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Prosthetic Rehabilitation
Part II: Technical Procedures
Edited by
Giulio Preti, MD, DDS
Professor Emeritus
Section of Oral and Maxillofacial Rehabilitation
School of Dentistry
University of Turin
Turin, Italy

Translated by
Jennifer Sardo Infirri

Quintessence Publishing Ltd.

London, Berlin, Chicago, Tokyo, Barcelona, Istanbul, Milan, Moscow,
New Delhi, Paris, Beijing, Prague, São Paulo, Seoul, and Warsaw
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Contents

Foreword IX
Preface XI
Acknowledgments XIII
Contributors XIV
An Explanation of the Criteria Used for Evaluating the Dental Literature XV

Chapter 1 Total Edentulism 1

Physiopathology of the Edentulous Mouth 1
Conclusive Considerations and Therapeutic Approach 3

Chapter 2 Constructive Principles of the Complete Denture: Retention, Stability, Support 5

Retention 5
Stability 6
Support 9

Chapter 3 Construction Principles for Complete Dentures 11

Requirements of the Impression and Limits of the Prosthetic Body 11
Anatomy of the Edentulous Jaws 11
Maxillomandibular Relationships 17
Maxillomandibular Relationships on the Horizontal Plane 19
Esthetics in Complete Dentures 21
Summary 37

Chapter 4 Introduction to Prosthetic Rehabilitation of Edentulous Patients 41

Patient Satisfaction and Incorporation of the Complete Denture 41
Guidelines for Prosthetic Rehabilitation of the Edentulous Patient 43
Initial Patient Visit 44
Summary 52

Clinical Application of Construction Principles 55

Treatment of Single-Arch Edentulism 76
Follow-up 77

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Chapter 5 Oral Mucosal Diseases in Patients with Removable Dentures 81 ub

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Prosthetic Stomatitis 82 tio
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Angular Cheilitis 83 ss e n c e
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Prosthetic Hyperplastic Fibrosis 84
Allergy: Contact Toxic Stomatitis 84
Traumatic Ulcers 86
Other Lesions 86

Chapter 6 Provisional Prostheses 89

Constructive Principles of the Provisional Prosthesis 89
Preparation Procedure 90
Restoration of the Preexisting Prosthesis 92

Chapter 7 Conditioning Supporting Tissues 95

Biomechanics of the Supportive Tissues: Viscoelastic Behavior 95
Composition and Behavior of Conditioning Materials 98
Technique 99

Chapter 8 Denture Adhesives 103

Indications 103
Contraindications 103
Adhesives and Candidiasis 103
Composition 104
Ideal Characteristics 104
Mechanism of Action 104

Chapter 9 Unfavorable Anatomic Conditions 107

Minor Preprosthetic Surgery 107
Prosthetic Alternatives to Surgery 110

Chapter 10 Burning Mouth Syndrome 115

Epidemiology 115
Symptoms 115
Histologic Characteristics 116
Classification 116
Possible Causes 116
Therapy 120
Diagnostic-Therapeutic Protocol 120

Chapter 11 Implant-Retained Overdentures 125

Mandibular Implant-Retained Overdenture 125
MIR-OVD: Clinical Procedures 129
Peri-overdenture 136
Maxillary Implant-Retained Overdenture 142

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Implant or Denture Rehabilitation: Choice Criteria 156 ss e n c e
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POVD Design 157
Final Considerations and Therapeutic Approach 158
Clinical Planning and Construction of the POVD 158

Chapter 13 Treatment of Partial Edentulism 165

Part I: Partial Distal Extension Edentulism 165
Part II: Edentulous Gaps 187
Types of Rehabilitation 188
Fixed Partial Adhesive Denture 220
Implant-Supported FPDs 231
Removable Partial Denture 233
Conclusion 234

Chapter 14 Hygiene and the Longevity of Prosthetic Rehabilitation 245

Patient Motivation 247
Hygienic Preparation of the Oral Cavity 248
Oral Hygiene at Home 249
Professional Oral Hygiene 257
Patient with a Prosthesis 259

Chapter 15 Follow-up Care of Prostheses 271

Considerations 271
Biologic Aspects of Maintenance 271
Follow-up of Removable Partial Dentures 272
Follow-up of Fixed Prosthesis 273
Follow-up of the Implanted-Supported Prosthesis 274
Recording Oral Hygiene and Periodic Controls 274

Index 279

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Foreword

The past two decades of the 20th century were extraordinary Prosthodontics has been in the “spare parts” business for a
ones for my discipline of predilection—prosthodontics. They long time, although we have done it with only a small degree of
ushered in a strong biologic focus, which gradually matched the anguish found in the medical field. As a result, we have not
and perhaps even eclipsed traditional exclusive concerns with been unduly burdened with the sort of tricky ethical questions
dental materials and techniques. The change was an inevitable associated with genetics and organ transplantation.
and welcome one, and it belatedly paralleled the shift toward However, our commitment to enriching our patients’ lives,
emphasis in basic and clinical sciences that had influenced rather than prolonging them, demands the same degree of
development in the discipline. Neurophysiology, bioengineer- scientific rigor in the way we make clinical decisions and carry
ing, and health economics emerged as profound concerns out prosthodontic therapy.
in the effort to provide predictable treatment outcomes that The need for outstanding texts that articulate this new
recognized both patient as well as dentist-mediated concerns. vision for prosthodontic rehabilitation has therefore become
It is perhaps impossible to identify a specific text or event a serious and major priority. Professor Giulio Preti and his col-
that catalyzed the much-needed changes. Most seminal events leagues have provided us with such a text, and all of us in the
in history or breakthroughs in science tend to have similar ori- discipline have been enriched by this masterful effort. I have
gins—often unrelated, but ultimately convergent occurrences. been studying the Turin team’s contribution to dental scholar-
Small streams of thought and experiment gradually converge ship—research, education, service—for several years, and theirs
to create a river full of force and momentum, which will in turn has been an exemplary record of commitment and leadership.
irrigate new sources of creativity. They have distilled an enormous body of knowledge and wis-
My own academic development was influenced by particular dom in writing this book and presented their convictions in a
Scandinavian works. The first was the 1977 article by Brill et lucid and highly organized manner. I have little doubt that this
al, “Ecologic changes in the oral cavity caused by removable contribution stands out among those distinguished texts in
partial dentures.”1 The second was the 1977 monograph by the all-too-small canon of significant works in prosthodontics.
Brånemark et al on osseointegrated implants.2 Both sets of Above all, the publication of this book is a compelling testimony
authors indirectly framed the prosthodontist’s twin concerns to the purpose and meaning of clinical academics’ lives. Giulio
that must dominate evidence-based clinical decisions. These Preti and his Turin colleagues deserve our gratitude for their
concerns can be posed as two questions: (1) What is the biologic outstanding contribution.
price paid as a result of the diverse sequelae and consequences
of loss of teeth? and (2) What is the biologic price inherent in the George A. Zarb, BChD, DDS, MS, FRCD
prosthodontic intervention? The very perceptive, if understand- Professor Emeritus, Department of Prosthodontics, Faculty of
ably limited, ecologic focus of Brill et al1 gradually expanded Dentistry, University of Toronto, Toronto, Canada
from the notion of adverse ecologic shifts to far beyond those
of plaque-induced and mechanical trauma. Brånemark et al,2 on
the other hand, proposed an entirely new model in pursuit of
understanding the therapeutic benefits resulting in a scientific 1. Brill N, Tryde G, Stoltze K, El Ghamrawy EA. Ecologic changes in the
transition from an uncontrolled to a controlled induced inter- oral cavity caused by removable partial dentures. J Prosthet Dent
1977;38:138–148.
face. The impact of both ideas cannot be underestimated, par-
2. Brånemark PI, Hansson BO, Adell R, et al. Osseointegrated
ticularly in the context of the subtle, yet profound, differences implants in the treatment of the edentulous jaw. Experience from a
in dental, as opposed to medical, biotechnology. 10-year period. Scand J Plast Reconstr Surg 1977;16(suppl):1–132.

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Preface

There can be no doubt that scientific advancement is today

articulated by papers published in specialized journals. Such
articles measure the progress made by research, even when the
truths they state are subsequently denied or enriched by the Boves, Italy, July 2001,
onward march of research. The sum of articles published by from the left: Professors
a research group or a school is a chronicle of what they have Bassi, Carossa, Bucca,
Preti, Pera.
contributed to a field of research. But a book . . . a book is not
part of a chronicle. Rather, it expresses the history of the steps
through which a school was born, matured, and changed—in
short, its evolution.
Over the years, two philosophies have had a strong positive
influence on our thinking: the Zurich School, with Professor
Albert Gerber and Professor Sandro Palla, which remains a
constant reference point for continuing and new students alike; Boves, Italy, July 2001, a
and the UCLA School of Dentistry, first with Professor Jim working group.
Krachtovil and now Professor John Beumer, in a collaboration
of more than 20 years that has contributed to the education
of several of our collaborators in the difficult art of maxil- and the professional contacts we have maintained over the
lofacial prosthetics. In addition, Professor Remo Modica has years. In compiling this book, two fundamental concepts
become our maestro in life as well as in our profession. These have been dominant: our teaching methodologies and the
individuals, with their enthusiasm and their commitment to the importance of providing supporting documentation from the
psychosocial aspects of prosthetic rehabilitation, have strongly literature. Today, when critically analyzing the effectiveness
influenced the direction our school has taken. of new therapies, the predictability of posttherapeutic success
During the past 25 years of teaching, treatment, and has become crucial. Following in the wake of evidence-based
research, our biennial congress has provided us with an oppor- medicine, evidence-based dentistry has now arisen, and within
tunity to compare our progress against the world’s most pres- this, evidence-based prosthodontics. This approach can only
tigious schools. Since then thousands of patients have been help our discipline make better progress, where in the past,
treated and hundreds of students trained in our department. randomized controlled trials were rare.
Some of our alumni are now professors in various Italian univer- Scientific progress in prosthetic dentistry has, nevertheless,
sities including Bari, Bologna, Brescia, Ferrara, and Genoa. Each not yet led to the large-scale adoption of new, improved thera-
of these institutions is committed to giving continuity to the pies. For example, implant dentistry offers enormous thera-
tradition of our school. Today, both our alumni and I believe peutic possibilities, but only a tiny fraction of the population
we have achieved sufficient maturity to communicate our phi- has been able to benefit from this treatment. When treatment
losophy through this book. This publication represents 25 years costs are high and patients’ economic situations must be taken
of collective knowledge and experience. Each book tells a story, into consideration, traditional therapies maintain their value in
and we would like to think that this is our story. comparison to new methods of prosthetic rehabilitation.
Although this book is the product of many authors’ work, it This text was split into two distinct parts. The first volume in
has a uniformity of thought, thanks to our common approach this series discussed diagnosis and the components of prepro-

