Removable partial dentures with rotational paths of

insertion: Problem analysis

David N. Firtell, D.D.S., M.A.,+ and Theodore E. Jacobson, D.D.S.**
University of California, School of Dentistry, San Francisco, Calif.

Ah e rotary path of insertion was reintroduced to

dentistry in 19713.‘~~The system proposed by Garver’ is
limited in use, since it is specific for a unilateral
removable partial denture with a fixed partial denture
on the contralateral side. The system proposed by King
et al.2” although limited to tooth-supported removable
partial dentures, has more versatility because it does
not depend on a fixed prosthesis and it supplements
efforts to resolve esthetic and functional problems. Krol
and Jacobson 4,5elaborated on the suggestion by King et
al. by presenting physiologic and engineering princi-
ples for use of the rotational path of insertion. Often
when a philosophy or technique is introduced, the
virtues are indicated, but the emphasis on problems is
limited. The purpose of this article is to reemphasize
the problems of using a rotational path of insertion so
that others can avoid the problems, yet not be discour-
aged from using a rotational design when indicated.

PRINCIPLES
KroY described a removable partial denture which
uses a rotational path of insertion by comparing it to a
conventional removable partial denture. Simply stated,
the conventional denture is inserted by means of a path
where all rests are seated simultaneously. A rotational
path prosthesis seats its first segment,‘which contains
the centers of rotation; then the framework is rotated,
positioning the second segment to the final seat of the
prosthesis. There are three basic types of rotational
paths that can be used: the anterior-posterior (AP), the
posterior-anterior (PA), and the lateral.
The PA path is used to replace bilateral missing
posterior teeth and obtains retention of its first segment
posteriorly by use of the mesial undercuts of the distal
abutments, which usually are tilted (Fig. 1). The AP
Fig. 1. A, Posterior-anterior rotating path of inser-
tion seats first segment with rigid retainer on posterior
abutment. Second segment with conventional retainer
iS: seated on anterior abutment. A indicates distal
aspect of posterior rest and center of rotation. A’ is arc
of rotation determined by a radius from A to A’. B
indicates area requiring blockout. C is retentive area
for conventional clasp. D is rigid retainer, which
rotates into mesial undercut for retention. C is body of
conventional clasp, which rotates to its seat with
retention below height of contour, F. As long as ‘E is
seated, D cannot be moved occlusally. B, Framework of
removable partial denture with PA rotational path
seated on its cast.

path is used to replace anterior teeth and obtains

Presented before the Pacific Coast Society of Prosthodontists, Jasper,
Alberta, Canada.
*Professor and Chairman, Division of Removable Prosthodontics.
**Assistant Clinical Professor, Division of Removable Prosth-
odontics.
retention for its first section anteriorly by use of the
mesial undercuts or anterior abutments (Fig. 2). The
AP path can also be employed in the case of missing
posterior teeth by making use of the distal undercuts of

8 JULY 1983 VOLUME 50 NUMBER 1

REMOVABLE DENTURES WITH ROTATIONAL INSERTION
Fig. 2. A, AP path replacing anterior teeth has rigid
retention mechanism A seated first; then long rest B is
seated as prosthesis rotates. Conventional clasp C is
seated last as rotation is completed. B, Framework of
removable partial denture with AP rotational path
replacing anterior teeth seated on its cast.
the anterior abutments, if they are adequate, for
retention of its first segment (Fig. 3). The lateral
rotational path uses the mesial and distal undercuts of
the abutments on either side of a unilateral edentulous
space for retention of its First segment and rotates to the
contralateral side (Fig. 4). Whichever rotational path is
used, the segment seated first uses a rigid retainer in
the proximal undercut for retention, and the second
segment uses a conventional clasp for retention. The
retention mechanisms of the first segment must be rigid
to lock into the undercuts, while the second segment is
rotated into a position where one or more conventional
clasps engage. Vertical displacement is impossible, and
removal of the prosthesis can occur only by reversing
the rotational path.
A long occlusal or cingulum rest serves as a stabiliz-
ing and reciprocating component for the first segment.
The PA path uses a long occlusal rest, seating the distal
aspect of the rest first (Fig. 1). This rest serves as a
center of rotation, and then the prosthesis is rotated
into place. The AP path replacing anterior teeth has
the rigid proximal retention mechanism seated first and
THE JOURNAL OF PROSTHETIC DENTISTRY
PATHS
Fig. 3. A, Anterior-posterior rotating path of inser-
tion that replaces posterior teeth seats first segment
with rigid retainer on anterior abutment. Second
segment with conventional retainer is seated on poste-
rior abutment. A is mesial aspect of anterior rest and
center of rotation. A’ is arc of rotation determined by a
radius from A to A’. B is area to be blocked out. C is
retentive area for conventional clasp, D. E is rigid
retainer, which rotates into distal undercut for reten-
tion. As long as retentive clasp of D is below height of
contour, F, E cannot be moved occlusally. B, Frame-
work of removable partial denture with AP rotational
path replacing posterior teeth seated on its cast.
then has the long cingulum or long occlusal rest seated
as the prosthesis is rotated into place (Fig. 2). The AP
path that uses a distal undercut seats its anterior rest
first and then rotates into its retained position
(Fig. 3).
Jacobson and Kro15 have reduced the rotational
paths to two categories. Category I includes all prosthe-
ses that seat the rest associated with the rigid retainer
first and then rotate the second segment into place.
This category includes all PA paths of insertion and all
AP paths replacing posterior teeth. Category II
includes all lateral paths and AP paths replacing
anterior teeth. These prostheses actually use a dual
path of insertion, rather than a completely rotational
path. In category II, the rigid retainer is seated first by
sliding it to an initial contact straight in from the
9

