Biomechanical principles in Removable Partial Dentures

Contents
   

Introduction Definitions Review of literature Mechanical principles applicable in removable Prosthodontics. Stress consideration in a partial denture Forces acting on partial denture

 

Biomechanical consideration of individual component Factors influencing magnitude of stress Controlling stress by design consideration Summary Conclusion References

Biomechanical consideration of individual component

REST
FUNCTIONS Provide vertical support for the partial denture. Maintains components in planned positions. Maintains established occlusal relations by preventing settling of the denture base. Prevents impingement of soft tissue. Directs and distributes occlusal loads to abutment teeth.

Relation between rest and abutment should be such that forces should be directed apically down along the long axis of the tooth

Stress absorbed by fibers of PDL without getting damaged

Rest
 

Primary rest

part of direct retainer unit

Secondary / Auxiliary rest

Primary rest:  prevent vertical movement of denture base towards tissue  Transmit horizontal forces applied during function to abutment teeth

Occlusal Rest

If angle greater than 90 degrees

Forces not along long axis

Slippage of prosthesis away from the abutment

Orthodontic like forces

Abutment severely tilted

Extended occlusal rest seat Decrease further tipping To ensure that the forces are directed along the long axis of the tooth.

Internal occlusal rest



Only in tooth supported partial denture Provides both support and horizontal stability

Adv:  Location of rest more favorable in relation to tipping axis of abutment



No clasp required buccally

Cingulum rest Vs Incisal rest

Cingulum rest nearer to center of rotation

less tipping of tooth Incisal rest Longer minor connector required

magnifies the forces being transferred to the abutment tooth

Positioning of occlusal rest in Distal extension base situations (JPD 1977:

38;261)

Moves the point of rotation anteriorly Transmits forces in a more vertical direction

Kratochvil et al (JPD 1963:13;114) Suggested using mesial occlusal rest so that the force delivered to the mesial aspect of the abutment tooth would tend to tip that tooth forward maintaining a tight contact with the tooth immediately anterior to it and gaining stabilization and support from the remaining anterior teeth. They suggested that occlusal rest be moved anterior to better use the residual ridge for support.

John W. Mc cartney (JPD 1980;43:15) Did a study on the effect of location of occlusal rest on abutment tooth movement and concluded that the mesial rest placement caused less abutment movement than distal rest placement. Stewart et al favored distal rest for distal extension prosthesis primarily to prevent food impaction between the tooth and denture.

ADVANTAGES OF MESIAL REST FOR DEB RPD

1. Decreases stress on abutment teeth

Distal occlusal rest Gingival extremity of denture base adjacent to posterior abutment tends to move in an arc towards the tooth Little or no support from the mucosa near the tooth

Tissue adjacent to tooth may be compressed between denture base and abutment causing tissue ischemia

Mesial rest produces more perpendicular transmission of occlusal forces Increased dependence of the denture on ridge for support Force more vertical near abutment tooth Decreased possibility of marginal tissue ischemia

2.Mesial rest will apply a mesial force to the abutment tooth, moving It towards the adjacent tooth.

3. Mesially placed rest helps to provide indirect retention of the denture (Zach et al JPD 1975;33;32-35) 1975;33;324. A mesial rest provides additional guiding planes to limit the possible path of withdrawl (Zach et al JPD 1975;33;321975;33;32-35) 5. Mesial rest and its accompanying minor connector can be instrumental in preventing distal displacement of RPD. (Zach et al JPD 1975;33;32-35) 1975;33;32-

SITUATIONS WHERE A MESIAL REST IS CONTRAINDICATED

1.If 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 wedging action.

2. If the only occlusal contact is against the rest, the opposing tooth will move into the space reserved for the rest when partial denture is not in patients mouth. Returning the prosthesis to place will produce a transient occlusal prematurity.

DIRECT RETAINER Any unit of removable dental prosthesis that engages an abutment tooth in such a manner as to resist displacement of the prosthesis away from basal seat tissue. Extra coronal retainers (clasps) operates on the principle of resistance of metal to deform

Prothero Cone theory as basis of clasp retention Described shape of crowns of premolar and molar teeth as 2 cones sharing a common base . Line where they meet height of contour. (represents contour. the greatest bulge). Suprabulge Infrabulge

 

Height of contour of tooth changes as the vertical position of tooth changes. Surface is retentive if it is cervical to its height of contour.

