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Digital Versus Conventional Design For Mandibular Distal Extension RPD: A

Study of Passivity of RPD Components and Principal Abutment Alveolar Bone
Height Changes

Article · December 2017

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 Mansoura Journal of Dentistry 2017;4(14):6-13.

Digital Versus Conventional Design For Mandibular Distal

Extension RPD: A Study of Passivity of RPD Components
and Principal Abutment Alveolar Bone Height Changes

El-Khamisy NE1, Habib AH2, El- Mekawy NE3, Emera RM4

1
BDS, MSD, Senior Teaching Assistant of Removable Prosthodontics, Faculty of Dentistry, Mansoura University, Egypt.
2
BDS, MSD, PhD, Professor of Removable Prosthodontics, Faculty of Dentistry, Mansoura University, Egypt.
3
BDS, MSD, PhD, Assistant Professor of Removable Prosthodontics, Faculty of Dentistry, Mansoura Universiry, Egypt.

Abstract:
Objectives: Evaluation of Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) versus traditional fabricated distal
extension removable partial dentures (RPDs) regarding passivity, changing of the alveolar bone height (radiographically) and mobility
of the abutment teeth.
Materials and methods: Within patient cross over study was carried out on six patients were selected for this study with maxillary
complete edentulous arch against mandibular distal extension ridges posterior to first premolar teeth. Half of the patients were used
metallic CAD-CAM RPDs for the first 12 months, and half of the patients were used removable partial dentures that was fabricated by
conventional lost wax technique. In the second 12 months, after rest period of 2 months cross matching of the patients was done.
Patients who had received metallic CAD-CAM RPDs were received metallic removable partial dentures that was fabricated by
conventional technique and the patients who had received metallic removable partial dentures that was fabricated by conventional
technique were received metallic CAD-CAM RPDs.
After manufacturing of each metallic frameworks and before delivery of the dentures to the patients, the passivity was evaluated. The
abutment teeth alveolar bone height changes were evaluated radiographically immediately after insertion, after 6 and 12 months of
denture insertion using Corel Draw 11 system. Abutment teeth mobility was evaluated using Periotest device immediately after
insertion, 6 and 12 for each type of the manufactured dentures.
Results: Group I (conventionally fabricated RPDs) recorded significant higher gaps between RPD components and supporting tissue in
mm and lower percentage of contact than Group II (CAD/CAM RPDs) at different sites of measurements. There was no significant
difference between group I (Conventionally RPDs) and group II (CAD/CAM RPDs) at both observation times (6 and 12 months)
regarding abutment teeth mobility. Abutment mobility after 12 months was significantly higher than mobility after 6 months for group I
i.e mobility increased with advance of time for group I only. There was a significant difference in abutment crestal bone loss between
groups at distal sites only (Mann Whitney test, p<.05); as group I recorded significant higher bone loss than group II at both observation
times for distal sites only.
Conclusion: CAD/ CAM RPD frameworks recorded significantly higher fit than conventionally fabricated RPD frameworks. The
lingual bar major connector showed significantly higher gap than other RPD framework components for both groups (Conventional and
CAD-CAM). CAD/CAM RPDs showed insignificant abutment mobility and significant lower crestal bone loss than conventionally
fabricated RPDs.
Key words: Co-Cr, RPD, CAD-CAM, Passivity, Mobility.

Introduction Computer Aided Design/Computer Aided

R emovable dentures remain an essential prosthetic Manufacturing (CAD/CAM) techniques have been
consideration in many conditions of oral introduced in dentistry, particularly to fabricate crowns and
rehabilitation, especially when the edentulous bridges (fixed partial dentures). Published data comparing
spaces posterior to the anterior remaining teeth are manufacturing of RPD either by (CAD/CAM) or
to be restored. conventional method was clinical trials (2), so this study aim
The conventional removable partial denture (RPD) is a to evaluate computer aided design/computer aided
denture fabricated from cobalt chromium using the "lost manufacturing (CAD/CAM) versus traditional fabricated
wax" technique. This hand-made way of working makes the distal extension removable partial dentures (RPD's)
final result vulnerable, not always predictable and not regarding passivity of the components of metallic frame
reproducible. Several errors may happened during the work of RPDs, changing of the alveolar bone height (radio
fabrication of a removable partial denture by conventional graphically) and mobility of the abutment teeth.
method.
The conventional fabrication of removable partial Material and method :
dentures (RPDs) is a complex, error-prone, time- Patient Selection
consuming, and expensive process. The use of computer- This study was conducted on six completely
aided design and computer-aided manufacturing (CAD- edentulous maxilla and remaining mandibular teeth
CAM) techniques, promises a more effective method for from right 1st premolar to left 1st premolar after
fabricating RPD frameworks. (1)
approval of the local committee for scientific research
ethics.
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 Mansoura Journal of Dentistry 2017;4(14):6-13.

