2
Clasp- retained partial denture
Points of View
Six Phases of Partial Denture Service
Education if patient
Diagnosis, treatment planning, design,
treatment sequencing, and mouth
preparation
Support jor distal extension denture bases
..
POINTS OF VIEW
The clasp-retained partial denture, with extracoronal
direct retainers, is probably used a hundred times more
than is the intracoronal, or internal attachment, partial
denture (Fig. 2-1). Although the clasp-retained partial
denture has disadvantages, for reasons of cost and time
devoted to fabrication, it will continue to be widely
used because it is capable of providing physiologically
sound treatment for most patients needing partial
denture restorations. The following are some of the
possible disadvantages of a clasp-retained partial
denture:
1. Strain on the abutment teeth often is due to
improper tooth preparation, clasp design, and/ or
loss of tissue support under distal extension partial
dentures bases.
2. Clasps can be unesthetic, particularly when
they are placed on visible tooth surfaces.
3. Caries may develop beneath clasp compo
nents, especially if the patient fails to keep the
prosthesis and the abutments clean.
Establishment and verification if occlusal
relations
and tooth arrangements
Initial placement procedures
Periodic recall
Reasons for Failure of Clasp-Retained
Partial Dentures
Self-Assessment Aids
Despite these disadvantages, the use of removable
prostheses may be preferred whenever tooth-bounded
edentulous spaces are too large to be restored safely with
fixed prostheses or when cross-arch stabilization and
wider distribution of forces to supporting teeth and tissues
are desirable. Fixed partial dentures, however, should
always be considered and used when indicated.
The removable partial denture retained by internal
attachments eliminates some of the disadvantages of
clasps, but it also has other disadvantages, one of which is
too great a cost for a large percentage of patients needing
partial dentures. However, when the alignment of the
abutment teeth is favorable, the periodontal health and
bone support are adequate, the clinical crown is of
sufficient length, the pulp morphology can accommodate
the required tooth preparation, and the economic status of
the patient permits, an internal attachment
prosthesis is unquestionably preferable for esthetic
reasons. In most instances, if the extracoronal clasp-
retained partial denture is de
9
10 McCracken's removable partial prosthodontics

B
A

D
c

Fig. 2-1 A, Maxillary removable partial denture with complete palatal coverage. It is retained
by extracoronal retainers (clasps) on terminal abutments. B, Mandibular removable prosthesis is
retained by clasps on terminal abutments. C, Maxillary arch is prepared for an internal
attachment restoration. Note the dovetail preparations in the distal portions of the restored first
premolars. Male portions of the attachments will be inserted into dovetail preparations in
restored abutments. D, Internal attachment restoration in the patient's mouth. Note the precise
fit of male and female portions of the attachments. E, Mandibular internal attachment partial
denture viewed from the residual ridge side. Male portions of attachments can be seen at
anterior aspect of each denture base. Buccal extracoronal retentive arms assist in retaining the
denture.

signed properly, the only advantage of the internal
attachment denture is esthetics, because abutment
protection and stabilizing components should be used
with both internal and external retainers. However,
economics permitting, esthetics alone may justify the
use of internal attachment retainers. Injudicious use of
internal attachments can lead to excessive torsional
load on the abutments supporting distal extension
removable partial dentures, especially in the mandible.
The use of hinges or other types of stressbreakers is
discouraged in these situations. It is not that they are
ineffective, but they are frequently misused. As an
example, in the mandibular arch, a stress-broken distal
extension partial denture does not provide for cross-
arch stabilization and frequently subjects
the edentulous ridge to excessive trauma from
horizontal and torquing forces. Therefore a rigid
design is preferred, and some type of extracoronal
clasp retainer is still the & most logical and frequently
used. It seems likely that its use will continue until a
more widely acceptable retainer is devised.
Dental treatment for patients must be highly
individualized. The dentist must be prepared to apply
the concept of optimum services to
patients whose individual circumstances, in spite of
their needs, may dictate no treatment,
limited treatment, or extensive treatment.
