journal of prosthodontic research 58 (2014) 310

Available online at www.sciencedirect.com

ScienceDirect
journal homepage: www.elsevier.com/locate/jpor

Position Paper

Clinical application of removable partial dentures

using thermoplastic resinPart I: Definition and
indication of non-metal clasp dentures
Kenji Fueki DDS, PhDa,d,*, Chikahiro Ohkubo DMD, PhDb,c,e,
Masaru Yatabe DDS, PhDb,d,f, Ichiro Arakawa DDS, PhDb,c,g,
Masahiro Arita DDS, PhDb,c,h, Satoshi Ino DDS, PhDb,i,
Toshikazu Kanamori DDS, PhDb,j, Yasuhiko Kawai DDS, PhDb,c,k,
Misao Kawara DDS, PhDb,l, Osamu Komiyama DDS, PhDb,l,
Tetsuya Suzuki DDS, PhDb,c,m, Kazuhiro Nagata DDS, PhDb,n,
Maki Hosoki DDS, PhDb,o, Shin-ichi Masumi DDS, PhDb,h,
Mutsuo Yamauchi DDS, PhDb,p, Hideki Aita DDS, PhDa,q,
Takahiro Ono DDS, PhDa,r, Hisatomo Kondo DDS, PhDa,s,
Katsushi Tamaki DDS, PhDa,t, Yoshizo Matsuka DDS, PhDa,o,
Hiroaki Tsukasaki DDS, PhDa,u, Masanori Fujisawa DDS, PhDa,v,
Kazuyoshi Baba DDS, PhDa,u, Kiyoshi Koyano DDS, PhDa,w,
Hirofumi Yatani DDS, PhDx
a

Japan Prosthodontic Society, Clinical Guideline Committee (20112012), Japan

Japan Prosthodontic Society, Non-Metal Clasp Denture Expert Panel (20112012), Japan
c
Japan Prosthodontic Society, Removable Prosthodontics Expert Panel (20112012), Japan
d
Section of Removable Partial Prosthodontics, Tokyo Medical and Dental University, Japan
e
Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine, Japan
f
Tokyo Branch, Japan
g
Department of Partial and Complete Denture, School of Life Dentistry at Tokyo, The Nippon Dental University, Japan
h
Division of Occlusion & Maxillofacial Reconstruction, Department of Oral Function, School of Dentistry, Kyushu
Dental University, Japan
i
Kanagawa Dental University, Yokohama Clinic, Japan
j
Tohoku & Hokkaido Branch, Japan
k
Department of Removable Prosthodontics, Nihon University School of Dentistry at Matsudo, Japan
l
Department of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo, Japan
m
Section of Oral Prosthetic Engineering, Tokyo Medical and Dental University, Japan
n
Comprehensive Dental Care, The Nippon Dental University Niigata Hospital, Japan
o
Department of Fixed Prosthodontics, Institute of Health Biosciences, The University of Tokushima, Graduate School,
Japan
b

* Corresponding author at: Section of Removable Partial Prosthodontics, Department of Masticatory Function Rehabilitation, Graduate
School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8549 Tokyo, Japan.
Tel.: +81 3 5803 5514; fax: +81 3 5803 5514.
E-mail address: kunfu.rpro@tmd.ac.jp (K. Fueki).
1883-1958/$ see front matter # 2013 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
http://dx.doi.org/10.1016/j.jpor.2013.12.002

journal of prosthodontic research 58 (2014) 310

p
Department of Prosthodontics, Division of Oral Functional Science and Rehabilitation, School of Dentistry, Asahi
University, Japan
q
Division of Occlusion and Removable Prosthodontics, Health Sciences University of Hokkaido, Japan
r
Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of
Dentistry, Japan
s
Department of Prosthodontics and Oral Implantology, Iwate Medical University, Japan
t
Department of Oral & Maxillofacial Rehabilitation, Removable Prosthetics, Kanagawa Dental College, Japan
u
Department of Prosthodontics, Showa University, Japan
v
Division of Fixed Prosthodontics, School of Dentistry, Meikai University, Japan
w
Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation Faculty of Dental Science, Kyushu
University, Japan
x
Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Japan

article info

abstract

Article history:

This position paper proposes a definition and naming standard for removable partial

Received 11 November 2013

dentures (RPDs) using thermoplastic resin, and presents a guideline for clinical application.