Sample size (n=6) was calculated using PASS (Power e. Relief was created by selecting the STL data of
Analysis Sample Size, 2008, NSCC, Utah, USA) to the mesh-retainer part and lifted 0.5mm towards
achieve a power of 91 % with a two tailed, occlusal direction. The formed saddle shells were
significance level (alpha) set at 0.05. then offset outside for creation of the stopper
1. All patients were selected from the outpatient areas.
clinic of Prosthodontic Department, Faculty of f. RPD Design of a class I mandibular RPD was
Dentistry, Mansoura University according to the selected with a default strategy of stress-releasing
following criteria: class I maxillomandibular design. Two free-end saddles connected with
relationship, sufficient inter-arch space verified lingual bar were selected, two RPA clasps were
by tentative jaw relation, their age range from added on the abutment teeth first premolars on
40 –60 years. They were free from systemic both sides included mesial rests, proximal plates,
diseases related to bone resorption as Diabetes and modified Aker retentive arm. Additional rests
Mellitus and osteoporosis, They had completely were added on the cingulum of the neighbouring
edentulous maxilla with partially edentulous canines teeth. Finally, occlusal rests were
mandible with remaining six anteriors and first connected to the lingual bar major connector; on
premolar teeth free from periodontal affection each side of the arch, through minor connector.
and They were free from T. M. J. disorders. g. The virtual design (Fig. 2) was milled by milling
2. Diagnostic digital periapical radiographs for first machine (Shera eco-mill 5x, Germany) to mill the
premolars were taken. Upper and lower primary cobalt chromium disc to the desired frame work
impression was made and poured in dental stone. design (Fig. 3). The frameworks were tried in the
Maxillary secondary impression was made. patient mouth to evaluate their passivity to the
Primary diagnostic surveying of diagnostic cast surrounding tissues by light body poly vinyl-
using dental surveyor. Abutment teeth siloxane impression material.
preparation were prepared as follow: Mesial h. Evaluation of the cobalt chromium framework
occlusal saucer shaped rest seat in 1st premolars, passivity was done by the following two
cingulum rest seat in mandibular canine, methods:
Proximal guiding plane were prepared in the Objective Method for evaluating the passive fit:
distal surface of the 1st mandibular premolars. a) Measuring the gap between the framework and
3. A single mandibular anatomic impression was the oral structures by evaluation the thickness of
made by medium body addition silicon and Light body poly vinyl-siloxane impression
poured in dental stone to produce master cast. material (Fig. 4) with digital poly-gauge at three
The master cast was removed from the secondary points (guiding plane, minor connector junction
impression after one hour. Then, the secondary with major connector and, the middle of the
impression was poured again to obtain another major connector) then the reading was recorded.
master cast to fabricate the CAD/CAM metallic b) Evaluating the ratio of metallic color (cobalt
framework on the first master cast and the chromium framework color) to orange color
conventional lost wax metallic framework on the (Light body poly vinyl-siloxane impression) in
second master cast. digital image taken by digital camera. The
Construction of CAD / CAM metallic framework: assessment was done electronic by counting the
a. The cast was scanned by optical scanning system pixels of the different colors with using Adobe
(Shera eco-scann7,Germany) Photoshop program in relation to the total image
b. Software created 3d virtual model by connecting pixels
the points cloud with triangular facets. Finally,
the 3D model was exported as STL file format. The digital images were scanned with a resolution 100
c. Digital surveying of the 3D model (Fig. 1) was dots per inch. The scanned image was copied into an
done in order to determine the presence or image of fixed size (5000x3370) pixels and stored in
absence of undercuts. The path of insertion of the Adobe Photoshop- format. Then, the color range tool
RPD was selected through anterior tilting of the was used (fuzziness20, 25, 30) to select the metallic
3D model in the sagittal plane. parts on the histogram. Subsequently a ratio was
d. The cast was ready at this step to draw the computed for the metallic display by dividing the
predetermined design directly on the 3D model number of pixels with metallic color to the total
that was duplicated and be used as a medium for number of pixels in the selected area.
RPD components creation.

