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Definition
A major connector is the component of the partial denture that connects
the parts prosthesis located on one side of the arch with those on the opposite
side. It is that unit of the partial denture to which all other parts are directly or
indirectly attached.
This component also provides the cross-arch stability to help resist
displacement by functional stresses. The basic function of the major connector is
unification. Connecting all the parts of a removable partial denture together helps
to distribute the stresses, particularly the horizontal forces which are more
damaging than vertical forces. By joining the different parts the force applied to
one side of the denture in the mouth are automatically transmitted to the other
sides thereby reducing the forces on chewing side considerably. lf they are
attached to, or originate from, a flexible connector, the effectiveness of
components can jeopardize the supporting oral structures and can be a detriment
to the comfort of the patient.
DESIRABLE CHARACTERISTICS OF MAJOR CONNECTORS
1. Made from an alloy compatible with oral tissues.
2. Rigid and uses the principles of broad distribution of stress.
3. Does not interfere with and is not irritating to the tongue.
4. Does not substantially alter the natural contour of the lingual surface of
the mandibular alveolar ridge or of the palatal vault.
5. Does not impinge on oral tissues when the restoration is placed,
removed, or rotates in function.
6. Covers no more tissue than is absolutely necessary.
residual ridges is minimal. In contrast, if there are only two abutment teeth
remaining, the palatal tissues should contribute maximally to the support of the
prosthesis, so as to reduce to a minimum the stresses which are transmitted to
these teeth. Many times there is a reluctance to employ a maxillary connector
which covers more than a minimum amount of palatal area, because of the
patient's presumed resistance to the greater areal coverage and because of the
resultant increase in bulk. This attitude is, in part, a holdover from an era of
dentistry when palatal coverage was accomplished with either acrylic resin or
gold alloy. It must be conceded that palatal coverage with acrylic resin, that
meets the requirement for strength, must be relatively bulky, whereas wide
coverage with gold alloy increases the weight of the prosthesis substantially.
However, as a result of the improved physical properties and advanced
techniques of fabrication of the chromium-cobalt dental alloys, it is possible to
cover the palate with a very thin though extremely strong, rigid covering which
adds little to either the bulk or the weight. Moreover, the patient's individual
palatal topography can be reproduced in the metal. Because the chromium-cobalt
alloys are polished by a deplating process, which eliminates the areas of uneven
thickness so often present in the gold alloy casting as a result of hand polishing,
problems due to excessive bulk are infrequent and phonetic difficulties are a
rarity. When one considers the obvious benefits to the abutment teeth of
employing the palatal tissues for support, and their eminent suitability for
providing it, there should be no hesitancy in using the connector which results in
minimal stress on the abutment teeth. It should be remembered, too, that in
addition to providing unification and support, a properly designed maxillary
connector can contribute materially to both latter by virtue of the interfacial
tension which is operant between the metal and the mucosa. The amount of
retention, stability, and support contributed will be directly proportional to the
amount of areal coverage.
Additional factors in selection of the most suitable palatal connector are:
(1) the presence of palatal tori, (2) the need for anterior tooth replacement) (3)
the requirement for indirect retention, (4) the need for stabilization of infirm teeth,
(5) phonetic considerations, and (6) the mental attitude of the patient.
Anterior-posterior palatal
U- shaped bars
Palatal type
If used it is limited to replacing one or two teeth on each side of arch and
placed no further anteriorly than the second premolar position. There must be
teeth capable of bearing an additional load both anteriorly and posteriorly to the
edentulous space.
Contraindication
It use is contraindicated in neither distal extension situation nor when anterior
teeth are to be replaced.
palate type. A wide palatal strap type maybe used for unilateral distal extension
situation but rarely bilateral situation.
Advantages
Because the palatal strap is located in three planes (the horizontal, or vault of
the palate: the vertical, or lateral slopes of the palate; and the sagittal, or
anterior slope of the palate), it offers great resistance to bending and twisting
forces. Thus greater rigidity with less bulk of metal is produced. This theory is
similar to the L-bar principle used in building construction. Forces transmitted
on different planes are counteracted more easily.
Because the palatal strap is inherently strong, it can be kept thin, thus
increasing patient comfort. It offers little interference to tongue action and as a
result is accepted well. In addition, by covering a relatively large area of
palatal tissue it helps distribute stress over a broad area.
Retention of the partial denture through the forces of adhesion and cohesion
is enhanced by the intimate contact between the metal and soft tissue.
The strap also contributes some indirect retention, preventing the partial
denture from rocking anteriorly when the pull of sticky foods or the force of
gravity tends to unseat the posterior end of the denture.
