A removable partial denture using an

esthetically designed round-rest distal

clasp on maxillary anterior abutment
teeth: A clinical report
Chi Tran, DDS,a Eugene LaBarre, DMD, MS,b and Howard M.
Landesman, DDS, MEdc
The Arthur A. Dugoni School of Dentistry, University of the
Pacific, San Francisco, Calif
A round-rest, distal depression clasp is suggested as an esthetic alternative to a conventional clasp for maxillary
anterior teeth serving as abutments for a removable partial denture. A lingual round rest provides support for the
prosthesis, and a mesiolingual reciprocating plate is present. A split minor connector engages a distal depression
for retention. The facial surface of the abutment displays no metal and provides an esthetic result. (J Prosthet Dent
2009;102:286-289)

Circumferential clasps on maxillary ments, but they are difficult to adjust tive area.14 A maxillary canine retainer
anterior teeth may not be esthetically and are seldom used for distal exten- with mesial groove reciprocation, me-
acceptable to patients who require sion RPDs.11 Tooth-colored polymer siolingual rest, and distofacial depres-
removable partial dentures1 (RPDs). clasps, featuring acetyl and thermo- sion retention has been described,15
Extracoronal and intracoronal preci- plastic resins, are used because of but it may not be applicable to maxil-
sion attachments can be esthetic, but ease of fabrication and esthetics, but lary incisors.
are of greater expense and are more are not readily adjustable and have A round-rest, distal depression
difficult to fabricate and maintain.2 A not demonstrated durability. Lingual clasp (RRDD) (Fig. 1) is presented
mesial rest, proximal plate, and I bar retention and the elimination of the as an esthetic alternative to a con-
(RPI) clasp,3,4 and mesial rest, proxi- visible facial clasp arm have been pro- ventional clasp for maxillary anterior
mal plate, and Akers (RPA) clasp5 can posed for premolars12,13; however, ca- teeth serving as abutments for a re-
be used for maxillary anterior teeth, nines may require the fabrication of a movable partial denture. The RRDD
but may present unacceptable esthet- crown with milled surfaces providing clasp design was developed specifi-
ics for patients with high lip lines or a deep rest and mesial lingual reten- cally for maxillary incisors or canine
high smile lines. A modification to
the RPA clasp has been described6
using a cast gold clasp engaging an
undercut at the distofacial line angle
of the maxillary canine and soldered
to the partial denture framework, but
fabrication of this clasp assembly is
expensive and complex. A wrought
wire clasp engaging a proximal un-
dercut and soldered to the partial
denture framework is an esthetic al-
ternative.7 Plunger attachments en-
gaging a distal depression have been
used8; however, there may not be ad-
equate space to place denture teeth. 1 RRDD clasp: support is provided by lingual round rest. Me-
Rotational path designs for partial sial reciprocating plane and distal guide plane are prepared as
shown. Distal depression is placed for retention. Denture tooth
dentures9,10 can achieve excellent es-
is placed against distal proximal contact.
thetic results for anterior teeth abut-

