Chapter 7

Direct retainers

119

Fig. 7-30 Ring clasp ma be used in re!erse on abutment located anterior to tooth-bound edentulous space.

Fig.7-3" #mbrasure clasp used $here no edentulous space e%ists. &lthough in this dra$ing both retenti!e clasp arms are located on buccal surface and nonretenti!e arms on lingual surface' retention and reciprocation can be re!ersed on both teeth or on either tooth' depending on respecti!e contours of the teeth. (o$e!er' if second molar is sound and suitable stabili)ing and retenti!e areas can be found' circum ferential clasp originating on distal surface of abutment is preferable.

Fig. 7-31 Back-action circumferential clasp used on premolar abutment anterior to edentulous space.

connector and should ne!er be supported b a clasp arm alone. 3f the occlusal rest is part of a fle%ible assembl ' it can34,.ot function ade/uatel as an occlusal rest. Embrasure clasp 3n the fabrication of an unmodified Class 33 or Class 333 partial denture' there are no edentulous spaces on the opposite side of the arch to aid in clasping. 5echanicall ' this is a disad!antage. (o$e!er' $hen the teeth are sound and reten

ti!e areas are a!ailable or $hen multiple restorations are *ustified' clasping can be accomplished b means of an embrasure clasp +Figs. 7-3" and 7-33,. -ufficient space must be pro!ided bet$een the abutment teeth in their occlusal third to make room for the common bod of the embrasure clasp +Fig. 7-3.,' et the contact area should not be eliminated entirel . (istoricall ' this clasp assembl demonstrates a high percentage of fracture caused b inade/uate tooth preparation in the contact area. Because !ulnerable areas of the teeth are in!ol!ed' abutment protection $ith inla s or cro$ns is recommended. 0he decision to use unprotected abutments must be made at the time of oral e%amination and should be based on the patient1s age' caries inde%' and oral h giene' as $ell as on $hether e%isting tooth contours are fa!orable or can be made fa!orable b tooth modification. 2reparation of ad*acent' contacting' uncro$ned abutments to recei!e an t pe

1"0

5cCracken1s remo!able partial prosthodontics

&

Fig. 7-33 5ultiple clasping in surgicall mutilated mouth. 6n the right are embrasure clasp' bar clasp arm' and con!entional circumferential clasp engaging lingual undercuts on three abutment teeth. 6n the left is $elldesigned ring clasp engaging lingual undercut' $ith supporting strut on buccal surface and au%iliar occlusal rest to pre!ent mesial tipping. 7ote rigid design of ma*or connector.

Fig. 7-38 &' #%ample of use of embrasure clasp for a Class 33 partiall edentulous arch. #mbrasure clasp on t$o left molar abutments $as used in the absence of posterior modification space. B' 6cclusal and pro%imal surfaces of ad*acent molar and premolar prepared for embrasure clasp. 7ote that rest seat preparations are e%tended both buccall and linguall to accommodate retenti!e and reciprocal clasp arms. Adequate preparation confined to enamel can rarely be accomplished for such a clasp, especially when clasped teeth are opposed by natural teeth.

Fig. 7-3. Embrasure and hairpin circumferential retenti!e clasp arms. 0he terminus of each engages suitable retenti!e undercut. 9se of hairpin-t pe clasp on second molar is made necessar b the fact that the onl a!ailable undercut li:s directl belo$ point of origin of clasp arm.

of embrasure clasp of ade/uate interpro%imal bulk is difficult' especiall $hen opposed b natural teeth. 0he embrasure clasp al$a s should be used $ith double occlusal rests' e!en $hen definite

pro%imal shoulders can be established +Fig. 7-38,. 0his is done to a!oid interpro%imal $edging b the prosthesis' $hich could cause separation of the abutment teeth and result in food impaction and clasp displacement. 3n addition to pro!iding support' occlusal rests also ser!e to shunt food a$a from contact areas. For this reason' occlusal rests should al$a s be used $hene!er food impaction is possible. #mbrasure clasps should ha!e t$o retenti!e clasp arms and t$o reciprocal clasp arms' either bilaterall or diagonall opposed. &n au%iliar occlusal rest or a bar clasp arm can be substituted for a circumferential reciprocal arm as long as definite reciprocation and stabili)ation result.

Chapter 7

=irect retainers

1"1

Lingual

<-Buccl Fig. 7-3; 3mproper application of embrasure clasp design (mirror view). Failure to locate retenti!e and reciprocating-stabili)ing arms in most ad!antageous positions +proper third of cro$ns, is /uite e!ident. Fig. 7-3> (alf-and-half clasp consists of one circum ferential retenti!e arm arising from distal aspect and a second circumferential arm arising from mesial aspect on the opposite side' $ith or $ithout secondar occlusal rest. Broken line illustrates nonretenti!e reciprocal clasp arm used $ithout secondar occlusal rest (mirror view).

f' <

Fig. 7-37 5ultiple clasp is actuall t$o opposing circumferential clasps *oined at terminal end of t$o reciprocal arms (mirror view). & linguall placed retenti!e bar clasp arm ma be substituted if a rigid circumferential clasp arm is placed on the buccal surface for reciprocation' pro!ided lingual retention is used on the opposite side of the arch. Common errors in the design of embrasure-t pe clasps are illustrated in Fig. 7-3;. 6ther less commonl used modifications of the cast circumferential clasp are the multiple clasp' the halfand-half clasp' and the re!erseaction clasp.

