category
Acrylic partial dentures –
interim or permanent prostheses?
SADJ November 2009, Vol 64 no 10 p430 - p436
VJ Wilson: BChD, MChD. Principal Specialist, Associate Professor, Head of Restorative Cluster, Faculty of Dentistry, University of the Western Cape, Bellville.
Tel: 021 370 4414 or 021 937 3077, Fax: 021 392 3250 or 021 937 2287. E-mail: vwilson@uwc.ac.za.
SUMMARY
An acrylic partial denture (APD) is one option for replacing
missing teeth and is also the most cost effective treatment option.
Dentists are faced with the demand for replacing missing teeth
from patients with limited financial resources; therefore the
replacement of missing teeth with an APD is a common occurrence.
One of the disadvantages of APD’s is its poor strength. Dentists
and dental technicians tend to design and construct acrylic
partial dentures with little or no tooth support. This can have a
detrimental effect on the surrounding hard as well as soft tissue.
This article argues that APD’s can be considered as a permanent
prosthesis, provided that proper patient selection, education and
the principles of partial denture design are adhered to.
INTRODUCTION
The construction of APD’s is one way of replacing missing teeth
in a partially edentulous patient. However, it is generally not
considered a permanent treatment option for replacing missing
teeth. The provision of metal-based removable partial dentures,
fixed partial prostheses or implant supported prostheses to
replace missing teeth is considered to be more permanent
treatment solutions.
In many less affluent societies, APD’s are commonly used in
private practice as permanent prostheses, mainly due to the lower
cost of the APD when compared to other treatment modalities.
This is largely owing to the cost-effectiveness of the material –
acrylic – used as a major connector, as well as low cost laboratory
procedures involved in the construction of this partial denture. In
a National Health Survey conducted over a 9 -year period (1992
to 2001) in the UK, it was found that for every metal-based partial
denture constructed, five APD’s were made.1 It can thus be
argued that the APD, if properly designed and constructed should
be considered as a permanent prosthesis.
One of the main problems with APD’s is that it is often designed
and constructed as a tissue supported denture instead of tooth-
supported. Patients also do not realize the value and importance
of regular post insertion visits to the dentist, as well as optimum
oral hygiene practices.2 In the light of the potential problems with
APD’s, this article is done to reinforce the principles of correct
design and construction of the APD.
Acrylic versus Metal
Although there are no data available in South Africa with regard
to the number of APD’s made in the private sector, it is assumed
that these will outnumber metal-based partial dentures because
of the low socio-economic status of the population at large.
430
A metal-based partial denture constructed in private practice
will cost the patient in the region of R2500 to R5000, whereas
an APD will cost in the region of R1000 to R2000. APD’s thus
offer a cheaper alternative to metal-based partial dentures as
it is relatively easy to construct in the laboratory, it is easier to
repair and reline1 and wrought wire components can be added
to the framework for retention and support.2, 3 However, its main
disadvantage is the low strength of the acrylic material and its
susceptibility to fracture. This problem is usually compensated for
by increasing the bulk of the material which has the potential of
traumatizing the soft tissues as well as periodontal tissues.
The literature on the subject of removable partial prostheses
places great emphasis on the design and construction of
metal-based removable prostheses and very little on its acrylic
counterpart. All removable partial dentures should utilize the
existing teeth for support and retention as teeth have a much
better response to loading when compared to soft tissue and
bone.4 This is easily achievable with the metal-based partial
denture as the entire denture is cast as one and support and
retention gained from rests and clasps extending from the
major connector. For an APD to be tooth-supported, additional
material such as stainless steel rests and clasps have to be added
to the acrylic major connector. This in itself presents a problem
as there is no chemical bond between stainless steel and acrylic
and clinically this can present itself as a weak area which, if not
handled properly is prone to fracture. However, with proper
patient selection, optimal clinical and laboratory procedures,
the disadvantages of APD’s can be minimized. The design of the
removable partial denture is more important than the material to
be used for its construction.5
Dentists and technicians tend to design and construct acrylic
partial dentures without adequate tooth support and retention.
This was shown in the National Health Survey that a large
percentage of the acrylic dentures were mucosa-supported
instead of tooth supported.1 Patel, Bredenkamp and Yengopal did
a survey of Removable Partial Dentures produced by commercial
dental laboratories and have shown that design principles for
APD’s were disregarded and that mucosa-supported dentures
were routinely constructed for patients.6 Davenport et al found
that the responsibility of designing dentures have been to a large
extent delegated to the dental technician.7 This results in patients
being provided with removable partial dentures that do not take
into account optimum clinical and biological principles.
A South African textbook (Fundamentals of Removable Partial
Dentures by Peter Owen) provides more information on APD’s
in comparison to other textbooks.3 This textbook contains the
principles of removable partial denture design, but uses cost-
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Table 1: Selection of Wrought wire diameter (in mm) for Molar Clasps for a b
different clinical situations:
0.25mm undercut 0.50mm undercut
Clinical situation Gold C/C S/S Gold C/C S/S
Tooth supported bases
Good periodontal support - - - - - 1.0

