Removable partial dentures
Factors
that
influence
partial
dentures
William E. Avant,
Columbia, S. C.
retention
of removable
D.D.S., MS.
Mechanical
and physiologic
forces retain removable
partial
dentures.
Physiologically,
the intimate
relationship
of the denture base with the mucous membrane
provides retenti0n.l
Mechanically,
elements of the framework
on the teeth provide
retention.
Those elements can be extracoronal
(clasps), intracoronal
(precision
attachments),
or a combination
of these two.
Intracoronal
attachments
are not discussed in this article.
PHYSIOLOGIC RETENTION
Physiologic
retention
is proportional
to the tissue covered by the denture base1
and is most important
in extension-base
removable
partial dentures. Impressions
for
extension bases should be comparable
to impressions
for complete
dentures
(Fig.
1). They should be extended to cover the maximum
area possible within
the limits
of the health and function
of the tissues.
Maximum
coverage is most urgently needed when distal extension bases are so
long that the primary
retention
line3 is so far anterior
that indirect
retention
is
ineffective
(Fig. 1) . In those situations,
maxillary
extension bases should include
the vibrating
line with a posterior
palatal seal. For mandibular
impressions,
the
lingual flange should be shaped similarly
to that used for mandibular
complete dentures.4 This type of impression
allows maximum
coverage of tissue because the
functional
anatomy of the floor of the mouth is respected, especially the action of
the mylohyoid
muscle which is mainly responsible
for producing
the typical Sshaped curve of the lingual flange (Fig. 1) .
MECHANICAL RETENTION
Flexible clasp tips placed in undercuts on teeth provide mechanical
retention
for
removable
partial dentures. A retentive clasp, completely
passive when the prosthesis is in place in the mouth, must be deformed
to be removed from the tooth. An
unseating force is required
to cause the deformation
of the clasp, and that force is a
measure of the retention
provided
by the clasp.
265
266
J. Prosth. Dent.
March,
1971
Avant
Fig. 1. The
tissue surface
of the base of a properly
extended
mandibular
distal-extension
removable
partial
denture
is shaped similarly
to a complete
denture.
The S curve
gives
lingual
borders
a bell shape which
is typical
of mandibular
complete
dentures.
Note
the retention
line (broken
line)
is so far anterior
that indirect
retention
is ineffective.
though
the lingual
plate is of little value
as indirect
retention,
it is an aid to position
framework
on the teeth
when
relining
becomes
necessary.
The
solid line represents
fulcrum
line.
the
that
Althe
the
Clasp retention
is not intended
to resist
hard
stresses. Applegate
stated that a
clasp should generate only an acceptable
minimum
of retention.
McCracken6
and
Hickey? wrote that retention
on all abutment
teeth should be as nearly equal as
possible. Excessive retention
should be avoided, and retention
should be distributed
bilaterally
as equally as possible. Optimum
bilaterally
balanced retention of removable
partial dentures cannot be achieved consistently
unless the mechanics involved
are
carefully considered.
FACTORS
THAT
INFLUENCE
MECHANICAL
RETENTION
The flexibility
of a clasp arm and the placement
of the clasp tip in an undercut
on a tooth influence the retention
of a clasp arm. The number and distribution
of
retentive clasp arms and the mechanical
advantages of the lever involved when unseating forces are active influence the over-all retention
of a removable
partial denture.
The flexibility
of a clasp arm is the end product of several factors: The length,
the diameter,
the shape of the clasp arm, and the material
from which it is made.6
Flexibility
may not be under the control of the dentist; however, he should know
the factors that affect it and be able to evaluate those factors.
Both the vertical distance that the clasp tip is cervical to the height of contour
of an abutment
tooth and the depth of the clasp tip in an undercut
influence the
retention
to
of a clasp.
the denture
Also,
the
placement
base can affect retention,
of the
especially
retentive
part
when indirect
of the
clasp
retention
in relation
is needed.8
Volume
Number
25
3
VE!RTlCAL DISTANCE
Factors
that influence
retention
of dentures
267
VS. DEPTH OF UNDERCUT
Apparently
the effect on retention
of the vertical distance that the clasp tip is
located in an undercut
has been overlooked.
