Prosthodontics

Enhanced CPD DO C

Jasmeet Heran

Wouter Leyssen and AD Walmsley

Acrylic Dentures: Fill the Gap.

Part 3: The Most Common Acrylic
Denture Cases
Abstract: Acrylic partial dentures often do not receive the same attention to detail when being planned compared to cobalt–chromium
prostheses. However, if a system of design is followed when planning acrylic dentures, retention, stability and support of the prostheses
can be improved, increasing patient satisfaction. The aim of the third part of this series is to demonstrate how the design principles
can be put into practice using a series of examples of the most common partially dentate situations encountered at the Birmingham
Dental Hospital.
CPD/Clinical Relevance: Knowledge of the principles of denture design for mucosal-borne partial dentures as applied to cmmon
saddle situations.
Dent Update 2023; 50: 170–174

Acrylic partial dentures are commonly teeth in a free-end saddle situation. Trends a period of healing prior to bridge/implant
prescribed by dental practitioners to replace were noted in the design for distinct groups of placement or the construction of a more
missing teeth. The first two articles of this partial denture cases and, for the purpose of permanent denture.1
series considered the system of design that this article, have been categorized as shown Because the anterior saddle area is
is followed when planning acrylic mucosal- in Table 1. small, and the force applied to the artificial
borne dentures. This final article demonstrates tooth/teeth during function is limited, soft
how to apply this in practice, with a review tissue support is usually adequate and tooth
Maxillary arch support not always necessary. The main
of the most common partially dentate cases
seen and treated with acrylic dentures at the Replacement of one or two anterior teeth challenge associated with these types of
Birmingham Dental Hospital. Acrylic dentures that replace one or a dentures is in achieving sufficient retention
Owing to routine work being suspended limited number of anterior teeth are often because tight posterior interdental contacts
during the COVID-19 crisis, ongoing denture provided as a temporary solution to replace and a fully dentate opposing arch may
cases at Birmingham dental hospital were teeth lost following extraction or trauma. complicate clasp design. Another difficulty
reviewed and assessed. Acrylic partial They are usually fitted immediately as an is in obtaining sufficient indirect retention
dentures were prescribed for 314 partially aesthetic replacement following tooth loss, as clasping posterior teeth on either side of
dentate arches. Of these cases, 63% replaced and used as an interim measure to allow for the arch forms a clasp axis, around which the
denture could rotate. Common design options
include the following.

Jasmeet Heran, BDS, MFDS, DCT, Birmingham Dental Hospital. Wouter Leyssen, BDS, Denture without clasps
MJDF, MSc, Specialty Dentist, Restorative Dentistry, Birmingham Dental Hospital. AD
In this type of denture, retention is derived
Walmsley, PhD, MSc, BDS, FDSRCPS, Professor of Restorative Dentistry, College of
from the buccal undercut of the anterior
Medical and Dental Sciences, University of Birmingham School of Dentistry.
edentulous ridge, friction between the acrylic
email: [email protected]
tooth/teeth and neighbouring teeth, friction