Accepted 5 December 2013

A panel of 14 experts having broad experience with clinical application of RPDs using

Available online 22 January 2014

thermoplastic resin was selected from members of the Japan Prosthodontic Society. At a

Keywords:

with retentive elements (resin clasps) made of thermoplastic resin. The panel classified non-

meeting of the panel, non-metal clasp denture was referred as the generic name of RPDs
Removable partial denture

metal clasp dentures into two types: one with a flexible structure that lacks a metal

Thermoplastic resin

framework and the other having a rigid structure that includes a metal framework. Accord-

Non-metal clasp denture

ing to current prosthetic principles, flexible non-metal clasp dentures are not recommended

Resin clasp

as definitive dentures, except for limited cases such as patients with a metal allergy. Rigid

Metal allergy

non-metal clasp dentures are recommended in cases where patients will not accept metal
clasps for esthetic reasons. Non-metal clasp dentures should follow the same design
principles as conventional RPDs using metal clasps.
# 2013 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.

Contents
1.
2.
3.
4.

5.

6.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Preparation of position paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Term and definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Indications and contraindications for NMCDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1. Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2. Contraindications and cases in which use requires caution . . . . . . . . . . . . . . . . . . . .
4.2.1. Type of partially edentulous arch and occlusal relationship . . . . . . . . . . . . . .
4.2.2. Anatomical factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2.3. State of oral hygiene. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Advantages and disadvantages of NMCDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.1. Advantages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.1.1. Esthetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.1.2. Feel during use of NMCDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.1.3. Metal allergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.2. Disadvantages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.2.1. Discoloration and degradation of thermoplastic resin. . . . . . . . . . . . . . . . . . .
5.2.2. Difficulty of polishing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.2.3. Breakage of resin clasp, difficulty of adjusting retention capacity and repair.
5.2.4. Design of retentive parts and periodontal condition . . . . . . . . . . . . . . . . . . . .
5.2.5. Ineligibility for insurance coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

5
6
6
6
6
7
7
8
8
8
8
8
9
9
9
9
9
9
9
9
9
10
10

journal of prosthodontic research 58 (2014) 310

1.

Introduction

Table 1 Thermoplastic resins available for non-metal

clasp dentures in Japan (December 2012).
Generic name

Esthetics is a matter of great concern for patients receiving

dental treatment, especially prosthetic treatment. Therefore,
esthetic aspects must be considered to ensure patient
satisfaction with dental treatment. Patients find the sight of
the metal clasp of removable partial dentures (RPDs) in the
esthetic area undesirable for both esthetic and psychological
reasons; this is one explanation for patients disliking the use
of RPDs. Conventionally, attachments have been used in
patients who place emphasis on esthetics, but the need to
remove large quantities of tooth structure and the requirement for specialist skills means that at present, this is not a
generally viable choice. In the United States, since the 1950s,
polyamide resin (nylon) has been used to fabricate RPDs that
do not contain any metal elements. Since 2007, a number of
thermoplastic resins have also been approved for use as
denture bases in Japan (Table 1). The use of RPDs made either
from resin alone or a combination of resin and metal is now
rapidly gaining popularity among general dentists and is
considered to be superior to conventional metal-clasp
retained RPDs with metal clasps in terms of both esthetics
and comfort [1]. Changes in public awareness have led to
increasingly strong demands from patients with respect to
esthetic aspects when fitting prostheses, with an increasing
number of patients avoiding RPDs because they are associated
with growing old. The need for dentists to respond to this
demand from patients may be a cause of the increasing
popularity of such RPDs.
RPDs using thermoplastic resin have some limitations as
revealed by prosthodontists [2]. The first issue is that some
RPDs using thermoplastic resin do not conform to the
principles regarding the standard RPD design in Japan, and
that the use of such RPDs may seriously affect the periodontal
tissues of abutment teeth and the residual ridge. As this
procedure is simple and is not covered by national health
insurance, if patients demands and desires for a good esthetic
appearance are given precedence and such RPDs are used
outside the scope of their intended use, this would be a serious
disadvantage for patients. It has also been pointed out that
depending on the material, problems including fracture of the
resin clasp, roughening of the polished surface of the denture
base, or discoloration of denture base resin may occur, and
treatment such as reline or repair may be difficult. In practice,
various problems do occur after denture fitting in at least some
patients, and while the evidence from clinical trials is limited,
there is a possibility that the inappropriate use of RPDs using
thermoplastic resin may become a social issue. If this situation
is left unaddressed, it may decrease public trust in dental
treatment and dentistry. In light of these circumstances, the
Japan Prosthodontic Society (JPS) has cautioned against the
regular clinical use of RPDs using thermoplastic resin, stating
that Although so-called non-clasp dentures have the positive
advantage of being effective in restoring external appearance,
they have the disadvantage that if they are used in the wrong
patients they may cause major damage, including abnormal
resorption of the residual ridge and increase of movement of
the abutment teeth, and their indications should be scientifically verified in the future. In a clinical guideline formulated