Clasp tip in infrabulge area resist the movement in occlusal direction because to release from tooth it has to undergo deformation. Degree of resistance to deformation determines the amount of clasp retention. Retention varied by: by: depth of undercut Flexibility of clasp arm positioned in undercut

Areas used for retention must be undercut in relation to partial dentures path of insertion and withdrawl

Requirements of clasp design:  Retention  Support  Stability  Reciprocation  Encirclement  passivity

1. Retention


Retentive arm provides retention

Three parts:  Terminal third  Middle third  Proximal third

Retention depends on:  Flexibility of clasp arm  Depth that the retentive terminal extends into the undercut  Amount of clasp arm that extends below the height of contour

Retentive undercut has three dimensions:

 

A) B-L depth of undercut: measured by Undercut gauge (thousands of an inch)

Distance between height of contour and a given B-L measurement Bdepends upon the angle formed by infrabulge and this vertical line. Angle is called angle of cervical convergence.

Less sharp this angle, greater distance needed between the height of contour and the retentive terminal to achieve the same amount of retention.

Clasp flexibility affects its placement

Cast chrome 0.01 inch Gold 0.015 inch Cast wrought metal 0.02 inch

B) another dimension distance between survey line and tip of the retentive clasp Effects clasp arm length influences flexibility of clasp

C) third dimension M-D length of clasp arm below the height of contour Longer this measurement more flexible the clasp

Flexibility of clasp depends on:  Length  Diameter  Taper  Cross sectional form  Material

Length of the clasp Increase length increased flexibility Flexure directly proportional 3 to (length) Clasp arm not to cover the tooth surface in straight line but be curved with tip facing occlusaly

Diameter


Flexibility inversely proportional to diameter of clasp arm

Uniform taper Essential in both width and thickness for retentive arm of clasp Clasp be half as thick at tip as at origin.

Cross sectional form:



Round clasp greater flexibility than a half round clasp with same diameter Round clasp flex in all spatial planes, while half round only in one plane

 

Material: Chrome alloys higher modulus of elasticity than gold alloys less flexible. Therefore smaller cross sectional form of the clasp and less depth of retentive undercut must be used for chrome alloy Wrought wire because of internal structure i.e. longitudinal structure as compared to grain structure of cast alloy greater flexibility

2. Support  Prime support unit of clasp assembly is the rest. 3. Stability  All components of clasp except retentive terminal contributes to stability.  Cast circumferential clasp greatest stability because its shoulder is rigid and aids in stabilization  Wrought wire clasp Less stability  Bar clasp

4. Reciprocation:

Each retentive arm must be opposed by reciprocal arm or other element of partial denture Capable of resisting these horizontal forces. It also plays role in stabilizing the denture against horizontal movement.

Reciprocal arm rigid, not tapered Positioned on tooth that is reasonably parallel to dentures path of insertion and withdrawal

If arm positioned on surface that is tapered occlusally slight movement of denture will cause clasp to loose contact with tooth reciprocal and retention lost

Placed as close to the height of contour as possible, no higher than middle third of the tooth. Preferably at junction of gingival and middle third

If height of contour high lowered by recontouring the enamel surface

5. Encirclement Each clasp designed to encircle more than 180 degrees of abutment tooth if not clasp act an orthodontic appliance forcing abutment tooth to move out of contact with clasp.

Encirclement  In form of continuous contact circumferential clasp arm



Broken contact Bar clasp. (assembly must contact atleast three different tooth areas {occ rest, retentive terminal, reciprocal terminal} that embrace more than half the tooth circumference.)

6. Passivity:


Clasp be completely passive Retentive function activated only when dislodging forces are applied to partial denture. Clasp be seated completely

Location of retentive terminals

Retentive terminal be located at mesial or distal line angle of the tooth.  If centre of facial or lingual surface used clasp shortened decreasing flexibility and compromising encirclement.
 

Retentive terminal generally preferred on facial/ buccal side than lingual side.

In a Kennedys class III situation the only function of clasp is to deform sufficiently during the insertion and removal of the restoration to allow them to flex over the height of contour of the teeth in passing to and from undercut area. The retentive clasp is not called upon to flex, other than to engage the undercut area of the tooth for the purpose of resisting vertical movement.

