REMOVABLE PROSTHODONTICS
SE:CTION EDITORS
LOUIS BLATTERFEIN S. HOWARD PAYNE
The effects on function of distal-extension
removable partial dentures as determined
occlusal rest position
James DeBoer, D.D.S.*
1J.S. Army DENTAC, Ft. Bliss, Tex.
T he positioning of rests on the occlusal surfaces of
abutment teeth for distal-extension removable partial
dentures is discussed at length in the literature without
concensus. This article reviews some of this literature
and proposes rational alternatives to improve denture
stability and prognosis by the selection of sites for
occlusal rests in distal-extension removable partial den-
tures.
REST PLACEMENT ALTERNATIVES
Functions
Rest functions are to (1) transmit occlusal force along
the long axes of abutment teeth, (2) prevent injury and
excessive displacement of the soft tissues beneath the
denture bases, (3) keep clasps in desired positions,
thereby preventing changes in retentive arm action, (4)
transmit some of the lateral forces acting on the prosthe-
sis to the abutment teeth through their minor connectors,
(5) prevent food impaction between the abutment tooth
and adjacent denture base extremity, (6) close small
spaces between teeth, (7) prevent extrusion of abutment
teeth, and (8) act as indirect retainers.’ While providing
these functions, the most advantageous position of the
occlusal rest has been much debated in the design of
distal-extension prostheses.’
Distal rests
Distal rests have been advocated by some authors.‘,’
Stewart et a1.2 favored distal rests for distal-extension
protheses primarily to prevent food impaction between
the tooth and denture. Goodkind, in a clinical experi-
ment using lone standing premolars, demonstrated
slightly more abutment tooth mobility when only a
mesial rest was used. All restorations had guiding
planes. These guiding planes tended to place torquing
forces on the abutment teeth by restricting the rotation of
the prosthesis. Therefore, it is possible that the guiding
The opinionp expressed in this article are those of the author and are
not to be construed as official or reflecting those of the U.S. Army or
the U.S. Department of Defense.
*Lieutenant Colonel, DC, US Amly; Chief, Removable Prosthodon-
tics.
THE JOURNAL 01: PROSTHETIC DENTISTRY
by
DISTAL RESTWITH DISTAL RESTWITHOUT
A 6UlDlNGPLANE
6UIDIWGPLANE
Fig. 1. Distal rests with guiding planes produce greater
torquing action than distal rests without guiding
planes.
planes caused the torquing of the isolated abutment teeth
instead of the rest placement. Cecconi et a1.,4testing four
different clasp designs, showed that only the mesial
rest-I-bar design produced significantly greater tooth
mobility than distal rests. Kratochvil and Caputo5
believed these results were due to a lack of physiologic
relief of the mesial rest-I-bar design. Physiologic relief
reduces rotational interferences caused by guiding planes
when occlusal force is applied to the denture base.
However, this may lead one to question the value of
guiding planes in any distal-extension design if they
only provide additional torque to the abutment teeth
(Fig. 1). Kotowicz et a1.6 advocated the omission of
distal guiding planes in distal-extension prostheses using
distal rests.
Intracoronal rests and retainers act much as distal
extracoronal rests. When coupled with stress-breaking
devices, the rotational point is placed at the distal aspect
of the abutment tooth. When the removable portion of
the attachment is allowed to move apically on occlusal
loading, it becomes difficult to distribute this force to the
abutment, and the removable partial denture may
become essentially tissue-borne. If the attachment is a
rigid connection, the removable partial denture has a
tendency to be fully tooth supported unless the edentu-
lous ridges are registered by an altered cast impression.
In both situations multiple splinted abutments are
advisable to properly distribute occlusal stresses.
693

Fig. 2. Mesial rest moves rotation point to mesial sur-
face of tooth, applying more vertical force to edentulous
ridge and also closing contact with adjacent tooth.
Fig. 3. When mesial rest must be coupled with lingual
plate, fulcrum of removable partial denture is moved to
distal edge of plate above height of contour.
Mesial rests
Mesial rests are advocated for distal-extension remov-
able partial dentures to reduce stress on abutment teeth.
Several advantages have been claimed for this design.’
During occlusal loading, a distal-extension removable
partial denture with distal rests will exhibit certain
movements. The gingival extremity of the denture base
adjacent to the posterior abutment tooth moves in an arc
toward the tooth. This results in little or no support from
the mucosa near the tooth. The tissue adjacent to the
tooth may be compressed between the denture base and
the abutment, causing tissue ischemia. In more posterior
regions, the force is transmitted to the ridge mucosa in a
more vertical direction. In addition, a distal rest with an
accurately fitted guiding plane will tend to rotate the
abutment tooth distally and away from the support of the
neighboring teeth. In contrast, a mesial rest will produce
a more perpendicular transmission of occlusal .force to
the mucosa in all regions under the denture base.
