REMOVABLE PARTIAL DENTURES

INFLUENCE OF OCCLUSAL REST POSITION AND

CLASP DESIGN ON MOVEMENT OF ABUTMENT TEETH

FRANK J. KRATOCHVIL,” COMMANDER (DC) USN

U. S. Naval Dental School, National Naval Medical Center, Bethesda, Md.

most interesting and thought-provoking situations occurs

0 NE OF THE DENTIST’S
when treatment requires a rigid prosthetic replacement which must be com-
patible with two different kinds of support. This situation exists in treatment with
distal extension partial dentures.
To weigh the merits of various designs, several methods of treatment must be
studied and their effects on both hard and soft structures evaluated.
Since the greatest difficulty occurs in the transition area where tooth support
ends and mucosa support begins, i.e., in the tooth-tissue region adjacent to the
edentulous space, this discussion will be confined to the distal extension situa-
tion. Three basic aspects will be considered : (1) the effect of the rotation or oc-
clusal rest position on the soft and hard tissues, (2) the effect of clasp design and
placement on hard and soft tissues, and (3) considerations at the junction of the
tooth and edentulous mucosa.

EFFECT OF THE ROTATION OR OCCLUSAL REST POSITION

The relative merits of the mesial and the distal rotation point, or rest, on the
most posterior abutment tooth have been discussed.1,2 A training aid can be used
to demonstrate clearly the effect of the rest placement (Fig. 1). This training aid
has a changeable rotation pin, and the movement of a partial denture base can be
diagrammatically shown. Fig. 1 demonstrates the direction of movement of a den-
ture base with a distal rest.
The gingival part of the denture base adjacent to the posterior abutment
moves in an arc almost parallel to the mucosa. This results in little or no support
from the mucosa near the tooth. Also, the soft tissue adjacent to the tooth may
be pinched, with resultant tissue strangulation.

Read before the Academy of Denture Prosthetics in Colorado Springs, Cola.

The opinions or assertions contained herein are the private ones of the author and are not
to be construed as official or reflecting the views of the Navy Department or the naval service
at large.
*Head, Removable Partial Denture Division.
114
 OCCLUSAL REST POSITIOK AND CLASP DESIGN 115

AS; the denture base is followed posteriorly, the arc of movement becomes I1lore
nearly 1lerpendicular to the surface of the mucosa.
R\ 7 movement of the rotation point (the occlusal rest) to the mesial s tlr face

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 1.-A training aid demonstrating the direction of forces against the edentulou arc=51
and the 1posterior tooth when a posterior rotation point is used.
Fig. 2.-The direction of forces is more nearly vertical when an anterior rotation p oil nt is
used.
Fig. 3.-The differences in the direction of forces. The lines with arrows show the di r-e,:tion
of the fc rces when a posterior rest is used. The lines without arrows result from the use 0If an
anterior rest.
 KRATOCHVIL J. Pros. Den.
116 Jan..Feb., 1963

Fig. 4.-An abutment tooth will be moved toward the side on which the rest is located.

of the most posterior tooth (Fig. 2)) the arc of movement of the denture base is
changed. The direction of movement and force application is more nearly perpen-
dicular to the surface of the mucosa in each region under the base (Fig. 3). The
mesial fulcrum will increase the support provided by the soft tissues. Also, the di-
rection of movement at the gingival region adjacent to the tooth is less likely
to cause pinching or strangulation of the gingival tissules.
The placement of an occlusal rest distally to the central axis of the posterior
abutment tooth will tend to tip the teeth posteriorly (Fig. 4). If the rest is
placed on the mesio-occlusal surface, it will tend to tip the tooth mesially3 so it
will receive support and bracing assistance from the teeth anterior to it (Fig. 7).
The effect of the distal rest is shown (Fig. 5). When movement of the edentu-
lous base occurs, the force exerted on the tooth can be compared to that of a
precision-constructed and fitted “wrench” (Fig. 6) which tends to tip or pull
the tooth backward. This can result in tooth mobility, bone loss, and tooth and
denture movement bodily, with resulting occlusal disharmony.
As a result of transferring the rest to the mesial surface (Fig. 7), the denture
movement will force the tooth anteriorly and reverse the wrench effect (Fig. 8). All
remaining teeth will combine to help withstand this forward force.