Multiple clasp 0he multiple clasp is simpl t$o opposing circumferential clasps *oined at the terminal end of the t$o reciprocal arms +Fig. 7-37,. 3t is used $hen additional retention and stabili)ation are needed' usuall on tooth-supported partial dentures. 3t ma be used for multiple clasping in instances in $hich the partial denture replaces an entire half of the dental arch. 3t ma be used rather than an embrasure clasp $hen the onl a!ailable retenti!e areas are ad*acent to each other. 3ts disad!antage is that t$o embrasure approaches are necessar rather than a single common embrasure for both clasps. Half-and-half clasp 0he half-and-half clasp consists of a circumferential retenti!e arm arising from one direction and a reciprocal arm arising from another +Fig. 7-3>,. 0he second arm must arise from a second minor connector' and this arm is used $ith or $ithout an au%iliar occlusal rest. Reciprocation arising from a second minor connector can usuall be accomplished $ith a short bar or $ith an au%iliar occlusal rest' thereb a!oiding

1""

5cCracken1s remo!able partial prosthodontics

so much tooth co!erage. 0here is little *ustification for the use of the half-and-half clasp in bilateral e%tension base partial dentures. Its desi n was ori inally intended to provide dual retention, a principle that should be applied onl to unilateral partial denture design. !everse-action clasp 0he re!erse-action' or hairpin' clasp arm is designed to permit engaging a pro%imal undercut from an occlusal approach +Fig. 7-39,. 6ther methods of accomplishing the same result are $ith a ring clasp originating on the opposite side of the tooth or $ith a bar clasp arm originating from a gingi!al direction. (o$e!er' $hen a pro%imal undercut must be used on a posterior abutment and $hen tissue undercuts' tilted teeth' or high tissue attachments pre!ent the use of a bar clasp arm' the re!erse-action clasp ma be used successfull . &lthough the ring clasp ma be preferable' lingual undercuts ma pre!ent the placement of a supporting strut $ithCmt tongue interference. 3n this limited situation the hairpin clasp arm ser!es ade/uatel ' despite its se!eral disad!antages. 0he clasp co!ers considerable tooth surface and ma trap debris? its occlu sal origin ma increase the functional load on the tooth' and its fle%ibilit is limited. #sthetics usuall need not be considered $hen the clasp is used on a posterior abutment' but the hairpin clasp arm does ha!e the additional disad!antage of displa ing too much metal for use on an anterior abutment. 2roperl designed' the re!erse-action clasp should make a hairpin turn to engage an undercut belo$ the point of origin +see Fig. 7-39,. 0he upper part of the arm of this clasp should be considered a minor connector' gi!ing rise to the tapered lo@A+er part of the arm. 0herefore onl the lo$er part of the arm should be fle%ible? $ith the retenti!e portion beginning be ond the turn' onl the lo$er part of the arm should fle% o!er the height of contour to engage a retenti!e undercut. 0he bend that connects the upper and lo$er parts of the arm should be rounded to pre!ent stress accumulation and fracture of the arm at the bend. 0he clasp should be designed and fabricated $ith this in mind.

Fig. 7-39 Re!erse-action' or hairpin' clasp arm ma be used on abutments of tooth-supported dentures $hen pro%imal undercut lies belo$ point of origin of clasp (mirror view), 3t ma be estheticall ob*ectionable and co!ers considerable tooth surface. 3t should be used onl $hen a bar-t pe retenti!e arm is contraindicated because of a tissue undercut' tilted tooth' or shallo$ !estibule.

0hese are the !arious t pes of cast circumferential clasps. &s mentioned pre!iousl ' the ma be used in combination $ith bar clasp arms as long as differentiation bet$een retention and reciprocation is made b their form and location. Circumferential and bar clasp arms ma be made either fle%ible +retenti!e, or rigid +reciprocal, in an combination as long as each retenti!e clasp arm is opposed b a rigid reciprocal component. 0he use of man of the less desirable clasp forms can. be a!oided b changing the cro$n forms of the abutments b tooth modification $ithin the enamel or $ith restorations. 3n fabricating abutment co!erage' tooth contours should be established that $ill permit the use of the most desirable clasp forms rather than a form that makes it necessar to use a less desirable clasp design. 0his is best accomplished b first altering the cro$n contour of abutment teeth not designated for restoration to meet the -re/uirements of guiding planes and sur!e line location. 0his is follo$ed b the prescribed cro$n preparations. Before tooth reduction for

Chapter 7

=irect retainers

1"3

Support Stabilization Retentio n

Buccal Fig. 7-.0 6nl one terminal of retenti!e arm engages undercut in gingi!al third of abutment. -uprabulge portion of retenti!e clasp arm pro!ides onl limited stabili)ation and ma be eliminated.

the prescribed cro$n preparations the re/uirements of guiding planes and sur!e line location should be met. Bar clasp 0he term bar clasp is generall preferred o!er the less descripti!e term !oach clasp arm. Reduced to its simplest term' the bar clasp arm arises from the denture frame$ork or a metal base and approaches the retenti!e undercut from a gingi!al direction +see Fig. 7-"3,. 0he bar clasp arm has been classified b the shape of the retenti!e terminal. 0hus it has betfn identified as a 0' modified 0' 3' or B. 0he form the terminal takes is of little significance as long as it is mechanicall and functionall effecti!e' co!ers as little tooth surface as possible' and displa s as little metal as possible. 0he 0 and B clasp arms are the most fre/uentl misused. 3t is unlikel that the full area of a 0 or B terminal is e!er necessar for ade/uate clasp retention. &lthough the larger area of contact $ould pro!ide greater frictional resistance' this is not true clasp retention' and only that portion engaging an undercut area should be considered retenti!e. 6nl one terminal of such a clasp arm should be placed in an undercut area +Fig. 7-.0,. 0he remainder of the

clasp arm ma be superfluous unless it is needed as part of the clasp assembl to encircle the abutment tooth more than 1>0 degrees of its greatest circumference. 3f the bar clasp arm is made to be fle%ible for retenti!e purposes' any portion of the clasp above the height of contour will provide only limited stabilization, because it is also part of the flexible arm. 0herefore in man instances this suprabulge portion of a 0 or B clasp arm ma be dispensed $ith' and the retenti!e terminal of the bar clasp should be designed to be biologicall and mechanicall sound rather than to conform to an alphabetical configuration. & current concept of bar clasp design is the RPI s stem +rest' pro%imal plate' 3-bar,. Basicall ' this clasp assembl consists of a mesioocclusal rest $ith the minor connector placed into the mesiolingual embrasure' but not contacting the ad*acent tooth +Fig. 7-.1' "). & distal guiding plane' e%tending from the marginal ridge to the *unction of the middle and gingi!al thirds of the abutment tooth' is prepared to recei!e a pro%imal plate +Fig. 7-.1' #). 0he buccolingual $idth of the guiding plane is determined b the pro%imal contour of the tooth +Fig. 7.1' " and C,. 0he pro%imal plate' in con*unction $ith the minor connector supporting the rest' pro!ides the stabili)ing and reciprocal aspects of the clasp assembl . 0he 3-bar

1".