McCracken6
wrote that uniform
retention, disregarding
flexibility,
depends upon the location of the clasp tip, not in relaticln to the height of contour but in relation
to the angle of cervical convergence
(depth of undercut).
Another source states that the depth of undercut
is the critical
measurement,
not the distance that the clasp is located vertically
below the su~ey
line. Furthermore,
it is claimed that the depth of the clasp tip in an undercut
is a
di.rect measure of retentive forces.lO
Thus, it seems to be accepted that, excluding
flexibility,
the distance a clasp tip
extends in an undercut
on a tooth determines
the amount of retention
provided by
a clasp. The reasoning
is that, regardless of the vertical distance of the clasp tips
cervical to the height of contour,
the retention
will be the same for two equally
Ae:xible clasp arms when they are in undercuts of equal depth because the two clasps
must be equally deformed
to be removed from the teeth. However,
that reasonwork is force times distance. The same amount
ing is deceiving.
By definition,
of work will be done to remove the two clasps, but the force required will vary with
the vertical distance that the clasp tips fall cervical to the height of contour of the
abutment
teeth. Force is inversely proportional
to distance. If the same amount of
work is to be accomplished
over a shorter distance, more force must be applied, and
vice versa. The force required
to remove a clasp from an undercut,
not the work
accomplished,
is a measure of retention.
Moreover,
a clasp tip must be forced over an inclined plane to be removed from
an undercut
on a tooth (Fig. 2). Inclined
planes, like levers, have a mechanical
advantage which is expressed as the length of the plane divided by the height of the
plane. The steeper the inclined plane, the less the mechanical
advantage,
and, consequently, the more force required.
The use of an undercut
gauge to determine
the
location of a clasp tip establishes the height of the inclined
plane (the depth of undercut) . The length of the inclined plane is directly proportional
to the vertical distance that the clasp is located cervical to the height of contour and inversely proportional to the angle formed by the surface of the tooth and the path of insertion
(Fig.
2:1. Moreover,
the retention of the clasp increases as the vertical distance of the clasp
tip cervical to the height of contour decreases. In other words, if a 0.020 inch undercut gauge is used to determine
the depth of undercut
for retentive clasp tips on t\vo
teeth. and the clasp tip on one tooth falls 4 mm. cervical to the height of contour
while the c1as.p tip on the other tooth falls 2 mm. cervical to the height of contour,
the latter clasp (2 mm.), other factors being equal, will provide more retention
than
the former (4 mm.).
EFFECT OF LEVERS ON RETENTION OF CLASPS
Levers are a factor in retention.8
Removable
partial dentures that are retained
by clasps and have indirect
retention
utilize the principle
of a Class 2 lever.8 The
resistance is located between the fulcrum
and the power in a Class 2 lever and the
mechanical
advantage
is greater than one. When indirect
retention
is present, the
resistance arm of the Class 2 lever should be as long as feasible to reduce the mechanical advantage.
The resistance arm can be of optimum
length when the indirect
268 Avant
J. Prosth. Dent.
March, 1971
Fig. 2. The left and right drawings iIlustrate the placement of two clasp tips in undercuts
of the same depth but of different vertical distances. The inclined planes over which
the clasp tips must be forced are equal in height but not in length. More force is required
to move a clasp tip over the shorter inclined plane on the right. The inclined plane at
the bottom is incIuded and labeled for clarity. T, the tooth surface; P, the path of insertion;
S, the survey line or height of contour; Y, the vertical distance of the undercut; 2, the
depth of undercut; L, the length of the inclined plane; H, the height of the inclined plane.
Fig. 3. Removal of a removable partial denture base that has clasp retention at each end
is an example of the application of a Class 3 lever. The clasp tip on the first premolar
represents the fulcrum (Ii) and the cIasp tip on the second molar represents the resistance
(R-4) when the unseating force (PA) is active between them. It is possible that the fulcrum
and resistance could be reversed, depending upon which clasp is dislodged first.
retention and the primary retention line3 are as far apart as feasible. Thus, the location of indirect retention and the primary retention line affect retention because
their locations affect the mechanical advantage of the lever.