SIX PHASES OF PARTIAL
DENTURE SERVICE
Partial denture service may be logically divided into
six phases. The first phase is related to patient
education. The second phase includes diagnosis,
treatment planning, design of the partial denture
framework, treatment sequencing, and execution of
mouth preparations. The third phase is provision of
adequate support for the distal extension denture base.
The fourth phase is establishment and verification of
harmonious occlusal relationships and tooth rela-
tionships with opposing and remaining natural
teeth. The fifth phase involves initial placement
procedures, including adjustments to the contours and
bearing surfaces of denture bases, adjustments to
ensure occlusal harmony, and a
Chapter Clasp-retained partial denture 11
2
review of instructions given the patient to optimally
maintain oral structures and the provided restorations. The
sixth and final phase of partial denture service is follow-
up services by the dentist through recall appointments for
periodic evaluation of the responses of oral tissues to
restorations and of the acceptance of the restorations by
the patient. The following is an overview of these phases.
The context of each phase is discussed in greater detail in
the respective chapters of this book.
Education of patient
The term patient education is described in Mosby's Dental
Dictionary, 1998, as "the process of informing a patient
about a health matter to secure informed consent, patient
cooperation, and a high level of patient compliance."
Responsibility for the ultimate success of a removable
partial denture is shared by the dentist and the patient. It is
folly to assume that a patient will have an understanding
of the benefits of a removable partial denture unless he or
she is so informed. It is also unlikely that the patient will
have the knowledge to avoid misuse of the restoration or
be able to provide the required oral care and maintenance
procedures to ensure the success of the partial denture
unless he or she is adequately advised.
The finest biologically oriented removable partial
denture is often doomed to limited success if the patient
fails to exercise proper oral hygiene habits or ignores
recall appointments. One of the primary objectives for a
partial denture, preservation, will most likely not be
achieved with only token cooperation on the
part of the patient.
Patient education should begin at the initial contact
with the patient and continue throughout treatment. This
educational procedure is especially important when the
treatment plan and prognosis are discussed with the
patient. The limitations imposed on the success of
treatment through failure of the patient to accept
responsibility must be explained before definitive
treatment is undertaken. A patient will not usually retain
all the information presented in the oral educational
instructions. For this reason, patients should be
presented with written suggestions to reinforce the oral
presentations.
12 McCracken's removable partial prosthodontics Chapter Clasp-retained partial denture 13
2
Diagnosis, treatment planning, design, treatment
sequencing, and mouth preparation A distinction
preparations have between
been indicatedthese two intypes of removable
colored pencil,
Treatment planning and design begin with a thorough restorations
occlusal is
adjustments, adequately
abutment made by
restorations, an
and acceptable
abutment
health history and a history of past dental experiences. classificationcan
modifications of be
removable
accomplished. partial dentures, such as the
The complete oral examination must include both Kennedy
Selected classification
proximal noted
tooth in Chaptershould
surfaces 3. be made
clinical and roentgenographic interpretation of (1) caries; Basically
parallel to providethe same
guiding principles
planes toapply
direct to the
the unilateral
placement
(2) the condition of existing restorations; (3) periodontal distal
and extension
removal of thedenture as
prosthesis. to the bilateral
Proximal distal
surfaces extension
adjacent
conditions; (4) responses of teeth (especially abutment todenture.
edentulousOn theareasother hand, generallyentirely different
provide theprinciples
optimumof
teeth) and residual ridges to previous stress; and (5) the design,for
location as guiding
stated previously,
planes. Occlusal apply torest a prosthesis that is
seats that direct
vitality of remaining teeth. Additionally, evaluation of totally
occlusal tooth
forces supported.
along the longEach axis type
of themust be
supporting designed
teeth
according
should be to the manner
established so ofthat
support.
neither the tooth nor the
the occlusal plane, the arch form, and the occlusal
It iswill
denture necessary
be displaced that aunder specific designloading.