5cCracken1s remo!able partial prosthodontics

&

-upport -tabili)ation Retention

6cclusal third +' 5iddle third Cingi!al third

lingual

-upport c -tabili)ation =

Buccal Fig. 7-.1 Bar-t pe clasp assembl . &' 6cclusal !ie$. Component parts +pro%imal plate minor connector' rest $ith minor connector' and retenti!e arm, tripod abutment to pre!ent its migration. (' 2ro%imal plate minor connector e%tends *ust far enough linguall so that together $ith mesial minor connector lingual migration of abutment is pre!ented. C' 6n narro$ or tapered abutments +mandibular first premolars,' pro%imal plate should be designed to be as narro$ as possible but still sufficientl $ide to pre!ent lingual migration. =' 3-bar retainer located at greatest prominence of tooth in gingi!al third.

Chapter 7

=irect retainers

1"8

Fig. 7.." Bar clasp assembl $here guiding plane ($%) and corresponding pro%imal plate (&&) e%tend entire length of pro%imal tooth surface. 2h siologic relief is re/uired to pre!ent impingement of gingi!al tissues during function. #%tending pro%imal plate to contact greater surface area of guide plane directs functional forces in hori)ontal direction' thus tooth +teeth, are loaded more than edentulous ridge.

Fig. 7-.3 Bar clasp assembl $here guiding plane (ep) and corresponding pro%imal plate (&&) e%tend from marginal ridge to *unction of middle and gingi!al thirds of pro%imal tooth surface. 0his decrease +compared $ith Fig. 7-.", in amount of surface area contact of pro%imal plate on guiding plane-more e!enl distributes functional force bet$een tooth and edentulous ridge.

should be located in the gingi!al third of the buccal or labial surface of .the abutment in 6.61-inch undercut +Fig. 7-.1' =,. 0he $hole arm of the 3-bar should be tapered to its terminus' $ith no more than " mm of its tip contacting the abutment. 0he hori)ontal portion of the approach arm must be located at least . mm from the gingi!al margin and e!en more if possible. 0here are three basic approaches to the application of the R23 s stem. 0he location of the rest' the design of the minor connector +pro%imal plate, as it relates to the guiding plane' and the location of the retenti!e arm are factors that influence ho$ this clasp s stem functions. @ariations in these factors pro!ide the basis for the differences among these approaches. &ll ad!ocate the use of a rest located mesiall on the primar abutment tooth ad*acent to the e%tension base area. 6ne approach recommends that the guiding plane and corresponding pro%imal plate minor connector e%tend the entire length of the pro%imal tooth surface' $ith ph siologic tissue relief to eliminate impingement of the free gingi!al margin +Fig. 7.",. & second approach suggests that the guiding plane and corresponding pro%imal plate minor connector e%tend from the marginal ridge to the *unction of the middle and gingi!al thirds of the pro%imal tooth surface +Fig. 7-.3,. Both

Fig. 7-.. 6cclusal !ie$ of R23 bar clasp assembl . 2lacement of 3-bar in 6.63-inch undercut4 &' on distobuccal surface? B' at greatest mesiodistal prominence? and C' on mesiobuccal surface.

approaches recommend that the retaining clasp arm be located in the gingi!al third of the buccal or labial surface of the abutment in a 6.61-inch undercut. 2lacement of the retaining clasp arm is generall in an undercut located at the greatest mesiodistal prominence of the tooth or ad*acent to the e%tension base area +Fig. 7-..' " and #). 0he third approach fa!ors a pro%imal plate minor connector that contacts appro%imatel 1 mm of the gingi!al portion of the guiding plane +Fig. 7-.8' ") and a retenti!e clasp arm located in a 6.61-inch undercut in the

1";

5cCracken1s remo!able partial prosthodontics

&

Fig. 7-.; Bar clasp arm properl used on terminal abutment. 5esial e%tension of 0 is neither ad!antageous nor desirable in this situation Fcause abutment tooth $as encompassed more than 1>0 degrees.

Fig. 7-.8 &' Bar clasp assembl $here pro%imal plate (&&) contacts appro%imatel 1 mm of gingi!al portion of guiding plane ($&). =uring function' pro%imal plate and 3-bar clasp arm are designed to mo!e in mesiogingi!al direction' disengaging tooth. Dack of sustained contact bet$een pro%imal plate and guiding plane distributes more functional force to edentulous ridge. &sterisk +E, indicates center of rotation. B' 5odification of R23 s stem +:& clasp, is indicated $hen bar-t pe clasp is contraindicated and desirable undercut is located in gingi!al third of tooth a$a from e%tension base area.

