BIOMECHANICS OF ESTHETIC REMOVABLE PARTIAL DENTURE

INTRODUCTION Esthetic dentistry is most often associated with anterior restorative dental care. Esthetic dentistry describes the efforts made to restore teeth or prostheses with-out drawing attention to those changes.Esthetic dentistry also may enhance ones appearance by improving contours of teeth and gingival architecture or by providing a brighter and more noticeable look. Removable partial dentures are one aspect of esthetic restorative dental care that often is neglected. The term esthetic zone is used here to describe the teeth and gingiva as they are observed when a patient emits a hearty laugh this laugh should be described and drawn in the treatment plan, or displayed in a photograph. This practice will allow dentists to avoid including unwanted display of clasps and other metal components in the treatment plan.According to Preston, the esthetic zone is wherever the patient thinks it is,even though the patient may not display metal while laughing, he or she still may believe that it can be observed. AESTHETIC CLASPS One major challenge with removable partial denture is esthetics since it requires clasps for direct retention. Clasps require at least 180 encirclement of the tooth to act as an active retainer. This means that the clasp arm may be displayed on the buccal surface of the tooth and be visible in the smile. There is an ongoing struggle to provide direct retention in the anterior area without the display of any clasp arm.

There are a number of alternative clasp designs,some of them are MGR clasp Round-Rest distal clasp Back action clasp Equipose clasp Hidden clasp Palatal I Bar RLS system

MGR Clasp Mesial groove reciprocation clasp(MGR clasp),an esthetic extracoronal retainer which incorporates a prepared mesial groove as reciprocation component thereby permitting an esthetically functional requirements. Retention is attained with a 19-gauge wrought wire I-bar clasp arm, the end of which engages the prepared dimple on the distolabial surface. acceptable clasp arm and satisfying

Reciprocation for the retentive clasp arm is provided by the distal proximal plate and the mesiolingual rod-like minor connector both of which are parallel to the path of placement. Simultaneous,continuous tooth contact is maintained as the prosthesis is either seated or removed and as the clasp arm flexes over the height of contour, in much the same manner as the

reciprocation provided by a lingual plate.

FUNCTIONAL DYANAMICS Resistance to occlusogingival movement of the MGR clasp is provided by the occlusal rest and the denture base. Mesiogingival relief in the retentive dimple and the infrabulge contour gingival to the tooth contact of the distal proximal plate permit a non binding rotation of the denture base about the fulcrum of the mesial rest.Functional rotation in a maxillary distal-extension prosthesis can occur, but it is usually minimal because of the additional support provided by the palatal major connector. Resistance to gingivo-occlusal displacement of the MGR clasp is provided by the retentive clasp arm and the parallel mesiolingual minor connector and distal proximal plate. With the retentive clasp tip becoming the fulcrum of rotation in this instance. Indirect retention is provided by the mesial rest (anterior to the fulcrum), supplemented by a cingulum rest in a prepared rest seat on the maxillary left central incisor. The stability afforded the prosthesis by the bilaterally parallel mesial grooves and distal guiding plates helps resist rotational displacement of the denture base and permits the use of wrought wire clasp arms for direct retention. A wrought wire I-bar permits placing the retentive tip deeper into an undercut,more gingival positioning for better esthetics, and easy adjustment if any distortion occurs. ROUND-REST DISTAL DEPRESSION CLASP A round-rest, distal depression clasp (RRDD) is presented as an esthetic alternative to a conventional clasp for maxillary anterior teeth serving as abutments for a removable partial denture. The RRDD clasp design was developed specifically for maxillary incisors or canine abutments for RPDs when esthetic

demands are high, conventional and polymer clasps are unacceptable, and the patient lacks the financial capabilities for an intra or extracoronal clasp retained RPD. If the edentulous residual ridge is distal to a maxillary incisor or canine, the RRDD clasp consists of a round rest seat located near the cingulum, a mesiolingual reciprocating plate, and a split minor connector engaging a distal depression for retention FUNCTIONAL DYANAMICS Support is provided by lingual round rest and distal depression is placed for retention.Mesial reciprocating plane and distal guide plane are prepared.Denture tooth is placed against distal proximal contact area. The RRDD clasp is not recommended for abutment teeth with excessive mobility, or in situations in which the cingulum of the abutment tooth has significant centric or eccentric occlusal contact.The RRDDclasp does not achieve 180-degree encirclement of the abutment; therefore, it is not recommended as the terminal abutment for a distal extension RPD. The RRDD is an alternative to the rotational path design, with the advantage of adjustable retention if needed. The RRDD clasp is not recommended for abutment teeth with excessive mobility, or in situations in which the cingulum of the abutment tooth has significant centric or eccentric occlusal contact. The RRDDclasp does not achieve 180-degree encirclement of the abutment therefore, it is not recommended as the terminal abutment for a distal extension RPD. BACK ACTION CLASP Owen reported its use on upper premolars.The clasp arm bends backwards at the buccal bulge of the tooth to reach the distal undercut, increasing its length and making it less obvious. Research compared load distribution on the abutment in

