Journal of the California Dental Association

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Esthetic Considerations With Removable Partial

Dentures

Terry E. Donovan & George C. Cho

To cite this article: Terry E. Donovan & George C. Cho (2003) Esthetic Considerations With
Removable Partial Dentures, Journal of the California Dental Association, 31:7, 551-557, DOI:
10.1080/19424396.2003.12224200

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Published online: 15 Mar 2023.

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Esthetic Considerations With

Removable Partial Dentures
terry e. donovan, dds, and george c. cho, dds

abstract The reduction in partial edentulism that has occurred due to successful preventive
procedures and the predictable use of osseointegrated implants has reduced the need for
removable partial dentures. However, for a variety of reasons, many patients can continue
to benefit from partial denture therapy; and these patients deserve the best esthetic result
possible. The primary esthetic objection to removable partial denture therapy is the unsightly
display of the clasp assemblies. This article describes three strategies that can be used by the
discriminating clinician to eliminate the display of the clasp assembly and provide an esthetic
and functional removable prosthesis.

T
authors he emphasis on esthetic lacking in many practices in the discipline
dentistry has increased in the of removable partial prosthodontics.1
Terry E. Donovan,
past two decades. This increase This situation is likely due to the reduced
DDS, is a professor
and co-director of
has also resulted in an increase number of removable partial dentures
Advanced Education in the amount of restorative fabricated in most contemporary
in Prosthodontics at dentistry that is essentially esthetically practices, combined with a reduced
the University of the driven. In addition, the tremendous emphasis in removable prosthodontics in
Southern California
emphasis on preventive dentistry that many dental school curricula.
School of Dentistry.
began in the 1960s and continues to the However, a significant number of
George C. Cho, DDS, is present day has reduced the incidence patients with partial edentulism are
an associate professor of partial edentulism for the majority of unable to take advantage of implant
and clinical director North American adults. The high success therapy because of financial, anatomic,
of Advanced Education
rates reported with osseointegrated psychological, or systemic health
in Prosthodontics and
director of Pre-doctoral
implants has permitted the routine constraints. These patients can derive
Implant Dentistry at USC restoration of edentulous spaces with considerable esthetic and functional
School of Dentistry. implant-supported fixed restorations benefits from removable partial denture
and has reduced the need for removable therapy. This article describes several
partial dentures. strategies for providing a highly esthetic
It is clear that most practitioners removable partial denture for those patients
pay meticulous attention to detail when who could benefit from such therapy.
providing services such as porcelain Many patients believe that removable
veneers, metal-ceramic and all-ceramic partial dentures are inherently damaging
crowns, fixed partial dentures, and basic to the natural dentition, and indeed a
direct and indirect operative dentistry. well-known prosthodontist once wrote,
However, in the opinion of the authors, “A removable partial denture is a device
this meticulous attention to detail is for extracting one’s teeth slowly, painfully

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that many factors unrelated to the clasp

assembly affect the ultimate esthetic
result achieved with a removable partial
denture. Some of these factors include
proper tooth selection, tooth placement,
flange length and contour, and proper
interdental papilla contours.

Infrabulge Clasp Assembly

The use of the infrabulge clasp
F i g u re 1 and 2. The unsightly display of the Figure 2 .
clasp assemblies on these removable partial dentures is
assembly is the simplest approach to
objectionable for most patients. eliminating clasp assembly display and
should always be considered before
more complex solutions are utilized.
The retentive arm of infrabulge clasp
assemblies approaches the undercut on
the tooth from a gingival direction rather
than from the occlusal direction as is the
case with suprabulge clasps. Depending
upon the specifics of each individual
patient’s smile, this simple approach often
eliminates or minimizes the display of the
clasp assembly (Figures 3 and 4).
F i g u re 3 and 4. This patient’s smile permits esthetic Figure 3 .
reconstruction with a mandibular removable partial denture
The most practical approach to
using the RPI design concept. designing such removable partial dentures
is to utilize the RPI (rest, proximal plate,
I-bar) concept originated by Kratochvil
and modified by Krol.15,16 Both designs
are acceptable. According to these authors,
and expensively.”2 This statement is removable partial denture with the clasp the advantages of infrabulge clasp
undoubtedly true with poorly designed assemblies in nonvisible locations. assemblies designed according to these
and fabricated removable partial In addition to this basic principle, concepts include simplicity, cleanliness,
dentures, and there are several articles there are three specific strategies that and minimal interference with the natural
that clearly document the potentially can be utilized to design both functional contours of the abutment. In addition,
deleterious consequences of removable and esthetic removable partial dentures. with Kennedy Class I and II situations,
partial dentures.3-9 However, there are These strategies include use of infrabulge these clasp assemblies are stress-releasing
also several well-documented studies rather than suprabulge clasp assemblies, and thus can be used in both tooth-borne
that indicate that properly designed, the very selective use of precision and and distal-extension situations.17-20
fabricated and maintained removable semi-precision attachments, and, where Infrabulge clasps provide additional
partial dentures can provide esthetic indicated, use of the concept of the retention with a given undercut due to
and functional long-term benefits with rotational path removable partial denture. their inherent tripping action.21
minimal negative consequences.10-14 The appearance of clasp assemblies While this approach does not
The primary esthetic deficiency can also be improved with the use of automatically hide the clasp assemblies
resulting from removable partial denture tooth-colored or pink flexible polymer on every patient, it frequently is a very
therapy is the unsightly display of clasps. Little information on the long- simple and effective means of providing
conventional clasp assemblies (Figures 1 term clinical performance of such clasps an esthetically acceptable removable
and 2). This display is not an inevitable is available in the literature, and this partial denture for many patients. With
consequence of removable partial denture approach cannot be recommended by the distal-extension removable partial
therapy, and often it can be avoided authors at this time. dentures, the use of corrected impressions
simply by analyzing the patient’s smile Although beyond the scope of this and the altered cast technique or a
and dental display and designing a article, it is important to understand functional refit at the time of insertion is

