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Support, design and occlusal

considerations for distal

extension base partial denture

Arjun Dhiman

Factors affecting support for distal extension
partial denture

Design for distal extension base

Occlusion for distal extension base

Class I: bilateral edentulous areas
located posterior to the natural teeth

Class II: a unilateral edentulous area

located posterior to the remaining
natural teeth
Class III:

A unilateral edentulous area

with natural teeth remaining both
anterior and posterior to it
A single, but bilateral (crossing
the midline), edentulous area located
anterior to the remaining natural teeth

Class IV:

How a distal extension base differs from

tooth borne partial denture?
Method of impression registration
Need for indirect retention
Need for relining


components of masticatory force
which prevents the partial denture
from being displaced toward the soft

Provided by the occlusal rest and

residual ridge

Support for distal extension

Tooth support: occlusal rest on the
abutment tooth.
The tooth should be engaged in such a
manner that prosthesis framework promotes
axial loading since teeth provides most
effective resistance when stressed along the
long axis.
In distal extension the denture becomes
increasingly tissue supported as the
distance from the abutment increases.
Closer to abutment , more of the occlusal
load is transmitted to the abutment tooth by
means of rest.

Factors influencing the support of a

distal extension base
Contour and quality of residual ridge

1) Contour And Quality Of

Residual Ridge
Ideal ridge:
Cortical bone covering dense cancellous bone
Broad rounded crest
High vertical slopes
Covered by firm, dense, fibrous CT

Easily displaceable tissue will not adequately

support a denture base, and tissue that is
interposed b/w sharp, bony residual ridge and
denture base will not remain in healthy state.

Nature and positional relation of bone to the

direction of forces
optimum support.





Lining mucosa restricts both lingual and

Buccal shelf region

Bounded by :
External oblique ridge
Crest of ridge

Better suited for primary

stress bearing area:
Relatively firm, dense, fibrous
CT supported by cortical bone.

Bears more of a horizontal

relationship to vertical forces

Oral tissues firm , dense nature
(similar to mucosa of hard palate)

Topography of a partially edentulous

area poses restriction on selection of
primary stress bearing area

Crestal area- primary stress bearing


Some resistance is provided by buccal

and lingual slopes of the ridge.

Palatal tissue dispaceable cant be

primary stress bearing area.

2) Extent of residual ridge coverage by

the denture base

Time-honored Principle: base should cover as wide

as area as the limiting structures will permit & that
the patient can comfortably tolerate

Supported by the Snow Shoe Principle : broader

coverage furnishes the best support with the least
load per unit area

Kaires stated max coverage of denture bearing

area with large , wide denture bases is of utmost
importance in withstanding both horizontal and
vertical stresses

Maxillary distal extension

Full coverage base extending to cover the
tuberosity & hamular notches
Posterior border: taper towards tissues; beveled
Termination on tissues that are resilient but not
Tissue surface should be lightly beaded if in
metal & post - dammed if in acrylic
Metal finished lines- sharp straight junction with
no overlapping of acrylic
Buccal flange should extend into vestibular
Anterior border of labial flange taper
posteriorly; beveled

2mm in thickness, rounded and smooth

Labial flange properly contoured; festooning

Extension of mandibular distal

extension base
T.Fischer and W.D. Sweeney total area
of maxilla capable of support 1.6 times

Should extent to cover retromolar pads

distally and laterally to include the
buccal shelf

Lingual flange : vertically downwards

into alveolingual sulcus.

Distolingual flange extended laterally

into retromylohyoid space; beveled.

Concave to allow adequate tongue space

Height : anatomy of mylohyoid ridge.
Labial and buccal extensions : mucosal

3) Need for special impression

Support derived tooth + residual ridge
Difference in

Two forms of residual ridge anatomic &


Difference in stress bearing capacity of

different areas of residual ridge



Dual impression

Record teeth in anatomic form & residual

ridge in functional form

Situations indicated for

Dual impression
Displacement of soft tissue covering the
ridge is more mandibular foundation