occlusal be carefullyThis
relations of the remaining teeth (visually and by
plannedthat
dictates in advance
the floorofofmouth the rest preparations
preparationand be that
made these
to
accurately articulated diagnostic casts) must be meticu-
mouthapically
incline preparationsfrom be carried
the marginal outridge
withand care,be in the proper
lously accomplished. After a complete diagnostic
sequence,
spoon shaped, as outlined in the treatment
with the marginal plan and on the
ridge lowered
examination has been accomplished, and a removable
todiagnostic
permit cast. Thenbulk
sufficient specific and precise
without occlusal mouth
interference
partial denture has been agreed on as the treatment of
preparations,
from the rest. including abutment restorations, will dictate
choice, a treatment plan and design can be developed
theRetentive
final form of the
areas must denture framework
be identified to be outlined
or created by tooth on
and sequenced that is based on the support available for
the master cast.
modification. They Theshouldfinal formprovide of the denture equal
relatively framework and
the partial denture.
should retention
uniform be drawn on accurately
all abutment onteeth,
the sufficient
master cast onlyafter
to
Distal extension situations, in which there are no surveying so that the technician
resist reasonable dislodging forces. can Tooth clearly see and
surfaces on
abutments posterior to the edentulous area, require an understand the and/or
exact design of clasp
the partial denture
which stabilizing reciprocal arms may be
entirely different partial denture design than does one in framework
placed also that must is tobebe identified
fabricated. or created by tooth
which total abutment tooth support is available. In distal The dental cast surveyor (Fig. 2-2) is an absolute
Fig. 2-2 Dental cast surveyor'tacilitates the design of a modification.
extension
removableconfigurations,
partial denture. Itthe extension
is an instrument bases must
by which necessity in any dental office
After mouth preparations areinconsidered
which patients are being
completed, an
derive their orprincipal
parallelism support from
lack of parallelism the underlying
of abutment teeth treated with removable partial dentures. The surveyor is
impression should be made in irreversible hydrocolloid
residual
and otherridge.
oralInterpretation
structures, onof the roentgenograms
a stone cast, can be and instrumental
and a cast formed in diagnosing
in quick-setting and guidingstone. the Thisappropriate
cast can
determined.
the surveying Use of the and
of abutments surveyor is covered
soft tissue contoursinto tooth
then be preparation
surveyed before and dismissing
verifying that the the mouth
patient prepara-
to ascertain
succeedingnecessary
determine chapters. mouth preparation must take into
tion has the
whether beenplanned
done correctly. abutment Therecontours
is no more havereasonbeento
consideration the greater torque and tipping leverages justify its omission
accomplished from a dentist's
or if additional armamentarium
recontouring is necessary. than
that the there ismouth
When to ignore the need have been completed, the
preparations
on theextension
distal technician to interpret
partial dentureroentgenograms
will impose onand thetoabutmentimpression
for roentgenographic
for the master equipment,
cast should thebemouth
mademirror
and the andcast
render a diagnosis.
teeth. explorer,
poured or the periodontal
immediately. The probe used
master cast formust
diagnostic
then be
After treatment
Sufficient planning,exist
differences a predetermined
between the tooth- purposes.so that the design of the partial denture
surveyed
sequence of mouth preparations can be performed
supported and the tooth-tissue-supported removable Several
framework canmoderately
be drawn on priced surveyors that adequately
it, prefera
with a definite goal in mind. It is mandatory that the
partial denture to justify a distinction between them. accomplish
bly with colored thepencil.
diagnostic procedures necessary for
treatment plan be reviewed to ensure that the mouth
Principles of design and techniques employed in designing
It must betheremembered
partial denture that the arelocation
available. of theIn clasp
many
preparation necessary to accommodate the removable
fabrication are dissimilar. The following list presents the dental
arms is offices,
determined this bymost the important
height of phase contourof ofdental the
partial denture design has been properly sequenced.
points of difference: diagnosis
abutment teeth.is This
delegated
height ofto the commercial dental
Mouth preparations, in the appropriate sequence,
1. Manner in which the prosthesis is supported 2. Type laboratory
contour existsbecause
for a given thispath invaluable
of placement diagnostic tool is
should be oriented toward the goal of providing
and extent of mouth preparation absenthence
only; or becauseproximal the dentist
guiding is apathetic.