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 Mansoura Journal of Dentistry 2017;4(14):6-13.

Subjective method for evaluating the passive fit Duplication of the occlusal and polished surfaces of
By visual method to the digital images and scoring of the CAD-CAM finished dentures was carried out to
the metal display was done to metal display area as construct duplicated denture. After removal of the
follow: finished denture and tin foil over the master cast, the
Score 1: area with metal display. second recording base was placed over the cast.
Score 2: area with thin layer of Light body poly vinyl- Artificial teeth with the same size and color were set
siloxane impression cover metal area. in its position inside the mould. Molten base plate wax
Score 3: area with thick layer of Light body poly was poured in the mould cavity. After cooling, the
vinyl-siloxane impression material. two halves were separated to obtain a duplicated
i. Finished RPD was constructed as follow:- record block of finished denture. The denture was
- Maxillary and mandibular record blocks were tried-in and processed by heat cured acrylic resin and
constructed and the jaw relation was registed. The then, the occlusion was refined.
casts were mounted on semi - adjustable Abutment teeth mobility and bone height changes was
articulator. Modified semi-anatomical acrylic evaluated at time of insertion, 6 and 12 months for
artificial teeth were arranged according to CAD–CAM and conventional RPDs.
lingualized non-balanced occlusion. The waxed
dentures were tried then flasked and wax Evaluation of abutment mobility and alveolar bone
elimination was carried out. resorption:
- Tin foil was adapted over the ridge on the cast Mobility was measured using Periotest device (Fig.
5). Abutment interdental bone height was radio
before processing the denture base then packing
and curing was finished. Deflasking, finishing, graphically evaluated by digital radiograph (Fig. 6)
and direct digitalization of measurement data was
and polishing without removing of the spacer,
done using Corel Draw 11 computer program. The
after the partial denture has been completed a
radiographs was evaluated during insertion, 6 and 12
functional reline impression method was carried
months after insertion.
out. A functional relining impression method was
carried out.
Statistical analysissss
- Reflasking, packing and curing with heat cure To detect significant differences for all tested
acrylic resin, Finishing and polishing of the parameters between groups, Mann Whitney test was
denture. Insertion of maxillary and mandibular used. Kruskal Wallis test followed by Mann Whitney
finished dentures. Post insertion instructions were test for pair wise comparisons was used to detect
given to the patient. significant difference between sites of adaptation
- Digital periapical X–ray film of the abutment measurements (guiding plates, minor connector and
teeth was taken immediately before, after 6 and 12 major connector). To detect differences in abutment
months of denture insertion. Abutment teeth mobility and bone loss between time intervals,
mobility was measured using periotest device at Wilcoxon signed ranks test was used. Mann Whitney
the time of denture insertion, after 6 and 12 test was used to compare abutment bone loss between
months of denture insertion. mesial and distal sites.

Conventional RPD framework construction:

Mandibular master cast was final surveyed, then
prepared. The modified master cast was duplicated to
produce refractory cast. The wax framework was
patterned on the refractory cast. The wax pattern was
invested, burned out and casted with chrome cobalt
alloy to produce the metallic framework.
The metallic framework was finished and polished,
then tried-in the patient mouth. Passivity was
measured in the same way as previously done with the
CAD-CAM framework. Record block was
constructed, jaw relationship was registered and the
casts were mounted on semi – adjustable articulator.
Figure 1. Digital surveying showing different color of undercut
Semi-anatomical acrylic teeth were arranged. and the final tilt.

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 Mansoura Journal of Dentistry 2017;4(14):6-13.

