A removable partial denture using an

esthetically designed round-rest distal

clasp on maxillary anterior abutment
teeth: A clinical report
Chi Tran, DDS,a Eugene LaBarre, DMD, MS,b and Howard M.
Landesman, DDS, MEdc
The Arthur A. Dugoni School of Dentistry, University of the
Pacific, San Francisco, Calif
A round-rest, distal depression clasp is suggested as an esthetic alternative to a conventional clasp for maxillary
anterior teeth serving as abutments for a removable partial denture. A lingual round rest provides support for the
prosthesis, and a mesiolingual reciprocating plate is present. A split minor connector engages a distal depression
for retention. The facial surface of the abutment displays no metal and provides an esthetic result. (J Prosthet Dent
2009;102:286-289)
Circumferential clasps on maxillary
anterior teeth may not be esthetically
acceptable to patients who require
removable partial dentures1 (RPDs).
Extracoronal and intracoronal precision attachments can be esthetic, but
are of greater expense and are more
difficult to fabricate and maintain.2 A
mesial rest, proximal plate, and I bar
(RPI) clasp,3,4 and mesial rest, proximal plate, and Akers (RPA) clasp5 can
be used for maxillary anterior teeth,
but may present unacceptable esthetics for patients with high lip lines or
high smile lines. A modification to
the RPA clasp has been described6
using a cast gold clasp engaging an
undercut at the distofacial line angle
of the maxillary canine and soldered
to the partial denture framework, but
fabrication of this clasp assembly is
expensive and complex. A wrought
wire clasp engaging a proximal undercut and soldered to the partial
denture framework is an esthetic alternative.7 Plunger attachments engaging a distal depression have been
used8; however, there may not be adequate space to place denture teeth.
Rotational path designs for partial
dentures9,10 can achieve excellent esthetic results for anterior teeth abut-

ments, but they are difficult to adjust

and are seldom used for distal extension RPDs.11 Tooth-colored polymer
clasps, featuring acetyl and thermoplastic resins, are used because of
ease of fabrication and esthetics, but
are not readily adjustable and have
not demonstrated durability. Lingual
retention and the elimination of the
visible facial clasp arm have been proposed for premolars12,13; however, canines may require the fabrication of a
crown with milled surfaces providing
a deep rest and mesial lingual reten-

tive area.14 A maxillary canine retainer

with mesial groove reciprocation, mesiolingual rest, and distofacial depression retention has been described,15
but it may not be applicable to maxillary incisors.
A round-rest, distal depression
clasp (RRDD) (Fig. 1) 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

1 RRDD clasp: support is provided by lingual round rest. Mesial reciprocating plane and distal guide plane are prepared as
shown. Distal depression is placed for retention. Denture tooth
is placed against distal proximal contact.

Assistant Clinical Professor, Department of Restorative Dentistry.

Associate Professor and Chair, Department of Prosthodontics.
c
Clinical Professor, Department of Prosthodontics.
a

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November 2009

2 As framework is seated or removed, split minor connector flexes.

When RPD is completely seated, split minor connector should be passive.
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 (Fig. 2). If the
edentulous ridge is mesial to a maxillary incisor or canine, this clasp design is no longer called an RRDD; it
becomes a round-rest mesial depression (RRMD). The RRDD and RRMD
are alternatives to a rotational path
design.
The purpose of this clinical report
is to describe a method of eliminating
the display of metal on the labial surface of maxillary anterior teeth used
as abutments for an RPD by using a
round-rest, distal depression clasp.

CLINICAL REPORT
A patient with a missing maxillary left canine due to root fracture
presented to the Arthur A. Dugoni
School of Dentistry, University of
the Pacific Dental Clinic (Fig. 3). The
premolars and first molar had been
previously lost, and the patient did
not want implant-supported restorations. Financial considerations were
a major concern. The patient also did

Tran et al

not want to display any metal clasp

on the anterior teeth. Three options
for an RPD were presented: a conventional RPD with infrabulge clasps, a
rotational path design, and an RRDD
design. The patient chose the RRDD
design for esthetic reasons and for
ease of placement.
The diagnostic casts were surveyed
and a maxillary RPD was designed
with a broad palatal strap as major
connector, occlusal rests and cast circumferential clasps on all molars, and
an RRDD clasp on the maxillary left
lateral incisor. A round cingulum rest
was prepared with a round bur (No.
4, 014, 1/10 mm; Brasseler USA, Savannah, Ga) to a depth of 0.75 mm.
The reciprocating plane on the mesiolingual surface of the incisor was
prepared with a thin parallel chamfer
tip carbide bur (H283.31.010: Brasseler USA) from the mesiolingual line
angle, and stopped just short of the
mesial proximal contact. The guiding
plane on the distolingual surface of
the tooth was prepared from the distolingual line angle to stop just short
of the distal proximal contact area. In
the middle of this surface, a distal depression, 0.5 mm deep, was prepared
with a No. 4 round bur (Brasseler
USA), 1 mm above the gingival margin, and 1 mm lingual to the proximal
contact (Fig. 1). A ball burnisher (TBall 34; Suter Dental Mfg Co, Chico,
Calif ) was placed in the round rest
seat and distal depression to verify
adequate preparation.

