or fixed
classification is the one proposed by Firtell &
prosthesis is costly and requires the preparation
Jacobson [11] (1983):
of the supports teeth. The implant-supported
- Anteroposterior (AP) - When the rigid prostheses require the surgical phase and are
direct retainers are the medial teeth, and costly, and the conventional RPD in this case
conventional direct retainers are positioned in would not provide a good aesthetics resolution.
the distal supports teeth. In this case, there was a clear advantage in
- Postero-anterior (PA) - When rigid employing the rotational path of insertion.
direct retainers are located in the distal teeth, After analyzing the study casts, we observed
and conventional direct retainers in the mesial that there were retentive areas in the mesial
support. surfaces of the canine, as well as in the molars. In
- Side - they use for the rigid retainers, this way, we opted for the treatment by the use of
the retentive distal surface of the mesial support a RPD with rotational insertion path.
tooth, and retentive mesial surface of the distal Although a typical example for the
abutment tof the same hemiarch, where the treatment by rotational insertion trajectory
rotational center will be located. is the Kennedy Class IV, the clinical case,
classified as Kennedy Class III Modification 1,
CASE REPORT is also reported as an indication for this kind of
A female patient, 25 years old, presented insertion. However, some care is necessary for
with anterior edentulous space with loss of the the use of this type of treatment when there are
anterior superior incisors, as well as the loss of multiple edentulous spaces.
tooth 16 (Figure 3). As it is, the replacement Planning implies the use of rigid direct
of the anterior teeth during anamnesis found retainers in canines and conventional direct
to aesthetic concern by the patient. It is well retainers in the posterior supports teeth.
known that exposure of the retentive terminal Therefore, it is necessary to make undercuts on
or part of the metal structure in anterior teeth is the mesial surfaces of the canine when the model
an objection by the majority of the patients. is with the occlusal plane parallel to the ground.
148 Braz Dent Sci 2017 Apr/Jun;20(2)
 Uemura ES et al.
Removable Partial Denture with dual
path of insertion: clinical case report

The preparations of the support in the centers, as well as insertion path in a rotational
canines must be of long, in inverted “V”, with movement to the final seating. We also conducted
well-defined lines and asymmetrical walls. The a draw in the previous metal grid saddle to
preparations to support the posterior teeth follow check if there was a displacement of rigid direct
the principles and conventional dimensions. retainers (this move should not occur).
In Figure 4, after the planning and design After preparation of the wax-up, we
of the study cast, we can see that there were no demarcate the reference lines and set up the
preparation in the mesial surfaces, of guide plans models in the articulator, for mounting the
in the canines, as these undercuts were needed artificial teeth (Figure 7). Held proof of teeth
for the construction of RPD rotational trajectory. in patient, the prosthesis was processed in
conventional manner.
After obtaining a functional cast, we
carried out the relief needed for future metal Installation and control of the prosthesis,
frame could reach the final seating position care must be taken that the RPD has adequate
without interference from undercuts. retention and stability: the rigid direct retainers
and conventional direct retainers should not
Initially we made a reliev with wax in the
wear out or polish on their inner faces, so that
region corresponding to the marginal gingiva
they maintain a close contact with the surfaces
of the mesial faces of canines. Following we
of retainers. After installation, vertical retention
filled with wax the distal face of the tooth 15, as
test must be held, or pull the anterior region
well as the mesial of the tooth 17. We begin to
to verify retention. In addition to other normal
study the rotational insertion movement using a
control care, the patient should be instructed
compass (Figure 5). The compass must tangent
to insert and remove the prosthesis only in the
the more oclusal portion of the tooth and
rotational path.
reaches the mucosa. This path should always be
relieved with wax so that the minor connector To obtain better aesthetics and lower
of the conventional clasp does not contact the interference of the flange, can be used metallic
retentive area. saddle, provided there is no excessive resorption.
The working cast, properly relieved, was In Figure 8, there is a high aesthetic yield
sent to the dental laboratory with the designed obtained by this treatment, where the resolution
model, taking care to contact the technician to was conservative and less expensive when
explain how this type of prosthesis works. compared to other kinds of treatment.

With the metal frame (Figure 6), we passed

to the test and adjustment phase, where we
observe: if there was intimate contact between
the hard direct retainer and abutment; the relief
area of the subsequent smaller connectors was
respected; if the support were in contact with
the preparations; the insertion path was correct
and the other conventional requirements of a
test with RPD were respected.
After the test in the model, we placed the
frame in mouth, to check if the above items were
also observed in the mouth. It is important at this
Figure 3 - Patient with absence of maxillary incisors and
stage to observe proper seating of the rotational tooth 16

149 Braz Dent Sci 2017 Apr/Jun;20(2)

 Uemura ES et al.
Removable Partial Denture with dual
path of insertion: clinical case report

Figure 4 - Retentive areas in the mesial of the canines and absence of guide planes.

Figure 5 - Wax reliefs performed using the compass. Figure 7 - Teeth proof; It is noted that the proximal plates are
not visible.

Figure 8 - High aesthetic yield proportioned by the double

Figure 6 - Test and adjustment of metal frame trajectory technique or rotational path of insertion.

150 Braz Dent Sci 2017 Apr/Jun;20(2)

 Uemura ES et al.
Removable Partial Denture with dual
path of insertion: clinical case report

DISCUSSION but when properly planned and built can be very

useful, considering that is a type of prosthesis
The use of rotational path of insertion
that will complement the traditional RPD.
have been of great value to the solution of Class
IV Kennedy cases.
References
The advantages are basically, the decrease 1. McCracken WL. Partial denture construction. Principles and
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Prosthet Dent. 1978 Apr;39(4):392-5.
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Conclusion
RPD with double path of insertion requires
sensitive technique and skill to its construction,

Eduardo Shigueyuki Uemu

(Corresponding address)
Endereço: Rua Jaraguá 439, Bom Retiro São Paulo – SP
Date submitted: 2017 Oct 28
CEP: 01129-000 TEL: 3331-6277
e-mail : esuemura@uol.com.br Accept submission: 2017 Jan 23

151 Braz Dent Sci 2017 Apr/Jun;20(2)

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