Results
A. Comparison of adaptation between groups (Group I
conventional R P D and group II CAD CAM R P D) and
between sites (guiding plate, minor connector, major
connector).
1. Adaptation of the RPD frameworks components to the
supporting structures in different groups
Table 1 represents Comparison of adaptation of RPD
framework to underlying supporting tissue between both
groups(Group I conventional R P D and group II CAD
CAM R P D) (Mann Whitney test at table rows); at
Figure 2. The virtual design. different measurement sites (guiding plate, minor
connector, major connector) .Kruskal Wallis test at table
columns represents comparison of adaptation at different
measurement sites within the same group.
Group I (conventional R P D) recorded higher statistical
significant gaps between RPD framework to underlying
supporting tissue than group II (CAD CAM R P D) gaps
between RPD framework to underlying supporting tissue in
all measurement sites as p<.05. In group I only there was a
significant difference in gap between sites as p<.05.
Highest statistical significant gap was present at the
major connector site (0.53±.27) (0.07±.04) for both groups
while the guiding plate represents the lowest gap for both
groups (0.14 ±.05) (0.03 ±.02).
Figure 3. The cobalt chromium disc and RPD after milling and 2. Percentage of contact
before cutting sprues. Table 2 represents comparison of percent (%) contact
between both groups (Group I conventional R P D and
group II CAD CAM R P D) (Mann Whitney test at table
rows) at different measurement sites (guiding plate, minor
connector, major connector) within the different groups
(Kruskal Wallis test at table columns represents comparison
of percent (%) contact at different sites within the same
group.
Group I (conventional R P D) recorded lower statistical
significant difference percent of contact than group II
(CAD CAM R P D) in all measurement sites as p<.05. In
group I only there was a significant difference in percent of
contact between sites as p<.05.
Lowest percent of contact was present at the major
connector site (2.32±.58) (10.30±6.22) for both
Figure 4. Digital image of Light body poly vinyl-siloxane impression groups(Group I conventional R P D and group II CAD
material. CAM R P D) while the guiding plate represents the highest
percent of contact for both groups (5.42 ±.75) (14.49
±9.47).
3.Visual scores
Table 3 represent comparison of visual scores between
both groups (Group I conventional R P D and group II
CAD CAM R P D). (Mann Whitney test at table rows) at
different measurement sites (guiding plate, minor
connector, major connector). (Kruskal Wallis test at table
columns represents comparison of visual scores at different
sites within the same group.
Group I (conventional R P D) recorded visual scores
with higher statistical significant difference than group II
(CAD CAM R P D) in all measurement sites as p<.05. In
group I only there was a significant difference in the visual
Figure 5. Measuring of the abutment tooth mobility by the periotest. scores between sites as p<.05.

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 Mansoura Journal of Dentistry 2017;4(14):6-13.

Highest visual scores was present at the major connector B. Comparison of abutment mobility between groups after
site (3±3) (2±2) for both groups while the guiding plate different time intervals
represents the lowest visual score for both groups (2 ±2) (1 Table 4 represents comparison of abutment mobility
±1). between both groups (Conventional and CAD CAM)(Mann
Whitney test at table rows) at different interval period
Table 1: Comparison of gap between RPD framework (Wilcoxon signed ranks test at table column).
components and supporting tissue between groups and There was no significant difference (p>0.05) between
measurement sites. group I (Conventionally RPDs) and group II (CAD/CAM
Mann RPDs) at both observation times (6 and 12 months)
Group I Group II regarding abutment teeth mobility. Abutment mobility after
Whitney
Guiding X 0.14 a X 0.03 a 12 months was significantly higher ((p<0.05) than mobility
0.008* after 6 months for group I i.e mobility increased with
plate SD ±0.05 SD ±0.02
Minor X 0.29a X 0.05a advance of time for group I only.
0.007*
connector SD ±0.16 SD ±0.03
C. Comparison of abutment bone loss between groups
Major X 0.53b X 0.07a
0.008* after different time intervals for different sites
connector SD ±0.27 SD ±0.04
(mesial/distal)
Kruskal Table 5 represents comparison of abutment bone loss
.015* .13
Wallis
X; mean. SD; standard deviation, * p value is significant at 5% level.
between both groups (Conventional and CAD CAM RPD)
Different letters in the same column indicate a significant difference (Mann Whitney test at table rows) and different interval
between each 2 sites of measurements (Mann Whitney, p<.05). period (Wilcoxon signed ranks test at table columns)
represents comparison of abutment bone loss at different
Table 2: Comparison of percent (%) of contact between groups sites (mesial/distal).
and measurement sites. There was a significant difference in abutment bone loss
Group I Group II Mann between groups at distal sites only as (p<0.05). Group I
Whitney (conventional R P D) recorded significant higher bone loss
Guiding X 5.42a X 14.49a .005* than group II at both observation times for distal sites only
plate as p<0.05. There was no significant difference in abutment
SD ±0.75 SD ±9.47
bone loss between observation times for both groups as
Minor X 3.58a X 12.84a .008*
p>0.05.
connector SD ±1.18 SD ±6.30
Major X 2.32b X 10.30a .006* Table 4: Comparison of abutment mobility between groups after
connector SD ±0.58 SD ±6.22 different observation times.
Kruskal .008* .40
Wallis Mann
X; mean. SD; standard deviation, * p value is significant at 5% level. Group I Group II
Whitney
Different letters in the same column indicate a significant difference
between each 2 sites of measurements (Mann Whitney, p<.05). 6 months after X 0.26 X 0.10
0.056*
insertion SD ±0.11 SD ±0.07
Table 3: Comparison of visual scores between groups and 12 months after X 0.36 X 0.10
measurement sites. 0.065*
insertion SD ±0.11 SD ±0.07
Group I Group II Mann Wilcoxon
Whitney signed ranks 0.048* 0.73
Guiding M 2a X 1a 0.023* test
plate SD 2 SD 1
X; mean. SD; standard deviation, * p value is significant at 5% level.
Max 2 2
Minor X 3b X 2b 0.033*
connector SD 2 SD 2
Max 3 Max 2
Major X 3b X 2b 0.032*
connector SD 3 SD 2
Max 3 Max 3
Kruskal 0.004* 0.009*
Wallis
M; mean, SD; standard deviation, max, maximum, * p value is significant
at 5% level. Different letters in the same column indicate a significant
difference between each 2 sites of measurements (Mann Whitney, p<.05)

