Rotational path partial denture design: A lo-year clinical

follow-up-Part II
T. E. Jacobson, DDS*
University of California, San Francisco, Calif.

A dvantages of the rotational path procedure re-
lated to the reduction of clasps contained within a pros-
thesis have been discussed by various authors.1-g However,
there has not been universal acceptance and application of
the rotational path concept among practicing dentists.
Presented before the Academy of Prosthodontics annual meeting,
Vancouver, B. C., Canada
BAssociate Clinical Professor, Department of Restorative Den-
tistry, School of Dentistry.
J PROSTHET DENT 1994;71:278-82.
Copyright @ 1994 by The Editorial Council of THE JOURNAL OF
PROSTHETIC DENTISTRY.
0022-3913/94/$3.00 + 0. 10/l/62261
Halberstam and Rennerg recently stated that “although
the rotational path removable partial denture has been
available for many years, it is often overlooked by the den-
tal profession.”
Perhaps, as Asher’O noted, there may be “. . . inadequate
understanding of the mechanics of rotational path remov-
able partial denture design.” Other reasons may include
difficulty in obtaining knowledgeable laboratory support,
the absence of documented evidence of long-term clinical
success,or a general lack of confidence in the efficacy of the
procedure.
To understand the reasons for the limited application of
the rotational path concept by dentists, a survey of the
membership of the Academy of Prosthodontics was con-

Fig. 1. Patient 1 at la-year recall. A, Occlusal view. B, Rigid retentive element closely
adapted to undercut portion of tooth. C, Rest closely adapted to rest seat preparation. D,
Rest and minor connector demonstrate stable relationship to abutment.

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JACORSON THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 2. Patient 2 at IO-year recall. A, Occlusal view of partial denture in mouth. 3, Rigid
retentive portion of partial denture in intimate contact with proximal surface of canine.
C, Rest and minor connector satisfies requirements of clasp design over time.

ducted. Although this population may not provide a valid
cross section of dentists who practice prosthodontics in the
United States, it may represent a cross section of prosth-
odontists currently involved in teaching and practicing
prosthodontics. The purpose of this survey was to gain in-
sight into the attitudes and thoughts of this particular
group of specialist,s regarding the rotational path of place-
ment design concept.
RESULTS
Table I lists the statements that were included in the
questionnaire that was distributed to the 93 associate, ac-
tive, and life fellows of the Academy of Prosthodontics
listed in the July 1992 membership roster. There were 62
written responses to the questionnaire. Members were
asked to provide a positive response to all statements that
were appropriate for their practice. The number of positive
responses of the 62 participants is listed next to each
statement in Table I. The number of positive responses for
each statement is also listed as a percentage of the total
number of respondents in the survey.
There were 31 members who were not included among
the respondents. This included those members who did not
respond and those who indicated that they were not
currently engaged in the teaching or practice of prostho-
dontics.
DISCUSSION
Most of the respondents (34 %) indicated that they often
make removable partial dentures in their practice. In sit-
uations that require the elimination of clasps, the group
was divided nearly equally between preference for the ap-
plication of precision attachments versus the rotational
path concept. Nearly half of the respondents use the rota-
tional path procedure often and have experienced long-
term favorable success rates. However, despite the advan-
tages cited by various authors for the use of the rotational
path design as an alternative to attachments when indi-
cated, many participants prefer to use precision attach-
ments.
Although most respondents believed that they under-
stood the rotational path concept, nearly 20% indicated
that they had only a superficial understanding. This lack
of understanding may be a reason for the reduced applica-
tion of this procedure in indicated situations. Perhaps the
level of understanding of the rotational path concept is

MARCH 15394 279

THE JOURNAL OF PROSTHETIC DENTISTRY JACOBSON

Fig. 3. Patient 3 at l&year recall. A, Occlusal view without partial denture, 3, Occlusal
view of partial denture in place. C, Close-up of rigid retainer on maxillary right canine. D,
Close-up of retainer on maxillary left lateral incisor demonstrates continuing adaptation
to rest seat.

Table I. Questionnaire statements

Positive responses Percentage of respondents

I often make removable partial dentures in my practice. 52 84

I rarely make removable partial dentures in my practice. 8 13
I do not make removable partial dentures in my practice. 2 3

I believe that I fully understand this concept (rotational path of insertion). 50 81

I have only superficial understanding of this concept. 11 18
I do not understand this concept. 1 2

I use this technique often and have experienced long-term, favorable 29 47

success rates.
I do not believe that this approach is as predictable as certain reports in 12 20
the literature and proponents have indicated.
I do not use this technique because of difficulties in obtaining 8 13
knowledgeable laboratory support.
I do not use this technique because of the absence of documentation of 10 16
long-term clinical success rates in the literature.