Removable partia1 dentures with clasp retention at both ends of the denture
bases are examples of a Class 3 lever, unless all clasps are removed from the teeth
simultaneously. Usually, the clasp tips at one end of the denture base act as the fulcrum while the clasp tips at the other end act as the resistance when an unseating
force is active between the clasps (Fig. 3). The power is applied between the fulcrum and the resistance in Class 3 levers, This prosthesis is easily retained because
a Class 3 lever has a mechanical advantage less than one.
Vdurne 25
Number 3
Factor5
thut
influence
retention
of dentures
269
NUMBER OF RETENTIVE CLASP ARMS
Clasp retention
on a tooth is greater when both clasp tips are in undercuts
than
uhen only one clasp tip is in an undercut. A clasp with both tips in 0.020 inch undercuts 3 mm. below the survey line will provide approximately
twice as much retention
as a comparable
clasp with only one tip in a 0.020 inch undercut
3 mm. below the
survey line. It follows, then, that if both clasp tips are to be in undercuts, it is necessary in some situations to reduce the amount of undercut used for each clasp tip. This
is, especially true when planning
bilateral
all-tooth-supported
removable partial dentures with retention
at both ends of the denture bases. For these prostheses, it may
even be desirable to use only one retentive clasp arm on each abutment
tooth.
PROVIDING MECHANICAL RETENTION
Hickey listed five ways that retention
can be provided.
These are: (1) buccal
and lingual undercuts on the same tooth, (2) a buccal or a lingual undercut
opposed
by a tooth surface on the opposite side of the same tooth that is parallel
to the path
of insertion,
(3) buccal undercuts
on opposite sides of the same dental arch, (4)
lingual undercuts on opposite sides of the same dental arch, and (5) a buccal undercut opposed by a lingual undercut of a different tooth on the same side of the dental
a.rch.
The first and second ways provide retention on a tooth independently
of any other
tooth. The fifth way provides retention on one side of the dental arch independently
of the other side. None of these ways provides bilateral
retention.
Only the third
and fourth M.ays provide bilateral
retention.
In essence, then, bilateral
retention
can
be provided by a buccal undercut on each side of the dental arch or a lingual undercut on each side of the dental arch. Moreover,
one acceptable
point of clasp retention on each side of the dental arch will provide adequate retention
for a removable
partial denture when the primary
retention
line3 passes near the center of supporting or stabilizing
areas, or when long extension bases are present (Fig. 1) .
A surveyor is necessary to select a path of insertion that will provide an acceptable distribution
of undercuts.
After the path of insertion is established, the surveyor
is again necessary either to measure or estimate the depths at which the clasp tips
are to be placed in the undercuts.
ISUMMARY
Factors that influence
the retention
of removable
dentures
retained
by clasps
Yhavc been discussed. Some of these factors have not been considered
previously.
The dentist should design partial dentures.
References
1.
2.
3.
4.
Boucher,
C. 0.: Impressions for complete dentures, J. A. D. A. 30: 14-25, 1943.
Boucher,
C. 0.: A critical
analysis
of mid-century
impression
techniques
for full dentures,
J. PROSTH. DENT. 1: 472-491,
1951.
Avant,
W. E.: Fulcrum
lines and retention
lines in partial
denture
planning,
J. PROSTH.
DENT. In press.
Boucher,
C. 0.:
Swensons
Complete
Dentures,
ed. 5, St. Louis,
1964,
The
C. V.
Mosby
Company, pp. 124-134.
270
Avant
J. Pro&h.
March,
Dent.
1971
5. Applegate, 0. C.: Essentials of Removable Partial Denture Prosthesis, ed. 3, Philadelphia,
1965, W. B. Saunders Company, p. 185.
6. McCracken, W. L.: Partial Denture Construction, ed. 2, St. Louis, 1964, The C. V.
Mosby Company.
7. Hickey, J. C.: Responsibility of the dentist in removable partial dentures, J. Kentucky
Dent. Ass. 17: 70-87, 1965.
8. Avant, W. E.: Indirect retention in partial denture design, J. PROSTH.
DENT.
16: 11031110, 1966.
9. Planned partial dentures, Hartford, The J. M. Ney Company, 1955.
10. Partial dentures, New York, J. F. Jelenko & Company, Inc., 1962.
2827
MILLWOOD
COLUMBIA,
AVE.
S. C. 29205