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Maxillary arch Mandibular arch palatal surfaces of the natural dentition has
the potential to be detrimental to periodontal
Replacement of one or two anterior teeth Free-end saddle with limited number health if the patient’s oral hygiene is not
of remaining teeth satisfactory. However, there may be certain
Limited number of teeth remaining Unilateral free-end saddle situations where a short-term compromise
 Limited number of anterior teeth remaining in periodontal health may be considered in
 Limited number of posterior favour of denture retention and stability.
teeth remaining
Spoon denture
Multiple bounded saddles Anterior saddles
A spoon denture (Figure 2) is designed at
Large anterior saddle area least 8 mm clear of the gingival margins and
Table 1. Categorization of common partial acrylic denture cases. retained mainly through adhesive forces
between the denture base and mucosa,
the tongue and tight contact between the
artificial tooth and adjacent teeth. To aid this
tight contact, the tooth contact point on the
plaster model can be very lightly abraded
using fine sandpaper. Palatal extension of
the connector helps to provide support
and bracing, hence, a high-vaulted palate
will be more anatomically favourable in
comparison to a shallow palate. For best
results, the posterior border of the denture
should lie past the mesial surfaces of the
second molars. Smaller spoon dentures with
less palatal coverage will be less retentive.
Figure 3. Modified spoon denture with Additionally, smaller dentures could pose an
Figure 1. Acrylic denture replacing two teeth. C-clasps to provide retention. The additional aspiration risk.3
There are no clasps and therefore, retention relies tooth unit replacing the UL7 will also provide
on tight contact. indirect retention. Modified spoon denture
A modified spoon denture is a traditional
spoon denture with clasps added to increase
retention. C-clasps (Figure 3) are more
commonly used, but Adam’s cribs (Figure
4) can also be used in patients with wider
interdental spaces. However, there is potential
for them to deform, so their use tends to be
limited to short-term options only. Another
alternative is the use of embrasure clasps,
although they have the disadvantage of being
plaque retentive. Clasps will be reciprocated
Figure 2. Spoon denture.
by extending acrylic onto the palatal surfaces
of the clasped teeth. Adding an additional
Figure 4. Modified spoon denture: Adam’s cribs tooth unit on the opposite side of the clasp
provide retention. axis of the anterior saddle will help provide
between the major connector and the palatal
surfaces of the adjacent teeth and adhesion/ indirect retention (Figure 3). The acrylic
cohesive forces between the denture base of the major connector is kept away from
and the denture-bearing area. Because this the gingival margins of the natural teeth
improved further by using the undercuts on where possible to limit increased plaque
denture type uses a planned path of insertion,
the palatal surfaces of the natural teeth. This accumulation in these areas.
casts will need to be surveyed and tilted
may involve requesting the lab technician to
so that the path of insertion will allow the
denture flange to sit in the buccal undercut limit/reduce blocking out these undercuts. An Every design denture
of the ridge. This will provide resistance to the Ideally the denture base should cover the An Every design denture (named after RG
path of displacement vertically. In addition, teeth just above the palatal survey lines Every who first described it) (Figure 5) is
the denture will need to be well adapted (Figure 1).2 This design is not suggested in useful when there are bounded saddles
to the soft tissues and a posterior pindam, immediate denture cases, as the amount of in an anterior Kennedy class 3 or Kennedy
which is considered to be a narrower form of ridge resorption that will occur following class 4 situation. The aims of the design
postdam, should be included in the design. tooth extraction can be unpredictable, leading are to minimize the risk of exacerbating
Maximizing palatal coverage will provide to early retention loss.3 Acrylic coverage of periodontal disease or caries while gaining
better support and retention, which can be the major connector onto and around the retention through the application of principles

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circumferential clasp (Figures 7 and 8)

more aesthetically acceptable. Acetal resin
(polyoxymethylene) is a strong but flexible
material. To provide sufficient retention when
engaging undercuts, the clasps need to be
greater in cross-sectional diameter than
metal-based clasps to prevent excessive clasp
flexure.5 A bulkier clasp will have implications
on aesthetics and plaque accumulation.
Another option is to reduce the weight of
these dentures by decreasing the bulk of the
denture acrylic as much as possible. Limited
palatal coverage can also be considered to
Figure 5. Every type denture. reduce the forces of displacement acting
Figure 8. Denture with limited palatal coverage
and acetal resin clasps. on the denture (Figure 8). Denture fixative
will likely be a helpful adjunct, and this
can be discussed with the patient at the
start of treatment so that expectations are
appropriately managed.