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Cinzano, Italy, October 1978, on a seminar with Prof Pecetto, Italy, October 2001, a seminar for writing the book.
Gerber.

sthetic care, whereas this book discusses the clinical and tech- effect if the mechanisms involved are not properly understood.
nical aspects of fabricating functional prostheses for patients Knowledge of these mechanisms is based on the awareness
with different stages of edentulism. Taken together, these two that long-term success of the rehabilitation is the product of
books offer a more biologic and patient-centered approach to patient compliance and consistent follow-up by the dentist.
prosthetic treatment. In this book, the various modalities of prosthetic rehabilita-
Some of these chapters have been written by our alumni tion of a stomatognathic system compromised by loss of some
who, while having worked as independent practitioners over or all teeth are next taken into consideration. The first subject
the years, have maintained their professional ties with our addressed is total edentulism because rehabilitation of the
department of prosthodontics, within which they have played edentulous patient presupposes knowledge that is often indis-
or still play an active consultant role. These chapters, far from pensable in rehabilitating the partially edentulous patient. The
being exhaustive for those who are experts in the subject, dis- discussion of rehabilitation of different degrees of edentulism is
cuss prosthetic aspects with two goals in mind: (1) to emphasize developed by considering different therapeutic options, ranging
our department’s philosophy of “comprehensive care”; and (2) from the simplest to the most sophisticated. One of our goals
to make the reader aware of his or her limits so that, on a case- was to provide the independent dental practitioner or the den-
by-case basis, he or she will refer to or consult with a specialist tal student with all those elements necessary to select the most
as required. suitable treatment for each patient, always bearing in mind that
The multidisciplinary approach to prosthetic rehabilitation of the patient is at the center of our interest.
the oral cavity is a complex process that proceeds through diag- No dentist can neglect a careful evaluation of his or her
nosis and application of the necessary technical knowledge to patient as a whole, from medical history to social and psycho-
design and construct a prosthesis to ensure long-term success. logic status, before formulating a personalized treatment plan.
Prosthetic treatment that modifies the oral cavity inevitably For this purpose we propose a guide to diagnosis and to the
must consider the patient’s physical as well as emotional needs. prosthodontic treatment plan in which, among other factors,
It is thus important to ensure correct communication so that every treatment considered ideal must then be adapted to the
we may understand our patients from psychologic, social, and requirements of the individual patient.
cultural points of view. In the final analysis, the treatment plan must address the
Clinical evaluation continues with morphostructural and articulated or perceived concerns of each patient. These impor-
functional evaluation of the stomatognathic system. Whereas tant determinants of any successful treatment outcome include
the former has long been considered indispensable and is a symptom-free, esthetic, and functional result that does not
routinely carried out, the same cannot be said for functional incur risks of morbidity or unnecessary expense.
evaluation. Failure to appreciate disorders of the stomatognathic
system before beginning treatment is frequently the cause of
treatment failure. Giulio Preti, MD, DDS
The ecosystem of the oral cavity is modified by the pres- Professor Emeritus, Section of Oral and Maxillofacial Rehabili­
ence of the prostheses, which may have a highly destructive tation, School of Dentistry, University of Turin, Turin, Italy

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Acknowledgments

Many people contributed to the writing of this book, and, at Dental technicians Valerio Burello, Adolfo Camisotti, Enrico
the risk of forgetting someone, we wish to thank: Hans Carlucci, Biagio Ciancio, Luigi Colleoni, Paolo Del Bianco,
Daniele Fiengo, Cristiano Gaggio, Giovanni Giachero, Giorgio
Our students for the continuing contact we have had with Perna, Paolo Riccio, and Alberto Sannazzaro.
them over the years, which has enriched us professionally as
well as personally. Administrative assistants Antonella Baldin and Roberto
Calcagnile, and a particular heartfelt acknowledgment to
Prof Pietro Bracco, for the Department of Orthodontics’ contri- Rosalia Genchi for her unseen but essential secretarial work.
bution to chapter 7.
Carlo ed Alessandro Piacquadio for his invaluable collaboration
Our colleagues Gaetano Calesini, Carlo Marinello, Giorgio on the illustrations.
Pedretti, Massimo Simion, and Carlo Tinti for the clinical cases
that they generously made available to us. Thank you to you all!

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Contributors

Guido Audenino, DDS, Lecturer, Department of Prosthodontics, Gianni Giannella, DDS, Tutor, Department of Prosthodontics,
School of Dentistry, University of Turin, Turin, Italy School of Dentistry, University of Turin, Turin, Italy
Eva Barabino, DDS, Private Practice, Turin, Italy Bartolomeo Griffa, DDA, Private Practice, Turin, Italy
Sandro Barone Monfrin, DDS, Lecturer, Section of Oral and Stefano Lombardo, DDS, Lecturer, Department of Prosthodontics,
Maxillofacial Rehabilitation, School of Dentistry, University of School of Dentistry, University of Turin, Turin, Italy
Turin, Turin, Italy Carlo Manzella, DDS, Private Practice, Turin, Italy
Francesco Bassi, MD, DDS, Professor, Department of Marco Mozzati, MD, DDS, Director SSCVD, Oral Surgery, Depart­
Prosthodontics, School of Dentistry, University of Turin, Turin, ment of Dentistry, San Giovanni Battista Hospital, Turin, Italy
Italy
Giovannino Muci, DDS, Private Practice, Nardo, Italy
Matteo Bonifacino, DDS, Private Practice, Turin, Italy
Paola Pera, MD, DDS, PhD, Professor and Chair, Department of
Mario Bresciano, DDS, Lecturer, Section of Oral and Maxillofacial Health Sciences, Section of Biostatistics, Genoa University, Genoa,
Rehabilitation, School of Dentistry, University of Turin, Turin, Italy Italy
Vincenzo Bruno, DDS, Private Practice, Naples, Italy Denis Pettenò, DDS, Private Practice, Turin, Italy
Dario Caire, DDS, Private Practice, Turin, Italy Enrico Poglio, DDS, Private Practice, Turin, Italy
Stefano Carossa, MD, DDS, Lecturer, Center for Cancer Giulio Preti, MD, DDS, Professor Emeritus, Section of Oral and
Epidemiology, San Giovanni Battista Hospital, Turin, Italy Maxillofacial Rehabilitation, School of Dentistry, University of
Marco Carrozzo, MD, DDS, Professor of Oral Medicine, School of Turin, Turin, Italy
Dental Sciences, University of Newcastle upon Tyne, Newcastle Riccardo Preti, DDS, Private Practice, Turin, Italy
upon Tyne, England
Valter Previgliano, MD, DDS, Lecturer, Department of
Santo Catapano, MD, Professor, Istituto di Clinica Odontoiatrica, Prosthodontics, School of Dentistry, University of Turin, Turin,
University of Ferrara, Ferrara, Italy Italy
Paola Ceruti, DDS, Assistant Professor, Faculty of Medicine and Alessio Rizzatti, DDS, Assistant Professor, Department of Oral
Surgery, School of Dentistry, University of Turin, Turin, Italy and Maxillofacial Rehabilitation and Dental Implants, University
Massimo Corsalini, MD, DDS, Assistant Professor, School of of Turin, Turin, Italy
Dentistry, University of Bari, Italy Gianluca Santià, DDS Private Practice, Turin, Italy
Francesco Erovigni, DDS, Tutor, Department of Prosthodontics, Gianmario Schierano, MD, DDS, Professor, Department of
School of Dentistry, University of Turin, Turin, Italy Prosthodontics, University of Turin, Turin, Italy
Sergio Gandolfo, MD, Professor, Section of Oral Pathology, Roberto Scotti, DDS, Professor and Chair, Department of
School of Dentistry, University of Turin, Turin, Italy Prosthodontics, School of Dentistry, Alma Mater Studiorum,
Gianfranco Gassino, MD, DDS, Assistant Professor, Department University of Bologna, Bologna, Italy
of Prosthodontics, School of Dentistry, University of Turin, Turin, Vassili Valentini
Italy
Patrizia Zoccola
Giorgio Gastaldi, MD, DDS, Professor, Department of Removable
Prosthodontics, School of Dentistry, University Of Brescia, Brescia,
Italy

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An Explanation of the Criteria Used for Evaluating the Dental Literature

