MOUTH PREPARATION IN

REMOVABLE PARTIAL DENTURES

Dr. BINDU

9/1/19 Department of Prosthodontics , PIDC 1

 LEARNING OUTCOMES
 At the end of the lecture, the student should be
able to
 State the importance of mouth preparation
 Categorize the various procedures involved in
mouth preparation
 Plan the sequence of procedures required for the
given partially edentulous condition

Department of Prosthodontics ,
9/1/19 PIDC 2
 DEFINITION

Mouth preparations are identified as those procedures

that are accomplished to prepare the mouth for reception
of prosthesis.
More specifically they are the procedures that change or
modify existing oral structures of conditions to
 Facilitate placement and removal of prosthesis
 Facilitate its efficient physiologic function
 Enhance its long term success
Mouth preparation follows preliminary diagnosis and
development of tentative treatment plan.
Department of Prosthodontics ,
9/1/19 PIDC 3
 IMPORTANCE OF MOUTH PREPARATION FOR
REMOVABLE PARTIAL DENTURES

 To establish a state of health in the supporting tissues

 To eliminate interferences or obstructions to the
placement, removal and function of prosthesis
 To establish an acceptable occlusal scheme
 To establish an acceptable occlusal plane
 To alter natural tooth form to accommodate
requirements of form and function of prosthesis

Department of Prosthodontics ,
9/1/19 PIDC 4
 MOUTH PREPARATION
PRE-PROSTHETIC PROSTHETIC
 To remove any hindrance in  To modify existing structures
prosthetic treatment to enhance the placement of
 Done along with diagnosis prosthesis
and treatment plan  Done after partial denture
 Relief of pain & infection design
 Periodontal therapy  Preparation of retentive
undercuts
 Oral surgical preparations
 Preparation of guiding planes
 Conditioning of abused &
irritated tissues  Preparation of rest seats
 Correction of occlusal plane
Department of Prosthodontics ,
9/1/19 PIDC 5
 Mouth preparation includes procedures in four
categories:

 Oral surgical preparation,

 Conditioning of abused and irritated tissue,
 Periodontal preparation, and
 Preparation of abutment teeth.

Objectives of the procedures involved in all four

areas are to return the mouth to optimum health
and eliminate any condition that would be
detrimental to the success of the removable
partial denture.
Department of Prosthodontics ,
9/1/19 PIDC 6
 ORAL SURGICAL PREPARATION

Department of Prosthodontics ,
9/1/19 PIDC 7
A variety of oral surgical techniques can prove beneficial to
the clinician in preparing the patient for prosthetic
replacements.

1) Extractions
2) Removal of residual roots
3) Impacted teeth
4) Malposed Teeth
5) Cysts and odontogenic tumour
6) Muscle attachments and frenum
7) Bony spiny ridges
8) Exostoses and tori
9) Hyper-Plastic tissues
Department of Prosthodontics ,
9/1/19 PIDC 8
Extractions
 teeth with poor prognosis
 Nonstrategic teeth that would present
complications RPD design

Department of Prosthodontics ,
9/1/19 PIDC 9
Residual roots adjacent to abutment teeth may
contribute to the progression of periodontal
pockets and compromise the results from
subsequent periodontal therapy.

Department of Prosthodontics ,
9/1/19 PIDC 10
 Impacted Teeth
All impacted teeth, including
those in edentulous areas and
those adjacent to abutment
teeth, should be considered for
removal.
The periodontal implications of
impacted teeth adjacent to
abutments are similar to those
for retained roots.

Department of Prosthodontics ,
9/1/19 PIDC 11
 Malposed Teeth
 Poor oral hygiene
 Inadequate access (proximal surface of crowded teeth)
 Difficulty in establishing guide planes
 Difficulty in determining a unique path of insertion

Department of Prosthodontics ,
9/1/19 PIDC 12
 Muscle attachment and frena
As a result of the loss of bone height, muscle
attachments may insert on or near the residual ridge crest
Appropriate ridge extension procedures can reposition
attachments and remove bony spines, which will enhance
the comfort and function of the removable partial denture.

Department of Prosthodontics ,
9/1/19 PIDC 13
 Bony Spines and Knife-Edge Ridges
Sharp bony spicules should be
removed and knifelike crests gently
rounded.

Department of Prosthodontics ,
9/1/19 PIDC 14
 Exostoses and Tori
Cause additional stress to denture
Removable partial denture components in proximity to
this type of tissue may cause irritation and chronic
ulceration.