Limited denture bearing area requiring

proper recording of the peripheral

extension mandibular distal extension

Long span anterior edentulous ridge

(normally including six anterior) some

portion of support must be derived from
the ridge

Objectives of dual impression

To distribute the support b/w ridge and
the abutment

To minimize the movement of the

denture base thereby reducing leverage

on the abutment

To obtain a corrected or an altered

master cast

Types of Dual impression


Physiologic or

Records the ridge

by placing occlusal
load on impression

Selective tissue
placement impression
Not only equalizes support but
has an added advantage of
directing forces to areas most
capable of withstanding the

McLeans & Hindels

Functional relining
Fluid wax technique

Providing relief in selective

areas of the impression tray

4) Accuracy of fit of denture base

Support enhanced by intimate contact basal
seat area

Tissue surface must represent the true negative

of basal seat of master cast.

6) Total occlusal load applied

Determine amount of support required
Denture base opposed by full complement of natural teeth
or if
edentulous span is long
increase support is required.
We can narrow the occlusal table
To increase the masticatory efficiency supplemental groove and
sluiceways can be made
less force will be transmitted to the
orient the food bolus over natural teeth rather than prosthetic
teeth, because:
More stable nature of natural dentition
Proprioceptive feedback they provide for chewing
Nociceptive feedback from the supporting mucosa.

5)Design of the removable

partial denture

Movements of distal
extension base

The requirements for movement control are

generally functions of whether the prosthesis will
be tooth supported or tooth-tissue supported.

For tooth supported prosthesis the movement

potential is less because teeth provide resistance
to functional loading.

For tooth tissue supported removable partial

denture , the residual ridge presents a quite
variable potential for support.

Systematically developed and outlined on

diagnostic cast:
From where prosthesis is supported?
How the support is connected?
How the prosthesis is retained?
How retention and support are connected?
How the edentulous base is connected?

I ) Support for Prosthesis

Distal extension tooth-tissue supported
Consider abutment tooth condition:
Pdl health
Crown-to-root ratio
Crown and root morphologies
Bone index area
Location of tooth in the arch
Relation of tooth to other support units opposing dentition.

If tooth and tissue supported.

Also Consider
Residual ridge condition: 6 factors

Denture base area adjacent to abutment teeth are

primarily tooth supported , as we proceed farther
away it becomes tissue supported.

it is necessary to incorporate characteristics in the

partial denture that will distribute the functional
load equitably b/w the abutment teeth and
supporting tissue of the edentulous ridge.

II) Connect the support

These connection is facilitated by designing and
locating major and minor connectors in
compliance with the basic principles and

III) Determine how the partial denture is to be retained.

Select clasp design that will

1. Avoid direct transmission of tipping &
torquing forces to the abutment
2. Accommodate the basic principles of clasp
design by definitive location of components
parts correctly positioned on abutment tooth
3. Provide retention against reasonable
dislodging forces.
4. Be compatible with undercut locations,
tissue contour, and esthetic desires of the

IV) Connect retention and

Through major and minor connector

V) Connect edentulous base

Outline and join the edentulous area to already
established design components.

Components of partial
3 Essentials of design:

In addition, in distal extension base, provision

should be made for:
Impression technique:
Method of direct retention : should be such that it
transfers the load directly along the long axis of
abutment teeth.
Indirect retainer

Support :
resistance to vertical force.


transmitted through saddles of
partial denture and is ultimately
resisted by the bone.

On the abutment teeth force is

transmitted to bone via teeth and
pdl, while in area of tissue
support forces are transmitted to
bone via mucosa.

Rest and rest seats


A rigid extension of fixed or

contacts a remaining tooth to dissipate
horizontal or vertical forces

Rest seat: That portion of a natural tooth

or cast restoration of a tooth selected or

prepared to receive an occlusal, incisal,
or lingual rest

The primary purpose of rest is to provide vertical support for

the partial denture.

Maintains components in their planned positions

Maintains established occlusal relationships by preventing

settling of the denture

Prevents impingement of soft tissue

Directs and distributes occlusal loads to abutment teeth

Basic guidelines for design:

Floor of rest seat preparation must be
less than 90 degrees with long axis of
tooth as this design grasps the tooth
to prevent its migration

Preparation should be saucer shaped

without any sharp angles and ledges.

