STRESSES INDUCED BY REMOVABLE PARTIAL

DENTURES AND THEIR MANAGEMENT

Presented by:
Dr. Simran Kaur Sahni
Maharana Pratap College of
Dentistry & Research Centre

CONTENTS

Introduction
Biomechanical considerations
Forces acting on partial denture
Factors influencing magnitude of stresses
transmitted to abutment tooth
Length of the span
Quality of support of underlying residual
alveolar
ridge
Clasp as a factor in stress
Occlusion as a factor

Designing considerations in the control of stress

direct retention
forces of adhesion and cohesion
frictional control
neuromuscular control
clasp position
quadrilateral configuration
tripod configuration
bilateral configuration

Clasp design as a stress control

circumferential clasp
vertical projection clasp
combination clasp
splinting of abutment tooth
Indirect retention as a means of stress control
Denture base
Major connector
Minor connector
Rests
Review of literature
Summary & conclusion
References

Introduction

Biomechanics:the application of mechanical

laws to living structures, specifically the
locomotor systems of the body

An application of the principles of engineering

design as implimented in living organisms.

As maxfield states that common observation

clearly indicates that the ability of living things to
tolerate force is largely dependent up on the
magnitude or intensity of the force.

The supporting structures for removable partial

dentures (abutment teeth and residual ridges) are
living things and are subjected to forces.

The forces occurring with removable prosthesis can be

widely distributed and directed and their effect is
minimized by appropriate design of the r.p.d. An
appropriate design includes the selection and location of
the components.

Unquestionably the design of r.p.d necessitates

mechanical and biological consideration .most of the
dentist are capable of applying simple mechanical
principals to design of r.p.d.

An understanding of simple machines applied to the

design of removable partial denture which helps to
accomplish the objective of preservation of oral
structures.

A removable partial denture in the mouth can perform

the action of two simple machines the lever and the
inclined plane.

The lever is a rigid bar supported at some point

along its length . If the lever rests against its support
and a weight is applied at another point, rotation or
movement will occur around the support.

Three types of lever:

First class lever: this is most efficient and easily
controlled lever.
Second class lever :this type is seen as indirect
retention in r.p.d.
Third class of lever:This class is not encountered in
partial dentures

Forces acting on partial denture

Forces acting on distal extension partial denture are

a result of a composite of forces arising from three
principal fulcrums.

One fulcrum is on the horizontal plane that extends

through two principal abutments, one on each side of
dental arch and is termed as the fulcrum line.

This fulcrum line controls rotational movement of the

denture in the saggital plane denture movement
toward or away from the supporting ridge.

Resulting force on abutment tooth from rotation in

sagital plane is usually in a mesio apical or disto
apical direction with greatest magnitude in apical
direction.

Fibers of the periodontal ligaments are so

arranged that vertical forces are resisted to a
much greater degree than horizontal or torsional
forces.

Second fulcrum is on the sagittal plane and extends

through the occlusal rest on the terminal abutment
and along the crest of the residual ridge on one side
of the arch.

In class 1 situation there would be two of these

fulcrums one on each side of the arch. This fulcrum
controls rotational movement of the denture in the
vertical plane (rocking or side-to-side movements
over the crest of the ridge).

Third fulcrum is vertical and is located in mid line

lingual to anterior teeth. It controls the movement of
denture in horizontal plane.

Factors influencing magnitude of stresses

transmitted to abutment teeth

Length of span: longer the edentulous span , the

longer will be the denture base and greater will be
force transmitted to the abutment tooth.

Quality of the underlying bone :

Form of the residual ridges:

large, well formed residual ridge
will absorb more of the
masticatory load, hence less
stress will be transmitted to the
abutment tooth. A well shaped
ridges permit the use of denture
flanges that are contoured so as
to contribute to the stability of
the prosthesis .

The type of mucosal covering:the type of

mucoperiosteum influences the magnitude of stresses
transmitted to abutment teeth.

A healthy mucoperiosteum approximately 1mm thick is

capable of bearing a greater functional load than is a
thin atrophic mucosa.

Soft, flabby,displaceable tissue contributes little to the

vertical support of the denture base .

This type of tissue allows excessive movement of the

denture, with resultant transmission of stress to the
adjacent abutment tooth

Qualities of clasp:

More flexible the retentive arm of the clasp the less

stress is transmitted to the abutment tooth. This is
the reason the combination or wrought wire retentive
clasp was suggested for the terminal abutment for
class1 and 2 partial denture.

A wrought clasp which is more flexible than

the cast clasp tends to dissipate forces
transmitted to abutment tooth and increase
force transferred to edentulous ridge . It also
provides less horizontal stability.