Fig. 4. A, Lateral rotational path uses mesial-facial
and distal-facial undercuts (A and B) of abutments on
either side of edentulous space to hold rigid retainer.
Conventional clasp, C, is rotated to its seat on contra-
lateral side. B, Framework of removable partial den-
ture with lateral rotational path seated on its cast.
Fig. 5. Paths of insertion of rigid retainer, A, and
conventional retainer, B, should be indicated by sepa-
rate tripod marks.
occlusal direction and then rotating the second segment
to place.
The initial determination of available undercuts is
accomplished with a surveyor in the usual manner.
When anterior teeth are replaced with a denture with
10
FIRTELL AND JACOBSON
Fig. 6. Finishing and polishing must be minimized
on rigid retainer. Space between retainer and abut-
ment would allow retainer to drop (arrow).
Fig. 7. Long rests, A and B, act as supports and
bracing elements in properly prepared rest seats.
an AP path of insertion (category Ii), the rigid
proximal retainer is placed first, and then the conven-
tional posterior retainer is rotated into position. The
path of insertion for the rigid anterior retainer and the
path of insertion for the conventional retainer should he
indicated by tripod marks for convenience of the
laboratory (Fig. 5).
PROBLEMS
Finishing and polishing. Finishing and polishing
are critical in providing adequate retention and stabil-
ity of a removable partial denture that uses a rotational
path. ‘s5When the denture is in place, the rigid retainer
must be in intimate contact with the proximal surface
of the abutment. Finishing and polishing must he
minimized on this surface, since mobility of any sort
cannot be tolerated. If a space develops, the pros-
JULY 1983 VOLUME 50 NUMBER 1
REMOVABLE DENTURES WITH ROTATIONAL INSERTION PATHS

Fig. 8. Anterior-posterior rotational path replacing

anterior teeth must have walls of rest seat parallel with
proximal retentive surface.
P-IA
thesis will be unstable and easily dislodged (Fig. 6).
Contour and location of rest seats. The contour
and location of rest seats are also critical factors. Long
rests (more than half the mesiodistal width of the
abutment) with nearly parallel walls should be used.
This configuration provides bracing and vertical distri-
bution of forces to the abutment (Fig. 7).
When planning a rest for an AP placement (category
II), the proximal surface used for retention and the
walls of the rest seat must be parallel to permit the
initial straight path of insertion. Checking this paral-
lelism with a surveyor is easily accomplished on a cast
(Fig. 8). Concerning posterior abutments, a common
error made by students is forming a rest seat perpen-
dicular to the occlusal surface (Fig. 9, A). Instead, the
walls of the rest seat must be bilaterally parallel to each
6
other in the vertical path of insertion (Fig. 9, B). /L)
Without this relation, insertion is impossible, even for a Fig. 9. Walls of rests must be parallel bilaterally. A is
conventional path. The rests should be at least 1.5 mm incorrect. B is correct.
thick for adequate rigidity when chromium alloys are
used.
Analyzing undercuts. Undercuts are analyzed by The surface of the prosthesis adjacent to the proxi-
means of a divider to determine the rotational path. mal surface of the abutment that will receive the
When posterior teeth are replaced by use of either an conventional clasp (second segment) must be analyzed
AP or a PA path of insertion (category I), judge the also to accommodate the rotational path. For this
undercut for the rigid retainer of the first segment with analysis, the first tip of the divider is kept at the same
the tip of a divider placed on the cast at the level of the position used for the first segment and the caliper is
rotational point (the end of the rest, Fig. 10, A) and expanded (Fig. 11). The second tip is placed in contact
with the second tip placed in the proximal undercut to with the greatest curvature of the proximal surface of
be occupied by the rigid retainer. If the second point the abutment that will receive the second segment. The
can be rotated occlusally without being trapped proxi- second tip is then rotated in an occlusogingival direc-
mally, the undercut and center of rotation are properly tion, with the first tip as the center of rotation. The
related. The rotational undercut can be changed by area visualized between the second abutment and the
altering the length of the rest, but this adjustment has second tip as the divider rotates will require blocking
limitations. If the undercut is incorrect and the divider out to allow placement of the prosthesis without
is trapped, the abutment may need recontouring (Fig. binding on the adjacent proximal surface.
10, B). When determining a lateral rotational path of inser-