Rest should be free to move within the

rest seat to release the stresses which
would otherwise transmit to the tooth

More the no. of teeth that bear rest

seats, the less will be the stress
places on each individual tooth.


1) Connectors: major and minor connector

Major connector

Major connector
MC should be free of movable tissue
Impingement of gingival tissue should be avoided
Bony and soft tissue prominences should be avoided
during placement and removal.
Relief should be provided beneath a major connector to
prevent its settling into areas of possible interference,
such as inoperable tori or elevated median palatal sutures.
MC should be located and or relieved to prevent
impingement of tissue because the distal extension
denture rotates in function.
The part of the framework adjoining the tooth surface
should be hidden in embrasures to avoid discomfort

Design considerations of major


Intentional relief:

Borders should be parallel to

gingival margins

Metal framework should cross

the gingival margin at right
angle only


procedures for
maxillary major connector
(Blatterfien 1953)

Step 1: primary stress bearing areas

that are to be covered by denture base
are marked

Step 2: relief areas are marked

Step 3: connector areas are outlined to
designate areas that are available to
place components of major connector

Step 4: selection of connector type

Step 5: unification

Design of mandibular major connectors:

Step 1: outline the basal seat areas
Step 2: Outline the inferior border of the
major connector

Step 3: superior border

Step 4: connect the basal seat area to
borders , and add minor connectors

Criteria of selection.
1. Requirement for indirect retention
2. horizontal stability and stress distribution.lingual
plate and double lingual bar

3. Anatomic considerations:lingual tori,lingual frenum,

interproximal spaces

4. Esthetics
5. Phonetics considerations
6. Patient preference factor.

Minor connector
Minor connector should be rigid for distribution of forces

Should not be bulky

When minor connector is present between two teeth,

it should be triangular and occupy minimum space

Junction of major and minor connector should be rounded

Metal surface towards tongue should be beveled.

contacts the guiding plane surfaces of the abutment

teeth ,

An open lattice or ladder type of design is preferable

and is conveniently made by using preformed 12
guage round wax strips.


for mandibular distal extension base should

extend posteriorly about 2/3rd length of the
edentulous ridge and have elements on both lingual
and buccal surface.
Add strength and minimize distortion of cured base
It should not interfere with the arrangement of artificial teeth.




It should be located
in embrasure where
it will be least
noticeable to the

It should be thickest
towards the the
the contact area

Direct retainer
Indirect retainer

Direct retainers
A direct retainer is any unit of a removable
partial denture that engages on abutment tooth
in such a manner as to resist displacement of
the prosthesis away from basal seat tissues

Direct retainers for distal extension cases:


dislodging forces without damage to abutment

To aid in resisting any tendency of the denture to

be displaced in horizontal plane

Must also be able to flex or disengage

denture base moves tissue ward under function.
Thus the retainer may act as a stress breaker

Round, tapered clasp forms or combination

circumferential clasp or a bar clasp can be

Tripod configuration
Used primarily for class 2 arches.

One clasp on the Dentulous side of the arch

should be positioned as far posterior, and the
other, as far anterior as factors such as
interocclusal space, retentive undercut, and
esthetics considerations will permit.

Bilateral configuration
Used in class 1 cases.
In this configuration the
clasps exert little
neutralizing effect on the
leverage induced stresses
generated be the denture
base. These stresses must
be controlled by other

The terminal abutment

tooth on the each side of
the arch must be clasped
regardless of where it is

Is indicated in class 3

arches particularly when

modification space exists
on the opposite side.

A retentive clasp is

positioned on each
abutment tooth adjacent
to the edentulous spaces.

In this design leverage is

effectively neutralized.

Forces acting on abutment teeth

A typical design of a distal extension base
( DEB)
- distoocclusal rest
- clasp arm in mesiobuccal undercut

Vertical component of occlusal load distal to

long axis of tooth - distal tilting.

Accentuated by clasp arm in mesial

undercut bottle opener principle.

Distal extension base

Moreover the proximity of the rest to the

denture base results in base rotating
around a small radius with fulcrum away
from COR of the abutment Steffel.

Mesial occlusal rest produces a more

favorable fulcrum point closer to the
COR and rotation around a larger radius.

