The Swing Lock Denture

By

Prof. Dr. Osama Baraka

Indications:

1- Too few remaining teeth for a conventional design.

2- The remaining teeth are mobile.
3- Position of the remaining teeth are not favorable for a conventional
design.
4- Retention and stabilization for Maxillofacial prostheses is required.
5- For retention of prosthesis in cases of loss of large segments of
teeth and alveolar ridge due to traumatic injury.
6- Missing of key abutments (canines).

Contraindications
1- Shallow vestibule.
2- High labial frenal attachment.
3- Poor oral hygiene.
4- Esthetic requirements.

Design:
It consists of two major connectors; a conventional major connector
and a labial bar. Such a configuration will be impossible to insert together.
Hence, the labial bar consists of a hinge on one end in the manner of a gate
and a latch (lock) on the other. The denture is inserted with the gate opened

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and locked in position after insertion of the denture. Because of this locking
mechanism the denture is termed ‘Swing–Lock’ denture (Fig. 1).

Fig. (1): Right; Swing lock bar opened. Left; the bar closed and locked.

1- Major connectors:
The lingual plate major connector is usually the connector of choice for
the mandibular arch. The lingual plating must be positioned above the
survey line and scalloped with extensions to the contact point areas of the
teeth. A double lingual bar (Kennedy bar) can be used, but it has more
disadvantages than advantages.
A full palatal coverage is generally indicated in the maxillary arch. The
remaining teeth are plated on the lingual surfaces, with the plating
extending above the survey line. An anteroposterior palatal strap design
can also be used if anatomic considerations or patient desires indicate the
need for an opening in the palatal coverage.
2- The labial bar:
The labial bar is generally designed in two ways:
a- Small I- or T-bar vertical projections attached to the labial bar contact
the labial or buccal surfaces of the teeth gingival to the height of contour
providing retention and stability. The depth of undercut engaged is relatively

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unimportant, because the retentive struts do not pass over the maximum
convexity of the tooth on insertion.

Fig. (2): The Swing Lock denture labial bar. Left; metallic. Right: The labial bar
may include beads to permit attachment of an acrylic resin veneer.
b- The labial bars can also be designed with acrylic resin retention
components (retention loops on the labial arm) in which retention and
stability are provided by an acrylic resin denture plate attached to the labial
bar. This design is used if the vertical projection bars would produce a poor
esthetic result; when the patient has mobile or short lips. It is indicated also,
if extensive loss of gingival tissue has occurred and a resin gingival veneer
is needed to improve appearance (Fig. 3).

Fig. (3); The Swing Lock Denture acrylic labial bar.

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 3- Support and indirect retention:
Lingual plate above survey line prevent tissue ward movement of the
partial denture. Well-designed rests in properly prepared rest seats ensure
that the forces are directed along the long axes of the teeth. Rests are
placed adjacent to edentulous areas. If teeth are present distal to the first
premolar, an additional rest is placed on the mesioocclusal surface of the
first premolar or on the lingual or incisal surface of the canine to act as
indirect retainer.

4- Location of the hinge and locking mechanisms

Location of the hinge and locking mechanisms is determined by the
patient's ability to open the lock. It is usually easier for a right-handed patient
to open the locking mechanism if it is located to the right of the prosthesis.
5- Selection of metal for Swing-Lock framework:
The framework and bar is constructed in cast cobalt chromium alloy,
with the hinge and lock attachments provided as preformed plastic patterns
which are invested and cast in metal in the normal fashion.
Gold is contraindicated because the hinge and lock mechanisms show
noticeable wear in a relatively short time when gold is used. Moreover, to
provide the necessary rigidity and strength, gold components must be
bulkier than chrome components.

Advantages:
1- It provides a relatively inexpensive method for using all or most of
the remaining teeth for the retention and stabilization of prosthesis.
2- It allows wide distribution of stress during function to all remaining
teeth and residual ridges rather than to just a few abutments

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 3- The construction of a swing-Lock removable partial denture is
relatively simple and inexpensive, it can be used in situations in which more
conventional types of treatment may appear hopeless.
4- When the appliance is inserted and locked into position the enclosed
natural teeth are held rigidly in a fixed position. This has a splinting or
stabilizing action on these teeth, which may have often a poor periodontal
condition, or be particularly unsuitable for isolated loading due to their
anatomical form.
5- A natural tooth can be removed and added to the major connector
of a swing–Lock prosthesis through a simple laboratory procedure.

Disadvantages:
1- Relatively poor esthetics for patients with short or highly mobile lip.
2- Obtaining perfect adaptation of a resin veneer is difficult.
3- The remaining teeth are grasped firmly and movement of distal
extension base can tip these teeth (Fig. 3).

Fig. (3): Occlusal forces (solid arrows) applied to a distal extension Swing-Lock
prosthesis may cause the denture base to move toward the soft tissues. This may
produce distal rotation of the abutments (open arrows).