Product name

Manufacturer

Polyamide

BIO PLAST
Valplast
Flex Star V
BIO TONE
Lucitone FRS
Ultimate

HIGH DENTAL JAPAN

UNIVAL
Nippon Dental supply
HIGH DENTAL JAPAN
DENTSPLY International
Ultimate

Polyester

EstheShot Bright
EstheShot

i-Cast
i-Cast

Polycarbonate

Reigning N
Reigning
JET CARBO-S
JET CARBO RESIN

Toushinyoukou
Toushinyoukou
HIGH DENTAL JAPAN
HIGH DENTAL JAPAN

Acrylic resin

ACRY TONE

HIGH DENTAL JAPAN

Polypropylene

UNIGUM

WELDENZ

in 2008, JPS stated that Application of flexible dentures solely

from the viewpoint of anterior esthetics is not recommended.
The second problem identified by prosthodontists is that
there is no set definition or name for RPDs using thermoplastic
resin, which are commonly known as flexible dentures, nonclasp dentures, clasp-free dentures, and metal-free dentures.
Recently, non-clasp dentures has become the generally
used term, but according to the definition in the US GPT-8
Glossary of Prosthodontic Terms [3], the resin part that
extends from the denture base to include the abutment teeth
and which is responsible for retention is a structural element
that should be called a clasp, and the term non-clasp is
therefore inappropriate.
In light of this situation, the Clinical Guideline Committee
responded to a request from the Social Insurance and Dental
Service Problem Committee and considered correcting the
guideline. They first searched the literature in PubMed and
Igaku Chuo Zasshi (ICHUSHI, Japan Medical Abstracts Society)
to collect the latest clinical evidence, and found that there
were a limited number of studies: as of August 2011, only one
original paper had been published based on clinical research
on RPDs using thermoplastic resin [4]. Then, a questionnaire
was sent to a panel of prosthodontists on how to formulate a
guideline (dentures to be covered, types of defect, design,
whether or not to limit them to thermoplastic resin materials).
The results revealed that most prosthodontists wanted to
formulate a guideline on the different types of thermoplastic
resin currently in use, cases in which their use is indicated,
and denture design. Given the lack of evidence, however, it
was considered that it would be difficult to formulate a
guideline for such a wide diversity of patients using standard
methods. The decision was therefore made to select an expert
panel from among JPS members who had clinical experience
with RPDs using thermoplastic resin in order to form a
consensus based on clinical experience, and to publish the
results as a position paper. The objectives of this position
paper were (1) to propose an official term and definition for
RPDs using thermoplastic resin, and (2) to provide guidelines
for prosthodontists and general dentists on points to note with
respect to the indications and contraindications, design, and
clinical use of such dentures.

journal of prosthodontic research 58 (2014) 310

Fig. 2 A non-metal clasp denture with metal rests.

