Prosthodontic rehabilitation with a swing-lock removable partial denture
and a single osseointegrated implant: A clinical report
Robert McAndrew, MScD, BDSa
University of Wales College of Medicine, Heath Park, Wales, United Kingdom
This article details the use of a swing-lock removable partial denture and single osseointegrated dental
implant in the prosthodontic rehabilitation of a partially dentate patient. Used together, these treat-
ment options solved a difficult clinical problem with a satisfactory outcome. (J Prosthet Dent 2002;88:
128-31.)
T he first documented report on the use of a swing-
lock removable partial denture (RPD) has been attrib-
uted to Simmons,1 although Ackerman2 described a
similar concept involving a gate clasp and snap lock in
1955. The swing-lock RPD has been successfully used in
the prosthodontic rehabilitation of many patients.3-10
Clinical considerations, advantages, and disadvantages
associated with this treatment option have been de-
scribed in the literature,4,7,10-12 as have the technical
considerations related to its fabrication.4,10,13
Swing-lock prostheses are indicated in the following
situations: (1) when dental or alveolar undercuts would
not provide sufficient retention for conventional remov-
able dentures, which might be true for patients with
large distal extension bases, exaggerated gag reflexes, or
maxillofacial defects; (2) when the abutment teeth are
periodontally involved, in which case the swing-lock
prosthesis would act as a splint and help distribute forces
evenly between the remaining teeth; (3) when the pro-
vision of a complete denture or overdenture is unaccept-
able; (4) when, for economic reasons, a fixed prosthesis
cannot be fabricated; and (5) when excessive and un-
sightly gingival recession is encountered, in which case
an acrylic flange could be incorporated on the swing-
lock prosthesis.
Swing-lock prostheses are contraindicated when a pa-
tient exhibits poor oral hygiene, when a patients manual
dexterity is so poor that he or she could not open or
close the clasp portion of the swing-lock, when a patient
presents with a shallow vestibule or high frenal attach-
ments, and when interocclusal or interarch space would
prevent the successful accommodation of the prosthesis.
Limited clinical reports show that, in general, swing-
lock RPDs preserve periodontal health and do not
overtly damage abutment teeth when they are used cor-
rectly.5,6,14 Patient acceptance of the swing-lock RPD
appears to be good.5
It is known that prosthesis support can be improved
with the use of osseointegrated dental implants.15,16 Re-
movable implant-supported overlay prostheses have nu-
a
Senior Lecturer and Honorary Consultant in Restorative Dentistry,
Department of Adult Dental Health, Dental School.
128 THE JOURNAL OF PROSTHETIC DENTISTRY
merous potential advantages, including increased reten-
tion, increased stability, increased patient satisfaction
(compared to that associated with conventional remov-
able prostheses),17-19 and the preservation and mainte-
nance of existing hard and soft tissues. Moreover, im-
plant-supported overlay prostheses are a less expensive
alternative to implant-supported fixed prostheses.
This article describes the prosthodontic rehabilitation
of a patient with a swing-lock RPD and a single os-
seointegrated dental implant. Use of these items helped
the clinician overcome many of the difficulties associated
with a large edentulous span and achieve the treatment
objective: to provide the patient with an esthetic and
functional prosthesis that met her demands.
CLINICAL REPORT
A 46-year-old woman was referred by her general
dentist. The patient had a history of denture intolerance
and rapidly progressive periodontal disease. She had
been aware of her periodontal problems for 16 years and
had sought specialist treatment for them over the previ-
ous 7 years. Other than a history of allergy to penicillin,
the patient was in good health. She had smoked approx-
imately 20 cigarettes a day for 30 years.
An intraoral examination revealed that the mandibu-
lar arch was intact except for the third molars. Various
teeth were absent in the maxilla: the right lateral incisor,
left first molar, left premolars, and right and left second
and third molars. According to the patient, the missing
maxillary teeth had been extracted because of periodon-
tal involvement. A completely mucosa-supported, re-
movable partial denture made of acrylic resin replaced
only the missing maxillary lateral incisor.