gingi!al third of the tooth at the greatest prominence or to the mesial a$a from the edentulous area +see Fig. 7..' C,. 3f the abutment teeth demonstrate contraindications for a bar-t pe clasp +that is' e%aggerated buccal or lingual tilts' se!ere tissue undercut' or a shallo$ buccal !estibule, and the desirable undercut is located in the gingi!al third of the tooth a$a from the e%tension base area' a modification of the R23

s stem +the R2& clasp, should be considered +Fig. 7-.8' #). &pplication of each approach is predicated on the distribution of load to be applied to the tooth and edentulous ridge. 3n most situations the bar clasp arm can be used $ith tooth-supported partial dentures' $ith tooth-supported modification areas' or $hen an undercut that can be logicall approached $ith a bar clasp arm lies on the side of an abutment tooth ad*acent to a distal e%tension base +Figs. 7-.; through 7-80,. 3f a tissue undercut pre!ents the use of a bar clasp arm' a mesiall originating ring clasp' a cast' or a $rought-$ire clasp or re!erse-action clasp ma be used. 2reparation of ad*acent abutments +natural teeth, to recei!e an t pe of interpro%imal direct retainer' tra!ersing from lingual to buccal surfaces' is most difficult to ade/uatel accomplish. 3ne!itabl the relati!e si'e of the occlusal table is increased' contributing to undesirable and additional functional loading. 0he bar clasp arm is not a particularl fle%ible clasp arm because of the effects of its half-round form and its se!eral planes of origin. &lthough the cast circumferential clasp arm can be made more fle%ible than can the bar clasp arm' the combination clasp is preferred for use on terminal abutments $hen tor/ue and tipping are possible because of engaging an undercut

Chapter 7

=irect retainers

1"7

Fig. 7-47 Bar clasp arm on distal abutment must be made light enough to be fle%ible and ma be used onl $hen it can engage pro%imal undercut ad*acent to e%tension base. 5esial 0-portion of clasp arm had to be placed to encompass abutment b more than 180 degrees. 3t is placed on height of contour. 7ote finishing line (arrow) $here clasp and denture base $ill *oin. a$a from the distal e%tension base. -ituations often e%ist' ho$e!er' in $hich a bar clasp arm ma be used to ad!antage $ithout *eopardi)ing a terminal abutment. & bar clasp arm s$inging distall into the undercut ma be a logical choice' since mo!ement of the clasp on the abutment as the distal e%tension base mo!es tissue$ard is minimi)ed b the distal location of the clasp terminal. 0he specific indications for using a bar clasp arm are +1, $hen a small degree of undercut +0.01 inch, e%ists in the cer!ical third of the abutment tooth' $hich ma be approached from a gingi!al direction? +", on abutment teeth for tooth-supported partial dentures or toothsupported modification areas +Fig. 781,? +3, in distal e%tension base situations? and +., in situations in $hich esthetic considerations must be accommodated and a cast clasp is indicated. 0hus use of the bar clasp arm is contraindicated $hen a deep cer!ical undercut e%ists or $hen a se!ere tooth andGor tissue undercut e%ists' either of $hich must be bridged b e%cessi!e blockout. Hhen se!ere tooth and tissue undercuts e%ist' a bar clasp arm usuall is an anno ance to the tongue and cheek and also traps food debris.

Fig. 7-.> Bar clasp arm on ma%illar terminal abutment. 7ote uniform taper from point $here it $ill emerge from resin base and that it engages tooth undercut on side ad*acent to distal e%tlmsion base. Butt-t pe *oint for finishing line bet$een direct retainer and acr lic resin base is pro!ided. 6ther limiting factors in the selection of a bar clasp assembl include a shallo$ !estibule or an e%cessi!e buccal or lingual tilt of the abutment tooth +Fig. 7-8",. -ome common errors in the design of bar-t pe clasps are illustrated in Fig. 7-83. 0here are se!eral other t pes of bar clasps' one of $hich is the infrabulge clasp. 3t is designed so that the bar arm arises from the border of the denture base' either as an e%tension of a cast base or attached to the border of a resin base +Fig. 7-8.,. 3t is made more fle%ible than the usual bar clasp arm in that the portion of the cast base that gi!es rise to the clasp arm is separated from the clasp arm itself' either b a sa$ cut or b being cast against a separating shim of matri% metal' $hich is later remo!ed $ith acid. 3t ma be made more fle%ible through the use of $rought $ire' $hich is attached to a metal base b soldering or is embedded in the border of a resin base. -ome of the ad!antages attributed to the infrabulge clasp are +1, its interpro%imallocation' $hich ma be used to esthetic ad!antage? +", increased retention $ithout tipping action on the abutment? and +3, less chance of accidental distortion resulting from its pro%imit to the denture border. 0he $earer .should be meticulous in the care of a denture so made' not onl

1">

5cCracken1s remo!able partial prosthodontics

Fig. 7-.9 Bar clasp arm on lo$er molar abutment engaging mesiobuccal undercut. 7ote proper use of parallel pro%imal guiding planes.

Fig. 7-80 Bar clasps used for both retention and reciprocation. Bar-t pe retainer on right second premolar engages distobuccal undercut. Bar-t pe configuration on lingual aspect of left molar is used for stabili)ation and reciprocation and does not engage undercut.

for reasons of oral. h giene but also to pre!ent cariogenic debris from being held against tooth surfaces.

Fig. 7-81 Bar retainer is used on anterior abutment of modification space' and its terminus engages distobuccal undercut. =enture is designed to rotate around terminal abutments $hen force is directed to$ard basal seat on left. -uch.rotation !!ould impart force on right premolar directed superiorl and anteriorl . (o$e!er' this direction of force is resisted in great part b mesial contact $ith canine. =irect retainer on right premolar engaging mesiobuccal undercut $ould tend to force tooth superiorl and posteriorl .

Combination clasp 0he combination clasp consists of a $rought$ire retenti!e clasp arm and a cast reciprocal clasp arm +Fig. 7-88,. &lthough the latter ma be in the form of a.bardasp arm' it is llsuall a

circumferential arm. 0he retenti!e arm is almost al$a s circumferential' but it also ma be used in the manner of a bar' originating gingi!all from the denture base. 0he ad!antages of the combination clasp lie . in. the I3e%ibilit ' the .ad*ustabilit ' and the

Chapter 7 & B

=irect retainers

1"9

Fig. 7-8" Contraindications for selection of bar-t pe clasps. &' -e!ere buccal or lingual tilts of abutment teeth. H, -e!ere tissue undercuts. C' -hallo$ buccal or labial !estibules.

