Prosthetic Dentistry

Lec.16
Principles of Partial Denture Design

Differentiation Between Two Main Types of Removable Partial Dentures

Certain points of difference are present between Kennedy Class I and Class II types of
partial dentures on the one hand and the Class III type of partial denture on the other.
(1) Differentiation in support
 The Class III type derives all of its support from the abutment teeth.
 The Class I type and the distal extension side of the Class II type derive their
primary support from tissues underlying the base and secondary support from
the abutment teeth.
(2) Impression registration.
 In tooth supported RPD, the anatomic form and the relationship of the
remaining teeth in the dental arch, as well as the surrounding soft tissues, must
be recorded accurately.
 In tooth-tissue supported RPD, the supporting form of the soft tissues
underlying the distal extension base of the partial denture should be recorded.
Firm areas are used as primary stress–bearing areas and readily displaceable
tissues are not overloaded.

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(3) The need for some kind of indirect retention.
In tooth-supported, Class III type, no extension base is present to lift away from the
supporting tissues. Therefore, the tooth-supported partial denture does not rotate
about a fulcrum, as does the distal extension partial denture. The indirect retainers
should be as far from the primary fulcrum line as possible (90°), and placed on the
opposite side of the fulcrum line from the denture base.
(4) Type of a Denture base material
 The Class III partial denture is entirely tooth supported, so it does not require
relining except when it is advisable to eliminate an unhygienic, unesthetic, or
uncomfortable condition resulting from loss of tissue contact. Metal bases
therefore are more frequently used in tooth-supported restorations.
 Acrylic-resin is generally used as a base material for distal extension bases.
(5) Clasp Design
 The only requirement for clasps that support tooth supported RPD is that they flex
sufficiently to pass over the height of contour of the teeth in approaching or
escaping from an undercut area. While in its terminal position on the tooth, a
retentive clasp should be passive. Cast retentive arms, designed to be ideally placed
in the gingival 1/3 of the tooth margin to minimizes the torque on teeth and
optimizes esthetics and no closer than 1-1.5 mm from the free gingival, are
generally used for this purpose. Reciprocal arms should be placed in the middle 1/3
of the tooth occlusogingivally.

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  In the combination tooth and tissue–supported RPD, the direct retainer adjacent to
the distal extension base must perform still another function, in addition to
resisting vertical displacement, it must be able to flex sufficiently to dissipate
stresses that otherwise would be transmitted directly to the abutment tooth as
leverage. Clasp used in conjunction with a mesial rest may not transmit as much
stress to the abutment tooth because of the reduction in leverage forces (RPI,
RPA). Additionally, a retentive clasp arm made of wrought wire can flex more
readily in all directions (combination clasp).

 When there is marked mobility of one or more of the abutments, the use of stress-
releasing direct retainers becomes more important.

Factors affecting clasp design

 Caries susceptibility: Cast clasps cover more tooth surface than wrought round
clasps. The latter clasps would be preferred if caries incidence is higher than usual.
 Size of the tooth: may affect the choice of retentive clasps, since it affects possible
clasp length and hence flexibility. Less flexible clasp materials or designs can be used
on large teeth since the increase in clasp length compensates by increasing clasp
flexibility.
 Tooth position in the arch: Some clinicians feel that the canine teeth should be
clasped with cast infrabulge retainers since these teeth are relatively unsupported
against mesially directed forces. It is reasoned that wrought clasps are too flexible and
will not resist such movement.

Mesial movement of the premolar is

prevented by the canine anteriorly.
The canine¸ when clasped has no tooth
immediately anterior to buttress
against such movement.
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 Retentive undercut: if no undercut can be found, it is possible to prepare a small
retentive area on a tooth when the designated surface be approximately parallel to path
of insertion. The determined position for the prepared area may influence the design
of the clasp to be used. If the proposed retentive surface diverges greatly from the path
of insertion and no other usable retentive area exists, crowning the tooth may be
necessary.

Design Sequence
When drawing a design on a cast, sharpened, coloured pencils should be used. In general,
after the path of insertion and the abutment teeth have been selected, the positions of the
rests for the partial denture are chosen, since their placement will affect other parts of the
design. The order of other design elements usually follows the sequence:
1. Rests.
2. Major connector.
3. Minor connectors.
4. Direct retainers.
5. Indirect retainers.

Essentials of Partial Denture Design

The design of the partial denture framework should be systematically developed and
outlined on an accurate diagnostic cast based on the following prosthesis concepts:
1. Where the prosthesis is supported?
2. How the support is connected?
3. How the prosthesis is retained?
4. How the retention and support are connected?
5. How edentulous base support is connected?

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1. Where the prosthesis is supported?
In developing the design, it is first necessary to determine how the partial denture is to be
supported. In an entirely tooth-supported partial denture, the most ideal location for the
support units (rests) is on prepared rest seats on the occlusal, cingulum, or incisal surface
of the abutment adjacent to each edentulous space. In evaluating the potential support that
an abutment tooth can provide, consideration should be given to (1) periodontal health;
(2) crown and root morphologies; (3) crown-to-root ratio; (4) bone index area (how tooth
has responded to previous stress); (5) location of the tooth in the arch; (6) relationship of
the tooth to other support units (length of edentulous span); and (7) the opposing
dentition.