THE JOURNAL OF PROSTHETIC DENTISTRY 11


INCORRECT
Fig. 10. A, Correct rotational path is determined
with divider. If divider is not trapped by proximal
surface, center of rotation and undercut are correct. B,
If divider is trapped by proximal surface (arrow), cen-
ter of rotation and undercut are incorrectly related.
Fig. 11. Blockout on abutment for conventional clasp
is determined with divider. One tip is placed at level
of center of rotation and second tip is rotated to
contact greatest curvature of abutment (arrow). Area to
be blocked out is between arrow and abutment.
tion (category II), the first tip of a divider is placed at
the proximal retentive points of each abutment. The
second tip is placed into the area of the rest and rotated
to ensure that the rest will clear adjacent surfaces. The
rigid retainers can be inserted in a straight path from
the occlusal aspect, so the rests do not need to clear the
entire occlusal surface of the abutment. The abutment
12
FIRTELL AND JACOBSON
\ AI
I
I
!I
!n
! ;
!I I1
i3
Fig. 12. Centers of rotation must be at same level to
ensure proper determination of retentive areas on
abutments of conventional retainers. With centers
horizontal (line A-B), vertical path of conventional
clasp passes through its arc of rotation, represented by
dashedline. With centers at different levels (line A-C),
path of conventional clasp is represented by dnshed-
doffed line.
Fig. 13. Length of edentulous space affects amount of
blockout required for conventional retainer and reten-
tion of rigid retainer. Teeth Nos. 2 and 2 have same
dimensions. A is center of rotation. A-B and A-E are
radii of arc B-E. A-C and A-D are radii of arc C-D.
Blockout required at D is less than that required at E.
When conventional clasp rotates through arc C-D,
rigid retainer moves from horizontal line A-C to G.
When conventional clasp rotates through arc B-E, rigid
retainer moves from horizontal position to F. Differ-
ence in vertical movement of rigid retainer is mea-
sured by distance between lines G-H and F-I. Differ-
ence in effective undercut is defined by distance
between lines F-F’ and G-G’.
with the shortest distance from retention point to rest is
the most critical, since it will have the tightest rotation-
al path. The conventional clasp on the contralateral
side should have its path of insertion judged in relation
to the tightest rotational path.
Restoration of abutments. Proximal silver alloy
restorations are acceptable in abutments for rotational
removable partial dentures, but well-retained cast
restorations may be preferred. The force applied by the
rigid retainer of a rotational path is directed occlusally
JULY 1983 VOLUME 50 NUMBER 1

