Give this file a read as it will help you understand the basics of Removable Partial Denture.

PRACTICE +
prosthetics
Some Questions at the end of the file for revision are included.

2
The removable partial
denture equation
J. C. Davenport,1 R. M. Basker,2 J. R. Heath,3 J. P. Ralph,4 and P-O. Glantz,5

This article describes the benefits and risks of

providing RPDs. It emphasises the importance of In this part, we will discuss
• The benefits of RPDs
co-operation between the dental team and patient • Tissue damage associated with RPDs
to ensure that the balance of this ‘equation’ is in • Preserving oral health
the patient’s favour. • The importance of teamwork

he title of this part of the series requires immediate explana- • The essential oral functions of appearance, mastication and
T tion. The term ‘equation’ refers to the balance that must be
struck between the good and the bad which can arise from the
speech.

wearing of RPDs. In this chapter we explore the benefits which It is only after this analysis has been completed that the decision
can be conferred on patients by RPDs and, at the same time, of whether or not to treat a particular patient can be taken. For
highlight the possible risks of tissue damage that can be associ- example, prosthetic treatment must not begin until it has been
ated with such prostheses. verified that there is a significant reduction in one or more of the
Every prosthetic treatment is associated with the placement of a essential oral functions. A simple determination of the number
foreign object (the prosthesis) in the mouth of the patient. As a and position of the remaining teeth is not a sufficient foundation
direct consequence of such placement the burden on the tissues in for making the decision of whether or not to initiate treatment.
the oral cavity will be increased. For example, plaque more readily If it is indicated, a treatment plan is then devised identifying the
accumulates on alloplastic materials than biologic ones. Further- various stages and the most appropriate type of prosthesis.
more, even non-toxic materials will release small amounts of their
components into the oral cavity. To justify prosthetic treatment Benefits of RPDs
and to ensure that it is beneficial to the patient, the need for such The potential benefits of RPDs which will be considered in this
treatment must be established, the patient must be appropriately section are their contribution to the following.
motivated, and the dentures properly designed, constructed and
• Appearance
maintained. Thus the initial step in determining if prosthetic
• Speech
treatment is indicated must always be the assessment of:
• Mastication
• The patient’s wishes and concerns • Maintaining the health of the masticatory system:
• The relevant dental and medical history — preventing undesirable tooth movement
• The results of the extra-oral and intra-oral examinations — improving distribution of occlusal load
• Oral hygiene habits and status • Preparation for complete dentures.

1*Emeritus Professor, University of Birmingham, UK; 2Professor of Dental

New publications:
Prosthetics, University of Leeds and Consultant in Restorative Dentistry, Leeds
Teaching Hospitals NHS Trust, Leeds, UK; 3Honorary Research Fellow, University
All the parts which comprise this series
of Manchester (Formerly Senior Lecturer in Restorative Dentistry, University of (which will be published in the BDJ) have
Manchester) and Consultant in Restorative Dentistry, Central Manchester been included (together with a number
Healthcare Trust, Manchester, UK; 4Consultant in Restorative Dentistry, Leeds of unpublished parts) in the book
Teaching Hospitals NHS Trust and Senior Clinical Lecturer, University of Leeds
and Honorary Visiting Professor, Centre for Dental Services Studies, University of A Cinical Guide to Removable
York, York, UK; 5Professor of Prosthetic Dentistry, Consultant in Prosthetic Partial Dentures (ISBN 0-904588-599)
Dentistry, Faculty of Odontology, University of Malmo, Sweden and A Clinical Guide to Removable
*Correspondence to: 5 Victoria Road, Harborne, Birmingham B17 0AG
email: [Link]@[Link]
Partial Denture Design (ISBN 0-904588-637).
REFEREED PAPER Available from Macmillan on 01256 302699
© British Dental Journal 2000; 189: 414–424

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Fig. 1 — Appearance
The restoration of the missing UR2 (12), UR1(11) and UL1(21)
undeniably benefit this patient, an 18 year-old girl, and the motivation to
wear the denture is understandably strong. Particular attention has been
paid to the appearance of the denture by the careful choice of artificial
teeth and design of the flange. A natural appearance has been created by
using a ‘veined’ acrylic, by reproducing the pre-extraction form of
alveolar ridge and by making the distal margin of the flange thin and
irregular, thus masking the transition from flange to adjacent mucosa.

a b

Fig. 2a and b — Appearance

Not only may an RPD help to restore appearance but it may actually improve it.
(a) This patient’s maxillary lateral incisors had never developed and she
was concerned about the spacing of the anterior teeth.
(b) The combination of orthodontic movement of the central incisors and the provision of RPDs improved the
appearance.

Fig. 3 — Appearance
If an incisor is not replaced soon after extraction, successful treatment at
a later date may be compromised. Here, the adjacent teeth have drifted
into the unrestored UL1(21) space. The reduced space does not allow
for an artificial tooth of a realistic size to be used on a denture. If a
reasonable aesthetic result is to be obtained the space must be re-
established by orthodontic treatment.

Fig. 4 — Speech
The loss of maxillary anterior teeth may prevent the clear reproduction
of certain sounds, particularly the ‘F’ and ‘V’ which are made by the lower
lip contacting the edges of the maxillary incisors. The replacement of
missing maxillary anterior teeth will make a significant contribution to the
quality of speech.

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Fig. 5 — Mastication
With modern foods and methods of preparation it is unlikely that a
patient will suffer from malnutrition even though a large number of teeth
are missing. However, the gaps that arise through the loss of posterior
teeth reduce the efficiency of mastication: the bolus of food is allowed to
slip into the edentulous areas and thus escape the crushing and shearing
action of the remaining teeth. An RPD will prevent this escape of the
bolus and thus contribute to efficient mastication.

Maintaining the health of the masticatory system

The provision of an RPD can make a positive contribution to
oral health by preventing, or minimising, the undesirable conse-
quences of tooth loss, as described in the following paragraphs.

Fig. 6 — Preventing undesirable tooth movement

When teeth are lost from a dental arch the teeth adjacent to the
edentulous space may tilt and move into that space. This drifting of teeth
opens up further spaces which increase the opportunity for food
impaction and plaque formation, encouraging inflammation of the
periodontal tissues and decalcification of the proximal surfaces of the
teeth. Inevitably, the longer such spaces remain unrestored, the greater
the chance of tooth movement. When teeth are lost from an opposing
arch over-eruption may occur with similar deleterious effects on the oral
health. However, if tooth movement has not occurred in spite of the
teeth being lost some years previously, it can be assumed that it is not
going to occur subsequently.

Fig. 7 — Preventing undesirable tooth movement

The long-term absence of antagonists has resulted in over-eruption of
maxillary and mandibular teeth. The teeth are virtually contacting the
opposing edentulous ridges creating major problems if RPDs have to be
provided.

Fig. 8 — Preventing undesirable tooth movement

In this example, UR6 (16) has over-erupted to such an extent that it has
lost most of its bony support. Extraction of the tooth is inevitable.

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Fig. 9 — Improved distribution of occlusal load
The loss of a large number of teeth puts an increasing functional burden
on the remaining teeth. In this example there is existing periodontal
disease. The increased functional load has hastened the destruction of the
periodontal attachments of the maxillary anterior teeth, which have
become increasingly mobile and have drifted labially.

Fig. 10 — Improved distribution of occlusal load

If the periodontal attachments of the remaining teeth are healthy, the
increased load may result in excessive tooth wear or may cause damage
to existing restorations. The restoration of gross loss of tooth substance,
as in this example, is likely to involve complex and prolonged treatment.

a b

Fig. 11a and b — Improved distribution of occlusal load

Over-eruption of a tooth may place it in such a position that it bears the brunt of the load on initial contact or in excursive movements of the mandible
and therefore it may well be subjected to excessive force. In addition, where over-eruption of a tooth has created an occlusal interference (*), the
patient may modify the habitual movement patterns of the mandible in order to avoid the interfering contact. Although such a modification may reduce
the load applied to the tooth, the changed pattern in activity of the mandibular musculature may subsequently produce muscular dysfunction.

From the foregoing examples it will be appreciated that if tooth expected to retain their remaining natural teeth for a consider-
loss is restored in sufficient time to prevent tooth movement, or able number of years, thus allowing the RPD to be regarded as a
to avoid excessive stress being placed on the remaining structures, long-term restoration. But we should remember those patients
the subsequent health of the oral tissues can benefit considerably. whose remaining teeth carry a relatively poor prognosis and for
However, the point should be made that severe damage to the whom, in due course, complete dentures are inevitable. If simple
existing structures is not an inevitable consequence of tooth loss. acrylic RPDs are provided, the patient is able to serve a pros-
The implications of this statement will become apparent later in thetic ‘apprenticeship’ with appliances which receive some sta-
this section when the damaging effects of the dentures them- bility from the few remaining teeth. In the fullness of time these
selves are described. transitional dentures become more extensive as further teeth are
extracted and the patient is gradually eased into the totally artifi-
Preparation for complete dentures cial dentition. This form of transitional treatment can be of con-
Most of this book is devoted to the treatment of patients who are siderable benefit, especially for the elderly patient.

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Fig.12 — Preparation for complete dentures
The location of the remaining teeth plays an important part in the success
of such a transitional denture. It is common for the six mandibular
anterior teeth to be the last remaining teeth in the mandible. A denture
restoring the posterior teeth is frequently not worn by the patient for the
following reasons. Firstly, the denture may be unstable because there is
little resistance to its displacement in a posterior direction; secondly,
there is very little motivation to wear the denture as the anterior teeth
are still present.

Fig. 13 — Preparation for complete dentures

If, instead of extracting all the teeth, the canines are retained, the denture
will be more stable. When the denture replaces anterior teeth it is very
much more likely to be worn and thus the patient is likely to gain greater
benefit from the transitional denture.

Fig. 14 — Preparation for complete dentures

It should be remembered that the transitional RPD is being placed in a
mouth where existing dental disease is only poorly controlled or is
uncontrolled. As will be seen in the next section, the very presence of a
denture aggravates the situation. If the mouth is not inspected regularly to
identify treatment needs as they arise, there is the likelihood of
acceleration of tissue damage, which may prejudice the eventual
complete denture foundation.
In this case the inflammation and hyperplasia of the palatal mucosa was
so severe that surgery had to be performed before further prosthetic
treatment could be undertaken.

Causes of damage related to the wearing of RPDs

Harmful effects can arise from the wearing of RPDs in a variety of wearing RPDs, such as caries and periodontal disease, can be
ways: from the plaque which is likely to accumulate around any avoided. However, frequent technical maintenance of RPDs is still
RPD; from direct trauma by individual components of the den- required if optimal oral function and health are to be preserved.
ture; from excessive functional forces which will be transmitted by When tissue damage does occur it is sometimes referred to as
an ill-designed prosthesis and from errors in the occlusion. the ‘biological price’ of wearing RPDs. The possible causes of
If the patient, with the help of the dental team, can maintain damage and their sequelae are summarised in the following table
optimal plaque control the hygiene-related complications of and are discussed in more detail in the subsequent sections.

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Table 1 Summary of damage that may result from wearing an RPD

Causes Teeth Periodontal tissues Edentulous areas Muscles of mastication

Plaque accumulation Decalcification Inflammation of gingival Inflammation of mucous

and caries tissues membrane
Progression to underlying
structures

Direct trauma from Abrasion and Inflammation of gingival Localised inflammation

components fracture of tissues of mucous membrane.
teeth or Progression to underlying Denture-induced
restorations structures hyperplasia

Transmission of (a) Tooth mobility Inflammation of mucous

excessive functional (b) Aggravation of existing membrane
forces periodontal disease Resorption of bone

Occlusal error (a) Tooth mobility Inflammation of mucous Muscle dysfunction

(b) Aggravation of existing membrane
periodontal disease Resorption of bone

Increased plaque accumulation

A considerable amount of research effort has been directed affects the quantity. Not only does more plaque accumulate
towards an understanding of the relationship between plaque around the teeth in the jaw in which the denture is placed, but also
accumulation and the wearing of RPDs. It is possible that the pres- more is found around the teeth in the opposing jaw unless the
ence of a denture influences the quality of the plaque; it certainly patient is instructed in meticulous oral hygiene procedures.

a b

Fig. 15a and b — Increased plaque accumulation

The areas that tend to collect most plaque are the proximal surfaces of abutment teeth adjacent to the saddle.
(a) These surfaces are difficult to clean when using a conventional toothbrush.
(b) An interdental brush cleans the proximal surfaces more effectively.

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a b

Fig. 16a and b — Increased plaque accumulation

The design of the denture may have a significant effect on plaque accumulation. For example, it has been shown
that more plaque collects under a lingual plate than under a lingual bar.
(a) The lingual plate is well supported on the natural teeth and fits well against tooth surfaces.
(b) However, gingival inflammation has been caused by the increased accumulation of plaque.

Fig. 17 — Increased plaque accumulation

Denture
If the plaque is allowed to persist, the inflammatory process will progress
to the deeper tissues, resulting in a chronic periodontitis. The periodontal
Tooth
attachment is progressively destroyed, a periodontal pocket develops and
the investing alveolar bone is lost.
Plaque

Pocket

Bone

Fig. 18 — Increased plaque accumulation

Unless the increased accumulation of plaque is prevented, root caries is
likely. This is a problem that will increase as more patients continue to
wear RPDs into old age. Root caries is strongly associated with gingival
recession and the use of gingivally-approaching clasps in patients who are
at risk because of a cariogenic diet and poor plaque control.

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Fig. 19 — Increased plaque accumulation
If plaque is allowed to persist on the denture impression surface, a
generalised inflammation, called denture stomatitis, may occur. Typically
the extent of the inflammation is demarcated by the outline of the palatal
connector. This condition is discussed more fully in Part 11.

a b

Fig. 20a and b — Direct trauma from components

The oral mucosa is vulnerable to direct trauma from components of dentures.
(a) In this instance the lingual bar has been positioned too close to the gingival margin. The continuous clasp
offers only limited tooth support for the denture.
(b) The denture has sunk into the tissues, stripping away the gingival tissues on the distal and lingual aspects of
LL3 (33).

There is no evidence for the contention that a clasp arm may wear away the enamel surface to a degree that is
significant clinically. However, the movement of a clasp arm may wear the surface of restorative materials.

Transmission of excessive force

Functional forces are transmitted by an RPD to the tissues with appreciated that the forces are tensile in nature and are dissi-
which it is in contact. If a denture is supported primarily by the pated over a relatively large area. A very different state of affairs
natural teeth most of the forces will be transmitted to the alveo- exists when a denture is supported only by the mucosa. Here the
lar bone through the fibres of the periodontal ligament. Bearing forces, largely compressive in nature, are transmitted over a
in mind the orientation of most of these fibres, it will be more restricted area.

