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Contemporary Partial Denture Designs PDF
Contemporary Partial Denture Designs PDF
Fig. 1. A removable partial denture which is entirely tooth- Fig. 2. A removable partial denture which is both tooth- and
supported through the medium of occlusal rests on each tissue-supported through the medium of occlusal rests on the
abutment tooth. (Kennedy Class III.) abutment teeth and tissue-supported denture bases. (Kennedy
Class I.)
Fig. 5. Anterior and posterior palatal bars as major con- Fig. 6. An anatomic palatal strap major connector in an
nectors in an upper partial denture design. upper partial denture.
Fig. 11. A, The anatomic or static form of the edentulous ridge as recorded with a hydrocolloid impression material. B, The
functional form of the same edentulous ridge as recorded with a wax that is fluid at mouth temperature, such as Kerr’s Korecta
wax No. 4. The denture base areas of the master cast have been repoured as in Fig. 12.
damage. In addition, direct-indirect retention which the circumferential and bar type retainers are just as
frequently eliminates the need for anterior indirect re- effective and are more economically constructed than
tainers is obtained. intracoronal retainers. Therefore, they are more
The true test of any major connector is its rigidity and universally used.
the damage done to oral tissues. Vulnerable areas on the abutment teeth must be pro-
tected by restorations with either type of retainer. The
DIRECT RETAINERS FOR TOOTH-BORNE clasp retainer must not impinge upon gingival tissues.
PARTIAL DENTURES The clasp must not exert excessive torque upon the
Retainers for tooth-borne partial dentures have only abutment tooth during insertion and removal.
one function, and that is to retain the prosthesis against Therefore, it must be placed at the least acceptable dis-
reasonable dislodging forces without damage to the tance into the tooth undercut for retention, and it
abutment teeth while they pass to and from their termi- must be designed to have the least acceptable bulk and
nal positions. There is no movement of the prosthesis tooth contact.
tissueward because each terminus is supported by an The bar or Roach clasp14 (Fig. 7) is used by some
occlusal rest. There can be no movement away from the technicians as if there were no other types of clasps.
tissues and, therefore, no rotation can occur because Actually, it should be used only where the area for reten-
each end is secured by the action of a direct retainer. tion lies close to the gingival margin of the tooth and
Any type of retainer is acceptable as long as the abut- where little tissue blockout is necessary. If the clasp lies
ment tooth is not jeopardized by its presence. high occlusally, or if an objectionable space exists be-
Intracoronal (precision) retainers are ideal for tooth- tween the bar and the tissues, then the clasp has not
borne appliances and offer esthetic advantages not to been wisely chosen, and a circumferential clasp should
be found in the extracoronal retainers. Nevertheless, have been used.
movement.7,10,15 It is the purpose of all the stabilizing olar bone. The occlusal rest support is effective only at
components to distribute stresses equally to all support- the abutment end of the denture base.6,9,15,16
ing teeth without the abuse of any one tooth. All minor The effectiveness of this tissue support is dependent
connectors that contact vertical tooth surfaces, and all upon four things: the quality of the residual ridge, the
reciprocal clasp arms must function in this manner. It total load applied, the accuracy of the denture bases,
is necessary that they have sufficient bulk to be rigid, and the accuracy of the impression registration.
and yet that they present as little bulk to the tongue as The quality of the ridge cannot be influenced, except
possible. This means that they should be confined to in- to modify it or improve it by surgical intervention.
terdental embrasures wherever possible. If minor con- This modification is infrequently advisable and is less
nectors are located on proximal tooth surfaces, they frequently done.
should contact surfaces that have been made parallel to We may influence the total occlusal load applied to
the path of insertion. When cast restorations are used, the residual ridge by reducing the occlusal area through
these surfaces of the wax patterns should be made paral- the use of fewer, narrower, and more efficiently shaped
lel to each other on the surveyor prior to casting. denture teeth.