694
DEBOER
Fig. 4. When mesial rest is placed on mesially tipped
abutment tooth, distal guiding plane will be above
height of contour in its entirety and will move effective
fulcrum line distally.
Fig. 5. If space between distal abutment and its mesial
neighbor will not allow minor connector. to rotate,
ocdusal force will weiige’teeth . apart and force distal
abutment distally.
Therefore, the mesially placed rest will increase the
dependence of the denture on ridge-support. Since the
force is more vertica1 ‘near the.. abutment tooth, the
possibility of marginal tissue &hernia is reduced. The
mesial rest will apply a mesial force to the abutment
tooth, moving it toward its adjacent tooth (Fig. 2). Zach
stated additional advantages of mesial rest. A mesially
placed rest helps to provide indirect retention of the
denture. A mesial rest provides additional guiding planes
to limit the possible paths of withdrawal. In addition, the
mesial rest and its accompanying minor connector can be
instrumental in preventing distal displacement of the
removable partial denture.
Demer: while reiterating the claims of other authors,
also listed some situations where a mesial rest, particu-
larly when coupled with an I-bar retainer, is contraindi-
cated. He stated that where a lingual plate contacts the
tooth occlusal to the height of contour, the fulcrum point
will be moved from the mesial rest to the distal edge of
the lingual plate (Fig. 3). When a mesially inclined
abutment tooth presents a distal surface with a mesial
inclination from a perpendicular to the occlusal plane,
any contact with this mesially inclined distal guiding
plane will shift the rotational point distally (Fig. 4). If
DECEMBER 1988 VOLUME 60 NUMBER 6
EFFECTS ON FUNCTION
Fig. 6. Occlusal contact in region of rest will usually
produce an unstable occlusal situation, necessitating
movement of occlusal rest distally.
the space between the distal abutment and its adjacent
tooth does not allow adequate space for the minor
connector to rotate, occlusal force on the denture base
will cause a wedging action. This wedging action will
force the abutment. tooth distally, diminishing the advan-
tages of the design (Fig. 5). An abutment tooth rotated
distally will often have its mesial fossa placed so far
buccally that accessto it becomes impractical. Occlusal
contact in the region of the mesial rest will usually
produce an unstable occlusal situation (Fig. 6).
DISCUSSION
Placement of a rest on the mesial part of the occlusal
surface of the distal abutment tooth appears to be the
most advantageous in light of current thought. However,
a mesial rest, in certain situations, may lose many of its
advantages.
As Demer9 discussed, disrupting the only stable occlu-
sal contact with the opposing tooth would contraindicate
a mesial occlusal rest. If the only occlusal contact is
against the rest, the opposing tooth will move into the
space reserved for the rest when the removable partial
denture is not in the patient’s mouth. Returning the
prosthesis to place will produce a transient occlusal
prematurity. In this situation, it is tempting to move the
occlusal rest to the mesial surface of the tooth anterior to
the abutment.. However, if a rest is not present on the
terminal abutment, the retentive arm of the clasp assem-
bly may lack effective reciprocation and the clasp
assembly will tend to move gingivally as ridge resorption
occurs (Fig. 7). Therefore, a distal rest may be indicated
when occlusal interference contraindicates a mesial
rest.
Patients with flat edentulous ridges present an obvious
THE JOURNAL OF PROSTHETIC DENTISTRY
+ MESIAL DISTAL*
Fig. 7. When occlusal contact prevents use of mesial
rest, if rest is moved mesially of adjacent tooth, instabil-
ity of distal abutment may result.
dilemma. The only resistance to lateral forces may be the
natural teeth. In such situations, lingual or palatal plates
may be necessary. If these plates are to be effective, they
must contact the teeth occlusal to the height of contour.
On occlusal function, the fulcrum will be effectively
moved distally and a distal rest may be used. If the
natural occlusion allows, it may be advisable to avoid
excursive occlusal contact by the prosthesis, reducing
lateral forces transmitted to the abutments.
In situations where a mesial rest cannot be used
without resultant unfavorable force generation, a distal
rest may be considered. The distal rest should be
designed to minimize distal rotation of the abutment
tooth. Distal guiding planes should be excluded and any
binding spots should be physiologically relieved to allow
as much rotation as possible around the occlusal rest.
The denture base area should be extended as fully as
possible within functional anatomic limits to reduce the
need for framework rotation. The use of distal rests also
requires definite indirect retention to resist rotation of
the denture base away from the ridge.