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a b

Fig. 21a and b — Transmission of excessive force

If the forces transmitted to the mucosa and bone of the edentulous area are excessive, the mucosa will become
inflamed and the bone will resorb. The obvious consequence of bone resorption is an irreversible loss of part of
the denture foundation.
(a) In this example the denture is supported only on the tissues of the edentulous area. It has caused resorption
of the bone to such an extent that the lingual bar connector has been pushed down towards the floor of the
mouth.
(b) The amount of bone that has been destroyed is apparent when the denture is removed.

Fig. 22 — Transmission of excessive force

1 2 If the design of the denture is such that it transmits excessive force to a tooth there is
every chance that the tooth will become mobile.
In this example the incorrectly designed cingulum rest (1) transmits a horizontal force
to the canine tooth. Such horizontal forces are especially damaging to the periodontal
tissues. The incisal rest (2) transmits a more favourable vertical load.
Where periodontal changes are restricted to the marginal gingivae, elimination of
excessive force will usually allow the periodontal attachment to return to a normal
healthy state. Where the supporting structures have been affected by periodontal
disease there is unlikely to be complete resolution.

1 2 3

Fig. 23 — Occlusal error

If the occlusal surface of the RPD is not designed correctly, normal jaw closure may be prevented by a
premature occlusal contact. There are three possible sequelae:
(1) If the premature contact is on a natural tooth, damage to the tooth or its periodontal ligament may occur.
(2) If the saddle bears the brunt of the force of closure, there will be localised mucosal inflammation and
resorption of the underlying bone.
(3) If the patient attempts to steer the mandible around the premature contact until a more comfortable
occlusal position is found, this abnormal closing pattern throws increased demands on certain muscles of
mastication, which may result in the patient complaining of facial pain.

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Balancing the RPD equation
A number of longitudinal clinical studies of RPDs have shown With greater understanding of the relationship between
that the types of damage itemised in the last section may be plaque and dental disease and of the importance of plaque con-
commonly found amongst wearers of RPDs. Of considerable trol, reports have appeared whose findings make for more
concern are reports that many patients expressed satisfaction encouraging reading. There is now firm evidence that the wear-
with their dentures, in spite of the fact that dental health had ing of RPDs can be compatible with continued oral health. This
deteriorated markedly. Perhaps this finding is not altogether satisfactory outcome depends upon a three-fold effort, that of
surprising when we remember the insidious nature of the pro- the clinician, the dental technician and the patient.
gression of caries and periodontal disease.

a b

Fig. 24a and b — Contribution of the clinician

The primary responsibility of the dentist and the clinical team is to ensure that the remaining teeth and
supporting tissues are restored to a healthy state and that the patient is effectively motivated and instructed in
how to maintain this state.
(a) This mouth is not in a fit state to receive an RPD. There is chronic periodontal disease and accumulation of
plaque.
(b) This patient has responded well to instruction in oral hygiene and the periodontal tissues are healthy. The
dangers of wearing the RPDs are thus minimised.

The second area of responsibility of the clinician is in relation • Clearance of gingival margins
to the design and construction of the denture. Accuracy of the • Simplicity
clinical procedures must, of course, be ensured. In addition, the • Rigid connector.
clinician should produce a design based on criteria that have
been shown to promote continued oral health: These criteria are considered in greater detail in our BDJ book
• Effective support ‘A Clinical Guide to Removable Partial Denture Design’.

Fig. 25 — Contribution of the dental technician

The dental technician’s contribution is directed towards the careful
translation of the prescribed denture design into the denture itself, and
accurate construction and positioning of the denture components. In this
instance the inaccurate fit will encourage plaque formation with
consequent periodontal disease and caries, thus introducing an
unnecessary and avoidable risk to oral health.

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Fig. 26 — Contribution of the patient
It is probably true to say that a patient who maintains immaculate plaque
control and has a good tissue resistance, or ‘host response’, can be
provided with a less than satisfactorily designed denture and still maintain
good oral health. Such is the importance of patient factors in the RPD
equation. This patient has worn a maxillary RPD for many years. The
gingival tissues are healthy and the teeth are well supported by bone; all
this in spite of the fact that there is little opportunity to provide tooth
support.

For every patient, when a denture is contemplated, it is the disadvantage it is likely that it will be in the patient’s best interest
dentist’s responsibility to assess the advantages and disadvan- that a denture is not prescribed. Of course, where a denture is
tages for that particular individual. The level of disadvantage is required to replace an anterior tooth or teeth, the demand from
influenced primarily by the patient’s dental awareness and the patient will usually be overwhelming even if the level of
plaque control. When the balance of the equation leans towards plaque control is less than satisfactory.

a b

Fig. 27a and b — Contribution of the patient

In this mouth the reasons for providing dentures are not overwhelming. There are sufficient teeth at the front of
the mouth to satisfy the demands of appearance and speech. There are certainly enough teeth to allow a varied
diet to be eaten. Most of the teeth have antagonists in the opposing arch.
If the mouth is well cared for and the patient requests dentures, the RPD equation is favourably balanced.
However, if plaque control is suspect, there is a strong argument for advising against dentures, at least for a few
months until the long-term response to oral hygiene advice is ascertained.

Further reading Renner R P. Periodontal considerations for the construction of removable partial
dentures — I and II. Quintessence Dent Technol 1985; 9: 169-72, 241-245.
RPDs and Oral Health Wagg B J. Root surface caries: a review. Comm Dent Health 1984; 1: 11-20.
Bates J F. Plaque accumulation and partial denture design. In Bates J F, Neill D J, Yap U J, Ong G. Periodontal considerations in restorative dentistry. Part 2: Prostho-
Preiskel H W (ed). Restoration of the Partially Dentate Mouth, 225-236. Chicago: dontic considerations. Dent Update 1995; 22: 13-16.
Quintessence, 1984.
Berg B. Periodontal problems associated with use of distal extension removable partial Survival of Removable Partial Dentures
dentures — a matter of construction? J Oral Rehabil 1985; 12: 369-379. Bergman B, Hugoson A, Olsson C-O. A 25 year longitudinal study of patients treated
Blinkhorn A S. Dental health education: what lessons have we ignored? Br Dent J 1998; with removable partial dentures. J Oral Rehabil 1995; 22: 595-599.
184: 58-59. Bergman B. Prognosis for prosthodontic treatment of partially edentulous patients. In:
Budtz-Jorgenson E. Oral mucosal lesions associated with the wearing of removable Owall B, Kayser A F, Carlsson G B. Prosthodontics: principles and management
dentures. J Oral Path 1981; 10: 65-80. strategies. London: Mosby-Wolfe, 1996.
Carlsson G E, Hedegård B, Koivumaa K K. Studies in partial denture prosthesis IV. Frank R P, Milgrom P, Leroux B G, Hawkins N R. Treatment outcomes with mandibu-
Final results of a 4-year longitudinal investigation of dentogingivally supported lar removable partial dentures: a population-based study of patient satisfaction.
partial dentures. Acta Odont Scand 1965; 23: 443-472. J Prosthet Dent 1998; 80: 36-45.
Chandler J A and Brudvik J S. Clinical evaluation of patients eight to nine years after Kapur K K, Deupree R, Dent R J, Hasse A L. A randomised clinical trial of two basic
placement of removable partial dentures. J Prosthet Dent 1984; 51: 736-743. removable partial denture designs. Part I: Comparisons of five year success rates
Germundsson B, Hellman M, Odman P. Effects of rehabilitation with conventional and periodontal health. J Prosthet Dent 1994; 72: 268-282.
removable partial dentures. Swed Dent J 1984; 8: 171-182. Kapur K K, Garrett N R, Dent R J, Hasse A L. A randomised clinical trial of two basic
Gray R J M, Davies S J, Quayle A A. Temporomandibular disorders. a clinical approach. removable partial denture designs. Part II: Comparisons of masticatory scores.
London: British Dental Association, 1995. J Prosthet Dent 1997; 78: 15-21.
MacEntee M I. Biologic sequelae of tooth replacement with removable partial den- Libby G, Arcuri M R, LaVelle W E, Hebl E. Longevity of fixed partial dentures. J Pros-
tures: a case for caution. J Prosthet Dent 1993; 70: 132-134. thet Dent 1997; 78: 127-13 1.
McHenry K R, Johansson O B, Christersson L A. The effect of removable partial den- Vermeulen A H B M, Kelyjens H M A M, van’t Hof M A, Kayser A F. Ten-year evalua-
ture framework design on gingival inflammation — a clinical model. J Prosthet tion of removable partial dentures: survival rates based on retreatment, not wearing
Dent 1992; 68: 799-803. and replacement. J Prosthet Dent 1996; 76: 267-272.
Orr S, Linden G J, Newman H N. The effect of partial denture connectors on gingival
health. J Clin Periodontol 1992; 19: 589-594.

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 Introduction to Removable Partial Dentures - 1

Introduction to Removable Partial Dentures

A. Definitions

1. Partial denture: A prosthesis that replaces one or more, but not all of the natural teeth
and supporting structures. It is supported by the teeth and/or the mucosa. It may be fixed
(i.e. a bridge) or removable.
2. Removable partial denture (RPD): A partial denture that can be removed and replaced
in the mouth by the patient.
3. Interim denture (provisional; temporary): A denture used for a short interval of time to
provide:
a. esthetics, mastication, occlusal support and convenience.
b. conditioning of the patient to accept the final prosthesis.

4. Retention: Resistance to removal from the tissues or teeth

5. Stability: Resistance to movement in a horizontal direction (anterior-posteriorly or
medio-laterally
6. Support: Resistance to movement towards the tissues or teeth
7. Abutment: A tooth that supports a partial denture.
8. Retainer: A component of a partial denture that provides both retention and support for
the partial denture
B. Treatment Objectives
1. preserve remaining teeth and supporting structures
2. restore esthetics and phonetics
3. restore and/or improve mastication
4. restore health, comfort and quality of life

C. Alternatives to RPD's (Treatment Options - Important for Informed Consent)

1. No Treatment (Shortened Dental Arch)
- Most patients can function with a shortened dental arch (SDA)
- Requires anterior teeth + 4 occlusal units (symmetric loss) or 6 occlusal units
(asymmetric loss) for acceptable function (opposing PM =1 unit, opposing molars
= 2 units)
- RPD doesn’t usually improve function if minimal occlusal units present
2. Fixed partial denture – requires abutments at opposite ends of edentulous space, more
expensive than RPD, must grind down abutments, flexes and can fail if too long.
3. Implant supported prosthesis – most costly, closest replacement to natural dentition,
less costly over long term
4. Complete denture (if few teeth left, with poor prognosis); if replacement of missing
teeth is very complex or costly

D. Indications for RPD's

1. lengthy edentulous span (too long for a fixed prosthesis)
2. no posterior abutment for a fixed prosthesis
3. excessive alveolar bone loss (esthetic problem)
Table of Contents - 2

4. poor prognosis for complete dentures due to residual ridge morphology

5. reduced periodontal support of remaining teeth (won't support a fixed prosthesis)
6. cross-arch stabilization of teeth
7. need for immediate replacement of extracted teeth
8. cost/patient desire considerations

Treatment Sequence for Partial Dentures

If an RPD is part of planned Treatment:

PLAN THE RPD BEFORE BEGINNING ANY OTHER TREATMENT

• Survey, tripod, heights of contour

• Draw design on surveyed cast
• Design approved before any treatment started:
o Affects direct restorations
o Can influence need for/preparations for crowns
o Insures RPD can be completed successfully
o NO EXCEPTIONS

CLINICAL STEPS
1. Diagnosis, Treatment Plan, Hygiene
2. Diagnostic Casts
3. Draw design & list abutment modifications on Prosthesis Design page
4. Instructor Approval
5. Complete Phase 1 treatment
6. Abutment modifications
7. Preliminary impression to check abutment modifications
8. Crown or Fixed partial denture’s for removable partial denture abutments (if necessary)
9. Final Framework Impression (must include hamular notches/retromolar pads for distal
extension removable partial dentures
10. Make two casts
11. Draw design on 2nd cast
12. Instructor approval/corrections
13. Complete RPD Framework Prescription (instructor signature required)
a. Second poured cast with design sent to Lab with 1st pour
14. Inspect wax-up
15. Framework Adjustment
16. Altered Cast impression, if needed
17. Try-in with teeth in wax
18. Process, deliver to patient
 Introduction to Removable Partial Dentures - 3

E. Components of a Partial Denture

a. Major Connector: The unit of a removable partial denture that connects the parts of one
side of the dental arch to those of the other side. It's principal functions are to provide
unification and rigidity to the denture.

b. Minor Connector: A unit of a partial denture that connects other components (i.e. direct
retainer, indirect retainer, denture base, etc.) to the major connector. The principle
functions of minor connectors are to provide unification and rigidity to the denture.

c. Direct Retainer: A unit of a partial denture that provides retention against dislodging
forces. A direct retainer is commonly called a 'clasp' or 'clasp unit' and is composed of
four elements, a rest, a retentive arm, a reciprocal arm and a minor connector.

d. Indirect Retainer: A unit of a Class I or II partial denture that prevents or resists

movement or rotation of the base(s) away from the residual ridge. The indirect retainer
is usually composed of one component, a rest.

e. Denture Base: The unit of a partial denture that covers the residual ridges and supports
the denture teeth.
Table of Contents - 4

F. Classification

The Need for Classification

There may be over 65,000 possible combinations of teeth and edentulous spaces. A
classification system facilitates communication between dentists. Since there are several
methods of classifying partial dentures, the use of non-standard classifications could lead to
confusion. Therefore, the Kennedy system has been adopted by most dentists.

Kennedy Classification
In 1923, Kennedy devised a system that became popular due to its simplicity and ease of
application. A tremendous number of possible combinations can be reduced to four simple
groups.

Class I - bilateral edentulous areas Class II - unilateral edentulous area

located posterior to all remaining teeth. located posterior to all remaining teeth.

Class III - unilateral edentulous area Class IV - a single, but bilateral

bounded by anterior and (crossing the midline) edentulous
posterior natural teeth. area located anterior to remaining teeth.
 Introduction to Removable Partial Dentures - 5

Applegate's Rules for Applying the Kennedy Classification

Rule 1: Classification should follow rather than precede extraction.

Rule 2: If the 3rd molar is missing and not to be replaced, it is not considered in the
classification.