Fig. 1 A non-metal clasp denture without metal elements.

2.

Preparation of position paper

The 21 members selected to serve on the expert panel for 2011

2012 were requested to complete a questionnaire, and five
members who had clinical experience with RPDs using
thermoplastic resin in several patients were included in our
expert panel. Information was then gathered from JPS
members who had at least 5 years clinical experience with
RPDs using thermoplastic resin, and an additional nine
members were selected to join the expert panel. Thus, a total
of 14 members prepared the initial draft of this position paper.
At a panel meeting in August 2012, members discussed the
official term and definition for RPDs using thermoplastic resin
and the structure of the position paper, and reached a
consensus. All the members of the expert panel were
responsible for writing different sections of the draft position
paper, and the content was corrected through Internet
discussion among the panel as a whole until a consensus
was obtained. The final document was completed after review
by the clinical guideline committee. The PubMed and ICHUSHI
online databases were used to search the literature, as well as
manual search. The selection of literature was not carried out
systematically.

3.

Term and definition

In 1956, the US company Valplast developed super-polyamide,

a type of nylon, as a material for use in dentures. Dentures for
which all the structural elements other than the artificial teeth
are manufactured from this thermoplastic resin without the
use of metal have been mostly known by the company name,
Valplast, but are also called flexible dentures or nylon
dentures, and have become widely used worldwide (Fig. 1)
[5,6]. In Japan, these dentures were individually imported and
used on a trial basis before they were approved by the Ministry
of Health, Labour and Welfare, and it became common to call
them by names such as non-clasp dentures or metal-free
dentures. Since their approval under the pharmaceutical
affairs law in April 2008, numerous thermoplastic resins have
been developed, and these have mistakenly been known by
the names of their manufacturer, supplier, or laboratories;
however, in general, the name non-clasp dentures has
taken root among general clinicians.

According to the GPT-8 [3], a clasp is defined as the

component of the clasp assembly that engages a portion of the
tooth surface and either enters an undercut for retention or
remains entirely above the height of contour to act as a
reciprocating element. Generally it is used to stabilize and
retain a removable dental prosthesis. According to this
definition, a clasp is not described as being made of metal.
The resin retentive elements known as arms, fingers, and
wings may thus be regarded as genuine clasps according to
this definition, as they use undercuts to retain and stabilize
RPDs, and they are also known as resin clasps or esthetic
clasps [7,8].
This interpretation therefore indicates that the term nonclasp dentures refers only to those that do not incorporate
clasps in any form, such as attachment dentures, milling
dentures, or telescope dentures. Thus, in this position paper,
the term non-metal clasp dentures (NMCDs) is used to refer
not only to dentures that do not contain any metal elements,
but also to dentures that incorporate a metal rest or framework (Figs. 2 and 3), and is defined as the general name for
RPDs using denture base resins as the denture retentive
parts. This definition thus includes not only those dentures in
which the retentive parts and the denture base are produced
as a single whole, but also those dentures in which a resin used
for the retentive parts is different from that for denture base
(Fig. 4). In this position paper, the resin retentive part of
NMCDs is referred to as the resin clasp.

4.
Indications and contraindications for
NMCDs
4.1.

Indications

In this position paper, NMCDs have been categorized into two

types; NMCDs with/without overall rigidity according to
whether or not they include a metal structure and the elastic
modulus of the denture base resin (Table 2) and indications are
suggested in each type of NMCD. NMCDs that do not include a
metal structure and are not rigid are indicated as interim
dentures or spare dentures for patients with metal allergy,
patients with few missing anterior teeth, and patients with
few missing teeth with occlusal support, and as epitheses for
patients in whom the dentures carry no functional burden,
patients for whom esthetics must be given top priority, and

journal of prosthodontic research 58 (2014) 310

Fig. 3 A non-metal clasp denture with a framework (Reigning NW). (a) Basal surface of the denture; (b) metal rest and resin
clasp.