planes Thisaccurate
and situation
adequate support, stabilization, retention, and a
3. Impression methods required for each places the
blockout of technician
proximal in the role
tooth of diagnostician.
surfaces are required. The
harmonious occlusion for the partial denture. Placing a
4. Types of direct retainers best suited for each 5. Denture position Any clinical
of the treatment
cast in basedtoonthethe
relation diagnosis
surveyor must ofbethe
crown ,or restoring a tooth out of sequence may result
base material best suitedteeth
for each technician so remains
that the the responsibility of the
the dentist.
cast onThis
in the need to restore that 6. Need
were notforplanned
indirectfor recorded technician can place a
retention makes no
surveyor in more
the sense than relying
restoration, or it may necessitate remaking a
restoration or even seriously jeopardizing the success
of the removable partial denture. Through the aid of
diagnostic casts on which the tentative design of the
partial denture has been outlined and the mouth
14 McCracken's removable partial prosthodontics

same position parallel to the blackout material. This is the need for exacting occlusal records make it necessary
easily done by scoring the base of the cast on three sides for the denture framework to be returned to the dentist for
parallel to the path of placement or by tripoding the cast further records before the restoration is completed.
(see Fig. 11-16), but this must be done before the cast is
removed from the surveyor.
Surveying the master cast, recording the relationship Support for distal extension denture bases
of the cast to the surveyor, and drawing a definite
The third of the six phases in the treatment of a patient
outline on the master cast are still not enough. It is
with a partial denture is obtaining adequate support for
difficult to draw all the details of the denture design on
distal extension bases; therefore it does not apply to tooth-
the master cast. The detail is accomplished by labeling a
supported removable partial dentures. In the latter,
colored pencil drawing on an illustration of the dental
arch, which provides the technician with an outline of support comes entirely from the abutment teeth through
the partial denture framework and allows for the use of rests.
instructions for the technician to follow in fabricating For the distal extension partial denture, however, a
the denture. From this information it is possible for the base made to fit the anatomic ridge form does not provide
technician to return a casting that the dentist can adequate support under occlusal loading (Fig. 2-3).
superimpose on the outline as drawn on the master cast. Neither does it provide for maximum border extension
The dentist is responsible for the design of the partial nor accurate border detail. Therefore some type of
denture frameworl< from the beginning to finish and corrected impression is necessary. This may be
therefore is accountable for providing the technician accomplished by several means, any of which satisfy the
with all the information needed. It is the responsibility requirements for support of any distal extension partial
of the technician to follow the written instructions given denture base.
by the dentist, but at the same time it is the technician's
prerogative to demand that these instructions be so
informative that they can be followed without question.
Up to this point the treatment planning and
preliminary design of the partial denture, the mouth
preparation procedures, and the design of the denture
framework have been accomplished by the dentist. With
the written instructions and the master cast on which the
dentist has precisely drawn the partial denture design,
the technician may then fabricate the metal framework.
The finished framework should be
returned to the dentist so that its fit in the mouth can be
evaluated and any necessary adjustments on the framework
can be made.
When laboratory procedures are correctly executed,
the framework should fit the master cast as planned. If
the framework does not fit the mouth as planned, the
dentist must determine whether the error is the result of
a faulty
impression, an inaccurate master cast, or a laboratory
procedure. In any event, adequate support for distal
extension denture bases and
Fig. 2-3 Cast on the right was made from an impression that
recorded anatomic form of residual ridge. On the left is the
same cast, with residual ridge recorded in a functional, or
supporting, form by a corrected impression. Note that the
supporting form of the ridge clearly delineates the extent of
coverage available for a denture base.

Foremost is the requirement that certain soft tissues
in the primary supporting area should be
recorded or related under some loading so that
the base may be made to fit the form of the ridge when
under function, thereby providing support and ensuring
the maintenance of that support for the longest possible
time. This requirement makes the distal extension
partial denture unique in that the support from the
tissues underlying the distal extension base must be
made as equal to and compatible with the tooth support
as possible.