The direct retainer for the free end saddle must perform still other function in addition to that of resisting vertical displacement. Because of absence of distal support saddle will move tissueward under function proportionate to the quality of the supporting tissues and the accuracy of the supporting base. Therefore these elements of Clasp which lie in an undercut area must flex sufficiently to dissipate the stresses which would otherwise be transmitted to the abutment tooth as leverage.

But clasp can not effectively dissipate this stress because:

i)

Material itself can have only limited flexibility .

ii) Clasp are made half round in shape it can flex only in one direction therefore can not effectively dissipate, by flexing all stresses placed on it. Therefore most of the tilting stress is transmitted to abutment as leverage.

Henderson and Steffel:- suggested a Steffel:wrought wire retentive arm that would be more flexible and therefore will not pull the tooth posteriorly. Alternate suggestion was to use a barbartype clasp arm in the distal facial undercut to reduce force on the abutment.

Kurrasch et al recommended to place the retentive arm of the clasp at the height of contour rather than into an undercut and rely on friction for retention, thereby decrease force on the abutment.

INDIRECT RETAINER

Function: 1. to prevent the DEB from moving away from its seat because of cheek and tongue forces, sticky food. It uses mechanical advantage of leverage by moving the fulcrum line farther from the force

2. Contributes to support and stability of the partial denture counteracts horizontal forces applied to the denture. Long span mandibular lingual bar major connector (even if tooth supported), IR provides additional support and rigidity for lingual bar. Prevents impingement of the lingual bar on the mucosa during function.

Effectiveness of indirect retainer depends upon: 1) Its distance from the fulcrum line greater the distance between fulcrum line and IR more effective (because the mechanical advantage increases proportionately)

2) Effectiveness of the direct retainer Direct retainer must be effective if the indirect retainer is to function when the denture rotates otherwise the partial denture will be dislodged.

3) The quality of support of the indirect retainer. An indirect retainers effectiveness is reported to decrease when it is placed on an inclined plane because the tooth moves and the retainer slips. (JPD 1975;34;241975;34;2430)

Frank and Nicholls (JPD 1977:38;494) did a study on the effectiveness of indirect retainer and concluded that use of a mesial rest instead of a distal rest on the terminal abutment tooth does not decrease indirect retention. Thus the choice of indirect retainer location should be made mostly on the basis of abutment tooth support, a crown form favoring adequate rest seat preparation, and the patients esthetic desires.

Frechette et al (JPD 1956;6:195-212) 1956;6:195demonstrated that removal of the indirect retainers from a RPD results in the application of more pressure to the direct abutment teeth. The indirect retainer probably is effective in distributing forces to teeth other than direct abutments, and in preventing denture base lifting.

Major Connector
Connects parts of prosthesis located on one side of the arch with those on the opposite side Should be rigid  Distribution of force  Effectiveness of other components If flexible forces concentrated on individual teeth or ridge damaging.

L beam effect applicable to the anteroanteroposterior palatal bar or strap major connector. The two bars lying in two different planes produce a structurally strong L beam effect that gives excellent rigidity to the prosthesis.

Horse shoe shape/ U shape connector



When vertical forces applied tendency to spread or straighten. (movement can occur at open end). Not a good connector when cross arch stabilization is required.

Green LK et al (J Prosthet Dent. 2003;89:400-7 ) 2003;89:400Did a study to determine the effects of changing width, thickness, and shape on the rigidity of U-shaped maxillary major Uconnectors. They concluded that Doubling the thickness of the anterior strap of a UUshaped maxillary major connector improved the rigidity of the framework to torsional loads.

Guiding planes Definition: two or more parallel, vertical surfaces of abutment teeth, so shaped to direct a prosthesis during placement and removal. Functions:  Provides one path of placement and removal  Ensure the intended action of reciprocal, and retentive components  Eliminates gross food traps.

Guiding planes need to be as parallel to the long axis of abutment teeth. Establishing guiding planes on several abutment teeth (preferably more than two teeth), located at widely separated positions, provides for a more effective use of these surfaces. Effectiveness is increased if these surfaces are prepared on more than one common axial surface of the abutment teeth. Should be located on the abutment surface adjacent to the edentulous area. area.

Guiding planes squarely facing each other should not be prepared on lone standing abutment place undue strain on abutment when denture is rotated. Unfavorable leverages avoided by preparing guiding plane surfaces to slightly diverge in buccal direction.