Fig. 4 A non-metal clasp denture using different denture base resins for retentive elements and a denture base. (a) Resin
clasp on working cast; (b) delivered denture.

Fig. 5 A non-metal clasp denture without metal framework replacing missing maxillary bilateral frontal teeth (ValplastW).
(a) Labial view on working cast; (b) palatal view on working cast.

patients who do not consent to the preparation of abutment

teeth (Fig. 5). NMCDs that include a metal structure and are
rigid are basically indicated in a wide range of cases (Figs. 24).

4.2.
Contraindications and cases in which use requires
caution
Contraindications for NMCDs depend on the type of partially
edentulous arch and occlusal relationship, anatomical factors
that affect the design and fabrication of RPDs, or a state of oral
hygiene that may affect the maintenance and management of
RPD treatment.

4.2.1. Type of partially edentulous arch and occlusal

relationship
NMCDs may be designed with a metal rest or framework to
control displacement of the dentures while in use, and designs
that incorporate metal may be used with almost all types of
partially edentulous arches. Their use is difficult, however, in
patients with non-vertical stop occlusion or those with few
remaining teeth, in whom good treatment results cannot be
expected even with the use of metal clasp-retained RPDs. For
patients with non-vertical stop occlusion in particular,
rotation and sinking of the denture base, changes in occlusal
position, and resorption of the residual ridge tend to occur,

journal of prosthodontic research 58 (2014) 310

Table 2 Rigidity of non-metal clasp dentures using thermoplastic resins.

Elastic modulusa

Generic name

Product name

Polyamide

Valplast
Lucitone FRS
Ultimate

Low
Low
Low

Rigidb
Rigidb
Rigidb

Polyester

EstheShot Bright
EstheShot

Low
High

Rigidb
Rigid

Polycarbonate

Reigning
Reigning N

High
High

Rigid
Rigid

a
b

Denture rigidity

Low < 2000 MPa; high  2000 MPa.

With metal framework.

resulting in the concentration of excessive force in the resin

clasp. As there is a high risk that resin clasps may quickly
become deformed or break, they are contraindicated.
The stress on the resin clasp may also be high in patients
with few remaining teeth. Although it depends on the location
of the remaining teeth and the condition of the opposing
dentition, particular caution is required if molar occlusal
support has been entirely lost, the occlusal position is
unstable, or poor support is provided by the mucosa of
residual ridge at the edentulous area due to severe residual
ridge resorption or abnormal mucosa under the denture base.

4.2.2.

Anatomical factors

As the upper margin of the resin clasp of NMCDs is designed to

be positioned on the tooth surface and the lower margin on the
gingiva, its external shape is affected not only by the crown
morphology of the abutment tooth but also by the morphology
of the alveolar part. In patients with a clinically short crown
length, in whom the distance between the survey line on the
abutment tooth and the oral vestibule is inadequate, and with
an excessive undercut in the alveolar part, it may be difficult to
design a resin clasp of appropriate shape and width. The resin
clasp may lack sufficient retention capacity and strength, and
caution is therefore required. In most NMCDs, the thermoplastic denture base resins cannot be chemically bound to the
artificial teeth, meaning that holes must be made to hold the
artificial teeth and they must be mechanically fixed. In
patients with a small amount of clearance with opposing
teeth at the missing area, the artificial teeth may be lost,
cracked, or fractured, and caution is therefore required.

4.2.3.

State of oral hygiene

Metal clasps are designed in such a way that they do not to

come into contact with the gingival margin, but the resin
clasp of NMCDs covers the tooth structure of the cervical
region of abutment teeth, the marginal gingiva, and the
labial-buccal mucosa. As a wide area around the abutment
teeth becomes unhygienic, this may cause or exacerbate
caries and periodontal disease. The need for adequate dental
plaque control has been emphasized [9], and patients with
poor oral hygiene and those who do not respond regular
repeat appointments are not suitable candidates. As the
degradation of resin materials may also increase the
adherence of dental plaque, worsening the cleanliness of
dentures, regular oral maintenance is essential. In patients
who use a NMCD with no support from a metal rest, should
the dentures sink then the resin clasp compresses the

Fig. 6 Deterioration of thermoplastic resin used for nonmetal clasp denture. Polished surface of the maxillary
complete denture (left) was good, however surface of
denture base of a mandibular non-metal clasp denture
(EstheShotW) has become roughened after a year and
6-month use. Denture base of the posterior area was
repaired using a cold-cured resin (indicated with arrow).

marginal gingiva, potentially causing its mechanical damage.