If periodontal support of the abutment tooth is good, a less

flexible clasp such as vertical projection clasp would be indicated
because the tooth can with stand greater amount of stress.

If periodontal weakened more flexible clasp such as the

combination with wrought wire retentive arm should be used so
that the residual ridge will share more amount resistance to
horizontal forces acting on the partial denture.

Design of the clasp:

A clasp that is designed so that it is passive when it

is completely seated on the abutment tooth will
exert less stress than one that is not passive.

A clasp should be designed so that during insertion

or removal of the prosthesis the reciprocal arm
contacts the tooth before the retentive tip passes
over the greatest bulge of the abutment tooth.

This will stabilize or neutralize the stress to which the

abutment tooth is subjected as the retentive
terminal passes over the greater bulge of the tooth.

Length of clasp:the more flexible a clasp the less

stress it will exert on abutment tooth . Flexibility can
be increased by lengthening the clasp. Doubling the
length of a clasp will increase its flexibility five
times . Clasp length may be increased by curved
rather than straight course on abutment tooth.

Material used in clasp construction

Clasp constructed of cr-co alloy will normally exert

greater stress on abutment tooth than a gold clasp
because of the greater rigidity of the cro- co alloy .

To compensate for this property, clasp arms of croco alloy are constructed with a smaller diameter
than a gold clasp.

Abutment tooth surface : surface of gold crown or

restoration offers more frictional resistance to clasp
arm movement than does the enamel surface of
tooth. There fore greater stress excreted on a tooth
restored with gold than tooth with intact enamel.

The occlusion as a factor :

A dis harmonious occlusion will generate horizontal

stresses when magnified by leverage, will be
harmful to abutment tooth and residual ridge alike.

The type of apposing occlusion: Individuals with

natural teeth are able to exert a biting force of as
much as 300pounds where as in artificial teeth it
may be reduced to a force as little as 30pounds.

So partial denture base which apposes an artificial

denture will be subjected to a lessened amount of
occlusal stress than with one which opposes healthy
natural teeth.

The area of the base to which the load is applied:

there will be less movement of the base if the load is
applied adjacent to the abutment tooth than if it is
applied at the terminus of the base movement may
be four times greater at the distal extremity of the
base than it is in the immediate vicinity of the clasp.

Design consideration in the control of stress

Direct retention :the retentive clasp arm is the

element of partial denture that is responsible
for transmitting most of the destructive forces
to the abutment teeth .

A R.P.D should always be designed to keep

clasp retention to prevent dislodgement of the
denture by unseating force.

Forces of adhesion and cohesion:adhesion is the

attraction of saliva to the denture and the tissues.

Cohesion is the internal attraction of the molecules

of saliva to each other.

To secure the maximum possible retention

through the use of the forces of adhesion and
cohesion,the denture base should cover the
maximum area of available support and must
be accurately adapted to the underlying bone.

Frictional control:the partial denture should be

designed so that guide planes are created on as
many teeth as possible.

Guide planes are areas on teeth that are created so

that they are parallel to each other and with drawn
from mouth.

Planes are created on enamel surfaces of teeth or

restorations placed on teeth .

The frictional contact of the prosthesis against these

parallel surfaces can contribute significantly to the
retention of the denture.

Neuromuscular control:Is patients ability to control

the action of the lips, cheeks,and tongue; can be a
major factor in retention of a denture.

Patient who lacks the ability or co-ordination to

control the movement of these tissues may not be
able to retain a prosthesis.

Clasp position:people who design R.P.D use too many

retentive clasps.

Usually the position or the relation of the retentive

clasp to the height of contour is more important in
retention and in controlling stress than is the
number of clasps .

The number of clasps that should be used in the

design is most of dictated by the classification.

Quadrilateral configuration:

It is seen particularly in
class 3 situation .

When four abutment teeth

are available for clasping
and the partial denture can
be confined with in these
four clasps all the leverage
is neutralized.

This quadrilateral pattern of

clasping with the prosthesis
entirely confined with in the
four clasps is ideal for
support and leverage
control.

Tripod configuration:

It is used primarily in
class2 situation.

The distal abutment on one

side of the arch is missing .

The inevitable lever is

created by the distal
extension base.

In this conditions the

leverage my be controlled
to some degree by creating
a triangular pattern of
clasp placement.

When employing this pattern the two clasps on the tooth

supported side should be placed on teeth as far separated
as possible consistent with acceptable esthetics.