Compromised periodontal - - 1.0 0.9 0.9 0.9

support
Distal extension bases
Good periodontal support
Compromised periodontal
support
Gold = platinum-gold-palladium wire; C/C = cobalt-chromium wire;
S/S = stainless steel wire
Figure 2a and b: Inflammation (Denture Stomatitis) of the oral mucosa and plaque retained
around the teeth in a 15-year schoolgirl wearing a tooth-supported acrylic partial denture.
- - - - - 1.0 Figure 3. The denture must
contact the abutment tooth
- - 1.0 0.9 0.9 0.9 at the survey line – if it ends
below the survey line a gap
occurs between the denture
and the tooth leading to
denture movement and
food accumulation 10.

Table 2: Selection of Wrought wire diameter (in mm) for Premolar Clasps for
different clinical situations
0.25mm undercut 0.50mm undercut
Clinical situation Gold C/C S/S Gold C/C S/S Potential disadvantages of
Tooth supported bases Acrylic Partial Dentures
Good periodontal support 0.9 0.9 0.9 - - 0.8
Acrylic due to its nature is a porous material and thus has an
Compromised periodontal - 0.8 0.8 - - -
increased area for plaque accumulation. Upper APD’s appear to
support
have a better prognosis mainly due to the larger surface area that
Distal extension bases
Good periodontal support - - 1.0 0.9 0.9 0.9 is covered. It was also found that maxillary APD’s can function
over prolonged periods of time if a thorough, routine oral hygiene
Compromised periodontal 0.9 0.9 0.9 - - 0.8 regimen is followed.2 If a proper oral hygiene and rigorous recall
support
regimen is not followed, the potential for damage to the tissues
effective materials to enable the socio-economically disadvantaged increase (Figure 2)
to have access to lasting, non-iatrogenic prostheses. Some of the Poor laboratory technique and/or poor communication between
design principles of the APD are adapted from the Every Denture8. the dentist and the technician has also been reported as another
Every designed an upper mucosa-borne denture for bounded problem in the construction of APD’s.1 Technicians should block
saddles and with specific features such as gingival margin relief out unwanted undercuts and interdental spaces on the master
and clasps distally to provide horizontal stability (Figure 1). This model, pour a duplicate cast and process the denture on the
design however, cannot be applied to all acrylic partial denture duplicate cast. Failure to block out these unwanted undercuts
patients as it requires bounded saddles and patients do not usually lead to problems in seating the denture with the dentist
necessarily present with these criteria. APD’s are designed using adjusting the acrylic and inevitably grinding away too much
some of the features of the Every denture as well as additional of the acrylic and thus compromising the acceptability of the
features to accommodate the needs of the patient who is missing denture. This has been illustrated by Davenport et al (Figure 3)10.
more teeth than what the Every denture allows for. Clinically this can be seen as a space between the denture and
For support and retention similar principles as in metal- the abutment teeth with subsequent trauma to gingival tissues
based partial dentures, are advocated but with the use of cost- (Figures 4 and 5).
effective materials.3 Goolam, as part of her Masters’ research Lower APDs present an additional problem: the surface area is
project, investigated the appropriate use and flexibility of metal
much smaller compared to an upper denture and there can be
components (used as active clasp components) and made
no relief of gingival margins. The acrylic major connector has to
recommendations as to the required diameters of these wire
cover all the abutment surfaces to provide additional strength
components to provide adequate retention in the acrylic partial
denture. (Table 1 and 2).9 to the acrylic. Support must be gained from the remaining teeth
otherwise the denture will tend to “sink” into the tissues with a
a b c resultant stripping of the gingivae
from the abutment teeth.11
Lower APD’s tend to break more
often and have the potential of
causing more damage to the
periodontal tissues if optimum
design principles and clinical and
Figure 1: Every Denture (a) Wire stops on distal surface of most distally placed natural teeth – help prevent anterior movement of denture
laboratory procedures are not
base as well as distal movement of natural teeth; (b) and (c) gingival relief areas - minimum clearance of 3mm is regarded as satisfactory. 8
adhered to (Figure 6).