It has been reported that NMCDs that contain no metal
structures at all tend to sink [9], suggesting that more careful
follow-up is required for patients with metal-free NMCDs.

5.

Advantages and disadvantages of NMCDs

5.1.

Advantages

5.1.1.

Esthetics

Denture wearers, both men and women, are highly concerned

about the esthetic appearance. Although dental implant
treatment is effective, many patients dislike the idea of
inserting a metal implant into the bone, or are afraid of
surgical treatment. The cost is also generally high. RPDs may
be proposed as an alternative, but both patients and dentists
may hesitate at the thought of a metal clasp visible from the
outside. The esthetic appearance of RPDs may be guaranteed
by the use of magnetic or precision attachment, milling
dentures, or telescope dentures, but if the abutment tooth is a
vital tooth, such retainers may be difficult to use, and dentists
may be at a loss how to deal with this. With NMCDs, it is
possible for the retentive parts to actively utilize a vital tooth,
increasing the opportunities for both patients and dentists to
choose RPDs.

journal of prosthodontic research 58 (2014) 310

Fig. 7 Deterioration of thermoplastic resin used for non-metal clasp dentures. (a) Loss of burnish on polished surface
(ValplastW); (b) discoloration and decolorization of thermoplastic resin (Lucitone FRSW).

5.1.2.

Feel during use of NMCDs

The resins currently in use have a lower elastic modulus

and a softer surface compared with acrylic resin [1013],
meaning that patients feel better when worn. There also
appears to be no problem with fit [14,15]. As there is a low
risk of breakage of dentures made solely of resin, which are
highly elastic and not at all rigid, the denture base can be
made thinner. This makes them lighter and thinner than
RPDs using an acrylic resin or metal framework to ensure
rigidity.

5.1.3.

Metal allergy

Dentures that contain no metal at all eliminate concerns about

metal allergy. Historically, the first NMCDs in the 1950s were
made of polyamide resin, which was developed to deal with
the allergic reaction to residual monomers after the polymerization of acrylic resin [16]. This advantage has also been
utilized subsequently for avoiding metal allergy [17].

5.2.

Disadvantages

5.2.1.

Discoloration and degradation of thermoplastic resin

rubbery form, and the heating effect of polishing may also be

detrimental.

5.2.3. Breakage of resin clasp, difficulty of adjusting retention

capacity and repair
No guidelines have been indicated for the design of resin
clasps of NMCDs. Therefore, the width, thickness, and length
are designed via trial and error. Design guidelines based on
differences in materials physical properties would therefore
be desirable [26]. Frequent breakage of the retentive elements
in the early years has led to improvement in their physical
properties. Clasp wires were buried in the retentive parts with
the aim of ensuring continued retention and preventing
breakage. If the material is one that adheres to self-curing
resin, then the retentive capacity may be recovered to some
extent, but if not then it is difficult to adjust. We will address
adhesion to self-curing resin in the context of repair and reline
of different materials in Part II. Materials to which self-curing
resin does not adhere must be repaired in a laboratory.

5.2.4.
Surface roughening after a few months of denture delivery
was identified in all but a few materials [18]. As the surface is
not as hard as that of acrylic resin, the depths and the widths
of marks were greater than the acrylic resins by the scratch
test [19], thus the polished surface loses its luster. Discoloration and loss of color are also seen [2022] (Figs. 6 and 7).
Candida growth is not a concern as long as denture
maintenance is possible, but if adequate cleaning cannot be
performed then more caution would be required than for
acrylic resin [23].

5.2.2.