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F i g u re 5. Intracoronal attachments require the removal of Figure 6 . Extracoronal attachments create an alteration F i g u r e 7. Secondary dental caries related to this
significant amounts of sound tooth structure to accommodate of the normal physiologic crown contour of the abutment extracoronal attachment necessitated removal of the fixed
the attachment within the confines of physiologic crown contour. tooth, which makes it difficult, if not impossible, to perform restoration.
This exacts a biologic price over time. adequate oral hygiene procedures.

indicated to provide optimum fit of the or complicate plaque removal (Figures 6 maintenance with an endless series of
denture base and the residual ridge. This and 7). The lack of adequate oral hygiene adjustments in a hopeless attempt to
has been shown to minimize stress on the that usually occurs frequently results in regain the initial level of retention.
abutment teeth.15, 22-26 Unfortunately, recurrent caries, destructive periodontal Attachments are simply an esthetic
these procedures are rarely utilized by disease, or both. There are a wide variety replacement for a traditional clasp
most North American dentists in spite of of extracoronal attachments available; assembly. Thus, the clinician must analyze
the documented benefits they provide.27 and they vary in design, size, and shape. each attachment prior to use to ensure
In general, it is best to avoid extracoronal that its design will meet all the functions
Precision and Semiprecision attachments with natural tooth abutments. of a traditional clasp assembly. These
Attachments If it is impossible to avoid use of such functions include retention, support,
The second approach to concealing attachments, the smallest attachment bracing, reciprocation, encirclement, and
the clasp assembly is the use of precision that will do the job should be selected to passivity at rest.28,29 With Kennedy
or semiprecision attachments. It is minimize the effect on physiologic crown Class I and II situations, attachments
the authors’ opinion that precision contour. The importance of excellent should also be stress-releasing and utilize
attachments are generally poorly oral hygiene must be emphasized to the traditional occlusal or gingival rests to
understood and overutilized by the patient, and the patient should be recalled support the attachment and prosthesis.
profession. frequently to reinforce hygiene procedures The reality is that very few commercially
Attachments may be classified as and intervene promptly should pathology available attachments meet these
precision or semiprecision, intracoronal result. specifications, and those that fail to do so
or extracoronal, and resilient or In the opinion of the authors’ most should be avoided.
nonresilient. Precision attachments are resilient attachments are to be avoided The authors have utilized two
machined by the manufacturer, while wherever possible. They rarely function approaches using attachments that have
semiprecision attachments are custom in the manner intended, are inherently proven to be successful and are worthy
fabricated by the laboratory technician. extracoronal in design, and are usually of consideration in certain specific cases.
The major disadvantage with intracoronal complex and technique sensitive. They The first concept is that of the stable base
attachments is that room must be made often require an inordinate amount of precision attachment removable partial
for the attachment within the crown. Box maintenance over time. denture.30-33 This concept utilizes the
forms to accommodate the attachment Nonresilient attachments can be very concept of mucostatics, and the master
must be prepared within the tooth at the difficult to fabricate, utilize frictional impression is made using a cast aluminum
time of tooth preparation. This removes retention, and should only be used in custom tray and a zinc-oxide eugenol
a considerable amount of healthy tooth tooth-borne situations. Such frictional impression material of very low viscosity
structure and often exacts a biologic price retention is often very impressive initially, to obtain an impression of the ridge at
later (Figures 5). but is also often lost or substantially rest (Figures 8). An extremely accurate
Extracoronal attachments inherently reduced over a short period. This again partial denture base is fabricated and
result in overcontoured areas that prevent results in an inordinate amount of united to the fixed restorations using

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Fig ur e 8. Mucostatic impressions are made with a very Figure 9 . With the stable base precision attachment F i g u r e 1 0 . The stable base precision attachment
low viscosity zinc-oxide eugenol impression material. removable partial denture, the base is accurately related to removable partial denture produces an esthetic result with no
the fixed component using an intraoral pick-up. display of clasp assemblies.