a
Assistant Clinical Professor, Department of Restorative Dentistry.
b
Associate Professor and Chair, Department of Prosthodontics.
c
Clinical Professor, Department of Prosthodontics.
The Journal of Prosthetic Dentistry Tran et al
November 2009
2 As framework is seated or removed, split minor connector flexes.
When RPD is completely seated, split minor connector should be passive.
abutments for RPDs when esthetic
demands are high, conventional and
polymer clasps are unacceptable, and
the patient lacks the financial capa-
bilities for an intra- or extracoronal
clasp-retained RPD. If the edentulous
residual ridge is distal to a maxillary
incisor or canine, the RRDD clasp
consists of a round rest seat located
near the cingulum, a mesiolingual
reciprocating plate, and a split mi-
nor connector engaging a distal de-
pression for retention (Fig. 2). If the
edentulous ridge is mesial to a max-
illary incisor or canine, this clasp de-
sign is no longer called an RRDD; it
becomes a round-rest mesial depres-
sion (RRMD). The RRDD and RRMD
are alternatives to a rotational path
design.
The purpose of this clinical report
is to describe a method of eliminating
the display of metal on the labial sur-
face of maxillary anterior teeth used
as abutments for an RPD by using a
round-rest, distal depression clasp.
CLINICAL REPORT
A patient with a missing maxil-
lary left canine due to root fracture
presented to the Arthur A. Dugoni
School of Dentistry, University of
the Pacific Dental Clinic (Fig. 3). The
premolars and first molar had been
previously lost, and the patient did
not want implant-supported restora-
tions. Financial considerations were
a major concern. The patient also did
Tran et al
not want to display any metal clasp
on the anterior teeth. Three options
for an RPD were presented: a conven-
tional RPD with infrabulge clasps, a
rotational path design, and an RRDD
design. The patient chose the RRDD
design for esthetic reasons and for
ease of placement.
The diagnostic casts were surveyed
and a maxillary RPD was designed
with a broad palatal strap as major
connector, occlusal rests and cast cir-
cumferential clasps on all molars, and
an RRDD clasp on the maxillary left
lateral incisor. A round cingulum rest
was prepared with a round bur (No.
4, 014, 1/10 mm; Brasseler USA, Sa-
vannah, Ga) to a depth of 0.75 mm.
The reciprocating plane on the me-
siolingual surface of the incisor was
prepared with a thin parallel chamfer
tip carbide bur (H283.31.010: Bras-
seler USA) from the mesiolingual line
angle, and stopped just short of the
mesial proximal contact. The guiding
plane on the distolingual surface of
the tooth was prepared from the dis-
tolingual line angle to stop just short
of the distal proximal contact area. In
the middle of this surface, a distal de-
pression, 0.5 mm deep, was prepared
with a No. 4 round bur (Brasseler
USA), 1 mm above the gingival mar-
gin, and 1 mm lingual to the proximal
contact (Fig. 1). A ball burnisher (T-
Ball 34; Suter Dental Mfg Co, Chico,
Calif ) was placed in the round rest
seat and distal depression to verify
adequate preparation.
287
After completion of mouth prepa-
rations, an addition-reaction silicone
impression (Aquasil; Dentsply Intl,
York, Pa) was made. The definitive
cast was prepared and surveyed. The
minor connector and mesiolingual
plate of the RRDD were 3 mm wide
mesiodistally and 0.5 mm thick occlu-
sogingivally, respectively, to provide
adequate rigidity. Distal to the minor
connector, a 1- to 1.5-mm-wide split
was placed in the casting. A smaller
minor connector, 2 mm wide tapering
to 1 mm, engaged the distal depres-
sion. This small minor connector had
a length of 10 mm from the major con-
nector to the center of the depression
to allow adequate flexibility (Fig. 2).
The flexibility of the minor connector
engaging the distal depression can be
altered by increasing its length or by
thinning the dimensions of the arm.
A cast chrome (Vitallium; Dentsply
Austenal, York, Pa) RPD framework
was fabricated (Fig. 4). The frame-
work was evaluated intraorally and
adjusted. The retentive values of this
clasping design were comparable to a
cast circumferential clasp or wrought
wire.16-18 After maxillomandibular jaw
relation records were completed,
denture teeth (Bioblend; Dentsply
Trubyte, York, Pa) were arranged and
evaluated intraorally. Prior to denture
base processing, a rubber separat-
ing medium (Rubber Sep; Kerr Corp,
Orange, Calif ) was used generously
on the minor connector flexible arm
so that it could flex without bind-
ing from the processed acrylic resin
denture base. The denture base was
processed and finished. A round bur
(No. 1; Brasseler USA), sandpaper, or
emery-coated discs (Moore’s discs;
E.C. Moore, Dearborn, Mich) were
used to remove excess acrylic resin to
prevent interference with the flexible
arm (Figs. 5 and 6). The denture was
inserted and the patient was recalled
twice each year for 7 years. The pa-
tient was pleased with the functional
and esthetic results (Fig. 7).
288 Volume 102 Issue 5

3 Partially edentulous situation. Distal attachment may 4 Cast chrome RPD framework with conventional cast
leave minimal space for denture tooth. circumferential clasps on molars and RRDD clasp on
lateral incisor.

5 Split minor connector engaging distal depression must 6 Distal depression and guide plane are lingual to proxi-
have slight clearance to flex without binding against den- mal contact to avoid display of metal on facial surface.
ture base.

7 RRDD clasp engaging maxillary left lateral incisor.

The Journal of Prosthetic Dentistry Tran et al

November 2009
DISCUSSION
The RRDD clasp assembly de-
scribed is technically demanding.
The dentist must plan the design of
the RPD and perform detailed tooth
modifications with a clear under-
standing of the clasp function. The
dental laboratory technician also
must fabricate the framework with
care and precision, because any tech-
nical deviation may result in loss of
retention of the clasp assembly.
Postoperative radiographs may
demonstrate a slight radiolucent area
suggesting proximal caries, but the
radiographic shadow is created by
the proximal depression preparation.
Since this depression is adjacent to an
edentulous area, it can be observed
directly. The RRDD clasp is not rec-
ommended for abutment teeth with
excessive mobility, or in situations in
which the cingulum of the abutment
tooth has significant centric or eccen-
tric occlusal contact. The RRDD clasp
does not achieve 180-degree encircle-
ment of the abutment; therefore, it
is not recommended as the terminal
abutment for a distal extension RPD.
The RRDD is an alternative to the ro-
tational path design, with the advan-
tage of adjustable retention if needed.
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Tran et al
289
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