Difficulty of polishing

Toothbrush friction experiments (measuring the decrease in

volume) on the denture base material used in NMCDs have
shown that it loses less than one fifth of the volume lost by
acrylic resin [24]. Nevertheless, although the surface is easily
damaged, as described above, these materials are regarded as
not susceptible to surface loss even when damaged. This
property means that compared with acrylic resin they may be
difficult to polish at the chairside [25], and a special polish is
required. When the glass transition point is exceeded in the
non-crystalline portion of a polymer material, it takes on a

Design of retentive parts and periodontal condition

In NMCDs, the resin clasp covers the cervical area of the

abutment teeth over a wide area on both the crown and root
sides, being designed to be part of the gingiva. This means that
the area covered by the resin clasp is large, and the undercut
and relief regions may easily become dead space, with the risk
of exacerbating periodontal conditions. Meticulous cleaning is
therefore essential.

5.2.5.

Ineligibility for insurance coverage

NMCDs using thermoplastic resin are not covered by national

health insurance in Japan. The cost of NMCDs consisting
entirely of resin is different from that of dentures that utilize a
metal framework for rigidity. Their ineligibility for insurance
coverage means that patients must pay a greater amount, but
as mentioned in the opening sentences of this paper, many
people prefer to use NMCDs, and this is based heavily on the
improved esthetics of RPDs.

6.

Recommendations

In this position paper, within the current restricted scope,

non-rigid NMCDs cannot be recommended as definitive

10

journal of prosthodontic research 58 (2014) 310

dentures in light of current prosthetic principles, with the

exception of patients with metal allergies and some others.
NMCDs that include a metal framework to provide rigidity
may be recommended in cases in which the patient is
uncomfortable with a metal clasp running through areas that
would affect esthetic appearance. Methods of reline and
maintenance should be understood with reference to the
properties of the different materials used.

Conflicts of interest
The preparation of this position paper was funded by JPS. JPS
does not receive support from any specific group or
corporation. No funding from any group or corporation
was used for the preparation of this position paper. The
members of the expert panel and clinical guideline committee involved in the preparation of this position paper did not
receive any support from any specific group or corporation
with respect to NMCDs. Members of the expert panel who
had contributed to the development of or lectured on a
specific resin were not involved in writing about the resin
concerned.

Acknowledgement
This paper is the secondary publication of the position paper
published in the Annals of Japan Prosthodontic Society [27].

references

[1] Suzuki T, Shimpo H, Kitano N, Sato M, Kawai Y, Kanki Y,

et al. A questionnaire survey on the thermoplastic
dentures. Ann Jpn Prosthodont Soc 2011;3:133 [special
issue; in Japanese].
[2] Ohkubo C, Yatabe M, Arita M. Present status and clinical
problems of non-metal clasp denturescan it become one
choice for prosthetic rehabilitation? Ann Jpn Prosthodont
Soc 2012;4:634 [special issue; in Japanese].
[3] Glossary of prosthodontic terms. 8th edition. J Prosthet
Dent 2005;94:185.
[4] Saito M, Oguma H. Questionnaires for patients satisfaction
with a super-polyamide denture in a clinic. J Esthet Dent
2009;22:604 [in Japanese].
[5] Lowe LG. Flexible denture flanges for patients exhibiting
undercut tuberosities and reduced width of the buccal
vestibule: a clinical report. J Prosthet Dent 2004;92:
12831.
[6] Meijer GJ, Wolgen PJ. Provisional flexible denture to assist in
undisturbed healing of the reconstructed maxilla. J Prosthet
Dent 2007;98:3278.
[7] Kaplan P. Flexible removable partial dentures: design and
clasp concepts. Dent Today 2008;27:1223.
[8] Singh JP, Dhiman RK, Bedi RP, Girish SH. Flexible denture
base material: a viable alternative to conventional acrylic
denture base material. Contemp Clin Dent 2011;2:3137.
[9] Hosoi T. Non-clasp denture. DE 2009;168:14 [in Japanese].

