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Flexible Partial Dentures -A hope for the Challenged Mouth

Article · July 2012

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 Review Article
Flexible Partial Dentures - A hope for the Challenged Mouth
G.K. Thakral, Himanshu Aeran, Bhupinder Yadav, *Rashmi Thakral
Department of Prosthodontics, *Department of Preventive Dentistry, Seema Dental College and Hospital, Rishikesh

(Received January, 2012) (Accepted May, 2012)

Abstract:
The strong, flexible nature of flexible denture material is perfectly suited to the variety of natural conditions in the
mouth, simplifying design and enabling the flexible nylon resin to act as a built-in stress-breaker that provides superior
function and stress distribution. Partially edentulous patients with challenging conditions like abused ridges, allergy to
denture resins, undercuts due to angulated remaining teeth, cancerous lesions and cleft palate pose a great challenge for
the fabrication of a successful removable partial denture.
Flexible denture offers a simpler and cost effective treatment for the oral rehabilitation of such cases. Flexible
nature of the material allows shifting of the burden of force control from the design features of the appliance to the material
properties of the base material. The clinical procedures are simple not requiring any expertise. A cast model prepared from
a conventional alginate impression is sent to the laboratory that fabricates the desired prosthesis.
The stress distribution of the partial denture is accomplished by flexibility of the major connector, behaving as a
stress-breaker. The tissue-supported saddles float on the edentulous ridge independently, without placing a stress load
on the abutment teeth. In the long term, the flexibility of the complete or partial denture also appears to act as a tissue
conditioner. Flexible partial dentures certainly offer advantages over conventional partials by way of superior aesthetics,
better function, durable material and longevity of the prosthesis.

Key Words: Flexible dentures, Removable Partial Denture (RPD), Undercuts, Acrylic clasps

Introduction: fabrication. The cast partials require accurate tooth

Modern dentistry offers many options for the preparations for guide planes and placement of occlusal
restoration of partially edentulous mouth, like rest. Very accurate surveying is required on the
removable partial dentures (RPD), fixed bridges and diagnostic cast to help inform about the tooth preparation
dental implants. Removable partial dentures became (Lowe, 2004). However, the main limitations from
very popular many decades ago with the introduction these materials come from a steady loss of function as
of acrylic polymers and chrome cobalt alloys in the edentulous ridge undergoes a natural process of
dentistry. Many patients choose removable partial resorption and the obvious non-aesthetic visible metal
dentures due to factors ranging from cost to physiology. clasps (Shamnur et al, 2005). The patient needs to
Today, more dentists are advising flexible partial maintain the partial dentures routinely in terms of clasp
dentures because they make better and stronger adjustment and relines, and if any of the requirements
appliances that are comfortable and long lasting (Naylor are slightly compromised, the design will fail to work
& Manor, 1983). The strong and flexible nature of the as intended. Irrespective of the accuracy with which
material is perfectly suited to the variety of natural the metal partial denture is designed for its fit, this
conditions in the mouth, simplifying design and enabling
perfection is gradually lost after the partial denture is
the flexible nylon resin to act as a built-in stress-breaker
placed for the reasons cited above.
in order to provide superior function and stress
The need to make improvements in the lives
distribution in a removable partial denture.
of people using removable partial dentures, inspired
further research in this particular field of dentistry.
Prevailing Materials: Limitations of function and cosmetics of framework
Acrylic partial dentures offer a relative ease supported removable part of RPDs, which created a
of fabrication as compared to the metal frame need to fundamentally change the technique of
----------------------------------------------------------------------------- designing and fabrication of RPD. This is what led to
Corresponding Author: Dr. Himanshu Aeran, Director P.G. Studies,
Professor & Head, Prosthodontics, Seema Dental College & Hospital, the introduction of Flexible Dentures in the late 1940s.
Veerbhadra, Rishikesh (Uttarakhand) Two young brothers, Arpad and Tibor Nagy, had the
Phone No.: 0135-2453465 (College), 09837063005
E-mail : [email protected]
vision to experiment with the new polymers of the day

People’s Journal of Scientific Research 55 Vol. 5(2), July 2012

Flexible Partial Dentures – A hope for the Challenged Mouth --------- G.K. Thakral, H. Aeran, B.Yadav & R. Thakral

(nylon) to create a type of partial denture that was occlusal rest is designed to keep pressure off the residual
able to address the fundamental requirements of ridge. Actually, this simplification may be an
retention, support and stability, at the same time it unintended side effect of the true function, which is to
provides beautiful aesthetics that was far superior to resist force imbalance due to the combination of tooth
their metal counterparts, (Kaplan, 2008; Fig. I). and tissue support in a rigid framework. The flexible
Their research gave birth to what is known base eliminates the need of an occlusal rest since the
today as Valplast – a Flexible denture material. The stress distribution is naturally in balance (Fig. II).
product was introduced in order to improve upon both
the aesthetic and functional limitations of conventional
removable partial denture. It was also developed to
give a more affordable aesthetic restoration that can
be expected to provide long-term function (Goiato et
al, 2008).

