Direct Retainers Part 1

Dr. Akshi Gvalani

PG. Dept. of Prosthodontics
Terna Dental College Nerul, Navi Mumbai

Direct Retainers Part 1

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RETENTION
That quality inherent in the dental prosthesis acting to resist the forces of dislodgment
along the path of placement
Contents
Retention in an RPD
Direct retainer terminology
Review of literature
Types of direct retainers
Principle of clasp function
Attributes of a direct retainer
Clasp selection
Types of clasps

Adhesion
Cohesion
Atmospheric pressure
Plastic molding of tissues on polished surfaces
Gravity
Mechanical


Direct retainer Terminology
Direct retainer
That unit of an RPD used to retain and prevent dislodgement away from the basal seat
tissues consisting of a clasp assembly or precision attachment GPT
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Parts of a clasp

Rest
Body
Arms (2)
Shoulder
Minor connector (truss,tail,tang,upright,approach arm )


Review of literature
Dr. Herman S. Chayes 1906 first formulated the principle of the internal attachment
Prothero in 1916 gave the Cone theory

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Kennedy coined the term Height of Contour

DeVan coined the terms infrabulge and suprabulge areas
Nesbit in 1916 introduced the cast circumferential clasp
FE Roach in 1930 gave the term Roach clasp
Blatterfein in 1951 gave a classification of survey lines
Dr. O C Applegate in 1965 introduced the combination clasp
Miller in 1972 gave the cingulum clasp
Kratochvil and Krol developed the RPI bar clasp concept in order to deal with the
stresses on abutment teeth in a distal extension partial denture
Grasso developed the VRHR concept
Eliason in 1983 gave the RPA clasp
Goodman developed the equipoise clasp system
Classification
Intra coronal Extra coronal
Manufactured
Flexible clips / rings
Clasp type
Circumferential / Akers / Suprabulge / occlusally approaching / Neys type I
Bar -type / Roachs / Infrabulge / Vertical projection / gingivally approaching / Neys type
II
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GINGIVALLY APPROACHING CLASPS
Infra Bulge
Push Clasp
Roach Clasp
This bar clasp approaches the retentive undercut in a gingival direction resulting in a
push type of retention. This push type of retention is more effective than pull type
retention characteristic of circumferential clasp
TYPES OF CLASP RETAINERS

Circumferential clasps/ occlusally approaching
Circumferential clasp
Embrasure clasp.
Ring clasp.
Back action clasp.
Reverse action / hair pin clasp.
Multiple clasps.
Half-and-half clasp.
Combination clasp.
Onlay clasp.
Bar/Roach clasps / gingivally approaching clasps
T-clasp
Modified T-clasp
Y-clasp
I-clasp
RPI concept.
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Other clasp designs
RPA clasp.
VRHR clasp.
Clasps utilizing proximal undercuts
-Mesiodistal clasp
-Devan clasp
Cingulum clasp

Types of clasps construction
Cast grain structure crystalline
Wrought grain structure more fibrous
Combination

Principles of clasp function
Extracoronal
Resistance of metal to deformation
Undercut at a single path of placement and removal
Frictional resistance

Intracoronal
Consists of a receptacle created in the crown or onlay on the abutment tooth into
which a projection in the cast framework fits snugly.
Wedging
Frictional resistance

Attributes of a direct retainer
Retention
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Stability
Support
Passivity
Encirclement
Reciprocation
Retention
1. The size of the angle of the cervical convergence.
2. How far into the cervical convergence the clasp terminal is placed.
3. Flexibility of the clasp arm.


Flexibility/resiliency of the clasp arm:
1. The length of the clasp arm.
2. The diameter of the clasp arm.
3. The taper of the clasp arm
4. The cross-sectional form.
5. The type of metal used.
6. The kind of alloy used
7. The heat treatment
Size of the angle of cervical convergence

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Guiding planes determine the path of placement and removal of a partial denture.

Degree of Undercut
Retentive clasp arms must be located so that they lie in the same approximate degree
of undercut on each abutment tooth, despite the variation in the distance below the
height of contour.
The measurement of the degree of undercut by mechanical means is achieved by the
help of an undercut gauge attached to a dental surveyor.

Flexibility of clasp arms
Length of the clasp arm

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Circumferential Bar type

Length
(inche
s)
Flexibility
(inches
)
Length
(inche
s)
Flexibility
(inches
)

0-0.3 0.004 0-0.7 0.004

0.3-0.6 0.008 0.7-0.9 0.008

0.6-0.8 0.012 0.9-1.0 0.012


Diameter of clasp arm
Inversely proportional
Midway between its origin and its terminal end.
Thickness of the clasp arm in the buccolingual direction is to be considered
rather than the width in the occluso-gingival direction.