Mario Bresciano, DDS, University of Turin, Turin, Italy of high quality) presented in scientific journals, textbooks, and
Giovannino Ciccone, San Giovanni Battista Hospital, Turin, Italy continuing education courses.
Making sense of these often contradictory sources requires
Man prefers to believe what he prefers to be true. a new skill—that of being able to select information that is
Francis Bacon, Novum Organum, 1620 valid and useful in clinical practice. The questions that dentists
must pose to themselves are: (1) Is the information scientifi-
Experiments are the only means of knowledge cally correct, and if this is the case, is it new and valid? and (2)
at our disposal; the rest is poetry, imagination. Is it clinically important? We propose a hierarchical scale of
Max Planck assessment (see Table 1), based on the quality of the experi-
mental evidence, to assist clinicians to select therapies for their
patients that are supported by reliable verified data and to set
A new scientific publication is the product of authors elaborat- aside those based only on personal opinion or equivocal data.
ing on the present knowledge of a specific subject through the Differences in scientific weight are determined by the type of
mediation and integration of their personal experiences. A sci- source and the type of experimental study from which the data
entific text is, therefore, the product of detailed research from are obtained. The clinical relevance and practical utility depend
many sources that is presented in a natural and logical order. instead on external evaluation of the research.
The success of this process is based on the ability of the authors
to explain their arguments and the validity of what they have
written. Even if the reader can easily judge the quality of the Sources
authors’ ideas, this is not the case for the scientific accuracy of
the ideas cited from other sources. How many readers take the Scientific information that is the product of valid and repeatable
trouble to check the bibliographic sources cited in a text? In experiments is published almost exclusively in professional jour-
order to provide readers with an additional means to substanti- nals that use a review system for selecting articles for publica-
ate their learning, every reference cited in this volume has been tion. Such information is rarely obtained from books, courses, or
ranked by scientific weight, following the evaluation criteria continuing education conferences. Textbooks logically present
and methodology published by Jacob and Carr.1 In particular, the results of research that has already been published, and so is
every reference has been categorized according to the type of not new, as well as the opinions, usually implicit, of the authors.
article (Table 1). Often new results of experimental research are presented for
the first time at conferences. However, given the limitations of
the lecture format, it is not possible to present all of the informa-
Scientific Validity tion needed to evaluate or replicate the results of the studies and
therefore determine their veracity. In addition, much research
Technologic innovations of the last 20 years have forced den- presented at conferences is not subsequently published.
tists to acquire new knowledge and techniques to stay in step All dental journals do not have the same scientific impor-
with the advances in the profession. Remaining up-to-date tance. The most prestigious journals ensure that all articles are
and assessing the efficacy and safety of new products, proce- evaluated by a group of experts (peer review) before being
dures, and techniques are becoming increasingly difficult, if not accepted for publication. Other less rigorous journals accept
impossible, given the constant flow of information (not always articles at the discretion of the editor alone.

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One system of valuing scientific journals, called impact fac- lica
tor (IF), is based on the number of citations of the journal or tio
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its articles found in other journals. The IF index thus permits Traditional review articles are narratives, often the
fo r
a valuation of the scientific weight of a publication. Articles
en
one author, that comment on publications on a specific topic,
published in a journal with a high IF have greater probability of in a uniform fashion, from the author’s point of view and expe-
being considered valid by the scientific community. rience. The scientific data reported in such articles are drawn
It is timely to recognize that nearly all dental journals that from various types of studies, often not selected in a systematic
have a high IF are published in English. As in the 17th century manner, and not evaluated in a standard mode. Reviews with
the language of music was Italian, so in the 21st century the these characteristics, though useful as a synthesis of a particular
language of science is English. argument, risk presenting conclusions that are not reproducible
and that reflect, in some measure, the opinion of the author as
well as those expressed in the reviewed literature.
Types of Scientific Articles
In vitro experiments
The Council of Science Editors has defined a scientific article as
“the first publication containing sufficient information to allow In vitro experiments are carried out in laboratories using
colleagues to understand the observations, repeat the experi- models to, more or less, reproduce clinical reality. They are
ment, and evaluate the intellectual process.”2 Clearly this defi- the overwhelming majority of studies published in dentistry
nition is based on scientific methods enunciated by Bacon and and prosthodontics because of the ease of execution and lim-
Galileo in the 17th century. Essentially, to determine the validity ited expense. Numerous types of models are used, including
of information, it is necessary above all to verify the methodol- mechanical, computerized, and those using extracted teeth.
ogy by which the study was made. For this reason, we have The conclusions that can be drawn from such experiments are
classified the various types of articles based on the hierarchy often difficult to accept as conclusive scientific proof, due to
proposed by Jacob and Carr1 (see Table 1). their evident limitation as only partially reproducing the clinical
reality, which is decidedly more complex and practically impos-
Personal communications sible to represent using such defined models.

Not everything printed in scientific journals is scientific. Personal Animal studies

opinions expressed as editorials, letters, or contributions to
roundtable discussions are usually cited as personal commu- Animal studies provide a first approximation of what happens in
nications. They are judged as hypotheses, ideas, opinions, the human oral cavity; the higher the animal subjects are in the
and comments that are not to be confounded with data of evolutionary scale, the better the experiment will approximate
scientific relevance, especially if the primary argument concerns results found in humans. Because animals can be sacrificed in
questions that can be tested in experimentation. More rigor- experiments, important data can be obtained, particularly in the
ous critical evaluation must be applied to informative leaflets area of histology. Obvious differences between the oral cavity
provided by manufacturers to publicize and promote the sale of animals and that of humans, however, limit the validity of
of their products. this type of study.

Case reports Clinical studies

These articles introduce a new technique or results of a new Studies with consenting humans are without doubt the prin-
product used in a limited number of cases. Their scientific cipal sources from which we can draw reliable information
importance is exclusively chronological, only establishing the for daily clinical practice. For the numerous types of clinical
author as the first person to propose the innovation. It is clearly studies, the scientific weight increases as study variables that
impossible to draw extensively applicable conclusions based on may influence the results are strictly controlled. Schematically,
the results of one or two cases that were followed for a very clinical studies can be divided into two primary categories: (1)
limited time period and, above all, derived from observations analytical studies, in which there are two groups of subjects,
that have no analytical design. one that receives the experimental treatment and the other
that serves as a control; and (2) descriptive studies, in which
there is no control group. These categories, in turn, can be

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subdivided into two types: experimental, in which treatment bers of subjects involved. Fundamental to this kind of analysis
cat
is assigned to randomly defined groups of subjects according the comparability of the various clinical studies taken together. i
te by the affilia-on
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to a research protocol; and epidemiologic or observational, in The scientific relevance of these analyses is givenss e n c e
fo r
which the treatment is assigned to subjects without the control tion of the studies that are compared.
of the researcher.
Descriptive studies
Experimental studies
Clinical studies are defined as descriptive if an analytical control
Prospective controlled, randomized studies, in which the exper- of the experiment is not possible because of the lack of subjects
imental treatment is assigned to two homogenous groups, that can act as a control group. If the therapy or the diagnostic
represent the “gold standard” on the methodologic plane procedure for analysis was already accomplished before the
for evaluation of efficacy. In a randomized controlled trial the patients were selected for the study, it is called a retrospective
inclusion of a group of subjects that is identical to the group study. If, instead, the individuals were selected prior to the
under treatment serves as a control to verify the real efficacy experiment proceeding, it is a prospective study. Because of the
of the therapy or the experimental diagnosis. For example, in possibility of controlling patient participation and the execution
pharmacologic investigations, the control group is given either of the study, prospective studies are more relevant from the
a pharmaceutical placebo or a drug that is considered the scientific point of view than retrospective studies.
present standard treatment. In these studies, it is important
that the distribution of the subjects between the two groups
is completely randomized and double blind, in which neither Conclusion
the participating patients nor the researchers know which type
of treatment is being followed. This allows a probable uniform The majority of studies presented in the prosthodontic literature
distribution of the various prognostic factors and of possible fall into the categories described here. Undertaking experimen-
unpredictable variables. tal or observational studies is very difficult because of practical
Studies in which subjects are assigned to a group in a man- concerns (eg, the difficulties of always having a control group),
ner that is not completely random are known as quasirand- economic funding (ie, scarce economic re­sources available for
omized controlled trials. When the control group is made up of dental research), and the high degree of individualization in
the same subjects who receive the various treatments (experi- prosthodontic therapy.
mental and comparative) in two different periods, this is called Most articles in the prosthodontic literature are derived
a randomized crossover trial. from in vitro studies, which are easier and more economical
to carry out but of inferior scientific weight. The few clinical
Observational studies experiments of long duration concern, above all, retrospective
epidemiologic analyses without control groups. Despite the
Nonexperimental epidemiologic studies can be of two types: (1) infrequent publication of prospective clinical studies, such arti-
case controlled studies, in which a group of subjects with a cer- cles (eg, work on implant osseointegration) have been essential
tain problem are confronted with a homologous control group to advancements in dentistry in recent years.
that does not have the problem to identify the relevant factors
that might be responsible; and (2) cohort studies, in which sub-
jects who have received different treatments are followed over Table 1 Evaluation categories for cited references
time to evaluate the incidence of relevant clinical events.
Category 1 Experimental clinical analytical studies
Systematic review of the literature (meta- Category 2 Observational clinical analytical studies
Category 3 Prospective descriptive clinical studies
analysis) Category 4 Descriptive clinical studies
Systematic literature reviews are conducted according to a Category 5 Animal studies
rigorous and explicit protocol that prescribes criteria for the Category 6 In vitro studies
search, selection, and evaluation of the literature on a defined Category 7 Books and narrative reviews of the literature
topic. Meta-analysis studies gather together and statistically Category 8 Case reports
analyze similar clinical studies, often with limited samples, pro- Category 9 Personal communications
viding reliable scientific data because of the overall higher num-

XVII
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References

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1. Jacob RF, Carr AB. Hierarchy of research design used to categorize te ot n

n
the “strength of evidence” in answering clinical dental questions. J
ss e n c e
fo r
Prosthet Dent 2000;83:137–152.
2. Day RA. How to Write and Publish a Scientific Paper. Philadelphia:
ISI Press, 1979:2.

XVIII
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a b
Fig 3-6 Regions of Schroeder (red circles); coronal section of the pal- Fig 3-7 (a) Functioning of the maxilla frena acording to Gerber: Grasp
ate. the cheek with a thumb and index finger and pull it gently out and
downward; (b) functioning of the mandibular frena: Grasp the cheek
with the thumb and index finger and pull it gently out and upward.