< 3 & c

Fig. 7-83 Common errors and recommended corrections in design of bar-t pe clasp assemblies. &' -ur!e line is unsuitable for bar clasp +too high,. H, Retenti!e portion of bar clasp arm improperl contoured to resist dislodging force in occlusal direction. C' Retenti!e tip not located in gingi!al third of abutment. D, Contour of abutment correctl altered to recei!e bar clasp. # and F' Correct position of bar clasp assembl .

130 5cCracken1s remo!able partial prosthodontics appearance of the $rought-$ire retenti!e arm. 3t is used $hen ma%imum fle%ibilit is desirable' such as on an abutment tooth ad*acent to a distal e%tension base or on a $eak abutment $hen a bar-t pe direct retainer is contraindicated. 3t ma be used for its ad*ustabilit $hen precise retenti!e re/uirements are unpredictable and later ad*ustment to increase or decrease retention ma be necessar . & third *ustification for its use is its esthetic ad!antage o!er cast clasps. Hrought in structure' it ma be used in smaller diameters than a cast clasp' $ith less danger of fracture. Because it is round' light is reflected in such a manner that the displa of metal is less noticeable than $ith the broader surfaces of a cast clasp. 0he most common use of the combination clasp is on an abutment tooth ad*acent to a distal e%tension base $here onl a mesial undercut e%ists on the abutment or $here a large tissue undercut contraindicates a bart pe retainer +Fig. 7-8;,. Hhen a distal undercut e%ists that ma be approached $ith a properl designed bar clasp arm or $ith a ring clasp +despite its se!eral disad!antages,' a cast clasp can be located so that it $ill not cause abutment tipping as the distal e%tension base mo!es tissue$ard. Hhen the undercut is on the side of the abutment a$a

<

Lingual

Dingual

Buccal

Buccal

Fig. 7-8. 3nfrabulge clasp designed b 5.5. =e@an (mirror view), & and B' 1Dirigual aiJped1 ma be open or plated. =e@an recommended that t$o occlusal rests be used on each abutment. C' Clasp arm arises from border of metal base and is separated b sa$ cut or b ha!ing been cast agairist a metal shim' $hich is later remo!ed. Hrought-$ire retenti!e arm ma be soldered to metal base to accomplish same purpose. =' Clasp arm is attached to buccal flange of acr lic resin denture base $ith autopol meri)ing acr lic resiri. 0his is usuall a $rought-$ire arm.

Chapter 7 from the e%tension base' the tapered $rought$ire retenti!e arm offers greater fle%ibilit than does the cast clasp arm and therefore better dissipates functional stresses. For this reason the combination clasp is preferred +Fig. 7-8;' =,. 0he combination clasp has se!eral disad!antages4 +1, it in!ol!es e%tra steps in fabrication' particularl $hen high-fusing chromium allo s are used? +", it ma be distorted b careless handling on the part of the patient? and +3,' because it is bent b hand' it ma be less accuratel adapted and therefore pro!ide less stabili)ation in the suprabulge portion. 0he disad!antages of the $rought-$ire clasp are offset b its se!eral ad!antages' $hich are +1, its fle%ibilit ? +", its ad*ustabilit ? +3, its esthetic ad!antage o!er other retenti!e circumferential clasp arms? +., that a minimum of tooth surface is co!ered because of its line contact $ith the tooth' rather than ha!ing the surface contact of a cast clasp arm? and +8, that fatigue failures in ser!ice are less likel to occur $ith the tapered

=irect retainers

131

$rought-$ire retenti!e arm than $ith the cast' half-round retenti!e arm. 0he disad!antages listed pre!iousl should not pre!ent its use regardless of the t pe of allo being used for the cast frame$ork. 0echnical problems are minimi)ed b selecting the best $rought $ire for this purpose and then either casting to it or soldering it to the cast frame$ork. -election of $rought $ire' attachment of it to the frame$ork' and subse/uent laborator procedures to maintain its optimum ph sical properties are presented in Chapter 1". 0he patient ma be taught to a!oid distortion of the $rought $ire b e%plaining that to remo!e the partial dentures' the fingernail should al$a s be applied to its point of origin' $here it is held rigid b the casting' rather than to the fle%ible terminal end. 6ften' lingual retention ma be used rather than buccal retention' especiall on a mandibular abutment' so that the $rought-$ir: arm is ne!er touched b the patient during remo!al of the denture.

&

Fig. 7-88 &' Combination clasp consists of cast reciprocal arm and tapered' round $rought-$ire retenti!e clasp arm. 0he latter is either cast to' or soldered to' a cast frame$ork. 0his design is recommended for anterior abutment of posterior modification space in Class 33 partiall edentulous arch' $here onl a mesiobuccal undercut e%ists' to minimi)e the effects of first-class le!er s stem. B' 3n addition to ad!antages of fle%ibilit ' ad*ustabilit ' and appearance' $rought-$ire retenti!e arm makes onl line contact $ith abutment tooth' rather than broader contact of cast clasp.