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Figure 4: Too much relief of the acrylic with
resultant gaps between the abutment teeth and
the denture – creating a possible food trap.
a greater responsibility for the
b this treatment is responsible for
Figure 5: (a) Inappropriate fit of denture around surveyor in the dental surgery /
abutment teeth. (b) Inflammation of gingival
marginal tissues of abutment teeth.
Figure 6: Lower acrylic partial denture, with
poor tooth support and spaces between
the major connector and lingual surfaces of when designing an APD.
Principles in Acrylic a b
Partial Denture design
and construction
It is the joint responsibility of
the dentist and the technician to
construct a prosthesis that will
be a success both biologically Figure 7: Design sheets upper and lower arches:
and mechanically. The dentist, a. indicating the survey line. b. indicating gingival margin.
however, due to the nature of
a b
his /her training must assume
patient’s welfare.12 The dentist
as the leader of the dental
team treating the partially
dentate patient must take
responsibility for the design of
partial dentures, appropriate to Figure 8: (a) Design sheet of a mucosa-supported acrylic partial denture. (b) Acrylic Partial
Denture – with no rests and no clasps.
the needs of each patient.12,13
The patient as the third party in a b
the proper maintenance of the
prosthesis and should exercise
good plaque control.
Surveying the diagnostic cast
is essential for effective diagno-
Figure 9: (a) Intraoral view of a mucosa-supported acrylic partial denture. (b) Gingival margin
sis and treatment planning and inflammation of 14 and 24 - denture removed.
therefore the use of a dental
Figure 10: (a) Fitting
a b
surface of upper
clinic is mandatory. These casts acrylic partial den-
ture with ½ round
should be articulated to assist stainless steel pre-
with the designing of the den- molar rest;
(b) Intraoral view
tures. Design sheets with the of denture in situ
appropriate design for the APD with mesial pre-
molar rest
must accompany the study casts
to the laboratory (Figure 7).
surface of the tooth that has been prepared such that the forces
The same principles as for the
exerted by the denture will be directed along the long axis of
design of the metal-based
the abutment. Rests in the APD can either be metal (half-round
partial denture are applied
stainless steel) (Figure 10), or acrylic rests – the latter can only be
13

abutment teeth. These include: used on anterior teeth (Figure 11).

• the edentulous areas / saddles
• support
• retention
• reciprocation
• connector
• horizontal stability
Every removable partial prosthesis should be tooth supported
(Kennedy Class III and IV) or tooth-and-mucosa supported
(Kennedy Class I and II), but never only mucosa–supported
(Figure 8). For these mucosa-supported prostheses, the term
“gum stripper”12 was coined as it tends to “strip the gingiva from
the tooth” and is commonly associated with an inflammatory
response of the marginal gingiva (Figure 9). Teeth that are
preferred for support are the multirooted (molars and premolars)
and the long-rooted teeth (canines). Support is obtained from an
extension of the denture (=rest) that will engage the abutment
Retention is gained from the abutment teeth and can be passive
(depending on a long and single path of insertion) or active
(wrought clasps engaging undercuts on abutment teeth). For any
prosthesis to be retentive it requires a single long path of insertion
and this is usually determined by the edentulous saddles and the
degree of parallel surfaces that can be obtained on the abutment
surfaces. Guiding planes are 2 or more parallel surfaces prepared
on the abutment teeth which can be used to limit the path of
insertion and improve the stability of a removable prosthesis.
Guiding planes must have a minimum length of 3 mm to provide
adequate passive retention14 (Figure 12). Guiding planes should
be kept as far from the gingiva as possible.15
Active retention makes use of wrought wire components
(stainless steel or gold clasps) that engage the desired undercuts
on the abutment teeth (Figure 13). These desired undercuts have
to be determined with the aid of a dental surveyor and should
be 0,25mm or 0.5 mm depending on whether the abutment is