STRESS BREAKERS/ STRESS DIRECTORS

GPT 7- A device or system that relieves 7specific dental structures of part or all of the occlusal forces and redirects those forces to other bearing structures or regions

In distal extension situation Rigid connection between denture base and retainers stress breaking Allows independent movement of the denture base and the direct retainers. separates the action of the retaining elements from the movement of the denture base

stress on abutment

reduced by using functional basing, broad basing, coverage, harmonious occlusion and correct choice of direct retainers

The need for stress breakers on free end RPDs has been recognized on the basis that the resiliency or displaceability of the mucosal tissue ranges between 0.4 mm to 2mm, while the vertical resiliency of a 2mm, normal healthy tooth in its socket is approx. 0.1mm. This tissue resiliency differential of 20 to 40 times the axial displaceability of a normal tooth in its socket dictates the necessity for some form of stress direction in the partial denture design.

2 types of designs: 1) HINGE DESIGN: Base is permitted to move in a vertical plane only. The hinge type device spares the tooth virtually all of the stress which results from vertical movement of the base, but it is still subjected to all the lateral loads and torsional stress. Eg: Gerber Hinge, DE Hinge type. 2. ROTATIONAL TYPE: Works on the ball and socket principle, movements of the base is allowed in all planes, and the tooth is relieved of virtually all stresses. Eg: CRISMANI, DALBO

SPLIT BAR MAJOR CONNECTOR

Henderson and Steffel suggested a split lingual bar to redirect the force on the abutment tooth. Vertical and diagonal forces applied to tissue-supported tissuebase must pass anteriorly along lower bar and then back along more rigid upper bar to reach abutment. Thus tipping forces that would otherwise be transmitted directly to abutment tooth are supposedly dissipated by flexibility of lower bar and distance traveled.

Reitz PV et al did a photoelastic study and confirmed that split major connectors were effective as stress breakers. Philip V. Et al JPD 1991: 66:220) did a study and concluded that use of split lingual bar decreased the amount of stresses on abutment teeth and increased stresses on residual ridges.

The vertical movement permitted by a hinge in the sagittal plane is such that the distal base portion, in effect, becomes a beam that under load behaves like the moving radius of a circle.

The distal extremity of the distal base will scribe an arc, and because it is furthest from its centre of movement at the hinge will consequently undergo more movement than any other point along the length of the denture base.

Flexible DEB RPD showing a steep arc differential when location of stress breaker hinge results in shortshort-radius beam. beam.

Long radius designs (like split major connector) seeks to lengthen the active radius of the system by ensuring that the flexible joint is located as far anterior as possible. Lengthening the beam radius could reduce the arcing differential to a gradient more in keeping with the inherent displaceability of the ridge tissues.

INDICATION FOR THE USE OF STRESS BREAKER

Because the stress breaker does, in far relieve the abutment tooth of the forces generated by the masticatory load, the stress is then borne by the residual ridge. Therefore a prime indication for the application of this principle would be the mouth where in an abutment tooth is inherently weak. weak.

Factors influencing magnitude of stresses transmitted to abutment teeth 1 quality of support of ridge Form of residual ridge type of mucosal covering 2 Length of span 3 clasp factor design length material amount of tooth contact

4 occlusion Type of teeth Harmony of occlusion 5 Areas of the base to which load is applied

1.


Quality of support of ridge

Better support by ridge less stress on abutment teeth A) Form of residual ridge Large well formed ridges absorb greater stress less stress on abutment Broad ridges with parallel sides longer flanges on the denture base stabilize the denture against lateral forces.

 

B) Type of mucosa


Influences magnitude of stresses transmitted to abutment teeth. Healthy mucosa capable of bearing greater functional loads than thin atrophic mucosa

Soft, flabby, displaceable mucosa Contribute little to vertical support of denture allows excessive movement of denture stress transmitted to abutment teeth

2. Length of span


Longer edentulous span longer denture base greater force transmitted to abutment teeth

Every effort be made to retain a posterior abutment to avoid class I and class II situation.

3. clasp as a factor in stress



More flexible the retentive arm of clasp less stress to abutment tooth But, flexible clasp arm provides less stability against horizontal forces increase stress on residual ridge.

In examination phase decide whether ridge or abutment tooth require more protection

If periodontal support good less flexible clasp like vertical projection clasp indicated.

If periodontal support weak

use more flexible clasp like combination clasp (residual ridge share more resistance to horizontal forces).

