KENNEDYCLASS IV

Definition
- Edentulous area located anterior to the remaining natural teeth Crossing or Reaching the midline
- it has no modification (if another span presents the anterior will be the mod.)
Causes:
1 Trauma for boys usually, while games playing accident.
2 Caries may cause the early extraction in adolescence.

Class IV design is classified according to age

A - for children ( young age)

In case of missing one to two teeth, RPD is the indicated treatment rather than FPD in young age
( under 12 years) because of :
a- incomplete Apexification .
b- incomplete crown eruption
c- large pulp size & high pulp horns (reduction may cause exposure)
d- to allow for growth of the jaw .
NB. Not to leave the case unrestored as the neighboring may occupy the space (the RPD will act
as a space maintainer.
- After full growth and teeth formation this denture is replaced by suitable appliance.

Suitable designs for young patient

1 - Mucosal born denture:

- Large area of the palate and gingival margin of the standing teeth will be covered,
- The gingival margin must be relived,
- No clasps, to allow growth of the jaw
- Retention comes from :a- Friction fit between natural and artificial teeth
b- Festooning of the denture base,
c- Adhesion & cohesion
d- extension of the denture to the junction of hard and soft palate
e- tongue action to hold the denture against vertical displacement.
Support : achieved by the large palate covered.

Bracing : achieved by lateral slop of the palate.

Disadvantage:
1 covering the FGM causing gingivitis.
2 - food particles accumulation causing caries.- Single saddle lies entirely anterior to the
abutments (crossing the midline).

2 - Spoon denture design:

- denture covering large area of palate and extend to the PPS area.
- constricted anteriorly and widened posteriorly
- denture peripheries kept 3-4 mm clear of gingival margin (self cleansing
area).

Prognosis of spoon denture

(indication & factors of success)
1 Better in short spans not more than two teeth.
2 Usually indicated for children due to their quick adaptation. not widely accepted by adult.
3 Normal firm fibrous sub mucosa provides best retention as:
- very thin mucosa decrease physical retention
- very thick mucosa provides no seal compression.
4 Calm patient is indicated because nervous excursive movement lead to instable denture.
5 V- shape hard palate is better than the flat one , because v-shape resisted lateral .
movement of the denture.
5 - Anterior flange of the denture will stabilize the denture against backward/ vertical
replacement.
6 - Normal saliva is indicated to aid in physical relation.
- Watery saliva: poor cohesion
- Thick saliva: denture displacement (interfere with seating)
7 Occlusion :
- Traumatic vertical overlap : no adequate thickness of the acrylic base (metal base needed)
- Deep overbite will increase the stress applied to the denture during incising so cause denture
displacement.
8 Friction fit between and saddle and abutment must be high t increase retention of the
denture.

Advantage of this design:

- Uncovered gingival margins, no food accumulation, gingivitis and caries are not caused.
Allow normal growth of the jaw .
No surveying need ( no obliteration of palate undercuts)
- Simple design of low cost.
- Less technical and chairside time required.

Disadvantage :
1 - Poor retention.
- depends on adhesion and the action of dorsum of the tongue.
- Posterior extension? to the junction of the soft and hard palates is essential
Since 1adhesion is directly proportional to the area covered, and it 2helps the action of
the tongue against the posterior part of the base to stabilize the denture against vertical
displacement.
2 - Displaced during incision. Incision should be on both natural & artificial teeth to avoid this.
3 - Liability to be swallowed, inhaled (Air way obstruction).

NB. Any totally acrylic small, poorly retentive appliance must have a radio-opaque factor in the
mixture of the resin.

Modifications of spoon denture:

When adequate retention or stability are doubtful, the following
modifications may be considered:

1 - The first modification:

Extensions of the palatal plate are brought into contact with
the first permanent molars with Adam crib :.
(Adams Clasp)
- constructed in 0, 7 mm stainless steel wire.
- provides a contact point retention in the buccal embrasures.
- The buccal arm extending clear of the buccal surface of the teeth ,reduce the buccal caries risk
Advantages: better retention (adding mechanical retention)
Indication: when there is a space for the wrought wire between opposing arch without
interfering the occlusion . grind the enamel in adult to accommodate the clasp arms.

