I.T.

S DENTAL COLLEGE, MURADNAGAR

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

RETENTION, STABILITY AND SUPPORT

IN COMPLETE DENTURE
CONTENTS

1. Introduction
2. Retention
3. A brief history
4. Factors affecting retention
5. Clinical evaluation of retention
6. Stability
7. Support
8. Conclusion
9. References
INTRODUCTION

• The recognition, understanding and incorporation of certain mechanical,

biological, and physical factors are necessary to ensure optimal function of
complete denture treatment.

• These factor are the determinants that promote the properties of :

• Retention,
• Stability,
• Support in the finished prosthesis.
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RETENTION

• ACCORDING TO GPT 8 :
It is defined as “ that quality inherent in the prosthesis which resist the force
of gravity, adhesiveness of foods, and the forces associated with the opening
of the jaws.”

• ACCORDING TO THE BOUCHER :

Retention is the ability of the denture to withstand displacement against its
path of insertion.
• Numerous contradictory and controversial techniques have been
proposed and documented to achieve optimal denture retention.

• Bohannan appropriately noted that “techniques itself is merely the

practical application of principles, and if the principles are unsound,
the most elaborate and painstaking technique is doomed to failure”.
• Therefore, it is necessary to understand each property and its
contributing factors separately and to recognize their interaction to be
able to critically analyze and select procedure and technique that can
lead to successful fabrication of the prosthesis.
CONCEPT OF DENTURE RETENTION :
A BRIEF HISTORY

• Fish(1949) was among the first to discuss the determinants of

retention and differentiate between the tissue, polished and occlusal
surface of a complete denture.

• The proper design of the tissue polished and occlusal surface permits
dentist to incorporate the mechanical, biological and physical factors
of retention.
• Craddock (1951) describes the gripping action of the buccinators
muscle on the buccal flange of a mandibular complete denture.

• Lundquist agreed to the finding of Craddock through

electromyographic study an published an article “electromyographic
analysis of the function of the buccinator muscle on denture retention”
in 1959.
• Schlosser and fish(1957) proposed that balanced occlusion is critical
in promoting complete denture retention.

• Their study was supported by Schiesser (1964) and agreed that a

denture will have maximum retention when the teeth are arranged in
neutral zone.
FACTORS AFFECTING RETENTION

• A number of factors combine to retain complete denture in position.

• Not all the factors acts simultaneously, instead, some act only when
there is certain dislodging force acting onto the denture.
 ANATOMICAL

MUSCULAR PHYSICAL

MECHANICAL PHYSIOLOGICAL
ANATOMICAL FACTORS

i. Size of the denture-bearing area:

Retention increases with increase in the size of the denture-bearing area.
The average size of the maxillary denture-bearing area is around 24 cm2
and that of the mandibular denture-bearing area is around 14 cm2.
(A) Maxillary edentulous ridge and (B) mandibular edentulous
ridge. Both ridges are well formed but size of denture-bearing
area is smaller in the lower jaw.
ii. Quality of the denture bearing area
The displaceability of the tissues affects the retention of the denture.
Tissues displaced during impression making will rebound during
function and lead to loss of retention.
PHYSIOLOGICAL FACTORS

• SALIVA:
1. The viscosity of saliva determines retention.
2. An adhesive is more effective when the contact angle between the
adhesive and the substrate is low i.e. it has got better wettability.
3. Saliva acts as an adhesive between the denture base and mucosa.
• Thick and ropy saliva adheres well to both the denture base and
mucosa but it gets accumulated between the tissue surface of the
denture and the mucosa thereby leading to decrease in flow
property.
• When dislodging forces are applied there is discontinuities in the
salivary film due to lack of flow leading to loss of retention.
• Another disadvantage with thick and ropy saliva is, they have many
air bubbles incorporated in them which enlarges in size when
dislodging forces act.
• Thin and watery saliva can also lead to compromised retention
because of decrease in physical properties like surface tension and
cohesion.
• Mixture of serous and mucinous saliva is ideal for retention.
PHYSICAL FACTORS

INTERFACIAL
ADHESION COHESION SURFACE
TENSION

ATMOSPHERIC PERIPHERAL
CAPILLARITY
PRESSURE SEAL
ADHESION

• Adhesion is defined as the physical attraction of unlike molecules to

one another.
• Saliva is present in between the denture base and the mucosa, and its
contact with both these surfaces creates adhesion.
• It is achieved by ionic forces between the salivary glycoproteins and
surface epithelium or acrylic resin.
• It depends on:
1. Close adaptation of denture.
2. Size of denture-bearing area.
3. Type of saliva.
• Adhesion also takes place directly between the denture base and
mucosa in case of xerostomia (lack of saliva), but this leads to
ulcerations and abrasions in the mucosa.
COHESION

• Cohesion is defined as the physical attraction of like molecules to one

another.
• Occurs within the film of saliva and aids in retention.
• As viscosity of saliva increases, greater is the cohesion but very thick,
mucous saliva can physically push the denture out, resulting in loss of
retention.
INTERFACIAL SURFACE TENSION