Fig. 14. With A as retention point for conventional
retainer, rigid retainer will be held by undercut B,
even if point A becomes a center of rotation in
function. If curve of Spee increases and C becomes
point of retention for conventional retainer, B will no
longer be retentive if C becomes a center of rotation in
function.
with a shearing action, and a silver alloy restoration
can break more easily under shearing force.
Horizontal position of centers of rotation. The
horizontal position of centers of rotation can affect
retention. To ensure proper retention of the conven-
tional retainers, the centers of rotation must be ana-
lyzed in the same horizontal plane. If there is a vertical
discrepancy between the centers of rotation, a discrep-
ancy will occur in the path of insertion. This discrep-
ancy can be depicted by drawing lines connecting the
left center of rotation to the right center of rotation
when the left center is at two different vertical positions
(Fig. 12). Then a perpendicular line is dropped from
the left center of rotation as it appears at the two
different positions. The discrepancy is defined by the
difference in angulation of the two perpendicular lines.
Because of this discrepancy, two problems can develop.
First, binding can occur between the rests, since the
walls of the rest seats will not be parallel. Second, the
path of insertion (the vertical arc of rotation) of the
conventional clasp may be offset so that what appears
to be a proper retentive undercut is not. The undercut
can be inadequate or excessive, depending upon the
direction of the discrepancy.
Length of posterior edentulous ridge. The length
of a posterior edentulous ridge will affect the retention
of the rigid retainer and the amount of blocking out
required on the proximal surface of the conventional
retainer (Fig. 13). Potential problems are related to a
comparison of the arcs of circles made by radii of
different lengths. If two teeth are of equal dimension
occlusogingivally, the tooth that is farthest from the
center of rotation will require less blocking out to
prevent the prosthesis from binding because the arc
THE JOURNAL OF PROSTHETIC DENTISTRY
D
0
Fig. 15. A, In square arch form, axis of rotation runs
from center of rotation No. 2 to center of rotation No.
2. Radius of center No. 2 is perpendicular to line 1-2,
along line A, through point D and E. Length of span
(B-C) is distance between D and E. B, In tapered arch
form, axis of rotation remains the same. Radius of
rotational path should be measured along broken line
A’. Effective length of span for purpose of rotation is
measured as difference between lines B-D and C-E and
not from points B to C. Effective length of span can
also be defined as difference between radii from axis
of rotation along A and A’ by arc F with a center of
rotation at No. 2. Because of shorter radius of A’,
prosthesis can bind at C and G if radii Z-C and 2-G are
used to determine blockout required.
will have less curvature and be more vertical. The
amount of vertical movement that can occur around the
center of rotation below the occlusal plane is limited by
an arc that is determined by two radii with the same
center of rotation. The first radius passes from the
center of rotation to the proximal-occlusal line angle,
and the second radius passesfrom the center of rotation
to the proximal-gingival line angle. The longer span
and the shorter span may create arcs that can move
through the same occlusogingival height at the conven-
tional retainer. However, as the two prostheses
approach their centers of rotation, the occlusogingival
distance they can travel will vary, with the length of the
radius determining their respective arcs. Nearer the
center of rotation, the longer radius will allow a
smaller amount of occlusogingival movement than the
13

