Removable Prosthodontics

(Standards of Care)

1. Patient History and Treatment Plan

An adequate history is obtained from the patient and required medical and dental consultations have been obtained. All necessary radiographs are present and diagnostic.
The patient's medical conditions and past dental history will be considered in the treatment plan and the plan based on sound prosthodontic procedures. The resident will have discussed options and possible complications. The patient should be in agreement with the plan and the time table to complete it.

2. Diagnostic Casts

Casts will be accurate, bubble-free reproductions of the required structures and properly articulated when required. Casts will be surveyed and a tentative removable partial denture design drawn on the lab prescription form. The final design will be approved by a mentor.

3. Preparations

Rest preparations and tooth modifications should be carried out with sound prosthodontic principles in mind, following the proposed design. The amount of tooth structure removed should provide for the desired support, retention, and stabilization of the removable partial denture or overdenture as well as proper thickness for development of occlusion and esthetics. Preparations should be checked by the mentor before final impressions.

4. Final Impressions

The final impression must include all the desired anatomical structures needed in the construction of the prosthesis and must be accurate and distortion free. Border extensions and tissue pressure should be in accordance with the impression technique used.

5. Final Casts

All final casts must be neat and free of bubbles and voids with land areas smoothed. The RPD master cast will be properly tripoded and borders of the desired major connectors may be marked. Prescription forms with neat, legible removable partial denture designs and instructions will be countersigned by a prosthodontic mentor prior to being sent to the laboratory.

6. RPD Framework Try-In

The completed framework should be evaluated prior to the try-in. The framework must completely seat without rocking. The fit of all components, the retention, and the occlusion must be verified in the mouth.

7. Centric Jaw Relation Records

Record bases must be accurate and stable. Jaw relation records must accurately record the appropriate centric position at the proper occlusal vertical dimension. An appropriate material should be used and the record must be reproducible. A facebow will be used. Acceptable anterior and posterior shades and molds should be selected and included with the design and other necessary information on the prescription form.

8. Wax Try-In

The correct centric relation position, occlusal vertical dimension, lip support, mid line, occlusal plane and phonetics should be verified. The size, shape, shade, and arrangement of the anterior teeth should be accepted by the patient and the doctor.

9. Insertion

All acrylic surfaces must be free of sharp projections or edges. Tissue bearing surfaces must be evaluated with Pressure Indicator Paste and the proper border extensions verified. The occlusion should provide uniform contacts in excursive movements and the principles of a definite occlusal scheme should be identifiable. The cameo surface of the prosthesis should be properly contoured and highly polished.

10. Home Care Instructions and Post Insertion Care

The patient must be given the appropriate wearing, care, and cleaning instructions. Adequate follow-up appointments must be scheduled to verify the fit, occlusion, and the patient's management of the prosthesis.

11. Laboratory Relines/Rebases; Corrected Casts

An accurate impression must be made at the proper occlusal vertical dimension. The framework must be completely seated.

12. Patient Management

All patients must be treated in accordance with the highest professional standards.

13. Time Management

All clinical procedures should be preplanned, discussed, and approved by the mentor. Residents should arrive on time, begin treatment promptly, and complete treatment in an expeditious manner. All laboratory procedures should be accomplished to allow the laboratory technicians ample time to meet the delivery date.

14. Laboratory Procedures

Impression trays should be smooth and extended in accordance with the technique being used. The record base should be free of all sharp edges and must be accurate and stable. The tooth set-up must be in accordance with the principles of the occlusal scheme being used. The processed prosthesis should be dense and have no more than 1.5 to 2mm pin opening at the lab remount. The finished prosthesis should be highly polished with no sharp edges, blebs, or flash.

15. Standards of Care

All patients will be evaluated using the appropriate standards of care form.

Removable Partial Dentures Standards of Care Evaluation Form

Complete Dentures Standards of Care Evaluation Form