Clasp design Clasp be passive once framework seated completely

 

Length of clasp Increase in length increased fexibility

Flexure directly proportional to (length)

3

 

Material: Chrome alloys higher modulus of elasticity than gold alloys less flexible. Therefore smaller cross sectional form of the clasp and less depth of retentive undercut must be used for chrome alloy Wrought wire because of internal structure i.e. longitudinal structure as compared to grain structure of cast alloy greater flexibility

Type abutment tooth surface



Surface if gold crown offers more frictional resistance to clasp arm movement than does enamel surface of tooth. Greater stress exerted on tooth restored with crown than with intact enamel.

Amount of clasp surface in contact with tooth

Greater the area of tooth to metal contact between clasp and tooth more will be stress exerted on the tooth.

Occlusion as a factor A) Harmony of occlusion or lack of it Disharmonious occlusion generate horizontal stresses when magnified by factor of leverage can transmit destructive forces to both abutment teeth and residual ridge.

B) type of opposing occlusion



Play important role in determining amount of stress generated by occlusion Natural teeth can exert closing force upto 300 pounds/inch square, whereas, complete denture upto 30 pounds/inch square. Therefore RPD constructed against removable prosthesis is subjected to much less occlusal stress than one opposed by natural dentition.

Area of denture base to which load is applied Less movement of base if load applied adjacent to the abutment tooth than if it is applied to the distal end of the base. movement may be 4 times greater at distal end of base than next to the clasp.

Controlling stress by design consideration



1. Retention as a means of stress control A) forces of adhesion and cohesion B) atmospheric pressure C) Frictional contact D) Neuromuscular control 2 Strategic clasp positioning a) Quadrilateral configuration b) Tripod configuration c) Bilateral configuration

3 Clasp design a) circumferential clasp b) bar clasp c) combination clasp 4 Indirect retention 5 Functional basing 6 occlusion a) harmonious occlusion b) size of food table c) occlusal pattern of posterior teeth 7 Denture base a) Size & configuration b) accuracy of adaptation of base to the tissues

  

1.

Retention as a means of stress control

Retention : that quality inherent in the prosthesis acting to resist the forces of dislodgment along the path of placement. Retentive clasp arm retention transmits destructive forces to abutment teeth. Any retention by other components of RPD decrease the amount of retention that clasp need to provide decrease stress on abutment teeth. By exploiting retentive potentials in various other areas of mouth, both support and stability may be enhanced at the same time and stress is reduced.

A) Forces of adhesion and cohesion



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 must be accurately adapted to the underlying mucosa.

B) Atmospheric pressure Although not possible to develop a complete peripheral seal around borders of partial denture because of presence of teeth may still contribute to a slight amount of retention.


Noted particularly in maxillary complete palate major connector when an accurate metal casting is used and margins of connector are beaded.

C) Frictional contact


Partial denture designed guide planes created on as many teeth as possible Frictional contact of the prosthesis against properly planned guide planes can contribute significantly to the retention of denture.

D) Neuromuscular control Patients ability to control denture with lips, cheek and tongue important factor in retention. Design and contour of denture base also important factors. Any overextension of denture base loss of retention abutment teeth bearing direct retainers will be stressed more.

2. Strategic clasp positioning as a means of stress control



Leverages can be controlled to a large extent by means of clasps, if there are sufficient abutment teeth and they are strategically distributed in the dental arch. If number and location of potential abutments is less than ideal harmful effects can be decreased by strategic placement of clasps.

a) Quadrilateral configuration When 4 abutment teeth available for clasping and partial denture confined within 4 clasps all leverages neutralized. Ideal (for support and leverage control) Indicated most often in class III arches (with modification space on opposite side)

Class III with no modification space

B) Tripod configuration Class II situations Distal abutment on one side of arch missing leverage controlled to some extent by creating tripod configuration of clasp placement.

 

Class II with no modification space

Separating two abutments on dentulous side as far as possible largest possible area of denture will be enclosed in a triangle formed by retentive clasps.

Bilateral configuration
For class I situations Not considered ideal, but best option available Stress must be controlled by other means.