Fig. 16. In tapered arch, radius is relocated from
dashed line A to dashed line A’. Point of contact of
radius changes from D to G. Amount of blockout will
decrease as arc I? (defined by A-C) approaches facial
aspect of abutment because this surface of abutment is
farther from center of rotation.
.J
I ments perpendicularly from an axis of rotation uniting
Fig. 17. Lingually tilted teeth and soft tissue protu-
berances require special consideration when planning
rotational paths of insertion.
shorter radius. Although the entire undercut can be
filled with the rigid retainer, the degree of undercut
that can be used effectively by the longer radius will be
less than the shorter radius. Vertical displacement of
the rigid retainer is therefore easier. For this reason,
the longer radius may prevent the use of a rotational
path of insertion if a minimal undercut exists. The
shorter radius, however, will increase the tendency of
the prosthesis to bind on both the rigid and convention-
al retainers and their abutments.
Anterior-posterior vertical relation. The anterior-
posterior vertical relation of the undercut used for
retention ‘of the conventional clasp and the undercut of
the rigid retainer may be critical. With a mild curve of
Spee, there usually is no problem. However, as the
14
FIRTELL AND JACOBSON
FORCE REACTION
Fig. 18. Rotational paths of insertion should not be
used in distal-extension situations. Force on extension
will fulcrum at rest of conventional retainer, and
reaction will be leverage by rigid retainer (arrow).
curve of Spee increases, there is an increase in the
height of the retentive point of the conventional retain-
er above a horizontal plane. With this increase, there
will be a decrease in the effective undercut of the
proximal surface used for the rigid retainer (Fig. 14).
This loss of retention occurs when gravity or function
places a center of rotation at the retentive point of the
conventional clasp. This problem becomesmore critical
as the edentulous span increases. With an increase in
the radius, the effective undercut of the rigid retainer
will decrease in the same manner that the blockout
decreases (Fig. 13).
Shape of the arch. The shape of the arch can affect
proper seating of a rotational prosthesis. A square arch
will have bilateral centers of rotation with radii that
are parallel bilaterally and pass through all the abut-
the right and left centers (Fig. 15, A). With a square
arch, the edentulous span can be measured along a
given radius. As the arch becomes tapered or the
centers of rotation become offset from each other
mesiodistally, a problem can develop. With a tapered
arch, all the abutments can no longer be located on
radii that are parallel to each other and perpendicular
to an axis of rotation that connects bilateral centers of
rotation (Fig. 15, B). A similar relation occurs when
the centers of rotation are offset mesiodistally. Most
individuals will define the radii to extend directly from
the centers of rotation on the abutment of the rigid
retainer to the proximal surface of the conventional
abutment. However, when an arch is tapered, the
centers of rotation and their radii must be relocated
along their axes of rotation. The bilateral radii must be
parallel to each other and must bisect their respective
abutments for the conventional clasp. The centers of
rotation are thereby relocated on the axis of rotation
where the radii drawn from the abutment. of the
JULY 1983 VOLUME 50 NUMBER 1
REMOVABLE DENTURES WITH ROTATIONAL INSERTION
conventional retainer intersect the axis perpendicular-
ly. The result is a shorter radius from the relocated
centers of rotation to the abutment of the conventional
clasp. The effective span length from the relocated
center of rotation to the proximal surface of the
abutment of the conventional clasp is shortened. As
indicated earlier (Fig. 14), a shorter span (radius) will
require more blockout for the conventional clasp. If the
original center of rotation were used instead of the
relocated center, there would be less blockout than
necessary, and the resulting prosthesis would bind on
the surface of the abutment of the conventional clasp.
In addition, in a tapered arch, the point of contact of
the radius from the relocated center of rotation on the
abutment and the angle at which it approaches the
abutment will change from a proximal one toward a
lingual one (Fig. 16). Consequently, the amount of
blockout on the conventional abutment will vary as the
buccal aspect of the proximal surface is approached,
because the surface changes its distance from the center
of rotation. The effect is to lengthen the span (radius)
and reduce the required blockout. Binding may not
occur, but a tendency for creating food traps can be
increased. At the other extreme, however, open proxi-
mal surfaces will allow saliva flow and will perhaps
reduce plaque accumulation.
Lingually tilted teeth. Lingually tilted teeth, which
would not interfere when seating a conventionally
designed prosthesis, can prevent a rotating framework
from seating because the major connector strikes the
tooth (Fig. 17). On the mandible, a major connector
may need excessive relief to clear the tooth when being
seated, and this can create a trap for food or an irritant
to the tongue. Rotational paths should probably not be
used in these situations. Problems associated with
lingually tilted teeth become more acute with a tapered
arch.
Projections of soft tissue or bone. Projections of
soft tissue or bone can interfere with the position of the
retentive network of the framework or the acrylic resin
of the completed prosthesis. The problem is similar to
the lingually tilted tooth but can be remedied with
sufficient attention to detail and adequate blockout or
relief.
THE JOURNAL OF PROSTHETIC DENTISTRY
PATHS
Distal-extension ridges. A rotating path of inser-
tion should not be used with a distal-extension ridge
(Fig. 18). Force applied to the extension will fulcrum
at the rest seat of the conventional abutment and create
a reactive force at the rigid retainer. The reactive force
will tend to lever the abutment of the rigid retainer out
of the alveolus.
CONCLUSION AND SUMMARY
Removable partial dentures designed to use a rota-
tional path of insertion are technique sensitive. When
indicated and when the principles discussed are fol-
lowed, a denture that uses a rotational path can be
highly successful. Tooth coverage can be decreased,
which is an advantage in plaque control, caries reduc-
tion, and periodontal support. Esthetics can be
improved without resorting to intracoronal retainers,
and the number of components subject to distortion is
reduced. When properly designed and constructed, use
of a rotational path of insertion can result in a
removable partial denture that is strong, hygienic, and
esthetic.
We acknowledge editorial assistance provided by Hilary Prit-
chard, Senior Editor, Department of Restorative Dentistry, Univer-
sity of California, San Francisco.
REFERENCES
1. Garver, D. G.: A new clasping system for unilateral distal-
extension removable partial dentrues. J PROSTHETDENT
39:268,1978.
2. King, G. E.: Dual path design for removable partial dentures.
J PROSTHET DENT 39392, 1978.
3. King, G. E., Barco, M. T., and Olson, R. J.: Inconspicuous
retention for removable partial dentures. J PROSTHET DENT
39:505, 1978.
4. Krol, A. J.: Removable Partial Denture Design Outline
Syllabus, ed 3. San Francisco, 1981, School of Dentistry,
University of the Pacific, pp 55-68.
.5 Jacobson, T. E., and Kroi, A. J.: Rotational path removable
partial denture design. J PROSTHET DENT 48~370,1982.
Reprmt reyuatr to:
DR. DAVID N. FIRTELL
REMOVAELEPROSTHODONTICS,
D-2230
UCSF SCH~L OF DENTISTRY
707 PARNASSUS AVE.
SAN FRANCISCO, CA 94143
15