Limited number of posterior teeth remaining

The design of a denture for a patient with
one or two, spaced posterior teeth remaining
is another difficult situation. It is important
to rely on complete denture principles and
modify these to allow for successful treatment.
Figure 9. Cusil design around remaining UL8.
Accurate impressions are essential to record
the full denture-bearing area, which will
optimise support. However, obtaining a full
surface of last standing tooth to prevent border seal is not possible even with optimal
distal movement of abutment teeth flange extension because of the presence of
 Acrylic of major connector kept at least the remaining teeth, and retention is likely
3 mm free from gingival margins palatally to be suboptimal with a conventional partial
 Free-occlusion, meaning no denture design.
occlusal interferences An alternative approach is the Cusil
design (Figure 9). Denture acrylic is wrapped
Figure 6. Example of an anterior Valplast denture.
around the remaining tooth/teeth above
Flexible dentures
the survey line and a soft resilient lining is
As discussed in Part 2 of this series, attached to the fit surface of the denture
polyamide-based flexible dentures (eg underneath this point of maximum bulbosity
Valplast; Figure 6) can be used to replace a few around the entire tooth circumference.6 This
missing anterior teeth. Owing to their small allows a better border seal to be maintained,
size, they provide limited support, which may and retention is increased through frictional
traumatize the surrounding mucosal tissues resistance. As the lining material is flexible,
around the abutment teeth. There is also a risk the denture can still be removed and inserted
of inhalation with small dentures. without difficulty. In order to use this
Figure 7. Acetal resin clasps. approach, a high survey line is needed around
Limited number of teeth remaining the remaining tooth/teeth, and they should
Limited number of anterior teeth remaining not be excessively tilted.
employed in complete denture construction.4 The main challenge faced in designing Where the use of a Cusil design is not
The design should include: dentures for patients with a few remaining possible, retention can be obtained by
 Accurate shape of the polished surfaces to anterior teeth is achieving sufficient retention clasping the remaining teeth (Figure 10).
assist muscular forces because incisors often lack appropriate It is likely in these cases that patients will
 Appropriate extension of denture buccal undercuts. However, simple tooth need to rely on denture fixative to augment
base onto the palate to provide modification can be helpful to produce a more retention. Often, patients will use too
sufficient support favourable undercut depth, and commonly much adhesive, which will prevent contact
 Point contact between artificial denture this is created by composite addition. between the denture base and mucosa, so
teeth and natural dentition with Clasping anterior teeth with wrought it is important to advise on how to use their
wide embrasures clasps can compromise aesthetics. Some fixative appropriately, and that they follow the
 Distal wire stabilizers contacting distal patients may find the use of an acetal resin manufacturers guidance for use.

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In cases where there are no anterior

retained roots, the large edentulous space
provides sufficient support. This can be
increased by extending the denture base up to
the distal aspect of the last remaining natural
tooth of the arch. Retention can be gained by
clasps around the remaining abutment teeth,
and if there is insufficient undercut, this can be
modified and created. Distal stabilizers can also
be added as discussed for the Every denture.
A potential problem that may be
encountered is rotation of the saddle away
from the anterior edentulous space. This can be
reduced by extending the major connector into
the embrasure spaces above the survey line
(Figure 12), but this could have a detrimental
Figure 12. Large anterior saddle area: major effect on periodontal health especially if oral
connector extended into embrasure spaces of hygiene is poor. Another solution would be
remaining teeth. to engage the buccal undercut of the anterior
ridge, clasp the most anterior abutment teeth
or by addition of occlusal units posteriorly as
previously discussed.
Figure 10. Wrought clasp used for remaining
tooth with deep buccal undercut.
Mandibular arch
Free-end saddle with limited number of
remaining teeth
In free-end saddle situations with a limited
number of anterior teeth (Figure 13), it is
Figure 13. Mandibular partial acrylic denture and likely that support will mostly be derived from
master cast. the mucosa. Covering the remaining lingual
surfaces of the anterior teeth with acrylic
above the survey line will add an element of
to increase retention and prevent rotation. tooth support and provide indirect retention.
Depending on the distribution of the If possible, clasping the two teeth next to the
remaining teeth, the acrylic connector can free end saddle areas will enhance retention.
either be kept close to the survey lines on Guide planes could be considered when an
additional anterior bounded saddle is present,
the palatal aspect of the teeth (to provide
but often, this will affect the aesthetics.
reciprocation and possibly some retention)
Optimal impressions will allow for an
or kept 3-mm free if periodontal health is
accurate record of the functional depth and
a concern.
width of the sulcus so that flanges can be
Figure 11. Large anterior saddle area: note the
appropriately extended. This will help provide
Large anterior saddle areas bracing, as the denture cannot solely rely on
anterior retained roots.
A frequent finding of the large anterior the remaining dentition if there are only a
saddle cases being treated in our prosthetics few remaining teeth. Lingual plates are used
department was the presence of anterior as a major connector and extending the
Multiple bounded saddles retained roots (Figure 11), which lend major connector up to the lingual aspects
Usually when there are multiple bounded themselves to being used as overdentures in of the clasped abutment teeth provides the
saddles a Cobalt–Chromium (Co-Cr) denture these cases. required reciprocation.
is the preferred choice. However, when the An advantage of retaining pathology- For partially dentate arches with poor
remaining teeth have a dubious prognosis free anterior roots is that they can provide quality abutment teeth, it is important to
and planning for failure is indicated, or tooth-support for the denture and can act treatment plan the remaining teeth in respect
when patients’ preferences are taken into as an indirect retainer, helping to counteract to their importance in the denture design.
consideration, an acrylic denture could rotational movement. However, the roots Decisions are made on whether extraction
be an alternative. Often these cases are will maintain the volume of the bone which may be more suitable with the aim of trying to
relatively more straightforward to design will limit the space available for acrylic teeth. future-proof the prosthesis because extraction
because indirect retention is less of a There may also be difficulties in extending the of poor teeth following denture completion will
concern. It is worth assessing primary buccal flange owing to the buccal undercut result in bone resorption and deterioration of
models to identify/create guide surfaces of the anterior ridge. fit. Furthermore, trying to preserve at least one