Given the choice of this concept or attachments, I prefer the rotational 31 50

path design where indicated.
Given the choice of this concept or attachments, I prefer attachments. 25 40

280 VOLUME 71 NUMBER 8

JACOBSON
Fig. 4. Patient 4 at lo-year recall. A, Occlusal view of mouth. B, Occlusal view of partial
clenture in place. C, Close up of rest and minor connector on maxillary left lateral incisor
continues to indicate excellent adaptation.
even lower within the total population of dentists practic-
ing prosthodontics.
Eight of the participants do not use the rotational path
concept because of the difficulties in obtaining knowledge-
able laboratory support to assist in making the framework.
Although this does not constitute a large percentage of the
group, it does point out the importance of technical
support. Laboratory personnel should receive training in
the rotational path concept. The maintenance of intimate
contact of the rigid retainers with the adjacent tooth sur-
face and the development of appropriate relief of certain
framework components are two examples of laboratory-
controlled specifications.
A significant number of respondents indicated that they
do not use the rotational path concept because of the ab-
sence of documentation of long-term clinical success rates
in the literature. A similar number of respondents believe
that this technique is not as predictable as some propo-
nents have indicated. The author has used the rotational
path partial denture design in the private practice of pros-
thodontics since 1980 with predictable results. Although
impossible to validate through statistical analysis, long-
term clinical follow-up of patients who have received rota-
MARCH 1994
~EJOURNALOFPROSTHETICDENTISTRY
tional path removable partial dentures may provide evi-
dence supporting the clinical efficacy of this procedure.
LONG-TERM CLINICAL FOLLOW-UP
Patient 1
Patient 1 received a category I rotational path removable
partial denture in March 1981 that replaced missing max-
illary posterior teeth; right first molar, first and second
premolars, left first and second premolars, and first molar.
The prosthesis was evaluated in January 1993, having been
used for nearly 12 years by the patient without complaint.
Fig. 1 illustrates that the rests and minor connectors, which
served as rigid retainers, have maintained a stable rela-
tionship and intimate contact with the adjacent rest seats
and proximal surfaces of the abutments. The basic require-
ments of clasp design have been satisfied over the 12-year
period.
Patient 2
Patient 2 received a category I rotational path prosthe-
sis in August 1981 that replaced missing maxillary poste-
rior teeth; right first molar, first and second premolars, and
left first and second molars. The prosthesis was evaluated
281
THE JOURNAL OF PROSTHETIC DENTISTRY
in March of 1992. As indicated in Fig. 2, the rests and mi-
nor connectors of the rigid retainers have maintained a
stable relationship with the abutment teeth. Adequate en-
circlement of the abutment teeth has maintained stable
abutment tooth positions for over 10 years.
Patient 3 evidence of long-term clinical success,and a general lack of
Patient 3 received a category I rotational path removable
partial denture in April 1983 that replaced missing maxil-
lary posterior teeth; right first molar and first premolar, left
canine, and first and second premolar and first molar. Fig.
3 demonstrates the intimate relationship between rests and
rest seats and between the minor connectors and the prox-
imal abutment tooth surfaces that existed in February of
1993. After 10 years, the rigid retainers continue to dem-
onstrate support, stability, retention, adequate encircle-
ment, and passivity at rest.
Patient 4
Patient 4 received a category II rotational path prosthe-
sis in September of 1983 that replaced missing maxillary
posterior teeth; right first and second molars and left
canine, first and second premolars. In March 1993, the rest
and minor connector of the single rigid retainer demon-
strated intimate contact with the lateral incisor rest seat
and distal surface (Fig. 4). Patient 4 represents the appli-
cation of the rotational path concept in an extension base
situation. When tooth-supported modification spaces are
present in Kennedy class I and II situations, it is often
possible to apply a rotational path of placement. However,
the primary indication of this concept is for tooth-sup-
ported dentures.
SUMMARY
A review of the rotational path removable partial den-
ture design concept has been presented. The rigid direct
retainers used in these designs satisfy the basic require-
ments of clasp designs. The reported results of a survey of
282
JACOBSON
the members of The Academy of Prosthodontics may pro-
vide insight into the reasons for reluctance on the part of
some practitioners to use the concept more often when in-
dicated. Possible reasons include the following: lack of suf-
ficient understanding of the concept, difficulty in obtaining
knowledgeable laboratory support, absence of documented
confidence in the efficacy of the procedure as described in
the literature.
This article presents references that are available to im-
prove the understanding of technicians and dentists with
regard to the rotational path concept. In addition, several
patients followed up for 10 or more years demonstrated
long-term clinical success.
REFERENCES
1. King GE. Dual path design for removable partial dentures. J PROSTHJZT
DENT 1987;39:392-5.
2. King GE, Barco MT, Olson RJ. Inconspicuous retention for removable
partial dentures. J PROSTHET DENT 1978;39:505-7.
3. Jacobson TE, Krol AJ. Rotational path removable partial denture de-
sign. J PROSTHET DENT 1982;48:370-6.
4. Jacobson TE. Satisfying esthetic demands with rotational path partial
dentures. J Am Dent Assoc 1982;105:460-5.
5. Brien N, Lamarche C, Tache R. Les plans d’insertion multidirection-
nels: leurs applications aux pants papillian. J Dent Que 1965;22:69-‘76.
6. Krol AJ, Finzen FC. Rotational path removable pa&l dentures: Part
I. Replacement of posterior teeth. Int J Prosthet Dent 1988;1:17-27.
7. Krol AJ, Finzen FC. Rotational path removable partial dentures: Part
II. Replacement of anterior teeth. Int J Prosthet Dent 1988;1:135-42.
8. Krol AJ, Jacobson TE, Finsen FC. Removable partial denture design,
an outline syllabus. 4th ed. San Rafael, Calii Indent 1990:69-66.
9. Haberstam SC, Renner RP. The rotational path removable partial den-
ture. The overlook alternative. Compend Contin Educ Dent X13$4:544.
10. Asher ML. Application of the rotational path design concept to a
removable partial denture with a distal extension base. J PROSTHET
DENT 1992;68:641-3.
Reprint requests to:
DR. T. E. JACOBSON
129 SACRAMENTO ST.
SAN FRANCISCO, CA 94111
VOLUME 71 NUMBER 3