Cross-sectional form

Round cross-sectional form enables the clasp to be flexible in all directions
whereas the half-round form limits the flexibility to only one direction.
Cast clasps are half round in form and they flex away from the tooth, but
edgewise flexing is limited.

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If the cross-sectional area of clasp is doubled, the stiffness will be increased 4
times and the flexibility reduced 4 times.
Material used for clasp arm
The modulus of elasticity of
Cobalt-chrome alloys cast gold wrought gold wires.

Structure of the alloy
Wrought wires have greater flexibility than a cast structure due to its grain
structure being fibrous.
The tensile strength of a wrought structure is at least 25% greater than that of
the cast alloy from which it was made.
Wrought forms can be used in smaller diameters to enhance the flexibility and
they offer minimum friction and can have a stress breaking effect.

Stability is the resistance to horizontal displacement of a prosthesis. All clasp terminal
except the retentive clasp terminals contribute to this property in varying degree.

Support
Property of the clasp that resist the displacement of the clasp in gingival direction.
Primary support units of a clasp are occlusal, lingual or incisal rest

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Encirclement
More than 1800 of greatest circumference of the tooth must be included passing from
diverging axial surface to converging axial surface.


Passivity
A clasp in place should be completely passive.
The retentive function is activated only when dislodging forces are applied to the partial
denture and during removal of the denture.

Reciprocation


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The retentive arm exerts a fleeting, unreciprocated, thrust (whiplash) against the tooth
each time the prosthesis is inserted or removed from the mouth.
Reciprocation:
The means by which the effect of the retentive clasp arm on the abutment tooth is
countered by the action of the non-retentive clasp arm.
Located at the junction of the gingival and middle 3rd of the crowns of an abutment
teeth.



Bilateral Opposition:
Buccal retention on one side should be opposed by buccal on the other or lingual
on one side opposed by lingual on the other.
In class II situation, the 3rd abutment may have either buccal or lingual retention.
In class III retention may be either bilaterally or diameterically opposed.

Stress Breaking:
Clasp retainers on abutment teeth adjacent to distal extension bases should be
designed so that they will avoid direct transmission of tipping and rotational forces on
abutments.
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SURVEY LINE
Blatterfein in 1951 put forth a simple and comprehensive classification of survey line
with suggestion on clasp selection. He described four kinds of survey line:


Typical survey line or medium
Atypical A or Diagonal
Atypical B or High
Atypical C or Low

Typical or medium:
Extends from the occlusogingival midpoint in the near zone to the junction
between the occlusal two third and cervical one third in the far zone.

Clasps suggested for use where such a survey line exists include the occlusally
approaching and gingivally approaching clasps.
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Atypical A or diagonal:
This runs diagonally across the tooth surface from a high position in the near
zone to a low position in the far zone.

- A reverse action or hairpin clasp is recommended.
- Gingivally approaching clasp may also be used.


Atypical B or High Survey line:
This type of survey line is parallel to the occlusal surface and lies close to it.
A wrought occlusally approaching clasp arm may be used.
If accompanied by a low survey line on the opposite side of the tooth, a ring or a
back action have been recommended.

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Atypical C or Low Survey line:
The low survey line is parallel to occlusal surface but has just above the level of
the gingival margin.
This type of survey line contraindicate the placement of a retentive clasp arm on
the tooth surface concerned, as the arm would need to be placed too close to the
gingival margin for safe application.

When all the usable surface of a tooth present the survey lines of this type, retention
may be obtained by
Placement of a crown on the tooth to artificially develop undercuts.
Placement of a class V gold inlay a dimple is in the inlay and a ball head on a
gingivally approach arm is positioned to engage the dimple.
An extended clasp may be used where the tooth offers favorable conditions for
retention.
Undercut may be developed by recontouring the tooth.

Ney
3 basic survey lines with an appropriate clasp form.
Class I:
Survey line runs diagonally across the tooth surface from a low position on the
side of the rest to a high position on the other proximal side.
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A cast occlusally approaching arm or its variants, back action, reverse action and
ring clasps are recommended called as Ney class I clasps.
Class II:
Similar to Blatterfein atypical A or Diagonal survey line. Here gingivally
approaching is recommended and termed as Ney class II clasp.
Class III:
It is the same as the Blatterfein Atypical B or High survey line. The wrought wire
arm is used and termed as the Ney class III clasp.