Clinically, the patients oral hygiene could be de-
scribed as only fair; cervical plaque deposits were noted
on the lingual and interproximal aspects of many poste-
rior teeth. A periodontal examination revealed deep
probing depths (7 mm) throughout the dentition.
Several of the remaining maxillary teeth exhibited peri-
odontal mobility.
Radiographically, a 2:1 crown to root ratio was noted
on the majority of the remaining teeth, although the
maxillary right first premolar had no bony support and
VOLUME 88 NUMBER 2
McANDREW
Fig. 1. Maxillary arch after initial periodontal therapy. Sim-
ple cantilever, resin-retained fixed partial denture from right
maxillary premolar was used to replace missing lateral inci-
sor.
Fig. 2. First removable swing-lock prosthesis in place.
the second premolar only minimal bony support. Previ-
ous endodontic treatment had been performed on the
maxillary right second premolar; mandibular left second
premolar, and mandibular left first molar. No periapical
pathology was observed in the mandible, but periapical
widening was noted in the regions of the maxillary right
second premolar and maxillary left first molar.
Several different restorative options were discussed
with the patient; these ranged from maintaining the sta-
tus quo to extraction of the remaining maxillary teeth
and possible implant therapy. The patient expressed a
desire to keep as many of her remaining teeth for as long
as possible. She also wanted treatment to satisfy her
functional and esthetic needs.
AUGUST 2002
THE JOURNAL OF PROSTHETIC DENTISTRY
Treatment began with a course of nonsurgical peri-
odontal therapy. The patient was advised to stop smok-
ing. The maxillary right first premolar and maxillary
right first molar were extracted; endodontic therapy for
the molar was declined. After the initial periodontal
treatment, the referring dentist was advised to fabricate a
simple cantilever, resin-retained fixed partial denture
from the right maxillary canine to replace the missing
lateral incisor. After discussion with the patient, a deci-
sion was made to accept a shortened maxillary arch.
After completion of the above treatment, an addi-
tional and intensive course of nonsurgical periodontal
treatment, including subgingival debridement, was ini-
tiated. During this period, the long-term prognosis for
many of the remaining maxillary teeth was determined
to be poor, and arrangements were made for the provi-
sion of a maxillary RPD. Because of the position and
number of the maxillary teeth (Fig. 1) and the patients
history of denture intolerance, a horseshoe-shaped,
swing-lock RPD was prescribed. Because the patient had
a large labial frenum that would have unnecessarily com-
plicated denture fabrication, a frenectomy in the maxil-
lary central incisor region was performed. Endodontic
treatment of the maxillary right second premolar was
completed. All procedures were performed unevent-
fully, and the patient was placed on a periodontal main-
tenance program. Figure 2 shows the patient with the
initial prosthesis in place.
Two months after the maxillary denture was deliv-
ered, the maxillary right central incisor abscessed. End-
odontic treatment was performed but proved unsuccess-
ful. The central incisor was extracted, and an immediate
addition to the maxillary prosthesis was made.
Nine months after the initiation of treatment, the
patient reported satisfaction. Radiographic and clinical
examination, however, revealed that the maxillary right
second premolar and canine were unsaveable. These
teeth, including the resin-retained fixed partial denture,
were extracted and immediately added to the existing
swing-lock denture. In addition, continued alveolar
bone loss was noted throughout the patients dentition
(Fig. 3). Bacteriological samples were taken from areas
with persistently deep probing depths, and a microbio-
logic and antibiotic sensitivity assay undertaken. After
results were obtained, a further course of nonsurgical
periodontal therapy was completed under an antibiotic
umbrella of systemic doxycycline hyclate, 100 mg a day
for 14 days (APS, Ashbourne, Kent, United Kingdom).
Three months later, the patients periodontal tissues
appeared healthy, and no periodontal probing depths
4 mm were noted. The swing-lock denture was
deemed to be functioning well, but the patient com-
plained that it felt slightly loose on the right side. Orig-
inally, it was hoped that a fixed prosthodontic alternative
to the removable swing-lock RPD would be provided
for the patient. Implant therapy was discussed and
129
 THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 3. Dental panoramic tomograph following loss of hope-
less teeth in maxilla before insertion of implants.