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 Procedures:
Primary impression:
Alginate (irreversible hydrocolloid) is the impression material of choice
for a Swing-Lock denture. Heavy-bodied alginate is used for making the
impression. Most patients who require this type of treatment have gingival
recession and large gingival embrasures. Rubber base impression material
is too tough and will lock into undercut embrasure areas. Alginate, however,
will tear and release without excessive application of force. It also possesses
an exceptional degree of accuracy if it is handled properly.
The torn alginate in the embrasures is carefully approximated and luted
in position by sticky wax. The interproximal contour is important because the
framework will extend into interproximal areas because of the lingual path of
insertion. Impression is cleaned, disinfected, and poured within 12 minutes.

Surveying
The path of insertion for Swing-Lock prosthesis is from the lingual
direction with the labial arm open. However, it is imperative that the cast be
surveyed with the occlusal plane of the teeth parallel with the base of the
surveyor. Most of the forces applied to the prosthesis will be directed
perpendicular to the occlusal plane. Survey lines are drawn on all the
remaining teeth.
Final impression and mater cast:
Custom tray fabrication: The extension of the impression into the
buccal and labial vestibules is critical. A custom tray must be constructed to
record these areas accurately especially if the anterior teeth are labially
inclined. It is constructed from auto-polymerizing resin with relief to provide

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5 to 6mm of space for alginate around the remaining teeth. The tray should
be prepared with several holes to help retain the alginate in the tray.
Border molding: Modeling plastic is used to border mold the
vestibular areas of the tray to provide the proper extension.
Alginate is used for final impression and poured into dental stone. A
two stage pour technique is used.
Fitting the framework
Disclosing wax is added to all the framework that contact the teeth with
the exception of the labial arm. The framework is then seated under pressure
into position with the labial arm opened. The framework is removed and
inspected under magnification for metallic show through areas. These areas
are removed with a small round bur, and the procedure is repeated until the
framework is completely seated.
The same procedures are repeated for the labial arm in contact with
the teeth until the labial arm will close in the mouth with the same degree of
force needed when the framework is on the cast.
Initially it may be necessary to use a blunt instrument to open the lock.
After wearing the prosthesis for a short period, the patient will be able to open
the locking mechanism with the thumbnail alone.
The occlusion must be checked and corrected to ensure that no part
of the framework keeps the natural teeth apart.
Corrected cast procedure
All mandibular distal extension removable partial denture situations
require the making of corrected cast impressions. Optimum support from the
residual ridge is critical to the success of a distal extension removable partial
denture. Significant movement of the denture bases toward the soft tissues
will quickly loosen the remaining teeth because the teeth are so firmly
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engaged by the framework. Care should be taken during impression to avoid
over displacement of the tissue because the finished denture will apply
continuous force to the remaining teeth.
Development of occlusion
a- An occlusion that will minimize the lateral forces applied to the
prosthesis should be developed.
b- Simultaneous occlusal contact between both the natural and
artificial teeth at the patient's occlusal vertical dimension is essential.
c- Premature contact of artificial teeth on a distal extension base will
hasten the loss of the remaining natural teeth.
Placement of the completed prosthesis
a- Pressure indicator paste is used to locate pressure areas caused by
the denture bases. The lingual path of insertion may cause insertion
problems if the residual ridge is undercut on the buccal aspects. However,
this is rarely a problem.
b- The occlusion is evaluated and corrected in centric and eccentric
relations.
c- A plier can be used to adjust the vertical projection arms slightly to
obtain maximum retention.
d- Reducing retention by bending the arms slightly out of contact with
the tooth will allow some movement of the distal extension bases toward the
tissue without placing tipping forces on the remaining natural teeth.
Postinsertion care
a- Oral and prosthesis hygiene must be emphasized.
b- Distal extension denture bases must be relined if any appreciable
resorption of the residual ridges occurs. The impression of the denture base
areas should be made with the labial arm locked to ensure that the
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framework is in its correct position. The impression must be made with the
teeth out of occlusion.
c- Occasionally, a locking mechanism may loosen. It can be tightened
by adjusting the labial bar. The bar is stabilized at both ends, and a finger is
used to apply slight pressure to its lingual or internal surface. This adjustment
will usually necessitate slight adjustment of the vertical projection arms.
Adding teeth to swing lock
Teeth can be added to the Swing-Lock prosthesis as a relatively simple
laboratory procedure. An alginate impression is made with the prosthesis in
position and the labial arm unlocked. Usually the prosthesis will be retained
in the impression. Undercuts in the denture base areas are blocked out,
leaving only the borders exposed. A stone cast is poured. The labial arm will
be enclosed by alginate, so special care should be taken in removing the
impression from the cast. The safest procedure is to remove the tray from
the impression material and cast and to peel the alginate away from the
framework and cast.
A retention loop can be soldered to the major connector and the
replacement tooth attached with chemically activated acrylic resin.
Prognosis:
Clinical research has shown that teeth with unfavorable alveolar
support can be retained for significant periods by the use of a well-
constructed Swing-Lock prosthesis, provided the patient maintains an
adequate level of oral hygiene.