13"

5cCracken1s remo!able partial prosthodontics

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Fig. 7-8; Fi!e t pes of e%tracoronal direct retainer assemblies that ma be useeJ on abutments ad*acent to distal e%tension base to a!oid or minimi)e the effects of cantile!er design. &rro$s indicate general direction of mo!ement of retenti!e tips of retainer arms $hen cl.enture base rotates to$ard and a$a from edentulous ridge. &' =istobuccal undercut engaged b one-half 0-t pe bar clasp. 2ortion of clasp arm on and abo!e height of contour might afford some stabili)ation against hori)ontal rotation of denture base. B' 3-bar placed in undercut at middle +anteroposteriorl , of buccal surface. 0his retainer contacts tooth onl at its tip. 7ote that guiding plane on distal aspect of abutment is contacted b metal of denture frame$ork and that mesial rest is used. C' 3nterpro%imal ring clasp engaging distobuccal undercut. Bar-t pe retainer cannot be used because of tissue undercuts inferior to buccal surface of abutment. =' Round' uniforml tapered 3--gauge $rought$ire circumferential retainer arm engaging mesiobuccal undercut. & $rought-$ire arm' instead of a cast arm' should be used in this situation because of abilit of $rought $ire to fle% omnidirectionall . Cast half-round retainer arm $ould not fle% edge$ise' $hich could result in e%cessi!e stress on tooth $hen rotation of denture base occurs. #' (airpin clasp ma be used $hen undercut lies cer!ical to origin of retainer arm. Both hairpin and interpro%imal ring clasps ma be used to engage distobuccal undercut on terminal abutment of distal e%tension denture. (o$e!er' distobuccal undercut on terminal abutment should be engaged b bar-t pe clasp in the absence of large buccal tissue undercut cer!ical to terminal abutment. (airpin and interpro%imal ring clasps are least desirable of clasping situations illustrated here. F' Dingual !ie$ sho$s use of double occlusal rests' connected to lingual bar b minor connector in illustrated designs. 0his design eliminates need for lingual clasp arm' places fulcrum line anteriorl to make better use of residual ridge for support' and pro!ides stabili)ation against hori)ontal rotation of denture base.

3nstead' remo!al ma be accomplished b lifting against the cast reciprocal arm located on the buccal side of the tooth. 0his ma negate the esthetic ad!antage of the $rought-$ire clasp arm' and esthetics should be gi!en

preference $hen the choice must be made bet$een buccal and lingual retention. 3n most situations' ho$e!er' retention must be used $here it is possible to create it and the clasp designed accordingl .

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Fig. 7-87 &' 5inor connector supporting distal rest does not contact prepared guiding plane' resulting in uncontrolled stress to abutment tooth. B' 5inor connector contacts prepared guiding plane and directs stresses around arch through pro%imal contacts.

an e!ent' future ad*ustment or repair is facilitated. 0he use of lingual e%tracoronal retention a!oids much of the cost of the internal attachment et disposes of a !isible clasp arm $hen esthetics must be considered. 6ften it is emplo ed $ith a tooth-supported partial denture onl on the anterior abutments and' $hen esthetics is not a consideration' the posterior abutments are clasped in the con!entional manner +see Fig. ;-13,. 6ne of the dentist1s prime considerations in clasp selection is the control of stress transferred to the abutment teeth $hen the patient e%erts an occluding force on the artificial teeth. 0he location and design of rests' the clasp arms' and the position of minor connectors as the relate to guiding planes are ke factors in controlling transfer of stress to abutments. #rrors in the design of a clasp assembl can result in unc6ntrolled stress to abutment teeth and their supporting tissues. -ome common errors and their corrections are illustrated in Figs. 7-87 and 7-8>. 0he choice of clasp designs should be based on biologic as $ell as mechanical principles. 0he dentist responsible for the treatment being rendered must be able to *ustif the clasp design used for each abutment tooth in keeping $ith these principles.

(in ual retention in con)unction with internal rests 0he internal rest is co!ered in Chapter ;. 3t is emphasi)ed that the internal rest is not used as a retainer but that its near-!ertical $alls pro!ide for reciprocation against a linguall placed retenti!e clasp arm. For this reason' !isible clasp arms ma be eliminated' thus a!oiding one of the principal ob*ections to the e%tracoronal retainer. -uch a retenti!e clasp arm' terminating in an e%isting or prepared infrabulge area on the abutment tooth' ma be of an accept able design. 3t is usuall a circumferential arm arising from the bod of the denture frame$ork at the rest area. 3t should be $rought' because the ad!antages of ad*ustabil it and fle%ibilit make the $rought clasp arm preferable. 3t ma be cast $ith gold or lo$-fusing chromium-cobalt allo ' or it ma be assembled b being soldered to one of the higher-fusing chromiumcobalt allo s. 3n

60(#R 0B2#- 6F R#0&37#R7umerous other t pes of retainers for partial dentures ha!e been de!ised that cannot be classified as being primaril of the intracoronal or e%tracoronal t pe. 7either can the be classified as rel ing primaril on frictional resistance or placement of an element in an undercut to pre!ent displacement of the denture. (o$e!er' all of these use some t pe of locking de!ice' located either intracoronall or e%tracoronall ' for pro!iding retention $ithout !isible clasp retention. &lthough the moti!ation behind the de!elopment of other t pes of retainers has usuall been a desire to eliminate !isible clasp retainers' the desire to minimi)e tor/ue and tipping stresses on the abutment teeth has also been gi!en consideration.

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: c

< Fig. 7-8> &' Clasp assembl designed so that !ertical occlusal force results in pro%imal plate mo!ing cendcall and out of contact $ith guiding plane as illustrated in B. 0his lack of contact ma contribute to possible $edging effect. C' #%tending contact of pro%imal plate on prepared guiding plane or' as in =' eliminating space bet$een arti ficial tooth and guiding plane ( p* $ill help direct stresses around arch through pro%imal contacts.