Rule 3: If the 3rd molar is present and to be used as an abutment, it is considered in the
classification.

Rule 4: If the second molar is missing and not be replaced, it is not considered in the
classification.

Rule 5: The most posterior edentulous area determines the classification.

Rule 6: Edentulous areas other than those determining classification are called modification
spaces.

Rule 7: The extent of the modification is not considered, only the number.

Rule 8: There is no modification space in Class IV.

Surveying, Path of Insertion, Guiding Planes - 14

Surveying, Path of Insertion, Guiding Planes

A path of insertion (or removal) is the path along which a prosthesis is placed (or removed)
intraorally. A removable partial denture is usually fabricated to have a single path of insertion or
removal from the mouth. A single path of insertion is advantageous because it:

1. equalizes retention on all abutments

2. provides bracing and cross-arch stabilization of teeth
3. minimizes torquing forces of the partial denture
4. allows the partial denture to be removed without encountering interferences
5. directs forces along the long axes of the teeth
6. provides frictional retention from contact of parallel surfaces on the teeth

In order to provide a single path of insertion for a partial denture, some axial surfaces of
abutments must be prepared so that they parallel the path of insertion. These parallel surfaces
are called guiding planes.

Guiding planes are prepared wherever rigid components of a partial denture contact abutment
teeth. Specifically, guiding planes should usually be prepared for:

1. Proximal plates
2. Bracing arms
3. Rigid portions of retentive clasps

The dental surveyor is a diagnostic instrument used to select the most favorable path of
insertion and aid in the preparation of guiding planes. It is an essential instrument in designing
removable partial dentures. The act of using a surveyor is referred to as surveying.

Other Uses of a Surveyor:

1. Locating soft tissue undercuts, which can influence the extent of the denture base, the
type of direct retainers and the path of insertion selected.
2. Contouring wax patterns for fixed restorations that will be partial denture abutments.
3. Machining parallel surfaces on cast restorations.
4. Blocking out undesirable undercuts on master casts.
5. Placing intracoronal retainers (precision attachments).
6. Recording the cast position in relation to the selected path of insertion (tripoding).
 Surveying, Path of Insertion, Guiding Planes - 15

Parts of a Surveyor:

1. Surveying Table (Cast Holder): The part of the surveyor to which a cast can be attached.
Through the use of a ball and socket joint it allows the cast to be oriented at various tilts and
to be fixed along one of these planes.
2. Surveying Arm: A vertical arm used to analyze the parallelism of various axial cast
surfaces. It contains a holder so that several surveying tools may be attached and used.
3. Surveying Tools:
a. Analyzing Rod - A thin straight metal rod
used to analyze contours and undercuts.
This is the principal tool used in surveying.
The side of analyzing rod is brought into
contact with surfaces of the proposed
abutment teeth to analyze their axial
inclinations. This rod is easily bent and once
bent is difficult to straighten. Use it carefully.

b. Carbon Marker - Rods similar to pencil leads which can be used to mark the
location of the height of contour on a dental cast. Some surveyors use a protective
sheath to prevent or reduce breakage of the carbon markers.

c. Metal Gauges - Metal rods with terminal ledges or lips of various widths (the most
commonly used are 0.01" and 0.02"). Undercut dimensions can be measured on teeth
by bringing the vertical shaft of the gauge in contact with a tooth and then moving the
surveying arm up or down until there is also contact with the terminal lip.

d. Wax Trimmer - A tool with a straight sharp edge, which parallels the surveying arm.
It is used to contour waxed crowns for partial denture abutments, or to place blockout
for a partial denture framework. It is used with a dragging or shaving motion to
remove thin layers.
Surveying, Path of Insertion, Guiding Planes - 16

Selecting the Path of Insertion of a Removable Partial Denture

A path of insertion is selected to provide the best combination of retentive undercuts and
parallel surfaces for ALL ABUTMENTS. Use the following steps to do so:

STEP 1 Place the cast on the surveyor table and orient the plane of occlusion relatively
horizontal. The final tilt of the cast for the ideal path of insertion is seldom more
than 10° from this position.
STEP 2 Place the analyzing rod against the axial surface of a proposed abutment teeth (any
tooth adjacent an edentulous space). The tip of the rod should be at the level of the
free gingival margin. The point where the tooth touches the analyzing rod is greatest
convexity (bulge) of a tooth and is called the height of contour.

The position of the height of contour can be changed by tilting the cast. The area on a
tooth occlusal to the height of contour is called the suprabulge area. All portions of
a direct retainer that are rigid or semi-rigid must be located in this area. The area
gingival to the height of contour is an undercut and is called the infrabulge area.
The retentive portions of direct retainers are located in this area, since they can flex to
pass over the height of contour.

Note that when cast is tilted and the surveying arm remains vertical, the height of contour (large
arrows) changes, as does the distance of the analyzing rod to the tooth (small arrows)

STEP 3 Tilt the cast to gain maximum parallelism of axial surfaces of all of the proposed
abutments. Maximum parallelism is present when the heights of contour of all teeth
and all surfaces are as close as possible to the same position occluso-gingival. An
additional check for maximum parallelism is that equal amounts of undercut are
present on all abutments and all abutment surfaces. Check the mesial and distal tooth
surfaces while tilting the cast anterior-posteriorly (A-P). While maintaining the same
A-P tilt check facial and lingual parallelism. Lock the tilt of the cast when maximum
parallelism is achieved.

STEP 4 Use an undercut gauge to check for adequate and relatively equal retentive,
undercuts for retentive arms on all abutments. Alter the tilt of cast if required.
 Surveying, Path of Insertion, Guiding Planes - 17

STEP 5 Change the tilt of the cast if there are any major soft tissue interferences (i.e.
mandibular tori, residual ridge undercuts), or if the selected path of insertion will
cause an esthetic problem (i.e. clasp would have to be placed to far incisally on the
facial surface of an anterior tooth, as when the height of contour or required depth of
undercut is too close to the incisal or occlusal surface).

STEP 6 Lock the diagnostic cast in position on the surveying table and mark the heights of
contour on the denture abutments and soft tissues with the carbon marker. When
marking the heights of contour, ensure that the carbon tip follows close to the free
gingival margin so that you do not register a false height of contour.

The heights should be relatively equal occluso-gingivally.

STEP 7 Tripod the diagnostic cast so that the selected path of insertion may be easily found
for future reference.

The Optimal Path of Insertion

The optimal path of insertion of a partial denture is determined by:

A. Retentive undercuts - equalized on all abutments.

Clasp has different path of escapement (dashed arrow) than

guiding plane (solid arrows) and therefore must flex when the
denture is removed. This provides retention for the denture.

Retentive clasps(•) oppose each other when correctly designed (left). Retention at each principle
abutment should balance that of the tooth on the opposite side of the arch (i.e. equal in
magnitude and opposite in relative location).
Surveying, Path of Insertion, Guiding Planes - 18

B. Interferences - A path of insertion must be selected so that the prosthesis may be inserted
and removed without encountering tooth or soft tissue interferences. Tooth interferences are
usually encountered where rigid elements of the partial denture would require placement in
areas of undercut. Since rigid elements do not flex, such a partial denture will not seat.
Tooth interferences are often encountered in the bucco- or linguo-occluso-proximal point
angles, where the height of contour is high and where rigid portions of the clasp assemblies
must be placed.
Since only the terminal end of the retentive arm
flexes (circled area), the clasp on the left will
lock on the cast. The rigid portion of the clasp
will not release from the undercut. The clasp on
the right will release since only the flexible tip is
in the undercut.
When soft tissue undercuts exist (i.e. mandibular tori, residual ridge undercuts), the rigid
denture base can cause abrasion, irritation and /or ulceration as it is forced over the tissue.
As such, a path of insertion that involves interferences should only be selected if the
interferences can be eliminated by tooth preparation or reasonable blockout of the master
cast. If the interferences cannot be eliminated or minimized, then a different path of
insertion must be considered, even if less desirable guiding plane and retentive areas must
be selected.

Soft tissue undercuts require that the tissue be impinged

upon as the major connector or denture base passes over it.
If a large undercut is blocked out, the connector or base will
be remote from the tissue and collect food and debris.

C. Esthetics. A path of insertion should be selected to provide the most esthetic placement of
artificial teeth and the least amount of visible metal on the abutment teeth. Ensure that the
retentive undercut and the height of contour are not placed too far occlusally, so that the
retentive clasp and that anterior proximal plates are close to the gingival contours making
these components as inconspicuous as possible.

D. Guiding planes. Guiding planes are flat surfaces prepared on abutment teeth. Flat, rigid
elements of the partial denture (bracing elements and proximal plate minor connectors) fit
against these surfaces to ensure that a partial denture seats along one path of insertion.

Guiding planes are used to control and limit the directions of movement of a removable
partial denture as it is being inserted, removed or while it is in function. To do this, bracing
elements or proximal plates should, whenever possible, be the initial portions of the
partial denture to contact the abutments. In this way, the teeth are stabilized from the
potential moving forces as retentive elements of direct retainers flex over the heights of
contour into the retentive undercuts.
 Surveying, Path of Insertion, Guiding Planes - 19

When the retentive arm (•) contacts the tooth first, it can
cause movement of the tooth since the tooth is not
stabilized to resist displacement. When the rigid bracing
or reciprocal arm contacts first, it braces the tooth so the
retentive arm cannot displace it.

Guiding planes are most effective when they:

a. are parallel
b. include more than one common axial surface (e.g. proximal and lingual surfaces)
c. are directly opposed by another guiding plane (e.g. facing guiding planes in a
modification space)
d. are placed on several teeth
e. cover a large surface area (long and/or broad)

These guiding planes are parallel, include

more than one common axial surface (i.e.
distal of premolar, mesial of molar), directly
oppose one another and are fairly long. They
will be very effective.

When marked with a carbon marker, well-prepared guiding planes appear as wide survey lines:
Surveying, Path of Insertion, Guiding Planes - 20

Selection and Preparation of Guiding Planes:

a. A path of insertion is selected.

b. The number and position of guiding planes is selected.
c. With the diagnostic cast as a guide, parallel surfaces are prepared intraorally with straight
cylindrical burs (#1156 or #557L or equivalent cylindrical bur). The surveyed cast should
be nearby for comparison, so that the bur can be placed in the same relationship to the
tooth as the analyzing rod makes with the diagnostic cast.

The bur should be placed at the same

angulation as the surveying rod. The
triangular space below the height of
contour should appear to be the same.

d. Guiding planes should be at least 1/2 to 1/3 of the axial height of the tooth (generally a
minimum of 2 mm in height). Use a light sweeping stroke continuing past the bucco- and
the linguo proximal line angles. Reduction should follow the bucco-lingual curvature of
the tooth, rather than slicing straight across the tooth. Guide planes for distal-extension
cases should be slightly shorter to avoid torquing of the abutment teeth. Lingual guiding
planes for bracing or reciprocal arms should be 2-4 mm and ideally be located in the
middle third of the crown, occluso-gingivally. Use a good finger rest to establish parallel
planes.

e. If tooth surfaces selected for guiding planes are already parallel to the path of insertion,
little if any tooth modification may be necessary.
f. The prepared surfaces are polished rubber wheels or points.
g. Guiding planes are the first features prepared intraorally. If occlusal rest seats are prepared
initially, placement of a proximal guiding plane will remove some of the rest seat
preparation, and result in a narrowed rest with a sharp occluso-proximal angle.
 Surveying, Path of Insertion, Guiding Planes - 21

The Effects of Guiding Planes on Retention and Stability

1. Guiding Planes Maintain Retention

Retention is gained by the flexible retentive tip of the clasp engaging an undercut of an
abutment. Retentive undercuts exist only in relation to a fixed plane. If an undercut is
found on a diagnostic cast, and the cast is tilted in another direction, the undercut can be
eliminated. Likewise, in the mouth, if the partial denture does not have a single path of
insertion (as dictated by guiding planes) the prosthesis could be rotated so that the retentive
undercuts would be eliminated. The denture could then be easily displaced.

Point contact of the reciprocal arm allows rotation of the partial denture and release of the
retentive arm (left and middle). A broad flat plane does not (right).

2. Guiding Planes Minimize the Need for Retention

The use of too many clasps or the use of clasps with large undercuts can impair the health
of the periodontium. Frictional retention from parallel guide planes minimizes the retention
required from direct retainers.

3. Guiding Planes Stabilize Teeth

Guiding planes with intimate, firm and continual contact with the prosthesis are effective in
stabilizing teeth. Stability can be important if there is mobility due to periodontal bone loss.
This effect is most pronounced in Class III partial dentures. In Class I and II partial
dentures, stability is compromised by the lack of posterior abutments. These dentures tend
to rotate more and produce a torquing force, if the principal abutments are locked into the
denture. Slightly shorter guiding planes are used in distal extension cases to minimize this
torquing action.

Loading of a Class I denture base causes rotation around the rest seat. A short guiding
plane allows rotation into the gingival relief area. A long guiding plane has no area to
move and thus immediately torques the tooth.
Surveying, Path of Insertion, Guiding Planes - 22

Alteration of Other Axial Contours

While guiding plane surfaces are the most common axial tooth preparations made for removable
partial dentures, other axial preparations may also be required. These include:

A. Lowering Height of Contours

1. Lowering height of contours to eliminate tooth interferences in areas where rigid
frameworks elements will be placed (such as rigid portions of retentive arms).

2. Lowering height of contours to improve esthetics (e.g. to allow retentive arms to be

placed more gingivally to reduce clasp display).
When preparing axial contours for these situations, the heights of contour are most
quickly lowered by placing the bur parallel to the path of insertion.

B. Raising Height of Contours

The only time that a height of contour would be raised would be when there is no retentive
undercut present or when the undercut is so far gingival that the retentive tip would either
impinge on the free gingival margin or cause a hygiene problem due to its proximity to the
free gingival margin. In general, the inferior portion of the retentive undercut should be at
least 1mm above the free gingival margin. Raising the height of contour is only feasible
when the axial surface is parallel or slightly divergent to the path of insertion. If the
surface is grossly divergent from the path of insertion, then raising the height of contour
may be impossible.
The tooth on the right is grossly
divergent from the path of insertion,
so that excessive preparation is
required just to gain the appropriate
undercut. Dentin, or in extreme
cases, the pulp could be exposed.
Minimal preparation will be required
on the tooth on the left since its long
axis is close to the path of insertion.
Raising the height of contour for retentive undercuts can be accomplished by:
1. Preparing a retentive undercut. Prepare an ovoid undercut with the inferior border at
least 1 mm from the free gingival margin, using a round or chamfer diamond bur.

