Removable partial dentures

Factors partial

that

influence

retention

of removable

dentures
D.D.S., MS.

William E. Avant, Columbia, S. C.

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

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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. Also, the placement of the retentive part of the clasp in relation

the denture

base can affect retention,

especially

when indirect

retention

is needed.8

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Factors

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VE!RTlCAL DISTANCE

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

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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.

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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.

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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 AVE.

COLUMBIA,

S. C. 29205