&ll of the retainers that are discussed herein ha!e merit' and much credit is due to those $ho ha!e de!eloped specific de!ices and techni/ues for the retaining of partial dentures. 0he use of patented retaining de!ices and other techni/ues falls in the same limited categor as the internal attachment prosthesis and is' for economic and technical reasons' a!ailable to onl a small percentage of those patients needing partial denture ser!ice. 3nternal attachments of the locking or do!etail t pe un/uestionabl ha!e man ad!antages o!er the clasp-t pe denture in tooth-supported situations. (o$e!er' it is /uestionable $hether the locking t pe of internal attachments are indicated for distal e%tension remo!able partial dentures' $ith or $ithout stress-breakers and $ith or $ithout splinted abutments' because of inherent e%cessi!e le!erages most often associated $ith these attachments. 0he nonlocking t pe of internal attachments' in con*unction $ith sound prosthodontic prin

ciples' can be ad!antageousl used in man instances in Class 3 and Class 33 partiall edentulous situations. (o$e!er' unless the cross-arch a%is of rotation is common to the bilaterall placed attachments' tor/ue on the abutments ma be e%perienced +Fig. 7-89,. #%cellent te%tbooks de!oted to the use of manufactured intracoronal and e%tracoronal retainer s stems are a!ailable. For this reason' this te%t concerns itself primaril $ith the e%tracoronal t pe of direct retainer assemblies +clasps,. 6ther conser!ati!e treatment of partiall edentulous arches.$ith remo!able partial den tures can be accomplished in a !ariet of $a s. 0reatment is still contingent on the location and condition of the remaining teeth and the contour and /ualit of the residual ridges. Basic principles and concepts of design relati!e to support and stabilit must be respected e!en though a !ariet of retaining de!ices can be incorporated. #%amples of some of these retaining de!ices are illustrated in Figs. 7-;0 through 771.

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Fig. 7-89 &' &%es of rotation' although parallel' are not common because one a%is is located anterior to other a%is. B, Hhen one nonlocking internal attachment is ele!ated farther from residual ridge than its cross-arch counterpart' the a%es of rotation do not fall on a common line? thus some tor/uing of abutments should be anticipated. (o$e!er' in man instances the effect produced b this situation $ill not e%ceed ph siologic tolerance of supporting structures of abutments-all other tor/uing factors being e/ual.

Fig. 7-;0 &' 3ntracoronal retaining de!ice +Kest &nchor, consisti3lg of n lon male post secured to denture base. B, Female insert cemented in do$el space of clinical root. C' #sthetic result.

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5cCracken1s remo!able partial prosthodontics

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B Fig. 7-;" 3ntracoronal magnets used for retention in partial denture applications. &' 5agnets positioned on retained roots of canines. Leepers are cemented into endodonticall treated roots' and1 magnets are processed into the denture base. B' Cast and prosthesis illustrating the esthetic ad!antage and simplicit of using magnets for retention. +Courtes 5agnet-=ent =ental @entures of &merica' Borba Dinda' Calif.,

Fig. 7-;1 3ntracoronal retaining de!ice +Kagg attachment,. &' Female retaining de!ice secured in endodonticall treated teeth. B' 7 lon male post secured in denture base. +Courtes =r. Halter (oma oon' Dong 3sland' 7B.,

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Fig. 7-63 #%tracoronal spring-loaded plunger retaining de!ice +(annes &nchorG3C plunger,. 2ermits full range of motion. &' 5ale plunger fits into dimple or female recess in porcelain-fused-to-metal cro$n located belo$ height of contour on pro%imal surface of left central incisor. Band C' &cceptable retention and esthetics achie!ed if sufficient space is a!ailable.

Fig. 7-;. 3ntracoronal retaining de!ice +-er!o &nchor-&GCeka,. &' Female retaining de!ice secured in denture base +spacing ring pro!ides for !ariable resilienc ,. B' 0hreaded male stud and base soldered or cast to post and coping. C' &cceptable retention and esthetics achie!ed if sufficient space a!ailable to accommodate retaining de!ice.

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5cCracken1s remo!able partial prosthodontics

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c c

Fig. 7-;8 3ntracoronal retaining de!ice +Bona Ball,. &' Female retaining de!ice secured in denture base. B' 5ale stud cast or soldered to post and coping. C, &cceptable retention and esthetics if sufficient space a!ailable to accommodate retaining de!ice.

Fig. 7-;; 3ntracoronal retaining de!ice +Rotherman,. &' Do$-profile retaining de!ice allo$s both hinge and !ertical resilienc . 5ale stud cast or soldered to post and coping. B' Female retenti!e clip secured in denture base. Retention can be altered b compressing or spreading retention clips. C' Do$ profile pro!ides acceptable esthetics. +Courtes =r. Merr Halker' 5il$aukee' His.,

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B c

Fig. 7-;7 &' Cast $ith splinted cro$ns' (ader bar assembl ' (ader bar clip' and t$o #R& receptors. B' Frame$ork positioned on cast? #R& processing male components in place. C' Finished distal e%tension partial denture.

Fig. 7-;> &' =albo e%tracoronal attachment $ith Dshaped male portion attached to abutment cro$n on ma%illar right canine? B, female slee!e placed in artificial tooth ad*acent to abutment.

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c Fig. 7-;9 &' -terngold CD internal attachments $ith female portions cast into distal pro%imal surfaces of splinted ma%illar first premolars. B, 2rofile !ie$ of male portion attached to partial denture frame. C' Finished partial denture $ith male portion seated into female portions $ithin primar abutments.

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c Fig. 7-70 Dong copings on prepared natural abutments can pro!ide support and retention in compromised dentition. &' 2atient is adult $ith repaired Class 3@ cleft $ith resultant cross-bite' Class 333 occlusion' and se!ere anterior occlusal deficit. H, 3nternal surface of prosthesis fabricated to restore the arch. C' @ie$ of the internal o!erdenture structure $ith an 3C attachment (arrow) that engages a dimpled cro$n preparation. -e!eral such copings are placed to enhance retention. D, Dabial !ie$ of completed o!erdenture prosthesis.