Fig. 4. Patients dentition and integral implant with ball
attachment for O-ring in region of maxillary right canine.
agreed to by the patient. The relationship between
smoking and implant failure was stressed. The patient
agreed to stop smoking before any implant placement.
Six months later, after the maxillary extraction sites
had healed and the patient had stopped smoking, 4
Brnemark implants (Nobel Biocare; Go teburg, Swe-
den) were placed in the maxilla: 15 mm implants were
placed in the right central incisor, right canine, and
right premolar regions, and a 13 mm implant was
placed in the left premolar region. A buccal bony de-
hiscence in the right canine implant area was packed
with autologous maxillary bone chips.
Over a period of 5 months, 3 of the dental implants
(those in the regions of the left premolars, right central
incisor, and right premolar) failed to osseointegrate.
Consequently, these implants were removed. It was
also clear at this stage of treatment that the planned
fixed alternative to the swing-lock prosthesis could not
be provided. Given that the original swing-lock RPD
had been relatively successful, a new swing-lock pros-
thesis was fabricated with conventional procedures for
use with the remaining osseointegrated implant. An
130
McANDREW
Fig. 5. A, Palatal view of definitive swing-lock prosthesis. B,
Anterior view of definitive prosthesis in place.
O-ring attachment was used on the implant to provide
additional retention for the prosthesis.
Fifteen months later, the prosthesis was entirely sat-
isfactory to the patient, and the remaining teeth and
implant were in sound condition (Figs. 4 and 5). The
patient was placed on a 4-month review and mainte-
nance schedule.
DISCUSSION
For the patient described, a removable swing-lock
prosthesis provided satisfactory prosthodontic and es-
thetic results. The initial swing-lock denture afforded
the patient some measure of confidence with RPDs in
spite of her history of denture intolerance. That such
tolerance might have been impossible to attain with a
conventional RPD reinforces the belief that the swing-
lock denture can be a suitable alternative to more con-
ventionally designed removable prostheses. The first
swing-lock denture also successfully replaced teeth that
could not be saved and allowed the patients compliance
with dental treatment to be assessed.
VOLUME 88 NUMBER 2
McANDREW
Although implant-retained fixed prostheses were de-
sired for this patient, implant failure prevented this treat-
ment. The subsequent fabrication of a second swing-
lock RPD for use with a single osseointegrated dental
implant and associated O-ring provided a satisfactory
outcome. It should be noted that, because minimal
space was available for the attachment in the final pros-
thesis, the acrylic resin was thinned (Fig. 5, A). Through
the initial follow-up period of 15 months, no excessive
wear occurred in the thinned area and no evidence of
acrylic fracture was found. Nonetheless, the prosthesis
must be examined regularly for evidence of failure.
The final prosthesis overcame some of the problems
associated with conventional large-span, extension base
removable dentures. Prosthesis retention and stability
were obtained, an exaggerated gag reflex and excessive
gingival recession were stymied, existing hard and soft
tissues were preserved and maintained, and the patient
expressed greater satisfaction with the definitive swing-
lock RPD than with the nonimplant-retained prosthesis.
Despite the apparent success of treatment, the loss of 3
of 4 dental implants must be recognized as a failure.
Stricter control over the patients smoking habit might
have produced a different outcome. Nevertheless, the
value of even one successfully integrated implant was
demonstrated. It is suggested that swing-lock RPDs in
conjunction with dental implants be considered an op-
tion for the prosthodontic rehabilitation of some par-
tially dentate patients.
SUMMARY
For the partially dentate patient described, a remov-
able swing-lock prosthesis used in conjunction with a
contralateral implant to aid retention and stability pro-
vided a satisfactory treatment outcome.