2 - The second modification:

- The T- shaped chrome-cobalt denture

- made with close occlusal contacts in the molar region, retentive clasp arms extend around the
distal aspect of the last molars.

3 The Third modification:

- With close relation between incisal edge of the lower incisors and the
hard palate, the use of a spoon denture with casted chrome cobalt base
may be necessary with some grinding from the lower teeth.
- Also horse shoe stainless steel denture base can be used but it may be
intolerable for its bad taste.
- Teeth can be attached to theses metallic bases either by resin or by the metal packing with
colored restorative material.

B For Adult patient

A - Short span Saddles
- More than 2 teeth not reach to premolar

1 Implant
2 - Fixed bridge :
will be the best but RPD is constructed if the bridge is contra indicated as follow:
a- severe ridge resorption may necessitate addition for anterior flange.
b- condition of the abutment are not suitable for support the bridge.
c- patient refusing preparation for natural teeth

3 Resin Bonded bridge

Like Maryland bridge which has lingual extensions bonded to unprepared / minimally prepared
lingual surface of the abutment teeth .

4 - RPD

A - Skeleton Denture with

Posterior Clasping
Indications :
- anterior teeth not suitable for clasping
- esthetic reasons
- patient having heavy biting forces (posterior clasps increase retention)
- edentulous area more than 2 teeth.

Design:
- Two palatal bars, arising from the saddle, placed on the lateral walls of the palate
equidistant between the gingival margins and the
midline. No necessity for a posterior palatal connecting bar
- Their distal ends attaching the clasps, usually two on each
side.
- Rest seats are always prepared in the abutment teeth if they are
central incisors or canines.

NB. Lateral incisors must be accurately evaluated before being rested.

Mechanical considerations of the design:

- Retention during incision should be considered
1 - Functional seating vertical force:
- a displacing rotation tends to take place, its axis a line between the cingulae of the
abutment teeth on which the saddle is supported.
- This force magnitude depends on the distance between this axis and the most anterior
artificial tooth,
- Effective magnitude depends on the nature of the mucosa; the more compressible is this
tissue, the less resistance to the displacement.
- Weight of the appliance also may cause vertical displacement of the saddle.
2 Tissue away forces :
- In case of absence of anterior retentive components (next to the saddle) or in long span saddles
- resisted by the posterior rests (Indirect retainer)

These rotations are resisted by:

1 - Posteriorly placed clasping to the rotatory axis. The more posteriorly the clasping is placed
the greater is the retention.
2 - Engage into a soft tissue undercut with the labial flange of the denture.
3 - Occlusal rest bilaterally on the distal aspect of the most posterior molars together
with more anteriorly placed clasping if possible.

B- Metallic RPD with MD Clasping

- use of esthetic clasps which engage the proximal undercuts of anterior remaining teeth
- indicated with short spans and presence of canines in good condition with well developed ridge.

B - Long span Class IV Saddles

- If the premolars require replacement on one or both sides.
- seen only in adults.
- Usually the periodontal condition of the remaining teeth is good and varying degrees of
displaceability are found in the mucosa that covers the ridge.
- This type of denture presents a similar problem to that found in Class I dentures.
- The saddle has the feature of the free-end saddle in that its most remote part from the teeth is
tissue supported.

The solution to the problem:

1 - The hard palate is covered anterior to the fulcrum line?
between the abutments of each side, to resist sinking of the
denture, and provide retention by adhesion

2 - Multiple clasping of the multi rooted molars? This acts as

a splint to the remaining teeth and distributes any torque action.

3 - Indirect retention by posterior extension over the hard palate plus posterior resting
Since the premolars are used in the mastication of sticky foods and a displacement of the
saddle away from the ridge. (the most posterior rest is the IR)

4 - Frequent inspection for resorption and relining id essential to prevent further

movements and damaging the teeth and food accumulation.

Class IV lower denture

- Usually due to periodontal disease
- Alveolar bone is of negative index.
- Total tooth support is needed
- splinting the teeth with continuous clasps may be designed
- placing of principle rests more mesially (mesial on premolar or even
on canine if suitable), increase the efficiency of the posterior
clasping.
- Major connector is usually lingual bar as shown in this figure.