 Avoid placing rest in areas of heavy occlusal contact. In addition, extrusion of

opposing teeth must be noted to ensure that there is room for replacement denture
teeth.

In a tooth and tissue–supported partial denture, attention to these same considerations

must be given to the abutment teeth. However, equitable support must come from the
edentulous ridge areas. In evaluating the potential support available from edentulous
ridge areas, consideration must be given to:

(1) The quality of the residual ridge (contour and quality of the supporting bone) and
quality of the supporting mucosa
The quality of the residual ridge cannot be influenced, except that it can be improved by
tissue conditioning, or it can be modified by surgical intervention. Such modifications are
almost always needed but are not frequently done.

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(2) The extent to which the residual ridge will be covered by the denture base
Maximum tissue coverage for support that encompasses the primary stress–bearing areas
should be the primary objective in any partial denture impression technique. Distal
extension bases should be extended to 2/3 of the retro-molar pads and the entire extension
of the maxillary ridge as these structures provide peripheral seal.
Rotational movements increase with length of span of the distal extension. Also as arm
flexibility increases, resistance to lateral displaceability decreases. Therefore, it is
important to use maximum coverage of the edentulous ridge to reduce the degree of
lateral movement. This is particularly effective when there are large, broad ridges which
tend to provide greater resistance to horizontal movements.

(3) The type and accuracy of the impression registration

The best possible support must be obtained from the resilient tissues that cover the
edentulous ridges. This is accomplished by the impression technique more than by the
partial denture design, although the area covered by the partial denture base is a
contributing factor in such support.
Three factors must be considered in the acceptance of an impression technique for distal
extension removable partial dentures: (1) the material should record the tissues covering
the primary stress–bearing areas in their supporting form; (2) tissues within the basal seat
area other than primary stress–bearing areas must be recorded in their anatomic form; and
(3) the total area covered by the impression should be sufficient to distribute the load over
as large an area as can be tolerated by the border tissues. This is an application of the
principle of the snowshoe.

(4) The accuracy of the denture base

The accuracy of the denture base is influenced by the choice of materials and by the
processing techniques. Inaccurate and warped denture bases adversely influence the

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support of the partial denture. Materials and techniques that will ensure the greatest
dimensional stability should be selected.

(5) The design characteristics of the component parts of the partial denture framework
Direct retainers must be designed so that occlusal loading will result in direct
transmission of this load to the long axis of the abutment teeth instead of as leverage. The
partial denture, with one or more distal extension denture bases, must be designed so that
movement of the extension base away from the tissues will be minimized. This is often
referred to as indirect retention.

(6) The anticipated occlusal load

The total occlusal load applied to the residual ridge may be influenced by reducing the
area of occlusal contact. This is done with the use of fewer, narrower, and more
effectively shaped artificial teeth.

2. How the support is connected?

The second step in systematic development of the design for any removable partial
denture is to connect the tooth and tissue support units. This connection is facilitated by
designing and locating major and minor connectors in compliance with the basic
principles and concepts.

 Major Connectors
 Major connectors must be rigid so that forces applied to any portion of the
denture can be effectively distributed to the supporting structures.
 Major connectors should have smooth continuous contours that flow into
other elements of the partial denture.

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 Minor connector
 Cingulum rests can be designed to join proximal plates, rather than having
separate minor connectors, whenever possible.

correct incorrect incorrect

 Where a cingulum rest is not adjacent to an embrasure minor connector of an

occlusal rest, cross the free gingival margin directly.

incorrect Correct Incorrect

Don’t use an embrasure too far into embrasures
Minor connector

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3. How the prosthesis is retained?
The retention must be sufficient to resist reasonable dislodging forces. This is
accomplished by placement of mechanical retaining elements (clasps) on the abutment
teeth and by the intimate relationship of the denture bases and major connectors
(maxillary) with the underlying tissues.

Number of Direct Retainers

 Four: Four direct retainers offer an excellent amount of retention and are most
frequently used in tooth borne cases (i.e. Cl. III, mod 1). More than four direct
retainers are rarely necessary. Normally a single clasp can be omitted (maximizing
other retentive factors) by broad and intimate denture base adaptation, use of
guiding planes, indirect retainers, use of minor soft tissue undercuts, and rotational
path of insertion.
 Three: Less retentive than four direct retainers, most commonly used in Class II
cases.
 Two: Absolute minimum, usually only used in Class I partial dentures, unless a
rotational path design is selected.

4. How the retention and support are connected?

The fourth step is to connect the retention units to the support units. If direct and indirect
retainers are to function as designed, each must be rigidly attached to the major
connector.

5. How edentulous base support is connected?

The fifth and last step in this systematic approach to design is to outline and join the
edentulous area to the already established design components.

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General principles
1. Utilize what's present: Whenever possible, select a design that fits the teeth and soft
tissues, rather than choosing one that requires tissue alteration.

2. Plan for the future: When abutments of questionable prognosis are present, a design
should be chosen that would enable the partial denture to be adapted if such a tooth were
lost.

3. Minimize framework elements whenever possible. The fewest number of minor

connectors should be used. In some distal extension cases, one minor connector may be
used for adjacent direct and indirect retainers (e.g. mesial occlusal rest on a first premolar
and a cingulum rest on the adjacent canine).

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