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References lec 6

Chapter 3, Stewarts Clinical Removable Partial Prosthodontics )pages 51-83( Chapter 6, Removable Partial )pages 49-59( We are going to talk about direct retainers they are the next component of the metal frame work of the removable partial denture design in which we are discussing Retention in metal frame work of the removable partial denture is different from other prosthesis for example for the complete denture we get our retention from posterior palatal seal how ever in metal frame work partial denture we get our retention mechanically usually by engaging the clasp under the maximum bulge of the tooth There are two basic types of retention : Intra coronal retention -1 Within the contour of the tooth crown Like the rests , precision attachments ( key and key lock combination ), semi-precision ** we won't talk about these this semester they are more advanced Extra coronal retention -2 Outside the contour of the tooth crown * Cast
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* wrought wires essentially prefabricated stainless steal wires which we bend to form the tooth shape clasps Clasps above or below the bulge of the tooth above or below the survey line are Supra bulge and Infra bulge Infra bulge clasps give slight more retention than supra bulge ones the reason is due what is called push and pull theory It's harder to push a table than to pull it so clasps start from below the survey line when we try to remove it it will provide more resistance and retention than the clasps which start from above the survey line which is pulled so have less resistance

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The precision attachments provide support , retention and reciprocation Direct retainers usually form an assembly part of the assembly provide retention and the other parts of the assembly give kind of a balance to the retention which we need

so we have retention from this arm you see this arm is on the survey line ( the maximum bulge ) on the facial surface we have another arm on the lingual it's a mistake to think that both of these arms provide retention actually one of these goes to the undercut and the other will not go it's function is different the clasp assembly is composed of : the rest that gives support , the retentive arm that goes above or below the survey line to the undercut and that what provide retention and the reciprocation arm which balances what the retentive arm does or it's like an abutment ( removable partial denture provides retention because the clasps goes to the undercut ) We have two types of clasps in dentistry the prosthodontics and the orthodontics the ortho is designed to move the teeth but in prost once it's fully seated in the patient mouth it should not apply any force to the patient teeth However it's impossible to avoid some force on the teeth
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As the clasp is going down to be fully seated it's going to go over the maximum convexity as the clasps is going inside and outside the mouth it will hit the teeth in very short seconds this short time as it goes from above the survey line to below the survey line can cause force on the tooth and this force can cause movement even though it's only for short period of time because it is repeated and that's why we need something in the opposite side of the tooth to hold it in place and that's what we call reciprocation .

Here you can see the rest above and the reciprocating arm is entirely above the survey line where the retentive arm the tip is below the survey line ( the only part of the removable partial denture that goes to the undercut is the tip of the retentive arm ) So Direct Retainers Passive at rest Activated only during dislodgement basic requirements clasp assembly 1- retention from the retentive arm 2- support from the rest and keeps all the other components in place when it's fully seated in the rest place 3- stability that resist horizontal movements from the bracing arm ,the rest and the minor connecter 4- reciprocation
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receprocating arm rest retentive arm

If you take a look at this diagram if this is the tooth with the lingual side ( L ) and the buccal side (b ) you will see as the clasp is seated the reciprocating arm touches the tooth even before the rest and the clasp engage that means as this retentive arm goes over the undercut start to press on the tooth to move it this reciprocating arm ( balancing arm ) prevent movement of the tooth away from the retentive arm it keeps the tooth in it's specific place and here when it at rest it should be completely passive no any force on the tooth 5- Encriclement which provide stabilization directly which prevent tooth migration same idea as the reciprocation the design )the rest ,the retentive arm, the reciprocating arm and sometimes the minor connector )should go around the tooth for at least 180 degrees preventing both the denture and the tooth from migration