Correct Should be more Too close to

ovoid, like clasp free gingival
tip margin
 Surveying, Path of Insertion, Guiding Planes - 23

2. Place composite resin above the position of the retentive tip, using rubber dam isolation.
Place a Mylar matrix to separate the tooth from adjacent teeth. Clean the tooth with flour
of pumice, etch, apply bonding agent and place the composite with plastic instrument.
Place and contour the material as indicated below. Ensure there is adequate undercut
only in the area needed, even after polishing.

If the tooth is very

divergent from the path
of insertion, the
composite will have to be
grossly over contoured
(right), which is not
advisable for hygienic
reasons. Changing the
path of insertion or
uprighting the tooth
orthodontically may be
preferable alternatives.

3. Combination of Preparing an Undercut and Placing Composite Resin

This is most commonly done when the tooth is more divergent from the path of insertion
than usual. When possible, it is preferable to prepare retention in enamel rather than
place a resin bonded undercut. Preparation in enamel, when feasible, is less time
consuming, less expensive and probably more hygienic over an extended period of time.

Summary of Removable Partial Denture Abutment Modifications

After a path of insertion is selected and a partial denture design has been formulated, tooth
preparations are made according to the following sequence.

1. Prepare guiding planes along the path of insertion for:

a. Proximal plates
b. Bracing arms
c. Rigid portions of retentive clasps

2. Lower heights of contour to eliminate interferences and improve esthetics.

3. Raise heights of contour for retentive arm tips by preparation and/or placement of composite
resin.

4. Rest seat preparations or placement of bonded composite rest seats.

Rests and Rest Seats - 24

Rests and Rest Seats

A. Definitions

i. Rest: A rigid component of a removable partial denture which rests in a recessed

preparation on the occlusal, lingual or incisal surface of a tooth to provide vertical support
for the denture. Although a rest is a component of a direct retainer (retentive unit, clasp
assembly), the rest itself is classified as a supporting element due to the nature of its
function.

a. Occlusal rest - a rest placed on the occlusal surface of a bicuspid or molar.

b. Lingual (cingulum) rest - A rest placed on the cingulum of an anterior tooth (usually
the canine). Rests may also be placed on the lingual of posterior teeth by creating a
ledge of the tooth surface (prescribed for surveyed crowns).

c. Incisal rest - A rest placed on an anterior tooth at the incisal edge.

d. Intracoronal (precision) rest - A rest consisting of precision manufactured

attachments that are placed within the coronal contours of a crown or retainer.

ii. Rest Seat: A portion of a tooth selected and prepared to receive an occlusal, incisal or
lingual rest.

B. Functions of Rests

1. To direct forces along the long axis of the abutment tooth.

2. To prevent the denture base from moving cervically and impinging gingival tissue.

3. To maintain a planned clasp-tooth relationship.

4. To prevent extrusion of abutment teeth.
5. To provide positive reference seats in rebasing and/or impression procedures.
6. To serve as an indirect retainer by preventing rotation of the partial denture (Class I or II
RPD’s only).
 Rests and Rest Seat - 25

C. Preparation of Rest Seats

Rests seats should be prepared using light pressure with a high-speed handpiece with or without
water spray. Since minimal preparation is usually performed, minimal heat is generated. Good
visibility is required so that water coolant can be eliminated.

Since preparations are usually entirely in enamel it is best to avoid anesthesia so the patient can
inform the dentist when sensitivity is felt.

Occlusal rest seats can be prepared with medium round burs (#2 and primarily the #4 sizes).or
diamonds (e.g. 801-016, 38006-135)

Guiding planes and cingulum rest seats can be prepared with a long, medium diameter
cylindrical bur or diamond (e.g. #57L; 8837K-014).

D. Rest Seat Form

Rest seats should have a smooth flowing outline form (i.e. no sharp line angles).

1. Occlusal Rest Seats

(a) The outline of an occlusal rest seat is a rounded triangular shape with its apex
nearest to the centre of the tooth.

(b) The base of the triangular shape is at the marginal ridge and should be approximately
one third the bucco-lingual width of the tooth.

(c) The marginal ridge must be lowered and rounded to permit a sufficient bulk of metal
to prevent fracture of the rest from the minor connector (1 to 1.5 mm)
Rests and Rest Seats - 26

(d) The floor of the rest seat should be inclined towards the centre of the tooth, so that the
angle formed by the rest and the minor connector should be less than 90°. This helps to
direct the occlusal forces along the long axis of the tooth.

A clinician can test to see if a rest seat is ‘positive’ (i.e. <90°) by trying to slide an explorer
tip off the rest seat.

An angle of more than 90° fails to transmit the occlusal forces along the long axis of the
tooth and permits movement of the clasp assembly away from the abutment and
orthodontic movement of the tooth.

(e) The floor of the rest seat should be concave or spoon shaped to create a ball-and-socket
type of joint. This will prevent horizontal stresses and torque on the abutment tooth.
 Rests and Rest Seat - 27

When occlusal rest seats are prepared next to an edentulous space the morphology follows
conventional form.

When a single occlusal rest seat is prepared next to an adjacent tooth the form is modified. The
rest seat is not flared to the facial line angle. Instead, the lingual line angle is flared more
dramatically to provide additional space for the minor connector.

When embrasure occlusal rest seats are prepared on adjacent teeth, the form is also modified.
Additional tooth structure is removed in the marginal areas to provide at least 1.5 mm of room
for the embrasure clasps. The rest seats are flared more dramatically to the facial and the lingual
line angles to provide additional space for the retentive arms and minor connector. Inadequate
clearance in these areas will result in occlusal interferences with the opposing teeth and/or
inadequate thickness and strength of framework. Care must be taken to ensure all line angles are
smoothed.

2. Lingual Rest Seats

Lingual or cingulum rests on anterior teeth are often utilized when no posterior teeth are
present or when indirect retention is necessary. The anterior tooth most readily adaptable
to a cingulum rest is the canine, due to its well-developed cingulum. When a canine is not
available, the cingulum of an incisor may be used. In some instances, multiple rests spread
over the cingula of several teeth may be required, in order to minimize stress on the teeth.
Root form, root length, inclination of the tooth, and the crown-root ratio must be
considered in the planning for the use of such rests.

Cingulum Rest Seat Form

a. The rest seat, from the lingual aspect assumes the form of a broad inverted "V'
maintaining the natural contour often seen in the canine cingulum. From the incisal
view the rest seat is broadest at the central aspect of the canine (approximately 1
mm). The proximal view demonstrates the correct angulation of the floor of the rest
seat (< 90°). The borders of the rest seat are slightly rounded to avoid sharp line
angles in its preparation. As with occlusal rest seats, a preparation will test as
‘positive’ if an explorer tip does not slip off the rest seat when pulled lingually from
the base of the rest seat.
Rests and Rest Seats - 28

Correct Preparation

The cingulum rest seat should be prepared in the bulk of the cingulum to minimize tooth
reduction. The cavosurface should be less than 90° to prevent orthodontic movements of the
tooth.
Preparation Too High

If the preparation is started too high above the cingulum proper, much of the lingual surface
of the tooth above the cingulum will need to be reduced, in order to obtain sufficient width
for support. On maxillary anteriors, this may also cause the rest to interfere with the
opposing tooth.
Preparation Too Low

If the preparation is started too low, much of the cingulum will need to be reduced, in order
to obtain sufficient width for support. Enamel is thinner in this area, and preparation could
result in dentinal exposure, resulting in sensitivity. If correction of the outline form or depth
is required, there will be little tooth structure remaining to make such changes.
 Rests and Rest Seat - 29

b. Care must be taken not to create an enamel undercut that would interfere with the
placement of the denture. A medium or large diameter cylindrical fissure bur should
be utilized approaching along the long axis of the tooth. Approach from a horizontal
direction will often result in creation of an undercut incisal to the rest seat.

Correct Incorrect

A rest placed on an unprepared cingulum results in force being applied in a labial

direction. Orthodontic movement will occur with osteoclastic activity around the
centre of rotation of the root. A rest seat prepared in the cingulum of the tooth results
in the forces being directed along the long axis of the tooth.

The following factors should be considered prior to the preparation of a cingulum rest seat on a
natural tooth:

1. The prominence and shape of the natural cingulum. Cingulum rest seats must be placed in
sound tooth structure or restorations. Where the ideal position of the rest seat would be
upon an amalgam restoration it is advisable to select a different tooth surface or replace the
restoration with an onlay or crown, since the flow characteristics and relatively low yield
strength of the material make the possibility of fracture high. Where the cingulum is not
prominent or when preparation might encroach upon the pulp, other means of securing a
lingual rest seat must be considered (i.e. selection of a different tooth, use of a composite
bonded rest seat, onlay, crown etc.)
Rests and Rest Seats - 30

2. The interocclusal relationship of a maxillary tooth with the incisal edge of the opposing
mandibular tooth when the former will be prepared for a cingulum rest. When a deep
vertical overlap exists, care must be taken to ensure that the mandibular tooth does not
prematurely contact the area of the planned metal framework. Mounted diagnostic casts
should be used to assess this relationship, by drawing a line on the lingual surface of the
maxillary abutment, where the mandibular tooth touches when the models are in contact
with each other. The cingulum rest seat preparation should be 1.5-2.0 mm below this line
to allow for adequate framework strength.

Correct Incorrect

Composite Buildups for Cingulum Rests:

When a cingulum is poorly developed, with insufficient bulk for preparation for a cingulum rest
seat, a rest seat can be made using composite resin. Research has demonstrated that these
"bonded rest seats" can provide acceptable strength and longevity.

The cervical portion of the buildup should have a flat emergence profile (not over contoured)
with bulk increasing toward the incisal. Enamel should be pumiced, rinsed, etched, bonded, in a
relatively dry, isolated environment. Care must be taken to ensure the cervical composite is well
adapted and that most of the form is finalized prior to curing. The bonded rest seat should be
smooth and well polished, with no sharp line angles.

Composite Bonded Rest Seat Form

 Rests and Rest Seat - 31

Round Lingual Rest Seat Form

Round rest seats are occasionally prepared on the mesial of the canine teeth when the use of a
typical cingulum rest is contraindicated (i.e. large restoration, lack of clearance with the
opposing teeth, poorly developed cingulum). These rest seats are prepared spoon shaped, similar
to an occlusal rest seat, with reduction of the mesial marginal ridge. However, preparation is
more difficult due to the incline of the lingual surface of the canine and more tooth structure
must often be removed. Round lingual rest seats can be easily incorporated into crowns where
there is usually sufficient linguo-proximal reduction, without the problem regarding exposure of
dentin. Use care to ensure that no undercuts are prepared in relation to the path of insertion
if a round bur is used.

3. Incisal Rests

Incisal rests are inferior to lingual rests both mechanically and esthetically. Normally they
should not be used unless it is impossible to place a lingual rest seat or a composite bonded
rest seat.

a. An incisal rest seat is usually placed on the mesio- or disto-incisal angle of the incisor
teeth with the deepest portion towards the centre of the tooth. It is predominantly
used as an auxiliary rest or an indirect retainer.

b. It is usually used on the mandibular incisor where the lower lip can cover, as much as
possible, the metal of the rest that shows at the incisal edge.

Mechanically, a lingual rest is preferable to an incisal rest, because the lingual rest is
placed nearer to the center of rotation of the tooth and therefore, will have less tendency to
tip the tooth.
Major Connectors - 32

Major Connectors

Definition

The unit of a removable partial denture that connects the various parts of the denture. Its
principal functions are to provide unification and rigidity to the denture.

Functions of a Major Connector

1. Unification
A major connector units all other components of a partial denture so that the partial denture
acts as one unit.

2. Stress Distribution

By unifying all elements of a partial denture the major connector can distribute functional
loads to all abutment teeth, so that no one abutment is subjected to extreme loading.
Unification of the direct retainers with the denture bases aids in distributing forces between
both the teeth and the mucosa. This is particularly important in Class I and II partial
dentures. In some maxillary cases a major connector with broad palatal contact is selected.
In these situations the broad base offers additional support, distributing stress over a larger
area.

3. Cross-Arch Stabilization (Counterleverage)

By uniting one side of the arch to the other bracing elements on one side of the arch can aid
in providing stability to the other. This can aid in dissipating twisting and torquing forces.

Requirements of a Major Connector

1. Rigidity

Rigidity is necessary to ensure that the partial denture functions as one unit. If the denture
flexes, stress distribution and cross arch stabilization can be compromised since different
portions of the denture can move independent of the others. A major connector can be
made more rigid by:

a. using a more rigid alloy (Chrome-cobalt > gold alloys; cast > wrought metal)
b. using a 1/2 round or 1/2 pear shaped bars (more rigid than flat bars)
c. increasing the bulk as the length increases
d. corrugating linguo-plate or rugae areas.

2. Non-Interference with the Soft Tissues

Major connectors should not enter into undercut areas unless tissue impingement can be
avoided by changing the selected path of insertion or by using minor undercut blockout. In
addition, connectors should not end on the crest of rugae or at the free gingival margin. If
terminated in these areas, it is possible that movement of the connector could cause tissue
 Major Connectors - 33

impingement that could compromise blood flow. Major connectors should be placed as
far

from the free gingival margin as possible and practical. Where it is necessary to cross
the gingival margin (i.e. with a minor connector), it should be done abruptly and
perpendicular to the margin. In addition, a small amount of relief is used over the area
where crossing occurs, in order to minimize impingement.

Other areas of potential tissue impingement are the various hard structures such as the mid-
palatal suture or mandibular tori. Where it is necessary to cross these areas, relief should
be used so that the connector does not fulcrum on them during movement.

Soft tissue movements during function must also be allowed. Of particular importance are
the mandibular lingual frenum and the maxillary movable soft palate. Before a partial
denture design is finalized, the clinician should make a careful examination of the
mouth to ensure the selected major connector will not interfere with any of these
anatomical structures.

3. Food Impaction

This can be minimized by locating the margins of the connectors at the prescribed distance
from the free gingival margin and by taking care that the presence of minor connectors,
clasp arms and major connectors does not create "traps" or large concavities where food
can collect.

4. Unobtrusive

The margins of the major connector should have a smooth transition from connector to
tissue so as to minimize the obtrusiveness. All line angles and edges should be smooth and
rounded. Borders should not be placed in locations where they might interfere with
speech. Bulk should be reduced enough so as not to interfere with speech or appearance,
yet thick enough to ensure rigidity.