Reciprocal clasp arms must also be rigid and they We may influence the accuracy of the denture base by
must be placed above the height of contour of the abut- our choice of materials and by the exactness of the pro-
ment teeth where they will not be called upon to flex. By cessing techniques. Faulty and warped denture bases di-
their rigidity these clasp arms reciprocate the opposing rectly influence the support of partial dentures. Materials
retentive clasp and they also prevent lateral shifting of and techniques should be used which minimize the pos-
the prosthesis under horizontal stresses. If the reciprocal sibility of processing errors.
clasp is to be placed in the correct position on the tooth, The accuracy of the impression technique is entirely
judicious grinding of tooth surfaces is necessary to in- in the hands of the dentist. Maximum tissue coverage
crease the suprabulge area. Where crown restorations for support is the principal objective in any partial den-
are used, a lingual reciprocal clasp arm may be made ture impression technique. The manner in which it is ac-
a part of the tooth contour by providing a shoulder on complished is based upon a biologic comprehension of
the crown upon which the clasp may rest.13 This permits what happens beneath a free-end denture base when
a wider clasp arm to be used and restores a more nearly an occlusal load is applied.
normal tooth contour without sacrificing strength and The partial denture is unique in that its support is de-
rigidity of the clasp. rived from both comparatively unyielding abutment
The average dental laboratory technicians are not teeth and from comparatively yielding or resilient soft
cognizant of the difference between retention and recip- tissues. Resilient tissues, being unable to provide support
rocation. This is apparent because of the frequency of for the denture base comparable to that offered by the
the violations of the principles involved. Dentists must abutment teeth, are displaced by the occlusal load.
have a clear concept of which clasp arms are reciprocat- Only the projections of the underlying residual bone re-
ing and which clasp arms are retentive. This is necessary main to be traumatized by occlusal forces. This problem
to determine which clasp arm should have a taper and of support is further complicated by the fact that the
engage an infrabulge area and which should be of uni- patient has natural teeth remaining upon which he may
form diameter for rigidity and lie above the height of exert far greater force than he would were he completely
contour. Most clasp arms constructed in commercial edentulous. This fact is evidenced by the damage occur-
dental laboratories have the same dimension and taper, ring to an edentulous ridge when it is opposed by a few
with the terminal of each clasp arm engaging an under- remaining anterior teeth in the opposite arch.
cut. This procedure is followed because of unclear con- Ridge tissues recorded in their resting, nonfunction-
cepts of design, inadequate designing by the dentist, and ing form are incapable of providing the composite sup-
the widespread use of tapered plastic ready-made forms. port needed for a denture which derives its support from
The art of free-hand waxing of clasps is becoming lost to both the soft tissue and teeth. The ridge tissues are
the automaton of the ready-made clasp forms, and the recorded in their resting form by an elastic impression
loss of this art is a very real threat to the best quality of material such as hydrocolloid, rubber base impression
dentistry. materials, impression pastes, or plaster of Paris.
It is necessary that two factors be taken into consider-
ation in the acceptance of an impression technique for
RIDGE SUPPORT
free-end partial dentures. First, the material should re-
The support for the tooth-borne partial denture or cord the resilient tissues in their supporting form.
the tooth-borne modification space comes entirely Second, the total area covered by the impression should
from the abutment teeth by means of occlusal rests. be as great as possible, in order to distribute the load over
Support for any free-end denture base comes primarily as large an area as can be tolerated by the patient. This is
from the resilient soft tissues overlying the residual alve- an application of the principle of the snowshoe. Waxes
Fig. 15. A, The outline form of the denture framework has been carefully drawn in pencil on the surveyed master cast. The
laboratory technician has only to duplicate this design in his casting so that when the casting is placed on the master cast it
matches the penciled outline. B, The framework design is drawn on a chart with colored pencils. Labels and written instructions
are used to supply the specific details.