Nally (1963) Thompson, Kratochvil and Caputo

(1977) evaluted stress patterns and concluded:

1. Clasp with mesial rest, buccal I-bar/ wrought wire
and cast lingual arm : most favourable stress
2. Distal rests tilts abutments distally and roots
mesially : horizontal forces in bone.
3. Mesial rests transmit forces in a more vertical
4. Distal rests : > horizontal forces on abutment.

So, combination circumferential clasp or a

bar clasp can be used.

Box & Synge -PDL

is better able to
withstand vertical
forces directed
along the long axis
of abutment tooth
than the horizontal
forces as > PDL
fibers are
activated in
resisting vertical
forces than the off-

Rest, Proximal Plate & I bar concept

Kratochvil developed a concept

for an innovative clasp assembly
in the early 1960s

They are
An occlusal rest arising from a
minor connector on the side of
edentulous space

An I-shaped bar clasp retaining

arm placed midbuccally on the

A vertical plate contacting the

surfaces of the abutment
adjacent to the development

This clasp configuration was designed to allow
extension base removable partial denture some
degree of tissue ward rotational freedom without
torque to the clasped teeth

Krol made certain modifications in the design of

the proximal plate and supplied a name:
RPI bar clasp design

Thus a new system of bar clasp for removable

partial denture came into being

Indirect retainers
The component of removable partial denture that assists
the direct retainer in preventing displacement of the
distal extension denture base by functioning through
lever action on the opposite side of the fulcrum line
when the denture base moves away from the tissues in
pure rotation around the fulcrum line.

Indirect retainer also contributes to a lesser degree, to

the support and stability of the denture.

Imaginary Axis of rotation =fulcrum


Formed at terminal abutment axis

(line joining 2 posterior most rests)

The primary fulcrum line on distal

extension partial dentures, is an imaginary
line passing through the most distal rest
seat (of a tooth) on each side of the arch.

If the denture base extends mesially, the

primary fulcrum line passes through the
most mesial rest seat on each side of the

Class 1.
It must always be
used and positioned
as far anteriorly as

Class 2
its use is not as critical as in
class 1

An abutment tooth with suitable

contours for clasping should be
selected as far anterior on the
tooth-supported side as possible.

This rest and clasp assembly,

may serve as the indirect
retainer if it is located far enough
anterior to the fulcrum line.

If modification space exists The most anterior abutment

on the tooth supported side,

with its rest and clasp
assembly, may be located
far enough anterior to the
fulcrum line to serve as the
indirect retainer.

rest seat
anterior ,if possible, may
increase the effectiveness of
the indirect retention.

Denture base
denture base should cover maximum area of the
supporting tissue as possible

Denture base flanges should be as long as possible-to help

stabilize against horizontal movements

Distal extension denture base should cover the retro molar

area and tuberosity of maxilla as these structures better
absorb stress

Overextension should be avoided as

interference with functional movements of
surrounding tissues will transmit stresses to the
remaining teeth

Accurate adaptation of denture base leads to

less tendency for movement during function

Contour of the polished surfaces also helps in

reducing the stress transmitted.

Stress distribution in a distal

extension case depends on:
1. good PDL support with favorable ridge : any
retainer with equal distribution of load
2. good PDL support with unfavorable ridge:
>stress on abutment
3. poor PDL support with favorable ridge : >stress
on ridge therefore a stress releasing type of
4 Poor PDL & ridge support : stress releasing type
of retainer to preserve the remaining, teeth as
long as possible

Strain on abutment teeth can be

Functional basing
Broader coverage
Harmonious occlusion
Correct choice of direct retainers

Stress breakers
A device which relieves the abutment teeth of
all or part of the occlusal forces. -- GPT.

Concept of stressbreakers came in

existence in relation to free- end partial
dentures to reduce the torque & load on
abutment teeth

Designed to separate the action of

retaining elements from the movement of
denture base by allowing some
movement b/w the two

Types of stress directors

Group I

Group II

With movable joints

b/w Direct Retainers
and denture base
that permit vertical
movement, or
hinge-type or a

Articulated Partial Dentures

flexible connection b/w the
Direct Retainers and denture
base is provided.

Devices with
hinges, sleeves,
cylinders or ball and
socket joint.

