Prosthodontics

reappraisal of indirect retention in removable partial

dentures with long bilateral distal-extension saddles
R. K. F. Clark*/T W. Chow*
Wlten only the si.x anlerior teeth remain, it may appear that indirect retention cannot
be adiieved because tlie fulcrum line around which the denture may move when the
distal e.\ten.sions lift away from the mucosa is located behind tlte retentive tips ofthe
clasps on the abtitment teeth. This will be the case when the indirect retainer and the
tips oftlie clasps are on the satne level; however, if the tips ofthe clasps are nearer to the
gingival margin than the indirect retainer, indirect retentive effects will be achieved.
(Ouintessence Int 1995:26:253-255.)

Introduction
The principle of indirect retention, as it applies to
removable partiai dentures with distal-extension saddles, requires that a component ofthe denture base
(for convenience referred to as the indirect retainer) be
placed on the anterior teeth as far as possible in front of
a notional fLilcrum line, usually drawn through the
retentive portion oftlie clasps on the abutment teeth.'
When there is a tendency for the saddle to move away
from the mucosa, the notional ilcrum line is transferred from the retentive portion of the clasps to the
indirect retainer. The clasps are then said to be more
effective in retaining the distal-extension saddles.However, when only the six anterior teeth remain, a
common situation in the mandible, and the distalextension saddles are verj' long, it is difficult to achieve
indirect retention," because the fulcrum line drawn
between the retentive portions of the clasps on the
abutment teeth is anterior to the lingual aspects ofthe

* Department of Prosthetic Dentiiry. tJniversity of Hone Kong. Hong

Kong
Reprint requests: Prof R. K. F. Clark, Depanment of Prostlietii;
Denlistry, University of Hong Kong, Prince Philip Dental Hospital.
34 Hospital Road, Hong Kong.

Ouintesjeni; liltttfiytfuiiai

Fig 1 (he axis of rotation passing through the tips of the

ciasps is anterior to the lingual piate.

incisor teeth, where the indirect retainer may normally

be placed (Fig I ).
Clinical experience has shown that many removable
partial dentures made under these circumstances are
not worn successfully. Many clinicians recommend
prescription of overdentures on the grounds that
without indirect retention removable partial dentures
will be unretentive and difficult to manage. While
overdentures may also have the advantages of allowing
the clinician more control over the position of the
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Prosthodontics

Fig 2 When the saddles lilt away trom the mueosa, the
lingual bar moves upward and backward, leaving a gap
between the bar and the mueosa on the lingual side of the
alveolar process.

Fig 3 When the clasps are at the same level as the

Kennedy bar, the iingual bar moves upward and backward.

Fig 4 If the Kennedy bar is higher than the clasps, the

saddles are prevented from lifting.

Fig 5 1/eir) The clasps tips and the upper border ot the
lingual plate are on the same level; therefore, the lingual
plate cannot prevent the saddles from lihing. {right) The
vertical separation of the clasps and upper border of the
lingual plate allow the lingual plate to provide tndirect
retention.

occlusal plane and providing a better appearance,

many patients prefer removable partial dentures. There
are circumstances under which removable partial
dentures may be successful in this situation. One ofthe
factors for success is production of a retentive denture,
and in this regard indirect retention is important.
The purpose of this article is to analyze how indirect
retention can be achieved in these cases and to propose
an addition to the principle of indirect retention.
Because these cases most commonly occur in the
mandibulararch, they will be discussed in that context
although the principles are equally applicable to the
maxillary' arch.

Factors affecting indirect retention

254

Type of major connector

In a prosthesis with long distal-extension saddles
designed with a lingual bar major connector, there is
nothing to resist movement of the distal end of the
distal-extension saddles in an occlusal direction other
than the clasps on the abutment teeth. As the saddles
lift, the clasps will offer some resistance, thereby
producing a fiilcrum line, and the lingual bar will move
upward and backward, leaving a space between the bar
and the mueosa where food can lodge (Fig 2). As the
denture lifts away from the distal surface ofthe canine,

Quintessencel nternational

Voliimg

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Prosthodontics
the undercuts no longer relate to the planned path of
insertion and all retention is lost. The dentures will be
uncomfortable, inefficient, and poorly tolerated by the
patient.
If, on the other hand, a lingual plate (or a lingual bar
in combination with a Kennedy bar) is used, then can
indirect retention be achieved? In the example in Fig 3,
the Kennedy bar and tbe clasps are at the same level.
Therefore the lingual bar and Kennedy bar lift upward
and backward away from the teeth, and movement is
not prevented. However, if the Kennedy bar is nearer
to the incisai edges, and the retentive portion ofthe
clasps are nearer to the gingival margin (Fig 4), lifting
ofthe saddles is prevented. Therefore, the principle is
that, to achieve indirect retentive eflects, the indirect
retainer must be placed nearer to the occlusal plane at a
iiigher level than the retentive portion of the clasps.
The greater the vertical separation, the more indirect
retention will be achieved (Fig 5),
Clasp design
The retentive portions of the clasps are placed in
undercuts relative to the path of insertion and withdrawal ofthe denture. When the fulcriim line (vid.
sup.) is transferred to the upper margin ofthe lingual
plate, the clasps will tend to resist occlusal and distal
movement.
Occiusally approaching clasps should be designed
with the entire clasp as low as possible on the tooth

Quintessiie"lntemational

Voiume 26, riwriber 4/1995

consistent with gingival health to gain maximal mechanical advantage while reducing the visibility ofthe clasp.
If possible, the shape ofthe tooth should be modified
by grinding or addition of composite resin to place the
survey line low on the tooth. Ideally, the rigid part of
the clasp should be positioned on the survey line to
minimize leverage forces under occlusal load,
Gingivaiiy approaching clasps may be better estheticaUy and place fewer leverage forces on the abutment
teeth. However, their greater flexibility may necessitate
the addition of mesial and distal grips to resist dislal
movement of the denture.

Summary
Indirect retention can be employed when the clasp tips
are located anterior to a lingual plate provided that
there is adequate vertical distance between the indirect
and direct retainers. Where the indirect retainer is only
just anterior to the clasp tips, indirect retention is
increased as the vertical separation between the
indirect retainer and direct retainer increases.

References
1. Avant WE. Indirecl rdemion jn parlial denlure design, J
Dent 196ti;l6;llO3-lllU.
2. Nairn RI. The proble of frec-enil demure bases, J Prusthei Dent
U
1966,16:522-532

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