distal extension RPDs. Of all clasp designs studied, the back-action clasps with mesial rests were reported to have excellent results with regards to mechanical behavior. The framework with the back-action clasp showed the greatest early load resistance dislodgment, and retention. EQUIPOSE CLASP Goodman developed and described the equipoise system,the action of which is based on the principles of the back-action clasp.The equipoise clasp was developed claiming to address all the requirements of a successful clasp as well as aesthetics and favorable load distribution to the abutment.Clasp tips are placed in preparations in the enamel of the proximal surfaces of the abutment teeth. Equipose is the only Rpd system based on sound physics and engineering principles Class II lever forces Balance of force principles Intra arch configuration. COMPONENETS The counterpoise c rest. L-spring. The counterpoise c rest. The Counterpoise C-rest stabilizer is made up of a male and female component. These attachments are 10% iridium platinum and dovetail in design. The male is 0.0015 of an inch smaller in size to allow for stress relief.The Equipoise C-rest is

an intracoronal prefabricated attachment. The intracoronal design assures that a class II lever is maintained. Note: extracoronal attachments form class I levers which create excessive horizontal torque forces. L-spring The L-Spring (precision retentive device) is a stainless steel housing that contains an internal stainless steel leaf spring with contact ball for retention. The L-Spring provides a pre-measured resistance to deflection. A Load of 2.5 oz. is required to deflect the L-Spring ball 0.001 inch. This is at least 4-7 times less pressure than required by class retentive devices. The action of the counterpoise interlock and the L-Spring provides for ease of insertion and removal of the partial restoration The Equipoise Balance of Force Principle The Equipoise principle of partial denture design protects, preserves and strengthens abutment teeth while directing all masticatory forces down the long axis of the abutment tooth.This is accomplished through the use of the Equipoise Class II lever design. The Class II lever design has the rest (fulcrum) opposite of the retentive tip of the clasp (resistance arm) and the denture base (the effort arm) The clasp arm always moves in the same direction as the denture base while directing all forces down the long axis of the retaining abutment tooth. With the Class II lever design you always obtain stability during mastication and retention only when needed against dislodging forces.

The prepared rest becomes the fulcrum, the denture base the effort arm and the free end tip of the clasp become resistance arm- During the mastication, the free-end tip,moving in the same direction as the denture base, disengages the undercut on the abutment tooth. The only force transmitted to the abutment tooth is vertical along the long axis of the tooth. This force is transferred to the abutment tooth via the prepared rest. With a displacement force, the free-end tip and denture base move in the same direction.The free-end tip now engages the undercut and positive retention is assured. HIDDEN CLASP These clasps have been advocated for the Kennedy Class IV situations. The design achieves its aesthetic qualities by engaging the proximal under-cuts often naturally present on teeth. Disadvantages would include that of 1. complex designs, 2. permanent defo-mation after repeated flexure, 3. abutment displacement as no reciprocation is provided, 4. rotation of the clasp if a restricted path of placement is not used with resultant loss of retention, 5. variable retention and, 6. difficulty in cleaning. PALATAL I BAR According to research by Highton et al on the retentive capabilities of labially and palatally placed I-bars, the latter achieves better retentive and aesthetic

results than the former.It is usually shorter due to spatial confines and as a result is more rigid, offering more resistance to displacement. RLS-SYSTEM This is the acronym for mesio-occlusal rest, distolingual bar and distobuccal stabilizer. It has been advocated for distal extension RPDs when the RPI system cannot be used due to lack of a buccal undercut, or when aesthetics would be severely compromised. The authors claim success in fulfilling the aesthetic requirements of a large number of patients over the past few years, but fail to follow-up with scientific evidence.