Disadvantages
Indications
Contraindication
For reasons of torque and leverage, a single bar or strap palatal major
connector should not be used to connect anterior replacements with distal
extension bases. To be rigid enough to resist torque and to provide
adequate vertical support and horizontal stabilization, a single bar or strap
would have to be objectionably bulky. When placed anteriorly, this bulk
would become even more objectionable to the patient because it could
interfere with speech
restoration
of
short
span
tooth-supported
bilateral
edentulous
with
provision
for
cross-arch
attachment
by
either
.
U-SHAPED PALATAL CONNECTOR
From both the patient's standpoint and a mechanical standpoint, the Ushaped palatal connector is the least desirable of maxillary major connectors. It
should never be used arbitrarily.
It consists of thin band of metal running along lingual posterior teeth and
extending onto the palatal tissues for 6-8mm. Anteriorly the metal normally
covers the cingula of the present teeth and extends on to the palate to cover the
entire rugae area. Some variation of this outline form may occur.
The borders of the horseshoe connector must either be 6 mm from the
gingival margin or extend onto the lingual surfaces of the teeth. The borders
should also be placed in the valleys of the rugae. The lateral palatal borders
should be at the junction of the horizontal and vertical slopes of the palate. The
rigidity can be increased by extending the borders slightly onto the horizontal
palate surface. The connector should be symmetric, with the palatal borders
extending to the same height on both sides. All borders or angles of the
connector should be gently curved and smooth.
Advantages
This major connector is used primarily when several anterior teeth are
being replaced.
Disadvantages
To avoid the tendency to flex, the metal crossing the rugae area must be
thicker than that used in most other major connectors. This places the
greatest bulk of metal in the area where the tongue needs the most space.
Interferences with phonetics and patient comfort can result.
Indications
Contraindications
Its lack of rigidity (compared with other designs) can allow lateral flexure
under occlusal forces, which may induce torque or direct lateral force to
abutment teeth.
The design fails to provide good support characteristics and may permit
impingement of underlying tissues when subjected to occlusal loading.
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Disadvantages
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borders of the bars are a nuisance because the tongue tends to want to
investigate them.
Indications
The antero-posterior palatal bar may be used when support is not a major
consideration and when the anterior and posterior abutments are widely
separated.
The A-P bar may be the connector of choice for the maxillary arch which
has a torus palatinus that is either undercut, lobulated, or too massive to
be covered with a full coverage connector or a strap.
The Patient's Mental Attitude: The A-P bar may be used as a compromise
for the patient who strongly objects to the greater bulk or areal coverage of
the full palatal connector. Although the double palatal bar may serve
adequately, to all intents and purposes, in such a circumstance, it cannot
equal the full palatal connector from a standpoint of support and with its
borders positioned in the depressions and slopes of the rugae rather than
on the crests.
Contraindications
Because of the limited palatal tissue contact, little support is derived from
the bony palate. In many instances the extra rigidity offered by the anteroposterior palatal bar would be desirable, but its use is contraindicated
because of reduced periodontal support of the remaining teeth that
necessitates additional support from the palate.
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Advantages
The closed horseshoe is a rigid connector that derives good support from
the palate even though an opening is provided in the palate. The
corrugated contour of the metal over the rugae adds strength to the
connector and allows the metal to be made thinner. The circle effect of the
anterior and posterior straps contributes to the rigidity of the connector.
The shape of this connector also provides a definite L-beam effect [that is,
the metal lying in two planes increases the resistance to flexing}.
Disadvantages
Even though the metal over thin rugae area may be thinner than in some
other major connectors, interference with phonetics may occur in some
patients.
In addition, the extensive length of borders for the tongue to contact may
cause annoyance or discomfort.
Indications
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Class IV arches.
The corrugation in the anatomic replica adds strength to the casting; thus
a thinner casting with adequate rigidity can be made.
Surface
irregularities
are
intentional
By
virtue
of
intimate
contact,
between metal and tissues provides the prosthesis with greater retention.
Retention must be adequate to resist the pull of sticky foods, the action of
moving border tissues against the denture, the forces of gravity, and the
more violent forces of coughing and sneezing. These are all resisted to
some extent by the retention of the base itself, which is proportional to the
total area of denture base contact to the supporting tissues. The required
amount of both direct and indirect retention will depend on the amount of
retention provided by the denture base.
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Disadvantages
Indications
Six Remaining Anterior Teeth: When only six natural anterior teeth remain
in the maxilla, the mechanical problems created by a partial prosthesis
are so formidable that full palatal coverage may be considered essential
in all but exceptional instances.
It may be used as a plate of varying width that covers the area between
two or more edentulous areas, as a complete or partial cast plate that
extends posteriorly to the junction of the hard and soft palates or in the
form of an anterior palatal connector with a provision for extending an
acrylic resin denture base posteriorly
The palatal plate should be located anterior to the posterior palatal seal
area. Little posterior seal is ever necessary with a metal palate because of
the accuracy and stability of the cast metal. This is in contrast to the
posterior palatal seal needed with acrylic resin complete denture bases.