Fig 3-8 Anatomic regions of the mandible: anterior sublingual region Fig 3-9 Sagittal section of the
(a); lateral sublingual region (b); region of Fish (c); masseter region sublingual anterior region.
(d); retromolar pads (e); inferior labial frenum (f); carungle (g); sub-
lingual glands (h); and lingual frenum (i).

The Schroeder regions (Fig 3-6) are situated in the posterior Mandible
portion of the palate, laterally to the median raphe. They are
made up of adipose tissue in the anterior portion and adipose The structures and anatomic regions that are important in man-
and glandular tissue in the posterior portion. When taking the dibular denture construction5 (Fig 3-8) are:
definitive impression, the tray that corresponds to these areas
n Anterior sublingual region
must be perforated to allow the impression material to flow out
n Mylohyoid ridges
without compressing them.
n Posterior sublingual (retromylohyoid) regions
The frena are fibrous muscular formations covered by muco-
n Anterior buccal regions
sa, and extend from the alveolar mucosa to the genial and labial
n Region of Fish
mucosa. The anterior frenum and the lateral frena are found in
n Masseter regions
the maxilla. The frena become tense during contraction of the
n Retromolar pads
perioral muscles.
n Anterior and lateral buccal frena
In the tray, free spaces for the frena must be planned.
During impression taking, the frena should be positioned by The limits of the anterior sublingual region (Fig 3-9) are marked
the clinician (Fig 3-7) in order to be correctly situated in the anteriorly by the lingual surface of the mandible, inferiorly by
prosthetic body. To obtain a good seal and prevent dislocation, the mylohyoid and the genioglossus muscles, and posteriorly by
it is necessary to compress the less mobile portion at its base. the sublingual gland and the body of the tongue. The anterior
sublingual region plays a fundamental role in the retention of

14
 pyri g n
Anatomy N Co Jaws
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Fig 3-10 Inclination of the fibers of the

relaxed mylohyoid muscle (dotted lines) in
the anterior and posterior areas.

Fig 3-11 Individual impression tray above the mylohyoid ridge by 3 to 4 mm. Fig 3-12 Sublingual posterior area (red circles).
(From Gerber2.)

the denture. The space between the lingual surfaces of the body during function. If the anatomic limits are respected, the
alveolar ridge and the sublingual caruncles must be completely region can represent an important area of retention, as in a
occupied by the prosthetic body. The secretion ducts must be class II.
free. The anterior buccal regions are between the anterior labial
The mylohyoid ridge on the sublingual lateral region is the frenum and the lateral frena. The morphology of the buccola-
site for the insertion of the mylohyoid muscle. In the anterior bial regions is not constant during the functional movement of
portion the muscular fibers follow an almost perpendicular the lower lip. The margins of both the customized impression
direction with respect to the osseous plane; in the posterior por- tray and of the denture must be positioned in the second posi-
tion these gradually assume a more vertical direction (Fig 3-10). tion of the mobile buccal mucosa (Fig 3-3).
The margin of the individual tray must extend beyond the The lateral buccal area (region of Fish) is between the ante-
mylohyoid ridge by at least 3 to 4 mm by molding the borders rior margin of the masseter muscle and the lateral buccal frena,
with thermoplastic paste to push the alveolar mucosa down on and the limits are defined laterally by the external oblique
the osseous plateau. The prosthetic margin can extend beyond ridge—the site of insertion of the buccinator muscle. The
the ridge by about 1 mm. If the ridge is serrated and painful prosthetic body must reach the external oblique ridge without
at palpation, it is necessary to intervene surgically with bone covering it. The masseter regions are found distal to the region
remodeling (Fig 3-11) or to resort to a technical defect (see of Fish. Here the fibers of the masseter muscle run perpendicu-
chapter 9). The limits of the posterior sublingual region are lar to the buccinator muscle. Both the customized impression
defined posteriorly by the lingual head of the superior pha- tray and the denture must have a shape that avoids muscular
ryngeal constrictor and anteriorly by the palatoglossus and the interference during function.
posterior margin of the mylohyoid muscle (Fig 3-12). The retromolar pads represent the most distal portion of the
During swallowing and forward movement of the tongue, osteomucosal ridge (Fig 3-13). They consist of an anterior por-
this region changes in form and dimension. The degree of tion coated by attached mucosa and a more mobile posterior
change is individual, and three classes can be distinguished portion in which the pterygomaxillary ligaments are inserted.
based on the characteristics that the region assumes during the The tray must cover the retromolar pads and extend to the
movements of the tongue: pterygomaxillary ligament. The prosthetic body only covers the
part of the retromolar pads covered by the attached mucosa.
n Class I: The depth of the region is maintained.
The anterior and lateral buccolabial frena vary in number
n Class II: The depth of the region is appreciably reduced.
and extention from subject to subject. The margin of the den-
n Class III: The depth of the region is in between the previous
ture must extend to the base of the frena. The prosthetic body
classes.
must seat the portion of the frena that is subjected to tension
If the changes in form in the sublingual region are not respected during muscular contraction (Fig 3-14).
during preparation, the muscles will dislocate the prosthetic

15
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Fig 64 Baseplates for occlusal registration
in the articulator. Check the vertical dimen-tio
sions in centric occlusion int ethe
ot n

n
sspatient’s
fo r c
e n thee
mouth and then proceed with mounting
incisors and canines.

Fig 65 Photographs of the patient before

loss of teeth assist the restoration of dento-
facial harmony.

Fig 66 Choose the shape and color of the

teeth directly on the patient. The choice
is based on the color of the skin and the
morphology of the face. Dark skin and hair
require gray tones, and pink skin and blond
hair, pinkish tones.

Fig 67 Line of symmetry is registered on the

patient’s face and then transferred to the
wax rim.

a b c
Fig 68 (a to c) Mounting sequence. The wax rim must be removed on one side only. The other side is used as a guide for mounting the first three
teeth. Complete mounting of the contralateral teeth is then carried out, using the teeth already in position as a guide.

Fig 69 (a) The interincisive line does not

coincide with the line of symmetry of the
face. (b) The left-side teeth have been
mounted too close to the palate (note their
position compared with the interincisive
a b
papilla indicated with a dot).

68
 pyri g n
Clinical Application ofN Co Principles
Construction
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Fig 70 (a and b) Errors on the frontal plane

are corrected so that the interincisive line
coincides with the line of symmetry of the
face. On the sagittal plane, the anteroposte-
rior position of the teeth is now correct with
a b
respect to the interincisive papilla.

a b
Fig 71 The corrections made to the prosthe- Fig 72 Comparison of the old prosthesis (a) with the new one (b). Note that the new prosthesis
sis are checked. has restored the esthetics and the physiognomy.

Fig 73 (a and b) Manufactured teeth for

prostheses must be considered semifinished
products—the form and color can be modi-
fied. Always discuss these choices with the
patient, who may not always appreciate
a b
modifications.

a b
Fig 74 (a and b) Kits showing the colors available for customizing teeth in resin ceramic as well Fig 75 Coloring the prosthetic base is parti­cu­
as prosthetic bases. larly useful for smiles that show the gingiva.

69
 pyrig
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Fig 11-16 Position of the clip attachments in the prosthetic body. ub

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Fig 11-17 Hyperplastic tissue under the

bar may be due to the absence of adherent
mucosa or to insufficient space for hygiene
practices.

a b c
Fig 11-18 (a) Healing abutments in situ. (b and c) Removal with the appropriate screwdriver (Nobel Biocare).

Fig 11-19 (a) Implant head after removal

of healing abutment . (b) Transmucosal
pathway from the head of the implant to
a b
the margin of the peri-implant mucosa.

Ball retention n The choice of height of the prosthetic abutment is deter-

mined by the transmucosal pathway between the head of
For the aforementioned clinical and biomechanical the implant and the free margin of the peri-implant mucosa
aspects,19,20,23,31 ball retention is the option most chosen by (Fig 11-19). A millimeter gauge (Figs 11-20 and 11-21)
the University of Turin, even if bar retention is the method most should be used for measurement.
quoted in the literature. n The upper part of the abutment must emerge from the
About 3 or 4 weeks after stage-two surgery, the healing mucosa by 1.5 to 2.0 mm to make hygiene practices easier
abutments are removed and the ball retention system is placed (Figs 11-22 and 11-23).
(Fig 11-18). Proper execution of this procedure requires the n The upper profiles of the ball attachments must be at the
following: same height, and the line that joins them must be parallel to

132
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MIR-OVD: CoProcedures
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a b c
Fig 11-20 (a) Stainless steel gauge with millimeters indicated (Nobel Biocare). It is necessary to measure the transmucosal pathway in order to
select the appropriate prosthetic abutment. (b and c) In this patient the height is different in the two sites (4 to 5 mm and 5 to 7 mm).

Fig 11-21 Prosthetic ball attachments with Fig 11-22 Ball attachment screwed onto Fig 11-23 The ball patrix sits above the
pillars of various dimensions (3 to 5.5 mm). the implant. mucosa, which facilitates hygiene care.
The diameter of the ball patrix is about
4 mm.

Fig 11-24 Ball retention. A line connecting

the ball attachments (x) should parallel a
line connecting the rotational axes of the
condyles (y).

Fig 11-25 Correct placement of the ball

patrix is verified by radiograph.

the intercondylar rotation axis (Fig 11-24). It is often neces- Initially, the ball attachment is screwed manually onto the head
sary to use prosthetic abutments of different heights. of the implant, but not tightened. Intraoral radiographs with
n Perfect adaptation between the attachment components a centering device are useful to verify the correct adaptation
is indispensable to avoid the interposition of mucosa. between components (Fig 11-25). If there are no errors of posi-
Screwdrivers and pliers suitable for prosthetic abutments tioning, tightening is continued to 20 Ncm using a screwdriver
should be used. mounted on a contra-angle handpiece at low speed (Torque
Controller, Nobel Biocare).