I. Mandibular Major Connectors

A. Lingual Bar

This is the most commonly used mandibular major connector. It should be used whenever
possible unless there are advantages that can be obtained from another connector. Such
situations are rare.
1. Shape
- flat on tissue side
- convex or tear-drop on tongue side

(1/2 pear shape, with thin edge toward teeth)

2. Size
- occluso-gingival width = 4 to 6 mm.
- thickness = l.5 to 2 mm.
Major Connectors - 34

3. Position

- The inferior border should be as low as the lingual frenum and tissue reflections of
the floor of the mouth will permit, as determined by observing functional
movements of the tongue.

- The superior border should be l.5-2.0 mm or more below the free gingival
margin. For hygienic reasons the superior border should still be kept as far from
the gingival margin as possible.

- In distal extension cases there will be some tissue-ward movement of the lingual bar
as the denture base moves during function. If bone loss occurs over the edentulous
ridges, this movement can become more pronounced and this will cause the lingual
bar to impinge upon the lingual tissues. To eliminate the lingual bar from impinging
the soft tissues, a wax spacer (relief) of one thickness of 30 gauge wax is placed
under the major connector when it is being waxed for casting.

Note the anterior portion of the major

connector moves forward as the
posterior portion is loaded and rotates
around the rest. If relief is not
provided, impingement occurs.

B. Lingual Plate (Linguoplate)

The lingual plate consists of a lingual bar plus an

extension over the cingula of anterior teeth. This
mandibular major connector should only be considered in
those rare instances where a lingual bar cannot be used.
Most often, this occurs when there is a high floor of the
mouth, a prominent lingual frenum or lingual tori that
would be impinged upon by a lingual bar, if it was made
with adequate height and distance from the free gingival
margin.
The lingual plate has also been advocated for extensive distal extension cases with severe
vertical resorption of ridges (i.e. little resistance to horizontal rotational tendencies). In these
cases the major connector could provide some additional stability. The lingual plate has been
advocated for use to reduce heavy calculus formation or to stabilize mobile anterior teeth.
However, the plate usually does not reduce mobility, other than stabilizing the teeth during
function. Mobility per se is not a problem unless it is increasing (i.e. pathological process
continuing). Since mobility is often related to periodontal bone loss and since the plate
complicates hygiene by closing the lingual opening of the embrasure spaces, this connector
actually may be contraindicated when mobile teeth are present. When large diastemas are
present, the lingual plate may show through the embrasure spaces.
 Major Connectors - 35

A vertical stop or rest area must be prepared at each end of the anterior segments of the lingual
plate. This prevents excessive forces being directed facially by movements of the distal
extension
base. Any areas where the connector crosses the gingival tissue must be relieved to prevent
impingement caused by the movement of the lingual plate.

C. Continuous Bar Retainer (Kennedy Bar, Double Lingual Bar)

The connector consists of a lingual bar plus a secondary bar
resting above the cingula of the anterior teeth. The
secondary bar supposedly acts as an indirect retainer and
performs a role in the horizontal stabilization of
periodontally-involved teeth. The performance of these
functions is questionable. Additionally, this major
connector can create a food trap between the two bars. The
use of this type of connector is not encouraged.

D. Labial Bar

Where extreme lingual inclination of the remaining teeth is

present and no reasonable way exists to use a lingual bar
without interfering with tongue movements, a labial bar
may be used. It is essentially similar to the lingual bar and
the same rules apply for its use. Indications for it are
extremely rare. The swing-lock design is a variation of the
labial bar.

II. Maxillary Major Connectors

Major connectors in the upper arch should terminate 4.0 mm or more from the gingival crest
tissues.

A. Anterior-Posterior Palatal Strap

The anterior-posterior palatal strap provides
maximum rigidity and minimum bulk. The strength
of this connector lies in the fact that the anterior and
posterior sections are joined together by longitudinal
connectors on either side. Each component braces
the other against possible torque and flexure. It can
be used in most maxillary partial denture designs and
is especially useful in cases with a torus palatinus.

A variation of the double palatal strap is the anterior-posterior palatal bar connector where the
palatal connector elements are narrower anterio-posteriorly. Due to the narrowness of the
elements, the bars must have greater bulk for rigidity, and thus the design is more objectionable
to the patient. In addition, strap connectors provide greater distribution of stresses to the palatal
tissues since a greater surface area is contacted.
Major Connectors - 36

B. Full Palatal Plate

The full palatal plate is particularly indicated when maximum

tissue support is required. In particular it should be the major
connector of choice in long distal extension cases or where
six or less anterior teeth remain. It should be selected where
the primary abutments are periodontally involved, requiring
maximum stress distribution. Where the edentulous areas are
covered with flabby tissue or where there is a shallow palatal
vault this connector also provides greater stability and stress
distributing characteristics. The full palatal plate is usually
not used in the presence of torus palatinus.

The full palatal connector should be fabricated of a uniformly thin metal plate with accurate
anatomic reproduction of the rugae configuration (improves strength and rigidity). It should
cover the same area as a complete denture posteriorly. The large surface area of contact with the
mucosa improves the potential for retention.

Connectors of this type are generally of cast metal. However an acrylic resin plate may be used
in interim prostheses.

C. Palatal Strap (or Bar)

This type of connector can be wide (strap) or narrow (bar)

depending upon its location or the need for strength or
support of the denture. The palatal bar should only be used
in tooth supported cases where no other connector can be
used. It is usually objectionable due to its bulk. It should
never be used in cases involving distal extensions or
replacement of anterior teeth since it must be made to bulky
for rigidity.

The palatal strap is similar, but with a broader area of contact, providing better stabilization and
stress distributing properties with minimum bulk. Therefore it is preferable to the palatal bar for
posterior tooth supported cases. However, other connectors should be chosen if there is a large
torus or if many teeth are being replaced.

Relief may be required over bony midline areas in some instances to prevent fulcruming over the
overlying soft tissue. In these cases one thickness of 28 gauge wax relief should be placed over
the midline.
 Major Connectors - 37

D. Anterior Palatal Plate (U-Shaped Or "Horse-Shoe" Palatal Connector)

From a biomechanical standpoint the palatal horseshoe is a

poor connector and should never be used unless
absolutely necessary. To be rigid, the horseshoe connector
must have bulk in the rugae area where the tongue requires
freedom. Without sufficient bulk the U-shaped design
becomes flexible and allows movement posteriorly. In distal
extension partial dentures where posterior tooth support is
nonexistent, movement is particularly noticeable and is
traumatic to the residual ridge causing continual irritation
during function.

The anterior palatal plate should only be prescribed where the torus palatinus prohibits the use of
other connectors.
Minor Connectors - 38

Minor Connectors

Definition
A unit of a partial denture which connects other components (e.g. direct retainer, indirect
retainer, denture base, etc.) to the major connector.

Functions
1. Provide unification and rigidity
2. Provide stress distribution by transferring stresses from the major connector to other parts
of the partial denture and from the partial denture to the abutment teeth
3. Act as bracing elements through contact with guiding planes opposing the retentive arms.
4. Maintain a path of insertion via contact with guiding planes

Basic Types of Minor Connectors:

a. Minor connectors placed into embrasures between two adjacent teeth. These
connectors should be somewhat triangular shaped in cross section to minimize intrusion
into the tongue or vestibular spaces, while still providing adequate bulk for rigidity (a). A
minor connector should join the major connector at a right angle and cover as small an area
of tissue as possible (b). The juncture to the major connector should be rounded (arrow)
not sharp (X) unless the juncture includes an acrylic finish line. Relief should be placed on
the master cast so that the minor connector does not lie directly on the soft tissue (c).

A minor connector should fill the embrasure space so that a smooth surface is presented to
the tongue and so that areas where food can be trapped are minimized. Ideally, a minor
connector should not contact the teeth gingival to the height of contour. If a minor
connector fits tightly against an abutment below the height of contour, a wedging force
may be created during functional movements of the framework. This wedging can result in
increased tooth mobility. Alternatively, it may be difficult to seat or unseat the framework.

b. Gridwork minor connectors that connect the denture base and teeth to the major
connector. These minor connectors are adjacent edentulous spaces and usually connect
the major connector to a clasp assembly as well. Gridworks can be an open lattice work or
mesh type. The mesh type tends to be flatter, with more potential rigidity. Conversely the
mesh has been shown provide less retention for the acrylic if the openings are insufficiently
large. The lattice type has superior retentive potential, but can interfere with the setting of
teeth, if the struts are made too thick or poorly positioned. Both types are acceptable if
correctly designed.
 Minor Connectors - 39

Mesh Gridwork Lattice Gridwork

Adequate mechanical retention of the denture base resin is gained by providing relief under
the minor connector gridwork to allow the acrylic resin to flow under the gridwork. To
allow for this space, relief wax is placed on the cast in the edentulous areas prior to making
a refractory cast (for fabricating the framework). Usually one thickness of baseplate wax is
sufficient (about 1 mm of relief). After the framework has been waxed and cast on the
refractory model and returned to the master cast, the space provided by the relief wax is
available for the mechanical retention of the acrylic resin.

Relief under the gridwork should not be started immediately adjacent to the abutment
tooth but should begin 1.5 - 2 mm from the abutment tooth. This will create a metal to
tissue contact immediately adjacent to the tooth. A metal surface is preferable since it
wears less, and is less porous, thus facilitating hygiene.

metal immediately adjacent to tooth incorrect (acrylic of base is adjacent tooth)

Minor Connectors - 40

The junction of gridworks to the major connector should be in the form of a butt joint with a
slight undercut in the metal. The angle formed by the metal at this juncture must not be greater
than 90 degrees. This provides for maximum bulk of the acrylic resin denture base at the metal
junction, to prevent the creation of thin, weak, feather edges which can easily fracture or distort.

Minor connectors originating from the gridwork in an edentulous area usually take the form of
vertical metal plates (proximal plates) that make broad contact with prepared guiding planes.
These proximal plates may or may not terminate in an occlusal rest, depending on the partial
denture design. The plate is shifted slightly towards the lingual to increase rigidity, enhance
reciprocation and improve esthetics.

When the guiding plate type of minor connector makes contact with proximal guiding planes,
there is often a triangular space below the guiding plane (an undercut). Because the minor
connector must be rigid, it must not be allowed to contact the tooth in this undercut area.
Therefore, the technician will artificially block out these undercuts prior to waxing and casting
the framework to ensure the casting will not be placed below the height of contour. Blockout
wax is placed in these area and trimmed parallel with the path of insertion using the wax trimmer
in a surveyor, and the cast is duplicated in refractory material, before the framework design is
placed on the cast. Because this blockout does not deviate in inclination from the selected path
of insertion, it is referred to as a zero degree blockout. Instructions to the laboratory should
note “Use zero degree blockout”.
 Minor Connectors - 41

Gridwork Design

The gridwork on a mandibular distal extension should extend about 2/3 of the way from
abutment tooth to retromolar pad but not on the ascending portion of the ridge mesial to the pad.

Maxillary distal extension gridworks should extend at least 2/3 of the length of the ridge to the
hamular notch. However, the junction or finishing line of the maxillary major connector should
extend fully to point to the hamular notch area so that the acrylic resin base can be extended into
this area and provide a smooth transition from the connector to the base. The junction of
maxillary major connector with the gridwork should be approximately 2 mm medial to an
imaginary line along the lingual surfaces of the replacement denture teeth. This ensures a bulk
of acrylic surrounding the replacement denture teeth to provide adequate bond to the denture
base.

Mandibular distal extension gridworks should have a “tissue stop” at their posterior limit. This
is an extension of the metal through the relief wax providing direct contact with the ridge.
Minor Connectors - 42

When the denture is flasked for processing, only the gridwork is left exposed after the wax
removal. If there is no “tissue stop”, the framework can be bent or displaced during the pressure
packing of the mold with stiff doughy acrylic resin. If this occurs, the framework could resume
its normal shape after deflasking, and the denture would subsequently lift off the tissue. Rocking
of the denture base and clasp apparatus would result, and the occlusion would be high. A tissue
stop, in theory, prevents framework deformation and its consequences.

The denture teeth are embedded in investment in one

half of the processing flask, the framework is
embedded in the other, with acrylic resin in between
(note the absence of a tissue stop).

Closure of the flask under hydraulic pressure can

causes distortion of the framework, pushing it
tissueward.

Placement of the finished denture in the mouth (note lack

of tissue contact due to rebound of the distorted
framework).
 Direct and Indirect Retainers - 43

Direct and Indirect Retainers

I. Retention

Retention is the ability of a removable partial denture to resist dislodging forces during function.
Retention depends upon several factors:

a. adhesion, cohesion, interfacial surface tension and atmospheric pressure

b. gravity
c. frictional retention (guiding planes, bracing elements)
e. indirect retention
f. direction of dislodging force relative to the path of placement.
g. mechanical retention

Mechanical Retention

Mechanical retention is obtained by placing portions of the partial denture into tooth or soft
tissue undercuts. Maximizing the other retentive factors can minimize the need for mechanical
retention.

Most mechanical retention is derived from the use of direct retainers (clasp assemblies) utilizing
tooth undercuts. There are two classes of mechanical retainers: intracoronal and extracoronal.

Intracoronal retainers (precision attachments) are mechanical devices set into the casting of a
full crown. These are generally reserved for removable partial denture therapy that requires
exceptional effort in producing ideal esthetics. There are many contraindications and
disadvantages to precision attachments.

Extracoronal retainers engage an external surface of an abutment in a natural undercut or in a

prepared depression. There are two main classes of clasps: 1) those that approach the undercut
from above the height of contour (suprabulge retainers) and 2) those that approach the undercut
from below (infrabulge retainers).

II. Extra-Coronal Direct Retainers

Definition - A direct retainer is a unit of a removable partial denture that engages an abutment
tooth in such a manner as to resist displacement of the prosthesis away from basal seat tissues. It
is usually composed of a retentive arm, a reciprocal (bracing) element or arm, a rest and a minor
connector.