Bilateral configuration:

In bilateral configuration
single retentive clasp on
each side of the arch should
be located near the center
of dental arch or denturebearing area.
The terminal abutment
tooth on each side of the
arch must be clasped
regardless of where it is
positioned.
In the bilateral
configuration the clasps
exert little neutralizing
effect on leverage induced
stresses generated by the
denture base.

Unilateral configuration:

Leverage is not a problem with unilateral type of

configuration although torsional stresses on the
abutment teeth are apparent because of the
tendency of the prosthesis to rotate about a line
which extends through the occlusal rests of the two
clasp.

Clasp design as a means of stress control

The conventional circumferential cast clasp originating

from a distal occlusal rest on the terminal abutment
tooth and engaging a mesio -buccal retentive under
cut should not be used on a distal extension R.P.D.

The terminal of this clasp reacts to movement of the

denture base to wards the tissue by placing a distal
tipping or torquing forces on the abutment tooth.

This particular forces is the most destructive force a

retentive clasp exert.

Reverse circlet clasp:this circumferential clasp that

approaches a distobuccal undercut from the mesial
surface of a terminal abutment tooth.

The effect on the abutment tooth is reversed from

that of the conventional circumferential clasp.

As an occlusal load is applied to the denture base, the

retentive terminal moves further gingivally in to the
under cut area and loses contact with the abutment
tooth.

In this manner torque is transmitted to the abutment

tooth .

The reverse circlet clasp normally projects between

two teeth may reduce some wedging force.

This can usually be countered by occlusal rest on the

approximating surface of both teeth.

Vertical projection clasp or bar clasp

It is used on terminal abutment tooth on a distal

extension partial denture.

When retentive under cut is located on the

distobuccal surface. It is not indicated if tooth has a
mesiobuccal under cut.

Function is similar to the reverse circumferential clasp

As the denture base is loaded towards the tissue the

retentive tip of the T clasp rotates gingivally to
release the stress being transmitted to the abutment
tooth .

Bar clasp does not produce wedging forces like

reverse circumferential clasp.

Combination clasp:

When mesiobuccal undercut exists on an abutment

tooth adjacent to a distal extension edentulous
[Link] combination clasp can be employed to
reduce the stress transmitted the abutment tooth.

Wrought wire alloy by virtue of its internal structure is

more flexible than a cast [Link] can flex in any spatial
plane where cast clasp flexes in the horizontal plane
only.

The wrought wire retentive arm has a stressbreaking action that can absorb torsional stress in
both vertical and horizontal planes.

A cast circumferential clasp under the same

circumstance would transmit most of the leverage
induced stress to the abutment tooth.

Splinting of abutment teeth:

Adjacent teeth may be splinted by means of crowns to

control stress transmitted to a weak abutment tooth

Splinting one or more teeth actually increases the

periodontal ligament attachment area and distributes
the stress over a larger area of support.

Fixed splinting may be indicated when some loss of

periodontal attachment has accured after
periodontal disease and therapy.

To secure the maximum possible retention through

the use of the forces of adhesion and cohesion,the
denture base should cover the maximum area of
available support and must be accurately adapted to
the underlying bone.

Indirect retainer :

It is component of removable partial [Link] is

usually anterior to the fulcrum line.

Function is to counter act the tipping forces which act

on the prosthesis from opposite side of fulcrum line.

Fulcrum line is a imaginary line or lines which might

be drawn through the abutment teeth , around which
partial denture rotates

An embrasure rest, lingual plate, double lingual bar

,an occlusal rest, or even a part of the denture base
itself may perform the function of indirect retainer.

The forces attempting to move denture base away

from the residual ridge cause rotational movement
around a fulcrum line located near retentive clasp.

Placement rest anterior to fulcrum line provides

indirect retention.

In class1 partially edentulous arch runs through distal

occlusal rests of terminal abutment teeth.

Two indirect retainers should be used on each side of

arch

Indirect retainers should be positioned as far anterior to

fulcrum line as strength of remaining teeth will permit.

Mesial fossa of first premolar has been selected

In class2 partially edentulous arch with a

modification space fulcrum line runs through the
most posterior occlusal rests.

It is around this line that rotational movement in

sagital plane takes place.

A single indirect retainer is recommended on

opposite side of distal extension edentulous ridge.

In this case distal occlusal rest on first premolar can

act as indirect retainer.

If modification space is not sufficiently long for

occlusal rest on abutment tooth anterior to
edentulous space to act as indirect retainer, another
rest should be placed on canine for indirect retention
.

In class3 arch indirect retention is not required

because there is no distal extension base to create a
lever arm.

In class4 arch lever arm is anterior to fulcrum line,

mesial occlusal rest of anterior teeth.