- Wrought wire connectors

- Divided or split major connectors
- Movable joints b/w two major

Advantages of stress directors

Minimizes horizontal forces to the abutment teeth
Intermittent pressure of the denture bases provides physical stimulation
to the underlying tissues
Allows splinting of the weak teeth

Disadvantages of stress directors

More stresses to the residual ridges
Reduced effectiveness of the indirect
retention and cross arch stabilization.
Entrapment of the food particles
Distortion of the flexible connectors that places more stress on the
abutment teeth
Relining frequently needed
repair and maintenance costly

Occlusal consideration for

distal extension base
Occlusal harmony b/w rpd and the remaining natural
teeth is a major factor in the preservation of the
health of their surrounding structures.


occlusion: Occlusion whereby the

masticating mechanisms can carry out its physiologic
functions while factors of occlusion remain in state of
good health.
Factors of occlusion:
Neuromuscular mech.
Supporting structures.

The establishment of satisfactory occlusion for

the removable partial denture should include the
following :
Analysis of existing occlusion
Correction of existing occlusal disharmony
Recording of centric relation or an adjusted centric
Recording of eccentric jaw relations or functional
eccentric occlusion
Correction of occlusal discrepancies created by the
fit of the framework and in processing the rpd.

EDEC principle for the fabrication of prosthesis

E- examine pre-existing occlusion
D design the prosthesis
E execute the prosthesis
C- check the occlusion at the completion.

Occlusal forms of the teeth of rpd must be made

to conform to an already established occlusal

The only exception are those

in which an opposing complete denture can be
made to function harmoniously with the rpd
or in which only anterior teeth remain in both the
arches and the incisal relationship can be made so
that tooth contacts do not disturb denture stability
or retention.

All other types of rpd the remaining teeth

dictate the occlusion

Dentist should strive for planned contacts in

centric occlusion and no interferences in lateral

Approaches for the

establishment of occlusion
Conformative; occlusion conforms to the
constraints of patients present occlusion scheme.
Reorganized approach: occlusion is reorganized to
more ideal occlusion
For the correction of overclosure
Gross discrepancy b/w centric relation and maximum
intercuspation position.

Materials for artificial

Posterior teeth may be made of porcelain or resin.

Acrylic resin teeth are generally preferred to porcelain teeth ,

because they are more easily modified .

Improved acrylic resin teeth with gold occlusal surfaces are

preferably used in opposition to natural teeth.

The best combination of opposing occlusal surfaces to maintain the

established occlusion and to prevent deleterious abrasion are
porcelain to porcelain surfaces gold surfaces to natural or restored
natural teeth and gold surfaces to gold surfaces.

Posterior teeth form

Objective in rpd occlusion is harmony b/w natural
and artificial dentition .

In cd patient teeth is selected and articulated acc.,

to dentist of what constitutes the most favourable
cd occlusion, whereas rpd denture occlusion must be
made to harmonize with an existing occlusal pattern.

Teeth should be narrower b-l and m-d

Artificial Teeth morphology

For balanced occlusion as in denture opposing
complete denture : anatomic teeth preferred

Methods of establishing
Functionally generated pathway technique
Articulator or static technique
Analysis of existing occlusion
Correction on existing occlusion disharmony
Recording of the functional dynamic occlusion

Functionally generated pathway technique

Pathways of the natural tooth against edentulous
span are recorded using occlusal rim by making all
functional movements of the mandible
Pathways so generated are poured in improved
stone. Each ridge or groove in resulting stone cast
represents path of cusp
Setting the teeth in contact with the paths results
in functional and harmonious occlusion

Procedure :
directly under supervision of dentist
At home, movements performed and evaluated by
dentist after 24 hours

Setting of the artificial teeth

At increased vd (1mm)
Occlusal adjustments by selective grinding

Easy approach
Eliminates recording of interocclusal relationship &
transferring to articulators
No use of face bow

Occlusion in one arch must be formulated before other
Movement of distal extension base results in inaccurate
Verification of pathway is difficult

Static / articulator
Determination of vd
Determination of horizontal jaw relationships
Centric relation & intercuspal position coincides
with no evidence of occlusal pathology

Posterior teeth missing in both arches so

fabrication in centric relation

Face bow transfer allows accurate mounting of

upper cast wrt condylar axis, similar to one
relation which exists b/w maxilla & hinge axis

Indication: when multiple posterior teeth are

missing in one or both arches face bow transfer
eliminates error in establishing occlusion

Methods for establishing occlusal

Direct opposition of casts.
Interocclusal records with posterior teeth remaining
Occlusal relations using occlusal rims on record
Jaw relations records made entirely on occlusion

Direct opposition of casts.