3. Clasp design as a means of stress control a) circumferential cast clasp

b) Reverse circlet cast circumferential clasp (torque not transmitted to abutment tooth, May produce wedging forces (counteracted by rests on approximating surfaces of both teeth)

 

b) vertical projection clasp In DEB RPD when undercut on D-B Dsurface

 

  

C) Combination clasp In DEB RPD when undercut on M-B Msurface Wrought wire More flexible Flex in all planes

4 Indirect retention as a means of stress control Essential in class I and II situations

5. Functional basing as a means of

stress control
Alveolar ridge can assume two contours Resting or passive contour Functional form Functional basing: This approach includes the impression technique that record the tissue surface in the shape the residual ridge assume under functional load. When subjected to occlusal loading not displaced to any appreciable extent

Magnitude of stress transmitted to abutment less. FIG>>>>>>>>>>>>>>>>>>>>>>>

 

 

6 Occlusion as a means of stress control Harmonious occlusion minimum tipping forces on abutment teeth and residual ridge. Size of food table: Large food table potential of transmitting more pressure on both residual ridge and abutment teeth than a small one. Factor negligible when small morsel of food between teeth, but would become substantial when the teeth were forced to penetrate a mass of fibrous food resistant to comminution.

Occlusal patterns of posterior teeth  Cuspless teeth more occlusal load as compared to teeth with cusp.  Steep inclines be avoided tend to introduce horizontal forces .


  

7 Denture base as means of stress control maximum coverage without overextending. Accurate adaptation of denture base

Summary

Conclusion
In the oral cavity one would find a number of sources of stress generation, the human body is built in such a manner that it learns to adapt to any stressful situation. Great caution and reserve are essential whenever an attempt is made to interpret biological phenomenon entirely by mathematical computation.

Removable partial dentures by design are intended to be removed from and replaced into the mouth. Because of this, they are not rigidly connected to the teeth or tissues, which means that they are subjected to movement in response to functional loads. These movement can cause generation of stresses which if not controlled , can damage the remaining teeth and supporting bone.

It is very important for us as prosthodontist to understand these biomechanical principle in order to recognize their application. Efforts must be always directed towards minimizing the harmful forces on the remaining teeth by proper designing of the RPD.

References

Load distribution in extension saddle partial dentures:JPD 1952,(2)92-100:George W. 1952,(2)92Hindels. A comparison of tooth borne and tooth-tissue toothborne RPDs. JPD 1953:3;375-381. 1953:3;375Case analysis of partial denture problem : Friedman, JPD 1954; 4;82-86 4;82-

Abutment sites, spaces in partial denture analysis :Friedman, JPD 1954 Bilateral free end saddle lower denture : Lammie & Osborne, JPD 1954:4;640-652. 1954:4;640-

A study of partial denture design and masticatory pressure in a mandibular bilateral distal extension case. JPD 1958:8;340-350. 1958:8;340The removable partial denture in the general practice of tomorrow : Oliver Applegate, JPD 1958 An evaluation of the support for the RPD. JPD 1960:10;1121960:10;112-123 Occlusal rest position & clasp design : Kratochvil,JPD 1963 A comparative study of impression procedures for distal extension partial dentures. JPD 1966:16;708-720. 1966:16;708-

The rationale of resilient hinge-action stress hingebreaker. JPD 1968:20;204-215. 1968:20;204Clasp designs for RPD. JPD 1973:29;409-415. 1973:29;409An evaluation of photoelastic stres patterns produced by various designs of bilatearl DE RPDs. JPD 1977:38;261-273. 1977:38;261Management of loading forces on mandibular distaldistal-extension prosthesis:part I. JPD 1984:42;6731984:42;673-681 Motion vector analysis of an abutment for a distaldistal-extension RPD: A pilot study. JPD 1983:43:151983:43:15-21.

Direct retainers for distal extension removable partial dentures. JPD 1986:56;562-566. 1986:56;562Factors that augment the role of direct retainers in mandibular DERPDs. JPD 1988:60;696-698. 1988:60;696The effect on function of distal extension RPD as determines by occlusal rest position : James DeBoer, JPD 1988 Indirect retention. BDJ 2001:190;128-132 2001:190;128The effects of buccolingual width and position of occlusal rest seats on load transmission to the abutments for toothtoothsupported removable partial dentures. Sato Y et al: Int J Prosthodont. 2001:14:340-3 2001:14:340-

 

    

McCrakens Removable partial prosthodontics 8th edition Clinical Removable partial prosthodontics : Stewart & Rudd, 2nd edition Removable partial prosthodontics : Grasso & miller, 3rd edition Removable partial prosthodontics : Boucher Color atlas of Removable partial prosthodontics : Davenport & Heath