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19. Permissible fle%ibilities of retenti!e cast circumferential and bar clasp arms based on length ha!e been gi!en in 0ables 7-" and 7-3. Can a 6.7inch bar-t pe arm be safel placed in the same depth of undercut that a 0.7-inch circumferential arm canN Based on the information contained in 0ables 7-" and 7-3' e%plain the differences bet$een permissible fle%ibilities of duplicate retenti!e clasp arms made from a 0 pe 3@ gold allo and a chromium-cobalt allo . "0. Cast clasp arms are essentiall half-round in form' permitting fle%ing in onl one direction. Hhich direction is thisN "1. Hrought $ire' 3>-gauge round' is often used as a circumferential clasp arm. 3ts round form $ill permit fle%ing in $hich directionsN Fig.He 7-71 Do$-profile coping some "". speak of a reciprocal claspcontributes arm. #%plain $hat is additional but and primaril pro!ides meant b retention reciprocation describe the condition impro!ed support and stabilit . that must be met for true reciprocation to occur. "3. & basic principle of direct retainer +clasp, design is that the retenti!e and reciprocal arms must encompass more than 1>0 degrees of the greatest circumference of the tooth' passing from di!erging to con!erging a%ial surfaces. Hhat $ould probabl +E(%-"++E++ME,happen if a clasp failed to meet this criterionN "I.+ ".. -imple mechanical la$s +of le!ers, demonstrate that 1. 0he frame$ork ofretainer a remo!able partial denture the closer a direct assembl is located to the must furnish tipping a%is of support' the tooth'stabili)ation the less likelagainst that the hori)ontal !ertical, and periodontal +off ligament $ill be mo!ement' ta%ed from rotation mechanical (o$ mechanical tendencies ofretention. the denture. =ra$ is the coronal portion retention accomplishedN of an abutment? di!ide the enamel cro$n into thirds? ". and Hhat locate factor support' other than mechanical retention and retenti!e' stabili)ing' contributes to resistance of the denture to reciprocal components optimall . forcesN "8.dislodging Clasp retainers on abutment teeth ad*acent to distal 3. Hhat is thebases function of abe direct retainer e%tension should designed so that the $ill +clasp,N minimi)e direct transmission of tipping and .. 0here are basicall t$oabutment. t pes of direct retainers. rotational forces to the 0rue or falseN and label component parts in their the ";.=ra$ 0he location of their a usable undercut is perhaps correct positions single on an abutment tooth. most important factor in selecting a clasp for 8. use =escribe the principles $hich the e%tra$ith distal e%tension b partial dentures. 0rue or coronal falseN direct retainer and the intracoronal pro!ide for the remo!able "7.retainer 0here are man t retention pes and configurations of clasps? partial Hhat denture. factors are important to determine clasp ;. Hhat is meant b the hei ht of contour of an retention and designN abutment toothN 7. =ra$ a diagram of an abutment tooth and illustrate the an le of cervical conver ence.

9nder $hat is circumstances circumferential >. ">. & direct retainer an assembl ma of the follo$ing clasps usedNindi!idual Hhat are some real threeembrasure components that be perform function4 disad!antages of this pe of retainerN +1, support' b a rest? +", tstabili)ation-reciprocation' "9. Ci!e the indications the rigid use of a cast b a rigid clasp arm or for other component? and direct retainer. +3, circumferential a retenti!e element. =o these elements 30. Hhat obser!ations $ould to the selec necessaril ha!e to arise fromlead a common sourceN tion of a bar-t pe for claspN 9. Fle%ibilit is permitted $hich component 31. a combination clasp and $hat are of aHhat claspis assembl N the indications its useN 10. 0hefor amount of retention that a direct 3". -tateis three ad!antages of the depends combination retainer capable of generating on clasp. three factors. Hhat are these factorsN 33. 7ame the arm essential parts of a dental surbe fle%ible 11. 0he retenti!e of a direct retainer must !e or. an undercut $ith its terminal portion. to engage 3.. 0here are si%arm factors Fle%ibilit of the is a that determine the amount of retention a ph clasp is and capable of generating. 6ne of product of four sical composition these is the pe of metal from $hich it is made. factors. Hhat are tthese important factorsN 7ame on the all other fi!e. abutments should be as 1". Retention principal 38. (o$ does tilting the cast affect the selected nearl e/ual as possible. 0o obtain this' $hich is the areas a!ailable for clasp retentionN more important factor-the relation of the tip of the 3;. 0he pro!isions support and retention are t$o retenti!e arm to thefor height of contour or its depth in of the si% principles of design of an e%tracoronal the angle of basic cer!ical con!ergenceN retainer. Hhat are the other of fourN 13. =escribe the proportional tapers a cast' 37. =ra$ four common errors in the design of a half-round retenti!e arm. circumferential retainer. bar-t pe retainer. 1.. =escribe the taper of a cast'& half-round stabili)ing3>. Hould arm ou of agree that the single most important reciprocal a direct retainer assembl . For in must selecting a t pea of direct retainer for a $hatfactor reason there be difference in form distal partial denture is the location of the bet$een a e%tension retenti!e arm and a stabili)ing-reciprocal armNundercutN Hh N +#%plain our ans$er., 39. He tkno$ that guiding planes control the 18. 7ame the t$o basic pes of retenti!e . . path of placement and remo!al of a remo! clasp arms. able partial denture. Canapproaches the also contrib 1;. & circumferential clasp arm the retenti!e ute to additional retentionN 3f 4O0' ho$N undercut from an occlusal direction. From $hich .0. #%plain $ha itbar i4O neces4Oar retenti!e the direction does clasp armforapproach clasp arms to be bilaterall opposed in Class undercutN 3 partial dentures. 17. & clasp assembl ma be a combination of cast .1. 3n Class 333 partial dentures should the circumferential and bar clasp arms andJ or $roughtbilaterall orse!eral diametricall op $ire retention retenti!e be arms in one of combinations. #%plain. 0rueposedN or falseN .".arm =ifferentiate 1>. & bar clasp is taperedbet$een in e%actlthree the basic approaches to$a the application the R23 retainer s stemN.3. same that a cast'of half-round circumferential (o$ does clasp the amount of tapered' contact of the minor connector retenti!e arm is differing onl in pro%imal plate Hhich $ith the corresponding guidingif plane configuration. arm is the more fle%ible the in the R23 s stem influence $alengthN stress Hh is transferred to t$o different arms are thethe same N the abutment tooth and the residual ridgeN