• Interfacial surface tension is defined as the tension or resistance to

separation possessed by a film of liquid between two well adapted
parallel surfaces.
• It is dependent on the ability of the liquid to ‘wet’ the surfaces. The
‘wettability’ of the fluid is inversely proportional to the surface tension
of the surfaces.
Interfacial surface tension acts only when the two glass plates are pulled apart. The cohesive
forces between the molecules of the liquid, (intermolecular attraction) and the adhesive
forces between the plate and the liquid will result in preventing the plates to move away from
each other forming a concave meniscus.
• Interfacial surface tension is also dependent on existence of a liquid/air
interface at the boundary of the liquid/solid contact.
• If two plates with a fluid between them are immersed in the same
fluid, then there is no interfacial surface tension and they can be
separated easily.
• The external boundary of the mandibular denture is always filled
(immersed) in saliva, thereby reducing the surface tension effect.
• Hence, interfacial surface tension plays a significant role in retention
of only the maxillary denture.
• The interfacial surface tension can be calculated by Stephan’s
formula:

• Where F is surface tension, k is viscosity of liquid, r is radius of the

contacting surfaces, v is velocity of force, h is the space between
the surfaces.
• Thus, to obtain maximum interfacial surface tension:
1. Saliva should be thin and even.
2. Perfect adaptation should be present between the tissues and
the denture base.
3. The denture base should cover a large area.
4. There should be good cohesive and adhesive forces.
CAPILLARITY

• That quality or state, which because of surface tension causes

elevation or depression of the surface of a liquid that is in contact with
a solid.
• Capillarity causes the thin film of saliva to rise and increase its contact
with the denture base and the mucosa.
• Close adaptation of the denture base to mucosa is important for
capillarity to provide effective retention.
ATMOSPHERIC PRESSURE

• This can help resist dislodging forces if the dentures have an effective
border seal. Peripheral seal or border seal is defined as the contact of
the denture border with the underlying or adjacent tissues to prevent
the passage of air or other substances (GPT8).
• When a force is exerted perpendicular to and away from the basal seat
of a denture which is properly extended and fully seated, pressure
between the prosthesis and mucosa drops below the ambient pressure,
resisting displacement. This has been previously referred to as
‘suction’.
• Retention due to atmospheric pressure is proportional to the denture
base area.

When dislodging forces act on a properly extended

denture, pressure between the prosthesis and mucosa
drops, contributing to retention.
MECHANICAL FACTORS

• It includes:
1. Undercuts
2. Retentive springs
3. Magnetic forces
4. Denture adhesives
5. Suction chambers and discs
UNDERCUTS

• Moderate undercuts enhance retention because of the resiliency of

mucosa. Examples are unilateral tuberosity undercuts, undercuts in
maxillary premolar area, distolingual areas and lingual to the midline
of mandible.
• Severe undercuts covered with thin mucosa compromise retention and
need to be surgically eliminated. Undercuts like those present in the
retromolar areas and maxillary anterior ridge allow insertion of
denture with a rotational path with the undercut area seated first.
• They provide good resistance to displacement in a vertical direction.
RETENTIVE SPRINGS

• Made of coiled stainless steel or gold-plated base metal. Their ends

attached to swivels in the premolar areas on both sides of the upper
and lower dentures.
• As soon as they are released the dentures are forced apart by the action
of the springs and held in place.
• DISADVANTAGES:
1. Constant pressure causes excessive
resorption.
2. The inner surfaces of the cheeks
frequently become sore from frictional
contact with the springs.
3. Lateral movements of mandible
restricted and hence efficiency of the
dentures is impaired.
4. Unhygienic.
MAGNETIC FORCES

• Intramucosal magnets aids in increasing retention of highly resorbed

ridges.
• In 1979, Moghadam et al – described a simple technique for use of
magnets in overdentures.
• Use of small steel magnets beneath the molar and premolar teeth have
been advocated.
 DENTURE ADHESIVES

• Denture adhesive refers to nontoxic, soluble material (powder, liquid,

cream) that is applied to the tissue surface of the denture.
• They contain hydrophilic polymers which on contact with the saliva ,
these polymers absorb water and swells.
• Therefore, Eliminating voids between the denture base and its basal seat.
• Increasing the adhesive and cohesive properties and viscosity of the
saliva.
SUCTION CHAMBERS AND SUCTION DISC

• These have been used to create a negative pressure in the palatal

surface of the maxillary denture, thereby enhancing retention.
• They are best avoided due to their potential to cause papillary
hyperplasia.
MUSCULAR FACTORS

• Brill et al demonstrated that “it is muscular control that enables patient

to function with dentures that rest on basal seat that have undergone
resorptive changes and no longer relate to the intaglio of the denture.”