133
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a b
Fig 13-46 (a) Vertical space needed for an extracoronal attachment. With conventional attachments the space needed
in the proximal area is 7 mm, of which 5 mm is for the standard measure of the attachment, 1 mm for the esthetic
occlusal material, and 1 mm to respect the periodontal margins. (b) This lateral view shows the correct vertical position-
ing of an extracoronal attachment.

a b
Fig 13-47 (a) Buccolingual space available on the distal surface of the crown that determines the position of the attach-
ment. (b) Clinical view: The position of the attachment is slightly lingual to allow adequate thickness on the buccal
aspect for esthetics. The alignment of the attachment on the sagittal plane is not always necessary, whereas perfect
alignment on the vertical plane is essential.

how the initial satisfaction of the patient and surgeon tends correctly positioning the clasps (Fig 13-48). In such cases, to
to diminish because of the high incidence (63%) of complica- position the retentive and reciprocal arms on the enamel and
tions.87 in the areas with an undercut less than 0.50 mm, the clini-
cian must use areas that are too close to the occlusal surfaces,
resulting in esthetic and functional problems (eg, unfavorable
RPDs with adhesive attachments leverage arm) (Fig 13-49). A solution to such problems could
With elderly patients, the age-related changes in the dental be a fixed prosthesis, which is not always appropriate in elderly
and periodontal tissues must be taken into consideration when patients for economic and biologic reasons. Furthermore, it is
choosing the type of anchorage. Dental abrasion and gingival almost always necessary to resort to endodontic treatment and
retraction occurs frequently in this group. Morphologic changes a post reconstruction for the crown.
in teeth, and crowns that are clinically longer than the anatomic A more convenient solution can be found in adhesive
ones, with excessive inclinations, often cause difficulty when attachments,88–90 which are relatively simple to prepare and

182
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Part I: Partial Distal CoEdentulism
NExtension
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a b
Fig 13-48 Altered morphology in an elderly patient. The crowns are Fig 13-49 (a) In the presence of neck errosion, the retentive arm
lengthened in the mandibular incisors with exposed cementum and can be attached to an occlusal surface, but this is unfavorable for
erosion around the neck of the teeth. The incisors are fanned out, function and esthetics. (b) Use of mixed retention allows the use of
and the left canine is destabilized with a lingual inclination. In such a wire retentive arm that can be placed in a more favorable cervical
situations, the only support area in the undercut for positioning a position to suit the undercut.
retentive clasp is often too close to the roots.

Fig 13-50 (a) Lateral view of an RPD anchored with an adhesive

attachment on the maxillary right first premolar. (b) The same case
with the RPD removed. Cervical erosion does not permit correct posi-
a b
tioning of the clasp.

are priced reasonably (Fig 13-50). The preparation techniques, avoid placement of clasps on teeth with low periodontal sup-
execution, and cementation of the adhesive prosthesis are port or esthetic importance (Figs 13-57 and 13-58).
described in part II of this chapter.
Until a few years ago, the contraindications for the use of
Conclusion and considerations
this type of attachment were linked to the quantity of enamel,
particularly on the occlusal surface.90 Adhesives were not very 1. Whether or not to recommend prosthetic rehabilitation in
effective on the dentin. Now, with dentin-enamel adhesives, the case of partial endentulism depends on:
it is possible to extend adhesion to the dentin without losing
n Patient’s general health
retention.91 This method is advantageous in terms of esthetics,
n Condition of the residual teeth
retention, simplicity, the speed with which it is accomplished,
n Periodontal situation
reversibility, and the ease of repair in cases of failure.
n Patient motivation and expectations
Implant-supported RPDs n Patient’s ability to maintain oral hygiene and attend follow-
up visits
If there is enough bone, one or two implants can be placed
n Occlusal relationships and dental function
in a strategic position and can thus modify the RPD.75,92 The
n Advantages, disadvantages, and long-term prognosis of the
implant-supported RPD is an affordable therapy that is moder-
reconstruction
ately invasive and technically simple. The strategic placement of
n Complications that limit the probability of clinical success
a reduced number of implants allows the clinician to optimize
n Cost
the rotation axes of the RPD with mixed support (Figs 13-51 to
13-53, next page), eliminate the rotation axes to re-establish a 2. The morphologic restoration of all dental arches can, in some
supporting polygon for the FPD (Figs 13-54 to 13-56), and to conditions, constitute overtreatment.

183
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Index

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Page numbers followed by “f” denote fig- incongruent, 34 Buccinator muscle, 7, 8f, 15
ures; those followed by “t” denote tables; morphology of, 6, 7f Burning mouth syndrome
those followed by “b” denote boxes narrow, 35 allergies and, 117–118
resorption of, 2, 27, 33, 201 causes of, 116–119
A round, 51, 51f classification of, 116, 116t
Abrasive spray instruments, 258–259 knige-edge, 51, 51f epidemiology of, 115
Abutments square, 51, 51f histologic characteristics of, 116
fixed partial denture, 189, 190f, Anatomic limitations, 107–113 protocol for, 120–121, 121f
210f–211f Angular cheilitis, 81t, 83, 83f symptoms of, 115–116
hygiene of, 261, 264f Anterior buccal region, 15 Burs, 201–202, 202f
mandibular implant-retained Anterior sublingual region, 14f, 14–15 Butterfly plate, 64f
overdentures, 126, 126f, 130, 131f Ante’s rule, 189–190
perio-overdenture, 158, 159f Antimycotics, 101, 116.120 C
placement of, for implants, 156, 157f Antiseptics, 101 Cadmium allergy, 118
plaque concerns, 260–261 Apophysis geni, 9 Camper plane, 18
Ad linguam mounting, 72f Arkansas stones, 203, 203f Candida albicans, 82–83, 99, 116
Ad vestibulum mounting, 72f Articulator Candidiasis
Adhesion, 5, 5f master cast transfer to, 67f, 78f, 80f, 91f adhesives and, 103–104
Adhesives occlusal registration in, 68f burning mouth syndrome caused by, 116
removable partial denture with adhesive Atmospheric pressure, 5, 6f Canines
attachments, 182–183, 183f fixed partial denture for replacement
types of, 103–104 B of, 190–191
Ageing, 271 B vitamins, 118–119 positioning of, 28, 29f, 156
Alginate impression, 55f–56f Ball retention preparation of
Allergy hygiene of, 260f–261f for fixed partial adhesive
burning mouth syndrome caused of overdentures dentures, 224–225, 225f
by, 117–118 mandibular implant-retained for fixed partial dentures, 202–203,
contact toxic stomatitis, 84–86, 85f overdenture, 126f–127f, 127, 203f
Alveolar bone, 1, 3 129, 132f–133f, 132–133, 136f survival of, 153, 153f
Alveolar ridge perio-overdenture, 159f Cap mounting, 35
atrophy of, 43 of removable partial denture, 186f Caries, 246, 262f, 273
with curved shape, 32 Bar retention of overdentures Cast. See Master cast.
denture construction considerations disadvantages of, 154, 154f Cements, 193–194, 194f
stability, 6, 7f mandibular implant-retained Central incisors, 22, 24
support, 9 overdentures, 126f–127f, 130–131, Centric occlusion, 37
edentulous, surgical techniques to 131f–132f Centrolateral proportions, 25f–26f
increase, 201, 201f maxillary implant-retained Ceramics
examination of, 50, 50f overdentures, 145 abrasive-spray effects on, 258
flabby Beck Depression Inventory, 41, 42b fixed partial denture constructed
formation of, 50, 50f Blocking the master cast, 66f–67f of, 192, 196f, 218f, 263f
impression taking provisions for, 110 Bone grafts, for edentulous alveolar fracture of, 273–274
treatment of, 107–108, 109f ridge, 201 Chamfer margin, 197f, 199, 204, 204f
inclined occlusal plane in relation to, Bruxism, 43 Chlorhexidine, 257
31–33, 32f Buccal mucosa, 12, 13f Cingulum rests, 172, 173f, 177f, 225–226

279
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Clasps, 175–176, 176f, 207f during mastication, 31–37 E ub

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Clinical examination, 46–52 occlusal plane considerations, 72f Edentulism ti
Clonazepam, for burning mouth principles of, 6–9, 7f–8f te in, 6, 7f on
alveolar ridge morphology
ot