A complete denture is entirely tissue sup
ported, and the entire denture can move toward the
tissue under function. In contrast, any movement of a
partial denture base is inevitably a rotational
movement that, if tissueward, may result in
undesirable torquing forces to the abutment teeth and
loss of planned occlusal contacts. Therefore every
effort must be made to provide the best possible
support for the distal extension base to minimize
these forces.
Usually no single impression technique can
adequately record the anatomic form of the teeth
II and adjacent structures and at the same time
I suggestions and recommendations given by the dentist for
record the supporting form of the mandibular
edentulous ridge. A method should be used that can
record these tissues either in their supporting form or
in a supporting relationship to the rest of the denture
(see Fig. 2-3). This may be accomplished by one of
several methods, which will be discussed in Chapter
16.
Establishment and verification of occlusal
relations and tooth arrangements
Whether the partial denture is tooth supported or has
one or more distal extension bases, the recording and
verification of occlusal relationships and tooth
arrangement are important steps in the construction of
a partial denture. For the tooth-supported partial
denture, ridge form is of less significance than it is for
the tooth- and tissue-supported prosthesis because the
ridge is not called on to support the prosthesis. For the
distal extension base, however, jaw relation records
should be made only after obtaining the best possible
support for the denture base. This necessitates the
making of a base or bases that
Chapter Clasp-retained partial denture 15
2
will provide the same support as the finished denture.
Therefore the final jaw relations should not be recorded
until after the denture framework has been returned to the
dentist, the fit of the framework to the abutment teeth and
opposing occlusion has been verified and corrected, and a
corrected impression has been made. Then, either a new
resin base or a corrected base must be used to record jaw
relations.
Occlusal records for a removable partial denture may
be made by the various methods described in Chapter 17.
Initial placement procedures
The fifth phase of treatment occurs when the patient is
given possession of the removable prosthesis. Inevitably it
seems that minute changes in the planned occlusal
relationships occur during processing of the dentures. Not
only must occlusal harmony be ensured before the patient
is given possession of the dentures, but also the processed
bases must be reasonably perfected to fit the basal seats. It
must also be ascertained that the patient understands the
care of the dentures and oral structures, as well as
understands about expectations in the adjustment phases
and use of the restorations. These facets of treatment are
discussed in detail in Chapter 20.
Periodic recall
Initial placement and adjustment of the prosthesis are
certainly not the end of treatment for the partially
edentulous patient. Periodic recall of the patient to
evaluate the condition of the oral tissues, the response to
the tooth restorations, the prosthesis, the patient's
acceptance, and the patient's commitment to maintain oral
hygiene are all part of total treatment responsibility.
Changes in the oral structures or the dentures
must be ascertained early to avoid compromised
oral health; this can be accomplished by periodic recall.
Although a 6-month recall period is adequate for most
patients, a more frequent evaluation may be required for
some patients.
Chapter 20 contains some suggestions concerning this
sixth phase of treatment.
16 McCracken's removable partial prosthodontics Chapter Clasp-retained partial denture 17
2
SELF-ASSESSMENT 2. 7.Failure to provide
Recording of jawthe technician
relations with a orient
to properly specificmaster
AIDS design and casts
necessary
REASONS FOR FAILURE OF CLASP- opposing to aninformation to enable
articulator should the
be delayed
1. In chronologie order of accomplishment, give the technician
RETAINED until the toframework
execute thehas design
been fitted and a secondary
six PARTIAL
sequential,DENTURES
correlated phases in treating a 3. Failure of the technician to follow the design
impression has been made. True or false? Why?
partially edentulous patient with removable and written instructions
8. In the fifth phase of treatment (initial placement of the
prostheses. Support for denture
Experience with the clasp-retained partial denture made restorations), threebases
things are done before the patient
2. If responsibility for the success of treatment is 1. Inadequate
by the methods outlined has proved its merit and justifies is given possessionofofbasal
coverage seat tissuesTwo of these are
the denture(s).