SUMMARY
The mesial rest may be an excellent method of
reducing unfavorable occlusal forces acting on the abut-
ment tooth. However, when anatomic conditions and
therapeutic necessity require alternatives, the distal rest
may be used. The use of the distal rest demands that
additional procedures be used to reduce the occlusal
trauma to the abutment tooth.
I thank Mr. Charles H. Blackwell for providing the illustrations.
REFERENCES
1. Seiden A. Occlusal rests and rest seats. J PROSTHET DENT 1958;
8:431-40.
2. Stewart KL, Rudd KD, Kuebker WA. Clinical removable
partial prosthodontics. St Louis: The CV Mosby Co, 1983;
240- 1.
695

Goodkind RJ. The effects of removable partial dentures on
abutment tooth mobility: a clinical study. J PROSTHET DENT
1973;30:139-46.
Cecconi BT, Asgar K, Dootz E. The effect of partial denture
clasp design on abutment tooth movement. J PROSTHET DENT
1971;25:44-56.
Kratochvil F J, Caputo AA. Photoelastic analysis of pressure on
teeth and bone supporting removable partial dentures.
THET DENT 19?4;32:52-61.
Kotowicz WE, Fisher RL, Reed RA, Jaslow C. The combination
clasp and the distal extension removable partial denture. Dent
Clin North Am 1973;17:651-60.
Factors that augment the role of direct retainers
mandibular distal-extension removable partial
dentures
Thomas J. Donahue, D.D.S.
Auburn, N.Y.
0 ne of the frequently investigated aspects of the
mandibular distal-extension removable partial denture
(RPD) is the role of the direct retainer. Such research is
focused on the effect of direct retainers on abutment teeth
for the purpose of minimizing unfavorable stresses. A
review of the literature reveals confusing and contradic-
tory results.‘” Hence it may be useful to reevaluate the
problem from another viewpoint.
In many investigations, factors other than direct
retainer design have been identified that circumvent the
question of direct retainers altogether. This article will
review these factors. Whereas several patient-related
factors have been shown to be important,4 this article
will present those that are under the direct manipulative
control of the dentist.
DUPLICATION OF DIRECT RETAINER
FUNCTION
Each component of an RPD has more than one
function. Thus, components other than direct retainers
may duplicate direct retainer function. This duplication
does not lessen the importance of direct retainers, but it
does increase the importance of other components when
only a few primary abutment teeth remain.
The three broad functions of a direct retainer are to
provide support, stabilization, and retention. Support, or
resistance to movement of the denture toward the tissues,
is provided by rests in positive contact with rest seats.
Stabilization, or resistance to horizontal and rotational
movement, is provided by the reciprocal clasp arm and
the rigid portion of the retentive clasp arm. Retention, or
696
DEBOER
7. Kratochvil JF. Influence of occlusal rest position and clasp design
on movement of abutment teeth. J PROSTHET DENT 1963;13:114-
24.
8. Zach GA. Advantages of mesial rests for removable partial
dentures. J PROSTHET DENT 1975;33:32-5.
9. Demer WJ. An analysis of mesial rest-I-bar clasp designs. J
PROSTHET DENT 1976;36:243-53.
J PROS-
Reprint requests to:
DR. JAMES DEBOER
USA DENTAC
FT. BLISS, TX 79920
in
resistance to occlusal dislodgment, is provided by the
flexible portion of the retentive clasp arm as it engages
the appropriate undercut in conjunction with reciproca-
tion.
In terms of other RPD components, support is also
provided by indirect retainers and denture bases. Several
studies have shown that the presence of indirect retainers
reduces the movement of and stress to the primary
abutment teeth.4V7Indirect retainers allow forces to be
distributed to almost any remaining tooth in a mandibu-
lar distal-extension situation. Denture bases contribute
to the support of a prosthesis by distributing forces over a
wide region. Although oral mucosa is not effective as the
periodontal ligament in accepting stress, maximum
extension of denture bases yields a geometric effect in
terms of mucosal displacement. For example, it has been
shown that halving the region of mucosa covered from
150 mm2 to 75 mm2 results in approximately four times
greater displacement with a 3 Newton force.*
Stabilization is also provided by guide plates, minor
connectors, and denture bases. Two or more guide plates
contacting guiding planes are important elements for
denture stability. Unfortunately, fewer optimum loca-
tions for guiding planes are available in distal-extension
RPDs as compared with tooth-borne RPDs9 However,
minor connectors may be used to assist guide-plate
function. When tooth surfaces that will be traversed by a
minor connector are prepared parallel to the path of
insertion, the minor connector will function as a guide
plate. Multiple minor connectors and guide plates are
needed for the most efficient stabilizing effect. Denture
DECEMBER 1988 VOLUME 60 NUMBER 6