that are moldable at mouth temperature are the materials In the lower arch, the resiliency of the ridge tissues
of choice for the impression, because they are the only makes the functional form impression technique the
impression materials available that have the combined method of choice. In the upper arch, however, where
advantages of controlled displacement of fluid tissues the ridge tissues are generally more firm, and the support
and correctability under functional loading.15, 16 for the denture base is obtained from both the ridge and
Anyone who has had the opportunity of comparing the palatal tissues, the wax impression is not always used.
two master casts for the same partially edentulous Where wide palatal coverage is to be incorporated into
arch, one having the distal extension areas recorded in the partial denture design, an alginate or rubber base im-
their anatomic or resting form (Fig. 11, A) the other pression in an individual tray is sometimes acceptable.
having the distal extension areas recorded in their func- For this procedure, an acrylic resin tray is made by the
tional form (Fig. 11, B), has been impressed with the sprinkling method. The tray is made on the study cast,
differences of the forms of the two casts. A denture which is relieved with three thicknesses of wet, sheet as-
base processed to the functional form is less irregular, bestos. Occlusal stops on either side of the cast may be
and it has generally wider areal coverage than a denture left exposed if desired. A wire handle may be added to
base processed to the anatomic form (the form of the tis- the tray, or a loop of wire in the palate may be used for
sues at rest). Moreover, and of far greater significance, convenience in removal. The tray is trimmed just short
a denture base made to anatomic form exhibits less sta- of the reflections, border molded in modeling plastic,
bility under rotating forces than a denture base pro- wax, or an impression paste, and then perforated with
cessed to functional form, and it fails to maintain its a bi-bevel drill. This tray is used for the final impression.
occlusal relation with the opposing teeth. Wax biting The resulting master cast is acceptable for the upper
tests show that occlusion is maintained at a point of free-end partial denture because of the added support
equilibrium over a long period of time when the denture obtained by full palatal coverage.
base has been made to functional form. In contrast,
there is a rapid settling of the denture base when it is
INDIRECT RETAINERS
made to anatomic form, with an early return of the oc-
clusion to the original natural tooth contact only. Any strut placed anterior to the fulcrum line is mistak-
Such a denture not only fails to distribute the occlusal enly considered to be an indirect retainer. An indirect
load equitably, but it allows rotations which are damag- retainer can function only to assist in preventing the
ing to the abutment teeth and their investing structures. rotational movement of a free-end denture base away
Unfortunately, dental laboratory technicians have from the tissues when the indirect retainer is placed as
had no inclination to accept the correction of the mas- far anteriorly from the fulcrum line as adequate tooth
ter cast to the supporting form of the ridge as an es- support permits.15, 17 It must be placed in a prepared
sential part of partial denture design (Fig. 12). This rest in an abutment tooth that is capable of withstanding
is further evidence of a lack of biologic comprehen- the stresses placed upon it (Fig. 13). An indirect retainer
sion. It is, therefore, the dentists’ responsibility to per- cannot function correctly on an inclined tooth surface,
form this and certain necessary laboratory procedures nor can a lower incisor tooth be used for this purpose.
if the partial denture is to be more than a mechanical Either canine or premolar teeth must be used for this
device. purpose, and the rest seats must be prepared in those
teeth as carefully as the preparation for any other occlu- the appliance settles. More relief than this will leave an
sal rest. Where canine teeth are used, incisal rests or cin- unnecessary and objectionable space between the frame-
gulum rests are acceptable for indirect retainers, work and the underlying tissues.
provided a definite seat can be obtained. Where bar clasps are used, the blockout for the clasp
It should be remembered also that indirect retainers arms should be sufficient only to prevent tissue impinge-
serve a second purpose in partial denture design. This ment. However, excessive blockout is usually used with
purpose is that of occlusal rest support for major connec- a resulting annoyance to the tongue and cheek and with
tors. A long lingual bar or an anterior palatal bar is the sacrifice of esthetics. In many instances, where tissue
thereby prevented from settling into the tissues. undercuts exist, the bar clasp is contraindicated, and it
Indeed, even in the absence of a need for indirect reten- should not be used at all.
tion, such auxiliary support is sometimes indicated. All proximal tooth surfaces which underlie minor
It should be remembered also that, contrary to com- connectors, especially those at the point of origin of
mon usage, a secondary lingual (Kennedy) bar or a lin- the occlusal rests and clasp arms, should be as nearly par-
gual plate does not in itself act as an indirect retainer. allel to the path of insertion of the appliance as possible.