When the last remaining abutment tooth on either side of a Class I arch is
the canine or first premolar tooth, complete palatal coverage is strongly
advised, especially when the residual ridges have undergone excessive
vertical resorption.
In the maxillary arch any acrylic resin partial denture that replaces
posterior teeth should have full palatal coverage for strength.
The cast metal palate can be produced as a uniformly thin plate that
reproduces the anatomic contour of the palate. The surface irregularities
feel natural to the patient and the major connector serves as a secondary
masticatory surface. The corrugations resulting from the rugal contours
and the coverage of different palatal planes provide an L-beam effect,
making this a rigid major connector. The all-metal connector also
enhances the transfer of temperature changes to produce a more natural
sensation during eating and drinking. This advantage is lost when acrylic
resin is used.
Contraindication
Structural Details
The full palate connector should be thin, with the natural anatomy of the
palate reproduced in the metal. The material which covers the residual ridges
should be one that can be refitted easily (acrylic resin), because this is the area
of the mouth that is most susceptible to atrophic change. The posterior border
can be fabricated of either metal or acrylic resin.
If it is made of metal, the border must be precisely established, because if
overextended it will quickly induce soreness, and the metal is difficult to alter
satisfactorily. A slight bead should be provided in the metal by lightly scraping the
refractory cast, prior to forming the wax pattern for the framework.
The acrylic resin border is preferred when maximum adhesion and
atmospheric seal is needed, and it has the advantage of being easily altered. The
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post dam seal should be located in the zone of the palate where the mucosa is
resilient but not movable. This will be found at, or very near, a line drawn from
one hammular notch to the other, through the fovea palatinae. It may be located
quite precisely in the mouth by observing the region of the fovea palatinae while
the patient says "ah.' Articulation of the ah sound raises the palatal curtain, thus
disclosing the junction of movable and nonmovable tissue.
Normally the full palate connector requires no relief unless there is a
prominent palatal raphe or a large torus palatinus. The posterior border of the
complete palate normally extends to the juncture of the soft and hard palate. The
anterior border must be kept 6 mm from the marginal gingiva or must cover the
cingula of the anterior teeth. The connector can be made in the following three
forms:
1. All acrylic resin: The entire connector is made of acrylic resin. It covers the
entire palate and usually extends to two or more edentulous areas and to the
juncture of the hard.
2. Combination metal and acrylic resin: The anterior portion of the connector,
covering the rugal area, is constructed of metal cast to conform to the
convolutions of the rugae. Extending posteriorly from the metal are projections of
metal around which can be processed the acrylic resin that will cover the
remainder of the palate. This resin extends posteriorly to the junction of the hard
and soft palates.
3. All cast metal. The entire palate is covered with a thin metal casting, which
also extends posteriorly to the junction of the hard and soft palates.
The posterior palatal seal that is used with complete dentures should not
be employed with a removable partial denture. It is not possible to produce a
peripheral seal in a removable partial denture such as is produced by border
molding a complete denture.
Attempts to use a posterior palatal seal not only fail to accomplish the
desired purpose, but also, because of the rebound of the tissues under
compression, place unnecessary extra forces on the abutment teeth.
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A slight border seal or bead is needed along the posterior border of the
connector to prevent debris from collecting beneath the complete palate. The
intimate contact of the cast metal palate aids retention through adhesive and
cohesive forces.
Many practitioners resort to complete or partial coverage of the palate with
acrylic resin in preference to cast metal because of the mistaken belief that it is
difficult if not impossible to obtain an accurate casting of the size needed to cover
the palate. Inaccurate castings can most frequently be traced to inaccurate
impressions of the palatal vault area. Impression materials of the type generally
used for removable partial dentures tend to slump away from the palatal tissues
during their gelation period if the material is not supported adequately. This
slumping will produce an impression that appears accurate but in reality is
distorted.
Advantages of a cast palate over a complete resin palate make the complete
cast palate sufficiently preferable to offset the slight additional cost. However,
when the cost and fee must be held to a minimum, the latter method may be
used satisfactorily. The partial metal palate may also be used when later relining
is anticipated. In such circumstances the posterior heading can be redone as part
of the relining procedure.
The complete palatal plate is not a connector that has received universal
use. It has, however, become accepted as a satisfactory palatal connector for
many maxillary partial dentures. In all circumstances the portion contacting the
teeth must have positive support from adequate rest seats. The dentist should be
familiar with its use and, at the same time, with its limitations so that it may be
used intelligently and to the fullest advantage.
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