Teeth must be positioned in the ‘neutral zone’

between the tongue and cheeks.
1. The muscles apply supplementary retentive forces on the denture .
This is especially true for lower denture There should be a balance
between the forces acting from the buccal musculature and tongue.
This balance is obtained in the neutral zone.
2. Hence artificial teeth should be arranged in the neutral zone to
achieve the best retention possible.
TONGUE FACTOR

1. Tongue also aids in retaining the lower

denture if the lingual border of the denture
is extended underneath the Tongue parallel
to the mylohyoid ridge.

2. Tongue also aids in retention of maxillary

denture when patient tries to bite from his
anterior teeth, in such a situation anterior
part of the tongue raises and support the
posterior part of the upper denture to
prevent the posterior palatal seal to break.
Clinical Evaluation Of Retention

Maxillary denture

Denture is grasped by
the incisors and pulled
downward between Placing fingers on the
thumb and forefinger palatal surface and pulling
forward

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 Mandibular dentures

The retention of the lower denture is

assessed by gently pushing
posteriorly against the facial
surfaces of the mandibular incisors.
The denture should not be
dislodged.
STABILITY

• It is defined as “ the quality of a denture to be firm, steady or constant

to resist displacement by functional stresses and not to be subject to
change of position when the forces are applied.”
• It is the ability to withstand horizontal forces.
FACTORS AFFECTING STABILITY

1. VERTICAL HEIGHT OF THE RESIDUAL RIDGE

Large, broad, square ridges offer a greater resistance to lateral forces than do
small, narrow, tapered ridges.
2. QUALITY OF SOFT TISSUE COVERING THE RIDGE

• The ridge should provide a firm base of soft tissue with adequate
submucosa to offer good stability.
• Flabby ridge with excessive submucosa offer poor stability.
3. Relationship Of The External Surfaces And Periphery To The
Surrounding Oro-facial Musculature.

Lingual surfaces of the

Buccal flange of lingual flange should
maxillary denture Buccal flanges
of mandibular slope towards the centre
should slope up and should slope of the mouth so that the
out from the occlusal down and out. tongue can fit against
surface of the teeth. them and perfect the
border seal in lingual
side of the denture.
When buccinator muscle
contracts it will tend to
retain dentures.
INFLUENCE OF ORO-FACIAL MUSCULATURE

• The basic geometric design of denture bases should

be triangular.

•Maxillary buccal flange: laterally and superiorly

•Mandibular buccal flange: laterally and inferiorly

•Lingual flange: medially and inferiorly

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• The buccinator muscle may be divided in to superior, middle, and
inferior divisions.

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 According to Fish,

The inferior fibres

Superior fibers acts Middle fibres contributes to
to seat the maxillary controls the bolus of mandibular denture
denture. food. stability.

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• While the middle fibres contract, controlling the bolus, the inferior
fibres relax to form a pouch capable of storing food until needed to
form another bolus.

• Extension of a concave denture base into this pouch allows the cheek
to lie over the flange.

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4. OCCLUSAL PLANE
• The occlusal plane should be oriented parallel to the ridge.
• If the occlusal plane is inclined, then the sliding forces may act on the
denture, reducing the stability.
• The occlusal plane should divide the interarch space equally.
5. RELATIONSHIP OF THE OPPOSING OCCLUSAL SURFACES
• Denture should be free of interferences – within functional range of
movements of patients.
• Premature contacts causes uneven stresses.
• Bilateral balanced occlusion enhances the stability of the denture.
SUPPORT

• It is defined as “ the resistance to vertical forces of mastication,

occlusal forces and other forces applied in the direction towards
the denture bearing area.”
• In order to provide good support, the denture base should cover
as much denture bearing area as possible.
• This helps to distribute forces over a wide area and this ability is
known as “ SNOWSHOE EFFECT”.
• Thus, force per unit area is reduced.
CONCLUSION

1. Retention, stability and support are the key determinants of complete

denture success.
2. They depend on accurate impression, proper border seal, correct
occlusion, and healthy denture bearing tissues.
3. These factors are interrelated and must work in harmony for long
term comfort and function.
 REFERANCES
1. Boucher CO, Hickey JC, Zarb GA, Bolender CL. Boucher’s prosthodontic treatment
for edentulous patients. 12th ed. St. Louis: Mosby; 2004.
2. Sharry JJ. Complete denture prosthodontics. 4th ed. New York: McGraw-Hill; 1980.
3. Heartwell CM Jr, Rahn AO. Syllabus of complete dentures. 4th ed. Philadelphia:
Lea & Febiger; 1986.
4. Jacobson TE, Krol AJ. A contemporary review of the factors involved in complete
denture retention, stability, and support. Part I: Retention. J Prosthet Dent.
1983;49(1):5–15.
5. Jacobson TE, Krol AJ. A contemporary review of the factors involved in complete
denture retention, stability, and support. Part II: Stability. J Prosthet Dent.
1983;49(2):165–172.
6. Jacobson TE, Krol AJ. A contemporary review of the factors involved in complete
denture retention, stability, and support. Part III: Support. J Prosthet Dent.
1983;49(3):306–313.