Fig. 5.-An abutment tooth with a metal casting having the occlusal rest on the side ad-
jacent to the edentulous region. The arrows indicate the direction of forces when the denture
moves downward.
Fig. B.-The “wrench” effect exerted on an abutment tooth by a metal framework with
a disto-occlusal rest.
 Volun1e 13 OCCLUSAL REST POSITION AND CLASP DESIGN 117
Number 1

MfSlAL REST

Fig. 7. Fig. 8.

Fig. 7.-A mesio-occlusal rest on the metal casting on an abutment tooth. The arrows show
the direction of movement when the base moves.
Fig. S.-The wrench effect on an abutment tooth by a metal framework with a mesio-
occlusal rest is minimized.

EFFECT OF CLASP DESIGN AND PLACEMENT

Much importance is placed on the contour of fixed partial dentures, indi-

vidual crowns, and alloy restorations. Natural tooth anatomy and contour are
carefully studied because accurate reproduction of anatomic structures is essen-
tial for proper cleansing and stimulation of the gingival tissues.
When a circumferential clasp is placed on a tooth, the natural contour of the
tooth in cross section is altered (Fig. 9). Interference with the natural flow of
food over the tooth and onto the gingivae results in loss of the tissue stimulation so
necessary for healthy gingivae .4 This distortion of tooth form provides a space
for food debris to accumulate between the clasp and the gingivae. A much more
natural situation exists when an infrabulge I bar clasp is used5 (Fig. 10). This
type of clasp causes the least possible distortion of natural tooth contour and
allows for natural food flow, gingival stimulation, and minimal contact of the clasp
with the tooth.
The forces brought into play by different types of clasps on the distal abut-
ment tooth can be illustrated by a training aid, A commonly used T bar clasp is
shown in Fig. 11. As the metal framework rotates around a mesio-occlusal rest,
the mesial part of the clasp moves forward and slightly upward (Fig. 12). It

Fig. Q.-The contour of an abutment tooth is distorted by the circumferential type of

clasp arms.
 KRATOCHVIL J. Pros. Den.
118 Jan.-Feb., 1963

Fig. lO.-The infrabulge I bar clasp produces minimal alteration of tooth contour and
requires minimal contact with the tooth. The cuspid demonstrates the least possible alteration
of natural tooth contour and minimal tooth contact.

loses contact with the tooth and causes no adverse forces. The distal part of the
clasp moves forward and downward. This seems to be acceptable until an oc-
clusal view of the region is observed (Fig. 13). The distal part of the T bar wraps
around the natural curvature of the tooth. Then, when the distal part of the clasp
moves forward (Fig. 12), it engages the distal curvature of the tooth and exerts
a torquing effect which is most detrimental to the periodontal membrane. A solu-
tion to this problem is the use of an infrabulge I bar clasp (Fig. 14) with the
retentive tip placed at the point of greatest curvature of the buccal surface of the
tooth. As movement of the denture base occurs, the clasp moves forward and
downward away from the tooth (Fig. 15), completely losing contact with it and
removing any possibility of torquing action. If the clasp tip is placed distally
to the greatest curvature, it will engage the tooth in its forward movement and
produce torque.
If the fulcrum is moved to the distal surface of the tooth with the same

Fig. 11. Fig. 12.