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 Mansoura Journal of Dentistry 2017;4(14):6-13.
underlying supporting tissue in mm and lower percentage of
Table 5: Comparison of abutment bone resorption between groups contact than Group II (CAD/CAM fabricated metallic RPDs)
(Conventional and CAD CAM RPD) and measurement sites.
at different sites of measurements. These results were
supported by the significant higher visual scores of group I.
Group I Group II Mann
This may be attribute to that the CAD/ CAM technology
Whitney
allows the avoidance changes of the volume and shape of the
Mesial
prosthesis that is very common in conventional
6 months after X 0.18 X 0.04 0.12 manufacturing procedures. (3)
insertion SD ±0.08 SD ±0.01 The low fit of conventionally fabricated RPDs may be
12 months after X 0.19 X 0.04 0.13 attributed to several reasons; Firstly, errors in the wax
insertion SD ±0.08 SD ±0.00 blocking out and duplication by the agar-agar material that is
Wilcoxon signed 0.48 0.34 used in the traditional technique for the duplication process
ranks test which undergoes dimensional changes of syneresis and
Distal imbibition which may eventually adversely affect the
6 months after X 0.32 X 0.09 0.011* reproduction of the refractory cast.(4,5). Secondary, variability
insertion SD ±0.09 SD ±0.01 in expansion of the refractory material and the techniques
12 months after X 0.33 X 0.10 0.008* used for finishing and polishing of the metallic framework.
insertion ±0.08 ±0.01 In addition, the high linear solidification shrinkage of
SD SD
cobalt–chromium-based alloys (2.3%). (4,6,7)
Wilcoxon signed 0.47 0.87
The result of the present study is in agreement with
ranks test
X; mean. SD; standard deviation, * p value is significant at 5% level.
Vasantha Kumar et al., (8), who stated that, the reason for
more gaps in the conventional technique are due to lesser
Correlation between gap between different RPD capability of the molten metal in the refractory technique to
components and supporting tissue, bone loss and reproduce margins in the investment material mould cavity,
mobility which could increase marginal discrepancies. This
Table 6 represents the correlation between adaptation of assumption may be supported by the fact that the casting is
different RPD components and underlying supporting made over a duplicated cast, which is obtained with
tissue, and abutment mobility and crestal bone loss. There investment material having a more porous surface compared
was a significant positive correlation between adaptation, to dental stones. An impression material is also necessary for
and abutment mobility and crestal bone loss. When the gap the duplication process, which increases the risk of
increased in size, the abutment mobility and crestal bone distortions and inadequate detail reproduction. The agar
loss increased (p<0.012). impression material that is normally used for the duplication
process undergoes dimensional changes of syneresis and
Table 6: Correlation between gap between different RPD imbibition, which may eventually adversely affect the
components and supporting tissue, bone loss and mobility reproduction of the refractory cast. (9)
Furthermore; Fenlon et al., (10); Firtell et al., (11), stated
that the misfit between the RPD framework components and
Correlations
the supporting tissue reflects the dimensional inaccuracies
Gap Mobility Bone_Loss that occur during various stages (clinical and laboratory) of
Correlation
1.000 0.632** 0.762** framework construction. Brudvik and Reimers (5),
Coefficient
Gap
Sig. (2- mentioned that the misfit of the framework could by
. 0.003 0.000
tailed) observation of the spaces between the frameworks and the
Correlation
Spearman's Coefficient
0.632** 1.000 0.558* teeth, either on the cast or in the mouth. These spaces could
rho Mobility have occurred as a result of either abrasion of the stone casts,
Sig. (2-
0.003 . 0.011
tailed) the loss of metal during finishing and polishing procedures
Correlation
0.762** 0.558* 1.000 or the distortion of the frameworks.
Coefficient
Bone_Loss
Sig. (2-
0.000 0.011 .
Abduo et al., (12); Rekow et al., (13), reported that the
tailed) accuracy of CAD/CAM system milling is shown to be within
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed). 10 µm. CAD software allows continuous control of
individual elements of the prosthesis, and hence the control
of the implementation of planned mechanical parameters,
Discussion: and at the same time designing of minimally visible
attaching elements. Then, using the CAM, it is possible to
The fit of CAD/CAM RPDs was judged to be excellent. The precisely produce the whole prosthesis with an accuracy of
ending product of the present method is a precisely well- up to 0.1 mm. (14) Therefore, it is reasonable to have a more
fitted RPD framework. Although considerable time was accurate fit with the CAD/CAM RPDs because there was no
involved in producing a framework by this method, making duplication of the master cast, and the virtual design was
the CAD/CAM method competitive with existing carried out directly to the desired position on the scanned
conventional techniques. master cast and metallic RPDs milled directly from the
Group I (conventionally fabricated metallic RPDs) metallic disc without any laboratory procedure. It is a
recorded significant gaps size between RPD framework and generally accepted with Vasantha Kumar et al., (8), who
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 Mansoura Journal of Dentistry 2017;4(14):6-13.
stated that the fact that more extensive steps during the teeth specifically at the distal side. The authors agree that
framework manufacturing, greater the chance for distortion rigidity of major connectors and maximum coverage of
despite improvements in laboratory procedures. The denture-bearing areas with denture bases are of great
expansion of the refractory investment may have not importance in reducing stresses on abutment teeth. (17)
