Esthetic options for the fabrication of removable partial dentures:

A clinical report
Andiara De Rossi, DDS,a Rubens Ferreira Albuquerque Junior, DDS, PhD,b and
Osvaldo Luiz Bezzon, DDS, PhDc
School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
This clinical report describes a procedure for influencing the esthetics of a Kennedy Class
III–Modification 1 removable partial denture. The acrylic resin base is eliminated, and the reten-
tive clasp placed on the first premolars is modified. This technique is simple and inexpensive, and
in the treatment presented, it resulted in complete patient satisfaction. (J Prosthet Dent
2001;86:465-7.)

B oth masticatory function and esthetics should be

considered when denture treatment is planned. It is
unrealistic to assume that because acceptable mastica-
tory capability is achieved, patients will tolerate a poor
prosthetic appearance. When anterior teeth must be
used to support removable partial dentures (RPDs) or
when teeth are visible on smiling or speaking, circum-
ferential clasps and I bars can make esthetic restoration
a challenge.1 The use of rotational path RPDs can solve
some esthetic problems,2,3 but the disadvantage of this
type of prosthesis is that the rigid anterior retentive
portion of the framework cannot be adjusted.4
Another alternative is the use of proximal clasps
made from wrought wire and settled in a 0.01-inch
undercut on the tooth surface. This solution provides Fig. 1. Maxillary removable partial denture fabricated with-
both retention and esthetics to an anterior edentulous out typical buccal resin flange, allowing favorable
segment.5 However, disadvantages are also associated positioning of artificial teeth over ridge.
with this technique. Greater space between the reten-
tive component and artificial tooth is necessary to
allow a horizontal movement of the wire after the
framework is cast. Increased thickness of the major
connector over the wire clasp is required, and extra teeth also contribute to a harmonic design.10 The
laboratory steps incur added costs. In addition, the tooth-supported RPD constructed without the buccal
clasp is difficult to repair if broken.5 flange of the acrylic resin base can provide an esthetic
The esthetics of RPDs retained by anterior teeth result as well as enhance periodontal health of the
can be improved with extra-coronal adhesive attach- abutment teeth.11
ments. Although less invasive than the conventional This clinical report describes a procedure for influenc-
full crown preparation, this procedure involves tech- ing the esthetics of a Kennedy Class III–Modification 1
nique-sensitive steps and additional cost.6 Despite the RPD.
wearing process that occurs over time, composites can
CLINICAL REPORT
be used not only to bind structures but also to increase
retention with strategic positioning of clasps to pro- A 60-year-old woman expressed dissatisfaction with
vide a more natural-looking prosthesis.7-9 The cervical her maxillary RPD because of the unesthetic appear-
shape and alignment of both the artificial and natural ance of the buccal metallic clasps when she talked or
smiled. She had a Kennedy Class III-Modification 1
RPD in the maxillary arch and a Kennedy Class I RPD
aPostgraduate Student, Departments of Pediatrics and Preventive
in the mandibular arch (Fig. 1). The patient was satis-
and Social Dentistry.
bProfessor, Department of Dental Materials and Prostheses. fied with the mandibular prosthesis, which was hidden
cAssociate Professor, Department of Dental Materials and by the lower lip and cheek, and did not want the max-
Prostheses. illary right canine or lateral restored regardless of their

NOVEMBER 2001 THE JOURNAL OF PROSTHETIC DENTISTRY 465

THE JOURNAL OF PROSTHETIC DENTISTRY DE ROSSI, ALBUQUERQUE JUNIOR, AND BEZZON

poor esthetics. The decision was made to fabricate the

prostheses without the conventional buccal base, or
even without a resin base that matched the patient’s
tissue color, because of the favorable shape of the
residual ridge. (If the ridge shape were to change sig-
nificantly, an acrylic resin base would be the most
esthetic solution.)
A previously fabricated maxillary RPD without the
buccal flange had eliminated the patient’s complaint
about the unnatural look of the prosthesis. However,
complete satisfaction was achieved only when that
design was combined with the replacement of the con- Fig. 2. Dotted line represents 180 degrees of greatest cir-
ventional clasps with retentive arms in a palatal position. cumference of abutment.
The most favorable path of insertion and removal
was determined on the stone cast with the use of a
dental surveyor. The survey revealed no retentive areas
on the palatal contours of the maxillary first premolars.
These teeth were prepared as needed to support the
clasps and rests. A small amount of composite was
added in the mesial-palatal contour of the first premo-
lars to create retention for the clasp arms. The
framework was designed so that the traditional buccal
retentive clasp arm was moved to the palatal side of the
first premolars. The reciprocation was provided by a
minor connector and the distal buccal angle of the
artificial tooth, which extended more than 180
degrees of the greatest circumference of the crown
(Fig. 2).12
After the framework was clinically evaluated and
adjusted, artificial teeth were arranged over the resid- Fig. 3. Prosthesis with buccal flange-free design and palatal
retentive clasps.
ual ridge. The cervical contours of the artificial teeth
were marked with a pencil, and the cast was ground to
a depth of 0.2 mm where the cervical portion of the
artificial teeth would touch the cast. This step was per-
formed to compensate for acrylic resin shrinkage
during processing and to enable tighter adaptation
with the ridge. The space created was filled with wax
along the cervical tooth shape. Esthetics and phonet-
ics were verified with an intraoral trial. The prosthesis
then was packed and processed with an acrylic resin in
the same shade as the teeth.
The prosthesis was recovered, finished, and polished.
During final clinical adjustments, pressure indicator
paste with selective grinding was used to eliminate pres-
sure on the ridge in the cervical region of the artificial
teeth. Intimate contact between teeth and ridge was
obtained without putting pressure on the gingiva,
resulting in a natural appearance (Figs. 3 and 4). Fig. 4. Final prosthesis in place.
After 2 years, the prostheses needed no retention
adjustments, though the expected loosening occurred
initially. If necessary in the future, composite could be
added to restore the contour.
the cusp allows, the palatal clasp arm can be extended
DISCUSSION
mesially from the buccal-distal angle, providing recip-
This technique is applicable only to specific situa- rocation and preventing metal from showing. If the
tions. When contact between the first premolar and clasp had to be placed on a second premolar, recipro-