Fig. Il.-A partial denture with a mesial rest and a T bar clasp.
Fig. 12.-The arrows indicate the direction of clasp movement when used with a mesial
rest.
 OCCLUSAL REST POSITION .4ND CL.4SI’ DESIGN 119

Fig. 13.-An occlusal view of a T bar clasp. The forward movement of the distal part of
the clasp produces a torquing effect by engaging the distal curvature of the tooth.

clasping situation (Fig. 16), the ,movement of the clasp tip will be upward and
forward. This will involve immediate engagement of the undercut area on the
tooth and cause a torquing effect on the abutment tooth.
When a mesial rest is used, a lingual reciprocating clasp arm or lingual plate
covering the lingual surface of the tooth is not desirable. The lingual clasp (Fig.
17) distorts the natural contour of the tooth. If the clasp is placed above the sur-
vey line, the tooth will be pushed or twisted toward the cheek as downward move-
ment of the denture occurs and as the clasp moves downward over the greatest con-
vexity of the tooth. This action is exactly the same as on the facial surface (Fig. 12).
The lingual plate (Fig. 18) will exert the same forces on the abutment tooth
as those of the lingual clasp arm. Also, the lingual curvature of the teeth will not
usually permit complete gingival-metal contacts. The space below the survey
line will not allow for adequate tissue contact and stimulation, and hypertrophy
of tissue into the void or gingival recession will result.
The lingual surfaces of these abutment teeth can be best treated by design-
ing the rest arm to extend straight downward from the rest onto the mucosa well
below and away from the gingival crest where it connects with the lingual bar.
A metal arm is then brought upward to contact the tooth on its distolingual sur-
face (Fig. 19). A lingual design of this type will remove the possibility of torque
which might result from a lingual clasp or plate, will preserve the natural lingual
contour of the tooth, thus allowing for more natural gingival stimulation, and
will provide the necessary reciprocation against the buccal retention clasp arnl
through the mesial rest and the distolingual metal contact.

CONSIDERATIONS AT THE JUNCTION OF TOOTH AND MUCOSA

Many distal extension partial dentures cause difficulties at the distogingival

region of the most posterior abutment tooth. The pathosis found involves (1) re-
cession of mucosa and gingival irritation, (2) a large open space between the tooth
and the denture so that debris collects, affecting the tooth and gingiva, (3) decay,
(4) loss of bone followed by mobility of the tooth, or (5) movement of abutment
teeth which allows the denture to shift to a different position, resulting in de-
flective occlusal contacts and further tissue destruction.
Since metal is clean and compatible with hard and soft tissues, all tooth struc-
120 KRATOCHVIL J. Pros. Den.
Jan.-Feb., 1963

ture on the distal surface of the tooth should be contacted with a thin metal
plate that extends 1 to 2 mm. onto the soft tissues (Fig. 20).
The metal plate will eliminate any contact of acrylic resin with the tooth.
Acrylic resin is more difficult to keep clean than metal. The metal will not wear

Fig. 14.

Fig. 15.

Fig. 16.

Fig. 14.-The tip of the infrabulge I bar clasp is placed at the point of greatest contour
of the surface of the tooth.
Fig. 15.-Movement of the I bar downward and forward is away from the tooth when a
mesial rest is used. 0
Fig. 16.-A clasp with a distal rest moves upward and forward as it engages an under-
cut and creates torque. With a mesial rest, the movement would be as indicated by the arrow.
Volume 13 OCCLUSAL REST POSITION AND CLASP DESIGN 121
Number 1

or chip when it is finished or cleaned, no space is created where food debris can
collect, and there is no void into which gingival tissues can hypertrophy.

Fig. 17.

Fig. 17.-A lingual reciprocating clasp with a mesial rest distorts the tooth contour and
twists the tooth as the clasp moves downward.
Fig. 18.-A lingual plate distal to the fulcrum point. The downward arc of movement in
function will twist the tooth toward its buccal surface.
Fig. lg.-The suggested design of the lingual side of the metal framework. The lingual
surface of the tooth and the tissue is kept clear. A distolingual clasp arm is [Link] nnwnrd
against the tooth for reciprocation.
122 KRATOCHVIL .I. Pros. Den.
Jan.-Feb., 1963

MOUTH PREPARATION

Proper mouth preparation and tooth alteration are usually necessary in the
region of the lingual plate on the posterior abutment tooth to create a parallel
surface.6

Fig. 20.

