EPA 4C: Partial Edentulous Removable Partial Denture

Tooth Modifications

• Appropriate location and dimensions of modifications with adequate occlusal clearance
• Guiding surfaces parallel to path of insertion
• All modifications completed per approved design. Modified surface has a smooth polish
• No residual caries/ defective restorations/ missing survey crowns

• Slight deviation in location and dimensions with modifications limited to enamel
• Modified surface lacks finish

• Significant deviation in location. Over preparation extending to the DEJ or under preparation 0.5 - 1mm depth
• Inadequate occlusal clearance corrected by minor opposing enameloplasty
• Surface decidedly rough or pitted

• Gross deviation in location and extensions: overpreparation into dentin (restoration) or under preparation compromising framework integrity (< 0.5mm depth)
• Inadequate occlusal clearance that causes increase in VDO
• Missing modifications or no uniform path of insertion
• Surface deeply pitted or grooved
• Presence of residual caries/ defective restorations/ missing survey crowns

Impressions

• All critical landmarks captured: impression free of voids/ distortion/ burn through
• Borders properly extended: the material should extend to the depth of the vestibule without displacing tissues
• Appropriate impression materials and tray selection
• Adequate opposing arch record

• Minor voids/ distortion/ burn through in non-critical areas
• Borders overextension can be corrected with altered cast impression

• Major voids/ distortion/ burn through in non-critical areas

• Inadequate capture of critical landmarks or voids/ distortion in critical areas
• Border grossly over/ underextended
• Inappropriate impression material or tray selection
• Inadequate/ missing opposing arch impression

Framework Try-in

• Stable, complete seating of framework
• Occlusal contacts based on planned occlusal scheme maintained/ established
• Adjusted surface of framework polished

• Framework causes minor hyper occlusion: opposing minor enameloplasty without appropriate diagnosis
• Adjusted surface of framework lacks finish

• Framework causes hyper occlusion: opposing moderate enameloplasty without appropriate identification /diagnosis
• Adjusted surface of framework pitted/ grooved

• Unstable, incomplete seating of framework without identifying and planning a remake
• Framework causes severe hyper occlusion without appropriate identification /diagnosis
• Adjusted surface of framework deeply pitted or grooved

MMR / Tooth Try-In

Rims or try-in adjusted to establish the following records:

• correct centric relation
• appropriate vertical dimension of occlusion (VDO)
• Sufficient soft tissue support
• Appropriate esthetic evaluation
• Ideal phonetics: Clear speech
• Rims or try-in stable and bonded
• Occlusal contacts established based on planned occlusal scheme

Rims or try-in adjusted for the following records:

• Centric relation and VDO is close but may be slightly off and can be corrected at a subsequent step
• Soft tissue support slightly excessive/ inadequate but can be corrected at an appropriate step
• Esthetics slightly off but within acceptable range
• Speech slightly unclear but within acceptable range
• Some occlusal contacts are missing but can be adjusted chairside or learner requested for lab correction

Rims or try-in adjusted for the following records:

• Centric relation or VDO is incorrect. Learner able to evaluate but could not address
• Inadequate/ excess soft tissue support. Learner able to evaluate but could not address
• Esthetics not ideal. Learner able to evaluate but could not address
• Difficulty with speech. Learner able to evaluate but could not address
• Occlusal scheme or contacts not ideal. Learner able to evaluate but could not address

Rims or try-in adjusted for the following records:

• Centric relation or VDO is grossly incorrect. Learner unable to evaluate
• Grossly inadequate/ excess soft tissue support. Learner unable to evaluate and address
• Smile display unacceptable. Learner unable to evaluate and address
• Pronounced difficulty with speech due to inappropriate rim/ tooth position. Learner unable to evaluate and address
• Inability to evaluate rims/try-in or make records due to instability or debonding.
• Occlusal scheme not ideal: Inadequate occlusal contacts or gross premature interferences in centric and excursive movements

Insertion / Post-insertion

• Prosthesis is fully seated.
• Intaglio evaluated and adjusted for pressure spots/ prosthesis extension
• Occlusal scheme is ideal and occlusion is appropriately equilibrated
• Adjusted surfaces of prosthesis polished
• Home-care instructions discussed
• Patient indicates comfort, can insert and remove prosthesis
• Centric relation, vertical dimension of occlusion (VDO), Esthetics, and Phonetics are appropriate and acceptable

• Small interference or undercut remains, but able to seat
• Mild pressure spots/ prosthesis extensions remain that can be corrected at the following appointment
• Some contacts missing, but bilateral contacts exist
• Adjusted surfaces of prosthesis lacks finish
• Centric relation, vertical dimension of occlusion (VDO), Esthetics, and Phonetics, are within acceptable range

• Issues with seating of prosthesis/ prosthesis extension/ occlusion beyond clinical acceptable range or presence of pressure spots. Learner able to evaluate but could not address
• Quality of prosthesis (CR/ VDO/ Esthetics/ Phonetics) beyond clinical acceptable range. Learner able to evaluate but could not address
• Adjusted surfaces of prosthesis rough

• Gross issues with seating of prosthesis/ prosthesis extension/ Presence of pressure spots. Learner unable to evaluate and address Occlusal scheme not ideal: Inadequate occlusal contacts or gross premature interferences in centric and excursive movements
• Adjusted surfaces of prosthesis deeply pitted or rough
• Failure to provide home-care instructions
• Failure to address patient’s discomfort or inability to seat/remove prosthesis
• Unacceptable quality of prosthesis (CR/ VDO/ Esthetics/ Phonetics). Learner unable to evaluate and address

Implant assisted RPD Insertion

• Abutment correctly selected
• Abutment seated completely and torqued to manufacturer’s recommendation
• Intaglio adequately adjusted to create clearance for locator pick up
• Abutment pick up completed using spacers and appropriate pick-up material.
• Excess flash removed and surface finished and polished
• Housing stable within the denture. Appropriate insert placed based on patient dexterity

• Slight deviation in abutment height selection
• Slight deviation in intaglio clearance
• Intaglio surface lacks finish
• Patient is unable to remove prosthesis or finds it loose: learner can identify issue with retention insert selection

• Excess clearance created for abutment pick up
• Intaglio surface decidedly rough
• Patient is unable to remove prosthesis or finds it loose: learner is unable to identify issue with retention insert selection

• Excessive height of abutment that violates minimum denture thickness (<2mm)
• Abutments are incorrectly seated. Excess or inadequate torque applied.
• Incompatible prosthetic components used.
• Gross adjustment of intaglio compromising denture integrity
• Inappropriate pick-up material used. denture locked intra-orally due to missing spacers
• Intaglio surface deeply pitted or rough
• Housings do not engage/ prosthesis does not seat completely or is unstable post pick up