[10] Sano M, lto K, Nomura A, Kohno S. Properties of

thermoplastic polymers used for non-clasp dentures. J Jpn
Soc Dent Products 2009;23:2834 [in Japanese].
[11] Yokoyama N, Machi H, Hayashi K, Uchida T, Ono T, Nokubi
T. Physical properties of polyamide resin (nylon group) as a
polymeric material for dentures: Part 2. Surface hardness
and tensile strength. J Nippon Acad Dent Technol
2004;25:8792 [in Japanese].
[12] Kawara M, Suzuki H, Ishikawa S. Progress of EstheShot1 for
esthetic denture report of abrasion losses-. Ann Jpn
Prosthodont Soc 2011;3:E89 [in Japanese].
[13] Ucar Y, Akova T, Aysan I. Mechanical properties of
polyamide versus different PMMA denture base materials. J
Prosthodont 2012;21:1736.
[14] Hayashi K, Yokoyama N, Machi H, Uchida T, Ono T, Nokubi
T. Physical properties of polyamide resin (nylon group) as a
polymeric material for dentures: Part 1. Characteristics of
absorbent and dimensional change. Journal of Nippon
Academy of Dental Technology 2004;25:806 [in Japanese].
[15] Hishimoto M, Katou Y, Akita Y, Murakami Y, Iida S.
Physical properties of polyester copolymer for denture
materials. J Nippon Acad Dent Technol 2008;29:196 [special
issue; in Japanese].
[16] Stafford GD, Huggett R. The use of nylon as a denture-base
material. J Dent 1986;14:1822.
[17] Kuwahara K, Nagahama F, Kitahara K, Wada M, Makimura
S, Kimura K, et al. A case of using non-metalclasp partial
denture for the patient with metal allergy. Nichidai Koko
Kagaku 2004;30:1349 [in Japanese].
[18] Yatabe M. How to deal with non-clasp denture? Its
advantages and problems. Quintessence 2010;29:208390
[in Japanese].
[19] Kawara M, Iwata Y, Iwasaki M, Komoda Y, Iida T, Asano T,
et al. Scratch test of thermoplastic denture base resins for
non-metal clasp dentures. J Prosthodont Res 2014;58:3540.
[20] Takabayashi Y. Characteristics of denture thermoplastic
resins for non-metal clasp dentures. Dent Mater J
2010;29:35361.
[21] Katsumata Y, Hojo S, Ino S, Hamano N, Watanabe T, Kondo
N, et al. Color stability of a flexible nylon denture base
resin. J Kanagawa Odont Soc 2007;42:1405 [in Japanese].
[22] Sepulveda-Navarro WF, Arana-Correa BE, Borges CP, Jorge
JH, Urban VM, Campanha NH. Color stability of resins and
nylon as denture base material in beverages. J Prosthodont
2011;20:632863.
[23] Fernandes FSF, Pereira-Cenci T, Silva WJ, Filho APR,
Straioto FG, Cury AADB. Efficacy of denture cleansers on
Candida Spp. biofilm formed on polyamide and polymethyl
methacrylate resins. J Prosthet Dent 2010;105:518.
[24] Takahashi H, Kawada E, Tamaki Y, Teraoka H, Hosoi T,
Yoshida T. Basic properties of thermoplastic resins for
denture base material referred to non clasp denture. J Jpn
Dent Mater 2009;28:1617 [in Japanese].
[25] Abuzar MA, Bellur S, Duong N, Kim BB, Lu P, Palfreyman N,
et al. Evaluating surface roughness of polyamide denture
base material in comparison with poly (methyl
methacrylate). J Oral Sci 2010;52:57781.
[26] Taguchi Y, Shimamura I, Sakurai K. Effect of buccal part
designs of polyamide resin partial removable dental
prosthesis on retentive force. J Prosthodont Res 2011;55:
447.
[27] Fueki K, Ohkubo C, Yatabe M, Arakawa I, Arita M, Ino S,
et al. Clinical application of removable partial dentures
using thermoplastic resin (non-metal clasp dentures). Ann
Jpn Prosthodont Soc 2013;5:387408 [in Japanese].