Department of Prosthodontics ,
9/1/19 PIDC 15
 Hyperplastic Tissue

 Seen in the form of fibrous tuberosities, soft flabby ridges,

folds of redundant tissue in vestibule or floor of mouth
 Removal will produce a more stable denture, reduce stress &
strain on supporting tissue

Department of Prosthodontics ,
9/1/19 PIDC 16
 CONDITIONING OF ABUSED AND
IRRITATED TISSUE

Department of Prosthodontics ,
9/1/19 PIDC 17
 Many removable partial denture patients require some
conditioning of supporting tissue in edentulous areas before
the final impression phase of treatment. Patients who
require conditioning treatment often demonstrate the
following symptoms:
1. Inflammation and irritation of the mucosa covering the
denture-bearing areas
2. Distortion of normal anatomic structures, such as incisive
papillae, the rugae, and the retromolar pads
3. A burning sensation in residual ridge areas, the tongue, and
the cheeks and lips

Department of Prosthodontics ,
9/1/19 PIDC 18
 These conditions are usually associated with ill-
fitting or poorly occluding removable partial dentures.
However, nutritional deficiencies, endocrine imbalances,
severe health problems (diabetes or blood dyscrasias),
and bruxism must be considered in a differential
diagnosis.

Department of Prosthodontics ,
9/1/19 PIDC 19
 Use of Tissue Conditioning Materials
The tissue conditioning materials are elastopolymers
that continue to flow for an extended period,
permitting distorted tissue to rebound and assume
its normal form. These soft materials apparently
have a massaging effect on irritated mucosa, and
because they are soft, occlusal forces are probably
more evenly distributed.

Department of Prosthodontics ,
9/1/19 PIDC 20
 PERIODONTAL PREPARATION

Department of Prosthodontics ,
9/1/19 PIDC 21
 PERIODONTAL PREPARATION
It is strongly recommended that a gross
debridement be performed before tooth extraction
when patients have significant calculus accumulation.
This helps limit the possibility of accidentally dislodging
a piece of calculus into the extraction socket, which
could lead to an infection.
The periodontal health of the remaining teeth, especially
those to be used as abutments, must be evaluated
carefully by the dentist and corrective measures
instituted before removable partial denture fabrication.

Department of Prosthodontics ,
9/1/19 PIDC 22
 Prosthetic Mouth Preparation

Department of Prosthodontics ,
9/1/19 PIDC 23
The prosthetic mouth preparation will be discussed
under the following:
 Correction of Occlusal Plane
 Correction of Malalignment
 Provision of support for weakened teeth
 Reshaping Teeth
 Occlusal rest seat preparation
 Lingual or incisal rest seat preparation

Department of Prosthodontics ,
9/1/19 PIDC 24
 Preparation of abutment teeth
1.Correction of Occlusal Plane
 Enameloplasty
 Onlay
 Crowns
 Endodontics with Crown or Coping
 Extraction
 Surgery

2.Correction of Malalignment
 Orthodontic Realignment
 Crowns
 Enameloplasty

3. Provision of support for weakened teeth

 Removable Splinting
 Fixed splintingDepartment of Prosthodontics ,
9/1/19
 Overdenture Abutments PIDC 25
4.Reshaping Teeth
 Enameloplasty
a) Enameloplasty to Develop Guiding Planes
b) Enameloplasty to Change Height of Contour
c) Enameloplasty to Modify Retentive Undercuts
 Inlays, Onlays and Crowns

5.Occlusal rest seat preparation

6.Lingual or incisal rest seat preparation

Department of Prosthodontics ,
9/1/19 PIDC 26
 Correction of the Occlusal Plane
 Occlusal plane in partially edentulous patients is
usually uneven
 Due to supraeruption of teeth opposing the
edentulous space, mesial migration, tipping of
teeth adjacent to edentulous spaces
Methods of correcting undesirable occlusal plane
Enameloplasty
Onlay
Crowns
Department of Prosthodontics ,
9/1/19 PIDC 27
 Enameloplasty
 Enameloplasty /dimpling is a procedure done to
produce a retentive undercut
Design
 A gentle depression
 Prepared close & parallel to gingival margin
 Should be 0.01 inch deep when measured from a
tangent parallel to the path of insertion extending
over the surface of the tooth above the
preparation
 Preparation should be at least 2mm
occlusogingivally & 4mm mesiodistally
Department of Prosthodontics ,
9/1/19 PIDC 28
Indications
Small non retentive undercuts that require
modification
Teeth with nearly vertical buccal & lingual surfaces

Procedure
A small round ended tapered diamond stone is
used
Bur should be moved anteroposteriorly near the
line angle where undercut is to be prepared
Depression should be very gradual & not steep

Department of Prosthodontics ,
9/1/19 PIDC 29
Onlay
 It is a conservative method of
correcting the plane of occlusion
 One of the simplest methods of
reestablishing the plane of occlusion is by
the use of cast gold onlays, which an
either lengthen or shorten the crown
height of a tooth.
 Onlay is placed instead of full
veneer crowns when adequate
tooth structure is present
 Retentive terminal engages the
Department of Prosthodontics ,
undercut on sound enamelPIDC
9/1/19 30
Crowns
When the crown height of the tooth must be changed to harmonize the
occlusal plane. and the facial, lingual, or proximal surfaces must be
altered to produce a more desirable height of contour, a guiding plane, or
a retentive undercut, a full crown is normally restoration of choice.
Before the tooth is prepared to receive the crown, mounted diagnostic
casts should be measured to ascertain how much crown reduction is
necessary to correct the occlusal plane. If the reduction of tooth structure
will be so great as to endanger the dental pulp, a decision must be made
as to whether endodontic treatment is indicated or whether this extent of
treatment is not warranted and extraction would be the treatment of
choice.