6- Passivity once the partial denture is fully seated there should be no active force on the tooth Passivity word is used in two concepts
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1- Preventing partial denture from moving the teeth 2- Passivity of the alloy In Co-Cr alloy the main component is cobalt Cr is added to prevent corrosion we say that Cr provide passivity to the alloy Magnitude of Retention IMPORTANT: YOU MUST READ EXPLANATION FOR CLASP FLEXIBILITY/CLASP RETENTION FROM THE TEXTBOOK REFERENCE The slide and the lecture are not enough The equation is called law of beam and in our case it is the law of the retentive clasp arm which can handle an applied load and the clasp will be deflected away from the tooth There are dimensions of this beam it has a width , a thickness and a length It is important to understand these because the design of the retainer will affect how many retention and support ** If I want to make the clasp retainer longer it will be more flexible and the shorter it is the more rigid ** if I want to make the thickness thin or the width narrow it will be more flexible And this is what the equation stands for : D = 4PL^3 / Ewt^3 D : deflection P : applied force L : length E : elastic modulus w : beam width t : thickness
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by looking at the equation by increasing the length you increase the resistance of the clasp there are other factors other than the material quality of the clasp which can affect the retention : 1- The shape of the tooth or the angle of convergent If the angle of convergent is flat the surface is smooth that means the amount of retention is less so the depth o f the angle of convergence is important . the more convexity of the tooth the more retention we have

Clasp flexibility 1-the length, the longer it is the more flexible it will be and it's increased by the curvature so molar teeth have more retention 2- diameter thickness and width when increased more rigid and when decreased more flexible .The actual material of wrought wires is stainless steal is more flexible than cast metal which is more rigid 3-metal material, cobalt chromium is very rigid alloy while nickel chromium is softer 4-the shape the cross sectional geometry ,if its circular it bends easily with flexibility in every dimension (wrought wire) , if its square or semi circular( cast ) part of it will be flexible and the other part won't be it would be harder and the geometry will prevent the rotation you need to read it from the text book .
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Direct Retainer Selection Principal Pick a retainer to suit the existing teeth rather than prepare the tooth to fit a particular direct retainer design
Designed for Tooth-Tissue Borne. Designed for Tooth borne.

Stress releasing.

Direct Retainers

Non-stress releasing.

We talked about tooth tissue and tooth tooth borne partial denture. we said that one of the major concept of a partial denture design is the fabrication of partial denture rotation that is going to rotate around a specific fulcrum and this fulcrum is a tooth this tooth is going to take too much load and in our design when we make the clasp we do not apply too much force of the tooth which stand right at the end of the fulcrum. If we have a class one partial denture with a tooth in one side and a tissue on the other side the stress will be on the last tooth

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Types of clasps We have something that reduces the stress of the abutment and some which does not. some which is very tight and one which release when there is excessive force non-stress releasing retainers 1-cast circumferential clasp 2- ring clasp which goes all the way around the tooth 3-embrasure clasp but with two clasp next to each other 4-reverse action C clasp if It's adjacent to the edentulous place 1- cast circumferential clasp Our first choice usually of a posterior tooth is actually called-cast circumferential clasp which starts from above the survey line which we called supra bulge also known as Akers clasp ( name of the dentist who designed it ) Simple to make, hygienic. And they have excellent stabilization because we have good encirclement around the facial and lingual with the rest. And because they are supra bulge they are not considered esthetic as they appear when the patient smile they tend to be less hygienic from below and it's more difficult to adjust the longer it is the easier to adjust and vise versa .

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Typical Cast circumferential retainer.

Edentulous space mesial to the molar.

Undercut on the distobuccal of the molar (preferable location).

The rest adjacent to the edentulous area and the clasp is supra bulge we have something called the shoulder which is above the survey line and the terminus which engages the undercut and we have the middle section. here in this design we start near the edentulous area with the Reverse Action Circumferential clasp we do exactly the same thing but the rest is on the opposite side of the edentulous area 2 Ring clasp we have another design called a Ring clasp it engages the tooth not complete a 360 degree but maybe 300 degrees starting from one point and we remain above the survey line we go around the tooth and we engage the undercut in the lingual surface

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The thing that is significant about this kind of clasps is that the bracing arm is both bracing and retentive. sometimes because it is too long ( flexible ) we can add an extension (minor connector )to reduce this flexibility or usually mandibular molars which are mesialy and lingually tilted we add it to them as the pic on the left above.