Retention is derived by placing a clasp arm into an undercut area so that it is forced to deform
upon vertical dislodgment. Resistance of the clasp to deformation generates retention.
Resistance is proportionate to the flexibility of the clasp arm. Non-flexible portions of clasp
arms must be placed occlusal to the height of contour (suprabulge area).
Direct and Indirect Retainers - 44

Requirements of Direct Retainers

All clasp assemblies should meet the following requirements:

1. Support - resistance to gingival displacement (occlusal rests)

2. Reciprocity - resistance to orthodontic movement of teeth using reciprocal arms or
elements placed against guiding planes. During placement and removal of the partial
denture the retentive arm flexes over the height of contour and generates energy. At this
point the rigid reciprocal arm should contact the guiding plane and prevent orthodontic
movement from taking place.
3. Stability - resistance to lateral movement (reciprocal arms, minor connectors)
4. Retention - retentive arms located in undercuts on the abutments
5. Encirclement of greater than 180° of the tooth - prevents the prosthesis from moving
away from the tooth

6. Passivity - at rest, a direct retainer should not exert force against a tooth

Wherever possible direct retainers should be selected to fit the existing teeth. This is preferable
to preparing teeth to fit a particular clasp design. It may be possible to select a different clasp
design to meet the retentive requirements for a partial denture. Nonetheless, judicious tooth
preparation should not be avoided at all costs, since it can immeasurably improve prosthesis
biomechanics.

Factors affecting the magnitude of retention

1. Size of the angle of convergence.

 Direct and Indirect Retainers - 45

2. How far into the angle of convergence the clasp terminal is placed.

When the angle of convergence between two

abutments differs uniformity of retention can be
obtained by placing the clasp arms into the same
degree of undercut (i.e. both .01"). A guiding
principle of partial denture design is that retention
should be uniform in magnitude and bilaterally
opposed amongst abutments.

3. Flexibility of the clasp arm. This is influenced by the following factors:

i. Length

c. increased length increases flexibility (increasing clasp curvature increases length

d. length is measured from the point where the taper begins
e. length may be increased by using curving rather than straight retentive arms

ii. Diameter
" diameter is inversely proportional to flexibility
" in a uniform taper the average diameter lies midway
" if the taper is not uniform a point of flexure will exist at the narrowed
" area, weakening the clasp arm (possible fracture area)
" the point of flexure determines flexibility regardless of average diameter
A narrowing of the clasp arm
creates a point of flexure which
weakens, and affects the
flexibility of the clasp, since
flexure begins at this point

iii. Cross-sectional form

a. round forms are usually more flexible (wrought or cast)
b. l/2 round shape is limited to flexure in only two directions (cast)

iv. Clasp material

a) with cast alloys flexibility is inversely proportional to bulk
b) gold clasps are not as flexible or adjustable as wrought wire
c) wrought wire clasps have greater tensile strength than cast clasps and hence
can be used in smaller diameters to provide greater flexibility without fatigue
or fracture
Direct and Indirect Retainers - 46

Direct Retainers For Tooth-Borne RPD’s

Clasps for tooth-borne partial dentures (Class III, IV) have one function – to prevent
dislodgment of the prosthesis without damage to the abutment teeth. Since there is little or no
rotation caused by tissueward movement of the edentulous area (as happens in distal extension
cases) stress releasing properties are usually not required. These clasps can also be used in
modification spaces for tooth and tissue supported removable partial dentures (Class I, II).

1. Circumferential (Circle or Akers) clasp

a. the most simple and versatile clasp

(clasp of choice in tooth-borne cases)
b. clasp assembly has one retentive arm opposed by a reciprocal
arm originating from the rest

c. the retentive arm begins above the height of contour, and

curves and tapers to its terminal tip, in the gingival 1/3 of the
tooth, well away from the gingiva
d. the bracing arm is in the middle 1/3 of the tooth, and is
broader occluso-gingivally, does not taper and is either
entirely above the height of contour or completely on a
prepared guiding plane – it should never be designed into an
undercut, as it is a rigid element.

Advantages:
a. Excellent bracing qualities
b. Easy to design and construct
c. Less potential for food accumulation below the clasp compared to bar clasps

Disadvantages:
a. More tooth coverage than bar clasps
b. More metal is displayed than with bar or combination clasps
c. Adjustments are difficult or impossible due to the half round nature of the clasp

A direct retainer should be designed with its elements in the proper positions and in the
correct proportions. If the height of contour is incorrect for placement of the arms of the
direct retainer, the heights of contour and NOT the direct retainer should be altered (i.e.
perform abutment modifications – don’t distort the design of the direct retainer)
 Direct and Indirect Retainers - 47

2. Ring clasp
a. Encircles nearly the entire abutment tooth
b. Usually used with mesially and lingually
tilted mandibular molars (with a m-l
undercut) or mesially and buccally tilted
maxillary molars (with a m-b undercut)
c. The undercut is on the same side as the
rest seat (i.e. adjacent to edentulous span)
d. Should always be used with a supporting
strut on the non-retentive side with an
auxiliary occlusal rest on the opposite side. Omission of the supporting strut will allow
the clasp arm to open and close with minimum or no reciprocation.
e. Use a cast circumferential clasp with lingual retention and buccal bracing, in preference to
a ring clasp whenever possible, unless a severe tilt of the tooth will not permit

Advantages:
a. Excellent bracing (with supporting strut)
b. Allows use of an available undercut adjacent to edentulous area

Disadvantages:
a. Covers a large area of tooth surface, therefore requiring meticulous hygiene
b. Very difficult to adjust due to the extreme rigidity of the reciprocal arms
c. The lower bracing arm should be at least 1 mm from the free gingival margin and
relieved to prevent impingement of the gingival tissues.

Contraindications: excessive tissue undercuts prevent the use of a supporting strut.

3. Embrasure (Double Akers) Clasp

! Used in a quadrant where no edentulous area exists, or
where a distal approach clasp cannot be used on the most
posterior tooth (i.e. No usable retentive undercut).
! Two rests, two retentive arms, and two bracing arms
! Double rests with definite shoulders to prevent weakening
of clasp arms, separation of teeth and food impaction
! Buccal and lingual proximal areas must be opened (i.e.
Blend with axial contours, reduce height of contours,
round occluso-axial line angles)
! Use minimum retention – prone to distortion
! Use with discretion – use another clasp if possible

Advantages:
a. Allows placement of direct retainer where none could otherwise be placed (especially
contralateral to the edentulous span on a Class II case)

Disadvantages:
a. Extensive interproximal reduction is usually required
b. Covers large area of tooth surface - hygiene considerations
Direct and Indirect Retainers - 48

4. "C" clasp (Hair-pin or Reverse action)

a. The retentive area (undercut) is adjacent the
occlusal rest.
b. The upper arm is a minor a connector giving
rise to tapered lower arm.

Advantages:
a. Allows use of undercut adjacent to edentulous space

Disadvantages:
a. Almost impossible to adjust
b. Non-esthetic
c. Difficult to fabricate so the upper portion of the retentive arm clears the opposing
occlusion
d. Covers extensive tooth surface and acts as a food trap
e. Insufficient flexibility on short crowns due to insufficient clasp arm length

Cast suprabulge clasps should be used in most tooth borne cases. Exceptions to this rule include:

1. Esthetic concerns. Since wrought-wire clasps can be placed into greater undercuts
(0.02") than cast clasps (0.01") they can be placed lower on teeth, allowing better
esthetics in some cases. Infrabulge clasps are also less visible.
2. Where a posterior abutment is mobile or of questionable prognosis, the treatment
plan could call for the use of the stress-breaking qualities of a wrought clasp on the
anterior abutment. This would allow the prosthesis to be converted into a distal
extension type if the weak posterior abutment should be lost.
3. Where abutments are mobile, the tooth borne segment is extensive, the use of the
stress-breaking clasps should be considered.

Disadvantages of cast suprabulge clasps:

1. Create a "pump-handle" action on the abutment teeth in distal extension cases if the
guiding plane on the distal surface is too long, with insufficient relief.
2. Some clasps can be ineffective on teeth tilted buccally or lingually
3. Some varieties cover more tooth surface than is desirable
4. Poor esthetics in the anterior region

There have been many modifications to cast suprabulge clasps. Some are too complex and
impractical for common use.
 Direct and Indirect Retainers - 49

Direct Retainers For Tooth and Tissue Borne RPD's

Tooth and tissue borne situations (Class I & II) require special attention in direct retainer
selection, due to stresses created by rotational movements of the prostheses. When the denture
bases are placed under function, rotation occurs about the rest seats of the most posterior
abutments. Excessive occlusal forces on the distal-extension portion of the denture could cause
a torquing action on the abutment teeth unless direct retainers are designed with stress-breaking
capabilities. Stress releasing clasp assemblies include:

1. the bar clasp with mesial rest (e.g. RPI)

2. the RPA clasp
3. the combination clasp

1. Bar Clasps

a. The bar clasp is a cast clasp that arises from the partial denture framework and approaches
the retentive undercut from gingival direction (as opposed to a circumferential clasp that
approaches the undercut from the occlusal direction).
b. Retentive clasps are identified by shape of retentive terminal, i.e. T, Y, L, I, U, and S.

c. The shape is unimportant as long as the direct retainer is mechanically and functionally
stable, covers minimal tooth structure with minimum display (the I bar most often meets
these requirements)
d. T-and Y-shaped terminal ends are the most misused clasps. The full area coverage of the T
and Y terminal ends is rarely necessary for adequate retention.
e. L-shaped clasp is same as an I clasp with a longer horizontal component. The U-shaped
clasp is same as an L-shaped clasp with a terminal like a double I-clasp.
f. The S-shaped terminal end is used to avoid a mesial soft tissue undercut.
g. Soft tissue relief is provided under the approach arm with 28 or 30 gauge wax, to prevent
tissue impingement

Contraindications:
a) deep cervical undercuts - food trap or impingements result
b) severe soft tissue or bony undercuts - food trap or impingements result
Direct and Indirect Retainers - 50

c) insufficient vestibular depth for approach arm (requires 4 mm - 3 mm from free

gingival margin, 1 mm for thickness of the approach arm)
d) pronounced frenal attachments in area - impingement

The R-P-I Clasp

1. The components of this clasp assembly are:

"R" - rest (always mesial)

"P" - proximal plate
"I" - I-bar (retentive arm)

2. The rest is located on the mesio-occlusal surface of a premolar or mesiolingual surface of a

canine. The minor connector is located in the mesio-lingual embrasure but is not in
contact with the adjacent tooth (prevents wedging).

3. The proximal plate (essentially a wide minor connector) is located on a guide plane on the
distal surface of the tooth. The superior edge of the proximal plate is located at the bottom
of the guide plane (at approximately the junction of the occlusal and middle third of the
guide plane). The proximal plate extends lingually so that the distance between the minor
connector and the proximal plate is less than the mesio-distal width of the tooth. The plate
is approximately l mm. thick and joins the framework at a right angle.

4. The I-bar clasp is located on the buccal surface of the premolar and on the mesio-buccal
surface of the canine. The I-bar originates at the gridwork and approaches the tooth from
the gingival direction. The bend in the I-bar should be located at least 3 mm. from the
gingival margin. This distance will prevent food entrapment and provide the length for the
 Direct and Indirect Retainers - 51

necessary flexibility in the clasp arm. The clasp is usually cast and is placed just below the
height of contour line.

5. On premolars, the proximal plate should extend lingually so that the distance between
the proximal plate and the mesio-occlusal rest is less than the mesio-distal width of
the tooth. The proximal plate in conjunction with the mesial rest (and minor connector)
acts as the reciprocating element of the clasp and prevents the lingual migration of the
tooth when the clasp arm moves over the height of contour.

6. On cuspids, the minor connector cannot be used for reciprocation since it does not contact
the tooth until after the retentive element has passed across the height of contour and the
partial denture is seated. This is because the mesio-lingual rest is located fairly low on the
cingulum of the tooth. Therefore, the I-bar is located in the mesio-buccal undercut and
is reciprocated directly by the proximal plate.

7. The guiding plane is a parallel surface prepared on the occlusal one third of the distal
surface of the tooth. The guiding plane extends lingually enough so that, along with the
mesial rest, it can prevent lingual migration of the tooth. It is approximately 2 to 3 mm in
height.
Direct and Indirect Retainers - 52

Contraindications to the R.P.I. Clasp

1. Insufficient depth of the vestibule. (The inferior border of the I-bar must be located at least
4 mm. from the gingival margin.)
2. No labial or buccal undercut on the abutment
3. Severe soft tissue undercut
4. Disto-buccal undercut (less than 180° encirclement)

2. RPA Clasp

This clasp assembly is similar to the RPI design except a wrought

wire circumferential clasp (Akers) is used instead of the I-bar. This
clasp arises from the proximal plate and terminates in the mesio-
buccal undercut. It is used when there is insufficient vestibule
depth or when a severe tissue undercut exists.

3. Combination Clasp

The combination clasp is similar to the cast circumferential clasp

with the exception that the retentive arm is fabricated from a
round wrought wire (platinum-gold-palladium alloy or chrome-
cobalt alloy).

a. a cast reciprocal arm.

b. the wrought wire is flexible (round form)
c. more adjustable than cast or 1/2 round forms
d. better esthetics (due to its round form and smaller
diameter - 18 gauge)
e. can used with a mesial or buccal undercut
f. can be placed in 0.02" undercut due to its flexibility
(allows lower placement for better esthetics)
g. can be used in tooth borne cases as described earlier
h. for best results, the wire should be soldered remotely to the framework so it is not
overheated, which would cause recrystallization of the metal and loss of flexibility. If wrought
wire clasps are cast into the framework, a low heat chromium alloy should be used to avoid
recrystallization as well

The Distal Rest Concept

The proponents of the mesial rest concept (i.e. RPI, RPA designs) believe that the use of the
clasp assembly with a disto-occlusal rest (in a distal extension case) could lead to distal tilting
and possible loss of the abutment tooth. However, if correctly designed and executed, the distal
rest concept is as viable a treatment alternative as the mesial rest concept.

The premise of the mesial rest concept is that during vertical loading the distal extension base
causes the I-bar to move mesio-gingivally away from the tooth and the proximal plate to move
further into the undercut of the tooth.
 Direct and Indirect Retainers - 53

The I-bar and the proximal plate disengage the abutment tooth and thereby reduce torquing of
the tooth. This is an accurate deduction. Therefore the RPI design be used wherever possible.

However, an I-bar cannot be used routinely due to the fact that a tissue undercut frequently exists
in the region of the abutment.

A distal rest concept has drawbacks if designed incorrectly. If the guiding plane on the distal
surface of the abutment covers the entire length of the tooth, loading of the denture base will
cause the minor connector contacting the guiding plane to act as a "wrench" and torque the tooth.

However, if a short guiding plane is prepared with a relief area between the converging surface
of the tooth and the minor connector, the distal tilting of the abutment can be prevented or
minimized. During distal loading, the minor connector could move into the relief area and the
rest would be permitted to escape from the rest seat. This would change the fulcrum point from
point A to point B, driving the abutment tooth mesially against adjacent tooth.