shared by the dentist and the patient, what must be 2. Failure to record basal seat tissues in a support
its continued use. The occasional objection to the (1) correction of denture base contours and occlusal
undertaken to prepare patients to accept their ingdiscrepancies
form
visibility of retentive clasps can be minimized through that may have resulted from processing
responsibility? and (2) review of patient education, including
the use of wrought-wire clasp arms. There are few Occlusion
3. Because treatment planning is the sale 1. Failure to develop
adjustment a harmonious
expectations. Whatocclusion
other step must be
contraindications for use of a properly designed clasp-
responsibility of the dentist, which, if any, of the 2. Failure
accom to use compatible materials for opposing
retained partial denture. Practically all objections to this
following may be omitted as noncontributory to occlusal
plishedsurfaces
during the appointment?
type of denture can be eliminated by pointing to defi-
total treatment: (1) a complete health history, (2) a 9. What is therelationship
purpose of periodic recall of patients
ciencies in mouth preparation, denture design and Patient-dentist
history of past dental experiences, (3) an oral 1. treated
Failure of with
the removable
dentist partialadequate
to provide dentures?dental
fabrication, and patient education; these follow:
examination, (4) a roentgenographic examination, 10.health
Whatcare information,
is the includingreason
one predominant care and usethe
why of clasp
(5) an evaluation of occlusal relations of prosthesis
type of partial denture is used more often in most
remaining teeth, (6) a survey of diagnostic casts, 2. Failure of thethan
practices dentistis totheprovide recall
internal opportu type of
attachment
(7) cost, or (8) patient desires? nities on a periodic basis
prosthesis?
4. A specific design of the removable restoration 3.
11.Failure of the patient
Deficiencies to exercise
in design and afabrication
dental healthand those
Diagnosismustandbe treatment
plannedplanning
before mouth preparation care regimen and respond to recall
1. Inadequate diagnosis related to patient education are the culprits of limited
procedures. The dentist (can-should
2. Failure to use a surveyor or to use a surveyor not) delegate success in treatment with removable
A removable partial denture designed and fabricated prostheses.
the responsibility
properly during treatment forplanning
the design to a dental so that itAvoiding avoids the these
errorsdeficiencies will make
and deficiencies listedthe goal of
is one
. laboratory technician. that prosthetic
proves the dentistry
clasp type ofobtainable.
partial This goal
denture can is to,
be madeand
Mouth5. preparation
Stability inprocedures
a removable restoration (is-is not) functional, esthetically pleasing, and long lasting without
1. Failure to properly sequence mouth preparation
desirable to help maintain the health of oral damage to the supporting structures. The proof of the
procedures
structures.
2. Inadequate A tooth-supported
mouth preparations, restora
usually resulting merit of this type of restoration lies in the knowledge that
tion usually (can-cannot)
from insufficient planning of be the
made more of the
design (1) it permits treatment for the largest number of patients,
stable
partial than aorrestoration
denture failure to supported by teeth
evaluate that mouthand at reasonable cost;
residual ridges.
preparations have been properly accomplished (2) it provides restorations that are comfortable
3. Failure
6. When to return supporting
a removable tissues
partial to optimum
denture is supported and efficient over a long period of time, with adequate
health before
both impression
by teeth procedures
and residual ridges, support by the support and maintenance of occlusal contact relations; (3)
Designresidual ridge should be made as equal as it can provide for healthy abutments, free of caries and
of the framework
possible
1. Incorrect use to the support
of clasp designsgiven by the teeth. This periodontal disease; (4) it can provide for the continued
2. Use may
of cast
be clasps
accomthat have too little flexibility, health of restored, healthy tissues of the basal seats; and
are too broad
plished byinrecording
tooth coverage,
which formand have
of thetoo little ridge(5) it makes possible a partial denture service that is
residual
consideration
in makingfor esthetics
impressionsanatomic (static) or definitive and not merely an interim treatment.
3. Flexible or incorrectly
functional? located major and minor
Removable partial dentures thus made will contribute
connectors
4. Failure to use properly located rests to a concept of prosthetic dentistry that has as its goal the
promotion of oral health,
Laboratory procedures the restoration of partially edentulous mouths, and an
1. Problems in master cast preparation elimination of the ultimate need for complete dentures.
a. Inaccurate impression
b. Poor cast-forming procedures
c. Incompatible impression materials and gyp
sum products