Resting on inclined tooth surfaces as they do, they serve This is accomplished either by disking these surfaces or
more as orthodontic appliances than as support for par- by paralleling the wax patterns of the cast restorations.
tial dentures. Terminal rests at each end of these lingual The latter should be done on the surveyor whenever
plates should be used to stabilize the dentures and pre- possible, rather than attempting to parallel the finished
vent movement of the teeth contacted. If such rests restorations in the mouth. At the same time, tooth
are used, they alone are the indirect retainers, and they contours which provide for the location of retentive
function equally well without the added bar or plate. and stabilizing clasp arms should be established.
The use of a lingual plate is indicated where the lower If the dentist has made no provision for parallel tooth
anterior teeth are subject to calculus formation or are surfaces, carelessness on the part of the laboratory tech-
weakened by periodontal disease (Fig. 14). Calculus nician in accomplishing the blockout can do little harm,
may then form on the plate instead of forming on the for in such a case too much relief is better than too little.
teeth. Experience with the lingual plate has shown that On the other hand, if the dentist or the laboratory tech-
the underlying tissues do remain healthy and that there nician has provided for parallel guiding planes on the
are no harmful effects to the tissues from the metallic proximal tooth surfaces, those guiding planes should
coverage. not be obliterated by a careless blockout. Having deter-
However, one precaution must be taken. Adequate mined the path of insertion for the partial denture in
relief must be provided where the bar or plate crosses advance, the blockout must be so paralleled on the
the gingival margins and the adjacent gingivae. This surveyor that guiding planes are left exposed and effec-
should be accomplished by using at least a 0.002 gauge tive. The only permissible relief over these areas is
tin-foil blockout in these areas, in addition to a wax a tin-foil relief to prevent cast abrasion during the
blockout of the gingival crevice. surveying and the blockout procedures.
It does not seem that there are any advantages to
be had from the use of the Kennedy bar that are not
SUMMARY
enhanced by the use of a lingual plate. There are times,
however, when the lingual plate would show through I have attempted to excuse the shortcomings of the
interproximal embrasures of the teeth, and, for esthetic commercial dental laboratory by pointing out the re-
reasons, the Kennedy bar would be preferred. The deci- sponsibilities of the dentist for biologic partial denture
sion as to when to use the Kennedy bar or the lingual design and his frequent failure to provide the laboratory
plate and its design should be made by the dentist rather technician with casts of properly prepared mouths and
than by the laboratory technician and should be clearly adequate prescriptions for him to follow. By ‘‘prescrip-
indicated by the dentist on the cast. tion’’ I am referring to penciled outlines (Fig. 15,A), di-
agrams (Fig. 15,B), and written instructions prepared by
the dentist for the dental technician.13 Now I must also
BLOCKOUT OF UNDERCUTS
make a statement regarding the responsibilities of the
The decision as to where to use blockout wax should commercial dental laboratory in the hope that they, too,
be made by the dentist from his survey of the master cast. may find some motivation for improving their services.
Twenty-eight gauge wax, in addition to a wax blockout In the average commercial dental laboratory today,
of the tissue undercuts, is usually sufficient to relieve the mass production is an economic necessity. It is aug-
lingual bar connectors. Two or three-thousandths mented by the use of stereotyped designs and plastic pat-
gauge tin foil should be used over all gingival crossings, tern forms. Added to this, the salary level of the skilled
in addition to blocking out the gingival crevice. Any dental laboratory technician is not high by today’s eco-
less relief than this will cause tissue impingement when nomic standards, and the training facilities for dental
laboratory technicians are woefully inadequate. In many 3. Wright WH. Partial denture prosthesis: A preventative oral health service.