Fig. II: Better stress distribution of Flexible Denture Base without

occlusual rests.

Stress distribution:
The stress distribution in the rigid partial denture
Fig. I: A more aesthetic clasp of Flexible RPD as compared to metal.
is controlled by structural elements of the design;
specifically the cooperative relationship of the retentive
Functional Benefits of the Flexible Material: clasp, occlusal rests, reciprocating clasps, minor
The functional advantages of the flexible connectors, and guide planes, if used. The stress
materials are somewhat less obvious. The key to the distribution of the flexible partial is accomplished by
functional benefit is in the flexibility of the material that flexibility in the major connector behaving as a stress-
helps to shift the burden of force control from the design breaker. The tissue-supported saddles float on the
features of the appliance to the properties of the base edentulous ridge independently, without placing a stress
material. A lever is more efficient if it is made from a load on the abutment teeth. In distal extension partials,
rigid material. Leverage is the critical component of the free end saddle equally distributes force at all points
the conventional RPD design that can be controlled along the edentulous ridge (Fig. III, IV).
using flexible materials. A flexible lever does not work
well as a lever. Therefore, a flexible partial denture
reduces the leverage effects of its extensions without
compromising good retention and support.

Occlusal Rests:
There is no need of an occlusal rest or vertical
stop in the flexible partial denture (Zhao et al, 2003).
The occlusal rest is a structural component of the rigid
partial, whose specific function is to compensate for
potentially damaging stresses resulting from the fulcrum
effect of a rigid major connector. This function is
frequently over-simplified, the idea is that the Fig. III: A bilateral lower posterior edentulous mouth.

People’s Journal of Scientific Research 56 Vol. 5(2), July 2012

Flexible Partial Dentures – A hope for the Challenged Mouth --------- G.K. Thakral, H. Aeran, B.Yadav & R. Thakral

Preservation of tissues: Following are some of the advantages of a flexible

In the long term, the flexibility of the partial partial denture:
also appears to act as a tissue conditioner. The slight More acceptable esthetics, since there are no
movement over the tissue stimulates the blood metal clasps.
circulation under the partial, and dynamic transfer The material has good flexibility like Titanium.
occlusal forces appears to reduce the atrophy that can Therefore, even if there is a little bit of bending, it
set-in beneath a saddle that does not engage the tissue comes back to the original shape and position.
and bone (Parvizi et al, 2004). At the same time, Ease of insertion in the mouth with alveolar
flexibility of the major connector eliminates the fulcrum undercuts because of the flexibility.
effect across the arch. The fulcrum is one of the Even if there is slight shifting of the remaining
behavioral components of the conventional rigid RPD teeth over time, the flexibility of the denture
that must be compensated for by structural design of material, allows the use of prosthesis with little
the retention, rest, and passive retainers. We also have adjustment.
the concept of Wolff’s Law from orthopedic theory. There is no need of modification of the remaining
Wolff’s Law refers to the correlation between bone teeth to receive occlusal rests as for the metal
regeneration and behavior with physiological force. clasps.
When force applied to bone structures are within In cases of undercut due to tilted teeth, flexibility
physiological norms, the bone responds by achieving of the material makes it possible to insert the
and stabilizing with physiologically normal mass and prosthesis over the angulated teeth.
density. When force is below normal, bone responds The denture can be heated up in hot water for
by resorbing or shrinking. When force is excessive, about a minute and can easily be adjusted and
bone responds by growing to above-normal mass and inserted in the undercut area.
density. We would typically expect to see atrophy in Rebasing (Changing the entire plastic / tissue area
the ridge where ridge is not being engaged in except the acrylic teeth) is possible.
mastication. When the ridge is excessively engaged, A real boon for patients with compromised oral
we would see re-apposition. When the ridge is engaged conditions. Opens up scope to address the needs
normally, we would expect to see normal and stable of such patients with ease.
bone mass and density. This concept is actually what
allows implants to work as well as they do. The implant Disadvantages of Flexible Partial Dentures:
creates a normal environment for the supporting bone
(Meijer & Wolgen, 2007). While no partial will Being a plastic material, it cannot be made into
replicate this exactly, the tissue-bearing partial comes thin sections like metal. It is likely to break if cut
closer than the tooth-supported partial. The only factor thin sections.
to consider is balancing the force distribution over the Since they need to be made bulkier than cast
edentulous ridge, not whether or not to engage it at all. partials, it may take longer to get used to a flexible
partial denture.
Advantages of Flexible Partial Dentures: It does not conduct heat and cold like metal.
Metal-free restorations and prosthesis are Therefore, the patient may not enjoy certain food
future of dentistry. Flexible partial is the optimal choice like hot soup or ice cream.
whenever partial is the choice of treatment or the patient Since flexible dentures utilize the gaps (because
prefers not to use a fixed restoration. Patients, who of some missing teeth) for the ‘Retento-Grip
have used both conventional RPD and a Flexible partial, Tissue-bearing Technique’ (Iselin et al, 1990) for
report that the later feels more natural and is more retention, the remaining teeth have to be in fairly
comfortable to wear. It also provides a higher standard good periodontal health.
of function by using the flexibility of the material to The patients that have periodontal problem may
balance masticatory forces over the entire supporting have several teeth that are mobile due to bone
ridge instead of individual support points (Phoenix et loss. Therefore, the whole area keeps on flexing
al, 2004). As a result, the balanced distribution of forces causing unfavorable forces that in turn result in
can often lead to longer lasting appliances that may more bone loss.
not require frequent relines. The laboratory fee is a little higher.