However, if the retentive arm is place into a mesiobuccal undercut, torquing might still occur,
since the retentive tip would tend to rotate in an occlusal direction, thereby engaging the tooth.
To minimize the activating effect of the retentive arm, a wrought wire arm should be used
(greater flexibility, less ability to torque). In addition and where possible, the retentive undercut
should be place in the mid-buccal of the tooth, with the mesial clasp tip placed above the height
of contour. Thus occlusal movement of the clasp tip will disengage rather than engage the tooth.
Similarly, lingual bracing arms should not be carried too far into embrasures in distal extension
cases, since tissueward movement could also result in torquing forces being placed on the
abutments.
Direct and Indirect Retainers - 54

If the distal rest retainers are correctly designed, they can be just as effective and safe as the
mesial rest retainer.
 Direct and Indirect Retainers - 55

Direct Retainer Selection

Selection is based on:
1. Position of tooth undercuts, restorations, occlusion, classification of edentulous arch, tooth
type
2. Nature of the bony and soft tissue support. Is there an unfavourable:
a) bony undercut
b) frenal attachment
c) vestibular depth
3. Esthetics

Direct Retainer Choices

- Kennedy Cl III & IV (Tooth Borne)

-
- – Clasp of choice: cast circumferential
- if can’t use cast circumferential next to edentulous space, use double embrasure
clasp
- if abutment is severely tilted use (depending on location of undercut):
! Cast circumferential clasp with lingual retention
! Ring clasp with support strut
! Rotational path removable partial denture

- Kennedy Cl I & II (Tooth & Tissue Borne)

- For posterior abutments, or any tooth needing stress release:

- Clasp of choice: RPI (mesial rest, distal proximal plate and I-bar)
- If can’t use an I-bar in vestibule, because of
! frenum
! shallow vestibule
! deep soft tissue undercut
then use an RPA retainer (mesial rest, distal proximal plate and wrought wire clasp)
- If can’t use a mesial rest because of:
- rotation
- heavy centric contact on mesial
- - large amalgam restoration on mesial
- then use Combination Clasp (distal rest, buccal ww retention, lingual bracing)
- for abutments adjacent modification spaces (use tooth borne retainers)
- # of direct retainers –, minimum of 2 posterior abutments for Cl. I & II, all abutments for Cl
III, IV to maximum of 4 normally
- if eliminate a direct retainer for esthetics, plan more retention with other features (soft tissue
coverage, longer guiding planes, etc)
Direct and Indirect Retainers - 56

III. Indirect Retainers

Definition: A part of a removable partial denture that prevents rotational displacement of the
denture about the rests of the principal abutment teeth. Indirect retainers usually take the form of
rests, on the opposite side of a fulcrum line.

Vertical movements of distal extension bases can occur in two directions. Movement of a distal
extension base toward the ridge tissues will be proportionate to the displaceability of those
tissues, the fit of the denture base and the load applied. Movement of a distal extension base
away from the ridge tissues will occur via either displacement of the entire denture (resisted by
the direct retainers), or a rotational movement about an axis. This axis passes through rests of
the most posterior abutment teeth and is called the fulcrum line. Most tooth borne partial
dentures do not exhibit rotational movements, due to their extensive tooth support. However,
any Class III or Class IV partial denture that has mobile abutments may exhibit rotational
movements.

The fulcrum line on a Class I partial denture as passes through the rest areas of the most
posterior abutment on either side of the arch (A and B). On a Class II partial denture, the
fulcrum line is always diagonal, passing through the occlusal rest area of the abutment on the
distal extension side and occlusal rest area of the most distal abutment on the other side (C). If a
modification area is present on that side, the additional abutment lying between the two principle
abutments may be used for support of the indirect retainer if it is far enough removed from the
fulcrum line (D). In a Class IV partial denture, the fulcrum line passes through the two
abutments adjacent to the single edentulous space (E and F). In a tooth and tissue supported
Class III partial denture, the fulcrum line is determined by considering the weaker abutment as
nonexistent and that end of the base as being a distal extension (G and H).
 Direct and Indirect Retainers - 57

Rotation of a partial denture about the fulcrum line is prevented by indirect retainers placed
against definite rest seats on the opposite side of the fulcrum line from the distal extension base.
Indirect retainers should be placed as far as possible from the distal extension base so as to gain
the best possible leverage advantage against lifting of the distal extension base.

Although, the most effective location of an indirect retainer is frequently in the vicinity of an
incisor tooth, these teeth may not be strong enough to support an indirect retainer. In addition,
incisors often have steep lingual inclines that cannot be favourably altered to support a rest. In
such cases, the nearest canine tooth or the mesial occlusal surface of the first premolar may be
the best location, despite the fact that it is not as far removed from the fulcrum line.

The factors influencing the effectiveness of an indirect retainer include:

1. Proper seating of the denture. Unless the principle occlusal rests are held in their seats by
the action of the direct retainers, rotation about the fulcrum line will not occur and,
therefore, an indirect retainer cannot act to prevent lifting of the distal extension base away
from the tissues.

2. Distance from the fulcrum line.

3. The rigidity of the connectors supporting the indirect retainer. All connectors must be
rigid if the indirect retainer is to function as intended.

4. The effectiveness of the supporting tooth surface. The indirect retainer must be placed on a
definite rest seat,, on which slippage or tooth movement will not occur. Tooth inclines and
weak teeth should never be used for the support of indirect retainers.

In addition to preventing movement of a distal extension base away from the tissues, an indirect
retainer may serve the following auxiliary functions:

1. It tends to reduce torquing leverages on the principle abutments. This is important when an
isolated tooth is being used as an abutment (a situation that should be avoided whenever
possible). Ordinarily, proximal contact with the adjacent tooth prevents such tilting of an
abutment as the base lifts away from the tissues.

2. Contact of the indirect retainer’s minor connector with vertical tooth surface aids in
stabilization against horizontal movement of the denture. Such tooth surfaces, when made
parallel to the path of placement, may also act as auxiliary guiding planes.
Direct and Indirect Retainers - 58

3. Anterior teeth with indirect retainers are supported against lingual movement.

4. Indirect retainers act as an auxiliary rests to support a portion of the major connector. For
example, a lingual bar may be supported against settling into the tissues by an indirect
retainer acting as an auxiliary rest.

The indirect retainer may take any one of several forms. All are effective proportional to their
support and the distance from the fulcrum line that they are placed.

1. Auxiliary cingulum rests. The cuspid is the most easily utilized anterior tooth for
preparation of a rest seat since the cingulum is usually more prominent than the lateral or
central incisors.

2. Auxiliary occlusal rest. Usually placed on the mesial occlusal of a first bicuspid tooth when
their is inadequate cingulum tooth structure on the canines or there is poor access to the
lingual surfaces of the anterior teeth.

3. Continuous bar retainers and lingual plates. Technically, continuous bar retainers and
lingual plates are not indirect retainers since they rest on unprepared lingual inclines of
anterior teeth. The indirect retainers are actually the terminal rests at either end in the form
of auxiliary occlusal rests or canine rests.
 Denture Bases - 59

Denture Bases and Replacement Denture Teeth

Functions

1. Support and retention of the denture teeth

2. Transmission of stresses to oral tissues - maximal coverage within anatomic
limitations, accurate reproduction of supporting tissues
3. Improve esthetics

Materials

1. Acrylic Resin Bases

Acrylic resin bases are the most common types used in removable partial dentures. They
should be routinely used in distal extension cases to allow for relining of the base to
maintain mucosal support. Acrylic resin should make a butt joint (or slightly undercut
joint) with the major and minor connectors. If the resin is brought to a feather edge, it will
distort, break or separate from the framework, causing injury to the underlying soft
tissues.

Advantages:
a. ability to reline the base as the supporting tissues change
b. esthetically superior to metal bases
c. ease of repair

Disadvantages:
a. dimensional stability less than metal bases - warpage
b. lower strength than metal - long spans
c. porous - hygiene
d. low thermal conductivity

2. Metal Bases

Metal bases can be used wherever acrylic resin bases are used. However, the esthetic
result can be compromised unless the metal can be veneered with sufficient thickness of
acrylic. If an insufficient veneer is used, a greyish hue of the underlying metal becomes
visible. Where single tooth replacements are placed, there is often insufficient room to
fabricate a retentive gridwork. A full metal base is often used in these instances. When
this type of base is used, denture teeth are attached to the framework with acrylic resin via
beading or retentive posts on the metal surface. In some rare instances, a tooth-bounded
edentulous span may exist that is too small for placement of a denture tooth. When this
type of edentulous space is encountered, it is can be completely filled with the framework
metal, if it will not compromise esthetics.

Metal bases cannot be relined, so they are generally not used for tooth-tissue borne
removable partial dentures, or in areas where teeth have been removed within 12 months
(resorption will still be occurring at an increased rate and relining will be usually be
required).
Denture Bases - 60

Beaded metal base for single tooth replacement

Metal filled edentulous space Retentive posts

can be particularly useful
in anterior regions
Advantages:

1. Thermal Conductivity - Thermal conductivity is thought to maintain tissue health by

ensuring patients do not swallow substances that are too hot. Some patients feel that
improved thermal perception lessens the feeling of the denture as a foreign object.

2. Accuracy and Permanence of Form - Metal alloys cast accurately and maintain their
accuracy. The accuracy in casting can eliminate the need for a posterior palatal seal. In
contrast, acrylic resins distort due to release of internal strains after processing. This causes
them to distort away from palate in the posterior region, thereby affecting retention. In
addition, acrylic resins can imbibe or lose moisture depending on their storage conditions,
leading to distortion and/or warpage if they are improperly stored. Abrasion from tooth
brushing can adversely affect retention of acrylic resin bases in extreme cases.

3. Hygiene - Metal surfaces are less porous than resin surfaces. This lessens food, plaque and
calculus accumulation, thereby maintaining healthy tissues.

4. Weight and Bulk - The metal bases can be cast thinner than resin bases while maintaining
adequate strength. Thus, metal bases have minimal weight and bulk.

Flange Extension

1. Denture bases for tooth-tissue supported partial dentures (Class I and II) should be extended
to provide the greatest available surface area for support and retention, without overextension
or impingement on movable border tissues.

2. Tooth supported partial dentures (Class III and IV) need not necessarily be extended
maximally, since most of the support for these dentures comes from the teeth.

3. Maxillary distal extension denture bases should terminate in the hamular notches.
 Denture Bases - 61

4. Mandibular distal extension denture bases should terminate on the pear-shaped retromolar
pads.

5. Occasionally, the path of insertion can cause the denture flanges to impinge on the mucosa
above undercut portions of the residual ridge, when the partial denture is being seated. In
these instances, it is usually preferable to shorten the flange, rather than relieving the
internal surface. If the internal surface is relieved significantly, a space will exist between
the denture base and the tissues when the denture is fully seated. Food may become
trapped in the space and work its way under the partial denture.

Deep lingual undercut Do not relieve internally Shorten flange

(difficulty seating, pain) (food trap) (maintain usable undercut)
(for retention)

Acrylic Resin Finish Lines

1. Denture bases should have internal

and external finish lines which do not
coincide (offsetting improves the
strength at the metal/denture base
junction). Internal finish lines should
be placed furthest from the abutment
teeth.
2. Finish lines should be slightly
undercut to provide a margin with
maximum bulk of resin strength and
maximum retention of the resin.
3. The external metal finish line should be located approximately 2 mm lingual to the lingual
surface of the replacement denture teeth.

Partial Denture Replacement Teeth

Material

Acrylic denture teeth should be used in most instances since they will not wear the opposing
dentition to the same degree as porcelain teeth. Porcelain denture teeth cause accelerated wear
Denture Bases - 62

of the natural dentition, particularly once the surface glaze has been broken. Acrylic teeth are
easier to arrange, modify and adjust.

Tooth Form

The selected tooth form should be selected to harmonize with the opposing teeth. Where the
replacement teeth oppose natural dentition with minimal wear, a 30° or 33° tooth form may be
indicated. Where the opposing dentition exhibits advanced occlusal wear, a form with more
shallow or no cuspal inclinations might be indicated. In almost all instances where the teeth will
oppose a natural dentition, adjustment of the occlusal surfaces will be necessary to provide
acceptable occlusal contacts.

Denture teeth should be selected to harmonize with the shade, shape, length and width of the
remaining dentition. Appearance will be most compromised if there is a vast difference in tooth
length between the replacement tooth and adjacent natural teeth.

In order to improve esthetics, teeth adjacent to the abutment teeth may have to be modified to
ensure the proximal plates and other framework components do not interfere with proper
positioning of the denture teeth. Replacement teeth may be modified so they can veneer over
proximal plates and other framework elements to provide the best possible appearance.

The denture tooth is adjusted to

provide room for the proximal
plate, while allowing placement of
the tooth close to the natural tooth
for best appearance. Note on the
facial surface that the denture
tooth slightly overlaps the
proximal plate to hide this portion
of the framework.

Occlusal Scheme

The occlusal scheme selected for a partial denture may vary from a fully balanced occlusal
scheme when opposing a complete denture, to an anterior disclusion arrangement when a tooth
borne partial opposes a natural dentition with all remaining natural anterior teeth. If the partial
denture can be made with a scheme that does not require balance to ensure its stability, then a
nonbalanced scheme should be chosen. As more of the occlusal table is involved in the
prosthetic replacement teeth, the more a balanced occlusal scheme may be of benefit.
 Principles of Partial Denture Design - 63

Principles of Partial Denture Design

General:

1. Utilize what's present. Whenever possible, select a design that fits the teeth and soft
tissues, rather than choosing one that requires tissue alteration. When minimal tooth
recontouring is required, surface roughness is minimized and teeth will be less susceptible
to plaque adhesion and subsequent caries. Minimal preparation may also provide an
economic advantage to the patient (e.g. if crowns are not required). The goal is to avoid
gross, unnecessary preparation but not to avoid essential preparation. For instance, when
recontouring of axial surfaces is required to lower heights of contour to place retentive
arms lower for esthetics, it should be done. On the other hand, if a posterior tooth already
has an occlusal rest seat prepared on it, placing a new rest seat in a different position due to
design philosophies will adversely affect the integrity of the tooth.

2. Plan for the future. When abutments of questionable prognosis are present, a design
should be chosen that would enable the partial denture to be adapted if such a tooth were
lost. An example would be a tooth borne partial denture in which a posterior abutment was
periodontally involved. In this instance, a stress-relieving clasp should be used on the
anterior abutment so that torquing stresses would not compromise its periodontal support
upon conversion to a distal extension partial denture. Planning for the future might also
involve designing castings with rest seats and guiding planes so they may subsequently be
used as partial denture abutments, if required.