compensated adequately for solidification and cooling As there was a significant difference in abutment crestal
contraction of the cobalt chromium alloy. (9) bone loss between observations times i.e abutment crestal
Also, there are other factors which may affect the bone loss increased with advance of time, which indicate the
accuracy of milling such as, the scanning precision, the accumulative hazardous effect of the less fit conventionally
method used to transform the data into a 3D model, the fabricated RPD frameworks.
numerical control program, and the level of accuracy that There was a significant difference in abutment bone loss
can be achieved by the milling machine which may also between groups at distal sites only; as group I recorded
influence the adaptation of resulted framework. (1) significant higher bone loss than group II at both observation
Arnold et al., (1), stated that well-fitting RPDs can be times for distal sites only. This can be explained by the less
accurately manufactured with CAD-CAM techniques. In fit of the conventionally fabricated RPDs and the high
comparison with the lost wax technique method, the direct degree of the abutments mobility.
CAD-CAM milling process showed a significantly better fit. Aviv et al., (18), stated that the increase tissue-word
In addition, this result is in agreement with Bibb et al., (15), movement of the denture base under functional loading as a
who found that the metallic RPD frameworks fabricated by result of rotational movement of the denture base along the
the subtractive methods were clinically verified and found to fulcrum axis causing resorption of supporting alveolar bone
be acceptable and a satisfactory fit. of both ridge and abutment teeth.
It was found that, Major connector recorded the highest Igarashi et al., (19), stated that the rotary movement not only
gap and lowest percent of contact between framework and lowers the denture function and causes the patient
supporting tissue, while guiding plate recorded the lowest discomfort but also traumatizes the supporting tissues of
gap and highest percent of contact between framework and dentures.
supporting tissue. This is may be attributed to the The results of this study showed that the alveolar bone
dimensional changes of casting which vary between different resorption in the distal side of the principle abutments were
areas of the casting due to excessive shrinkage of the alloy at higher than the mesial sides in both groups. This may be due
area greater than other sites, as the lingual bar is greater in to that the alveolar bone resorption occurs as a result of
thickness and length than the guiding plate and minor torquing forces that affect the distal abutments. In Distal
connector. (9) This is agreed with Vasantha Kumar et al., (8), extension removable partial denture, the excessive torquing
who mentioned that there is more shrinkage in the zone of forces that may act on the abutments distally towards the
the bulky parts compared with the remainder thinner parts. edentulous area, by time lead to distal wall resorption and
An actual contact between the guiding plane surface of a tooth movement. (20)
prepared abutment tooth and the minor connector of the RPD The results of this study is in accordance with Malara et
casting can be expected to aid in the retention of the partial al., (3), concluded that the produced prosthesis adheres tightly
denture. Control of a number of laboratory procedures is to the tissue improving its stability, retention and uniformly
essential to obtain this level of contact. (5) transferring loads on the tissue, causing less interference in
Brudvik (5), stated that during finishing of the metallic the oral mucosa with less bone resorption.
RPD framework, the range of total loss values obtained The result showed that, there is a direct correlation
(0.042 mm to 0.410 mm) was considerable, as might be between the gap (between RPD components and supporting
expected from the amount of hand work involved. These tissue), mobility and bone loss. This is may be due to less
values may be considered to represent the minimum loss of fitting of the prosthesis may cause mechanical failures of the
metal that would occur in a clinical situation because they prosthesis, or biologic complications of the surrounding
were obtained with care in a controlled environment. Lanier tissue. (5)
et al., (16), concluded that the fit of the chrome-based alloys From biomechanical aspects of RPD design, bilateral or
used for RPDs may be compromised by poor mouth unilateral distal extensiosn RPDs share their support between
preparation, inaccurate master casts, errors in blockout and the abutment teeth and the edentulous ridge with increase in
duplication, difficulty in obtaining sufficient expansion of the stress concentration on the abutment teeth.(17) So that the
the refractory, and the techniques used in fitting and fitting discrepancies magnify the stresses applied on the
finishing the metal framework. abutment teeth and stresses from the rotation of the RPD
The degree of abutment teeth of distal extension resulting in increase of the bone resorption which may lead
removable partial dentures showed a significant difference in to the abutment mobility.
abutment crestal bone loss between groups. This may be
attributed to the high stress transmitted by the conventionally Conclusion
manufactured RPDs to the abutment’s supporting bone. This
results was confirmed by the low fit of conventionally Within the limitations of this study, it can be concluded that
fabricated RPD frameworks in comparison to CAD/CAM  CAD/ CAM RPD frameworks recorded
RPDs; as the less the accuracy of fit of the RPD with more significantly higher fit than traditionally fabricated
stress transmitted to the supporting tissues. RPD frameworks.
The differences in the resilience between the supporting
elements have effects on the forces exerted on the abutment
12 El-Khamisy NE
 Mansoura Journal of Dentistry 2017;4(14):6-13.