People’s Journal of Scientific Research 57 Vol. 5(2), July 2012

Flexible Partial Dentures – A hope for the Challenged Mouth --------- G.K. Thakral, H. Aeran, B.Yadav & R. Thakral

7. Requires more chair-side time for adjustment. Athletes

8. Requires special instruments (knives and polishing Police and Firefighters
kit) to make the adjustment. Military Personnel
9. A Flexible denture is very hard to repair if Prisoners and Prison Officers
fractured. No additions can be made onto it. In Any person who might be exposed to physical
such cases, rebasing is recommended. harm or injury

Indications for flexible partial denture:

The appropriate and acceptable uses for a
flexible partial denture include all cases of conventional
partial denture indications plus the areas where
conventional partials are limited or contra-indicated.
There are virtually no cases where a conventional
partial would work better than a flexible partial. Flexible
denture materials like Valplast are available in five
natural tissue shades as well as in additional un-
pigmented option for special applications (Iselin et al,
1990). The unique physical properties of the material
Fig. IV: A Tissue supported RPD avoides stress on the remaining
also make it more adaptable in challenging cases and Teeth
situations involving pediatric patients, cancerous mouths
and cleft palates. Because of it s excellent
biocompatibility, it is also an ideal replacement for
acrylic when patients are allergic to denture acrylics.
Flexible partials could be a treatment of choice in cases
of patients having a history of repeated partial denture
frame breakage. They can also be used as an easy
and affordable alternative to implants or fixed partial
dentures and also for tooth or tissue-coloured clasps in
high esthetic areas.
Fig. V: Unilaterally missing single manibular molar.
Additional applications of Flexible denture material
include:
1. Cosmetic gum veneers
2. Bruxism appliances
3. Implant retained over-dentures and full dentures
for patients with protuberant bony structures or
large undercuts
4. Unilateral Space Maintainers (Fig. V, VI)
5. Temporary Prostheses (short and long-term)
6. Obturators and speech therapy appliances
7. Orthodontic Devices
8. Occlusal splints and sleep apnea appliances
9. Anatomical bite restorer (Used during full mouth Fig. VI: A Flexible RPD for a unilaterally missing mandibular molar
serves as a satisfactary space maintainer
rehabilitations)
Contraindications:
Flexible Partials For People With Special Needs: Contra-indications include patients who simply
The safety issue is important to many people should not or would not wear any type of removable
in high physical risk exposures. Flexible Partials are appliance. However, Flexible partials are not advisable
ideal for people in high-risk situations like: in cases of:

People’s Journal of Scientific Research 58 Vol. 5(2), July 2012

 Flexible Partial Dentures – A hope for the Challenged Mouth --------- G.K. Thakral, H. Aeran, B.Yadav & R. Thakral

1. Deep overbites (4mm or more) where anterior Accuracy of Injection Molded Denture Base Material
teeth can be dislodged in excursive movements to that of Conventional Pressure-Pack Acrylic resin.
2. Little remaining dentition with minimal Journal of Prosthodontics, 2004;13(2):83-89.
undercuts for retention. 8. Phoenix RD, Mansueto MA, Ackerman NA, Jones RE:
3. Where there is less than 4 mm of inter-occlusal Evaluation of mechanical and thermal properties of
commonly used denture base resins. Journal of
space in the posterior area.
Prosthodontic, 2004;13(1):17-27.
4. Bilateral free-end distal extensions with knife- 9. Shamnur SN, Jagadeesh KN, Kalavathi SD, Kashinath
edge ridges or lingual tori in the mandible. KR: “Flexible dentures”- an alternate for rigid dentures?
5. Bilateral free-end distal extension on maxilla Journal of Dental Sciences & Research, 2005; 1(1):74-
with extremely atrophied alveolar ridges. 79.
10. Zhao X, Cao J, Zhang Y: Clinical application of flexible
Conclusion: gingival epithesis material. West China Journal of
No product can solve all the problems Stomatology, 2003; 21(4):324-326.
associated with partial prosthesis. Nor can it meet all
the requirements of a challenged mouth. The key is to Source of Support : Nil.
Conflict of Interest: None declared.
solve and address as many problems and needs as
possible in a simple way that is affordable for the
patient. An effort has been made to focus on
improvements over conventional partials in aesthetics,
function, durability, and longevity of a Partial Denture
made from a Flexible denture material. With further
improvisations in the working techniques, adjustments
and repair potential of the material, Flexible partials
may become a simpler answer to complex partially
edentulous oral conditions.

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People’s Journal of Scientific Research 59 Vol. 5(2), July 2012

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