Which tooth is one of the most extracted teeth ? A : 6 molars because of bad oral hygiene with the lack of knowledge that it is not a deciduous tooth so extracted early in life because of caries then when the 7 erupts there is nothing in the place of 6 so the 7 tilts mesially and lingually with such a tooth it is very difficult to put a clasp in the right position so we use the ring clasp Disadvantages of a ring clasp: they are very difficult to adjust; they have poor hygiene (especially with the presence of the strut). They are contraindicated when there's excessive tissue undercut: sometimes the lower piece of metal has to go near the bone, so if there is excessive undercut they are difficult to extend.

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3- Double Embrasure Clasp the rests are back to back . some people like it a lot some hates it a lot because they require a preparation of the tooth so the clasp will go to the embrasure. however if I don't have an edentulous space how can I put a rest for the minor connector ?? as u can see that the embrasure clasp is going to the facial surfaces of both of the teeth

4- C clasp ( Hair pin clasp ) It is the least desirable design When we survey a tooth we mark the maximum convexity of the tooth . some teeth are a symmetrical when the under cut of the same tooth is law in one side and high on the other . so sometimes we are forced to start the clasp from a point and goes to the undercut to the rest distal corner . the question is how to start from above from the distal and finish here ?? ( look at the pic )

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So we have to go and then come back and it is very difficult to adjust and not hygienic and technically difficult to make But there are other solutions is putting the rest on the mesial and bring the clasp down, there is different choices. There is an unusual type of clasps where there is a concavity in the occlusal plane we can solve it by adjusting the occlusal plane using metal on top of the tooth ( not important ) Now we finished the non stress bearing design we will start talking about three Stress bearing design when the denture goes away from the tissue or goes down to the tissue we will end up with excess amount of force on this tooth . the clasp is designed not to over load this tooth There is something called mesial rest concept when I have an edentulous area the best place to put the rest mechanically to put it in the point as close to the edentulous area except in tooth tissue borne prostheses we usually put the rest away from the edentulous area. if u place it on the distal you will over load the tooth as the
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force vector is almost horizontal and the posterior teeth and the tissues are not designed to get lateral forces. But on mesial rest concept because the arm of rotation is larger we have more vertical forces and this what happens when we change the position of the rest . What happens with the clasps when we put the rest on the distal side when the patient bite on the partial denture? the clasp will extract the tooth . the retention is needed when the patient opens his mouth and when there is a sticky material in between his teeth so I don't need retention now ( we get retention from the clasp ) .you can see that the clasp is working while the patient is biting and we don't won't this to happen so as he bite he extract his own tooth . but if we put the rest mesially and when the patient bite the clasp will go away from the tooth ( stress relief ) it works when it must and it disengage when we don't won't it to work . 1- and this is what is called RPI system "R" Rest (always mesial) "P" Proximal Plate (distal) "I" I - Bar (buccal) We essentially have a bar or an infra bulge which comes from below it provides aesthetics bar

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2- RPA Clasps in RPA we have the R ( mesial ) the P but the A here is from wrought wires where in PRI was cast metal from I bar now the A here is coming from above so it is supra bulge and what they did actually they brought wrought wires and bend it instead of metal clasps Used where infrabulge approach not possible "R" Rest (always mesial) "P" Proximal Plate (distal) "A" Aker's retentive arm (always wrought wire) 3- Combination Clasp Circumferential clasp with wrought wire clasp Bracing and retentive arms originate from distal rest Guide plane must not run entire occluso-gingival height Used when : 1- Tooth-borne cases with poor prognosis for posterior abutments 2- Mesial rest and infrabulge approach not possible

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Notes about the lecture :

1- The dr emphasized to read the lecture from the book as he was talking briefly 2- The dr changed the syllabus so this lecture is not as 2009 one he said that everything in this lec will be easier when we take the biomechanics lecture which is on this Sunday 3- He was talking in Arabic all the time so I tried my best to make everything clear 4- Forgive me as there are not enough pictures in the script but I don't have the slides Finally I would like to say hi to my lovely adorable friends Ala2 , hashim , sawsan and Areej love u <3 Done by : Mais Tahseen Maloul

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