After completion of mouth preparations, an addition-reaction silicone

impression (Aquasil; Dentsply Intl,
York, Pa) was made. The definitive
cast was prepared and surveyed. The
minor connector and mesiolingual
plate of the RRDD were 3 mm wide
mesiodistally and 0.5 mm thick occlusogingivally, respectively, to provide
adequate rigidity. Distal to the minor
connector, a 1- to 1.5-mm-wide split
was placed in the casting. A smaller
minor connector, 2 mm wide tapering
to 1 mm, engaged the distal depression. This small minor connector had
a length of 10 mm from the major connector to the center of the depression
to allow adequate flexibility (Fig. 2).
The flexibility of the minor connector
engaging the distal depression can be
altered by increasing its length or by
thinning the dimensions of the arm.
A cast chrome (Vitallium; Dentsply
Austenal, York, Pa) RPD framework
was fabricated (Fig. 4). The framework was evaluated intraorally and
adjusted. The retentive values of this
clasping design were comparable to a
cast circumferential clasp or wrought
wire.16-18 After maxillomandibular jaw
relation records were completed,
denture teeth (Bioblend; Dentsply
Trubyte, York, Pa) were arranged and
evaluated intraorally. Prior to denture
base processing, a rubber separating medium (Rubber Sep; Kerr Corp,
Orange, Calif ) was used generously
on the minor connector flexible arm
so that it could flex without binding from the processed acrylic resin
denture base. The denture base was
processed and finished. A round bur
(No. 1; Brasseler USA), sandpaper, or
emery-coated discs (Moores discs;
E.C. Moore, Dearborn, Mich) were
used to remove excess acrylic resin to
prevent interference with the flexible
arm (Figs. 5 and 6). The denture was
inserted and the patient was recalled
twice each year for 7 years. The patient was pleased with the functional
and esthetic results (Fig. 7).

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Volume 102 Issue 5

3 Partially edentulous situation. Distal attachment may

leave minimal space for denture tooth.

4 Cast chrome RPD framework with conventional cast

circumferential clasps on molars and RRDD clasp on
lateral incisor.

5 Split minor connector engaging distal depression must

have slight clearance to flex without binding against denture base.

6 Distal depression and guide plane are lingual to proximal contact to avoid display of metal on facial surface.

7 RRDD clasp engaging maxillary left lateral incisor.

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November 2009
DISCUSSION

SUMMARY

The RRDD clasp assembly described is technically demanding.

The dentist must plan the design of
the RPD and perform detailed tooth
modifications with a clear understanding of the clasp function. The
dental laboratory technician also
must fabricate the framework with
care and precision, because any technical deviation may result in loss of
retention of the clasp assembly.
Postoperative radiographs may
demonstrate a slight radiolucent area
suggesting proximal caries, but the
radiographic shadow is created by
the proximal depression preparation.
Since this depression is adjacent to an
edentulous area, it can be observed
directly. 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 RRDD clasp
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 round-rest, distal depression

clasp is proposed as an esthetic clasp
assembly for maxillary incisors and
canines. The clasp uses a distal proximal depression for retention, and the
clasp arm is adjustable. The design
satisfies the criteria for esthetics, retention, support, and stability for a
maxillary RPD.

REFERENCES
1. Hansen CA, Iverson GW. An esthetic
removable partial denture retention for
the maxillary canine. J Prosthet Dent
1986;56:199-203.
2. Becerra G, MacEntee M. A classification
of precision attachments. J Prosthet Dent
1987;58:322-7.
3. Kratochvil FJ. Influence of occlusal rest
position and clasp design on movement of abutment teeth. J Prosthet Dent
1963;13:114-24.
4. Krol AJ. Clasp design for extension-base
removable partial dentures. J Prosthet Dent
1973;29:408-15.
5. Eliason CM. RPA clasp design for distalextension removable partial dentures. J
Prosthet Dent 1983;49:25-7.
6. McMillan AS, Hunter N. An esthetic
denture clasp for maxillary canine teeth. J
Prosthet Dent 1997;78:330.
7. Belles DM. The Twin-Flex clasp: an esthetic
alternative. J Prosthet Dent 1977;77:450-2.
8. Donovan TE, Derbabian K, Kaneko L,
Wright R. Esthetic considerations in removable prosthodontics. J Esthet Restor Dent
2001;13:241-53.
9. King GE. Dual-path design for removable partial dentures. J Prosthet Dent
1978;39:392-5.

10.Krol AJ, Jacobson TE, Finzen FC. Removable partial denture design: Outline syllabus. 5th ed. San Rafael: Indent; 1999. p.
73-91.
11.Donovan T. Use of the rotational path
removable partial denture concept in a
Kennedy Class II patient: a case report. J
Esthet Restor Dent 2008;20:294-8.
12.Pardo-Mindan S, Ruiz-Villandiego JC. A
flexible lingual clasp as an esthetic alternative: a clinical report. J Prosthet Dent
1993;69:245-6.
13.DeRossi A, Albuquerque RF Jr, Bezzon OL.
Esthetic options for the fabrication of removable partial dentures: a clinical report.
J Prosthet Dent 2001;86:465-7.
14.Brudvik JS, Palacios R. Lingual retention
and the elimination of the visible clasp arm.
J Esthet Restor Dent 2007;19:247-54.
15.McCartney JW. The MGR clasp: an esthetic
extracoronal retainer for maxillary canines.
J Prosthet Dent 1981;46:490-3.
16.Frank RP, Nicholls JI. A study of the flexibility of wrought wire clasps. J Prosthet Dent
1981;45:259-67.
17.Frank RP, Brudvik JS, Nicholls JI. A comparison of the flexibility of wrought wire
and cast circumferential clasps. J Prosthet
Dent 1983;49:471-6.
18.Ahmad I, Sherriff M, Waters NE. The effect
of reducing the number of clasps on removable partial denture retention. J Prosthet
Dent 1992;68:928-33.
Corresponding author:
Dr Chi Tran
The Arthur A. Dugoni School of Dentistry
University of the Pacific
2155 Webster St, Rm 522
San Francisco, CA 94115-2333
Fax: 415-929-6654
E-mail: ctran@pacific.edu
Copyright 2009 by the Editorial Council for
The Journal of Prosthetic Dentistry.

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