Rotational forces will occur around fulcrum line in a

direction opposite to that in class1 or class2 arch.

In this indirect retainer is positioned posterior to

fulcrum line.

In this condition indirect retainer are shown as a distal

occlusal rest on first molar and mesial occlusal rest on
second molars.

Occlusion as a means of stress control :

A smoothly functioning occlusion that is in harmony

with the movements of both the T.M.J and the
neuromusculature will minimize the stress
transferred to the abutment teeth and residual
ridge.

The size of the food table:A large food table has the
potential of transmitting considerably more pressure on
both the residual ridges and the abutment teeth than
does a small one.

Occlusal pattern of the posterior teeth:the occlusal

pattern of the posterior teeth may influence the amount
of stress.

Cusp less teeth will generate more load on the denture

base than with sharp cusp teeth because of the
increased power needed to force them through the
bolus.

Steep inclined cusp teeth may introduce horizontal

forces which generate torsional stresses

Denture base as a means of stress:

A properly designed denture base can provide

better stability , support and retention to the
prosthesis.

Size and configuration of the base:

coverage

of a large area of soft tissue by the base will

distribute the functional stresses over greater
area of support, thus reducing the burden that
must be borne by each supporting structure.

Having the denture flanges extend in to the vestibules

the flanges should provide a seal with the border
tissues.

Accuracy of adaptation of the base to the tissue: the

more intimate contact of base to the mucosa, the
greater will be its adhesion ,less will be its tendency to
movement and the smaller will be the magnitude of the
stress that is transmitted to the abutment.

Major connector:

In the mandibular arch the lingual plate major connector

that is properly supported by rest can aid in distribution
of functional stresses to the remaining teeth .

It is particularly effective in supporting weakened

anterior teeth.

Lingual plate also adds rigidity to the major connector.

The added rigidity contributes to the effectiveness of
cross arch stabilization.

In maxillary arch the use of broad palatal major

connector that contacts several of the remaining
natural teeth through lingual plating can distribute
stress over a large area .

The major connector must be rigid and must receive

vertical support through rests from several teeth .

the maxillary major connector that uses maximum

coverage of this area can contributes greatly to the
support,stability, and retention of the prosthesis.

Minor connector:

The most intimate tooth to- partial denture contact

takes place between the minor connector joining the
clasp assembly to the major connector and the
guiding planes on the abutment teeth surface.

This close metal to enamel contact serves two

purpose first it offers horizontal stability to the partial
denture against lateral forces on the prosthesis.

The tooth with its supporting bone help dissipate

these displacing stresses.

Second through the contact of the minor connector

and the abutment tooth. The tooth receives
stabilization against lateral stresses .

Lateral forces are the most destructive their control

is essential. If guiding planes on addition abutment
teeth are incorporated. The force resisted by each
tooth can be minimized.

Rests:

A properly prepared rest seats will help in control

stress by directing forces transmitted to abutment
teeth down the along axis of those teeth .

The periodontal ligament is capable of with standing

vertical forces of greater magnitude than horizontal
and tort ional forces

The floor of the rest seat preparation must form an

angle of less than 90 degrees with a perpendicular
line dropped down the long axis of the tooth.

Review of literature:

Bert T . Cecconi., Kamal Asgar, and Edward Dootz,

(1971):in their study a series of laboratory tests were
undertaken to observe and evaluate the effect of the
partial denture clasp assembly and its component
parts on abutment tooth movement .

Four different clasp assemblies were compared as to

their effect on abutment tooth movement. A statistical
analysis of the data showed that casting no.3 caused
significantly greater abutment tooth movement than
did the other clasp assemblies tested

Authors have concluded that under these testing

condition, the clasp assembly consisting of a mesialocclusal rest, distal guide plane , and buccal I-bar
retentive clasp arm caused significantly greater
movement of the abutment tooth than did the other
assemblies casting nos.1,2,and4 did not significantly
differ as to their effect on abutment tooth
movement.

The direction of abutment tooth movement was not

significantly altered by clasp design.

James s. Brudvik, and john h. Wormley,(1973):conducted

study on construction techniques for wrought-wire retentive
clasp arms as related to clasp flexibility in their study three
standard means of attachment of circumferential wrought
wire retentive arms to removable partial denture framework
were tested for their in-fluence on component flexibility.

A wire retentive arm, adapted after framework construction

and soldered to the frame on the base retentive mesh work

Well away from the minor connector was found to be more

flexible than the other common methods of wire
attachment. Wire components, attached in this manner,
appear to have the same degree of flexibility as unattached
wire.