J Am Dent Assoc 1951;43:163-8.
areas, adequate training facilities are nonexistent. 4. Loos A. Bio-physiological principles in the construction of partial den-
However, despite this, quality partial denture and tures. Br Dent J 1950;88:61-8.
mouth rehabilitation service is needed now more than 5. Steffel VL. Fundamental principles involved in partial denture designs—-
With special reference to equalization of tooth and tissue support. Dent J
ever before. Teeth that would have been lost in the Aust 1951;23:68-77.
past by periodontal disease, caries, or by pulpal involve- 6. Lammie GA, Osborne J. The bilateral free-end saddle lower denture. J
ment are being saved now by the thousands. Increased Prosthet Dent 1954;4:640-52.
7. Frechette AR. Partial denture planning with special reference to stress dis-
life expectancy has placed us on the threshold of geriatric tribution. J Prosthet Dent 1951;1:710-24.
dentistry, with its many implications and challenges for 8. Hindels GW. Stress analysis in distal extension partial dentures. J Prosthet
the future dental care of an aging population.18 Dent 1957;7:197-205.
9. McCracken WL. A comparison of tooth-borne and tooth-tissue-
Human mouths are not stereotyped, and neither are borne removable partial dentures. J Prosthet Dent 1953;3:375-81.
the problems in mouth reconstruction. Stereotyped par- 10. Steffel VL. Fundamental Principles Involved in Partial Denture Design. J
tial denture service must be replaced with individualized Am Dent Assoc 1951;42:534-44.
11. Applegate OC, Nissle RO. Keeping the partial denture in harmony with
treatment planning and rehabilitation service.19 biologic limitations. J Am Dent Assoc 1951;43:409-19.
Dentists must do more than make a single impression, 12. Perry C, Applegate SG. Occlusal rest—An important part of a partial den-
send it to the commercial dental laboratory, and receive ture. J Mich Dent Soc 1947;13:9-13.
13. McCracken WL. Mouth preparations for partial dentures. J Prosthet Dent
a finished appliance to be inserted in the mouth. 1956;6:39-52.
Also, it seems a little bit incongruous to spend a great 14. Roach FE. Roach bar clasp. Dent Surv 1945;21:249.
deal of time and effort on elaborate research in the test- 15. Applegate OC. Essentials of removable partial denture prosthesis. Phila-
delphia: WB Saunders; 1954.
ing of some of the clinical principles in partial denture 16. Applegate OC. The partial denture base. J Prosthet Dent 1955;5:
design, when these very principles are being so flagrantly 636-48.
violated by those responsible for their clinical applica- 17. MacKinnon KP. Indirect retention in partial denture construction. Dent J
Aust 1955;27:221-5.
tion. 18. Applegate OC. Conditions which may influence the choice of partial or
If training facilities and increased salary standards for complete denture service. J Prosthet Dent 1957;7:182-96.
dental laboratory technicians are needed, then let the 19. Craddock FW. Partial dentures in oral rehabilitation. N Z Dent J 1953;49:
6-13.
dental profession have the courage and the integrity to
lead the way toward their improvement. But also, let
the profession demand standards of individualized ser-
0022-3913/$30.00
vice from the commercial dental laboratory in keeping Copyright Ó 2004 by The Editorial Council of The Journal of Prosthetic
with competent and informed leadership. Dentistry
REFERENCES
1. DeVan MM. The nature of the partial denture foundation: Suggestions for
its preservation. J Prosthet Dent 1952;2:210-8.
2. Christensen G. Partial dentures—A benefit or a menace? Aust J Dent 1945;
49:102-7. doi:10.1016/j.prosdent.2004.08.001