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a b a b

Figure 11: (a) Intra-oral view of an upper acrylic partial denture with an acrylic cingulum rest
on 23. (b) Extra-oral view of acrylic partial denture.
Figure 15: (a) Design sheet and (b) Lower
Acrylic Partial denture with ring clasp engaging
mesiolingual undercut on 47 (and C-clasps on
44 and 35).

commonly used when aesthetics will be compromised by the use

Figure 12: Guiding planes (3 mm) on distal
and mesial surfaces of the abutment teeth.15 of a grey stainless steel clasp. Different types of clasps can also be
used namely:
a b
• C-clasp
• Ball clasp
• Ring clasp
• Gingivally approaching clasp
The C-clasp is used most commonly on premolars and molars
and engaging mesio-buccal or disto-buccal undercut (Figure 14).
Figure 13: (a) Design sheet of and (b) Class IV acrylic partial denture with canine cingulum The Ball clasp is used to engage interproximal undercut that exists
rests and wrought wire (SS) clasps engaging mesio-buccal undercut on 16 and 26. Gingival in the embrasure between two teeth. This clasp is useful on teeth
relief areas around 14, 15 and 24, 25.
with short clinical crowns or when mesial or distal undercuts are
a premolar or molar. This retentive clasp should only become
not available (Figure 14). The disadvantage of this type of clasp is
active when a force wants to remove the denture and the clasp is
that reciprocation must be provided on both abutment teeth as
required to keep the denture in situ. The denture should contact
the opposing surface of the tooth (reciprocation) at the height of both provide retention. Relieving the gingival margins become dif-
the survey line to prevent the active retainers from exerting an ficult as both teeth have to be reciprocated by the acrylic base. The
unwanted force on the tooth and thus become an orthodontic Ring clasp is indicated for lone-standing, tilted or rotated abutment
appliance. Reciprocation in the APD is provided by the acrylic teeth – this clasp is self-reciprocating and the acrylic major connec-
major connector. a b
The gingival margins should be relieved (left uncovered)
wherever possible to assist in the maintenance of a high level of
oral health. This is in line with a review done by Öwall et al16 in
which they reported that partial dentures should include open
/ hygienic principles in the designs so as to minimize damage
to the soft tissues and optimize plaque control. The completed
design must be assessed for horizontal stability, strength of the
connector as well as biological acceptability.
Retentive Wrought Wire Components
Wrought wire (metal) components used for retention (clasps) Figure 16: Class I Acrylic lower partial denture (a) and Design sheet (b) with wrought wire
can be either stainless steel or gold – the latter is more costly and gingivally approaching clasp engaging undercut on 45.

a b c tor does not have to be extended on to the

lingual surface of the tooth to provide re-
ciprocation (Figure 15). Due to its increased
length the ring clasp is more flexible and
if proper care is not taken can fracture off
more easily from the major connector. The
gingivally approaching clasp poses a similar
problem due to its length and increased
flexibility (Figure 16). Gingivally approach-
ing clasps are useful when aesthetics is
a consideration. However, they are more
Figure 14: Design sheets and a Class IV Acrylic upper partial denture: (a) Wrought wire C-clasp engaging mesio-buccal undercut
on16; (b) Acrylic Partial Denture with C-clasp in 1st quadrant and Ball clasp in 2nd quadrant; (c) Design sheet of same APD
damaging to gingival health than occlusally
with Ball Clasp engaging interproximal undercut between 24 and 25. approaching clasps.

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CONCLUSION
Taking into consideration the financial constraints faced by so
many potential partial denture patients in South Africa, upper APDs
can be considered as a permanent prosthesis, provided that:
(i) the principles of support and retention in the design of the
denture are adhered to
(ii) patient selection and education (especially the importance of
post insertion visits) is given special attention by the dentist
(iii) the patient adhere to a thorough oral hygiene program
(iv) the laboratory construction of the acrylic partial denture
is optimal with the routine blocking out of undercuts and
pouring of duplicate models
(v) the dentist takes responsibility for the careful designing
of the prosthesis that will succeed both biologically and
mechanically.
Lower APDs, due to the small surface area and the bulk of material
required to improve the strength of the prosthesis, and should
mainly be constructed as an interim prosthesis.
Declaration: No conflict of interest was declared
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