 The lingual bar major connector showed 8. Vasantha Kumar M, Murugesan K, Swathi N,
significantly higher gap than other RPD Aparna. The accuracy of fit of cast clasps designed
framework components for both groups with conventional wax pattern and light cured
(conventional and CAD-CAM). patterns-A comparative in vitro study 2010;1(1):10-
 CAD/ CAM RPDs showed less abutment teeth 13.
mobility and lower bone loss than conventionally 9. Phillips R W. Skinner’s science of dental materials.
fabricated RPDs. WB Saunders Co., Philadelphia. 1991. Pp 385-
392.
Recommendations
10. Fenlon MR, Juszczyk AS, Hughes RJ, Walter JD,
- Adequate oral hygiene instructions, careful Sherriff M. Accuracy of fit of cobalt–chromium
prosthetic treatment planning and regular recall removable partial denture frameworks on master
appointments play an important role in preventing casts. Eur J Prosthodont Restor Dent 1993;1:127-
changes in abutment tooth mobility caused by 30.
removable partial denture placement. 11. Fritell DN, Muncheryan AM, Green AJ.
- Current innovations and developments in dental Laboratory Accuracy in Casting Removable Partial
technology allow the fabrication of removal Denture Frameworks. J Prosthet Dent
dentures using CAD/CAM technologies from start 1985;54(6):856-62.
to finish, thus decreasing the chair side and
working time for patients and dentists and 12. Abduo J, Lyons K, Bennamoun M. Trends in
providing superior or satisfactory functional and computer-aided manufacturing in prosthodontics: a
esthetic outcomes. review of the available streams. Int J Dent 2014;
volume 2014 Article ID 783948:15 pages.
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13 El-Khamisy NE

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