Fig. 20.-All tooth contacts are metal plus 2 mm. of mucosa adjacent to the abutment
tooth.
Fig. 21.4old rouge and chloroform are used to detect contacts at the tooth-metal contact
areas.
Fig. 22.-The areas of pressure against the tooth are revealed by shiny spots where the
gold rouge has been wiped away.
Volume
Number
13
1
OCCLUSAL REST POSITION AND CLASP DESIGN 123

The movement of the denture at the distogingival surface of the posterior abut-
ment tooth, as shown in Fig. 2, is downward and forward. This movement must
be considered when using distal plate coverage. This can be accomplished intra-
orally in the same manner and by using the same principles which apply when
adjusting the tissue surface of a complete denture to the tissue using a pressure-
indicating paste. Gold rouge and chloroform are excellent indicating materials for
metal. The gold rouge, wetted with chloroform, is painted on the metal (Fig. 21).
When the rouge has dried, partial denture movement is produced with finger
pressure in the patient’s mouth. The areas of contact are revealed as shiny spots
where the gold rouge is worn off (Fig. 22). These areas are carefully relieved and
retested until the pressure points have disappeared. Particular attention must be
directed to the rest arm which lies between the proximal surfaces of the abutment
teeth and moves with rotation of the denture. Pressure points d&closed by the
gold rouge in this region must be relieved to prevent a wedging action between
these teeth when movement of the denture occurs.

SUMMARY

1. When treatment with a removable partial denture is necessary, the transi-

tion region from tooth to mucosa support must receive most careful consideration.
2. An occlusal rest placed on the mesial or anterior part of the most distal
abutment tooth provides mucosa or soft tissue support more perpendicular to the
residual alveolar ridge than does one on the distal side of that tooth.
3. The gingival mucosa adjacent to the most posterior tooth is less likely to
be pinched when the occlusal rest is placed on the mesial side of the tooth.
4. The occlusal rest providing a mesial rotation point will tend to tip the
abutment tooth anteriorly where it will be reinforced and assisted by other
teeth.
5. All extracoronal retainers alter the natural tooth contour and interfere with
proper stimulation of the gingivae and natural cleaning action. The infrabulge
I bar design alters natural tooth contour the least and allows for more natural
gingival stimulation than any other type of extracoronal retainer. The area of
contact of the clasp with the tooth is minimal.
6. The I bar retentive clasp, when placed at the point of greatest circum-
ference of the tooth and used in conjunction with a mesio-occlusal rest or anterior
rotation point, will exert no adverse or torquing force on the abutment tooth.
7. The region of the junction between the tooth and the edentulous area ex-
hibits pathosis most frequently. The tooth contact should be made \vith a thin
metal plate which extends onto the soft tissue for at least 1 mm. This will increase
cleanliness and prevent mutilation of the denture base which results in a space at
the tooth-mucosa junction.
8. The metal-tooth contact at the distal gingival region must be physic+
logically adjusted in the patient’s mouth to prevent tooth and tissue impingement.

REFERENCES

1. Hind&, G. W. : Distal Extension Partial Dentures, J. PROS. DEN. 7:197-205, 1957.

2. McCracken, ‘CI’. L.: Contemporary Partial Denture Designs, J. PROS. DEN. 8:71-84, 1958.
 J. Pros. Den.
124 KRATOCHVIL
Jan.-Feb., 1963

3. Lammie, G. A., and Osborne, J.: The Bilateral Free-End Saddle Lower Denture, J. PROS.
DEN. 4:640-652, 1954.
4. Trapozzano, V. R., and Winter, G. R.: Periodontal Aspects of Partial Denture Design, J.
PROS. DEN. 2:101-107. 1952.
5. DeVan, M. M.: Preserving’ Natural Teeth Through the Use of Clasps, J. PROS. DEN.
5:208-214, 1955.
6. Seiden, A. : Occlusal Rests and Rest Seats, J. PROS. DEN. 8:431-440, 1958.
U. S. NAVAL DENTAL SCHOOL
NATIONAL NAVAL MEDICAL CENTER
BETHESDA 14, MD.