3. Minimize framework elements whenever possible. The fewest number of minor

connectors should be used. This decreases potential for plaque adhesion. In some distal
extension cases, one minor connector may be used for adjacent direct and indirect retainers
(e.g. mesial occlusal rest on a first premolar and a cingulum rest on the adjacent canine)

Cingulum rests can be designed to join proximal plates, rather than having separate minor
connectors, whenever possible.

# $ $
Principles of Partial Denture Design - 64

Denture Bases
1. Use broad tissue base support. Maximizing the denture base coverage provides greater
stress distribution and resistance to displacement by lateral forces. However, the denture
base should not be overextended so that it is displaced during functional movements. If
this occurs the overextension will cause greater rotational forces to be placed on the
denture and the abutment teeth.

2. Distal extension bases should be extended to the retromolar pads and the maxillary
tuberosities as these structures provide comfort and a peripheral seal for retention.

Direct Retainers

1. Minimize requirements for direct retention by maximizing other retentive factors (e.g.
broad and intimate denture base adaptation, use of guiding planes, indirect retainers, use of
minor soft tissue undercuts).

2. Design retentive clasps tips to be ideally placed in the gingival 1/3 and modify any
heights of contour to eliminate interferences with rigid portions of the direct retainer. This
minimizes the torque on teeth and optimizes esthetics.

3. Consider caries susceptibility. Cast clasps cover more tooth surface than wrought or cast
round clasps. The latter two clasps would be preferred if caries incidence is higher than
usual.

4. The height of tooth may affect the choice of retentive clasps, since it affects possible clasp
length and hence flexibility. Less flexible clasp materials or designs can be used on large
teeth since the increase in clasp length compensates by increasing clasp flexibility.

5. Consider the tooth position in the arch. Some clinicians feel that the canine teeth should be
clasped with cast infrabulge retainers since these teeth are relatively unsupported against
mesially directed forces. It is reasoned that wrought clasps are too flexible and will not resist
such movement.

Mesial movement of the

premolar is prevented by the
canine anteriorly. The canine,
when clasped, has no tooth
immediately anterior to buttress
against such movement.

6. If no retentive undercut can be found it is possible to prepare a small retentive area on

the tooth. In order to recontour the tooth properly, the designated surface must be
approximately parallel to path of
insertion or too much tooth structure will
have to be removed. The prepared area
should follow the shape of the retentive
arm tip and should be well away from
free gingival margin (at least 1-1.5mm from the free gingival margin).
 Principles of Partial Denture Design - 65

If the proposed retentive surface diverges greatly from the path of insertion and no other
usable retentive area exists even crowning the tooth may not provide adequate retention. A
diagnostic wax-up should be undertaken to see if adequate retention can be placed in the
crown.

7. Circumferential retentive arms should be drawn in ideal position on diagnostic casts – the
retentive tip no closer than 1-1.5 mm from the free gingival margin and the beginning rigid
portion of the clasp low enough to prevent occlusal contact with the opposing tooth and low
enough for acceptable esthetics.

The retentive arm on the left has been designed to avoid height of contour at the beginning of
the arm rather than being designed ideally, and appropriate height of contour changes being
made subsequently

8. Bracing arms should be placed in the middle 1/3 of the tooth occlusogingivally. If the height
of contour is above the inferior border of the arm, the height of contour should be lowered by
preparing a guiding plane on the corresponding axial surface.

9. When there is marked mobility of one or more of the abutments, the use of stress-releasing
direct retainers becomes more important. Stress relieving clasp assemblies allow release of
the tooth and therefore, result in more of load being transferred to the denture base tissues.

10. I-bars should gently curve from the gridwork and originate from the gridwork approximately
one tooth posterior to the replacement tooth adjacent to the abutment. Do not use L-bars
(less flexible). Do not flatten retentive end of the I-bar, to increase surface contact since the
hygienic properties of the clasp will be compromise. A properly designed I-bar should not
require an increased contact area with the tooth.

11. Whenever possible, it is advisable to avoid placing rest seats or guiding planes on direct
restorations such as amalgams. The relatively high creep values and low yield strengths of
these materials results in frequent failure under partial denture frameworks. It is better to
redesign the partial denture to avoid these restorations or to replace the restorations with
onlays or crowns. While partial dentures can and are made upon direct restorative materials,
Principles of Partial Denture Design - 66

the financial savings to the patient in not replacing such restorations is often lost when the
restoration fails and a casting or remake of the denture framework is subsequently required.

12. Avoid placing rest in areas of heavy occlusal contact. Therefore, it is imperative that the
clinician check the occlusion intraorally. In addition, extrusion of opposing teeth must be
noted to ensure that there is room for replacement denture teeth.

Number of Direct Retainers

Four: Four direct retainers offer an excellent amount of retention and are most frequently used
in often used in tooth borne cases (i.e. Cl. III, mod 1). More than four direct retainers are rarely
necessary, except in maxillofacial prostheses. Normally a single clasp can be omitted, if other
supplemental retention is substituted (long guiding planes, many modification spaces, short
edentulous spaces)
Three : Less retentive than four direct retainers, most commonly used in Class II cases.
Minimal number of clasps usually used in a Class III partial denture.
Two: Absolute minimum, usually only used in Class I partial dentures, unless a rotational path
design is selected.

Indirect Retainers

Class I and Class II partial dentures often require indirect retainers. These should be as far from
the primary fulcrum line as possible (90°), and placed on the opposite side of the fulcrum line
from the denture base. They are normally not required for tooth-borne RPD’s.

Major Connectors

1. Assess tori, height of floor of mouth, frenal attachments. These will affect the type of
major connector and direct retainers selected.

2. The posterior extensions of a maxillary distal extension framework should point to hamular
notches.

3. Major connectors should have smooth continuous contours that flow into other elements of
the partial denture. Abrupt changes of contour or bulky contours should be avoided,
particularly at junctions with the acrylic denture bases.
 Principles of Partial Denture Design - 67

Minor Connectors

Where a cingulum rest is not adjacent an embrasure minor connector to an occlusal rest, cross
the free gingival margin directly – do not use an embrasure minor connector. Cover the entire
rest seat preparation, but do not wrap these minor connectors into embrasures.

Incorrect Correct Incorrect

Don’t use an embrasure Too far into embrasures
Minor connector

Distal Extension Case Considerations:

1. Use stress releasing direct retainers in distal extension cases. There are three axes of
rotation for these partial dentures. If abutment teeth are locked into the frameworks they
can be torqued in many directions. Stress-relieving clasps allow for some release of the
teeth to minimize torquing potential.

Three Axes of Rotation of a Partial Denture

Rotational movements increase with length of span of the distal extension. Also as arm
flexibility increases, resistance to lateral displaceability decreases. Therefore, it is
important to use maximum coverage of the edentulous ridge to reduce the degree of lateral
movement. This is particularly effective when there are large, broad ridges which tend to
provide greater resistance to horizontal movements.

2. The character of the mucoperiosteum can affect rotational movements. Flabby tissue is
more displaceable leading to increased rotation and therefore increased potential for stress
transference to the abutment teeth.
Principles of Partial Denture Design - 68

General Considerations

Consider Soft Tissue Variables

Soft tissue anatomy such as frenal attachments and vestibular depth can affect the choice of
major connectors, and direct retainers. Characteristics of the soft tissues, such as undercuts and
tissue compressibility of attached mucosa, may also affect design decisions. These aspects of the
tissue need to be identified intraorally, since they can frequently not be determined solely on the
basis of a diagnostic cast.

Consider Hard Tissue Variables

The opposing occlusion, significant abutment mobilities, the access to embrasures, presence of
rotations, the positions of tooth undercuts and the presence of restorations can all influence the
selection of direct retainers. The presence of tori can affect major connector selection.

Design Sequence

In general, after the path of insertion and the abutment teeth have been selected, the positions of
the rests for the partial denture are chosen, since their placement will affect other parts of the
design. The order of other design elements usually follows the sequence:

1. Rests
2. Major connector
3. Minor connectors
4. Direct retainers
5. Indirect retainers

Drawing the Design

When drawing a design on a cast, sharpened, coloured pencils should be used. The following
colours will be used to designate various components at Dalhousie University:

Red: Retentive undercut, Wrought wire arms

Blue: All other elements

Clinicians should use absolute accuracy in drawing their desired framework elements, in order to
avoid guesswork on the part of the laboratory technician. In order for technicians to place
elements in proper position, with proper proportions, the design should be drawn with single
distinct lines.
 Principles of Partial Denture Design - 69

Summary of Design Principles for Removable Partial Dentures

General Principles
- Minimize framework elements (minimize minor connectors, plating, etc.) – more hygienic
- Obtain good base adaptation - better stress distribution; use altered cast for mand. distal extensions
- Use what is present (e.g. existing rest seats)
- Plan for the future (e.g. designing for continued use of RPD framework if a critical abutment is lost; placing
rest seats, guide planes and undercuts on crowns to allow fabrication of an RPD later)
- Never plan an RPD using a single cast alone. You can’t assess abutment mobility, compressibility of mucosa,
the level of the floor of the mouth, prominent frena, or occlusion. Use mounted models and assess these
features intraorally as you plan and check your design.
- Occlusion – AVOID:
o centric contacts on rests (also ensure no increase in OVD)
o heavy buccal contacts on denture teeth– causes more movement of removable partial denture
- When other dental treatment is planned, and an RPD will be made at the end of treatment – ALWAYS PLAN
THE RPD FIRST. You will see which abutment modifications will be needed, and will ensure the planned
RPD is feasible, prior to beginning treatment

Rest Seats/ Rests

Ensure sufficient depth, especially at junction of the rest & minor connector (1.5mm minimum)
Tooth Borne (Kennedy Class I & II) – place rests adjacent to edentulous space (both ends)
Tissue/Tooth Borne (Kennedy Class I & II)
- mesial rest preferred (less torquing of abutment)
- distal rest preferred when:
- abutment is rotated (limited access for minor connector to mesial)
- plunger cusp/heavy centric contact on mesial
- large restoration on mesial
- no long guiding planes with distal rests - potential torquing
- if tooth is severely weakened periodontally – sometimes move rest to the next tooth anterior

Incisal rests/rest seats

- don’t use - poor esthetics
- more tilting/torquing forces (long lever arm from center of rotation)

Cingulum rests/rest seats

- use composite build up, if no prominent cingulum (less dentinal sensitivity)
- size - min 1 mm (if deeper, chance of dentin exposure)
- ensure sufficient clearance from opposing occlusion for maxillary cingulum rests

Occlusal rests/rest seats

- size - 1/3 of B-L width of the tooth
- depth : 1.5 mm of clearance from opposing occlusion (critical at junction of rest & minor connector)
- line angle of the marginal ridge should be rounded
- deepest part should be located centrally (positive)

Indirect Retainers
- 90° from fulcrum line & as far away from primary abutment as possible
- none required on tooth borne (Cl III & IV) cases
- canine is usually the most anterior tooth used for indirect retention
- usually don’t use a lateral (root length) or central incisor (speech)
- also helpful for seating and support, but not always possible or necessary
Principles of Partial Denture Design - 70

Direct Retainers
- Kennedy Cl III & IV (Tooth Borne)
- – Clasp of choice: cast circumferential
- if can’t use cast circumferential next to edentulous space, use double embrasure clasp
- if abutment is severely tilted use (depending on location of undercut):
! Cast circumferential clasp with lingual retention
! Ring clasp with support strut
! Rotational path removable partial denture

- Kennedy Cl I & II (Tooth & Tissue Borne)

- For posterior abutments, or any tooth needing stress release:
- Clasp of choice: RPI (mesial rest, distal proximal plate and I-bar)
- If can’t use an I-bar in vestibule, because of
! frenum
! shallow vestibule
! deep soft tissue undercut
then use an RPA retainer (mesial rest, distal proximal plate and wrought wire clasp [Akers])
- If can’t use a mesial rest because of:
- rotation
- heavy centric contact on mesial
- - large amalgam restoration on mesial
- then use Combination Clasp (distal rest, buccal ww retention, lingual bracing)
- for abutments adjacent modification spaces (use tooth borne retainers)
- # of direct retainers –, minimum of 2 posterior abutments for Cl. I & II, all abutments for Cl III, IV to
maximum of 4 normally
- if eliminate a direct retainer for esthetics, plan more retention with other features (soft tissue coverage, longer
guiding planes, etc)

Mandibular Major Connectors

Lingual Bar whenever possible (less tissue coverage - hygiene)
Lingual Plate if:
- high floor of mouth
- tori
- frenum
- terminate at FGM
Tissue relief – mandibular major connector (29-30 gauge relief) to avoid tissue impingement

Maxillary Major Connectors

No tissue relief
Tooth borne (Class III & IV): Palatal Strap
Tooth & Tissue borne (Class I & II):
A-P Strap whenever possible
– better sensation, preferred (minor salivary glands & taste buds)
Full Palatal Strap
- periodontal involvement of abutments
- less than 6 teeth left
- displaceable mucosa (increased coverage
Anterior Strap (Horseshoe) – only if inoperable torus is present
– NEVER for Class I or II

Other Principles of Design:

Design drawings – absolute accuracy
- RED – wrought wire, undercut position, circled tripod marks; BLUE – everything else
 Clinical Protocol, Final Impressions - 79

Clinical Protocol for Removable Partial Dentures

Summary

If an RPD is part of planned Treatment:

PLAN THE RPD BEFORE BEGINNING ANY OTHER TREATMENT

• Survey, tripod, heights of contour

• Draw design on surveyed cast
• Design approved before any treatment started:
o Affects direct restorations
o Can influence need for/preparations for crowns
o Insures RPD can be completed successfully
o NO EXCEPTIONS

CLINICAL STEPS

1. Diagnosis, Treatment Plan, Hygiene

2. Diagnostic Casts
3. Draw design & list abutment modifications on the Prosthesis Design page (see attached)
4. Instructor Approval
5. Complete Phase 1 treatment
6. Abutment modifications
7. Preliminary impression to check abutment modifications
8. Fabricate & cement crowns or fixed partial dentures
9. Final Framework Impression
10. Make two casts
11. Draw design on 2nd cast
12. Instructor approval/corrections of drawing/design on cast
13. Complete RPD Framework Prescription (instructor signature required)
14. Second poured cast with design sent to Lab with 1st pour
15. Inspect wax-up
16. Framework Adjustment
17. Altered Cast impression, if needed
18. Jaw relation records
19. Select & set denture teeth
20. Try-in with teeth in wax
21. Process, adjustment, deliver to patient