Thanks are extended to Juliet Evans for her secretarial work and
Mr W. McLaughlin (Consultant in Restorative Dentistry) for his en-
couragement in the presentation of this treatment scenario.
REFERENCES
1. Simmons JI. Swing-lock stabilization and retention: a preliminary clinical
report. Tex Dent J 1963;81:10-2.
2. Ackerman AJ. The prosthetic management of oral and facial defects fol-
lowing cancer surgery. J Prosthet Dent 1955;5:413-32.
AUGUST 2002
THE JOURNAL OF PROSTHETIC DENTISTRY
3. Renner RP, Foerth D, Antos E Jr. Overdentures and swing lock partial
dentures as alternatives to traditional removable prosthodontics: a survey
of American dental schools. J Dent Educ 1977;41:695-6.
4. Antos EW Jr, Renner RP, Foerth D. The swing-lock partial denture: an
alternative approach to conventional removable partial denture service.
J Prosthet Dent 1978;40:257-62.
5. Schulte JK, Smith DE. Clinical evaluation of swinglock removable partial
dentures. J Prosthet Dent 1980;44:595-603.
6. Gomes BC, Renner RP, Antos EW, Baer PN, Carlson M. A clinical study of
the periodontal status of abutment teeth supporting swinglock removable
partial denturesa pilot study. J Prosthet Dent 1981;46:7-13.
7. Bolender CL, Becker CM. Swinglock removable partial dentures: where
and when. J Prosthet Dent 1981;45:4-10.
8. Adams D. A cantilevered swinglock removable partial denture design for
the treatment of the partial mandibulectomy patient. J Oral Rehabil 1985;
12:113-8.
9. Black WB. Surgical obturation using a gated prosthesis. J Prosthet Dent
1992;68:339-42.
10. Padilla MT, Campagni WV. The swing-lock removable partial denture.
J Calif Dent Assoc 1997;25:387-92.
11. Becker CM, Bolender CL. Designing swinglock partial dentures. J Prosthet
Dent 1981;146:126-32.
12. Talbot TR. Review of the Swinglock removable partial denture. Int J
Prosthodont 1991;4:80-8.
13. Schwalm CA, LaSpina FV. Fabricating swinglock removable partial den-
ture frameworks. J Prosthet Dent 1981;45:216-20.
14. Gomes BC, Renner RP, Antos EW Jr, Boer PN. A three year study on the
periodontal health status of the natural teeth supporting swing-lock re-
movable partial dentures. Quintessence Int 1982;13:965-72.
15. Keltjens HM, Kayser AF, Hertel R, Battistuzzi PG. Distal extension remov-
able partial dentures supported by implants and residual teeth: consider-
ations and case reports. Int J Oral Maxillofac Implants 1993;8:208-13.
16. Halterman SM, Rivers JA, Keith JD, Nelson DR. Implant support for
removable partial overdentures: a case report. Implant Dent 1999;8:74-8.
17. Zarb GA, Schmitt A. Osseointegration and the edentulous predicament.
The 10-year-old Toronto study. Br Dent J 1991;170:439-44.
18. Chan MF, Johnston C, Howell RA, Cawood JI. Prosthetic management of
the atrophic mandible using endosseous implants and overdentures: a six
year review. Br Dent J 1995;179:329-37.
19. Clancy JM, Buchs AU, Ardjmand H. A retrospective analysis of one
implant system in an oral surgery practice. Phase I: Patient satisfaction.
J Prosthet Dent 1991;65:265-71.
Reprint requests to:
DR ROBERT MCANDREW
DEPARTMENT OF ADULT DENTAL HEALTH, DENTAL SCHOOL
UNIVERSITY OF WALES COLLEGE OF MEDICINE
HEATH PARK
CARDIFF CF14 4XY
UNITED KINGDOM
FAX: (44)29-2074-3120
E-MAIL: mcandrew@cardiff.ac.uk
Copyright 2002 by The Editorial Council of The Journal of Prosthetic
Dentistry.
0022-3913/2002/$35.00 0 10/1/127714
doi:10.1067/mpr.2002.127714
131