I. Aviv, Ben-ur, h.s. cardash, (1989):described the axis of

rotation of symmetric and asymmetric distal extension
r.p.d .occlusal forces applied to the base of the
asymmetrical bilateral or unilateral distal extension r.p.d
causes denture base movement nonparallel to the
longitudinal axis of the residual ridge and possible
trauma to the soft tissues.

The infra bulge I-bar retainer of the RPI clasp assembly,

when used with asymmetrically placed occlusal rests,
may torque the abutment tooth as the denture base
rotates tissue ward.

The RPL clasp assembly seems to be a functionally

acceptable deign for asymmetric distal-extension r.p.d.

John e. Holt(1981):In his article he discussed the

function of guiding planes and their possible locations,
destructive potential, and the differentiation between
tooth-borne and distal-extension removable partial
dentures as they affect the choice of guiding plane
location.

Guiding planes that are contacted by guiding plates are

an important aspect of removable partial denture design
principles.

Complete vertical contact of guiding planes is

beneficial for tooth-borne removable partial dentures.

When distal-extension ridge are present,complete

contact is detrimental. The design should be modified
to take in to account the different resiliencies of the
supporting structures.

Richard p. frank, and Jack [Link],(1977):in their

investigation they measure the effectiveness of an
indirect retainer and determined the effect of the
other components of a removable partial denture on
dis placement of denture base.

A mandibular bilateral distal-extension base

removable partial denture was lifted from a model
under standard conditions.

The amount denture base displacement under various loads

and the forces of removal were measured electronically.

The frame work was constructed to allow repeated changes

in the type of clasp, location of indirect retainer , and
position of the rest seat on the terminal abutment tooth.

The usefulness of an indirect retainer in preventing occlusal

displacement of the denture base appears to be limited .

The type of clasp had the greatest influence on the

amount of denture base movement .

Proximal surface guiding planes were also found to

be important in preventing lifting of the denture
base .

Use of mesial instead of distal rests on the terminal

abutment teeth did not decrease indirect retention.

Bert T. Cecconi(1974):A laboratory study was

undertaken to determine the effect of several types of
partial denture rest on abutment tooth movement . It
was found that,as related to force transmission to
abutment teeth, the depth of rest in gingival direction
is more significant factor than the type of rest.
The authors have concluded that :
1. precision rests and deep rests affect abutment
tooth
movement in a similar manner.
2. Rests with gingival seats at maximum depth in
abutment teeth can significantly decrease abutment
tooth movement.
3. Bilateral loading of a removable partial denture
causes significantly less abutment tooth movement
than does
unilateral loading

A study was conducted in our college under the

able guidance of Dr. [Link] sir in this study they
observed the influence of composition of co-cr
alloys on the quality of retention of clasp generally
used in removable partial denture designing.

A Typhodont mandibular 2nd premolar tooth

utilized for placement of simple circulate clasp.A
total number of 24 test sample were made to
observe the force required for dislodging the clasp
in vertical direction away from the tooth .

Instron machine was employed for conducting

test .

Force required to dislodge simple circular clasp

fabricated from 3 different co-cr alloy composition
compared favorably with one another.

The tested alloys showed difference in their

quality of retention , deflection and flexibility.

SUMMARY & CONCLUSION

REFERENCES:
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2.

3.

4.

5.

McCrackens:Removable partial
[Link] [Link],
mosby Co.2005.
Stewart,Rudd, and kuebker:clinical removable
partial prosthodontics . Second [Link]
Euro America,Inc,publishers. Tokyo.
[Link].2000.
Miller. [Link] Grasso. J.E. :Removable partial
[Link] edition. B.c. decker, Inc,
ontario, canada.1989.
P. F. Richard and I. N. jack:an investigation of
the effctiveness of indirect retainer. J. prosthet .
Dent. 38:494-506.1977.
T. C. Bert:Effect of rest design on transmission
of forces to abutment teeth. J. prosthet. Dent .
32:141-151.1974

6. E. [Link]:guiding planes:when and where. J. prosthet.

Dent .46:4-6.1981.
7. Aviv,Ben-Ur,and cardash:An analysis of rotational
movement of asymmetrical distal-extension
removable partial dentures. J. prosthet. Dent .61:211214.1989.
8. S. B. James,and H. W. john:construction techniques for
wrought-wire retentive clasp arms as related to clasp
flexibility.30:769-775.1973.
9. T. [Link], kamal Asgar, and D. Edward:the effect of
partial denture clasp design on abutment tooth
movement.25:44-56.1971.
10. N. P. Patil, and Sreenath.H.P:comparative evaluation
of the influence of alloy composition on the quality of
retention, deflection and flexibility of clasp cast from
base metal alloys. 1998.