Less clinical appointments
Better than recording of inaccurate wax record

Exaggerates existing Occlusal disharmony

Interocclusal records with

posterior teeth remaining
Most common
Least accurate
Interocclusal wax record
errors- during or after removal from mouth,
chances of distortion
a wax contacts mucosal surfaces can distort soft
tissues resulting in inaccurate seating over stone
Wax record should be corrected with bite
registration paste- final recording medium

Occlusal relations using occlusal

rims on record bases
Record bases- stable & accurate
Material :
vlc., self cure acrylic, cast metal, compression
moulded/ processed acrylic

Record made with

Soften wax occlusion rims
Quick setting impression plaster
Bite registration paste
Auto polymerizing resin

Jaw relations records made

entirely on occlusion rims
No opposite natural tooth contacts e.g.. Maxillary
complete denture opposite mandibular distal
extension bases.
No interocclusal material is added.

Arrangement of posterior teeth

Simultaneous bilateral contacts

of opposing posterior teeth must
occur in centric occlusion.

Maxillary Complete
Partial Denture.




contacts in a protrusive
appearance , phonetics,
and or a favourable
occlusal plane.



simultaneously with
of the
distribute the stress
over the greatest
possible area

Maxillary Bilateral Distal Extension

Rpd opposing mandibular distal
extension base or natural teeth
Simultaneous working and balancing
contacts should be
whenever possible.




The Maxillary Or Mandibular Unilateral

Distal Extension Rpd
Only working contacts need to be formulated for
either. Balancing side contacts wont enhance
stability of the denture coz it is entirely tooth
supported by the framework on balancing side.

Balanced contact of opposing posterior teeth in

a straightforward protrusive relationship and
functional excursive positions is desired only
when an opposing complete denture or bilateral
distal extension maxillary rpd is placed.

Artificial teeth should not be arranged farther

distally than the beginning of a sharp upward
incline of the mandibular residual ridge or over
the retromolar pad.

Design Principles for distal extension cases
For Class I
1. Clasps
2 clasps on each terminal tooth are sufficient.
For distobuccal undercut a vertical projection clasp is
For mesiobuccal undercut wrought wire clasp.
Reciprocal arm should be rigid. Can also be replaced
with lingual plate.

For Class II
1. Clasps
Usually 3 clasps are designed.
The distal extension side can be designed similar to
Class I
The tooth supported, or modification side should have
two retentive clasps:

For Class I and II

2. Rests
For maximum possible support.
Designed for direction of stress in a direction along the
long axis of the tooth.
Should always be placed on the tooth adjacent to the
edentulous area.

For Class I and II

3. Indirect Retention
Location: as far anterior to the fulcrum line
2 indirect retainers for Class I situation, and 1 on the
on the opposite side as the edentulous area in Class II
is sufficient.
Lingual plate with rest seats is an efficient retainer.

For Class I and II

4. Major Connector
Must be rigid and not impinge on soft tissue.
Maxillary: support from hard palate whenever possible.
Mandibular: lingual plate for increased rigidity, indirect
retention and elimination of areas of food impaction.
5. Minor Connector
Positioned to enhance comfort,
placement of artificial teeth



6. Occlusion
Centric relation and occlusion should coincide.
Artificial teeth should be positioned to reduce stress.
Positioned to enhance comfort, direction of stress along long
axis, and efficiency of mastication.

7. Denture Base
Broad coverage for equal stress distribution.
Borders should not interfere with the functional movements of
the tissues.

Selective pressure technique is indicated for edentulous


McCrackens Removable Partial Denture Alan
B. Carr, Glen P. McGivney

Clinical Removable Partial prosthodontics

Stewart , Rudd,Kuebker