Fig ur e 11. Plunger attachments can be adjusted to Figure 12 . Plunger attachments are positioned in a F i g u r e 1 3 . A milled lingual bracing arm with a positive
increase or decrease the desired amount of retention. custom cradle in the partial denture framework. proximal rest is the best method of ensuring stability of the
position of the abutment tooth.

semiprecision attachments (Figures 9 varying amounts of retention. They rest cingulum rest can work effectively as well
and 10). A precise occlusion is established in custom cradles provided in the cast (Figure 1 3). Splinting the abutment teeth
using gold occlusal surfaces attached denture base and provide retention by is often desirable.
to resin denture teeth. This approach is engaging a dimple placed in the proximal
based on the concepts of mucostatics surface of the abutment tooth or crown Rotational Path Removable Partial
and the tissue-base-constant that have (Figures 11 and 12). As mentioned, these Dentures
not been verified scientifically. In spite of attachments are quite versatile and can The third approach that can be
this fact, the authors have experienced be used in both tooth-borne and distal utilized to eliminate display of the
favorable results using these very extension situations. In the latter cases, clasp assemblies is the rotational-path
detailed techniques.34 However, this is optimum fit of the base is obtained using removable partial denture. Although
a very time-consuming technique, and the altered cast technique or a functional variations of this concept have been
meticulous attention to detail is required. refit. described for many years, this approach
It is likely that this approach is too The clinician must understand that is also poorly understood by the majority
technique-sensitive for routine use in the the constant force of the spring-loaded of practitioners. However, in contrast
majority of general practices. plunger against the abutment tooth to attachments, which tend to be over-
The second potentially useful approach has the potential of orthodontically utilized, the rotational path partial is
using attachments involves spring- moving the tooth and thus losing desired underutilized.
loaded plunger attachments.35 This is a retention. Stability of the abutment This concept originated in the 1930s,
relatively simple and practical approach teeth is obtained with careful design of and been described and extensively
that has proven to be versatile as well. The the partial denture framework. A milled analyzed in the literature.36-46 This
attachments are essentially spring-loaded lingual bracing arm with a positive approach is ideal for the replacement of
plungers that can be adjusted to provide proximal rest is preferred, but a positive missing anterior teeth when replacement

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Fig ure 14a through c . This rotational-path Figure 1 4 b. F i g u r e 1 4 c.

removable partial denture provides an excellent esthetic
result for a patient missing several anterior teeth as well as a
considerable amount of supporting tissues.

Fig ure 15a through c. Using the rotational-path Figure 1 5b. F i g u r e 1 5 c.

partial denture concept, clasp assemblies can be moved from
more anterior visible teeth to posterior teeth, thus providing
an excellent esthetic result.

of the soft tissue with the denture base the metal framework that is in contact path removable partial denture, these
is also desirable. It is also indicated with the abutment teeth prior to electro- details have been adequately described
with missing anterior teeth when the polishing.48,49 This will prevent loss of elsewhere.50
remaining abutments are periodontally the intimate contact of the framework
compromised and not ideal as fixed with the abutment teeth that is essential Conclusion
abutments. The rotational path partial to provide retention. It is apparent that removable partial
can also be utilized to restore posterior The partial denture requires two dentures often are not provided at the
edentulous bound spaces and has been paths of insertion, with the framework optimal level possible given the current
advocated in specific Kennedy Class II being placed into the undercut first level of knowledge. Clearly, patients
situations.47 and then rotated to seat the posterior requiring removable dentures have
The basic concept with rotational path clasp assemblies. When properly the same desires regarding esthetics as
removable partial dentures is relatively designed and fabricated, the removable patients receiving fixed prosthodontic
simple but requires meticulous attention partial denture cannot be dislodged therapy and they deserve the best possible
to detail if success is to be attained. The by a force perpendicular to the plane treatment outcome.
prosthesis is retained by rigid portions of occlusion. The ultimate result is a With removable partial dentures, the
of the metal framework engaging retentive removable partial denture with primary esthetic problem is display of the
proximal undercuts of the anterior no anterior clasp assemblies and the clasp assembly. This unaesthetic display
abutment teeth. It is advisable that the posterior assemblies in a position where can often be avoided by simply utilizing
wax-up of the framework be evaluated they are not visible (Figures 14-18). While infrabulge clasps. Precision attachments
by the clinician prior to casting, and the it is beyond the scope of this article to are poorly understood and overutilized.
work authorization should instruct the describe the precise details involved with The use of precision attachments can
technician to block out any portion of designing and fabricating a rotational provide short-term esthetic results, but

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Fig ur e 16a through c . The posterior teeth in Figure 1 6 b. F i g u r e 1 6 c.

this patient are periodontally compromised and are poor
candidates as abutments for a fixed prosthesis. The anterior
teeth have been restored with acceptable esthetics using the
rotational-path concept.

Fig ur e 17 . A vertical force resulting from tugging the Figure 1 8 a a nd b. The framework for this rotational-path removable partial denture is seated first into the planned
anterior framework with dental floss will not dislodge the undercut provided by the proximal surfaces of the anterior abutments and is then rotated into place. The rotational path partial
framework when the undercuts are properly engaged. denture provides excellent esthetics in the maxillary arch while the I-bar removable partial denture with infrabulge clasps does
the same in the mandibular arch.

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Robert Wright for some of the photos used in this article.
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