n
syndrome, 120 testing of, 47, 48f facial effects, 21–22, 22f ss e n c e
fo r
Collagen fibers, 2 support of, 9, 9f initial visits with patients with, 45–46
Complete denture surfaces of, 5, 5f Kennedy classification of, 165f, 169
alveolar ridge considerations, 6, 7f teeth in masticatory load affected by, 3
buccal flanges, 6 diatoric, 31, 36, 36f mucosal histology in, 2f
centrolateral proportions, 25f–26f mandibular incisors, 31 occlusal plane in, 18
compensatory incorporation of, 43 maxillary incisors, 28f–29f, 28–30 oral health effects, 81
complaints about, 43, 44f natural-looking, 22, 23f, 68f orthopantomograph of, 130f
construction of, 55–80 selective grinding of, 36–37, 73f–74f, osseous resorption, 2
anatomic considerations, 11–16 80f partial. See Partial distal extension
diatoric teeth, 31, 36, 36f shape and color of, 68f edentulism.
esthetics in. See Esthetics. types of, 69f patient profile, 81
follow-up after, 77, 78f–80f Composite resins, for fixed partial patient’s response to, 41
impression, 11 denture, 192 physiopathology of, 1–3
mandibular considerations, 14–15, Condylar theory of Gerber, 36, 36f single-arch, 76–77
15f–16f Condyloform, 31, 32f therapeutic approach for, 3
mandibular incisors, 31 Conic burs, 201–202 Edentulous gaps
master cast, 11 Contact toxic stomatitis, 84–86, 85f, 117 definition of, 187
maxillary considerations, 11–14 Crossbite, 34, 35f fixed partial adhesive denture for
maxillary incisors, 28f–29f, 28–30 Crossed mounting, 71f advantages of, 220
maxillomandibular relationships, Curettes, 258, 258f, 265 canine preparations, 224–225, 225f
17f–20f, 17–20, 36 Curve of Spee, 32 cementation, 230–231, 231f, 235
occlusal relationships, 77 Customized impression tray. See Impression characteristics of, 220
existing, rehabilitation in patients tray. cingulum rest, 225–226
with, 46–47 Cytokines, 2, 128 contraindications, 222
follow-up, 77, 78f–80f impression technique, 227–228, 228f
hygiene of, 259f, 259–260 D incisor preparations, 224–225, 225f
inclined occlusal planes, 31–33 Defluxion holes, 59f–60f indications for, 221f–222f, 221–
incongruent, 23f–24f, 43 Deglutition, 37, 37f 222, 235
interdental contacts, 9 Dental adhesives, 103–104 laboratory procedures, 228–230, 229f
interincisive line, 68f–69f Dental floss, 252–253, 253f lingual reduction, 225, 225f
lingual flanges, 6 Dental history, 46, 47b metal framework, 229f–230f
load transfer across, 31 Dentate patients, 45 molar preparations, 226, 226f
in macroglossia patients, 8, 8f Dentofacial harmony occlusal rests, 222, 227, 227f
maladaptation to, 43 lack of, 47f palatal reduction, 225, 225f
mounting of, 68f, 71f restoration of, 68f, 70f pantograph, 223–224, 224f
mucosa-saliva-denture interface, 5–6 Dentogenesis, 25 parallelometer, 223, 223f–224f
multilocularly and independently stable Denture. See also Overdenture. premolar preparations, 226, 226f
mounting, 31–37 complete. See Complete denture. preparation techniques, 222–227
neuromuscular control, 7–8, 8f, 43 fixed partial. See Fixed partial adhesive proximal grooves, 225–226, 227f
neutral zone considerations, 33–34, 34f denture; Fixed partial denture. survival of, 221
occlusal harmony of, 9, 43 masticatory efficiency and, 3 try-in, 229–230, 230f
occlusal planes, 31–33, 32f provisional partial, 45 fixed partial denture for
occlusal relationship in, 19–20 removable partial. See Removable partial abutments, 189, 190f, 210f–211f
occlusion registration base, 63f–64f denture. Ante’s rule, 189–190
in older adults, 43 Depression, 41, 42b, 43f biomechanical considerations,
oral hygiene of, 259f, 259–260 Diabetes, 119 189–191, 190f
in painful mylohyoid ridge patients, Diamond burs, 201, 202f canine preparations, 202–203, 203f
110, 112f–113f Diastema, 22 case studies, 205–219, 206f–219f
patient satisfaction with, 41, 43 Diatoric teeth, 31, 36, 36f cements, 193–194, 194f
retention of, 5–6 Disclosing wax, 59f complete preparation, 192–193, 193f
roughening of, for tissue conditioner Disinfectants, 257, 260 diagnostic approach, 191
application, 99f Distal extension edentulism. See Partial disadvantages of, 189
spatial discrepancies, 70f–71f distal extension edentulism. extension of dental surface,
stability of 194–196, 195f
during deglutition, 37, 37f failure of, 220

280
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functional considerations, 191 Esthetics ub
removable partial denture, 272–273,

Q ui
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hygiene, 262, 263f–264f canine positioning, 28, 29f 276f tio
implant-supported, 231–232f, diatoric teeth, 31, 36, 36f Fornix, 110, 111f te ot n

n
231–233, 235 impression taking, 27 Free centric relation, 36f ss e n c e
fo r
incisor preparations, 202–203, 203f interdental space, 22, 23f Frena, 14f, 14–15, 52, 52f, 58f, 75f, 107,
indications for, 188–189, 234 mandibular incisor positioning, 31 108f
interproximal spaces, 264f maxillary incisor positioning Frenotomy, 107, 108f
margins, 196–199, 197f–199f, 204, in horizontal plane, 28, 29f
204f in vertical plane, 30 G
master casts, 216f, 218f neutral zone, 33–34, 34f Gauze, 253f, 253–254, 259f
material selection, 191–192, 192f, occlusal plane, 27, 27f Gingivitis, 154f, 197
196, 234 overview of, 21–22 Gingivoplasty, 201, 201f
maxillary, 206f patient involvement and education, Gold alloy, for fixed partial denture, 191–
maxillary canines replaced with, 22f–27f, 22–27 192, 196, 264f
190–191 personality considerations, 25, 26f Goniometer, 224, 224f
metal, 192, 192f, 263f prosthetic body, 28 Gothic arch technique, 21, 21f, 66f
metal-ceramic, 211f, 264f psychologic considerations, 22 Gracey curettes, 258, 258f
molar preparations, 203–204, removable partial denture, 179–180, 180f Graphic registration, 20–21
204f–205f vertical dimension of occlusion, 27, 28f Growth-associated protein 43, 128
90-degree bevelled shoulder margin, Extracoronal attachment, with removable
197f–198f, 197–199 partial denture, 180–181, 181f–182f H
130-degree bevelled shoulder margin, Extraction of teeth, 90, 92f Hard palate, 9
197f–199f, 198, 203–204, 235 Eye movement, 21 Hygiene. See Oral hygiene.
partial crown preparations, 234–235 Hyperglycemia, 119
partial preparation, 193, 193f F Hypertrophic tuberosity, 51, 51f, 110, 111f
pontics, 189–190, 199–201, 200f–201f Face Hypotrophic tuberosity, 51, 51f
preparation, 192–199, 201–205, edentulism effects on, 21–22, 22f
202f–204f embryogenic theory of Gerber, 24f–25f, I
provisional prosthesis, 205–219, 24–25 I-bar clasp, 176, 176f
206f–219f Facebow, 65f–66f Implant(s)
radicular surfaces, 189, 190f Fibroma, 109f abutment placement, 156, 157f
retention of, 193–194, 196f Fixed partial denture denture vs, 156
stability of, 193–194, 195f edentulous gaps treated with. See extraction of teeth decisions, 156
survival of, 193, 220 Edentulous gaps, fixed partial denture for. painful mylohyoid ridge managed with,
tapering, 196, 196f follow-up, 273–274, 276f 110
treatment plan, 191–219 hygiene, 247f, 262, 263f–264f, 273 removable partial denture supported by,
functional consequences of, 187 implant-supported 183, 184f–185f
implant-supported fixed partial dentures edentulous gaps treated with, residual teeth positioning considerations,
for, 231–232f, 231–233, 235 231–232f, 231–233, 235 156
masticatory considerations, 187–188 follow-up, 274, 276f single-tooth, 168, 168f, 231
need for treatment, 187–188 hygiene of, 264–266 tissue graft during placement of, 110,
periodontal disease associated with, 191 partial distal extension edentulism 111f
removable partial dentures for treated with, 167–169, 168f–169f Implant-retained overdentures
hygiene, 233 partial distal extension edentulism mandibular
indications for, 233, 235 treated with. See Partial distal extension adaptation period, 129–130
with rotational path of insertion, edentulism, fixed partial denture for. anchorage system, 130, 131f
233f, 233–234 periodontal disease around, 245f, 247f ball retention, 126f–127f, 127, 129,
treatment planning considerations, Flabby ridges 132f–133f, 132–133, 136f, 260f–261f
233 formation of, 50, 50f bar retention, 126f–127f, 130–131,
summary of, 234–235 impression taking considerations, 110 131f–132f
Elastic deformation model, 95, 96f treatment of, 107–108, 109f, 110 clinical procedures, 129–136
Electric toothbrushes, 251f, 251–252 Floss, dental, 252–253, 253f cytokine studies, 128
Electrolytic etching, 229, 229f Fluoride, 257 healing abutments, 130, 131f
Electroscalpel, 201, 201f Follow-up history of, 125
Embryogenic theory of Gerber, 24f–25f, complete denture, 77, 78f–80f indirect retention technique, 134, 134f
24–25 considerations for, 271 laboratory phases of, 134–136,
Enamel contouring, for removable partial fixed prostheses, 273–274, 276f 135f–136f
denture, 176, 177f implant-supported prostheses, 274, 276f mathematic models of, 126f–127f
Epulis fissuratum, 82 record of, 276f oral function studies in, 128–129

281
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perio-overdenture. see Perio- Inclined occlusal planes, 31–33, 32f ub
ball retention, 126f–127f, 127, 129,