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teeth (Figure 16). If the tooth adjacent to the

anterior saddle area is an incisor or bulbous
canine then preparation of a guide surface
to enhance retention is difficult to achieve
without changing the appearance of the
tooth, thereby compromising the overall
aesthetics. Another option to increase
retention could be to not fully block out the
undercuts and have acrylic collets extending
into the interdental areas. This may create a
risk to periodontal health if a patient does not
have optimal oral hygiene.
To overcome rotation of the denture into
the anterior saddle area during function, the
acrylic should cover the palatal aspect of the
canines up to and above the survey line thus
providing indirect retention.
Figure 14. Single lone-standing canine
mandibular arch. Figure 16. Denture replacing limited number of
anterior teeth.
Conclusion
Acrylic partial dentures can be useful in
restoring function and aesthetics of the
partially dentate patient. Clinical care and
prevent rotation and would be more aesthetic
than a Cusil approach. However, the close attention needs to be given to the design of
adaptation to the tooth surfaces combined the prosthesis in order to prevent damage
with the movement of the saddle could to the hard and soft tissues, and to achieve
compromise the long-term survival of the an optimal result. When greater numbers
abutment tooth. Alternatively, retained canines of teeth are lost, there will be more reliance
may be root filled and used as overdenture on mucosal support, and this could also
abutments or extracted. limit overall retention and stability of the
prosthesis, which has been discussed for
Unilateral free-end saddle several partially dentate situations. Therefore,
Unilateral saddle areas can be best treated any successful treatment plan will need to
by clasping the most posterior teeth of ensure that the patients’ expectations are
the dentate segment and at least one realistic and appropriately managed.
other clasp crossing over into a tooth
embrasure (Figure 15). Extending the Compliance with Ethical Standards
Figure 15. Unilateral saddle area. denture appropriately will also maximize the Conflict of Interest: The authors declare that
support available. they have no conflict of interest.
Bracing will be provided by the remaining Informed Consent: Informed consent was
long-rooted tooth either side of the midline teeth and clasps. Indirect retention will be obtained from all individual participants
will help improve stability of the denture. an issue, but the presence of multiple clasps included in the article.
In a situation where only one canine will limit rotational movement. Also, for these
remains (Figure 14), a Cusil approach can cases, denture fixative is a useful adjunct. References
be used, although it may not be the most 1. St George G, Hussain S, Welfare R. Immediate dentures:
1.Treatment planning. Dent Update 2010; 37: 82–91.
aesthetic option. For canines where there has Anterior saddles https://doi.org/10.12968/denu.2010.37.2.82
been significant recession or more extensive A denture replacing a few anterior lower 2. Farrell J. Partial Denture Designing. London: Henry
undercuts, this option will be less suitable. The incisors is another common situation. Issues Kimpton Publishers, 1962.
3. El Maroush MA, Benhamida SA, Elgendy AA,
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