Clasp selection criteria
Survey line location and degree of undercut.
Root condition
Oral hygiene
Undercuts (soft/hard )
Esthetic requirements
Selection of clasp based on requirement of retention & stability
A large number of edentulous area, bilaterally placed would mean more number of
clasps and guide planes, thus the entire prosthesis has greater retention and stability.
Cast circumferential clasp properly designed shows greater retentive and bracing
properties than a bar clasp used in a similar situation.
Ideal amount of retention is that which will retain the removable partial denture against
reasonable dislodging forces without placing the undue strain on the abutment teeth.
Thus minimum retention and maximum stability is the ideal.
Root size and form of the tooth:
Abutment teeth with short, conical roots, bone loss, and periodontal ligament, mild
periodontal problem may not be able to withstand lateral forces that would be within
physiologic limits of a healthy sound tooth. Such tooth must be preserved.
Oral hygiene and caries
High caries index. Contraindicate the use of clasp with an unprotected tooth surface as
with a ring clasp.
Bar clasp has minimum tooth structure contact and less interference with natural
cleansing action.

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CLINICAL SITUATIONS
CIRCUMFERENTIAL CLASP
This clasp is the most universally used clasp today as it fulfills almost all the
requirements of an ideal clasp



No edentulous space on opposite side of arch
Tooth supported partial denture
Lone standing abutment
Tilted molar
Periodontally weak teeth
Lingually inclined premolars
Anterior retention
Diastema
Occlusal caries
Abutment tooth without undercut
Proximal undercuts
DEPD
Mesial undercut
Distal undercut

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KENNEDYS CLASS II, III, IV
EMBRASURE CLASP
Bonwill/ Crib/ Double Akers/ Back to back


TOOTH SUPPORTED PARTIAL DENTURE
MULTIPLE CLASP

LONE STANDING ABUTMENT/TILTED ABUTMENT
RING CLASP

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DISTAL EXTENSION PARTIAL DENTURE
MESIAL UNDERCUT
COMBINATION CLASP (tissue undercut)

Advantages and disadvantages of combination clasp
Combines the resiliency of wrought clasps with the stabilizing features of cast
clasps

Enables better neutralization of the torsional forces exerted on the abutment
teeth
Less fatigue failure
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Minimum tooth contact
1. Wrought arm reduces the horizontal stabilization of the combination clasp

2. Increased base movement thus subjects residual ridges to a greater degree of
lateral stress
3. Steps of fabrication

DISTAL UNDERCUT
BAR CLASP


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BACK ACTION CLASP

HAIRPIN CLASP (tissue undercut)


MESIALLY TILTED ABUTMENT
HAIRPIN CLASP (ring contraindicated)
PERIODONTALLY WEAK ABUTMENT
MULTIPLE CLASP



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LINGUALLY INCLINED PREMOLARS
HALF AND HALF CLASP

OCCLUSAL CARIES
ONLAY CLASP

ABUTMENT TEETH WITHOUT USABLE UNDERCUTS
EXTENDED CLASP




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PROXIMAL UNDERCUTS
DEVAN CLASP

ANTERIOR RETENTION
BAR CLASP
CINGULUM CLASP

DIASTEMA
MESIODISTAL GRIP CLASP


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EQUIPOISE CLASP

Based on the principles of the back action clasp

Clasp selection criteria
Survey line location and degree of undercut.
Root condition
Oral hygiene
Undercuts (soft/hard )
Esthetic requirements

REFERENCES
Applegate O.C.: Text book of Removable Partial Prosthodontics, St. Louis, CV
Mosby Co.
Cecconi B.T., Asgar K., Dootz F. The effect of partial denture clasp design on
abutment tooth movement. J. Prosthet. Dent., 1971; 25: 44-55.
Davenport J.C., Baskar R.M., Heath J.R., Ralph J.P. A color atlas of RPD,
Wolfe Medical Publications Ltd., 1988.
Henderson D., McGivney G.P., Castleberry D.J.: McCrackens removable partial
prosthodontics, 8th Edn. St. Louis; CV Mosby Co.
Miller E.L., The cingulum clasp. J. Prosthet. Dent., 1972; 28: 369-372.
Miller E.L. Text book of Removable Partial Prosthodontics. St. Louis, CV Mosby
Co.
Osborne J., Lammie G.A. Partial dentures, 4th Ed CBS publishers and
Distributors, Delhi, India.
Stewart,Rudd and Kuebker: Clinical removable Partial Prosthodontics ,2nd Ed,
Euro America Inc., publishers Tokyo, 1997