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overdenture. Incongruent prosthesis, 23f–24f, 43 132f–133f, 132–133, 136f, 260f–261f ti
prosthetic abutment, 126, 126f Intercuspal position, 20 te 130–131, on
bar retention, 126f–127f, ot

n
studies of, 125–128 Interdental brushes, 252, 252f, 261f, 263f 131f–132f ss e n c e
fo r
success rate of, 129 Interdental contacts, 9 clinical procedures, 129–136
tactile innervations of edentulous Interdental papillae, 201 cytokine studies, 128
ridge mucosa affected by, 128 Interdental space, 22, 23f healing abutments, 130, 131f
maxillary Interincisive line, 68f–69f history of, 125
indications for, 142 Interocclusal distance, 19 indirect retention technique, 134, 134f
metal structure of, 155, 155f Interocclusal rest space, 47, 48f laboratory phases of, 134–136,
rehabilitation protocol for, 142, Interproximal spaces, 209f, 262 135f–136f
143f–147f Intracoronal attachment, with removable mathematic models of, 126f–127f
painful mylohyoid ridge managed partial denture, 180, 181f oral function studies in, 128–129
with, 110 perio-overdenture. See Perio-
Implant-supported fixed partial denture J overdenture.
edentulous gaps treated with, 231–232f, Jendrassik maneuver, 18 prosthetic abutment, 126, 126f
231–233, 235 studies of, 125–128
follow-up, 274, 276f K success rate of, 129
hygiene of, 264–266 Kelly syndrome, 142 tactile innervations of edentulous ridge
partial distal extension edentulism Kennedy classification of edentulism, 165f, mucosa affected by, 128
treated with, 167–169, 168f–169f 169 Mandibular incisor positioning, 31
Impression Kinematic facebow, 65f–66f Margins, for fixed partial dentures, 196–
alginate, 55f–56f Knife-edge alveolar ridge, 51, 51f 199, 197f–199f
esthetic considerations, 27 Master cast
fixed partial adhesive denture, 227–228, L articulator transfer of, 67f, 78f, 80f
228f Lateral buccal area, 15 blocking of, 66f–67f
flabby ridge considerations, 110 Lingual plate, 174f, 174–175 construction of, 11, 57f, 62f
mandibular, 56f, 61f Lingualized occlusion, 36 edentulous crest transfer to, 70f
margin of, 12 Lip vermilion, 17 fixed partial denture, 216f, 218f
maxillary, 55f, 61f Load mandibular, 62f
perio-overdenture, 136, 137f–138f, 161, excessive, parafunction secondary to, 117 maxillary
161f supporting tissue affected by, 97, 97f illustration of, 62f, 80f
preparation of, 55f–58f transfer of implant-retained overdentures, 143f
provisional restoration, 90, 91f complete denture, 31 perio-overdenture, 138f, 141f, 158, 158f
relined, 55f–56f description of, 2 Mastication
requirements of, 11 Lombardi’s scheme, 27, 27f multilocularly and independently stable
trimming of border, 58f–60f mounting of teeth complete denture,
Impression tray M 31–37
esthetic considerations, 27 Macroglossia, 8, 8f, 19, 49, 50f phase 1, 31–35, 37f
mandibular, 16, 56f–57f, 57f Mandible phase 2, 36–37, 37f
margin of, 12 centrifugal resorption of, 2 Masticatory cycle, 3
maxillary, 57f complete denture construction Masticatory load, 2–3
perio-overdenture, 161, 161f considerations, 14–15, 15f–16f Maxilla
prosthetic body and, 16f functional deformation of, 3f anatomy of, 2, 11–14
Schroeder region considerations, 14 hinge axis measurement and atrophy of, 156
sizing for, 55f palpation, 65f centripetal resorption of, 2, 2f
soft palate considerations, 13 implants in, 156 complete denture construction
trimming of, 60f impression taking, 56f, 61f considerations, 11–14
tuberosity coverage, 13 master cast of, 62f implants in, 156
Incisal rests, 172, 173f, 177f occlusion registration base, 63f–64f impression taking, 55f, 61f
Incisive papilla, 28 open rest position of, 18–19 master cast of, 62f
Incisors perio-overdenture, 157f occlusion registration base, 63f–64f
central, 22, 24 postural position of, 18 osseous morphology of, 142, 142b
mandibular, 31 residual teeth, 156 perio-overdenture, 157f
preparation of resorption of, 2 resorption of, 2, 2f, 27
for fixed partial adhesive dentures, Mandibular cast, 62f shape of, 50, 50f
224–225, 225f Mandibular implant-retained overdentures Maxillary bones, 1
for fixed partial dentures, 202–203, 203f adaptation period, 129–130 Maxillary cast, 62f, 80f
survival of, 153, 153f anchorage system, 130, 131f

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Maxillary implant-retained overdentures Mylohyoid ridge mouthrinses, 257 ub

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indications for, 142 examination of, 15, 15f, 51, 60f noxious pathology eliminated through,tio
metal structure of, 155, 155f painful, 110, 113f 248–249 te ot n

n
rehabilitation protocol for, 142, 143f–147f overdenture, 260, 261f ss e n c e
fo r
Maxillary incisor positioning N patient motivation for, 247–248, 248f
in horizontal plane, 28, 29f, 36 Nasolabial crease, 17 periodontal concerns, 245f–246f, 246
in vertical plane, 30 Neuromuscular control, 7–8, 8f, 43 periodontal disease secondary to lack of,
Maxillary occlusal rim, 17–18 Neutral zone, 6, 33–34 245f, 248f
Maxillary tuberosities, 51, 51f 90-degree bevelled shoulder margin, plaque
Maxillomandibular relationships 197f–198f, 197–199 disclosing agents for, 256
complete denture construction Nonverbal communication, 45 removal of, 246. See also
considerations, 17f–20f, 17–20 Nutrition Toothbrushes.
on horizontal plane, 19–21 burning mouth syndrome and, 118–119 polishing, 259, 259f
provisional restoration construction edentulism effects on, 3 poor, 245f–246f
considerations, 90 patient guidelines, 271–272 professional, 257–259, 258f–259f
vertical dimension of occlusion, 17–19, prosthetic considerations, 246–247
19f, 27, 28f, 48f O provisional prosthesis, 263f
Maxillomandibular space, 17–18 Occlusal planes record of, 275f
Maximum intercuspidation, 19, 36, 73f esthetic considerations, 27, 27f removable partial denture, 170, 170f,
Maxwell model, 95–96, 96f inclined, 31–33, 32f 233, 261, 262f, 272
Medical history, 46 Occlusal rests with tissue conditioners, 100
Meniscus, 6, 6f for fixed partial denture, 222, 227, 227f tongue brushing, 256
Menopause, 118 for removable partial denture, 172, 173f, toothbrushes
Metal allergies, 117 177f brushing techniques, 254–256,
Metal framework Occlusal rim, maxillary, 17–18 255f–256f
fixed partial adhesive denture, 229f–230f Occlusion electric, 251f, 251–252
fixed partial denture, 192, 192f, 263f lingualized, 36 types of, 249f–252f, 249–252
fracture of, 273 types of, 34, 35f toothpastes, 256–257, 257f
maxillary implant-retained overdenture, vertical dimension of. See Vertical Oral mucosal diseases
155, 155f dimension of occlusion. angular cheilitis, 81t, 83, 83f
perio-overdenture, 161f–162f, 161–162 Occlusion registration base, 63f–64f contact toxic stomatitis, 84–86, 85f
removable partial denture, 171f–177f, Older adults prevalence of, 81t, 81–82
171–176 adaptation to complete denture by, 43 prosthetic hyperplastic fibrosis, 84, 84f
Methylmethacrylate allergy, 82, 84–86, 117 hygiene in, 260 prosthetic stomatitis, 81t, 82f, 82–83,
Micro-glenoid fossa, 36 natural-looking teeth in, 22 103, 117, 260
Mimic muscles, 7, 8f removable partial dentures in, 182, 183f traumatic ulcers, 85f, 86
Minimal occlusion, 34, 35f Olthoff protocol, 129 Orbicular oris, 12
Minor preprosthetic surgery for anatomic 130-degree bevelled shoulder margin, Orthopantomograph, 130f
limitations 197f–199f, 198, 203–204, 235 Osseous morphology, 142, 142b
flabby ridges, 107–108, 109f Open rest position, 17–19 Overadaptation, 41
fornix deepening, 110, 111f Oral cavity examination, 49b Overdenture. See also Denture.
frenotomy, 107, 108f Oral glucose tolerance test, 119 contraindications, 155–156
hypertrophic tuberosity reduction, 110, Oral hygiene definition of, 154
111f abutments, 261, 264f final considerations for, 158
overview of, 107 ball attachment of overdenture, 260f–261f hygiene of, 260, 261f
tori removal, 107, 108f case studies, 265f–266f implant-retained. See Implant-retained
Mixed-support fixed partial denture, 168– complete denture, 259f, 259–260 overdentures.
169, 169f dental floss, 252–253, 253f indications for, 155–156
Modiolus, 7, 8f disinfectants, 257, 260 oral hygiene considerations, 260, 261f
Molar preparation fixed partial denture, 247f, 262, perio-overdenture. see Perio-overdenture.
for fixed partial denture, 203–204, 263f–264f, 273 residual teeth, 153, 156
204f–205f, 226, 226f fluoride, 257 root-anchored, 154f, 154–155
Mucosa gauze, 253f, 253–254, 259f types of, 154, 154f
buccal, 12, 13f goals of, 245 Overlay, 154f, 154–155
edentulism-induced modifications, 2f, 2–3 home-based, 249f–257f, 249–257
examination of, 51, 52f implant-supported fixed partial denture, P
folds, 51, 52f 264–266 Palatal seal, 13
Multilocularly and independently stable interdental brushes, 252, 252f, 261f, Palate
mounting, 31–37 263f complete denture support, 9

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hard, 9 sequelae of, 166 ub
removal of, 246. See also Toothbrushes.