466 VOLUME 86 NUMBER 5

DE ROSSI, ALBUQUERQUE JUNIOR, AND BEZZON THE JOURNAL OF PROSTHETIC DENTISTRY

cation would not be so easily achieved because the
retentive arm would not be adequately extended
mesially.
SUMMARY
In the treatment presented, complete patient satis-
faction was achieved when conventional RPD clasps
were replaced with retentive arms in a palatal position
and the buccal flange was eliminated.
8. Quinn DM. Artificial undercuts for partial denture clasps. A technique
using composite filling materials. Br Dent J 1981;151:192-4.
9. Hebel KS, Graser GN, Featherstone JD. Abrasion of enamel and com-
posite resin by removable partial denture clasps. J Prosthet Dent
1984;52:389-97.
10. El-Askary AS, Pipco DJ. Autogenous and allogenous bone grafting tech-
niques to maximize esthetics: a clinical report. J Prosthet Dent
2000;83:153-7.
11. Sykora O. Esthetic considerations in the construction of a removable par-
tial denture. Quintessence Int 1994;25:757-62.
12. McGivney GP, Carr AB. McCracken’s removable partial prosthodontics.
10th ed. St. Louis (MO): Mosby; 2000. p. 97-142.

Reprint requests to:

REFERENCES DR OSVALDO LUIZ BEZZON
1. Reagan SE, Rold TM. Practical, esthetic options for retention of remov- DEPARTMENT OF PROSTHODONTICS
able partial dentures: a case report. Quintessence Int 1996;27:333-40. SCHOOL OF DENTISTRY OF RIBEIRÃO PRETO
2. King GE. Dual-path design for removable partial dentures. J Prosthet UNIVERSITY OF SÃO PAULO
Dent 1978;39:392-5. AVENIDA DO CAFÉ S/N°
3. Jacobson TE, Krol AJ. Rotational path removable partial denture design. J RIBEIRÃO PRETO–SP
Prosthet Dent 1982;48:370-6. BRAZIL
4. Firtell DN, Jacobson TE. Removable partial dentures with rotational paths CEP: 14040-904
of insertion: problem analysis. J Prosthet Dent 1983;50:8-15. FAX: (55)16-633-0999
5. Belles DM. The Twin-Flex clasp: an esthetic alternative. J Prosthet Dent E-MAIL: olbezzon@forp.usp.br
1997;77:450-2.
6. Marinello CP, Shärer P, Meyenberg K. Resin-bonded etched castings with Copyright © 2001 by The Editorial Council of The Journal of Prosthetic
extracoronal attachments for removable partial dentures. J Prosthet Dent Dentistry.
1991;66:52-5. 0022-3913/2001/$35.00 + 0. 10/1/119678
7. Piirto M, Eerikainen E, Siirila HS. Enamel bonding plastic materials in
modifying the form of abutment teeth for the better functioning of partial
prostheses. J Oral Rehabil 1977;4:1-8. doi:10.1067/mpr.2001.119678

Access to The Journal of Prosthetic Dentistry is reserved for print subscribers!

Full-text access to The Journal of Prosthetic Dentistry Online is available for all print sub-
scribers. To activate your individual online subscription, please visit The Journal of Prosthetic
Dentistry Online, point your browser to http://www.mosby.com/prosdent, follow the prompts to
activate online access here, and follow the instructions. To activate your account, you will need
your subscriber account number, which you can find on your mailing label (note: the number
of digits in your subscriber account number varies from 6 to 10). See the example below in
which the subscriber account number has been circled:

Sample mailing label

**************************3-DIGIT 001
This is your subscription
SJ P1
account number
FEB00 J010 C: 1 1234567-890 U 05/00 Q: 1
J. H. DOE
531 MAIN ST
CENTER CITY, NY 10001-001

Personal subscriptions to The Journal of Prosthetic Dentistry Online are for individual use
only and may not be transferred. Use of The Journal of Prosthetic Dentistry Online is subject
to agreement to the terms and conditions as indicated online.

NOVEMBER 2001 467