Department of Prosthodontics ,
9/1/19 PIDC 31
 Correction Of Malalignment

Teeth that are malposed facially or lingually are frequently

more difficult to correct than overerupted or submerged
teeth. There are definite limitations to repositioning of
these malposed teeth, Often it is the design of the
removable partial denture that must be altered rather than
the tooth position.

Department of Prosthodontics ,
9/1/19 PIDC 32
Orthodontic Realignment
The technique of orthodontically moving the
malpositioned tooth should be considered first. Whenever it is
possible, it is the treatment of choice. Unfortunately it is often
not possible to use this method. In many mouths where a large
number of teeth are missing there may not be enough
remaining teeth to serve as an anchor from where the moving
force can be applied. There must be some means of applying
force and resisting the equal and opposite counter force that
will be generated.

Department of Prosthodontics ,
9/1/19 PIDC 33
 PROVISION OF SUPPORT FOR WEAKENED
TEETH
In many partially edentulous mouths some or all the
remaining teeth have lost varying amounts of the supporting
periodontal ligament and alveolar bone. To use these teeth to
help support and stabilize a removable partial denture, it will
be necessary to provide additional support for these teeth by
splinting the teeth together or by using overdenture abutments.

Types :Removable Splinting / fixed splinting

Department of Prosthodontics ,
9/1/19 PIDC 34
 RESHAPING OF TEETH BY ENAMELOPLASTY
Tooth surfaces often need to be reshaped to accomplish
specific purposes. This changing of tooth contour may be
accomplished in the enamel, on the surface of an existing restoration,
or by placing a new restoration.

Department of Prosthodontics ,
9/1/19 PIDC 35
Enameloplasty to Develop Guiding Planes

Guiding planes are those surfaces on the teeth, of

sufficient area and parallel relationship to each other, so
that they may serve to determine positively the direction of
appliance movement .
 Surveyed diagnostic cast is needed
 Handpiece with cylindrical diamond point is positioned
over abutment tooth in primary cast, the same
relationship should be reproduced in the mouth
 Mild, sweeping stroke is made from buccal line angle to
lingual line angle
 2-4 mm high occlusogingivally
 Flat & follow contour of proximal surface
Department of Prosthodontics ,
9/1/19 PIDC 36
 Department of Prosthodontics ,
9/1/19 PIDC 37
Enameloplasty to Change Height of Contour
The height of contour is changed most frequently to
provide better positions for clasp arms or 4 lingual plating.
Ideally the retentive clasp arm should be located no
higher than the juncture of the gingival and the middle thirds.
This position not only enhances the esthetic quality of the
clasp, but also provides a definite mechanical advantage

Department of Prosthodontics ,
9/1/19 PIDC 38
Enameloplasty to Modify Retentive Undercuts
Occasionally a proposed abutment tooth has less than a
sufficient retentive undercut.
This technique does not have universal application, but in a few
instances it may be beneficial.

Department of Prosthodontics ,
9/1/19 PIDC 39
 OCCLUSAL REST SEAT
PREPARATION

Department of Prosthodontics ,
9/1/19 PIDC 40
 Form of occlusal rest
 Outline form:
seat
rounded triangular shape with
apex towards centre of the
occlusal surface
 Size- ½ of buccolingual width
between cusp tips, 1/3 to ½ of
mesiodistal width of tooth
 Angle between line drawn along
proximal surface of tooth & floor
of the rest seat should be < 90
degree to prevent forces
transmitted along an inclined
Department of Prosthodontics ,
plane.
9/1/19 PIDC 41
 Cingulum Rest Seat Form
 Usually prepared on the
canine, due to its well-
developed cingulum
 When canine is not available,
an incisor may be used
 Inverted “V”:< 900
 Slightly rounded to avoid sharp
line angles
 1mm depth
 Place in sound tooth structure
or restorations
 Not on amalgam restorations
Department of Prosthodontics ,
9/1/19 PIDC 42
 Lingual Rest Seat
Form
 Spoon shaped, similar to occlusal rest
seat
 More difficult due to the incline of the
lingual surface
 Easily incorporated into crowns
 Prepared on the mesial of the canine
teeth when typical cingulum rest is
contraindicated or in the presence of
– Large restoration
– Lack of clearance with the opposing
teeth
– Poor cingulum
Department of Prosthodontics ,
9/1/19 PIDC 43
 Incisal Rests
 Inferior mechanically &
esthetically
 Placed mesio incisal or disto
incisal angle

Department of Prosthodontics ,
9/1/19 PIDC 44
 THANK YOU

Department of Prosthodontics ,
9/1/19 PIDC 45