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region of Schroeder, 14, 14f short dental arch, 166, 166f Polishing, 259, 259f tio
soft. See Soft palate. Partial edentulism Polymethylmethacrylate, 84,
te 98, 117 ot n

n
Palatine foveae, 13 description of, 45 Polyneuropathy, 119 ss e n c e
fo r
Palatine rugae, 28, 29f distal extension. See Partial distal Pontics, 189–190, 199–201, 200f–201f
Pantograph, 223–224, 224f extension edentulism. Pre-existing prosthesis, 92–93
Paracrine signaling, 3 Kennedy classification of, 165f, 169 Premolar preparation, for fixed partial
Parafunctional activity, 117, 120, 166, 167f prosthetic rehabilitation factors, 183 adhesive denture, 226, 226f
Parallelometer, 171f–172f, 171–172, 223, Partially edentulous patients, 45 Pressure revealer, 93
223f–224f Patients Probing, 273
Paratuberosity regions, 13, 13f attitude of, 272 Prognostic factors, 49b
Partial distal extension edentulism dentate, 45 Prosthesis. See also Prosthetic rehabilitation.
fixed partial denture for expectations of, 44 denture. See Denture.
cantilever, 167, 167f, 183 initial visit with, 44–46 hygiene considerations, 245f, 246–247
implant-supported, 167–169, involvement of, in complete denture incongruent, 23f–24f, 43
168f–169f esthetics, 22f–27f, 22–27 instability of, 92
mixed-support, 168–169, 169f nutrition guidelines given to, 271–272 pre-existing, restoration of, 92–93
need for treatment, 165–166, 166f–167f oral hygiene by, 247–248. See also Oral provisional. See Provisional prosthesis.
parafunction evaluations, 166, 167f hygiene. relining of, 77
pre-treatment evaluations, 165–166 partially edentulous, 45 sliding of, 93
removable partial denture for responses to edentulism, 41 stomatitis caused by, 81t, 82f, 82–83,
abutments, 185f Peri-implantitis, 110f 103, 117, 260
adhesive attachments, 182–183, 183f Periodontal disease, 89f, 191, 245f–246f, toothbrush considerations, 250, 250f
axis, 173f, 184f 248f Prosthetic body
base, 177–178, 178f–179f Periodontal ligament, 170, 170f esthetic considerations, 28
biomechanical factors, 169–170 Periodontal probing, 273 functions of, 28
cingulum rests, 172, 173f, 177f Perio-overdenture impression tray and, 16f
clasps, 175–176, 176f, 207f abutments, 158, 159f limits of, 11, 13
connectors, 172, 174, 174f casts for, 158, 158f, 162, 163f mandibular, 75f
construction of, 171f–178f, 171–178 clinical planning of, 158–164 painful mylohyoid ridge provisions, 110,
delivery of, 178 construction of, 158–164 112f–113f
ecologic factors, 169–170 contraindications, 156 palatal seal, 13
efficacy studies of, 170–171 costs associated with, 155 tissue conditioner application to,
in elderly patients, 182, 183f delivery of, 163, 163f 99f–100f, 99–101, 130f
enamel contouring for, 176, 177f description of, 136–141, 137f–141f, Prosthetic condition, 43
esthetics, 179–180, 180f 154–155 Prosthetic history, 47, 47b
extracoronal attachment, 180–181, design of, 157–158 Prosthetic hyperplastic fibrosis, 84, 84f
181f–182f esthetics, 161–162 Prosthetic rehabilitation
hygiene, 170, 170f hygiene of, 163, 164f, 261f anatomic limitations for, 107–113
implant-supported, 183, 184f–185f indications for, 155–156 case history, 46
incisal rests, 172, 173f, 177f interdental brush for cleaning of, 261f clinical examination, 46–52
indications for, 169, 169f, 171 mandibular, 157f complete denture. See Complete denture.
intracoronal attachment, 180, 181f maxillary, 157f dentate patients, 45
lingual plate, 174f, 174–175 metal structure, 161f–162f, 161–162 exploration of problem, 44–46
mandibular connectors, 174, 174f–175f mounted teeth try-in, 162, 163f fixed partial denture. See Fixed partial
metal framework, 171f–177f, 171–176 provisional prosthesis adaptation, 158, denture.
mouth preparation, 176, 177f 159f follow-up. See Follow-up.
occlusal rests, 172, 173f, 177f root caps, 160–161, 161f guidelines for, 43–52, 44b
parallelometer analysis, 171f–172f, study casts for, 158, 158f history-taking, 46–47
171–172 try-in, 161–162, 162f–163f minor preprosthetic surgery for anatomic
patient instructions, 178 waxup, 139, 140f, 158, 158f limitations. See Minor preprosthetic
physiologic adjustments, 176–177, 178f Peripheral seal, 11 surgery for anatomic limitations.
precision attachments, 180f–182f, Phonetic monitoring, 19 partially edentulous patients, 45
180–182 Physiognomy, 25, 26f, 69f prognostic factors, 49b
radicular attachment, 180, 181f Piriform eminence, 59f, 75f removable partial denture. See
rests, 172, 173f, 176, 177f Plaque Removable partial denture.
summary of, 183, 186 on complete denture, 259 systemic illnesses that affect, 46b
treatment plan, 171 disclosing agents for, 256 totally edentulous patients, 45–46
try-in, 176–177 on implant-supported prostheses, 274 Prosthetic space, 34

284
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Prosthetic stomatitis, 81t, 82f, 82–83, 103, incisal, 172, 173f, 177f T ub

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117, 260 occlusal, 172, 173f, 177f, 222, 227, 227f Tapering, of fixed partial denture tio
Provisional prosthesis Retention preparation, 196, 196ft
ess c e n
ot

n
advantages and disadvantages of, 90b in complete denture construction, 5–6 Teeth. See also Canines; Incisors.
fo r
en
construction of in fixed partial denture construction, diatoric, 31, 36, 36f
case study example, 208, 209f–219f 193–194, 196f extraction of, 90, 92f
description of, 89, 90b Retromolar pads loss of, 41, 153
direct technique, 208 anatomy of, 15, 16f prosthetic
mixed technique, 208, 209f complete denture support, 9 natural-looking, 22, 23f, 68f
fixed partial denture, 205–219, 206f–219f Retropositioning of tongue, 50, 50f pontics, 189–190, 199–201, 200f–201f
hygiene of, 263f Roberts diagram, 188f selective grinding of, 36–37, 73f–74f,
indications for, 89 Root caps, 160–161, 161f 80f
interproximal spaces, 209f Root-anchored overdenture, 154f, 154–155 shape and color of, 68f
materials, 205 Roots, 154, 190f types of, 69f
partial denture, 45 Round alveolar ridge, 51, 51f residual, 47, 49, 49f, 153, 156
perio-overdenture, 158, 159f Rugae, 28, 29f Tensor veli palatini, 12
preparation for, 90–92, 91f Therapeutic position, 66f
sliding of, 93 S Thermoplastic paste, 78f, 80f
types of, 205, 206f–207f Sagittal condyle, 65f Tissue conditioners
waxup of, 90, 91f Salivary flow composition and behavior of, 98t, 98–99
Psychologic interferences, 41–43, 42b, 43f, assessment of, 49, 50f description of, 95
119 burning mouth syndrome caused by hygiene instructions, 100
Pterygomandibular plica, 12 reduced, 118 renewal of, 100
Pterygomaxillary ligaments, 13 Sand-bath technique, 229 technique for applying, 99f–100f, 99–101
Pterygomaxillary notches, 12 Secondary support of complete denture, 9, 9f Tongue
Selective grinding, 36–37, 73f–74f, 80f brushing of, 256
R Short dental arch, 166, 166f burning mouth syndrome symptoms, 115
Radicular attachment, with removable Single-arch edentulism, 76–77 examination of, 49–50, 50f
partial denture, 180, 181f Single-tooth implant, 168, 168f, 231 macroglossia, 8, 8f, 19, 49, 50f
Reduced occlusion, 34, 35f Sodium hypochlorite, 257 movements of, 8
Region of Fish, 15 Soft palate, 12–13, 13f retroposition of, 50, 50f
Region of Schroeder, 14, 14f Spatial discrepancies, 70f–71f Toothbrushes
Relining Splinting, of implants, 146, 146f–147f brushing techniques, 254–256, 255f–256f
of denture, 101f Square alveolar ridge, 51, 51f electric, 251f, 251–252
of impression, 55f–56f Stability types of, 249f–252f, 249–252
of prosthesis, 77 of complete denture Toothpastes, 256–257, 257f
Removable partial denture during deglutition, 37, 37f Tori, 107, 108f
burning mouth syndrome caused by, 117 during mastication, 31–37 Traumatic ulcers, 85f, 86
clinical evaluation of, 272–273 principles of, 6–9, 7f–8f Tuberosities
edentulous gaps treated with testing of, 47, 48f description of, 13
hygiene, 233 of fixed partial denture, 193–194, 195f hypertrophic, 51, 51f, 110, 111f
indications for, 233, 235 Static space, 22, 23f hypotrophic, 51, 51f
with rotational path of insertion, Stomatitis Tungsten-carbide burs, 202, 202f
233f, 233–234 contact toxic, 84–86, 85f
treatment planning considerations, prosthetic, 81t, 82f, 82–83, 103, 117, 260 U
233 Subgingival margin, 197, 197f Ulcers, traumatic, 85f, 86
emergencies, 273 Sublingual bar, 174f, 174–175 Ultrasonic instruments, 258
follow-up, 272–273, 276f Sucralfate, for burning mouth Universal model, 96–97, 97f
hygiene of, 261, 262f, 272 syndrome, 120
long-term studies of, 245 Sulcus, 72f V
partial distal extension edentulism Supportive tissue Vertical dimension of occlusion
treated with. See Partial distal extension biomechanics of, 95–98, 96f–97f assessment of, 48f
edentulism, removable partial denture for. conditioning of, 95–101 determination of, 18–19, 19f, 27, 28f
plaque deposition on, 262f viscoelastic behavior of, 95–98, 96f–97f intercuspal position, 17
radiographic follow-up, 272 Surface tension, 5 Vibratile line, 12
toothbrushes for, 250, 251f Swallowing, 37, 37f Viscoelastic behavior of supportive
Residual teeth, 47, 49, 49f, 153, 156 Systemic conditions, 272 tissue, 95–98, 96f–97f
Rests Viscous deformation model, 95, 96f
cingulum, 172, 173f, 177f Voigt model, 96, 96f

285
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W X Z ub

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Waxup Xerostomia, 118 Zinc oxide–eugenol paste, 62f tio
for perio-overdenture, 139, 140f, 158,
ess c e n
Zygomatic implants, 142, t146
ot

n
158f
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for provisional prosthesis, 90, 91f, 214f

286